There is no necessity in explaining for specialists at kindergartens all difficulties of working with children having autistic symptoms (semiology), especially if it is the main kernel of distortion and isn't the consequence of speech undevelopments which limit child's possibilities in communication and speech contacts
Correctional work in these cases meets difficulties or impossibility of forming contacts during the beginning of communication: child doesn't react to any attempts of involving him/her in game process, or fly around on an office or even shows aggression signs towards the teacher.
But if not teaching them anything at all, the level of their "unclaimed" intelligence, abilities to social integration will inevitably decrease. There are many serious studies of foreign colleagues with such children that are mainly focused on researches of "speaking" autists, who are able for communication.
There were created instrumental possibilities facilitating work with such children at our institute. We have already written about therapeutic effects of transcranial micropolarization (TCMP) in children with retard of mental development (Preschool pedagogics. 2005. № 5. With. 4-7). As well as for psychologists and speech-language pathologist for us these children with autism symptoms is a large problem to work with too. First minutes of an influence session (sometimes even to the end) usually proceed under shouts of children (especially with "pure" autism) in intense embraces of parents. But it is necessary to suffer for both: them and us, so as the results of such therapy are usually visible to all participants of process soon enough.
If to compare to terms of known treatment methods and non-medicated corrections (these are months, and even years) it is possible to tell that results of TCMP appear promptly - after one-two sessions, that is in 20-40 minutes after influence at preschool age. It is not an advertising exaggeration, it is a consequence of the complex approach with the use of psychologists' and the speech-language pathologists' knowledge multiplied by possibilities of physiological correction methods, confirmed with patents of Russian Federations.
What gives TCMP at work with autists? First of all, this is possibility to enter effective training contact between the child and adult (the parent, the psychologist, the teacher). Positive changes during infantile autism (childhood autism) can be originally visible only within habitual conditions. I can quote parents: "For the first time the child in the evening has answered a question in the car :""Are you tired?" - "yes" ";" For the first time that day he himself without any help used the toilet (himself had used a toilet bowl and closed the door) ";" In two days we refused to lock a refrigerator as the child opened a door and took only what he wanted to eat (before - he opened the refrigerator and threw everything out of shelves ) ";"He has started to answer to requests and commands not from the tenth time, but after two-three repetitions ";" He has ceased to escape in the street during walk " and etc.
Effects of the first TCMP sessions can be local and be related only to the private problem specified above or can be the cause of system reaction concerning different mental functions. It depends on initial level of child's development, his/her brain compensatory (recovery) possibilities, features of the developing environment around the child (it is clear from clinical examples described below).
So if the child is 8-9 years old and he or she doesn't come into contact even with members of his/her family, eats from the spoon, wears diapers, isn't trained anything, only sits or walks, making stereotypic actions - our possibilities are rather limited in the present state of affairs. In particular, for the first course we may just help child to rid of diapers. To make a jump to thinking processes without having passed a stage of hygienic skills formation - is rather difficult.
If our patient is only 3-4 years old it is well known to psychologists and language-speech pathologists: the sensitive period of language-speech development is not yet rather far, so our chances for success significantly increase. It is even better if speech production is presented at least by echolalia. As long-term practice shows, in these cases we have the something (base) to "mold" the addressed speech from the first-person.
What is the range of changes in behavior and speech activity of the child with autistic semiology after TCMP course and in the delayed prospect?
If we speak about infantile autism there will be dynamics in speech understanding and the following increase efficiency of learning. With the same teacher (psychologist) or several constant experts the child:
• allows tactile and more long visual contact during the session;
• reveals decrease of aggression and self-aggressive reactions, stereotypes, echolalia;
• executes commands and requests much quicker during the session, searches for new tasks (looks through a box with didactic grants), prefers volume material as the work with flat printed material (pictures) begins later and through "don't want";
• can show strong-willed effort at work end, even if the task uninteresting.
