Sofia hosted the First International Conference "Autism is not a sentence. Practical solutions presented by leading experts” from November 11 to 13.
The organizer was the "Autism Today" Association, with the participation of specialists in the field of applied behavioral analysis, members of the public and parents of children on the autistic spectrum.
Among the leading international experts in the diagnosis and treatment of autism at the conference, who gave presentations and led working groups, Deena Singer, who works for the therapy center in Sofia and the center in Pleven as a coordinator and trainer, Ted Koch, Lauren Ross and Chad The Honeycutt.
At the conference, it was repeatedly explained that applied behavioral analysis is the only scientifically proven method of autism therapy, which achieves the maximum capacity of the child and the possibility of successful adaptation to the surrounding world.
Among the participants of the forum were the psychologist Alexandra Yanakieva, who works as a behavioral technologist at the therapeutic center "Autism today" in the "Gorublyane" quarter of the capital, and Maria Alexandrova - a psychologist and hypnotherapist at the same center.
Specially for "Doctor" Alexandra Yanakieva and Maria Alexandrova explained the possibilities of applied behavioral analysis.
What is Applied Behavior Analysis?
- Yanakieva: Initially, we assess the child's abilities, whether or not he has eye contact, whether he can speak or not, whether he has opportunities for imitation and other skills in different spheres of social life. After we identify the deficits in certain areas, we create an individual program to overcome the deficits.
Corresponding work methods are established for each deficit area. They are part of applied behavior analysis. We always work according to the individuality and needs of the particular child, and in most cases we observe a quick result.
The therapeutic program changes when a skill is mastered to build on it with a more complex and complex one. At six or nine months, we reassess the child's condition to determine what overall progress has been made and to set future short-term and long-term goals.
These re-evaluations are provided to the parents to see the result of the work and to be aware of the direction the therapy is going.
- Aleksandrova: In applied behavioral analysis, the child is mainly worked at a table. The necessary objects are placed in front of him - photos, pictures or other objects - and if the deficit is verbal, the child is shown the object, after which it is named by the therapist.
The aim is to achieve onomatopoeia and finally the child just names the object. Then we work on independent verbalization.
How long do you need to continue these activities to get a visible effect?
- Yanakieva: This is an individual process, each child has his own pace. There is no uniform period for achieving success. Children come one to four times a week for one hour of therapy. 50 minutes is the actual therapy, and we spend 10 minutes giving feedback to the parents.
Results are visible at different times. In some children, there are quick results already in the first two months. In others, the results come only after the first year of therapy. But with everyone, little by little, results are achieved.
What can the autistic child do after such therapy, how independent could he be?
- Aleksandrova: Independence depends on the preliminary level of development. There are high-functioning children who are able to take care of themselves completely. insults act on instructions.
When you tell them: "Bring the cup" or "Throw this in the bin", they do it without any problems. But there are also children who do not cope with such tasks, and sometimes several years of therapy are necessary for them.
What is the ultimate goal of this therapy?
- Aleksandrova: The ultimate goal is an independent life. Because the main problem for autistics comes when they are left without a parent or guardian. Very often then they die in accidents because they don't know how to take care of themselves, they don't have the capacity to live independently.
Aren't overprotective parents one of the reasons their children don't function independently? Do you work with parents?
- Aleksandrova: There is also this moment. Because the parents are the problem, they either over-care for the children or they underestimate them. In this way, they stop their development. It cannot be said unequivocally, of course, that this is the reason.
Certainly the parent plays a big role. He tries from the beginning to take care of his child. There is no separation between parents and children, which occurs naturally in normal children.
- Yanakieva: We always give guidance to parents according to what we do in therapy. We want to bring therapy home by teaching parents how to build on what has already been achieved.
We even have a program that allows parents into therapy, where they can borrow the methods and apply them. Then everything depends on them.
- From experience abroad with applied behavior analysis, to what extent do people with autism achieve independence?
- Aleksandrova: Yes, great integration and independence is achieved. Of course, things are strictly individual.
Ms. Alexandrova, as a hypnotherapist, explain how hypnosis helps in working with children with autism?
- Aleksandrova: It is possible to work with hypnosis to the extent that the child is calmed down. Because many children are hyperactive, screaming, running, which to some extent is normal for any child, but interferes with our work. There are techniques and tricks that help to calm down and adapt more quickly to the environment and get to work.
What do you learn from your supervisor Deanna Singer?
- Yanakieva: Certainly, our consultations with Dina Singer are extremely useful. We constantly encounter new and new cases of higher functioning children and much lower functioning, very young children - for example, one year and six months old.
Due to the lack of experience and practice in this field in Bulgaria, Dina Singer helps us what approach and what techniques to apply.
In practice, what is the lowest age from which applied behavior analysis methods can be applied?
- Aleksandrova: It is good to start therapy as early as possible, because then the child absorbs it more easily and the effect is faster.
But there is another barrier - lack of a rich passive vocabulary. An active vocabulary is not mandatory, the child may not speak, but he must understand. When it does not have a stable base of learned knowledge, it is difficult to learn new ones.
Autism diagnosis in Bulgaria is generally made after the child turns three years old, that is why children around this age come to us most often.
- Yanakieva: This does not prevent interventions to begin before a diagnosis is made. However, most parents wait for confirmation of the diagnosis before taking action. When deficits are evident, one should not wait.
Timely initiation of therapy is essential for a child's progress. The period between the second and fifth years is extremely favorable for the rapid development of autistic children.
In our therapy center "Autism Today" we apply applied behavioral analysis to children up to 7-8 years of age. Separately, we have specialist speech therapists and occupational therapists who work with older children.
- Aleksandrova: We are currently working with about 30 children in our center in Gorublyane district. There is interest from many more parents, but the capacity does not allow us to cover all applicants.
We have a waiting list. Therefore, a second center for applied behavioral analysis in Sofia is under development. It will be in the "Studentski Grad" quarter. In addition, there is such a center in Pleven. An opening is coming in Burgas as well.
We all wonder where did autism come from? Has it happened before?
- Yanakieva: It certainly did not appear in the last half century. Autism has always existed, but it has been called by different names. So it's not some modern disease, a scourge of modern life.
- Alexandrova: From what I have read on the subject, there is no unified opinion. New and new studies are coming out. Autism is generally thought to be a mental disorder.
There was an opinion that it was triggered by vaccines, but this was categorically refuted. Although there is no one-size-fits-all answer, we focus on helping these children with abnormal behavior.