ساختار آموزشی (ساماندهی )کودکان اوتیستیک
مقدمه
اوتیسم سندرمی پیچیده و دارای علایم عصبی _ روانی است که در دوران ابتدائی رشد ونمو کودک ظاهر می گردد ودارای علائمی همچون اختلال و نقص درتعامل اجتماعی و روابط بین فردی، مسایل جدی در زبان وتکلم ، وجود رفتارهای تکراری والگوهای رفتاری قالبی ومحدود،اصرار بر "همانی"و عدم تغییر در محیط است که با الگوهای ادواری وکلیشه ای رفتاری همراه می گردد و درمجموعه اختلالات نافذ وفراگیر رشدی (Pervasive .D.D ) طبقه بندی می شود.
رشدغیرعادی مهارتهای ارتباطی واجتماعی بعنوان ویژگیها ونشانه های کلیدی محسوب می گردند وافزون برآن، رشدگویش ونحوه برقراری ارتباط از عوامل مهم پیشگوئی درمورد این افراد محسوب می گردد.
معیارهای تشخیصی
معیارهای مورداستفاده بعنوان مبنای تشخیص اتیسم ، قطعی ومسلم نیستندودرطی زمان دائمأ تغییر می یابند.افزون برآن ، از زمانیکه تشخیص اختلال نافذرشد درمحیط های آموزشگاهی بیشترجا افتاده ومتعاقب آن کودکان بیشتر وبیشتردسته بندی می شوند ، تشخیص وافتراق اتیسم واقعی ازسایراختلالات نافذ رشد نیز روزبه روز مشکل ومشکل تر می شود. درمجموع چنین به نظر می رسد که اتیسم نتیجه ومحصول نهائی اختلالات مختلفی است که تمامی آنها در علائمی همچون ناهنجاریهای اجتماعی ، زبانی وعصب شناختی مشترک می باشند.
اتیسم معمولأ درمحدوده سنی 2 تا 4 سالگی تشخیص داده می شود منتها علائم ممکن است خیلی زودتر آشکار گردند. برخی از کودکان اتیستیک ممکن است درتمامی مواردوجنبه ها دچارمشکل نباشند ، در حالیکه هستنـد کــودکانـی که فـوق العـاده آشفتــه ، پریشـان خاطر وسـردرگم انـد وحتـی احتـمال دارد که به خودآسیب برسانند.برخـی ازآنـان مقاطع رشدی مختلف وبا اهمیتی همچون صحبت کردن وراه رفتن را حتی جلوتر از زمان تعیین شده درجدول رشدکسب می کنند. به همین دلیل ، اغلب والدین با مشاهده ازدست رفتن تدریجی برخی ازاین مهارتها درکودک ، پریشان خاطر وآشفته حال می گردند. اوتیسم واپسگرا (regressive autism ) اصطلاحی است که به این گروه اطلاق می شود. دسته دیگری ازاین کودکان ازهمان ابتدا دچارتأخیرات رشدی می شوند.
مخرب ترین ویژگیهای اتیسم عبارتند از:
رشد وآموزش ارتباطات و مهارتهای اجتماعی
درمیـان تمام پستانداران ،آدمـی دربدو تولد ناتـوان ترین آنهاست وبه طولانی ترین دوره رشدی نیاز دارد تا بتواند به تمامی مهـارتهای ویژه نوع خود دست یابد. کنش متقابل ودائمی بین توارث ومحیط،تعیین کننده رشدآدمی است .یعنی آمادگی های زیستی موجود در بدو تولد ، با تجاربی که دردوران رشدازمحیط کسب می گردد درهم می آمیزندو مسیررشدی فرد راترسیم می سازند.
رشدروانی- اجتماعی برخلاف انواع دیگر رشدها رونـدی است که در تمـام طـول عمـر ادامـه می یابـد.
رشداجتماعی ازنظر مفهوم یعنی رشدتوانائی عملکرددرگروه وپذیرفتن خواستهای فرهنگ واجتماعی که فرد درآن زندگی می کند.اجتماعی شدن تابع اصل یادگیری است وهیچ کودکی ذاتأ اجتماعی زاده نمی شودبلکه این مسئله درمسیر رشد ودرطی فرصتهای فراهم شده شکل می گیرد.
دوره اول کودکی ( ازتولد تا سه سالگی )
رفتار عاطفی نوزاد ازحدود 4 ماهگی آشکار می شود.در 6 ماهگی میل به تماس با دیگران درطفل شدت می یابد و مایل است که او را درآغوش بگیرندو نوازش کنند.در اواخر یک سالگی با شوق و لذت منتظرمادرش می شود و به محض دیدن او شادی می کند. درسال دوم این علاقه مندی به سایراشیاء ماننـداسبــاب بـــازی ها ، لبــاس وچیــزهای دیگرمعطوف می شود.