In home conditions the child with IA (I quote parents): ""agrees" to persuasion in condition of no possibility to execute his/her request immediately"; "Ceases to arrange hysterics if in shop we don't buy the chosen toy, chocolate..."; "Can sit in the car without DVD"; "Allows to cut hair and nails in the afternoon instead of during a dream, as usual" and etc.
So this gives a possibility to get to a kindergarten in correctional or even in speech-language therapy group in the close future. And there move further under sensitive management of the experts having experience of working with such children.
What is the difficulty in work with IA children, more precisely, with their parents at the given stage? Infringement of communicative functions that is the base social requirement stimulating the speech initiative leads to the situations (we already said about it) that positive shifts at autists go concerning quality of their impressive speech, understanding of a context and nuances of speech addressing to them. Own speech activity especially at the first reference to us at the age of 5-6 years when there is no even lallation words (there are only shouts and howls) remains at the level close to zero.
Quite often it will disorient parents ("What for to teach a child if he or she doesn't speak yet?") and even experts ("he/she is a moron, what I will check him for?"). It is surprising but it is possible to teach such children to read and write. If something is "extremely" necessary for a child, the child can ask.
There are cases when the first course even at early age (3-4 years) was undergone without results "peer to zero". First time we even recommend parents if there will be no delayed effect of TCMP within 1-1,5 months: don't waste time for course repetitions. Nevertheless even in such patients goes recovery process.
Let's describe some examples of work with children when the supervision period was 1,5-3 years. Below are given appraisals of experts at an initial stage of correction with usage of TCMP and a state of affairs for today.
1. Matvei M.
The first visit to institute was at the age of 3 years. During 1,5 years the boy had 5 courses of TCMP ( 4-6 sessions in a course, 20 minute session duration). The primary conclusion from the pre-school educational institution (kindergarten) for children with different disabilities: "During stay in correctional group Matvei M showed a minimal dynamics of development; He does not come in contact with adults and children, does not react to requests; he is unemotional, indifferent. He does not perform the tasks for estimation of sensory abilities and cognitive activity etc. Speech is absent". He has an environment dependent behavior in the examination situation. The clinical diagnosis is infantile autism.
After the first sessions Matvei began to repeat simple words, appeared curiosity to external events and pictures in the book. At the same time work on the desk with didactic materials was still inefficient both at home and in a kindergarten, the child couldn't understand and do difficult instructions. The addressed speech was absent, but the indicatory gesture appeared; if it was necessary the boy pulled the adult by a hand showing what he needed.
Presently (the boy is 5 years old) he visits a correctional group of a kindergarten, adressed speech is present (but from third-person: "Matvei goes by the car"). He does not avoid children, can approach and smile.
From the experts' conclusions: The child contacts easily and with a smile. Working capacity has been risen, but the tendency to exhaustion by the intellectual load remains. Interest to exercises grown up, basically to the game material; there is an interest to a writing of figures.
Perception parametres: the form - he puts all six figures, does not name them himself, however using an example of the adult can name a circle, a triangle, an oval, an asterisk; he can define and name the sizes - "big", "small" and he can sort things by their size.
The boy can operate with size row of three elements - spreads the size spectrum independently, while using six elements he needs the help of the adult. Thinking (analysis-synthesis): he reconstructs pictures that were slit to three pieces on a vertical himself.
The counting: He recognizes figures till 3, he can enumerate a numerical elements one after another.
Speech: speech is less emotional and insufficiently clear for others; He understands the more difficult speech patterns and fulfills a simple requests. The active dictionary has increased, but the passive dictionary remains wider. Syllabic speech structure has increased up to 4-5 syllables. A speech grammatical system: there is undevelopment of lexical and grammatical and phonetic-phonemic components of speech. Speech is phrasal from 4-5 words without grammatical rules (coordination errors).
Coherent speech: the boy can tell what happens at home, but he is quite often limited by rehearsal of events and subjects.
As we observe, the positive process is going but now it is complicated due to insufficient mental load in a kindergarten that does not correspond to the diagnosis of the child and due to practically absent cognitive load at home. All these things reduce development speed of retarded functions.
