From Medication to Education

Eve Mandre, doctoral dissertation

Lund University 2002

Problem area

Suspected autism spectrum disorders in longterm psychiatric patientsPatients can not be understood or treated from existing diagnosesGeneral psychologic knowledge insufficient for understanding behaviour

Educational programmeIn 8 clinical psychiatric units in different areas of Sweden(in-patient, out-patient, forensic)6 two-hour-long sessions in the course of 8-12 monthsTotal of 100 participators: 60 on a more regular basisLearning 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 discussionsIn other respects, I thought/was of the opinion…

Training sessions based on

The needs of each unitProblem oriented Patient focusedAnchored in the daily reality

Understanding autism as atypical psychological

development

Can not be understood from general psychological knowledgeSocial dimension of learning is lackingConsequences for personality developmentConsequences for cognitive development

Early developmentFace-to-face interactionRythm, turn taking, expectations on others´actionsDevelops and consolidates non verbal communicationAssimilates inner image of The Other as partner in interaction

Social learning

Perception is social and culturalSocial learning crucial for personality developmentSelf-image develops in dialogueCommon meaning and symbols develop through social learning

The world of objects

Assimilation through social interactionThe child seeks The Other´s reactionEmotion+object= new concept

Concept formation

Is social and cultural – not only developmentalThrough imitation and social interactionThrough language useThrough 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 thinkingInhibits impulsivity Tries out possibilities before actingAnalyses, recreates new entitiesOrientation towards future

Higher mental processes

Inner speech directs perception and organizes actionsCompares present to past and futureThe symbols of language can select parts and reconstruct eventsAbility for self-reflection

Thinking in complexes

Thought is tied to the concrete and realUnable to abstract elements and use in other contextCan not mentally reconstruct into new combinations

Consequences for learning

Obstacle for in-depth learningInability to move out of own frame of referenceDifficulties adapting to new demandsAbsence 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 approachesBetter understanding of patients leads to more adequate treatment”Unlearning” of previous knowledgeIncreased staff´s behavioral repertoire

Qualitative results: new knowledge in old

organizations

New assessment creates problemsIndividualized treatment problematic in existing organizationsStaff education problematic in existing organizations

From Medication to Education-People with

Autism in Adult Psychiatry

http://www.english.certec.lth.se/doc/frommedicationto/