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Toward a New Paradigm

MEDICINE, EDUCATION, AND THE BATTLE FOR THE RIGHT TO BE DIFFERENT

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Agenda

ASD Voices, Continued

What ASD teaches us about the LD Paradigm

Emerging Critiques of the DSM and Medical Model

Educational Alternatives

Notes toward a new paradigm

Preview: Tuesday’s Review Session and Wednesday’s Exam

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ASD Voices

Rainman – The Classic Stereotype
Autistic Reporter
Interview with an Autistic Child
Basketball Player
Temple Grandin

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What ASD Teaches Us

Social norms and forms of difference
What constitutes a disorder? How does the line get drawn, and by whom?
Do the characteristics of very high intellect, focused interest, and social awkwardness constitute a medical condition?
What does it mean when 15-25 percent of male children and adolescents are diagnosed with a developmental disorder?
What do we make of the reality that America has generally embraced most forms of cultural diversity and individual difference, but labels and stigmatizes so many of its children?

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The Problems with the DSM

The history of psychiatry: a cautionary tale (slides)
The narrow lens: when all you have is a hammer….
The reaction against Feud and psychoanalysis (1980 DSM), and the promise of an emerging science
Wonder drugs in a quick-fix culture
The problem of cost and insurance—an endemic focus on short-term profits
Diagnostic drift in structural terms – definitions in the DSM
Diagnostic drift in professional terms – poorly trained physicians doing psychiatric diagnosis
The medicalization of ordinary human challenges

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Psychiatry’s Defense

DSM diagnoses are based in emerging science and years of experience and research
Psychiatry has moved far beyond the ills of the past
New medications provide a relief from suffering that was never available before
Psychiatry works within constraints imposed by cost, insurance agencies, etc.

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Psychiatry’s Defense

Most psychiatric drugs, especially for ADHD, have few side effects when used as prescribed
Medications always work based when used with behavioral or educational interventions—it’s not psychiatry’s fault that this often does not happen
Problems with poor practice, medication abuse, and so on, are societal issues, and don’t invalidate the medical model
Psychiatry is not responsible for the pressure to perform; it is simply responding to societal needs

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Real Social Problems

An epidemic of diagnosed depression and anxiety and treatment by meds
An epidemic of diagnosed childhood ADHD and emerging epidemic of ASD
The use of Adderall and other stimulants as aids to performance
The epidemic of illicit Adderall use on college campuses
The medicalization of a broad range of human behaviors, from grief to shopping

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Universal Design: Embracing Neurodiversity

Universal design….

…anticipates diversity in learners as the norm and operates on the premise that the planning and delivery of instruction as well as the evaluation of learning can incorporate attributes that embrace heterogeneity in learners without compromising academic standards.

McGuire & Shaw, 2001 as cited by McGuire & Scott, 2006, p.22.

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The Concept of Universal Design�

UD incorporates economic, engineering, cultural, gender, and

environmental concerns to meet the needs of the

widest range of users.

Example of UD in architecture

Add/subtract?

St James Church, Woodstock, VT

Let’s explore the term “universal design” by looking at this slide. If you can stretch your imaginations to imagine the building with a ramp on the side, then I want to ask you to tell me what’s wrong with this picture? Are there problems with having the ramp on the side of the building?

Samples answers:

It’s ugly

It separates people

It’s not built into the design of the building

When architects were first given mandate to make public buildings accessible to those with mobility impairments, they found that the above was true. However, when they integrated the “universal design” they found that they were helpful to the most diverse needs. So, when we think about for example,

Question: How might an elevator benefit a variety of people using a building, not just someone who is paralyzed? E.g. Someone carrying large load, pregnant woman, someone with a broken leg, etc.

Left: Church before the renovation

Right: graceful entry ramp and stone wall, designed by Mark Mitchell Associates, of Brandon, VT (Ben Mitchell’s dad)

As we’re going to see in a minute – there was a culmination of legislation which drove the need for UD.– additions and changes to building can pose significant challenges to universities and colleges whose buildings were built pre 1968 (prior to the Architectural Barrier Act of 1968) – costly renovations and modifications are needed to ensure students have physical access to learning environments. Many buildings are obviously not built with the concept of UD -- Often times, Disability Service providers need to relocate course locations, so that students with mobility impairments can get to class – i.e. move the class to a building with an elevator, etc.

There is a distinct difference between making a building accessible vs. universal --- one is the adaptation of the building to serve a particular need of possibly one or a handful of people, while the other takes into consideration the potential needs of all users . . .

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Principles of Universal Design for Instruction

Equitable use
Flexibility in use
Simple and intuitive
Perceptible information
Tolerance for error
Low physical effort
Size and space for approach and use
A community of learners
Instructional climate

8/3/2014

Shaw, S., Scott, S., & McGuire, J. (2001). Retrieved on March 12, 2007, from http://www.facultyware.uconn.edu/UDI_examples.htm

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Additional Elements

Curriculum modification in elementary and secondary grades (e.g., Response to Intervention)
Explicit strategy instruction: Teaching the hidden curriculum
Teaching skills and capacities in meaningful contexts, in ways that connect to a wide variety of strengths
Integrating Gardner’s “Multiple Intelligences” into the curriculum – recognizing the value of other kinds of strengths

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Gardner’s Multiple Intelligences

1. Verbal-linguistic intelligence (well-developed verbal skills and
sensitivity to the sounds, meanings and rhythms of words)
2. Logical-mathematical intelligence (ability to think conceptually and
abstractly, and capacity to discern logical and numerical patterns)
3. Spatial-visual intelligence (capacity to think in images and pictures, to
visualize accurately and abstractly)
4. Bodily-kinesthetic intelligence (ability to control one’s body movements
and to handle objects skillfully)
5. Musical intelligences (ability to produce and appreciate rhythm, pitch
and timber)

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Gardner (cont.)

6. Interpersonal intelligence (capacity to detect and respond appropriately
to the moods, motivations and desires of others)
7. Intrapersonal (capacity to be self-aware and in tune with inner feelings,
values, beliefs and thinking processes)
8. Naturalist intelligence (ability to recognize and categorize plants,
animals and other objects in nature)
9. Existential intelligence (sensitivity and capacity to tackle deep questions
about human existence such as, What is the meaning of life? Why do we
die? How did we get here?

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Notes Toward a New Paradigm

Embraces the neurodiversity of children and young adults
Operates from a combination of phenomenological observation/experience and research-based knowledge about neurodevelopmental variations
Resists labels and diagnosis, except in severe cases

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Notes Toward a New Paradigm

Provides a rich, hospitable environment for learning in a way that focuses on abilities, keeps learning expectations high and meaningful, and engages all students in considering the importance and value of difference and neurodiversity
Combats “ableism” just as much as it combats racism, sexism, prejudice, homophobia, and other forms of insult to difference
Appreciates the right of each individual to determine their own destiny

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Preview: Test Prep and Review

What are some of the key themes of the lecture series – what general points have I come back to again and again?
What are some of the central concepts we have covered?
What are key figures, names, dates, and facts?
Tests are designed to be tricky – what strategies will you use?
Tomorrow, come prepared to discuss these questions, and also be sure to develop at least two questions of your own, put them on paper, and hand them in at the beginning of class