در12 ماهگی کودک اصواتی در پاسخ به گفتگوی بزرگسالان ادا می نماید.بین 18ماهگی تا2سالگی کنترل رفتارطفل دشوارمی گردد زیرا بواسطه توانائی کودک درحرکت وکنجکاوی شدید، هرمحرکی برایش جالب بوده وگاهأ اعمالش مخاطراتی برای او ایجادمی کند.چنانکه رفتارش را محدودکنند ، ناراحتی بسیارشدیدی ازخودنشان می دهد.
رابطه با همسالان
قبل از5 ماهگی کودک نمی تواند بااطفال دیگر ارتباط برقرار کند. میان 6 تا 8 ماهگی کودک یک سوم وقت خودش را صرف توجه به محیط اطرافش نموده و توجه چندانی به هم بازی های دیگرخودش نشان نمی دهد. چنانچه تماس دوستانه ای برقرار شود، محدود به نگاه کردن ، و یا چنگ زدن می گردد.
بین 9 تا13 ماهگی کودک به اسباب بازیهایش توجه بیشتری نشان می دهدو چنانچه هم بازیهایش بخواهنداز بازیچه های وی استفاده نمایند ، غالباً کودک به مقابله برمی خیزدو بین آنها نزاع درمی گیرد. هرچند، باید اذعان داشت این نزاع جنبه عداوت وخصومت ندارد و از روی کینه توزی و دشمنی نیست.
از 14 ماهگی تا 18 ماهگی بتدریج توجه کودک به سوی همبازی هایش معطوف می گردد و تمایل به نزاع برسر بازیچه ها کاهش محسوسی می یابد. درمحدوده 19 ماهگی تا 2 سالگی ، کودک علاقه خود به بازی با بازیـچه ها را با علاقـه به بــازی با همـسالان درهم می آمیزد و تلفیقی از این دو پدید میآورد بازیهایش بیشتر و طولانی ترمی شود.
شاخصه های رشد اجتماعی
DISCLAIMER: This page is not science, it"s just some thoughts by a Dad who has done a bit of reading and is lucky enough to spend lots of time with two great kids.
[ More definitions and points of view | Asperger"s Syndrome ]
Autism (or PDD, PDD-NOS, "autism spectrum disorder")
Autism (and the related pervasive developmental disorders) is a severe developmental disorder which, left unchecked, usually progresses to developmental disability at a young age. The causes of the disorder are largely unknown; they include genetic and environmental (chemical and biological) factors, or some interaction of the two. (Many in the psychoanalytic community once believed that lack of parental nurturing was the cause, but that is perhaps the only factor we now know is not important.) Symptoms may be present from or even before birth (yes, Moms can tell), or appear gradually or suddenly after two or more years of apparently normal development. Although some related conditions such as Landau-Kleffner syndrome cause measurable changes in brain activity, in most cases the only diagnostic information is the child"s behavior. Other biological markers are sketchy: there is some evidence of altered neurotransmitter (serotonin) levels; some children show slight physical changes, such as the shape of their ears; there is a strong correlation with maleness and non-right-handedness; and there is correlation with certain genes. There is about a one in nine chance that a sibling will also have autism.
رشد وآموزش ارتباطات و مهارتهای اجتماعی
درمیـان تمام پستانداران ،آدمـی دربدو تولد ناتـوان ترین آنهاست وبه طولانی ترین دوره رشدی نیاز دارد تا بتواند به تمامی مهـارتهای ویژه نوع خود دست یابد. کنش متقابل ودائمی بین توارث ومحیط،تعیین کننده رشدآدمی است .یعنی آمادگی های زیستی موجود در بدو تولد ، با تجاربی که دردوران رشدازمحیط کسب می گردد درهم می آمیزندو مسیررشدی فرد راترسیم می سازند.
رشدروانی- اجتماعی برخلاف انواع دیگر رشدها رونـدی است که در تمـام طـول عمـر ادامـه می یابـد.
رشداجتماعی ازنظر مفهوم یعنی رشدتوانائی عملکرددرگروه وپذیرفتن خواستهای فرهنگ واجتماعی که فرد درآن زندگی می کند.اجتماعی شدن تابع اصل یادگیری است وهیچ کودکی ذاتأ اجتماعی زاده نمی شودبلکه این مسئله درمسیر رشد ودرطی فرصتهای فراهم شده شکل می گیرد.
