Understanding and Supporting the Activities of
Autistic Patients --Based on the Fundamentals of
Cognitive Science and the Science of the Brain
Fuyuko TAKASHIMA, Takeshi MATSUISHI
The targets of the study in this research paper are
autistic patients (including autistic children), which even among children with
disorders that I have encountered in educational settings up to now, have
mysterious worlds that are difficult to understand particularly in speech and
conduct.
Even though we just say autism, the breadth of their intellectual
capacity is very great, such that the term autistic spectrum has become
pervasive recently, and the mental and behavioral states vary, making a clear
definition of autism difficult. Even in the Ministry of Education, Culture,
Sports, Science and Technology "Position of Future Specially Funded Education
(Final Report)" and elsewhere, high functioning autism and Asperger syndrome
have become targets of specially supported education, but even with their high
functioning autism, there are few that become independent and are successful in
terms of employment. At present, support aimed at making them independent is an
important element that cannot be left out. In addition to clarifying the
psychological and behavioral characteristics, inclusive of highly capable
autistic patients, methods for supporting them in the future are considered.
Specifically, as an on-site teacher continuing to be involved with them in the
future, I have, in Chapter I, arranged the behavioral characteristics of
autistic patients from the standpoint of the field of symptomatology.
Since
1980, many autistic patients, starting with Temple Grandin, have published
autobiographies telling about their backgrounds and inner lives, but in Chapter
II, I have brought together material related to what I call the theory of autism
and the heart with reference to these. In Chapter III, I summarize the currently
known facts about the causes of autism, which is also said to involve genetic
factors, from the standpoint of brain science. Furthermore, in Chapter IV, I add
a consideration of manner in which autistic patients are supported based on the
knowledge up to this point. The following gives overviews of each of the
chapters.
Chapter I Understanding the Behavior of Autistic Patients
It is widely known at present that autism is a developmental disorder based
on a brain disorder. However, there is currently no uniform general concept
or definition of the developmental disorder. Therefore, this research paper
handles it as a disorder belonging to "Pervasive Developmental Disorders"
classified under "Psychological Developmental Disorders" in the
World Health Organization (WHO) International Classification of Diseases
(ICD-10).According to this, infantile autism [autism] is a pervasive developmental
disorder defined by the appearance of three conditions, (1) a qualitative
disorder in social interaction, (2) a disorder of communication faculties
and (3) a disorder of imaginative faculties and repetitive, stereotypic
behavioral patterns, appearing before the age of three. This chapter arranges
behavioral characteristics according to various aspects of these three
disorders. In particular, an explanation of (1) is given using Lorna Wing's
four classes. (2) is discussed by dividing communication into prelinguistic,
nonverbal and spoken language and the accompanying characteristics. In
(3), I touch upon the persistence of repetitive routines, stereotypic behavior,
keenness of sensory perception and, further, solitary islands of ability.
Chapter II Understanding the Mind of Autistic Patients
The "theory of the mind" is a person's ability to grasp the intentions
and beliefs of others. From the results of a variety of research, it has
become known that autistic patients have a disorder in the "theory
of the mind." In this chapter, along with discussing the "Sally
Ann problem" and "Smarties problem," which are representative
tests for the "theory of the mind," the conclusion is drawn that
acquisition of a "theory of the heart" through "the obstruction
and deception problem" is not just caused on the level of linguistic
ability. Furthermore, problems for a second level of testing for the "theory
of the heart" have been implemented for high functioning autistic
patients and Asperger syndrome patients that pass the "theory of the
mind" tests.The following facts have come to the surface through the
results of experiments on the communications problems known as the "ice
cream shop problem" and "white lies." In other words, there
is a contradiction in that passing the tests for a "theory of the
mind" does not always mean the acquisition of a "theory of the
heart," and there is a possibility that these patients use a strategy
that is different from normal, healthy children. This chapter concludes
that these are important research themes for the future.
In the items that
follow, the parts related to the heart in the writings of Temple Grandin are
extracted, and there is a discussion of the difficulty of overcoming disorders
in the theory of the heart, no matter how high functioning autistic patients
are.
Chapter III Autism as Viewed from the Field of Brain Science
At present, it is thought that the cause of autism is some
biological disorder in the brain. There is no definitive conclusion concerning
either causes or treatment, but in this chapter, I bring together the causes of
autism derived from recent research and the relationships between the brain and
autism that have been made clear in the field of "brain science." Among the
expected biological causes are genetic factors, viral infections, complications
in birth or pregnancy, etc., and it is said that there is a possibility that any
of these could cause minute brain damage that could be thought of as a cause for
autism.
In terms of the relationship to genetics, a great deal of genetic
research has been published recently by groups studying the genetics of autism
in Great Britain. Even in identical twins, which are genetically the same, the
concordance rate for autism is not 100%, and for example, it is known that even
if both twins are autistic, there are large variations in the characteristics of
the symptoms, while at the same time, the great majority of siblings of those
with autism are healthy and normal. Therefore, a summary of the involvement of
genetic factors would conclude that "a series of genetic problems may bring
about autism, but it is difficult to explain the causes of autism as a whole by
these alone." It is the same concerning the involvement of viral infections and
complications in birth or pregnancy, and they may be partial factors in autism,
but it can be said that autism does not come about solely because of them.
Thus, all of these biological factors have the characteristic of bringing
about damage to areas of the brain, and it can be assumed that developmental
disorders, including autism and mental disabilities, are brought about by them.
This idea has been brought together in the "final common vehicle." From the
field of brain science, I take up the research results that have become clear
from brain imaging diagnostics using the newest scanning technology known as PET
and MRI. Sorting out the afflicted regions, there is a theory on the cerebral
limbic system and cerebellum, a frontal lobe theory and a theory of disorders in
both the frontal and temporal lobes and language regions. In addition, progress
is being made in research on the relationship with neurotransmitters. At any
rate, however, research in this field has just begun, so we must await future
research.
Chapter IV Considerations and Recommendations for the Manner in which Autistic
Patients Should Be Supported In this chapter,
along with discussing the changes in the treatment and education for autism in
Japan at various age levels, I have added considerations. In particular, I
emphasize that there is a need for supporting their being able to move around in
a self-sustaining manner with a view toward their future lifestyles in the
education of autistic patients in early adolescence and adolescence. For
autistic patients from adulthood on, the viewpoint is how we can improve the
quality of live (QOL improvement), and I discuss the importance of a "top-down
approach" that makes it possible for those with disabilities to live locally
just as they are. Along with the permeation of the normalization concept,
integration is being implemented in educational settings. However, in
integration, only the aspects of amalgamation, reconciliation, symbiosis and
coexistence have been emphasized, and there is the criticism that this has moved
forward with insufficient accommodation for individual needs. Thus there have
been developments in the idea of integration.
As a background for these
concepts, emphasis has been placed on the necessity of the so-called
environmental adjustment approach in "Manner of Support for Autistic Patients."
In support for student life, support for leisure activities, support for life in
the home, support for local living and support for employment independence, we
must align many areas, such as medicine, education, welfare and labor. I think
these problems organically bind the aid system for them.
For autistic
patients to be able to live fully in local society, a comprehensive support
system must be created to include direct support for them and support from the
environment surrounding them (the people around them).