From Medication to Education

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

2. 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

3. 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 8-12 months • Total of 100 participators: 60 on a more regular basis • Learning process evaluated through documentation, interviews, questionnaires

4. 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…

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

6. 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

7. 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

8. 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

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

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

11. 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)

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

13. 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

14. 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

15. 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

16. 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)

17. 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

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

19. From Medication to Education-People with Autism in Adult Psychiatry • http://www.english.certec.lth.se/doc/frommedicationto/