Adults with Autism: A Guide to Theory and Practice

by Hugh Morgan , Foreword by Geraldine Peacock

• ISBN13: 9780521456838
• ISBN10: 0521456835
• Format: Paperback
• Copyright: 1996-09-28
• Publisher: Cambridge University Press

Summary

From childhood services to adult provision, the needs of an individual develop and change, yet the literature addressing specific adult requirements is scarce. This volume sets out to fill this gap and provides practical help and guidance specifically for those caring for the growing recognised population of adults with autism. Issues of theory and practice from both local and international perspectives are included. Subsequent chapters analyse the implications arising from thought and behaviour inflexibility with emphasis on the management of transition and bereavement. Models for practice in employment and further education and also pharmacological and educational approaches to mental health problems, epilepsy and challenging behaviour are concluded by a chapter which develops many themes of this publication as the basis for a practitioner training programme in residential settings. An essential guide for all those concerned with the care and well being of adults with autism including parents, researchers, practitioners and community care workers.

Table of Contents

List of contributors	xvii
Foreword	xix
Geraldine Peacock
Preface	xxi
Professor John Corbett
Hugh Morgan
Introduction	1	(6)
Hugh Morgan
Services for adults with autism: an international perspective	7	(24)
Hugh Morgan
Recurring themes	7	(2)
Parent of a young man with autism in Greece	9	(1)
Parent of a young man with autism living in England	9	(1)
Snapshots of developmental progress around the world	9	(14)
Chile	10	(1)
India	11	(1)
Japan	12	(1)
Australia	13	(2)
Iceland	15	(2)
Luxembourg	17	(1)
Co-operative Peter Pan	17	(1)
Ordinary employment	18	(1)
Residential	18	(1)
Adults not provided for by The Institute	18	(2)
Spain	20	(2)
Portugal	22	(1)
Profile: the Greek experience	23	(5)
Incidence of autism in Greece	23	(1)
Awareness of autism in Greece	24	(1)
Provision for adults with autism in Greece	24	(1)
Political backcloth	25	(1)
1992-The Greek Society for the Protection of Autistic People receives legal approval	26	(1)
The future	27	(1)
Chapter summary	28	(1)
Acknowledgements	29	(1)
Bibliography	29	(2)
Underpinning philosophy in the provision of services for adults with autism: a critique of global values related to specific practice	31	(22)
Hugh Morgan
Underpinning philosophy	32	(1)
The roots of humanistic theory: a historical perspective	32	(2)
Appraising normalisation	34	(9)
Normalisation and parents	35	(1)
Normalisation and practitioner training	36	(1)
Celebration of differences	36	(1)
Normalisation, the concept of `self' and autism	37	(3)
Interpreting normalisation: issues of service design	40	(1)
What do adults with autism themselves seek in service design?	41	(1)
Summary of findings	42	(1)
The quality of the relationship between care-giver and the person with autism	43	(1)
Independence and autism	44	(2)
Chapter summary	46	(1)
Acknowledgements	47	(1)
Appendix 2.1	48	(3)
Bibliography	51	(2)
Evaluating services for adults with autism: the Autism Quality Audit and Accreditation Programme	53	(21)
Hugh Morgan
Bob Reynolds
Setting the scene	53	(1)
Sharpening the concept of quality	54	(2)
Which characteristics determine the quality of a service?	54	(1)
What general factors need to be included in a quality audit programme evaluating social care provision?	55	(1)
What are the potential benefits to service-users?	55	(1)
What are the potential benefits to employees?	56	(1)
The accreditation model	56	(2)
Why have an accreditation system?	57	(1)
Application of an accreditation system to services for adults with autism	57	(1)
One example of service evaluation: the Autism Quality Audit and Accreditation Programme	58	(4)
Background	58	(1)
The accreditation team	59	(1)
The objectives of the accreditation team	59	(1)
How evidence was gathered	60	(1)
The evidence	60	(2)
Who makes the decision whether to accredit or defer an establishment?	62	(1)
Experiencing accreditation	62	(3)
A parent's perspective	62	(1)
A team member's perspective	63	(1)
A Service Manager's perspective	64	(1)
Findings from the first two years of the programme	65	(5)
Identified advantages	66	(2)
Concerns	68	(2)
How does the Autism Quality Audit and Accreditation Programme measure up to critical design features outlined by Richards and Heginbotham (1992)?	70	(2)
Chapter summary	72	(1)
Acknowledgements	73	(1)
Bibliography	73	(1)
Encouraging flexibility in adults with autism	74	(15)
Rita Jordan
Stuart Powell
Introduction	74	(1)
The problems	74	(6)
Difficulties with change	74	(2)
Lack of spontaneity and initiative	76	(1)
Difficulties with creativity and imagination	77	(2)
