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Philosophy
Kris’ Camp’s therapeutic philosophy has evolved from the professional experience of some of the camp’s core therapists in combination with my goals and direction in starting Kris’ Camp. We do not adhere to one particular school of thought related to treatment, but utilize a positive approach based on several empirical findings and theories. We look at autism as a movement disorder: the inability to initiate, sustain, inhibit, or transition movements efficiently. We believe that when a person’s system is organized through sensory input, then they are able to regulate and modulate their motor output more effectively and thus able to demonstrate more of their true potential. We look at behaviors as communication and assess whether or not an individual’s self-initiated seeking of sensory input is an effective means of system organization. If not, we assist the individual in identifying a more appropriate accommodation for their daily life. Our approach is a positive, competency-based one in which we provide the least amount of assistance possible to promote the child’s independence and rely on their strengths to promote future successes. Within this framework, we encourage the parents to lead us in the treatment direction through their written/verbal input. Their goals and input then become our focus for treatment during the week.
Things that stand out in my mind in terms of what Kris got out of Adam’s Camp are: 1) He seemed so happy with himself and felt like he could really achieve things and that people believed in him, 2) He DID achieve things, and 3) We felt so accepted as a family, which was such a breath of fresh air. Frequently parents with special needs kids feel like they constantly have to advocate for their child. To be somewhere where you feel like the professionals involved truly have you and your child’s best interests at heart is truly an amazing feeling.
Treatment Components
Positive Approach/Empowering the Child
When we are talking to and working with the children we always assume competence. We assume that they understand us and we treat them with respect. It seems that frequently when people are working with kids with ‘invisible’ disabilities, they can get frustrated and feel like the child is behaving badly or that they cognitively cannot perform a task, rather than that their minds and bodies are not working together to allow them to follow through with a choice or communicate their needs. Given support and kind expectations placed on them, they can achieve much. However, this may be frustrating for some of the children initially at camp as they get used to having higher expectations placed on them.
Additionally, it has been shown that motivation is an important aspect of learning and thus of therapy too. Using a positive, respectful approach can go a long way for providing that motivation.
We also use supportive language to recognize and validate each child’s difficulties while promoting responsibility for self and others. Self-talk language is also used to facilitate interactions with others, engage in daily living tasks, and increase awareness of self in relationship to his environment.
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Understanding Autism as a Movement Regulation Disorder -
Least to Most Strategy
Recent findings by Dr. Philip Teitelbaum, a psychologist at the University of Florida in Gainesville, indicate that there are movement disturbances in persons with autism that effect perceptual-motor regulation (starting, stopping, and transitioning activities). In regards to motor output in persons with autism, he says that "the act gets done", which makes it hard to recognize that a problem exists, but he has analyzed that "the components of that movement are poorly integrated or disconnected." [http://www.autcom.org/articles%5CMovementRelationship.html]
Based on Teitelbaum’s research, information/personal experience provided by individuals with autism such as Donna Williams and Temple Grandin, and clinical experience, Kris’ Camp Staff look at these difficulties and provide accommodations necessary to promote independence including sensory integration techniques, neurologic music therapy interventions, motivating factors, and self-responsibility.
When considering autism as a movement disorder, we utilize the least to most strategy with all interventions. This aspect of treatment allows the person the least amount of support needed for him/her to be successful in all presented tasks, including motor output and communication. It promotes the person’s independence while also facilitating success in a given experience which then enhances his/her self-esteem.
Specifically we use a technique called “facilitated touch” to help with regulation of perceptual motor responses. This is the provision of light touch at the shoulder, tricep, elbow, forearm, wrist, or hand to promote initiation/inhibition of movement and/or sustained duration of motor output. Facilitated touch is not the directing of movement, but rather a touch cue to accommodate for one’s inability to initiate, sustain, or inhibit movement, i.e. regulate and modulate motor output. This external cue brings awareness to the part of the body necessary in performing a task and is provided only until an internal cue is developed. This accommodation is started at the shoulder for the least intrusive assistance and moved down the arm as needed by the individual.
This type of cue, while often utilized in motor tasks, is also important in allowing a person with autism to effectively communicate their intentions. (Please see Competency-Based Communication section.)
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Sensory/Motor Integration
Sensory Integration is a technique developed by Jean Ayres, an occupational therapist. For more information on this topic, you can visit the website: http://www.sensoryint.com/.
According to The Ayres Clinic, "For most children, sensory integration develops in the course of ordinary childhood activities. Motor planning ability is a natural outcome of the process, as is the ability to adapt to incoming sensations. But for some children, sensory integration does not develop as efficiently as it should. When the process is disordered, a number of problems in learning, development, or behavior may become evident." [https://mmm1106.verio-web.com/sensor/faq.html]
It has been theorized that disturbances in sensory modulation are the primary symptoms of autism and that disturbances of social relating, communication and language are consequences of difficulty in modulation of sensory input.
At camp the whole team works together led by the sensory motor therapist (OT/PT) to provide a variety of interventions and activities designed to help the children integrate their systems more efficiently. Each child has individual needs and as the week progresses these needs are assessed and approaches are discussed by the team for each child every day after therapy. Useful approaches are then utilized the following day in therapy by the entire team for consistency, followed by further discussion of its effectiveness within staff meetings. As children with autism are adept at providing their bodies with self-initiated accommodations to provide sensory stimulation, therapists at camp work to replace any inappropriate seeking of stimuli with more functional and effective accommodations. Many techniques are utilized to provide system organization to the children and often include vestibular, proprioceptive, tactile, and/or rhythmic input.