2. Gosha K.
The first consultation in institute was at the Gosha's 5 years. The speech anamnesis: cooing is since 4 months, babble is since 7 months, the first words are since 1 year, phrases are since 2 years. Regression in speech development appeared after Gosha's falling on a playground. From the conclusion of the speech therapist at kindergarten: "He does not contact with children and adults, does not respond to his name, he lies on a carpet and he runs to locker room if it becomes noisy, but he does not show any aggression to other children. He allows joint games with one child if he adapted in a group; He can ask adults ("give"), understands simple instructions".
According to examination and conclusion of psychologist in IHB RAS: The level of actual development of the child is considerably below age norms. The child has an environment dependent behavior in the examination situation. Educational difficulties are caused by communicative disturbances and retard of speech development. There is a failure in between child-parents interactions and early computerization of playing activity. The clinical diagnosis is IA.
During EEG procedure the child shouted and howled without interruption, he tore electrode cup off from his head, despite of parents' persistence and their physical efforts to hold him, displaying cartoons on DVD and other adequate efforts in reply to his inadequate behavior.
During 1,5 years he had 4 courses of TCMP (6 sessions in a course, 20 minute session duration). At first sessions of TCMP the child howled continuously and was under constant physical control of one (but already not two!) of the parents. After the first session indicatory gesture and naming of the separate subjects appeared. There also appeared the first answers to questions. On the first course progress several phenomena were noted (in sequence as they were mentioned in parents and experts reports): disappearance of a night enuresis, the boy has ceased to be afraid to go to a toilet, he began finishing a computer game under the speech request, he has ceased to eat with hands and has started to use a spoon under his own initiative, he has started to play board games; many new words appeared in his speech, there were many vocalisations and etc.
Positive dynamics remained after the course ending. In 5 months the psychologist marked the expressed growing up of educational interest, intellectual working capacity, communicative skills. By the time of repeated examination the child successfully adapted for speech group of a kindergarten (He "was not so noticeable" among nonspeaking children as he didn't avoid contacts with them, he looked in their eyes; kisses, he joined group activity by tutors requests).
Speech was obscure, but emotional, the vocabulary of own words is big (more than hundred words). The emotional activity has changed by other parameters too: he began to understand another's emotions at viewing of cartoons and he had empathy to them (he cried during a session when one of heroes was offended). At home the boy began contacting and playing with his father who was earlier steadily ignored.
He has ceased demanding a DVD player in the car and he has started to look to the window. After 4 courses of TCMP in a combination with correctional and developmental exercises the present child's state is estimated as follows: steady increase of intellectual working capacity, the boy can recognize and name primary colors, forms and figures. He knows the basic resumptive concepts; he collects picture that were slit into 4 parts. He counts up to 10, names letters. In his speech there are many verbs; he has started to answer questions, to play with children in a kindergarten in story games and etc. The child constantly is engaged at exercises and different activities in the kindergarten and at home that affects the speed of new knowledge and abilities development.
3. Felix Zh.
The first consulting was at the age of 5 years with diagnosis infantile autism. During 3 years the child has undergone 7 courses of TCMP (5-7 sessions for a course, one session - 20 minutes). The behavior at first inspection was restless, when adults insisted - revealed aggression (achieved through the cry), the boy did perceptual tasks with several difficulties, and he couldn't carry out mental operation tests. The psychologist estimated actual level of mental development of the child lower than age norms; difficulties in training were caused by disturbance of communicative functions, a delay of speech development, information of ideational operations.
After the first sessions the boy became calmer at home, the active dictionary including the addressed (turned) speech - requests started to grow ("Mum, give to me..."). On individual lessons he was engaged for an hour
By this time experts noted: the boy came into contact easier, didn't require repetitions of tasks, could behave himself adequately situation in a new place. He could count within 100, calculate within 10, but didn't understand yet the number structure. The general sounding of speech: remained staccato.
