Volume:4 Issue: 1 June 2012 - Engelliler Araştırma Enstitüsü

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Volume:4 Issue: 1
June 2012
International Journal of Early Childhood Special Education (INT-JECSE)
Volume 4, Issue 1, June 2012
EDITOR-IN-CHIEF:
Ibrahim H. Diken, Ph.D., Anadolu University, TURKEY, E-mail: [email protected], [email protected]
ASSOCIATE EDITORS:
Macid Melekoglu, Ph.D., Eskisehir Osmangazi University, TURKEY, E-mail: [email protected]
Orhan Cakiroglu, Ph. D., Karadeniz Technical University, TURKEY , E-mail: [email protected]
Tevhide Kargin, Ph.D., Ankara University, TURKEY, E-mail: [email protected]
EDITORIAL REVIEW BOARD:
Gonul Akcamete, Ph.D.
Ankara University, TURKEY
Stefanja Alisauskiene, Ph.D.
University of Siauliai, LITHUANIA
Aysegul Ataman, Ph.D.
Gazi University, TURKEY
Aydin Bal, Ph.D
University of Wisconsin-Madison, USA
E. Sema Batu, Ph.D.
Anadolu University, TURKEY
Necate Baykoc-Donmez, Ph.D. ., (Professor Emeritus)
Hacettepe University, TURKEY
Sue Buckley, Ph.D.
University of Portsmouth, UK
Funda Bozkurt, Ph.D.
Philippa Campbell, Ph.D.
Thomas Jefferson University, USA
Atilla Cavkaytar, Ph.D.
İlknur Çifci-Tekinarslan, PH.D.
Abant İzzet Baysal University, TURKEY
Sam DiGangi, Ph.D.
Arizona State University, USA
Özlem Diken, Ph.D.
Carl J. Dunst, Ph.D.
The Orelena Hawks Puckett Institute, USA
D. Alan Dyson, Ph.D.
University of Manchester, UK
Dilek Erbas, Ph.D.
Erciyes University, TURKEY
Climent Gine, Ph.D.
Ramon Llull University, SPAIN
Annemieke Golly, Ph.D.
University of Oregon, USA
Pilar Guties, Ph.D.
Universidad Complutense, SPAIN
Michael J. Guralnick, Ph.D.
University of Washington, USA
Hasan Gürgür, Ph.D.
Azar Hadadian, Ph.D.
Ball State University, USA
Jim Halle, Ph.D.
University of Illinoisat Urbana-Champaign, USA
Mary Louise Hemetter, Ph.D.
Vanderbilt University, USA
Angel Jannasch-Pennel, Ph.D.
Mark Innocenti, Ph.D.
Utah State University, USA
Ann Kaiser, Ph.D.
Sema Kaner, Ph.D., (Professor Emeritus)
Necdet Karasu, Ph.D.
Özlem Kaya, Ph.D.
Gonul Kircaali-Iftar, Ph.D., (Professor Emeritus)
Anadolu University , TURKEY
Ahmet Konrot, Ph.D.
Eastern Mediterranean University,
TURKISH REPUBLIC OF NORTHERN CYPRUS
Kourtland Koch, Ph.D.
Ball State University, USA
Joao Lopes, Ph.D.
University of Minho, PORTUGAL
Gerald Mahoney, Ph.D.
Case Western University, USA
Ilknur Mavis, Ph.D.
Heather Moore, Ph.D.
Brenda Smtih Myles
Chief of Programs and Development,
Autism Society of America, USA
Samuel L. Odom, Ph.D.
University of North Carolina, USA
Michaelene M. Ostrosky, Ph.D.
University of Illinois at Urbana-Champaign, USA
Selda Ozdemir, Ph.D.
Manfred Pretis, Ph.D.
Social Innovative Network, (S.I.I.N.), AUSTRIA
Jean A. Rondal, Ph.D.
Université de Liège, BELGIQUE
Sarah Rule, Ph.D.
Utah State University, USA
Ugur Sak, Ph.D.
Jane Squires, Ph.D.
Armin Sohns, Ph.D.
Fachhochschule Nordhausen, University of Applied Sciences,
DEUTSCHLAND
Patricia Snyder, Ph.D.
University of Florida, USA
Gilbert Stiefel, Ph.D.
Eastern Michigan University, USA
Bulbin Sucuoglu, Ph.D.
Elif Tekin-Iftar, Ph.D.
Seyhun Topbas, Ph.D.
Yildiz Uzuner, Ed.D.
Sezgin Vuran, Ph.D.
Steve Warren, Ph.D.
University of Kansas, USA
Mehmet Yanardag, Ph.D.
Paul Yoder, Ph.D.
Stanley H. Zucker, Ph.D.
International Journal of Early Childhood Special Education (INT-JECSE) (ISSN 1308-5581) is published twice (June and
December) a year at the www.int-jecse.net.
For all issues regarding the INT-JECSE, please contact Assoc. Prof. Ibrahim H. Diken, Editor-In-Chief, INT-JECSE, Anadolu
University, Faculty of Education, Department of Special Education, Yunus Emre Campus, 26470, Eskisehir, TURKEY, Phone
#:+90-222-3350580/3545, Fax # :+90-222-3350579, E-mail : [email protected] ; [email protected]
CONTENTS
REGULAR ARTICLES
1-16
Attachment and preschool teacher: An opportunity to develop a secure base
Purificación García Sierra
17-32
Investigation of social supports for parents of children with Autism
Aaron R. Deris
32-45
Otistik Bozukluk Gösteren Çocuklarda Bir Müdahale Yaklaşımı: Su İçi Etkinlikler
An intervention approach for children with Autism: Aquatherapy
Mehmet Yanardağ & İlker Yılmaz
BOOK REVIEW
46-49
Teaching Social Communication to Children with Autism
Emre Ünlü
From the Editor,
In this issue, you will find four different types of articles:
The first article written by Purificación García Sierrais on preschool teacher and
attachment. She focus on secure attechment between preschool teachers and young
children when alteration in attachment process happens between mothers and their
young children.
The second article entitled as “investigation of social supports for parents of children
with Autism” was written by Aaron R. Deris. The author tried to identify the forms
of social support that parents of children recently diagnosed with autism perceive as
being important. Twenty parents of children recently diagnosed with autism
participated and completed a Q-sort using the forms of social support.
The third article, as invited article written by Mehmet Yanardağ and İlker Yılmaz,
introduces a new a therapeutic approach called aquatherapy.
The last article is a book review. Doctoral candidate Emre Unlu reviewed the book
titled teaching social communication to children with autism.
Looking forward to being with you in December 2012 issue.
Ibrahim H. Diken, Ph.D.
Editor-In-Chief, INT-JECSE
Attachment and preschool teacher, 1
Purificación García
Sierra 1
Attachment and preschool
teacher:
An
opportunity to develop a
secure base
Abstract
Relying on a figure that makes us feel loved, safe and protected is a basic necessity of
human beings with repercussions in all the aspects of psychological development. Early
Intervention is based on knowledge and detection of risk factors and intervention in
creating and strengthening protective factor of development. When early relationship
between mother and child is altered due to the characteristics of the child, the mother or
the context, and insecure attachment is developed, preschool teachers may become secure
attachment figures influencing all the fields of present and future development. In this
article there are some detection indicators of possible altered affective relations as well as
conduct proposals to generate secure affective connections between children and their
teachers.
Keywords: Attachment, teachers, preschool years.
Introduction
Relying on one or various figures that make us feel loved, safe and protected, is a basic
necessity of human beings (Bowlby, 1969/1980). This feeling of security (physical and
psychological) is built over the establishment of an appropriate affective bond of
attachment. The attachment connection generates from the repeated interactions between
child and mother through the first three years, it consolidates during childhood and it has
a repercussion across the life span (López, 1990, 1993, 2003; Heese & Main, 2000).
The affective relationships of attachment must be understood as a complex framework
of bidirectional relationships, to which every component of the dyad contributes with its
1
PhD., Vice-chancellor of academic affairs, UNED, National University of Distance Education, Madrid, SPAIN, E-mail:
[email protected]
International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16
.
individual characteristics and in which the context where they take place also has a
powerful influence. The characteristics of the mother2 (psychological state, pathologies,
addictions, stress or background of insecure affection), of the child (disturbances,
premature birth or temperament) and of the context (extreme deprivation or violent
environments) leads to the development of a map of risk factors for the establishment of
an secure attachment between the child and his/her attachment figure.
Early Intervention is focused on detection of risk factors and the development of
strategies for strengthening protective factors. The school, during early years, plays a
key role in the development of children at risk. The teacher’s role as a attachment figure
is essential. He/she has the capacity to create an environment of comprehension and
security where the child feels capable and loved, and his/her advances are seen as
authentic progress. He/she has the capacity in essence to become an authentic secure
base where to return to catch their breath in the difficult journey of learning and
development.
When children are immersed in relationships of insecure attachment, they build up an
image of themselves as people that don’t deserve care and protection, and tend to get
isolated or to have an aggressive behavior with other children or adults in a thirst of selfdefense. Furthermore, the evolutionary tasks appropriate to their age turn in many
occasions into insurmountable pitfalls.
Under the light of a great number of investigations, for children that due to their own
characteristics, their mothers’ or the context, have affective histories of insecure
attachment, an healthy affective relationships with the teacher during preschool can
become an important protection factor of development (e.g. Pianta, 1990 or Silver et
al.,2005).
The purpose of this article is a brief review of the literature on risk factors for the
development of a secure attachment and add some lines of work that guide the teacher in
generating secure attachments with children at risk.
This article is divided into three parts. The first is dedicated to show a brief overview of
the most common risk factors for the development of an affective bond of secure
attachment. In the second part, we will conduct a review of the investigations centered in
the study of the teacher’s role as figure of child attachment. In the third we present,
show some indicators to detect children with altered affective relationships and some
proposals of intervention for the classroom.
2
Through the article, when referring to the attachment figure as the main care-giver, we will use the term mother, following
Bowlby (1963, 1980), in the sense that is the mother who usually plays this role. However, this term also collects any other figure
that provides care and confort to the child.
.
Risk factors for a secure attachment: mother, child and context
According to Isabella (1993) the origin of the type of attachment is found in the
interactional history of the dyad. From our point of view, the affective connection of
attachment must be interpreted from a systematic and ecological perspective (in terms of
Bronfenbrenner, 1974, 2005). So: a) attachment relationships concern (at least) two
human beings that are, both, growing; b) the interactions are influenced by the
psychological and affective characteristics of the mother as well as of the child; and last,
c) the affective bond of attachment is built on a context.
The precursor of a secure attachment may generically find in emotional and affective
synchronicity between the child’s demands and the mother’s responses. This affective
synchrony has its origin in the maternal sensitivity (Ainsworth & Blear. 1978). The
concept of maternal sensitivity embraces a collection of aptitudes, attitudes and
behaviors that are summarized in the mother’s capacity to capture baby’s signs, to
adequately interpret them and to react in a reasonable and consistent way (Isabella,
Belsky & Von Eye, 1989, Cantero, 2003). Ainsworth et al. (1978), defines maternal
sensitivity around several attitudes: the first one is acceptance of the child in all the
fields and dimensions, his/her temperament and limitations. Another attitude is
cooperation and it refers to a view of the child where the adjustment between control
and affection is produced in a natural way. The mother must respect the times and
necessities of the child, in a way that does not interfere nor invade, adjusting and
keeping in step the actions with the necessities and capacities of the baby. And in third
case, a sensitive mother shows herself accessible and available when the baby requires
her attention. Last, authors point out as a fundamental attitude of sensitivity, the
maternal capacity to express her emotions and to provide an environment where the
child can express themselves freely without being judged or punished, being taken care
of without reproaches.
The children whose mothers have responded in a sensitive way and that have
consistently been accessible and available figures, present greater capacity to explore
the, are self-confident and be able to establishing healthy relationship with other adults
and in other contexts. However, not always conditions are appropriate to ensure healthy
interactions that will result in a secure attachment relationship. Since the mid-20th
century, a great part of the studies of attachment carried about early interactions, have
focused on the study of risks factors for the establishment of a healthy attachment.
One of the most investigated topics concerns with the mental states of the mother. The
mothers’ stress from their personal or contextual stories, the suffering of psychological
alterations such as depression (e.g. Main & Hesse, 1990 or Quezada & Satelices, 2009)
or a history of abuse, negligence or abandonment during their childhood (e.g. Crowell &
Feldman, 1990; Ainsworth and Eichberg, 1991 or Moore and Pepler, 2006), are
considered predictors of insensitive and inconsistent interactions. In negative emotional
situations, mothers respond inappropriately to babys’ signals (Caselles and Milner,
.
2000; Pons-Salvador, Cerezo & Bernabé, 2005 or Cerezo, Trenado & Pons-Salvador,
2006). Such responses are the result of a bad detection or interpretation of the demands,
and of the incapacity to respond in a synchronized way (Cerezo, 2001). In conclusion, to
show availability and sensitivity.
Howe (2006) points out that the theory of Attachment leaves the responsibility of the
interaction on the characteristics of the main care-giver, giving little significance to the
characteristics of the other part implied in the dyad: the baby. Some authors such as
Poehlman (2000) find a high correlation between subclinical depression, with its origin
in the birth of a premature baby, and insecure attachment. The birth of a premature child
places the mother in an emotional and psychological situation of vulnerability (greater as
the baby’s gestation is lower). To the concern and anxiety derived from the maternity
experience, the necessity of rethinking her expectations as the care-giver of a “planned”
baby is added (Ammaniti, 1989). Other stress factor for this mothers is the autoperception of incompetence to take care and protect a baby seen as more vulnerable and
needed of priority medical attention, for which the mother thinks is not ready.