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Neurologic Music Therapy (NMT)
Kris’ Camp music therapists involve each child in a variety of vocal and instrumental music therapy interventions which facilitate demonstration of current cognitive, communication, motor, and social skill abilities. Music experiences provide opportunities for creativity and choice making, encourage independence and problem solving, promote self-confidence, and facilitate awareness of responsibility to self and others.
Specifically, these therapists incorporate Neurologic Music Therapy techniques which identify the physiological effects of rhythm to entrain motor responses (stabilization, timing, and adaptation of movement) as well as promote organization of the sensory and motor systems. Through the application of rhythm, and its corresponding impact on these systems, these therapists engage individuals in experiences that facilitate functional output and allow for increased affective/emotional responses. Structured improvisation presented at an individual’s internal cadence is also used while incorporating elements of self-talk to encourage awareness of the experience as well as self-responsibility for one’s actions.
NMT is defined as the therapeutic application of music to cognitive, sensory, and motor dysfunctions due to neurologic disease of the human nervous system. It is based on a neuroscience model of music perception and production and the influence of music on nonmusical brain and behavior functions. Treatment techniques are research based and directed towards functional therapeutic goals. (Thaut, 1999). For more information about NMT, please visit: Center for Biomedical Research at Coloradio State University
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Competency-Based Communication
Persons with autism typically exhibit difficulty communicating their wants, needs, and intentions. We believe that it is important to provide whole language communication methods that allow for demonstration of the child’s current level of functioning as well as enhance their functional communication. During each camp session, therapists assess each individual’s current method of communication, their motivation to use a given system, and potential accommodations needed to make those methods more effective or functional for the individual.
Kris’ Camp Staff also uses a variety of methods of competency-based communication which provide visual input to improve processing and language output including yes/no cards, word cards to indicate choice, word/phrase boards, and/or letter boards. The goal is to provide the child with a functional communication system which allows communication without reliance on verbal output. Persons with autism have shown that through the use of these systems, verbal language is developed and independence can be achieved.
When using these techniques, we also implement the least to most strategy. For example, if a child can immediately answer a given question related to choice without any input from the therapist, then that, of course, is a very independent response and no intervention is needed. If a child demonstrates difficulty, then ample processing time is provided, followed by the presentation of word cards. After a period of time, if no response is made verbally or by the touch of a card, then facilitated touch is used to help them initiate the move to a card. Facilitated touch as described above is started at the shoulder and then gradually moved down to the hand/wrist only after the child does not initiate movement. The use of these techniques accesses the visual sense in combination with the auditory channel in order to facilitate more efficient processing of information, and subsequent related output.
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Facilitated Communication
Facilitated communication (FC) is an alternative means of communication for people who cannot speak or have limited verbal language. The technique has been used as a means of expression for individuals with severe disabilities including persons with labels of mental retardation, autism, Down syndrome, and other developmental disabilities. It is a controversial technique because it requires a facilitator to support the communicator’s hand, wrist, elbow, or shoulder while providing backwards resistance as the individual points to letters and spells out words, phrases, or sentences on a letter board, keyboard, laptop, or other augmentative communication devices that have a letter board. As is the case with facilitated touch, the goal is to fade the external cue until an internal cue is developed; therefore, over a period of time, the amount of resistance and the placement of the facilitator’s hand should be moved back until ultimately faded. The amount of time that it takes to develop independence varies from person to person, but there are many independent “typers” who started out with resistance at their hand.
Though Kris’ Camp was not started with the intent that it would be a ‘facilitated communication’ camp, it was certainly something that I experienced with Kris after Adam’s Camp (see Kris' FC Story); and where I first became acquainted with the immense controversy surrounding this technique. Because of my experience with Kris, I was also very open to it though I hadn’t previously used the technique.
Unfortunately, FC has become a very divisive issue and frequently therapists have either experienced success using FC or they have been taught that it is a technique that has not been validated through research; that the therapist actually leads the child to make choices and as such it is harmful to the family in that it gives them false hope. This is not the case; therefore, due to the controversy surrounding this technique, we acknowledge our ethical responsibility to train and educate Kris’ Camp staff in the proper use of FC and other communication methods to protect the individuals we serve. Additionally we emphasize the importance of using a least to most strategy to maximize the individual’s independence as well as supporting a whole communication system that will allow each person the most success in functional communication.
FC is one approach used to help those kids who are non-verbal in particular but there are many individuals who have used FC who have then been able to further develop expressive language. Additionally individuals who already have expressive language are able to convey more clarity and complexity of their thoughts and communication using typing, facilitated or not. Visual cues combined with physical prompts help many of our clients coordinate through higher-level relationship/motor planning tasks.
For more information on the most recent research related to FC, please visit: The Facilitated Communication Institute at Syracuse University or www.autcom.org, or check out the book by Douglas Biklen and Donald N. Cardinal (eds.), (1997). Contested words, contested science: Unraveling the facilitated communication controversy. New York: Teachers College. 245 pp. Paper. $24.95 [http://soeweb.syr.edu/thefci/5-3bik.htm].
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Provision of Family Support
Therapists meet at the end of each camp day to discuss individual responses, program changes, and implementation of treatment ideas at great length. All of the information gathered in these staff meetings is compiled in preparation for parent meetings at the end of camp. The multidisciplinary team coordinates recommendations for each family based on the individual’s responses during the 5 day program. By puling from the range of disciplines with varying experiences, focused and led by parent goals, many of the kids experience a jump-start in their functional abilities at or shortly after camp.
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