Volume:4 Issue: 1 June 2012 - Engelliler Araştırma Enstitüsü
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Volume:4 Issue: 1 June 2012 - Engelliler Araştırma Enstitüsü
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: ihdiken@anadolu.edu.tr, ibrahimdiken@gmail.com ASSOCIATE EDITORS: Macid Melekoglu, Ph.D., Eskisehir Osmangazi University, TURKEY, E-mail: macidayhan@gmail.com Orhan Cakiroglu, Ph. D., Karadeniz Technical University, TURKEY , E-mail: cakirogluorhan@gmail.com Tevhide Kargin, Ph.D., Ankara University, TURKEY, E-mail: Tevhide.Kargin@education.ankara.edu.tr 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. Anadolu University, TURKEY Philippa Campbell, Ph.D. Thomas Jefferson University, USA Atilla Cavkaytar, Ph.D. Anadolu University, TURKEY İlknur Çifci-Tekinarslan, PH.D. Abant İzzet Baysal University, TURKEY Sam DiGangi, Ph.D. Arizona State University, USA Özlem Diken, Ph.D. Anadolu University, TURKEY 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. Anadolu University, TURKEY 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. Arizona State University, USA Mark Innocenti, Ph.D. Utah State University, USA Ann Kaiser, Ph.D. Vanderbilt University, USA Sema Kaner, Ph.D., (Professor Emeritus) Ankara University, TURKEY Necdet Karasu, Ph.D. Gazi University, TURKEY Özlem Kaya, Ph.D. Anadolu University, TURKEY 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. Anadolu University, TURKEY Heather Moore, Ph.D. University of Oregon, USA 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. Gazi University, TURKEY 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. Anadolu University, TURKEY Jane Squires, Ph.D. University of Oregon, USA 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. Ankara University, TURKEY Elif Tekin-Iftar, Ph.D. Anadolu University, TURKEY Seyhun Topbas, Ph.D. Anadolu University, TURKEY Yildiz Uzuner, Ed.D. Anadolu University, TURKEY Sezgin Vuran, Ph.D. Anadolu University, TURKEY Steve Warren, Ph.D. University of Kansas, USA Mehmet Yanardag, Ph.D. Anadolu University, TURKEY Paul Yoder, Ph.D. Vanderbilt University, USA Stanley H. Zucker, Ph.D. Arizona State University, USA 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 : ihdiken@anadolu.edu.tr ; intjecse@gmail.com International Journal of Early Childhood Special Education (INT-JECSE) Volume 4, Issue 1, June 2012 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 International Journal of Early Childhood Special Education (INT-JECSE) Volume 4, Issue 1, June 2012 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: psierra@psi.uned.es International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 2 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 3 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, International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 4 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 5 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 6 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 7 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 8 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 9 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 10 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 11 • • • • 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 12 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . Attachment and preschool teacher, 13 References Ainsworth, M.D.S., & Blear, M.C. (1978). Patterns of attachment: A psychological study of the strange situation. Hillsdale, NJ: Erlbaum. Ainsworth, M.D.S. y Eichberg, C. (1991). Effects on infant-mother attachment of mother´s unresolved loss of an attachment figure or other traumatic experience. In C.M. Parkes, J. Stevenson-Hinde y P. Marris (Eds.), Attachment across the life cycle. Londres, Routledge and Kegan Paul, 160-183. Ammaniti, M. (1989). 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Theory, research and clinical applications. (pp. 265286). NY: Guilford Press. Van Ijzendoord, M.H., Sagi, A.M. & Lanbernon, W.E. (1992). The Multiple Caretaker Paradox: Data from Holland and Israel. In R.C. Pianta (Ed). Beyond the Parents: The Role of Other Adults in Chldren´s Lives. (pp. 5-24). San Francisco: Jossey-Bass Publisher. Van Ijzendorn, M. H. (1990). Developments in cross-cultural research on attachment: Some methodological notes. Human Development, 33, 3-9. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 1-16 . 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. Investigation of social supports, 18 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 19 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 20 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 21 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 22 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** Special equipment to help meet my child’s needs .534* Financial help for expenses .491* Participation in an organized parent support group .490* Information on how I can help my child .440* Contact with other parent(s) who experienced the same situation .443 Help with independent living skills .365 Help with child care or respite care .