Several studies (e.g. Olexa & Stern, 1999, Divitto & Goldberg, 1979 or Stern, 2000)
show how mothers of premature babies interact less synchronically than other mothers.
Due to their lack of maturity, these babies are psychologically and physically less
organized, with greater difficulties to demand and appropriately regulate their behavior
to interactions, and seen as such by their mothers (Charavel, 2000). The mothers of
premature babies, carried away by the representation of the baby as fragile and
vulnerable, tend to interfere more in their relationships or, in any case, to not read or
interpret appropriately the baby’s needs (Cantero, 2003).
Disability is another characteristic of children that is related to the quality of the
affective interactions of attachment. Children with disabilities show lower attachment
behavior (crying, babble, verbalize, search or tracking, etc.) (Atkinson et al. 1999).
Therefore, they have greater difficulties to respond in an appropriate way to the
interactions of the mother. All these difficulties are many times the synchronizing of the
interactions of the figures of attachment. Mothers are under additional stress when they
don’t understand their children’s demands so that they can’t adjust their answers
(Johnston et al. 2003), feeling more secure when acting as efficient caregivers (Sloper et
al. 2003). These mothers tend to try to “eliminate” deficiencies perceived in their
children through over-stimulation and tend to be bossier and to interfere more in their
children than the mothers of normal children, which may impact in the attachment
(Howe, 2006).
Lastly, another aspect of great study about the origin of attachment is the social contexts
of the dyad. In this sense, families (and dyads) immersed in contexts of social risk offer
an environment of development and upbringing, where affective connections are more
likely to be “troubled” or insecure. Several investigations have demonstrated that the
manifestation of hostility by the figures of attachment are more often and have greater
consequences in families with social risk. It confirms that situations such as domestic
.
violence, socio-economical problems or emotional destructuration interrupt the
conditions for the upbringing and the interactions, creating insecure attachment and
more frequently, disorganized attachment, reaching a 34% in families with socioeconomical problems and a 77% in mistreated children (e.g. Main & Solomon,1990 or
Moore & Pepler, 2006).
Do not want to conclude this section without pointing out that despite all the risk factors
that we draw (maternal psychological state, the characteristics of the child and the
context), a large number of research show that acceptance and secure attachment history
are better predictors of the type of attachment than isolated characteristics or alterations
of the child (Down Syndrome, Autism Spectrum Disorder or other physical or cognitive
deficiencies) or depredate context (e.g. Capps et al. 1994; Rutgers et al. 2004).
Meanwhile, another group of research maintained that mothers with certain mental
disturbances (e.g. the depression) display behaviors most warm and tight to their
children after a psychological intervention program (e.g. Marvin, Cooper, Hoffman &
Powell, 2002).These findings bring back the classical interpretation that was earlier
discussed, regarding the central role of the attachment figure in early affective
connection and show the importance of the mother´s sensitivity regardless of the
features of the child or the context.
Development is a complex and multidimensional phenomenon where all the fields affect
each other. From this ecological and systemic perspective, the quality of the early
interactions, the nature of attachment between children and the attachment figure is a
key element in the comprehensive development of the child and it has repercussions
throughout life.
Preterm infants, with alterations to physical or mental, children of mentally vulnerable
mothers or are born in contexts of extreme deprivation, constitute risk groups on which
early intervention are key to their development. In general, such interventions are
intended to the biological and cognitive areas. In recent decades, however, it has
increased the interest in research and early intervention on attachment and more
specifically in the study and the intervention of the role of the teacher in the
development of attachment in children at risk.
In western societies more and more children of earlier ages and especially those with
unfavorable conditions, have in the preschool classroom an allied of integral progress.
As note Gútiez (2005) the preschool classroom is an essential context of prevention and
compensation especially for children with personal or social disadvantages. This
empowerment is supported in the possibilities of an effective scaffolding, and in the
early detection and intervention of the professionals of Primary Education. These
enabling actions of development can only be carried out by the figure of an adult: the
teacher, who becomes a referential point to learn and advance, not only in the cognitive
field but also socially and affectively.
.
Child’s attachment to the preschool teacher
Bowlby’s assumptions (1969) about the idea subsidiary figures of attachment, underlies
in the notion of Attachment Net (e.g. Thompson, 1999, van Ijzendoor, Sagi and
Lambernonn, 1992). This such Net refers to an emotional and affective framework
whose center is the mother or the main care-giver but that shares space with other
figures that are emotionally relevant for the child, specially those with whom he can
constantly interact in time and space. These figures, despite the characteristics of
intensity and interactions that are contextually different to those that take place in the
didactic and familiar context, also follow a role to provide care and affection with the
idea to provide physical and emotional security to the child.
In this sense, Crosnoe et al. (2004) and Levitt (2005) suggest that in these affective
structures, children establish a hierarchy that represents the degree of proximity and
emotional implication with the people that form this such Net. It not only contains the
parents and family, but what really matters to us, the teachers (Kobak, Rosenthal &
Servick, 2005).
Following this idea, van Ijzendoorn et al. (1992), conducted a research with children
among the ages 3 and 5, with the objective to compare their behaviors with a stranger
and with their teachers using the strategy of the Strange Situation. The conclusions of
the work show that there is a different behavior of the children with both figures,
showing attachment with the teacher, whom they approached and asked for help or
comfort.
An interesting study that follows this line is conducted by Howes and Ritchie (1999).
The authors analyzed the behavior of children among the ages 3 and 5 in their daily
activities and their interactions with their teacher. Looking at their attitudes and
behaviors, the authors classify affective relationships with teachers in three groups; a
classification that follows the main patterns of basic attachment. They are the following:
A group of children show conduct of physical and emotional contact with the teacher.
They grab and hug the teacher, and accept his/her caresses, games or talks he/she
proposes. At the same time, they can go away to play with the objects and the other
children without any problem to participate in activities and to show empathy. When
they feel disconcerted they look for the teacher’s company and comfort. They
adequately manage their frustrations. They are usually happy. They react easily and
quickly to the teacher’s demands and if he/she lies to them, they adapt their behavior to
what is required. They show interest and curiosity for their classmates, toys and new
tasks. These children are considered Secure children with respect to the connection with
their teacher.
Another group of children are constantly distracted. They rarely establish contact with
the teacher and their behavior is focused on the objects in the surrounding. When the
teacher calls them, they ignore her or slowly move closer, running away quickly to
continue playing by themselves. They never ask the teacher for help with complex tasks
.
or difficult situations. In this last case, when the teacher approaches them they reject
his/her comfort and look indifferent. They are cold and distant with other children. They
are classified as Evitative Insecure Attachment.
A third group of children that falls under the category of Resistant Insecure Attachment
towards the teacher, shows an emotional state of irritability and anger. This anger has its
center on the teacher even if he/she is not interacting with the child. These children are
easily frightened and in constant alert with the teacher, other children or any other
happening in their surrounding (noise, movement, etc.), causing them to cry. The
teacher’s strategies to comfort them show no result, however their demand of attention is
constant. They are impatient and they are rough or hostile without any notice.
In a generic conclusion, we can point out that children with insecure attachment are
irritable or isolate themselves, making demands that are incoherent and not synchronized
with external events. In this occasions, the teacher has greater difficulties to understand
these demands and interact with the children efficiently, since in many cases they feel
their comforting or scaffolding efforts to be rejected. As we know, some individual
characteristics of children or those who live in altered contexts (mental vulnerability of
parents, domestic violence or extreme deprivation) have a greater probability to generate
insecure attachment.
A secure affective relationship with the teacher may whether restructure the relationship
with the attachment figure or build a psychological and affective space to compensate,
where he/she can feel secure and confident. Looking at this premise, a secure
relationship with the teacher becomes a protective factor for children with insecure
attachment or with risk of suffering it (e.g. Howes, 1999; Carrillo et al., 2004 or
Maldonado & Carrillo, 2006). This protection has ramifications in very diverse aspects
of the child’s life. In one hand, children with secure attachment with their Primary
School teachers are more sociable, cooperative and have empathy with children and
teachers in other levels and educative strata (Rosenfeld, Richman & Bowen, 2000 or
Crosnoe, Johnson & Elder, 2004), reducing behavioral problems and socio-economical
competition (e.g. Kidwell et al. 2010), and increasing the degree of adjustment to the
surrounding and the school tasks (Howes & Ritchie, 2002, Davis & Dupper, 2004 or
Silver et al. 2005).
In the school as well as in the house, the construction or the affective connection of
attachment is a complex framework of mutual interactions and perceptions. Children
with secure attachment show, as we have seen, more attention and success with the
tasks, a more coherent and empathic behavior and a greater aptitude for warm and steady
affective relationships between themselves and the teacher, and other children. Their
demands are coherent with the circumstances, their tone is adequate and their reactions
to other children’s and the teacher’s responses are consistent and expected. This leads
teachers to a better and more adjusted interpretation of the demands and reactions of the
child, to feel satisfied with the cognitive and affective achievements of the child, and
therefore, to generate more spontaneous interactions with more frequency, better quality
.
and duration. Nonetheless, just like in any other didactic relationship, the characteristics
of the teacher play an essential role. The teachers that don’t properly interpret the needs
and demands of children, that are or look insensitive and that don’t answer in a
synchronized and contingent way to children’s demands tend to establish relationships
of insecure attachment very similar to the constructing process of the affective
relationship of the child with his/her primary attachment figure. In the other hand,
characteristics such as sensitivity, receptivity and personal involvement have a
prominent role in the establishment of this type of relationship (Howes & Ritchie, 2002)
even when the characteristics or initial circumstances of the child are adverse. Barret and
Trevitt (1991) consider the figure of the teacher as attachment figure to be especially
important for children with insecure attachment for their role to guide and order an
affective world that is unsettled, blurry and uncertain. At the same time, just like the first
relationships between mother and child generate internal models of the relationship,
early experiences with the teacher as attachment figure will generate a relationship
model too. Such models contain the representation once again of the child as a
competent being for learning in all the fields (curricular, skills, affective and social).
They also contain ideas about the sensitivity and availability of the teacher for his/her
demands. They also differentiate inferences between the emotion and the affection
created in the teacher. At last, these internal models are once again guides to interpret
context and future teachers. This way, there is a tendency to maintain the style of
affective relationship with teachers in later stages in life and the attitudes towards school
context, all its elements and agents (e.g. Howes et al. 2000).
How to generate secure attachment at preschool classroom: Some proposals
When the teacher becomes part of the emotional and affective net of the child, this
already has or (depending on the age of the child) is building an affective connection
with the mother. Researchers show contradictory results. While some authors find that
children with insecure attachment with their mothers tend to establish insecure affective
relationships with their teachers during Preschool (O`Connor & Kathleen, 2006; DiazAguado & Martinez Arias, 2006), others studies find only a moderate relationship
between styles of attachment in children with their mothers and the patterns of
attachment generated with the teachers (e.g. van Ijzendoorn, 1990 or Cugman, 2007). At
last, an important group of researchers find that while children with secure attachment
with their mothers generate secure attachments with their teachers, more than half of the
children with insecure attachment with their main care-givers generate secure
attachments with their teachers when they are approachable and sensitive (e.g. Silver et
al. 2005; Howes & Hamilton, 1992; Goossens & van Ijzerdoorn, 1990). These findings
confirm Bowlby’s proposals (1980) and more recently Crittenden’s (2002) who says it is
possible to generate new healthy attachment relationships or even reshape an insecure
internal model.
Therefore, in one hand the children that have generated insecure attachments with their
mothers can also generate secure ones with their teachers. And in another hand, a
.
relationship of security with the teacher has better psychological and academic results
from early ages. It seems essential that teachers have among their priorities the
construction of a good affective connection based on attitudes and behaviors of
sensitivity and warmth, especially with children that have personal or social
disadvantages (Bergin & Bergin, 2009).
From our point of view, the teacher’s knowledge of how the emotional and affective
development is produced and how it is influenced by altered circumstances is an
essential formative element that would ease in greater manner the detection and
comprehension of child progress. Other indicators can be useful to find children that
already have a difficult affective relationship or that show high risk of creating it with
his/her attachment figures. They are the following:
•
•
•
Know the personal and social history of the child. It will give essential information
about his/her individual and social situation. We know that children with
alterations or pathologies, or that live in very deprived social environments or are
socially rejected, have a higher risk to generate insecure attachments with their
usual care-givers.
Through a collaborative work with other professional of early attention, have a
clear knowledge of the pathology or the child alteration, his/her evolution as well
as the repercussions in all areas of development and learning. From this
knowledge we will have a fair comprehension of the affectation of the child to be
able to deliver or interpret affective and social indicators, routines and demands of
the surroundings.
Observe the patterns of affective behavior towards the attachment figure in daily
situations. In many occasions we have the opportunity to take part of the
interactions between the child and his/her attachment figure. It is obviously not a
diagnosis, but to keep in mind indications that with other signs let us sketch an
overview of the affective relationships among them. Situations such as
separations, reunions, and chatting moments with the teacher or tutoring can
provide valuable information to visualize some features of the relationship.
Some behaviors and attitudes of the child with the teacher can also be useful as signs of
insecure affective history and became a risk to be perpetual with the teacher in the
classroom. Regarding the didactic interactions with the child, the teacher must be able to
appropriately interpret the affective demands of the child. The characteristic behaviors
of these children are the hostility and indifference as a characteristic of the relationships
with the teacher, the shortage, non-existence or rejection of the physical/verbal/ocular
contact, the excessive or too scarce demands, the tendency to be isolated, lonely or little
active. They also show tendency to avoid the teacher as a protective and comfort figure.