Stereotypical thought and behaviour	79	(1)
Practical implications	80	(2)
Creating anxiety-free situations	80	(2)
Teaching understanding and awareness	82	(5)
Attending to relevant meanings	82	(1)
Developing memory strategies	83	(1)
Developing choice	84	(2)
Teaching more flexible and creative behaviour	86	(1)
Conclusion	87	(1)
Bibliography	87	(2)
Attachment and loss: a focus on transition and bereavement	89	(26)
Hugh Morgan
Attachment	90	(2)
Introduction	90	(1)
Attachment and adults with autism	90	(2)
Loss	92	(3)
Security-fostering attachments	92	(1)
Loss of attachments	93	(2)
Transition: one example of attachment and loss in autism	95	(8)
Introduction	95	(1)
Defining adult status	95	(1)
Transition in autism	96	(1)
Theoretical framework	97	(1)
Maturational transition	98	(3)
Situational transition	101	(2)
Summary	103	(1)
Bereavement	103	(7)
Bereavement is individually experienced	105	(1)
Reactions to bereavement by adults with autism	105	(1)
Supporting adults through the bereavement process	106	(1)
The role that practitioners can play in bereavement	107	(1)
Tasks	108	(1)
Pitching the level of explanation	108	(1)
Funeral arrangements	108	(1)
Working through the process of bereavement	109	(1)
Understanding the carers	109	(1)
Bereavement support groups	109	(1)
Chapter summary	110	(1)
Acknowledgements	110	(1)
Appendix 5.1	111	(1)
Bibliography	112	(3)
The significance of age, status and gender to adults with autism	115	(28)
Eve Matthews
Introduction	115	(1)
Chapter outline	116	(1)
Different ways of explaining the Triad of Impairments in autism	117	(2)
Affective Theory	117	(1)
Conative or Motivational Theory	117	(1)
Theory of Mind	118	(1)
Case study one: Robert	119	(1)
Case study two: David	120	(1)
Case study three: Sam	121	(1)
Case study four: Rachel	121	(2)
What are the implications for the experimental research?	123	(1)
The Visual Clues Experiment	123	(12)
Who took part in the experiment?	124	(1)
How were these groups matched?	124	(2)
What materials were used in the Visual Clues Experiment?	126	(3)
What was the procedure used in the Visual Clues Experiment?	129	(1)
What was the method of scoring in the Visual Clues Experiment?	129	(1)
What were the findings of the Visual Clues Experiment?	130	(5)
Summary of the research	135	(4)
What are the implications of the findings from this research in relation to current psychological theories?	136	(1)
Do these results provide more evidence to support these theories, or does it show inherent weaknesses in them?	136	(3)
Some concluding thoughts	139	(2)
What are the practical implications of the results of the Visual Clues Experiment?	139	(2)
Bibliography	141	(2)
Developing a support model, within a further education college, for adults with autism	143	(20)
Hugh Morgan
Gwenn Edwards
Lynn Mason
Political backcloth	143	(1)
The value of education for adults with autism	144	(1)
Adults with autism in further education	145	(1)
Recent changes in funding of further education colleges	145	(1)
Why have colleges of further education failed adults with autism?	146	(1)
Formal agenda	147	(1)
Informal agenda	148	(1)
Approaches to further education for adults with autism	148	(1)
The Oakfield House/Matthew Boulton College Project	149	(7)
Background and method	149	(1)
Settings/location	149	(1)
Procedure	150	(1)
Participants	150	(1)
Introduction to the college	151	(1)
Beginning the project	152	(1)
Changes made	153	(1)
Findings	153	(1)
Discussion	154	(1)
Recommendations	155	(1)
Chapter summary	156	(1)
Acknowledgements	157	(1)
Appendix 7.1	158	(3)
Bibliography	161	(2)
Employment training and the development of a support model within employment for adults who experience Asperger syndrome and autism: the Gloucestershire Group Homes Model	163	(22)
Alison Matthews
Introduction	163	(1)
The Gloucestershire Group Homes Employment Training Model	164	(1)
Key elements of a specialist employment service	165	(1)
Outlining the pathway to employment	166	(1)
Basic skills training and personal development	166	(3)
Assessment	169	(4)
ETU individual assessment	169	(1)
PACT (Placing Assessment and Counselling Team) assessment	169	(1)
Adapting the PACT assessment to people who experience autism or Asperger syndrome	170	(3)
Career guidance	173	(1)
Enclave work	174	(1)
ETU business model	174	(3)
Mobile Crew Work experience	177	(3)
Work experience with a job coach	180	(1)
Role of job coach supporting an individual in employment	180	(1)
Supportive employment services in the UK	181	(1)
Chapter summary	181	(1)
Acknowledgements	182	(1)
Appendix 8.1	183	(1)
Appendix 8.2	183	(1)
Bibliography	184	(1)
Health care of adults with autism	185	(12)
Gillian Wainscott
John Corbett
Medical assessment	186	(1)
Preventive medical care	187	(1)
Preventive dental care	188	(1)
Epilepsy and autism	189	(2)
Autism and adolescence	191	(2)
