From Medication to Education Eve Mandre, doctoral dissertation Lund University 2002

Problem area Suspected autism spectrum disorders in longterm psychiatric patients Patients can not be understood or treated from existing diagnoses General psychologic knowledge insufficient for understanding behaviour

Educational programme In 8 clinical psychiatric units in different areas of Sweden(in-patient, out-patient, forensic) 6 two-hour-long sessions in the course of months Total of 100 participators: 60 on a more regular basis Learning process evaluated through documentation, interviews, questionnaires

The learning process documented This was new for me in to-day´s session… I did not previously think that… There was really nothing new for me in to-day´s discussions In other respects, I thought/was of the opinion…

Training sessions based on The needs of each unit Problem oriented Patient focused Anchored in the daily reality

Understanding autism as atypical psychological development Can not be understood from general psychological knowledge Social dimension of learning is lacking Consequences for personality development Consequences for cognitive development

Early development Face-to-face interaction Rythm, turn taking, expectations on others´actions Develops and consolidates non verbal communication Assimilates inner image of The Other as partner in interaction

Social learning Perception is social and cultural Social learning crucial for personality development Self-image develops in dialogue Common meaning and symbols develop through social learning

The world of objects Assimilation through social interaction The child seeks The Other´s reaction Emotion+object= new concept

Concept formation Is social and cultural – not only developmental Through imitation and social interaction Through language use Through variation

Early symbolization and generalization Example (blocks on a slanting surface) Imitation (trial, new experience) Abstraction (the principle of slanting surface) Generalization (slanting surface =slide on the playground)

Inner speech Develops thinking Inhibits impulsivity Tries out possibilities before acting Analyses, recreates new entities Orientation towards future

Higher mental processes Inner speech directs perception and organizes actions Compares present to past and future The symbols of language can select parts and reconstruct events Ability for self-reflection

Thinking in complexes Thought is tied to the concrete and real Unable to abstract elements and use in other context Can not mentally reconstruct into new combinations

Consequences for learning Obstacle for in-depth learning Inability to move out of own frame of reference Difficulties adapting to new demands Absence of self-awareness

Quantitative results for patients Re-evaluations (6 cases) New diagnosis (2 cases) Changes in treatment/new treatment plans (all cases) Referred to community services (LSS) (3 cases, 2 from forensic psychiatry) Referred from outpatient to inpatient unit (1 case)

Qualitative results: staff reorientation Staff gained useful knowledge of autism and educational approaches Better understanding of patients leads to more adequate treatment ”Unlearning” of previous knowledge Increased staff´s behavioral repertoire

Qualitative results: new knowledge in old organizations New assessment creates problems Individualized treatment problematic in existing organizations Staff education problematic in existing organizations

From Medication to Education- People with Autism in Adult Psychiatry cationto/