Similarly, indicators of potential affective problems are the controversial interactions
with others due to excess (children with violent or hostile behaviors) or shortcomings
and isolated children from the environment, children and teacher.
.
Regarding the tasks, the fact that the child is never interested in a task or game, that
never or very rarely feels attracted by something or that his/her behavior shows low selfesteem, distrust or fear to be frustrated even in the easiest tasks, gives us information
about his/her view of him/herself as someone incapable and frightened to make
mistakes, probably foreseeing negative consequences to his/her acts. We must also
worry about the child that compulsively introduces actions and challenges. Children that
try to challenge themselves and others with tasks above their possibilities an aptitude,
constantly looking for the teacher’s approval and to compete among peers. These
children are permanently demanding, calling for attention and not doubting to transgress
rules or to use dangerous behaviors with the aim to be accepted and appreciated.
The ability to detect the affective configuration of the relationship between the child and
the mother is fundamental because as we have seen, the teacher may be a compensatory
or reaffirming figure of the altered process of the child, having repercussions not only in
the present but also in the future in his/her integral development.
The crucial role of the teacher with children that show in a general and consistent way
one or all of the behaviors and attitudes mentioned here, is to revert to this process as
long as it is possible. In essence, the sensibility, acceptance, accessibility, availability
and cooperation that we have emphasized as precursors of a secure affective relationship
between mother and child, are the same than the characteristics that define the affective
interactions and relationships between teacher and child. The coherence, the consistency
of the answers of the teacher and the productivity are once again the elements to make a
foundation of a good affective relationship.
We can summarize some recommendations for action with children with insecure
attachments or at risk of suffering.
-
-
One of the keys to the teacher’s intervention is the certainty that theses children
need to feel loved and secure, although their behaviors seem to indicate
otherwise. They are extremely vulnerable and dependent on the affection of an
adult. That is why it is essential that the teacher openly shows his/her attention
and tends to get closer physically (physical, ocular, verbal contact...) and
emotionally, even if he/she is rejected or ignored, because we know children
have learned to show hostility and lack of enthusiasm as a form of protection.
These children need to reshape a model where he/she wasn’t taken care of or the
responses were cold or even hostile. These children must understand and learn
through warm contact.
Understanding of the feelings, emotions and behaviors of the child from his
personal and social history is essential, as well as to turn the classroom into a
place of emotional learning. Children with alterations or altered contexts of
upbringing have problems to determine their emotions and link them to the
events, as well as to express them and of course to do it effectively. For this
reason, is essential the teacher´s ability to understand the social and emotional
behavior of the child in context and provide reconnaissance of the situation and
.
•
•
•
•
the labeling of the emotions and the events that cause them. Although the
emotional comprehension is an developmental task (Harris, 1989), when some
factors don’t favor the appropriate interpretation of the emotions and the
emotional adjustment, children have more difficulties to be emotionally
competent (Saarni, Mumme & Campos, 1998).
Children with insecure attachment don’t clearly understand the clues of
cooperative and combined tasks. These must be scaffolded by the teacher in a
way that the child doesn’t interpret it as a competition for the approval and the
praise of the teacher.
As a consequence to the non-existence or the deprivation of their security,
children with insecure attachments tend to be very alert to dissonances between
emotional messages in private and in public in respect to them. It is important to
find coherence between the emotions and the feelings that the child gets from the
teacher in private, as a result of daily interactions, and those transferred to other
adults, with special relevance to the parents. The disagreement can commit the
confidence in the teacher.
The physical environment must be able to provide physical and emotional
security with simple and approachable areas, predictable activities and coherent
and consistent routines to help them reshape their behavior.
-Finally, developmental calendars and also acquisition and referential calendars
in children with alterations or at risk are much more diversified than in normative
populations. That is true also for children with a very disturbed or disturbing
emotional history. This is why it is important that the expectations on the child
are fair and the demands are therefore coherent and adjusted in time. In many
occasions these children need simple tasks (even when these are under the
expected level and performance) to be accompanied and scaffold. And in this
case, is very important to strengthen successes and capabilities even if the child’s
answer looks indifferent.
Intervention at school, as any other context of early intervention, requires a
multidisciplinary approach. Likewise, detection and early intervention in school requires
the participation of the significant figures of the various contexts of development:
teachers and family. The involvement and coordination of all educational and social
actors is essential. It is necessary to create and implement protocols for the detection and
intervention and school in the area of attachment.
Conclusion
The need of affection and protection is, according to Bowlby’s proposal (and from that
moment it is accepted as such) as primary as the need for food or physical care. The
attachment is a dyadic construction between children and a specific figure with provides
protection and safety. It is based on the mother tight and consistent response to the
demands of the baby, in other words, on the sensitivity. A secure emotional base is a
protective factor of development throughout the life cycle.
.
Early Intervention is based on knowledge and detection of risk factors and intervention
in creating and strengthening protective factor of development. Preterm infants, children
of mentally vulnerable mothers or children with disabilities must be understood as risk
populations in the field of affective bonding attachment. These children are more likely
to generate insecure attachments with their mothers. The school can become a safe
environment and the teacher in an attachment figure that allows to build new
development opportunities. Like Pianta and LaParo (2003) note, the establishment of a
positive relationship between child and teacher must be seen as a key aspect when
evaluating the quality of an educative program.
.
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Investigation of social supports, 17
Aaron R. Deris1
Investigation of social
supports for parents of
children with Autism
Abstract
There has been an increase of children being identified with autism in the United
States (Center for Disease Control, 2009), leading to an increased concern of how to
best meet the needs of children with autism and their families. In response to each
reauthorization of the Individuals with Disabilities in Education Act (2004), in which
the roles of families have been strengthened in planning their child’s education and
professionals have had more input, the field has tried to uncover the ‘best’ ways to
support parents. Recommended practice suggests that parents are best able to identify
their own support needs, with assistance from professionals in identifying supports to
assist with these needs (Murray et al., 2007). The focus of this study was to identify the
forms of social support that parents of children recently diagnosed with autism
perceive as being important. Twenty parents of children recently diagnosed with
autism participated in this study. These parents completed a Q-sort using the forms of
social support, which allowed for a ranking from “most” to “least” important.
Statistically significant correlations were found on five support items. Factor analysis
was conducted to explore groups of participants with similar rankings of the Q sort
items.
Keywords: Social Support, Q sort, Autism
Overview
According to the Center for Disease Control and Prevetion in the US the prevalence of
Autism Spectrum Disorder (ASD) is an approximate average of one child in every 88.
The American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-IVTR, 2000) includes in its classification of Autism Spectrum Disorders the related
diagnosis of autistic disorder, Asperger’s disorder, and pervasive developmental
1
PhD, Department of Educational Studies, Elementary and Early Childhood Education, Minnesota State University, Mankato, MN,
International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31.
disorder-not otherwise specified. For clarity and consistency, and unless otherwise
stated, the term “autism” will be used throughout this paper to refer to those three
disorders. Autism represents a spectrum of behaviorally defined conditions that are
diagnosed by professionals using the DSM-IV-TR through clinical observation of
development.
Children who have autism are mandated to receive services through the Individuals with
Disabilities Education Improvement Act ([IDEA], 2004). Legislation includes families
as critical partners in the education of the child. Support for the family’s emotional,
physical, and educational needs has become an area of primary importance in programs,
which address the ongoing needs of the child ((Murray et al., 2007; Staley-Gane, Flynn,
Neitzel, Cronister, & Hagerman, 1996; Turnbull, Turnbull, Erwin, & Soodak, 2010).
Support for families, including families of children with autism, should address the
concerns, priorities, and resources of the family.
Social support is defined as being multidimensional, comprised of both ‘emotional’
(e.g., affection, sympathy and understanding, acceptance, and esteem from others) and
‘instrumental’ (e.g., goods, services, and information) functions that aid in mediating
stress and dealing with day-to-day interactions (Dunst, Trivette, & Cross, 1986; Flynn,
1990; Krahn, 1993; Meadan, Halle, & Ebata, 2010; Valentine, 1993). The functioning
of parents and child is enhanced when families receive the aid and assistance that match
their identified needs and priorities (Dunst, Trivette, & Hambry, 2007; Trivette & Dunst,
1987). Both emotional and instrumental supports have been linked to reducing stress
and improving the functioning and well-being of family members. Only families can
identify the type of support that is important to them. Research underscores the
importance of families’ having choices and decision-making opportunities about issues
concerning their child and family (Allen & Petr, 1996; Trivette, Dunst, & Hamby,
2010); however, the professionals who often guide parents along this path do not receive
training on deferring their own personal values (Murray & Mandel, 2004).
One of the first scales developed to document family support, The Inventory of Socially
Supportive Behaviors ([ISSB] Barrera & Ainlay, 1983) suggests that the extent to which
particular supports are considered important and the perceived satisfaction of recipients
of those supports are key to assessing the efficacy of supports for families of young
children with disabilities, including autism. Thus, family’s perspectives on the
importance of support and their subsequent satisfaction with those supports should be
the standard against which professionals measure their intervention behaviors.
Professionals (i.e., teachers, therapists, and medical personnel) who understand the
needs of families of children diagnosed with autism are better able to assist families in
accessing the supports that will be most beneficial to the child and family (Croen,
Grether, Hoogstrate, & Selvin, 2002; Gillberg, Cederlund, Lamberg, & Zeijlon, 2006;
Fombonne, 2003).
The purpose of this study was to identify the social supports that fathers and mothers of
young children recently diagnosed with autism perceive as important. This study
extends the literature by comparing the identified importance of specific support items
of fathers versus mothers and with a population of families whose child had been
recently diagnosed (within an 18-month period).
Method
Participants
Twenty parents consisting of mother-father dyads served as participants in the study.
Inclusion criteria for parent participation were: (1) child’s diagnosis of autism was
within the last 18 months, and (2) child was between the ages of three and five years old
at the time of data collection. Parents were recruited through advertisement in an Autism
Society newsletter, flyers at clinics and conferences, and flyers distributed by regional
special education coordinators across the state.
Demographic data was obtained including parent information (age and marital status)
child information (age, gender, age at diagnosis, and diagnosis), and sibling data
(gender, age, and diagnosis, when applicable). On average, both parents were in their
mid-30s (fathers M =37 years, range, 29 - 54 years old; mothers M =35 years, range, 24
to 52 years old). All couples were married with the exception of one that was divorced.
Children ranged in age from 3 years 1 month to 5 years 4 months (M =4 years 1 month)
comprised the children with autism (15 boys and 5 girls). The specific diagnoses varied
with 12 children being diagnosed with autism, 1 child with Asperger’s syndrome, and 7
children with pervasive developmental disorder- not otherwise specified. The children
were all formally diagnosed through qualified professional individuals or teams utilizing
the criteria set forth by the DSM-IV-TR. The length of time for being diagnosed ranged
from one month to 18 months (M =10.7 months).
Socioeconomic status was determined for each couple by using the Hollingshead Two
Factor of Social Position (Hollingshead & Redlich, 1958). Hollingshead is an accepted
research index to determine social economic status of individuals and families (Miller,
2002). Social position is assigned by occupation and education in the Hollingshead
index. There are five social class categories in the Hollingshead, ‘I’ being the highest
social class and ‘V’ being the lowest social class. Three families were in the highest
social class, 13 families in the second social class, three families in the third social class
and one family in the fourth social class. Thus, the majority of families were in the upper
middle social class. Broken down by income and education, the majority of families had
an income that was above $60,000 and almost all families had at least one parent with
some university education beyond high school.
Design and Instrumentation
The Q-methodology or Q-sort was used to gather data (Stephenson, 1953). The Q-sort is
a ranking procedure used to identify an individual’s subjectivity or personal point of
view on a subject with the capability of quantitative analysis (McKeown & Thomas,
1988). The Q-sort consists of sorting items into categories using a Likert-type scale.
This technique is a forced-choice method where individuals completing the sort must
place a specific number of items within columns. Ranking allows for comparison of
items that may otherwise be seen as very similar or ranked similarly in importance
(Stephenson, 1953).
A modified version of the copyrighted set of items from Flynn and Staley-Gane (1997)
were used in this study (See Table 1). A literature review was conducted in order to
determine new items that might be added to the Q-set from an extensive review of the
literature on social supports for families of children with disabilities, perusal of social
support family surveys (Bailey & Simeonsson, 1990; Dunst, Cooper, Weeldreyer,
Snyder, & Chase, 1988; Park, Hoffman, Marquis, Turnbull, Poston, Mannan, Wang, &
Nelson, 2003) and previous research (Flynn, 1990; Staley-Gane et al., 1996). No new
social support items were added; only the wording a few items was modified to reflect
current language.
The Q-set for this study was composed of 16 support items (modified from Flynn &
Stately-Gane, 1997). The Q-set contained emotional (e.g., a friend to talk to about my
concerns, a professional psychologist, involvement with a church) and instrumental
(e.g., information, special equipment, financial assistance, educational services) support
items (Flynn, 1990; Krahn, 1993; Unger & Powell, 1980), as identified in the previous
tool.
Procedures
Q-Sort. The family’s home was used as the location for data collection to make this
process as convenient and comfortable for the parents as possible. Data was collected
simultaneously from both parents; mothers and fathers were asked to separately rank Qsort items. Parents and the investigator were seated so that only the investigator could
see both of the Q-sorts. Parents could not see each other’s responses and, therefore, were
not influenced by one another. Parents were not previously known to the researcher and,
thus, were thought to not be influenced by his presence.