دوره اول کودکی ( ازتولد تا سه سالگی )
رفتار عاطفی نوزاد ازحدود 4 ماهگی آشکار می شود.در 6 ماهگی میل به تماس با دیگران درطفل شدت می یابد و مایل است که او را درآغوش بگیرندو نوازش کنند.در اواخر یک سالگی با شوق و لذت منتظرمادرش می شود و به محض دیدن او شادی می کند. درسال دوم این علاقه مندی به سایراشیاء ماننـداسبــاب بـــازی ها ، لبــاس وچیــزهای دیگرمعطوف می شود.
در12 ماهگی کودک اصواتی در پاسخ به گفتگوی بزرگسالان ادا می نماید.بین 18ماهگی تا2سالگی کنترل رفتارطفل دشوارمی گردد زیرا بواسطه توانائی کودک درحرکت وکنجکاوی شدید، هرمحرکی برایش جالب بوده وگاهأ اعمالش مخاطراتی برای او ایجادمی کند.چنانکه رفتارش را محدودکنند ، ناراحتی بسیارشدیدی ازخودنشان می دهد.
[HOME to OASIS] [IMPORTANT NEWS] [BOOKSTORE] [MESSAGE BOARDS]
What Is Asperger Syndrome?
Founder of the OASIS Web site (http://www.aspergersyndrome.org/)
Co-author of THE OASIS GUIDE TO ASPERGER SYNDROME (Crown, 2001, Revised 2005)
Asperger Syndrome or (Asperger"s Disorder) is a neurobiological disorder named for a Viennese physician, Hans Asperger, who in 1944 published a paper which described a pattern of behaviors in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills. In spite of the publication of his paper in the 1940"s, it wasn"t until 1994 that Asperger Syndrome was added to the DSM IV and only in the past few years has AS been recognized by professionals and parents.
Individuals with AS can exhibit a variety of characteristics and the disorder can range from mild to severe. Persons with AS show marked deficiencies in social skills, have difficulties with transitions or changes and prefer sameness. They often have obsessive routines and may be preoccupied with a particular subject of interest. They have a great deal of difficulty reading nonverbal cues (body language) and very often the individual with AS has difficulty determining proper body space. Often overly sensitive to sounds, tastes, smells, and sights, the person with AS may prefer soft clothing, certain foods, and be bothered by sounds or lights no one else seems to hear or see. It"s important to remember that the person with AS perceives the world very differently. Therefore, many behaviors that seem odd or unusual are due to those neurological differences and not the result of intentional rudeness or bad behavior, and most certainly not the result of "improper parenting".
Last Updated:
Sep 20, 2000 Mosaic Down Syndrome
by Dr. Len Leshin, MD, FAAP
Copyright 1997, 2000, All rights reserved
Before reading this essay on the mosaic form of Down syndrome, you should be familiar with how typical Down syndrome occurs. If you aren"t, take the time to read through my essay on the origin of Down syndrome.
What is Mosaicism?
Every cell in the human body comes from one initial cell: the fertilized egg, which is also called the zygote. After fertilization, the zygote then proceeds to divide. As new cells form, the chromosomes duplicate themselves so that the resulting cells have the same number of chromosomes as the original cell. However, mistakes sometimes happen and one cell ends up with a different number of chromosomes. From then on, all cells originating from that cell will have the different chromosomal number, unless another mistake happens. (All like cells originating from a single type of cell is called a cell line; for example, the skin cell line, the blood cell line, the brain cell line, etc.)
When a person has more than one type of chromosomal makeup, that is called mosaicism, like the mosaic style of art in which a picture is made up of different colors of tiles. In Down syndrome, mosaicism means that some cells of the body have trisomy 21, and some have the typical number of chromosomes.
How is Mosaicism Diagnosed?
Looking At Metabolism
by Joan E. Medlen, R.D., L.D.
Joan E. Medlen, R.D., L.D., is the mother of two boys, one of whom has Down syndrome.
She is a registered, licensed dietitian in private practice in Oregon and frequent speaker
at Down syndrome symposiums. This article was originally published in the journal
Disability Solutions, Volume 1, Issue 3, Sept/Oct 1996. Reprinted here with permission.
© 1996
In the first weeks after our son with Down syndrome was born, my thoughts strayed to his health throughout his life. My impression was that all adults with Down syndrome were very obese. As a dietitian, most of my work had been in the weight management area. I had seen first-hand the effects long-term obesity had on a person"s life. I remember emphatically explaining to my husband that we needed to be an aerobically active family. I asked him to consider cross-country skiing instead of downhill skiing, and to plan for activities like family biking trips.
Now, seven years later, Andy is a slender, tall boy, like his brother. He eats well, but not perfectly. He appears "active," but it"s not very aerobic. And, when I look at other children with Down syndrome at conferences and in my community, there seems to be a mix of body types: some are slight and petite, some are thick and stocky, and some are overweight. Where did that early image of obese adults come from? Had I fallen for a myth? Could it be that this younger generation of persons with Down syndrome will not have as many obese adults? Has the increase in community inclusion changed the incidence of obesity?