The conceptual dictionary became wider. The syllabic structure of speech is broken. Phonemic hearing: he reveals an initial sound, while during writing often misses vowels and consonants at confluence. A grammatical system of speech: the boy has a simple phrase with agrammatisms. Coherent speech: has echolalia addressed (turned) speech. Reading: spells, understands that was read in the alphabet. The writing: writes words with printed letters.
There is no doubt that such children keep their features also at later age (see the figure: internal pavors, alarm and fears of contacts to an external world are many visible acute lines, fancifulness of forms). Our task is to raise possibilities of their socialization, integration into children's society, and later - in adult's society if there is no real possibility to avoid contacts in a society (such situation couldn't be imagined, of course).
Catamnesis at our patients is favorable as a whole (especially if autistism semiology goes as a component in structure of retarding of higher mental development, instead of as the basic diagnosis IA): individual training at correctional school, speech school, even common schools if parents and teachers haven't lost their hearts. A twist of fate: two of our first patients last year (to it now 12-13 years) visited inspection at psychiatrists who conducted them early infantile autism diagnosis from early age, that was confirmed and in Moscow and even abroad. What was their verdict? "Such exit doesn't happen in autists so we have been mistaken with the primary diagnosis". Almost the citation from the letter "to scientific neighbor" A. P. Chekhov: "It can't be, because can be never".
We often hear from parents that experts of a different profile insistently advise "don't spend money in vain, better put the child to a boarding school" and so forth Sometimes such outcomes are inevitable, but while we have a chance to help children and parents we should realize it. Today about 50 children with infantile autism are under our observation, they mostly come because of the patients we have already helped. This way has appeared shorter, than contacts to official establishments.
Concerning medicament correction of behavior it is necessary to notice that practically during or after the first course of TCMP our patients gradually cease to accept neuroleptics (Rispolept, Neuleptilum) as necessity in them disappears: children become more contact, adequate, controlled. The dose decline of the neuroleptics which are "pressing down" not only pathological reactions, but also reducing wakefulness level as a whole, gradually liberates internal resources of the child, activates its compensatory possibilities.
Only two of our patients have changed the constant medical correction to seasonal reception of drugs during spring and autumn exacerbation when children become emotionally astable, show aggression to relatives and also auto aggression reactions.
What is the limit of our possibilities? Parents usually formulate their questions in a such way: "How early is it necessary to begin doing TCMP and how long is it necessary to do it?" It is yet difficult to name the exact period. If it is an IA there will be special age features. It has to be connected with ontogenesis (if not to take into account cases with a hearing loss, visions and other sensory defects) and its bounding with training through speech of the adult. And if autists have lower requirement for human contact and communication (disturbance of communicative functions) that means that if we are far from sensitivity period of speech development - the probability of success is less.
At 5-6 years there is still a probability of "developing" the child's effective interaction first with relatives and then and with narrow circle of extraneous people. But at 8-10 years, especially if the child doesn't show the informative requirements and skills: doesn't draw, doesn't sing, doesn't use the computer or doesn't have household and hygienic skills and there is no regular training, - probability of positive shifts occurrence in those limits which were mentioned above is minimum. Incomparably there is much more time is necessary for shifting pathological changes even to the category of moderate positive and parents energy to this age is already less.
One more question that parents and specialists usually ask: "Will he/she cease to be the autist? Well, though sometime? " On this question the answer is faster negative, than positive. Characteristics of behavior, speech, preference in activity will have the same but they will be shown certainly in less affective and more socially suitable form.
If we compare their behavior today with who they were when have come in the centre, according to parents opinion it is "sky and the earth": now it is possible to take a child in the public transport, to take he or she in the tourist tours. It is possible to get child's "agreement" in disputable situations (he/she becomes more obedient, in good sense of this word), he/she is more and with more pleasure engaged in different tasks. But! Any medical pedagogical committee (commission) compares a child with age norms, and very often - it is not child's advantage. And that is also realities of our life. Sadly, parents pull all difficulties of education and training of such children practically alone.
Pre-school pedagogica / May / 2010