Parents were instructed on the Q-sort procedure by the first author, who served as the
primary investigator. Parents were given a Q-sort board with predetermined squares
labeled “least to most”. A set of 16 cards with one item written on each card was given
to each parent. Parents were given step-by-step instructions (Appendix A) on how to
complete the sorting procedure. Their responses were recorded by the primary
investigator. Upon completion of the Q-sort, parents were asked if anyone or anything
was missing from the set of items. Responses were recorded verbatim by the primary
investigator.
Analysis
Descriptive and inferential statistics were used to analyze the data. Correlations were
conducted to determine if fathers and mothers ranked the items similarly. A factor
analysis was conducted to identify groups of participants with similar rankings of the Qsort.
Results
Results of the Q-sort completed by fathers and mothers of children recently diagnosed
with autism were calculated. Parent’s responses in each column were assigned weighted
values (-3 through 3) and the data was analyzed. Support Items for Both Parents.
Descriptive statistics (M and SD) were calculated for each support item 1 through 16 for
couples (see Table 1). Overall, the support item identified as “most” important by both
parents was “information on how I can help my child” (M = 1.93, SD = 1.20). Two
additional items were identified as “very important” for both parents were “involvement
with early intervention (infant and toddler), preschool or school program” (M = 1.23, SD
= 1.31) and “information about my child’s future” (M = .70, SD = 1.18). The support
item identified as least important was “help with child or respite care” (M = -2.25, SD =
1.37). Two additional items identified as “not being as important” for both parents were
“help with transportation” (M = -1.98, SD = .947) and “help with independent living
skills” (M = -1.17, SD = 1.39).
Table 1
Descriptive Statistics for Each Support Item for Couples
Support Item
Information on how I can help my child
M
1.93
SD
1.20
1.23
1.31
Information about my child’s future
.70
1.18
Financial help for expenses
.66
.56
Relaxing and fun activities for my child and family
.23
1.10
Information about my child’s condition or disability
.58
1.13
Contact with other parent(s) who experienced the same situation
.48
1.24
-.10
1.47
.03
1.18
-2.25
1.37
Participation in an organized parent support group
-.23
1.08
Involvement with a church or strong religious beliefs
-.95
1.55
A close friend or family member to talk to about my concerns
-.40
1.27
Special equipment to help meet my child’s needs
-.75
1.56
Help with independent living skills
-1.17
1.39
Help with transportation
-1.98
.95
Involvement with early intervention (infant & toddler), preschool or school
program
Counseling with a professional person
Discussions with medical people
Help with child care or respite care
Correlations between both parents were calculated to examine the relationships between
them to examine similarities in rankings among couples (see Table 2). Correlations
ranged from a high of .73 to a low of .06 with five statements being statistically
significant. The statistically significantly correlations statements included “special
equipment to help meet my child’s needs”, “involvement with church or strong religious
beliefs”, “information on how I can help my child”, “financial help for expenses”, and
“participation in an organized parent support group.”
Table 2
Correlations for Couples for Support Items
Support Item
Involvement with a church or strong religious beliefs
.730**
.534*
.491*
Participation in an organized parent support group
.490*
.440*
Contact with other parent(s) who experienced the same situation
.443
.365
.356
Involvement with early intervention (infant & toddler), preschool or school program
.344
A close friend or family member to talk to about my concerns
.282
.282
-.251
Information about my child’s condition or disability
-.162
Relaxing and fun activities for my child and family
.154
-.127
.064
*p < .05, **p < .01
Inferential Statistics
Factor Analysis An exploratory factor analysis was performed using Principal
Components analysis (PCA). These solutions were rotated using Varimax procedure
and examined interpretability and parsimony. A decision was made to look at all
participants as individuals and not in terms of couples because only five items were
found to be significantly correlated for the couples (see Table 2).
Inspection of the Scree plot obtained from the factor analysis indicated that solutions
with three or four factor were possible to explain the variables in the instrument. The
three-factor solution was selected as the one that was most interpretable and
conceptually sound. Approximately 44% of the variance was explained by this threefactor solution.
Table 3
Factor Scores for Each Support Statement
Support Statement
Factor 1
A close friend or family member to
talk to about my concerns
Factor 2
.435
.550
-.563
religious
Relaxing and fun activities for my child
and family
.667
.597
-.505
Involvement with early intervention (infant
and toddler), preschool or school program
Involvement with a church or strong
beliefs
Factor 3
.712
-.687
Information about my child’s condition or
disability
.498
Participation in an organized parent
support group
.706
-.666
.595
-.425
Contact with other parent(s) who
experienced the same situation
.521
-.481
.460
-.508
Factor one relationship items included “involvement with early intervention (infant and
toddler), preschool or school program,” “special equipment to help meet my child’s
needs,” “financial help for expenses,” “counseling with a professional person,”
“participation in an organized parent support group,” “contact with other parent(s) who
experienced the same situation.” Factor two external resources included “information on
how I can help my child,” “help with transportation,” “information about my child’s
future,” and “help with child care or respite care.” Factor three services included “a
close friend or family member to talk to about my concerns,” “discussions with medical
people,” “relaxing and fun activities for my child and family,” and “help with
independent living skills.”
Discussion
The purpose of this study was to examine the “most and least” important social supports
of mothers and fathers of children recently diagnosed with autism. Q-sort, the data
collection technique, gave a clear indication about the importance of support items as
indicated by the ranking decisions made by parents. The following sections will discuss
the support items ranked as most important, least important, additional support items
identified through the Q-sort method, limitations of the current study, clinical
implications, and future research.
Support Items Identified as Most Important
The top three support items ranked as most important by all participants were those in
the category of instrumental supports (two were information needs and one was
preschool services). When a child has a disability such as autism, parents may feel that
‘information is power.’ Information about how parents can help their child may give
them the knowledge and skills they feel are necessary to support their child to be
successful. Previous research supports parents’ need for information to better help their
child (Keen, Couzens, Muspratt, Rodger, 2010; Whitaker, 2002). Information about the
child’s future outcomes or prognosis may be particularly salient for parents of children
with autism because, currently, several treatment plans claim that a child’s autistic
behaviors may be significantly modified if a particular treatment is followed (Erba,
2000, National Professional Development Center on Autism Spectrum Disorders, 2009).
In other words, some parents may be looking for a “fix.”
Along with support items about information, both parents reported “involvement with
early intervention (infant and toddler), preschool or school program” as one of the top
three supports, which is similar to other recent findings (Twoy, Connolly, & Novak,
2007). All of these families had children that were either in the birth-to-three system or
preschool program. Parents may have found that these services for their child were
especially useful and, thus, very important in the months following their child’s initial
diagnosis.
“Help with finances” was also reported by these parents as an important support. Even
though most of the parents reported an annual income of over $60,000, they still
identified help with finances as a need. Raising a child with autism is expensive. In
particular, the cost of therapy that is frequently recommended may be high (Feinberg &
Vacca, 2000; Jacobson, Mulick, & Green, 1998, Sharpe & Baker, 2007). Regardless of
level of income and/or insurance options, raising a child with autism takes a financial
toll on families (Jarbrink, Fombonne, & Knapp, 2003, Sharpe & Baker, 2007).
Support Items Identified as Least Important
The support item identified as “least” important by both fathers and mothers was “help
with child care or respite care.” Possible explanations of this finding could be that none
of the participants were in Hollingshead’s lowest social class, which may indicate that
they had resources to provide for child care. Additionally, mothers may have felt that
they were the primary caregiver for their child, and therefore, the best person to provide
proper care and attention for their young child.
“Involvement with church or strong religious beliefs” was also rated as ‘least important’
by parents. Some previous researchers of families of children with disabilities (Crowley
& Taylor, 1994; Tarakeshwar & Pargament, 2001; Valentine, 1993) reported that
religion or spirituality (Schumacher & Bauer, 2010) was an important support. However,
other studies (Jones, Angelo, & Kokoska, 1998; Flynn, 1990) found that parents of
children with disabilities reported church members or strong religious beliefs as not
important as a support priority. This may be attributed to cultural differences between
groups sampled.
“Help with independent living skills” was identified by parents in this sample as ‘least
important’. Although parents of recently diagnosed children reported being concerned
about their child’s future, this support need may have been perceived to be something
they would need when their child becomes a young adult. These children were all
between the ages of three and five and, perhaps, more age appropriate developmental
milestones such as talking and playing with other children were more critical to these
families than independent living skills (Koegel et al., 1992). This finding is in contrast to
a finding by Pisula (2007) who reported that mothers were most concerned with their
child’s dependence on the care of others.
Other Supports Identified by Participants
The support items that participants identified as lacking or missing from the available
supports in the Q-sort can be found in Appendix B. These items were generally very
specific needs unique to the particular participant. For example, “information about
specialty schools past early intervention” and “information on helping children adjust to
a missing parent in the home” were both listed as support items that were missing from
the Q-sort. Other items identified as missing could be interpreted as items that were
contained already in other support items in the Q-sort in broader terms. For example,
“financial help that does not tie into my income or disqualify my child because of it”
would be a part of the “financial help for my expenses.” Overall, a recurring theme of
additional support item was not supported by the parents in this sample.
Clinical Implications
Factor analysis revealed that sampled support items clustered into three groups;
however, clustered groups did not appear to be conceptually related within each cluster.
Previous literature (House, 1981) has identified support items into the categories of
instrumental, informational and emotional. It is assumed that a larger sample may yield a
more conceptually cohesive clustering of support items. However, it is important to note
that practitioners should attend to the different dimensions of support by which families
of children with identified special needs may benefit.
Limitations of the Current Study
The results of this study are from a small number of fathers and mothers of children
recently diagnosed with autism from a limited geographical area. The majority of the
participants in the study were from a higher social economic class, which may have
impacted the supports identified by participants.
Recommendations for Future Research
This study examined the perceived importance of supports of fathers and mothers of
children recently diagnosed with autism. Future research of parents of recently
diagnosed children should include families from a wider variety of income and
education levels, as these groups may rank support items differently.
Past research (Staley-Gane et al., 1996) has found that the length of time a child was
diagnosed with Fragile X influenced parents’ needs and needs varied over time.
Researchers (Gray, 2006; Krahn, 1993) have cited the need for longitudinal research to
determine the changing supports desired by parents of children with disabilities.
Previous research was conducted primarily with mothers rather than fathers (Meadan et
al., 2010). Support priorities of both parents needs to be conducted to ensure that both
perspectives are gathered. Additional studies comparing mothers and fathers are needed,
especially mothers and fathers in the same family.
Future studies examining the relationship between the exact diagnosis (i.e., autism,
PDD-NOS, Asperger’s syndrome) and types of support identified as important would
add to the knowledge base of families of children with an Autism Spectrum Disorder.
Summary
The focus of this study was to identify the social support that fathers and mothers of
young children recently diagnosed with autism perceive as being important. Twenty
families completed a Q-sort, which allowed for a ranking of support items that indicated
the perceptions of support priorities of families. It is crucial to ‘family-centered’
practices that families of children with disabilities are allowed to identify their own
priorities. By allowing the families to identify their priorities and needs, service
providers will be able to better support these families in the delivery of services.
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Appendix A
Directions for completing the Q sort
Step 1: Take out the 16 cards and read each one. After reading the cards take out the six
cards you feel are the most important to you and your family. Place the ten remaining
cards to the left side of the board.
Step 2: From the six cards you feel are most important, take out the three cards you feel
are most important out of these six. Place the three cards you didn’t choose on the right
side of the board.
Step 3: Now from the three you chose, take out the one you feel is the most important.
Place the one card you chose into the blue column labeled most. Place the two other
cards in the two orange columns. Now take the cards you placed on your right and place
those in the three pink columns.
Step 4: Take the remaining cards you placed on the left side of the board and read each
one. After reading the cards, take out the six you feel are the least important to you and
your family. Place the four cards you didn’t choose at the top of the board. Place the
one card you chose into the yellow column labeled least. Place the two other cards in the
two green columns. Now take the cards you placed at the left side of the board and place
these in the three red columns.
Step 5: From the six cards you feel are least important, take out the three cards you feel
are least important out of these six. Place the three cards you didn’t choose on the left
side of the board.
Step 6: Now from the three you are holding, take out the one you feel is least important.
Place the one card you chose into the yellow column labeled least. Place the two other
cards in the two green columns. Now take the cards you placed at the left side of the
board and place these in the three red columns.
Step 7: Take the cards that you placed at the top of the board and place those in the four
middle purple columns. Look at all of the cards and make sure you have placed them
correctly.
Step 8: If there was something missing from or not included in the support items that
should have been included, please write it on this note card. (additional support items
identified by parents were recorded, see Appendix B).
Step 9: Now, turn the items over that you do not have or have not been available to you.
Appendix B
Additional Support Items identified by Parents as Missing
o Information about specialty schools past early intervention.
o Information on helping children adjust to a missing parent in the home.
o Financial help that does not tie into my income or disqualify my child because of it.
o Physical and alternative therapy.
o There is a gap between diagnosis and pediatric reviews
o A list of organizations who take kids with special needs (Autism), e.g., karate, dance,
swim, etc.
o A church where I can go with my autistic son.
o Taking part in field trips with children and families with the same condition
(autism).
o Balance time with child with autism and typically developing child.
o Therapy for interventions, such as eye contact.
o Alternate speech communication partners for child to give parents a break.
o Education professional who could refer a student who could come to our home to
offer services.
o More available schooling options for my child.
o Earlier evaluation by school system to give more time to make a decision moving
forward.
o A list of providers of Autism services in my community.
o Special instruction for pediatricians on the new science of autism.
o No pre-school ABA program in the parish.
o More information on adults with autism.
