Accommodations
by Alan Kurtz
Bruce, an adult with autism, often needs to make physical contact with another person before he can initiate some activities such as getting out of bed in the morning. Another man I know usually must rock back and forth several times before slapping his thighs in order to pass through a doorway. Many young children using facilitation need to sit on the floor with their backs supported by their facilitators bodies in order to focus on their communication.
Center for Community Inclusion and Disability Studies Director, Dr. Lu Zeph describes former students who had difficulty with school work in their classrooms unless their space was clearly defined. When she put tape on the floor to indicate a square in which the child could sit, the child could work on activities that otherwise would have been difficult or impossible.
Anne Donnellan and Martha Leary, in their very important book Movement Differences and Diversity in Persons with Autism and Mental Retardation (1994), begin to give us a framework for understanding these seemingly unrelated strategies. Relying on the work of the Russian neuropsychologist Aleksander Luria and one of his students - author Oliver Sacks - they call the things people may need to initiate, execute, stop, combine, or switch activities accommodations. Donnellan and Leary define accommodations as:
... the personalized strategies that assist in temporarily overcoming differences in movement which are problematic to an individual Accommodations include the use of gesture, touch, rhythm, behavior rituals, visualization, music and other strategies to temporarily overcome difficulties starting, executing, stopping, combining and switching behavior, thoughts, speech, language and emotions. An accommodation assists the individual by activating mechanisms for control, regulation or change of movement. (p.68)
Luria understood that willpower alone could not help people with neurological differences control their actions or behavior. At times it was impossible for people to control their behavior directly. Actions that a patient might desire to perform were not always directly accessible. Luria and his associates taught people indirect means for controlling their movements. "For example, they might blink their eyes rhythmically in order to initiate and sustain a particular hand movement." (Donnellan & Leary, 1994, p.67)
Donnellan and Leary, building on the earlier work of Hill and Leary (1993), help us to understand that persons with autism and other developmental disabilities often share many symptoms with neurological conditions such as Tourette's Syndrome, Catatonia, and Parkinsonism. Just as people with those conditions may need accommodations, persons with autism and other developmental disabilities may need certain accommodations to execute or stop particular combinations of movements.
If persons with autism experience movement difficulties similar to those with other neurological conditions, our approach to teaching and supporting those individuals must radically change. By looking at techniques used to help others with movement differences we may gain insight into how to better support persons with autism.
Traditionally, a person with autism's failure to perform a task was seen as resulting from of either a lack of understanding or a lack of motivation. Our interventions were designed around those presumptions. We searched for more effective ways to teach the components of tasks and to identify more effective reinforcers. Often those strategies worked but sometimes only after a long arduous training process.
Along the way most of us probably discovered accommodations that made learning easier for some individuals. I think in many cases we were not fully conscious of the accommodations we made. We probably also frequently misunderstood what we were doing.
For example, my friend Jay used to become very angry when asked to perform new unfamiliar activities. If someone asked Jay to join them in an activity that s/he had already begun Jay was usually more than happy to participate. I concluded that Jay did not like someone telling him what to do. He seemed to like doing things with people but not for them. In retrospect I believe Jay needed to watch someone else perform a new task before he could initiate it. It was not that he misunderstood or was not motivated. Watching someone else perform the activity was an accommodation that Jay used to get started. It was an accommodation we provided without awareness of what we were doing.
Discovering the types of accommodations a person may need is a creative process that may be stimulated by learning about what others do. Donnellan and Leary argue strongly that accommodations must be individualized and personalized. There are no cookbooks. There is nothing that says 'if a person has difficulty stopping a particular activity and going on to something else do this...." The use of accommodations that are not appropriate for an individual maybe ineffective or harmful.
Donnellan and Leary listed eight categories of accommodations with a number of examples for each. Following is a list of their categories:
*Accommodations using rhythm or tempo
Such as moving with another person or pacing of movements.
*Emotional accommodations
Such as expressions of confidence or using emotional imagery.
*Visual accommodations
Such as use of a picture schedule.
* Verbal accommodations
Such as sentence completion.
* Tactile accommodations
Such as use of touch to help a person initiate or Temple Grandin's "squeeze machine."
*Accommodations using smell
Such as "smelling an object or person to bring a name to minds."
*Cognitive accommodations
Such as auditory or visual imagery.
*Kinetic accommodations
Such as 'using indirect sequences: using a series of unrelated actions to lead up to the desired movement, such as touching the door frame to get through the door.'
Facilitated communication has helped us learn a great deal about
the kinds of unique supports that people need to control their
behavior and perform certain motor activities. With FC, people can
often tell us for the first time about the kinds of things they need
to accomplish a task when sheer willpower is not enough.
FC, itself, can be viewed as a combination of accommodations that are
unique for each user. Among the many accommodations used in FC
are:
touch to help a person stay focused;
physical interruption of perseverative responses to help a person switch;
holding a person back so that s/he looks at the keyboard before pointing;
emotional support so that a person gains confidence when stuck and is unable to continue;
backwards pressure that may slow a person down and help him/her gain control over impulsive unregulated movement;
Donnellan and Leary compare the relationship between a facilitator and an FC user to the relationship between dancers. We have known for some time that many FC users are very particular about with whom they will type.
Donnellan and Leary argue that the ability of one person to provide effective accommodations to another is partly a function of their relationship.
They cite Oliver Sacks describing people who were skilled in helping Parkinson's patients. This description might also apply to the relationship between an effective facilitator and an FC user:
The art of handling Parkinsonian patients,learned by sensitive nurses and friends - assisting them by the merest intimation or touch, or by wordless touchless moving- together, in an intuitive kinetic sympathy of attunement -this is a genuine art, which can be exercised by a man or a horse or a dog, but which can never be simulated by any mechanical feedback, for it is only an ever-changing, melodic, and living play of forces which can recall living beings into, their own living being.
Regardless of a person's ability to speak or type, they will usually communicate, in some way, their needs for particular accommodations. Sensitivity, creativity, and a willingness to really get to know a person will be required from those who seek to provide accommodations effectively.
Donnellan and Leary provide many more examples of accommodations. Their book is excellent and clearly the best information currently available on the movement differences" that affect many persons with autism and other developmental disabilities.
Movement Differences and Diversity in Persons with Autism and Mental Retardation is available from DRI Press, PO 5202, Madison, WI 53705 for a cost of $1 0.00.
A copy of this book is also available for loan from the Center for Community
Inclusion and Disability Studies library. You can call Jen Rice at (207)
581-1084 if you would like to borrow it.
The purpose of Facilitated Communication In Maine is to promote the appropriate use of facilitated communication through education, technical assistance, and support to people with disabilities, parents, educators, speech and language pathologists support providers, and other interested individuals. The project provides up-to-date information on current best practices, introductory and advanced workshops on the technique, resources regarding theoretical and practical components of facilitated communication and ongoing support to a network of resource persons who provide local education and support to other facilitators.
In complying with the letter and spirit of applicable laws and in pursuing its own goals of pluralism, the University of Maine shall not discriminate on the grounds of race, color, religion, sex, sexual orientation, national origin or citizen status, age, disability, or veterans status in employment education, and all other areas of the University. The University provides reasonable accommodations to qualified individuals with disabilities upon request. This publication is available on audiotape and upon request this material will be made available in other alternative formats to accommodate the needs of individuals with disabilities.