Person Centered Assessment and Intervention
Techniques for Practitioners
Mythily Chari, Director, IRIS
In India, however, I had to abandon the ABC model within a short period of two years. Instead, I started listening to the children and found remarkable talents and strengths. The kids conveyed in their indirect way saying, "no thanks, I do not want to be programmed for life". Behaviour management was no longer a race to gain control, our classrooms were much more disciplined anyway and social norms were usually taught by peers. Teachers managed fairly well with a much higher teacher pupil ratio for the very same reason. They had much less paper work in the form of maintaining records and none at all to protect themselves from litigation. Very few special schools could afford a psychologist or a counsellor, so the teacher had considerable autonomy which would be the envy of a teacher in the US. Parents respected the teacher for the service that s/he provided and did not interfere in the disciplinary methods.
Person Centered Approach (PCA)
While the child becomes the focal point in deciding the nature and range of therapy services, parents' needs are also prioritized. For example, a mother, the primary caregiver for her child, is going over to her parents' place for her second delivery, as is the custom in India. She wants a four month home training programme that she could carry on, and she intends to put the child in a school after a gap of six months. Another child who is high functioning and diagnosed with Asperger Syndrome is ready to attend the third grade; however he lacks the necessary social skills and the mother wants to get him to be 'school ready' before he is admitted to any school. She is very sure that premature placement in a regular school will result in his being expelled for inappropriate behaviour.
In India, special educators lack adequate experience
in handling children with autism. We do not have a certification process
by which a teacher can go in for a certification similar to TEACCH at
Chapel Hill, North Carolina. IRIS has adopted the TEACCH model. Inservice
training for (regular and special) school staff in handling children with
autism and Asperger syndrome is conducted, so that the facility is INCLUSIVE
and LEAST RESTRICTIVE for the children. Parents are advised to insist
upon trained teachers handling their children. Future projects include
settings up of therapeutic preschools where children with special needs
can be trained in integrated settings, Multidisciplinary Diagnostic Teaching
Clinic and a Communication Lab to address specific problems of children
with autism and Asperger syndrome. RIS intends to provide all the services
under one roof, be
The first step in person centered approach is to assess the child in the home, (exception to this rule is only when the family comes from outstation) and the interview conducted in the child's mother tongue. I use the child's toys and books first before introducing my collection. Parents are present throughout the session and they, and even the siblings, are invited to join in the game. The child's preferences are given the lead and it is the child who accepts or rejects an activity. The duration and the manner of play is also decided by the child. I access the functional level of the child, the level of imitation, the typical and atypical play, the optimum and modal level of play according to the Symbolic Play Assessment Protocol developed by Lombardino and Kim (1993). Social skill behaviour (turn-taking, waiting, and sharing) and problem solving skills are also assessed through play. The play scale mentioned earlier is divided into three categories;decentration (roles), decontextualisation (objects) and integration (actions) and is arranged hierarchically in order of increasing difficulty and assesses the play behaviours of preschool children.
According to Mc Cune-Nicolich and Carrol (1982), play and communicative behaviour correspond to each other. In the publication, "Development of Symbolic Play: Implications to the Language Specialist", play and language behaviours are divided into five levels and children between 11 and 24 months are assessed. Earlier literature on play research
(Westby,1988) and (Rygh and Altshuler, 1984) offers
scanty information on the manner in which children with autism play symbolically.
However recent research papers contend that the child with autism is no
less impaired at generating original actions with dolls (Lewis and Boucher,
1995). In the preschool setting, children with autism can be paired with
normally developing peers and through 'priming strategy', spontaneous
communication can be increased without excessive teacher intervention
(Zanolli, Daggett and Adams, 1996). Though children with autism are deficient
in some of the imitative skills, Dawson and Adams (1984) have
A Mother of a child with whom I worked, remarked that she had never played making tea or cooking or doll play with her son, as they were not considered appropriate for boys. During the assessment, I poured pretend tea for the child, he said 'small kids don't drink tea' (perhaps a remark by the mother which he had heard earlier). Then we pretended that we were drinking cola from the cup. He, it was reported, two days later, put a cup to his toy parrot and said 'drink cola'. The level of spontaneous communication in pretend play was never elicited by the mother before.
It has come to my notice that children with Asperger syndrome have depressed play skills especially in the object susbtitution and agent play but are good at thematic play. The children with whom I have interacted have displayed far superior verbal than play behaviour. I intend documenting my work so that I can see if higher level symbolic play can be elicited from children with Asperger syndrome to correspond with their language.
Lack of social skills is one of the three deficits
in the triad: Communication, Socialisation, and Imagination that characterise
children with autism. Play offers a rich canvas to elicit all three behaviours,
in a child friendly, autism specific way, that is also non-threatening.
Some of the social deficits exhibited by children with autism are lack
of emotional bonding with caregivers and the tendency to develop strong
attachments to objects/toys rather than humans (Cairns, 1984). Even in
a preschool set up, it is not enough to place children with autism among
children who are normally
developing and furnish them with toys. Oversensitivity and hyper reaction
to stimulii will defeat the very purpose of integration and the child
with autism will not benefit. By carefully structuring the environment
one can nurture socialisation and friendship. A child aged three years
used to grab a favourite food item from the lunch boxes of his peers.
The teacher who was not trained used to admonish him to no effect. She
even suspected he was hearing impaired. I taught him the 'please give'
gesture of open palm and
the situation dramatically improved, the little girl not only gave him
Our approach to behaviour is proactive rather than reactive. Parents and teachers are trained to assess the function of any challenging behaviour, so that they can form a hypothesis and test it. The emphasis is more on engineering the environment and fixing the little pieces so that the child with challenging behaviours can communicate in a socially appropriate and universally understandable way, rather than resort to aggression. In short, support the behaviour in a positive manner which involves training all the caretakers to react uniformly. The onus of generalising a skill falls on the caregivers rather than on the child. The mother is also assisted in creating a safety and support net for the child and the family. Through training, the parents feel empowered in creating these resources in the community and in turn, the child/person with autism functions in the mainstream as would a person without autism.