A broader explanation of all services available to my child’s diagnosis; not simply what
is available in our parish.
Otistik Bozukluk ve su içi etkinlikler, 32
H
Mehmet Yanardağ1
İlker Yılmaz2
Otistik Bozukluk
Gösteren Çocuklarda Bir
Müdahale Yaklaşımı:
Su İçi Etkinlikler
Özet
Otistik bozukluk, yaşamın ilk üç yılında ortaya çıkan, iletişim ve sosyal etkileşim
sorunları, sınırlı/yinelenen ilgi ve davranışlarla karakterize bir gelişimsel
bozukluktur. Otistik bozukluk teşhis ölçütü, duyu, algı ve motor becerileri kapsayan
sınırlılıklar içermemesine rağmen yapılan çalışmalar ve gözlemler, otistik bozukluk
tanısı almış bazı çocukların motor gelişiminde gecikmeler, fiziksel performans ve
aktivite düzeylerinde düşüklük, duyusal uyarılara tepki süreçlerinde otistik
bozukluk göstermeyen çocuklara göre farklılıklar bulunduğunu göstermiştir.
Alanyazında, su içi etkinlikler çocuklarda fiziksel performansı arttırma, duyusal
tepkileri düzenleme ve sosyal etkileşimi sağlamada bir müdahale yaklaşımı olarak
kullanılmaktadır. Ancak, bu yararlı etkilere rağmen, otistik bozukluk gösteren
çocuklarda su içi etkinliklere yeterince yer verilmemekte ve uygulanması
konusunda aileler, öğretmenler ve diğer uzmanlarca bazı sorunlar yaşandığı
gözlenmektedir. Bu çalışma; otistik bozukluk gösteren çocuklarda su içi
etkinliklerin yararları, yapılacak uyarlamalar ve izlenmesi gereken yaklaşımlar,
farklı yaş gruplarında yapılabilecek su içi etkinlik ve oyunlar ve etkinlik sırasında
alınması gereken önlemler üzerine odaklaşmaktadır.
Anahtar kelimeler: otistik bozukluk, su içi etkinlik, oyun, uyarlama
Otistik Bozukluk Gösteren Çocuklarda Bir Müdahale Yaklaşımı: Su İçi Etkinlikler
Otistik bozukluk, otistik spektrum bozukluğu (OSB) veya yaygın gelişimsel bozukluğun
(YGB) alt kategorilerinden biridir. DSM-IV-TR (2000)’ e göre Otistik Bozukluk,
1
PhD., Yard. Doç. Dr., Anadolu Üniversitesi, Engelliler Araştırma Enstitüsü, Eskişehir, E-posta: [email protected]
2
Ph.D., Prof.Dr., Anadolu Üniversitesi, Beden Eğitimi ve Spor Yüksek Okulu, Eskişehir, E-posta: [email protected]
Asperger Sendromu, Çocukluk Dezintegratif Bozukluğu, Rett Sendromu ve başka türlü
adlandırılamayan Yaygın Gelişimsel Bozukluk (Atipik Otizm) otistik spektrum
bozukluğu içinde yer alan alt kategorilerdir. Otistik bozukluk da sosyal etkileşimde
yetersizlik, iletişim sorunları ve sınırlı/ yinelenen ilgi ve davranışlar olarak ortaya çıkan
bazı tipik özellikler söz konusundur (Amerikan Psikiyatri Birliği, 2000).
A. Sosyal etkileşimde yetersizlik:
• Sosyal etkileşim için gerekli sözel olmayan davranışlarda (göz kontağı, jest ve
mimik, vücut postürü) yetersizlik.
• Yaşa uygun akran ilişkileri geliştirememek.
• Başkaları ile zevk, başarı ya da ilgi paylaşımında sınırlılık.
• Sosyal, duygusal davranışlarda sınırlılık.
B. İletişim sorunları:
• Dil gelişiminde eksiklik veya gecikme.
• Karşılıklı konuşmayı başlatmada, sürdürmede ve sonlandırmada zorluk.
• Sıra dışı ya da yinelenen dil kullanmak.
• Gelişimsel düzeye uygun sosyal oyun veya senaryolu oyunlarda sınırlılık.
C. Sınırlı / yinelenen ilgi ve davranışlar (Stereotip):
• Belirli alanda, yoğun ve sıra dışı ilgilere sahip olmak.
• Belli düzen ve rutinlere aşırı ısrarcılık.
• Yinelenen ve ardışık hareket manevraları (el veya parmaklarını sallamak, kendi
ekseni etrafında dönmek, durduğu yerde sallanmak)
• Nesnelerle sıra dışı ilgiler ve takıntılar şeklinde davranış özelliklerini içerir.
Otistik bozukluk tanısı için, çocuğun yukarıda yazılı 12 belirtiden en az altısına sahip
olması; bu belirtilerden en az ikisinin sosyal etkileşim kategorisinden, en az birer
tanesinin ise, diğer iki kategoriye (iletişim sorunları ve sınırlı/yinelenen ilgi ve
davranışlar) ait belirtileri taşıması gerekmektedir. Ayrıca, bu belirtilerden en az biri
hayatın ilk 36 ayından önce görülmelidir (Amerikan Psikiyatri Birliği, 2000).
Otistik bozukluk gösteren çocukların sınırlı ilgi ve davranışları, göz kontağı kurmadan
kaçınma, karşılıklı iletişim ve sosyal becerilerde yetersizlik, arkadaşlık edinme ve
sürdürmede sınırlılık, yaşıtlarıyla birlikte oyun oynama ve etkinliklere katılımlarını
olumsuz etkilemektedir. Bu da, fiziksel olarak aktif olamamalarına neden olmaktadır
(Reid, 2005). Otistik bozukluk teşhis ölçütleri içerisinde yer almamasına rağmen,
giderek artan sayıda araştırma bulgusu otistik bozukluk gösteren çocuklarda motor
yetersizliklerin yaygınlık gösterdiğini ortaya koyarken (Dewey, Cantell ve Crawford,
2007; Provost, Lopez ve Heimerl, 2007), tüm bu dezavantajlar otistik bozukluk gösteren
çocukların fiziksel aktivite programlarına başarılı bir şekilde katılımlarını
sınırlandırmaktadır. Düzenli fiziksel aktivite programlarına katılım, kalp ve dolaşım
sistemiyle ilgili hastalıklar, belirli kanser tipleri ve obezite gibi kronik hastalıklara bağlı
gelişebilecek ölüm veya engel durumuna ilişkin riskleri azaltarak sağlık ve iyilik halinin
sürdürülmesine yardımcı olmakta ve yaşam kalitesinin arttırılmasına katkı
sağlamaktadır. Otistik bozukluk gösteren çocukların fiziksel aktivite ve spor
etkinliklerine katılımı konusunda yapılan araştırma bulguları, spor ve fiziksel aktivitenin
sosyal etkileşim için fırsat oluşturabileceği (Berkeley, Zittel, Pitney ve Nichols, 2001;
Yu-Pan, 2010), tekrarlı yinelenen hareketleri azaltabilme (Burns ve Ault, 2009;
Levinson ve Reid, 1993; Prupas ve Reid, 2001), motor performans ve fiziksel uygunluğu
geliştirme (Bumin, Uyanık, Yılmaz, Kayıhan ve Topçu, 2003; Todd ve Reid, 2006;
Yılmaz, Yanardağ, Birkan ve Bumin, 2004) ve kendini yönetme becerisinin gelişimine
katkı sağladığını göstermektedir (Reid ve O’Connor, 2003; Yu-Pan, 2010). Ancak,
otistik bozukluk gösteren çocuklarda spor ve fiziksel aktivitenin araştırma sonuçlarıyla
ortaya konan yararlı etkilerine rağmen, bu konu üzerinde yeterince durulmadığı
görülmektedir (Todd ve Reid, 2006).
Fiziksel aktivite; yapılandırılmamış ve sistematik olmayan bir şekilde ev, okul, doğal
ortamlar (park, spor salonu, havuz) ve diğer alanlarda (sokak, alış-veriş merkezi) iskelet
kaslarının enerji harcayarak vücudun yer değiştirmesidir. Su içi etkinliklerde özellikle
çocuk ve ergenlerin kas-iskelet sistemi üzerine yük bindirmeden, hem kuvvet ve
dayanıklılık gelişimini hem de kalp, dolaşım ve solunum sistemlerinin verimli
çalışmasını sağlayan keyif verici bir fiziksel aktivite tipidir (Miles, 2007). İyi planlanmış
ve dikkatli uygulanacak bir su içi etkinlik programıyla, otistik bozukluk gösteren
çocuklar yaşam boyu kullanabileceği becerileri kazanarak sağlık ve iyilik halini
sürdürebilir.
Bu makalenin amacı, otistik bozukluk gösteren çocuklarda su içi etkinlik uygulamaları
sırasında izlenecek yaklaşımlar, ilkeler ve önlemleri ele alıp, alanda çalışan
akademisyen, uzman ve ailelerin bu uygulamalar sırasında karşılaştıkları olası sorunlara
ilişkin çözüm önerileri üzerine odaklanmaktır. Ayrıca, çalışmada farklı yaş grubundaki
otistik bozukluk gösteren çocukların yapabileceği su içi etkinlikler ve örnek oyunlara da
yer verilmektedir.
Su İçi Etkinliklerin Yararları ve Önemi
Otistik bozukluk gösteren çocukların genelde su içi etkinliklerden hoşlandıkları, suyun
onları rahatlattığı ve suyun içinde ya da sudan hemen sonra yapılan etkinliklere daha iyi
katıldıkları gözlenmiştir (Campion, 1985; Killian, Joyce-Petrovich, Menna ve Arena,
1984). Ayrıca, havuzdaki oyun becerilerinin çok sayıda otistik bozukluk gösteren
çocuğa potansiyel öğrenme fırsatı sunabileceği belirtilmektedir (Killian ve diğ., 1984;
Yılmaz, Konukman, Birkan ve Yanardag, 2010).
Suyun fiziksel özellikleri (özgül ağırlık, kaldırma kuvveti, direnç, ısı, basınç) havuz dışı
ortama kıyasla, hareketlerin daha başarılı ve kolay yapılmasına olanak tanır. Spor salonu
veya oyun parkı gibi ortamlarda hareket gerektiren aktivitelerde zorlanan ve bu
deneyimden yeterince keyif almayan otistik bozukluk gösteren çocuk, havuzda suyun
kaldırma kuvveti ve yüzdürme özelliğiyle farklı hareketleri kolaylıkla yaparak, hoş vakit
geçirip öğrenme deneyimine katkıda bulunur. Suyun diğer bir özelliği olan direnç etkisi
ise, yapılan hareketin zorluk derecesini, kas-iskelet sistemi üzerinde gelişimi
engellemeyecek ölçüde zorlaştırarak, aşamalı şekilde kas aktivitesini arttırır. Suda
hareket hızı arttırıldıkça, suyun vücut üzerinde oluşturduğu direnç etkisi artacaktır. Buda
kas kuvvetini arttırıcı yönde etki sağlayacaktır (Dumas ve Francesconi, 2001). Su içi
etkinliklere yeni başlayan bir otistik bozukluk gösteren çocuğa başlangıçta sudaki
hareketler yavaş bir tempoda yaptırılarak vücudu üzerinde daha düşük düzeyde direnç
oluşturulması hedeflenir. Zamanla sudaki hareket hızı arttırılarak suyun direnç etkisi
çocuk üzerinde fazlalaştırılır. Buda vücutta kalp, solunum, dolaşım ve kas-iskelet
sistemleri üzerinde dayanıklılığı arttırıcı etki yaratarak, çocuğun fiziksel kapasitesinde
artış sağlayacaktır. Suyun ısı etkisi ise, çocuğun kalp hızında değişiklik gibi fizyolojik
farklılıklara neden olur. Havuzda yoğun tempoda yapılacak bir fiziksel aktivite programı
için, su ısısı 26°C ve daha altında olması tavsiye edilmektedir. Ancak amaç gevşemeyi
sağlayarak hareketi kolaylaştırmaksa su ısısı 33.5 ile 35.5 °C arası olmalıdır (Becker,
2009). Ancak, ideal su ısısını belirlemede ortam ısısı ve çalışılan otistik bozukluk
gösteren çocuğun yaşı da dikkate alınmalıdır.
Otistik bozukluk gösteren çocukların duyu-algı fonksiyonlarına ilişkin pek çok araştırma
yürütülüp, ses, ışık, dokunma gibi duyusal uyaranlara daha farklı ve alışılmışın dışında
tepkiler verdikleri bilinmektedir (Bogdashina, 2003; Diken, 2011). Suyun fiziksel
özelliklerinden olan basınç, havuza giren çocuğun suyla temas eden vücudu üzerinde
eşit miktarda yayılarak, çocuğun hafif dokunma hissine irkilme veya geri çekilme
şeklinde tepki vermesini önleyecektir. Örneğin, otistik bozukluk gösteren çocuğa
sarılmak istenildiğinde, bu ani ve yoğun dokunma hissine çocuk, itme, geri çekilme,
irkilme veya öfkelenme gibi uygun olmayan davranışla tepki verebilir. Bu yoğun ve
beklenmeyen dokunma duyusu yerine, omuz seviyesine kadar havuzda su içi etkinliğe
katılmak otistik bozukluk gösteren çocuğun daha uygun bir davranış sergilemesiyle
sonuçlanacaktır (Martinez, 2006).