Probably not. Research suggests children with Down syndrome are as active as their peers, yet use fewer calories overall. They appear to have a lowered Basal Metabolic Rate, which is the rate a person burns calories for fuel when completely at rest - or sleeping. This means that children with Down syndrome use less energy when they are resting or sleeping.
Occupational Therapy
and the
Child with Down Syndrome
by Maryanne Bruni, BSc OT(C)
Copyright 2001, All rights reserved
If you are a parent reading this web site, you likely have a child with Down syndrome, as I do. My intent with this article is to provide you with some information about how an occupational therapist (OT) may be able to help you and your child. Occupational therapists who work with children have education and training in child development, neurology, medical conditions, psychosocial development, and therapeutic techniques. Occupational therapists focus on the child"s ability to master skills for independence. This can include:
• self care skills (feeding, dressing, grooming etc.)
• fine and gross motor skills
• skills related to school performance (eg: printing, cutting etc.)
• play and leisure skills
When your child is an infant, your immediate concerns relate to his health and growth, development of the basic motor milestones, social interaction with you and others, interest in things going on around him, and early speech sounds and responses. At this stage an OT may become involved to:
• assist with oral-motor feeding problems (this can also be addressed by Speech Pathologists). Due to hypotonia and weakness of the muscles of the cheeks, tongue and lips, feeding is difficult for some infants with Down syndrome. OTs suggest positioning and feeding techniques, and can be involved in doing feeding studies, if necessary.
• help facilitate motor milestones, particularly for fine motor skills. Occupational therapists and Physical therapists work closely together to help the young child develop gross motor milestones (eg: sitting, crawling, standing, walking).OTs work with the child at this stage to promote arm and hand movements that lay the foundation for later developing fine motor skills. The low muscle tone and loose ligaments at the joints associated with Down syndrome are real challenges to early motor development and occupational therapy can help your child meet those challenges.
When your child is a toddler and preschooler, she will likely have some independent mobility and will be busy exploring her environment. To assist her development you will want to provide her with many opportunities for learning, you will want to encourage the beginning steps in learning to feed and dress herself, you will want her to learn how to play appropriately with toys and interact with other children, you will be encouraging speech and language skills, and you will continue to provide opportunities for refinement of gross motor skills. At this stage an OT may become involved to:
• facilitate the development of fine motor skills. This is an important stage in the development of fine motor skills for children with Down syndrome. Now they will be developing the movements in their hands that will allow them to do many things as they get older, but many children need some therapy input to ensure that these movements do develop. Children do this through play; they open and close things, pick up and release toys of varying sizes and shapes, stack and build, manipulate knobs and buttons, experiment with crayons etc. Your child may face more challenges learning fine motor skills because of low muscle tone, decreased strength and joint ligament laxity.
• help you promote the beginning steps of self help skills. An OT can help parents break down the skills so expectations are appropriate, and can suggest positioning or adaptations that might help the child be more independent. For example, a child may have more success feeding herself with a particular type of spoon and dish.
Subclassification of Autism
A review of the most carefully controlled neuroscientific studies (Bachevalier, 1994) using various methods such as autopsy material, brain scanning and imaging (MRI, CAT, PET, SPECT, rCBF) suggest that it may be helpful to divide autism into two distinct subclasses: Type1, where there are distinct neurologic signs and varying ranges of mental retardation (encompassing approximately 60-70% of the autistic population); Type 2, where the CNS is anatomically intact and there is no mental retardation (encompassing approximately 30-40% of the autistic population). Obviously a continuum from severe functioning deficits to very minor exists in the autism population. DeLong (DeLong and Nohria, 1994) has appropriately described this phenomenon as the "spectrum" of disorders in autism. The two sub-types should be seen as fitting into such a spectrum or continuum.
It makes greater sense to subclassify autism in the above manner when the neurodevelopmental evidence is taken into consideration. For example, we know from the earlier discussion about critical periods, particularly during 8-16 weeks of gestation, that mental retardation is most likely to occur if any event interferes with the process of neuronal migration. This earlier onset disruption of the developing fetus, regardless of the cause, would produce more severe consequences. This type of disruption would affect many brain areas and have definite abnormalities such as those seen by Kemper and Bauman (1993). Cells in the limbic system (amygdala, hippocampus, cingulate, septum) would most likely be affected. The development of the Purkinje cells and deep cerebellar nuclei would also undoubtedly be affected. In this case, many neural circuits would not be properly formed and brain functioning would therefore be compromised later in life. The blend with mental retardation would make it difficult to reverse the brain functioning difficulties found with such people. Level of improvement would obviously be influenced to a very large extent by the degree of brain impairment.
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