November 23, 2009

Today was a very productive day in regards to understanding developmental disabilities. On Thursdays during the morning before I go to Riverside, I have a Social and Cognitive Development lecture. Today we discussed challenges in social and cognitive development – specially, autism and savants. This is review of a previous post, but our professor summarized the triad of impairments (according to the DSM-III-R) with three very clear indicators:

1. Impairments in reciprocal social integration
2. Impairments in communication and integration
3. Markedly restricted repertoire of interests (also know as stereotypes/rituals)

When discussing ritualistic and obsessive behavior, the question was raised whether certain rituals should be broken. Our professor, who usually has clear and complete answers ready to rehearse, smiled, sighed and said, “Therein lies the debate.” She then made the point that “people with autism” should be referred to as such because they are people first –their autism adds to who they are, but does not entirely constitute their identity. Some of the rituals and quirks of autism make people with autism who they are and interests that are not detrimental to them either physically or socially should not be discouraged. The professor then lectured on savants – individuals who have a generally intelligence in the below average range, and an islet of ability out of keeping with other skills. She specifically addressed the famous Kim Peek, on whom the film Rain Man was based. The lecture further aided my understanding of autism as a fascinating and complex condition.

In class, another major episode displaced us from the classroom. I am in the classroom only once a week for half the day and have experienced such an episode three times already – I wonder how often these disruptions occur on a regular basis. Appropriately, the lecture afterwards with Dr. Hinchcliffe focused on the issue of Challenging Behavior. Dr. Hinchcliffe summarized this behavior as having the potential to:

• Prevent participation in appropriate educational activities
• Isolate a student from his peers
• Affect the learning and functioning of others
• Reduce the opportunities for involvement in ordinary community activities
• Make extreme demands on parents, teachers, staff, and resources
• Place the student and/or others in physical danger
• Prevent the use of ordinary community facilities
• Prevent a normal home life, and
• Make the possibilities for future placement difficult

Some of the possible reasons he provided included:

• Severe communication difficulties
• Need for escape from a particular situation
• Tangible or sensory rewards
• Social attention
• Biological or health causes
• Physical discomfort
• Lack of stimulation

Dr. Hinchcliffe admitted that, “The reasons are obvious, but they are not always simple.” Interestingly, he too addressed the issue of the ethics behind extinguishing behavioral drives and agreed that it is right if they are socially damaging. The difficulty of functional analysis – the determination of the functions that the challenging behavior may serve for the individual – and extinguishing the behavior lies in the myriad of possible reasons behind each challenging display.

Today was the type of day that led me to deeply respect David and his TAs Ev, Jeannie, Amy, and Mark. In the aftermath of the episode, Ev said to me, “You can’t last two minutes in this school without a sense of humor!” I appreciate her humble simplification, but I believe she and the other faculty members are to be credited with a lot more than just a sense of humor.

Further information on Kim Peek:

http://www.wisconsinmedicalsociety.org/savant_syndrome/savant_profiles/kim_peek