Otistik bozukluk gösteren çocuklarda suyun özellikleriyle elde edilen yararlar sadece
fiziksel boyutla sınırlı değildir. Otistik bozukluk gösteren çocuklar suda hareket etmeyi
öğrendikçe, özgüven ve farkındalık duyguları gelişecek (Martin, 1983), başlangıçta
havuz ortamında belirsizlik nedeniyle oluşabilecek endişe hali azalıp sosyal ortamdan
daha fazla keyif alarak hedeflenen su içi beceriler kazandırılabilir ve böylece çocuk
tarafından sergilenen uygun olmayan davranışlar da azaltılabilir. Yilmaz, Yanardag,
Ergun, Uysal ve Konukman (2011) tarafından otistik bozukluk gösteren bir çocukla
yapılan çalışmada, 12 hafta süreyle haftada üç gün, günde bir saat süreyle su içi
etkinlikler uygulanarak, suda egzersizin otistik bozukluk gösteren çocuk tarafından
sergilenen tekrarlı/yinelenen davranışlar üzerine etkisi incelenmiştir. 12 haftalık su içi
egzersiz eğitim öncesi otistik bozukluk gösteren çocuğun tekrarlı davranış sayısı havuz
ortamında 15 dakikalık serbest etkinlik sırasında ortalama 21.6 olarak hesaplanırken,
eğitim sonrası davranış ortalaması 4.3 olarak tespit edilmiştir. Su içi etkinlikler sırasında
ise davranış ortalaması ise 0.25 olarak belirlenmiştir. Çalışma sonucunda, havuz
ortamında hedeflenen uygun motor davranışlar kazandırılarak, uygun olmayan tekrarlı
davranışların azaltılabileceği vurgusu yapılmıştır. Yilmaz ve diğ. (2004), dokuz yaşında
otistik bozukluk gösteren bir çocukta on haftalık yüzme eğitiminin tekrarlı/ yinelenen
davranışlar üzerine etkisini incelemiştir. Çalışma sonucunda, sallanma, dönme ve kelime
tekrarı gibi yinelenen davranışların süresinde azalma tespit edilmiştir. Crollick, Mancil
ve Stopka (2006), uygun olmayan davranışlar sergileyen otistik bozukluk gösteren
çocuklara yönelik, yüzme gibi vücudun geniş kas kitlelerini kapsayan ritmik aktiviteleri
önermişlerdir.
Otistik bozukluk gösteren çocuklar günlerinin büyük bir kısmını okul ve özel eğitim
merkezleri gibi akademik becerileri öğrendikleri ve alışık oldukları ortamlarda
geçirirken, topluma açık olan spor salonu veya havuz gibi kalabalık bir sosyal çevreden
yeterince yararlanamamakta ve uyum sorunları yaşamaktadırlar. Havuzda
gerçekleştirilecek su içi etkinliklerle otistik bozukluk gösteren çocuklara hareket
becerileri kazandırılarak, okul dışında farklı bir sosyal çevrede akademik becerilerle
sınırlı olan öğrenim repertuarı motor ve sosyal becerilerle genişletilmiş olacaktır. Yilmaz
ve diğ. (2004) tarafından toplum kullanımına açık olan kapalı yüzme havuzunda yüzme
eğitimine katılan otistik bozukluk gösteren çocuğun havuz ve suya uyum davranışları
incelenmiştir. On haftalık eğitim sonrası, havuza yaklaşma, suya dokunma, havuza
girme, havuzda çömelme, su kabarcıkları çıkarma ve suyun altına yüzünü daldırma gibi
suya uyum davranışlarının tümünü kendiliğinden, herhangi bir sözel veya görsel ipucu
almadan bağımsız sergilediği, havuz ortamına ve suya uyum sağladığı gözlenmiştir.
Huettig ve Darden-Melton (2004), dört otistik bozukluk gösteren çocuğa suya uyum
becerilerini kazandırmayı amaçlamıştır. Eğitim öncesi, sonrası ve süresince, suya uyum,
nefes alma, su üzerinde yüz üstü ve sırt üstü kalma, suda kulaç atma ve ayak vurma ve
havuza giriş ve çıkış becerileri değerlendirilmiştir. Dört yıl sonra araştırmada yer alan
otistik bozukluk gösteren çocukların tümünde ilgili becerilerde önemli gelişmeler elde
edilirken özellikle kulaç atma becerilerinin edinimi dikkat çekici bulunmuştur.
Annelerden ikisi, ilk kez çocuklarının aileleriyle birlikte yüzme etkinliğine
katılabildiğini, bir çocuğun su kayağını öğrendiğini, diğer bir çocuğunda program
sonrasında gölde dahi yüzebildiğini belirtmişlerdir.
Otistik bozukluk gösteren çocukların tanı ölçütlerinde yetersizlik alanlarıyla birlikte,
ölçütlerde yer almayan ancak bazı çocuklarda eşlik eden duyu, algı, motor ve
davranışsal farklılıklar görülebilmektedir. Tüm bu gelişimsel yetersizlik ve farklılıklar,
su içi etkinlikler sırasında da bazı uyarlamalar ve etkinlikler yapılmasına gereksinim
doğurmaktadır (Lepore, Gayle ve Stevens, 1998). Aşağıdaki bölümde bu uyarlamalar ve
etkinliklere yer verilmektedir.
Otizmli Çocuklarda Eşlik Eden Sınırlılıklara Yönelik Uyarlama ve Etkinlikler
Otistik bozukluk gösteren çocuklarda teşhis ölçütleri içerisinde sosyal, iletişim ve
davranış sorunları yer alırken, duyusal-algısal farklılık ve motor yetersizlik gibi
ölçütlerde yer almayan özelliklerin eşlik etmesi, otistik bozukluk gösteren çocuklar
arasında bireysel farklılıkların gözlenmesine yol açmaktadır. Mevcut bireysel
farklılıklar, bu çocuklarla çalışan özel eğitim, okul öncesi, sınıf öğretmeni, fizyoterapist,
iş-meşguliyet terapisti, çocuk gelişim uzmanı ve beden eğitimi öğretmeni gibi farklı
disiplinlerdeki uzmanların öğretim veya etkinlik sırasında bazı uyarlamalar yapmalarını
gerektirmektedir. Otistik bozukluk gösteren çocuklarda görülebilecek sınırlı dikkat
süresi, işitsel uyaranlara aşırı tepki, tekrarlı yinelenen hareketler, etkileşime girme
sorunları, hareket algılama bozukluğu, dokunma uyarısına tepkide bulunma ve
hatırlama/anlama güçlüğü gibi eşlik eden sınırlılıklar için havuzda su içi etkinliklerin
öğretimi veya programın uygulanması sırasında bazı uyarlamalar yapılması
gerekmektedir (Lepore, Gayle ve Stevens, 1998).
Sınırlı Dikkat Süresi: Beceriyi yapması için hedef uyaran sunarken veya beceriye ilişkin
geri bildirimde bulunurken, çalıştığınız çocuğun önce adını kullanınız. Aynı anda birden
fazla veya sıkça geri bildirim sunmayın. Havuzda çocuğa yakın pozisyon almaya çalışın.
Su içi etkinlik sırasında, bir etkinlik bitiminde veya diğer etkinliğe geçişte çocuğa
uyarıda bulunun. Zincirleme becerilerde, etkinlik kartı, akran veya öğretmen
yardımından yararlanın. Sözel yönerge, göz kontağı kurulduğunda sunulmalıdır.
Havuzda doğru yapılan etkinlik, pekiştirilmelidir. Havuzda etkinlik sırasında, katılımcı
sayısı sınırlı ve ortamdaki gürültünün asgari düzeyde olmasına özen gösterilmelidir. Su
içi etkinliklerde özellikle yeni öğretilecek beceriler için başlangıçta bire bir öğretim
düzenlemesi planlanmalıdır. Etkinlik süresinin uzunluğu çocuğun etkinliği bırakmasına
neden olacak kadar uzun olmamalıdır.
İşitsel Uyaranlara Aşırı Tepki: Sözel yönergeyle birlikte resimli etkinlik kartı kullanın.
Tekrarlı sözel yönerge, etkililiğini kaybedebilir ve otistik bozukluk gösteren çocuk
tarafından zor algılanabilir. Sözel yönergelerde bağırmak yerine, ses tonunda değişimler
ve jest-mimik kullanılarak dikkat çekilmelidir.
Tekrarlı/ Yinelenen Hareketler: Havuzda kullanılacak alanı, plastik renkli zincirler
yardımıyla sınırlandırın. Su içi etkinlikler öncesi çocuk bekletilmemeli, etkinlikler arası
süre sınırlı tutulmalıdır, aksi taktirde uygun olmayan davranışlar sergilenebilir. Tekrarlı
yinelenen hareketler, vücudun hangi uzuvlarını kapsıyorsa, o alanları etkinliğe dâhil
edecek motor beceriler seçilmelidir. Örneğin, ellerini sürekli sallayan çocuğa, havuzda
elleriyle su sıçratma etkinliği uygulatın. Etkinlik sırasında suda kullanılan araç veya
oyuncaklardan yararlanın. Baş ve kolları kapsayan tekrarlı hareketler için çocuk havuzda
omuz seviyesi derinliğine kadar getirilmeli ve orada etkinliğe başlatılmalıdır.
Etkileşime Girme Sorunları: Su içi etkinliklerin tipi, sıralaması ve havuzun kullanılan
kısmı, bir rutin içerisinde ve programda ani değişiklikler yapılmadan sürdürülmelidir.
Programda bazı etkinlikler eşli planlanmalı ve grup oyunları da dâhil edilmelidir. Belirli
zaman aralıklarında oyunlarda eşler değiştirilmelidir. Havuz ortamına giriş ve çıkışlarda,
havuzda çalıştığı öğretmen, uygulamacı ve arkadaşlarıyla ‘merhaba’, ‘günaydın’, ‘güle
güle’ gibi sözcüklerin kullanımı teşvik edilmeli ve pekiştirilmelidir. Etkileşimde bulunan
çocuklara pekiştireç sunulmalıdır (yiyecek ve içecek gibi pekiştireçler havuz ortamında
kullanılmamalı, bunun yerine belirli bir süre istediği oyunu oynama veya sevdiği havuz
materyaliyle etkileşime girmesine izin verilmelidir).
Hareket Algılama Bozukluğu: Bazı otistik bozukluk gösteren çocuklar hareket sırasında
uzuvlarının tam olarak yerini ve hızını algılama ve hareket koordinasyonunu sağlamada
güçlük çekerler. Havuzda su içi etkinlikler sırasında, hareket pozisyon hissini arttırmak
için suda türbülans (dalga) etkisi yaratılmaya çalışılmalıdır. Örneğin, kollarını
kullanarak suda etkinlik yapan çocuğun, omuz ve kol çevresindeki suyu
hareketlendirmek üzere, öğretmen eliyle dalga oluşturur, kas ve eklem çevresine suyun
oluşturduğu direnç ve bu dirence karşı çocuğun hareketini sürdürmeye çalışması, vücut
pozisyonunu daha iyi algılamasına yardımcı olacaktır. Yine aynı etkiyi açığa çıkarmak
üzere, su materyallerinden yararlanılabilir. Örneğin, havuzda çocuğun beline takacağı
kemer veya gövdesine giyeceği bir ceket, sudaki hareketleri sırasında çocuğun üzerinde
bir miktar ağırlık oluşturarak, eklemlerin üzerine yük binmesine ve böylece hareketin
farkında olma hissinin artmasına yol açacaktır.
Dokunma Uyarısına Tepkide Bulunma: Havuzda sünger veya köpük gibi araçlarla
etkinlik planlama. Örneğin, boru şeklindeki süngerleri su üzerinde her iki elle tutarken,
aşağı doğru bastırma ve bırakma. Bu oyun, hem farklı yüzey özeliklerine sahip araçlara
dokunma alışkanlığı kazandıracak hem de suyun kaldırma kuvvetine karşı iş yaparak
eklem ve kasların üzerine binen yükü arttıracaktır. Böylece kas ve eklem çevrelerinde
dokunma duyusu bilgilerini taşıyan reseptörlerin aktivasyonu da sağlanmış olacaktır.
Havuz eşli oyunlar yine dokunma duyusuna uyumu arttırıcı etkinliklerdir. Örneğin,
havuzda tren oyunu, her öğrenci önündeki öğretmenin omuzlarından tutarak tüm öğrenci
ve öğretmenler arka arkaya dizilerek bir tren oluşturup “S” şekli çizerek suda yürümeleri
hem dokunma uyarısına hem de havuza uyumu geliştirecektir. Bisiklet oyunu; çocuk
öğretmenine arkasını döner, ellerini öğretmenin ellerinin üzerine yerleştirir, öğretmen
çocuğu yaklaşık 30 cm ayağa kaldırır ve sonra çocuk pedal çevirir gibi ayaklarını
hareket ettirerek bisiklet oyununu oynar. Bu sırada çocuğun tüm ağırlığı öğretmenin eli
üzerine binip, aynı zamanda çocuğun omuz ve el arasındaki tüm üst uzvu, basınç altında
kalarak kas ve eklem reseptörleri uyarılır. Böylece dokunma duyusu algısı su içinde grup
oyunlarıyla doğal bir şekilde geliştirilebilir.