Autism in later life	193	(1)
Emotional disorders	194	(1)
Depression	194	(1)
Anxiety	194	(1)
Tics and Tourette syndrome	194	(1)
Schizophrenia	195	(1)
Chapter summary	195	(1)
Bibliography	196	(1)
Psychiatric and behavioural problems and pharmacological treatments	197	(34)
David J. Clarke
The classification of psychiatric disorders and their clinical features	199	(5)
Delusions	200	(1)
Hallucinations	200	(1)
Dementias	200	(1)
Delirium	200	(1)
Schizophrenia	201	(1)
Delusional disorders	201	(1)
Acute and transient psychotic disorders	201	(1)
Mood disorders	201	(1)
Depressive disorders	202	(1)
Bipolar disorders	202	(1)
Neurotic, stress-related and somatoform disorders	202	(1)
Behavioural syndromes associated with physiological disturbances and physical factors	203	(1)
Personality disorder	203	(1)
Mental retardation/learning disability	203	(1)
Autistic disorders	204	(1)
Disorders with onset in childhood or adolescence	204	(1)
Pharmacological treatments	204	(6)
The efficacy of antipsychotics and antidepressants	204	(1)
Antipsychotics	205	(2)
Tricyclic antidepressants (TCAs)	207	(1)
Specific serotonin re-uptake inhibitors (SSRIs)	208	(1)
Carbamazepine	208	(1)
Lithium	208	(1)
Propranolol	209	(1)
Opiate antagonists	210	(1)
Behavioural disorders and autism	210	(1)
Pharmacological treatment of behavioural disorders	211	(9)
Aggressive behaviour	211	(3)
Inappropriate sexual behaviour	214	(2)
Self-injurious behaviour	216	(3)
Pica	219	(1)
Treatment of features of autism	220	(4)
Conclusions	224	(1)
Bibliography	224	(7)
Appreciating the style of perception and learning as a basis for anticipating and responding to the challenging behaviour of adults with autism	231	(18)
Hugh Morgan
Psychodynamic approaches to treatment	232	(1)
Pharmacological approaches to treatment	232	(1)
Educational approaches to treatment	233	(1)
Behavioural approaches to treatment	234	(1)
Other interventions	235	(1)
Achieving levels of understanding rather than responding to symptoms	236	(1)
Illustration	237	(1)
Visible tip of the iceberg	237	(1)
Symptoms	237	(1)
Invisible part of the iceberg	237	(1)
Causes	237	(1)
Signposting	238	(2)
Relating difficult behaviour to the Triad of Impairments	240	(1)
Practitioner stress	241	(3)
Responding to difficult situations-general guidelines for practitioners	244	(2)
Chapter summary	246	(1)
Acknowledgements	246	(1)
Bibliography	246	(3)
Working with adults with autism in residential settings: a strategy for practitioner training	249	(22)
Hugh Morgan
Introduction	249	(1)
Influences on training	249	(2)
The close relationship between generic care practice and autism-specific practice	251	(1)
Demonstrating the need	252	(2)
How well equipped are staff working with adults with autism in the underpinning knowledge of good residential care practice?	252	(1)
Care staff	253	(1)
Managerial staff	253	(1)
So what conclusions relevant to work with people with autism can be drawn?	254	(1)
Level one - training designed to develop an underpinning knowledge for practitioners working with adults with autism	254	(5)
Level-one training topics	255	(1)
Strategies for training	256	(1)
In-house training	257	(1)
External short course (day and short courses)	257	(1)
Secondment for attendance on generic, external courses leading to a professional qualification	258	(1)
Distance learning	259	(1)
Level two-autism-specific training	259	(6)
Philosophy and history of a service	262	(1)
Targeting the range of disabilities to be found within autism	262	(1)
Understanding the unconventional nature of learning by people with autism and the responses that are required	263	(1)
Autism-specific assessments	263	(1)
Uses and abuses of medication	263	(1)
Attachment and loss: transition and bereavement	264	(1)
Creating a stable anxiety-free environment, but also teaching more flexible behaviours	264	(1)
Self-determination	264	(1)
Non-aversive approaches to managing difficult behaviour	265	(1)
Specialist professional qualifications for work with adults with autism	265	(3)
European Educautisme training programme	265	(1)
Advanced Certificate of Education Autism (Adults)	265	(1)
Identifying the need for a course for practitioners working with adults with autism	266	(1)
Course content	266	(1)
Teaching methods	267	(1)
Future developments	268	(1)
Chapter summary	268	(1)
Acknowledgements	269	(1)
Bibliography	269	(2)
Epilogue Future trends in services for adults with autism within the United Kingdom	271	(11)
Hugh Morgan
Influencing the public sector	271	(1)
Respite care	272	(1)
Practice with high-functioning adults with autism/Asperger syndrome	273	(1)
Education for life	274	(1)
Impact of literature upon practice	274	(1)
Training of practitioners	275	(1)
`Miracle cures'	276	(1)
Making the world more understandable: new technologies	276	(2)
Appendix 1	278	(2)
Bibliography	280	(2)
Index	282