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 Help with transportation .282 Information about my child’s future -.251 Information about my child’s condition or disability -.162 Counseling with a professional person Discussions with medical people 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 23 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 Discussions with medical people .550 Special equipment to help meet my child’s needs -.563 religious Relaxing and fun activities for my child and family .667 Information on how I can help my child Financial help for expenses .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 Counseling with a professional person .498 Participation in an organized parent support group .706 Help with transportation -.666 Information about my child’s future .595 Help with child care or respite care -.425 Contact with other parent(s) who experienced the same situation .521 Help with independent living skills -.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.” International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 24 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 25 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 26 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 27 References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorder, (4th ed., Text Revision). Washington, DC: Author. Bailey, D. B., Jr., & Simeonsson, R. J. (1990). Family Needs Survey (Rev. ed.). 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G., & Powell, D. R. (1980). Supporting families under stress: The role of social networks. Family Relations, 29, 566-574. Valentine, D. P. (1993). Children with special needs: Sources of support and stress for families. Journal of Social Work & Human Sexuality, 8(2), 107-121. Whitaker, P. (2002). Supporting families of preschool children with autism. Autism: The International Journal of Research and Practice, 6(4), 411-426. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 30 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. Investigation of social supports, 31 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 17-31. 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: myanardag@anadolu.edu.tr 2 Ph.D., Prof.Dr., Anadolu Üniversitesi, Beden Eğitimi ve Spor Yüksek Okulu, Eskişehir, E-posta: ilkery@anadolu.edu.tr International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 33 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 34 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 35 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 36 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 37 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 38 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 39 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 40 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 41 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! International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. Otistik Bozukluk ve su içi etkinlikler, 42 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. 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Prupas, A., Harvey, W.J., & Benjamin, J. (2006). An early intervention aquatics program for pre-school children with autism and their parents. Journal of Physical Education Recreation and Dance, 77, 46-51. Prupas, A. & Reid G. (2001). Effects of exercise frequency on stereotypic behaviors of children with developmental disorders. Education and Training in Mental Retardation and Developmental Disorders, 36, 196-206. Reid, G. (2005). Understanding physical activity in youths with autism spectrum disorders. Palaestra, 21, 6-7. Reid, G. & O’Connor J. (2003). The autism spectrum disorders. Palaestra, 19, 20-26. Todd, T. & Reid G. (2006). Increasing physical activity in individuals with autism. Focus on Autism and Other Developmental Disabilities, 21, 167-176. Yilmaz, I., Yanardag, M., Birkan, B., & Bumin, G. (2004). Effects of swimming training on physical fitness and water orientation in autism. Pediatrics International, 46, 624-626. Yilmaz, I., Yanardag, M., Ergun, N., Uysal, A., & Konukman F. (2011). Effects of pool exercise training on stereotypical behaviors in autism. Research Quarterly for Exercise and Sport, 82, A-76. Yılmaz, I., Konukman, F., Birkan, B., & Yanardağ, M. (2010). The effects of most to least prompting on teaching simple progression swimming skill for children with autism. Education and Training in Autism and Developmental Disabilities, 45, 440-448. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 32-45. 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, International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 46-49. Teaching social communication, 47 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 International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 46-49. Teaching social communication, 48 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. International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 46-49. Teaching social communication, 49 Reference Ingersoll, B., and Dvortcsak, A. (2010). Teaching Social Communication to Children With Autism. Newyork: The Guilford Press International Journal of Early Childhood Special Education (INT-JECSE), 4(1), 46-49.