Hatırlama ve Anlama Güçlüğü: Su içi etkinlik sırasında önceden öğrendiği ayak vurma
hareketini unutan çocuğa sözel ipucu sunulabilir. Örneğin, “kollarını yana aç” veya “kuş
oyununa başladın mı?” gibi hatırlatma amaçlı sözel ifade veya sorular yöneltilebilir. İlke
defa yeni bir beceri öğretimi gerçekleştiriliyorsa, görsel ipuçları, aktivite kartı veya canlı
model gibi ipuçlarından yararlanılmalıdır. Şayet bu ipucuna çocuk doğru motor yanıt
vermezse, fiziksel ipucu sunulmalıdır. Su içi etkinliği anlamada güçlük çeken otistik
bozukluk gösteren bir çocuk için, basamak sayısı bir ya da iki olan beceriyle başlanıp,
zamanla basamak sayısı daha çok olan etkinliklere geçiş yapılmalıdır. Beceri yönergesi,
kısa ve net olmalıdır. Örneğin, Ali “tren ol”.
Tipik Bir Su İçi Etkinlik Seansı Nasıl Olmalı?
Okul öncesi dönemdeki otistik bozukluk gösteren çocukların gelişimsel yetersizliği ve
günlük yaşam becerilerinde takvim yaşına göre gerilik göstermesi, havuzda uygun su içi
etkinlik seçimi gerektirirken, bu etkinliklerin öğretiminde bazı yaklaşım ve stratejilere
gereksinim duyulmaktadır. Örneğin, yeni bir beceri öğretiminde bire-bir öğretim
düzenlemesi planlama, yanlışsız öğretim tekniklerinden yararlanma veya pekiştireç
sunma gibi.
Otistik bozukluk gösteren çocuklar okulda sınıf içerisinde belirli rutinleri sürdürürken
havuz gibi topluma açık alanlara girişte sorunlar yaşayabilmektedir. Bu nedenle havuzda
etkinliğe başlarken okulda çocuğun sürdürdüğü rutinlerin bilinmesi ve buna uygun
olarak su içi planlamanın yapılması gerekir. Örneğin, okulda grup üyelerinin hep birlikte
bilinen bir şarkıyı söyleyerek derse başlaması. Böyle bir rutin içerisinde yer alan çocuk
havuz ortamında etkinliğe başlatılırken okulda söylediği bu şarkıdan yararlanarak su içi
etkinlikler için de benzer bir rutin oluşturulabilir. Okul öncesi dönemdeki otistik
bozukluk gösteren çocuklar için tipik bir su içi etkinlik programı, dört aşamada
yürütülmelidir. Bunlar, giriş şarkısı, bire-bir öğretim, boş zaman ve bitiriş şarkısı
aşamasıdır (Prupas, Harvey ve Benjamin, 2006).
Giriş şarkısı aşaması; ilk defa havuza gelen otistik bozukluk gösteren çocuklar için bu
aşama özellikle önemlidir. İlk gün bu aşamada yaşanılacak olumsuz bir deneyim su içi
etkinliğin cezbedici etkisini ortadan kaldırabilir. Havuzda su içi etkinliğe başlamadan
önce çocuklar havuz kenarına oturtulup suya ayaklarını daldırıp çıkartarak su ile
vücutlarının başlangıçta kısmi teması sağlanmalıdır. Daha sonra merdivenler
kullanılarak havuz içine giriş yaptırılır, merdivenden inerken çocuğun önünde pozisyon
alınır. Havuza giriş sonrası bağımsız yürüyerek suda hareket etme ve havuzu tanıması
sağlanır. Bu uyum etkinliği sonrası grup daire olacak şekilde el ele tutuşup okullarındaki
rutin içerisinde olan “hoş geldin” amacı taşıyan şarkı söylenmeye başlanarak havuzda su
içi etkinliklere başlandığı mesajı otistik bozukluk gösteren çocuklara aktarılır. Bu aşama
aynı zamanda çocukların aktivite öncesi ısınma fazını oluşturup aşamalı olarak kalp
hızlarını yükselterek daha tempolu aktivitelere geçişe hazırlık niteliğindedir ve yaklaşık
5-8 dakika sürdürülür (Prupas, Harvey ve Benjamin, 2006).
Bire-bir öğretim aşaması; hedeflenen su içi beceri çeşitli düzeydeki ipucu seviyesinden
yararlanarak çocuğa öğretilir. Beceri yönergesiyle birlikte fiziksel, görsel, jest-mimik ve
sözel ipuçlarından yararlanarak hedeflenen motor beceri veya oyun çocuğa öğretilmeye
çalışılır. Zamanla öğretim sırasında kullanılan bu ipuçları geri çekilerek otistik bozukluk
gösteren çocuğa sadece beceri yönergesi sunularak hedef beceriyi sergilemesi sağlanır.
Bu aşama yaklaşık 10 dakika boyunca sürdürülür (Prupas, Harvey ve Benjamin, 2006).
Boş zaman aşaması; öğretim aşaması sonrası çocuğun öğrendiklerini pekiştirmek
amacıyla ilgisini çeken su araçlarıyla (köpük, pinpon topu, su üzerinde yüzebilen çeşitli
oyuncaklar) etkileşime girmesi sağlanır. Bu aşama çocuk için aynı zamanda su içi
etkinliklerden daha fazla keyif aldığı aşamadır. Bu aşamada çocuğunun havuz
ortamındaki etkinliklere katılımda istekli ve mutlu olduğunu gözlemleyen ebeveyn, su
içi etkinliğe çocuğunun daha fazla katılımı ve havuzu kullanması konusunda istekli
olacaktır. Bu aşama yaklaşık 10 dakika boyunca sürdürülür (Prupas, Harvey ve
Benjamin, 2006).
Bitiriş şarkısı aşaması; okulda sınıf içi rutinde dersin sonuna gelindiği mesajını taşıyan
bu aşama havuz ortamında da kullanılarak otistik bozukluk gösteren çocuğa artık su içi
etkinliklerin bitmek üzere olduğu ve havuzdan dışarıya çıkacağı hatırlatılır. Böylece
çocuk keyif aldığı bu etkinlikten beklemediği şekilde aniden uzaklaştırılmayıp bir
sonraki süreçte olacağı tahmin ederek havuz çıkışında ağlama, bağırma ve çıkmak
istememe gibi uygun olmayan davranışların sergilenmesi de önlenebilecektir. Bitiriş
şarkısı, giriş şarkısı gibi grup daire olacak şekilde el ele tutuşup başlatılır. Girişte
yararlanılan merdivenler kullanılarak
havuzdan çıkış yapılır, çıkarken çocuğun
arkasında durulmalıdır (Prupas, Harvey ve Benjamin, 2006).
Farklı Yaş Gruplarında Otistik Bozukluk Gösteren Çocuklar İçin Su İçi Etkinlikler
Aynı yaş aralığında bulunan ve benzer fonksiyonel becerilere sahip tüm yaş grubundaki
otistik bozukluk gösteren çocuklar için havuzda su içi etkinlikler grup olarak
planlanmalıdır. Aynı yaş grubu olup yukarıda belirtildiği gibi otistik bozukluğa eşlik
eden sınırlılıkların olması, grup içinde bire-bir öğretim düzenlemesi yapılmasına
gereksinim doğurabilir.
3-5 yaş çocuklar: Bu dönemdeki otistik bozukluk gösteren çocukların kalp-dolaşım, kas
kuvvet ve dayanıklılığı ve denge gibi fiziksel uygunluk bileşenleri henüz yeterince
gelişmemiş olup, denge, yer değiştirme ve el becerileri gibi temel hareket becerileri yeni
gelişmektedir. Çocukların suya uyum becerilerinin de arttırılması gerekmektedir.
Havuzda omuz seviyesinde suyun direnç etkisinden yararlanarak öne, yana ve arkaya
yürüme çalışmaları tüm vücut kas kuvvet ve dayanıklılığını arttırır. Su sıçratma oyunu,
su üzerindeki farklı büyüklük ve renkteki topları havuz kenarındaki boş kovaya toplama
oyunu üst uzuv kasların koordinasyonunu, su üzerindeki büyük topu can simidi
içerisinden atma oyunu, çalışma el-göz koordinasyonu gelişimine yardımcı olur.
Havuzda çocuk dikey pozisyondayken, öğretmenin suda yaratacağı dalga ve akıntı
denge becerisinin gelişmesine, havuz kenarında otururken ayakları suya daldırma ve
çıkarma alt uzuv kaslarının kuvvetlenmesine katkı sağlar. (Lepore, Gayle ve Stevens,
1998; Lieberman ve Cowart, 1996).
6-8 yaş çocuklar: Bu dönemde otistik bozukluk gösteren çocukların suda farklı vücut
pozisyonlarında hareket algısı ve uzuvları birlikte ve koordineli kullanma becerisi henüz
gelişmemiştir ve suda solunum kapasiteleri sınırlıdır. Ayrıca ani kuvvet açığa çıkarmak
üzere performansları sınırlıdır. Suda matların üzerine yüzüstü yatıp tüm uzuvlarını
kullanarak havuzda yer değiştirmesi hem kas dayanıklılığını hem de uzuvlar arası
koordinasyonun gelişimine katkı sağlayacaktır. Su kabarcıkları çıkartma ve su
üzerindeki pinpon toplarını üfleyerek yer değiştirme solunum kontrolünün gelişimini
destekleyicidir. Havuz kenarından suya atlama ve suda kanguru oyunu alt uzuvlarda
patlayıcı kuvvet açığa çıkartma becerilerini geliştirir. Çocuklara pantolon veya gömlek
gibi kıyafetler giydirip, su içinde etkinliklere katılmaları, vücut üzerinde direnç
oluşmasına ve kassal dayanıklılığın gelişmesine yardımcı olacaktır (Lieberman ve
Cowart, 1996). Bu yaş grubundaki otistik bozukluğu olan çocuklarla suda sembolik
oyunlar planlanmalıdır. Her öğretmen önündeki çocuğa “güneş ol”, “yağmur ol”,
“rüzgâr ol”, “kar ol” ve “kasırga ol” gibi beceri yönergeleri sunarak, çocuğun bunlara
ilişkin suda motor yanıt açığa çıkarmasını bekler. Örneğin, “güneş ol” beceri yönergesi
sunulduğunda çocuk her iki elini başının üzerinde birleştirerek kollarıyla güneş gibi
çember şekli oluşturur. “Yağmur ol” beceri yönergesi sunulduğunda, çocuk elleriyle
yukarı doğru su fırlatma etkinliği yapar. “Rüzgâr ol” beceri yönergesi sunulduğunda ise
çocuk ağzını su seviyesine indirir ve suyu rüzgâr gibi üfleyerek su baloncukları çıkarır
(solunum kontrolü için de iyi bir oyun). “Kasırga ol” beceri yönergesi sunulduğunda ise
çocuk kollarını her iki yana açar ve elleriyle suyu hareket ettirirken gövdesini de kendi
etrafında döndürür (Lieberman ve Cowart, 1996). Bu yaş grubundaki çocuklara yukarıda
belirtilen oyun ve aktivite öğretiminden sonra suda gövde kontrolü, sırtüstü suda
dengede kalma ve sırtüstü basit ilerleme teknikleri öğretilerek genel vücut
performansında artış ve buna bağlı olarak günlük yaşam aktivitelerinde fonksiyonel
kapasitede artış sağlanmalıdır. Ayrıca bu yaş grubunda havuzda küçük grup etkinlikleri
motivasyon sağlamak amacıyla planlanmalıdır. Örneğin, beş kişilik iki grup 7-8 m
uzaklıkta birbirlerine dönük olarak yan yana dizilir. Ortadaki su topu, gruplardaki
çocuklar tarafından suda ayakları hareket ettirilerek oluşacak dalga ile topu karşı gruba
ulaştırmaya çalışırlar. Top hangi gruba önce ulaşırsa, o grup oyunu kaybeder. Bu yaş
grubuna yönelik hem sosyal etkileşimi hem de fiziksel performansı arttırıcı bir oyun
olarak planlanabilir (Lieberman ve Cowart, 1996).
Daire şeklindeki paraşüt kumaşı, havuzdaki çocuklar ve öğretmenler tarafından
kenarlarından tutularak gerdirilir ve saat veya tersi yönünde hareket ettirilir. Gergin
paraşüt suyun altına çekilmeye çalışılır. Paraşütü suyun altına çekerken her çocuk sırayla
paraşütün üstüne çıkarak dairenin diğer ucuna doğru hareket etmeye çalışır. Bu etkinlik,
hem kas kuvveti hem de kalp ve solunum sisteminin geliştirilmesine yardımcı olur ve
aynı zamanda havuza yeni başlayan otistik bozukluk gösteren çocuklar için suya
alışmayı sağlayıcı bir etkinliktir (Lieberman ve Cowart, 1996).
Yukarıda belirtilen yaş gruplarına yönelik çeşitli etkinlikler ve oyunlar; öğretim yapılan
havuz dışında, topluma açık başka havuzlarda da tekrarlanarak otistik bozukluk gösteren
çocuğun öğrendiği beceriyi farklı havuz ortamlarında sergilemesi ve böylece genelleme
becerisinin de kazanılması sağlanmalıdır (Prupas, Harvey ve Benjamin, 2006).
Su İçi Etkinlikler Sırasında Güvenlik Önlemleri
Otistik bozukluk gösteren çocuklar havuz gibi büyük, geniş ve çevresel uyaranın yoğun
olduğu bir fiziksel çevrede su içi etkinliklere katılmaktadır. Aynı anda birden çok
çocuğun böyle bir fiziksel çevrede yer alması ve bazı güvenlik kurallarına uyulmaması
durumunda, düşme ve çarpmaya bağlı yaralanma veya boğulma gibi yaşamı tehdit edici
durumların ortaya çıkışı söz konusu olabilir. Bununla birlikte; ağlama, bağırma ve
kurallara uymama gibi uygun olmayan davranışlar sergilenmeden havuz etkinliklerinin
akıcı ve verimli bir şekilde tamamlanması için aşağıda belirtilen kurallara uyulması
önemlidir (Lepore, Gayle ve Stevens, 1998).
