Autism - Description & Background

What is Autism? ››

What Causes Autism? ››

The History of Autism ››

The Triad of Impairments ››

The Continuum ››

Sensory Issues ››

Approaches

Approaches
SPELL
Over many years the NAS schools and services for adults have developed a framework for understanding and responding to the needs of children and adults with an autistic spectrum disorder.

The framework is also useful in identifying underlying issues; in reducing the disabling effects of autistic spectrum disorders; and in providing a cornerstone for communication. It also forms the basis of all autism-specific staff training and an ethical basis for intervention.

The acronym for this framework is SPELL which stands for:

• Structure
• Positive
• Empathy
• Low arousal
• Links

The SPELL framework recognises the individual and unique needs of each child and adult and emphasises that all planning and intervention be organised on this basis.

We believe that a number of interlinking themes are known to be of benefit to children and adults with an autistic spectrum disorder and that by building on strengths and reducing the disabling effects of the condition, progress can be made in personal growth and development with the promotion of opportunity and as full a life as possible. They are:

Structure
The importance of structure has long been recognised. It makes the world a more predictable, accessible and safer place. Structure can aid personal autonomy and independence by reducing dependence on prompting from others. The environment and processes are modified to ensure each individual knows what is going to happen and what is expected of them. This can also aid the development of flexibility by reducing dependence on rigid routines. Structure plays to the strengths of a sense of order and preference for visual organisation commonly associated with autistic spectrum disorder.

Positive (approaches and expectations)
It is important that a programme of sensitive but persistent intervention is in place to engage the individual child or adult, minimize regression and discover and develop potential. In this respect it is important that expectations are high but realistic and based on careful assessment. This will include the strengths and individual needs of the person, their level of functioning and an assessment of the support they will need. We must seek to establish and reinforce self-confidence and self esteem by building on natural strengths, interest and abilities.

It is vital that assessments are made from as wide a perspective as possible and that assumptions are made on the basis of painstaking rather than superficial enquiry. These should include a view of the barriers in accessing opportunity. For example, many people on the autistic spectrum may have difficulty with oral communication, leading to an underestimation of their ability and potential. Conversely some may have a good grasp of speech but this may mask a severe level of disability.

Additionally, many people with autism may avoid new or potentially aversive experiences but through the medium of structure and positive, sensitive, supportive rehearsal can reduce their level of anxiety, learn to tolerate and accept such experiences and develop new horizons and skills.

Empathy
It is essential to see the world from the standpoint of the child or adult with an autistic spectrum disorder. This is key to the development of the craft of working with children and adults with autism. We must begin from the position or perspective of the individual and gather insights about how they see and experience their world, knowing what it is that motivates or interests them but importantly what may also frighten, preoccupy or otherwise distress them.

Getting inside and respecting the experience of the person with autism will underpin any successful approach designed to underpin and develop communication and reduce anxiety. In this, the quality of the relationship between the person and supporter is of vital importance. People with autistic spectrum disorders may have considerable difficulties in understanding the thoughts and behaviours of others.
Effective supporters will be endowed with the personal attributes of calmness, predictability and good humour, empathy and an analytical disposition.

Low arousal
The approaches and environment need to be calm and ordered in such a way as to reduce anxiety and aid concentration. There should be as few distractions as possible. Particular attention is paid to potentially aversive or distracting stimuli, for example noise levels, colour schemes, odours, lighting and clutter. Information is given with clarity in the medium best suited to the individual with care taken not to overload or bombard.

Low arousal should not be confused with "no arousal". It is of course desirable that individuals are exposed to a wide range of experiences but that this is done in a planned and sensitive way. It is recognised that for the most part the individual may benefit most in a setting where sensory and other stimulation can be reduced or controlled. Additionally, supplementary relaxation and arousal reduction therapies, snoezelen (a multi-sensory environment), music and massage may be helpful in promoting calm and general well-being and in reducing anxiety.

Links
Strong links between the various components of the persons life or therapeutic programme will promote and sustain essential consistency. Open links and communication between people (e.g. parents and teachers) will provide a holistic approach and reduce the possibility of unhelpful misunderstanding or confusion or the adoption of fragmented, piecemeal approaches.

The people with autism, their parents or advocates are very much seen as partners in the therapeutic process. Links with the mainstream, through curriculum and other experiences enable the individual to participate in a meaningful way in the life of the wider community.
The SPELL framework can be applied across the whole of the autistic spectrum. It draws on and is complementary to other approaches, notably TEACCH.

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