Dersin başında kurallar kısaca ve basit şekilde anlatılmadır. Bazı otistik bozukluk
gösteren çocuklar suda havuz dışı ortama göre daha fazla hareketlidir. Bu nedenle
havuza giriş/çıkış alanları kuru olmalı ve buralarda takılma ve düşemeye yol açacak
araç-gereçler bulundurulmamalıdır. Bazı kurallara uyulmaması durumunda, kurala
uymayan çocuğa bu kuralı hatırlatıcı ve kısa cevaplı sorular sorulmalıdır. Örneğin, Ali!
Havuzun ne tarafına doğru yürümelisin? Soyunma odasından havuza gelişte, öğretmen
havuza yakın tarafta yürürken, otistik bozukluk gösteren çocuk uzak olan taraftan ve
öğretmenin yanında yürümelidir, hareketli olan ve havuza atlama riski bulunan
çocukların eli mutlaka öğretmen tarafından tutulmalıdır. Denge ve koordinasyonu iyi
olmayan veya su yutabilecek çocuklarla grup içinde bire-bir çalışılmalı ve öğretmen
temas gerektirmeyen etkinlikte çocuğa gölge olmalıdır. Sıçrayan sulara karşı hassasiyet
gösteren ve etkinlikten kendini geri çeken çocukların gözlük kullanması teşvik
edilmelidir. Havuzda su içi etkinliklere yeni başlayan veya yüzme bilmeyen çocukların
havuzun derin bölgelerine gitmemeleri için havuzun kullanılmayacak alanı, plastik
zincir çekilerek çalışma alanı güvenli hale getirilmelidir. Denge ve koordinasyonu iyi
olmayan çocuklar, kaygan havuz kenarında düşme riskine karşı suda giyilen spor
ayakkabısı kullanabilir. Derinliği algılamada güçlük çeken çocuklarda, suya
atlanmaması için etkinlik öncesi görsel işaretler havuz kenarına yerleştirilmeli ve sözel
uyarılarda bulunulmalıdır.
Sonuç ve Öneriler
Otistik bozukluk gösteren çocukların suya olan ilgisi ve havuz ortamından keyif
almaları, fiziksel aktivite düzeylerini arttırmak için bir fırsat oluştururken, çocukların
gereksinimleri doğrultusunda belirlenen amaçlar (örneğin, bacak ve kalça kas kuvvetini
arttırma, zayıf olan dengesini geliştirme, dokunma duyusuna karşı hassasiyetini azaltma)
doğal oyun ortamı içerisine yerleştirilerek topluma açık olan yüzme havuzlarında önce
2-3 kişilik küçük grup ve sonra 5-6 kişilik daha büyük grup etkinliğiyle en az 10-12
hafta ve haftada iki-üç seans sürdürülmelidir. Havuz ortamında otistik bozukluk gösteren
çocuk başlangıçta aynı öğretmenle etkinlikleri sürdürürken, grup oyunlarında farklı
öğretmenlerle aşamalı olarak çalışmaya başlamaları öğrenilen becerilerin genellemesine
katkı sağlayacaktır. Otistik bozukluk gösteren çocukların havuza giriş ve çıkışta
öğretmen ve birbirlerine “merhaba” ve “güle-güle” gibi iletişim becerisi kullanımı teşvik
edilerek diğer gelişim alanları da desteklenmelidir. Havuzda yapılacak etkinlikleri ve
sırasını gösteren etkinlik çizelgesi havuzda tüm çocuklar tarafından görülebilecek bir
yere yerleştirilmeli ve böylelikle bir sonraki etkinliği bilmemenin getireceği zihinsel
karışıklık önlenip, hedeflenen amaçlar gerçekleştirilmelidir. Havuza giriş-çıkışlarda ve
havuz içerisinde güvenlik önlemlerine uyulmalı, aksi takdirde istenmeyen bir durum
otistik bozukluk gösteren çocukta havuzun cezbedici etkisinin kaybolmasına yol
açabilir. İyi planlanmış su içi etkinlikler otistik bozukluk gösteren çocukların fiziksel
aktivite düzeyini arttırma, motor performansı geliştirme, öğrenilen sosyal ve iletişim
becerilerini kullanma, uygun olmayan davranışları azaltma ve uygun davranışları
arttırma fırsatı sağlayabilir. Gereksinimleri doğrultusunda su içi etkinlikler otistik
bozukluk gösteren çocukların haftalık rutinleri içerisine yerleştirilmelidir.
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autism. Education and Training in Autism and Developmental Disabilities, 45,
440-448.
Teaching social communication, 46
Book Review/Kitap Kritiği
By
Emre Ünlü1
Teaching Social
Communication to
Children with Autism
by
Brooke Ingersoll & Anna Dvortcsak
Bu kitap kritiğinde, Brooke Ingersoll ve Anna Dvortcsak tarafından yazılmış olan
“Teaching social communication to children with autism” isimli kitap ele alınmıştır.
Yazarlar kitabın yanında verilmiş olan materyaller ile birlikte aileler için geliştirilmiş
olan kapsamlı bir programı oluşturduğunu ifade etmektedirler. Bahsedilmiş olan
kapsamlı programın uygulama kılavuzu, yardımcı bir DVD ve aile kılavuzundan
oluştuğunu belirtmektedirler. Kitap üç bölüm ve eklerden oluşmaktadır. Yazarlar
geliştirilmiş olan bu aile eğitim programının, 5 yıllık bir çalışmanın ürünü olduğunu ve
farklı eyaletlerden yaklaşık 200 aile ile gerçekleştirildiğini belirtmişlerdir. Bu kitap üç
bölüm ve bölümlerin altında bulunan alt bölümlerle birlikte toplamda 386 sayfadan
oluşmaktadır. Bu bölümler “An introduction to parent training, Individiual parent
training program session guidelines ve Group parent training program session
guidelines’ dır.
Birinci bölüm olan “An introduction to parent training” kendi içerisinde üç alt bölüme
ayrılmıştır. Bu alt bölümlerden ilki olan “Training parents of young children with
autism: An Overview alt bölümünde aile eğitiminin önemi ve neden gerekli olduğu,
etkili aile eğitim programları, daha önce otistik spectrum bozukluğuna sahip çocukların
1
PhD Student and Research Assistant, Anadolu University, College of Education, Department of Special Education, Eskisehir,
aileleri ile gerçekleştirilmiş olan araştırmalar, aile eğitiminde karşılaşılan güçlük ve
engeller ve ImPACT (Improving parents as communication Teachers) isimli projeden
bahsedilmiştir. Ayrıca bu bölümün son kısımlarında aileler çocuklarına beceri
öğretiminde kullanabilecekleri teknik, yöntem ve öğretim formatlarına ilişkin bazı
ipuçları verilmiştir.
İkinci alt bölüm olan “Planning and Implementing Project Impact” aile eğitimcisi olmak
için gerekli olan becerilerin neler olduğu ve ailelere eğitim sunmada kullanılacak pratik
basamaklardan bahsetmektedir. Bu bölümün ilk kısmında aile eğitimine başlamadan
önce dikkat edilmesi gereken noktalar ve yapılması gereken planlamalardan
bahsedilmektedir. Bu bağlamda aile eğitimine kimlerin katılması gerektiği, eğitimin ne
zaman başlatılacağı, hangi öğretim formatının kullanılmasının gerektiği, eğitimin nerede
yapılacağı gibi soruların cevapları aranmaktadır. Bölümün ikinci kısmında ise aile
eğitimi sürecinden bahsedilmektedir. Bu kısımda aileler ile olumlu etkileşim kurma,
ailelerin çocukları için uygun amaçlar belirleme, kullanılacak olan tekniklere ilişkin bilgi
sunma, kullanacakları teknikleri gösterme, ailelere geri bildirim verme ve aileleri
ödevlendirme konuları ele alınmaktadır. Bu bölüm tamamlandığında okuyucu aile
eğitim sürecinin planlanması ve uygulanması konusunda artık fikir sahibi olmaktadır.
Üçüncü alt kısım olan “Program challenges, solutions, and modifications” aile eğitim
programlarının kültür, dil vb. ögelerden etkilenebileceği göz önüne alınarak
karşılaşılabilecek olası güçlük ve sorunlar, bunlara ilişkin çözüm önerileri ve programda
gerçekleştirilebilecek muhtemel uyarlamalardan bahsetmektedir. Karşılaşılabilecek olası
problemler kültürel farklılıklar, aile eğitimi oturumlarına katılımda yaşanan sıkıntılar,
ailelerin çocuklarının davranış problemleri olarak belirtilmiş ve bu tip sorunlara karşı
çözüm önerileri verilmiştir. Yapılabilecek olası uyarlamalara ise oturum sayılarının
azaltılması, kardeşlerin eğitilmesi ve toddler groups örnek olarak verilmiş ve bu
uyarlamaların nasıl gerçekleştirileceğine dair bilgi verilmiştir.
Kitabın ikinci kısmı olan “Individual Parent Training Program Sessions
Guidelines”adım adım bireysel bir aile eğitim programının nasıl yürütüleceğini
anlatmaktadır. Bu kısımda ilk olarak 24 bireysel aile eğitim oturumu ve bu oturumların
sıralaması, aile eğitim oturumlarının formatları ve ilk aile eğitim oturumlarına
başlamadan önce tamamlanması gereken adımlar ele alınmaktadır. İkinci kısımın
devamında ise 24 aile eğitim oturumunun içeriği ve yapılması gerekenler tek tek ele
alınmış ve açıklanmıştır. Her bir oturumun içeriği ve formatı farklık göstermesine
rağmen bu oturumların genelinde ortak olan noktalar şu şekildedir; a) Reviewing
homework from previous sessions b) introducing the rationale for the new technique c)
explaining how the technique relates to previously taught techniques d) describe the
technique’s key points e) demonstrating use of technique with the child f) having the
parent practice the technique while you provide feedback g) discussing and assigning
homework.
Kitabın üçüncü kısmını “Group parent training program session guidelines”
oluşturmaktadır. Grup formatında gerçekleştirilecek olan aile eğitim oturumlarını 12
oturum oluşturmaktadır. Bu oturumların 6’sını ikişer saatlik sadece ailelerle
gerçekleştirilen oturumlar oluşturmaktadır. Diğer 6 oturumu ise 45 dakikadan oluşan ve
ailelerin çocukları ile birlikte gerçekleştirilen individual coaching sessions
oluşturmaktadır. Yazarlar gerçekleştirilecek olan grup oturumlarının akşam yapılması ve
45 toplamda iki saat süren oturumlar arasında mutlaka mola verilmesini önermektedirler.
Ayrıca individual coaching sessions ların ise gündüz gerçekleştirilmesini tavsiye
etmektedirler. Gerçekleştirilecek olan toplam 12 oturum bir grup bir bireysel oturum
olacak şekilde arka arkaya gerçekleştirilir. Grup aile eğitimi oturumlarını şu oturumlar
oluşturmaktadır; a) Overview of the program and set up your home for success (group)
b) Review of set up your home for success and goaldevelopment (coaching) c) Make
play interactive and modeling and expanding language (group) d) Review of make play
interactive and modeling and expanding language (coaching) e) Create opportunities for
your child to engage or communicate and overview of the direct teaching techniques
(group) f) Review of create opportunities for your child to engage or communicate (
coaching) g) Teaching your child expressive and receptive language (group) h) Review
of teaching your child expressive and receptive language (coaching) ı) Teaching your
child social imitation and play (group) i) Review of teaching your child social imitation
and play (coaching) j) Putting it all together (group) k) Review of putting it all together
(coaching).
Gerçekleştirilen oturumların altısını oluşturan grup oturum formatlarında ortak olan
bileşenler şu şekilde sıralanmıştır; a) Revire homework from the previous coaching
session b) Conduct first half of presentation c) Take a break d) Conduct rest of
presentation e) Discuss and assign homework. Otrumların diğer altısını oluşturan
individual coaching sessions ortak olan bileşenleri ise şunlardır; a) Review homework
from previous session b) Provide a brief review of technique c) Demonstrate techniques
with child d) Have parent practice techniques while you give feedback e) Discuss and
homework. Kitabın bu bölümünde bu 12 oturumun her biri detaylı olarak açıklanmakta
ve her bir oturumda kullanılacak olan powerpoint sunularına ilişkin detaylar
verilmektedir. İlgili powerpoint slaytları ve kullanılan video ve ses dosyaları kitapla
birlikte verilen CD de yer almaktadır.
Bu kitabın özellikle otizm özellikler gösteren çocukların aileleri ile gerçekleştirilecek
olan aile eğitimi çalışmalarına yön vermek açısından yararlı bir kaynak olma özelliği
göstermektedir. Kitap yanında verilmiş olan CD ile birlikte bir aile eğitimi programının
baştan sona nasıl kullanılabileceğini göstermesi ve gerek bireysel gerekse grup aile
oturumlarını adım adım detaylı bir şekilde ele alması açısından aileler ile çalışacak olan
uzmanlara büyük kolaylık sağlamaktadır.
Reference
Ingersoll, B., and Dvortcsak, A. (2010). Teaching Social Communication to Children
With Autism. Newyork: The Guilford Press

Volume:4 Issue: 1 June 2012 - Engelliler Araştırma Enstitüsü

Transkript

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