Wednesday, July 13, 2011

Closer': A film dealing with autism

Recently I got chance to glimpse into the life of children/people with Autism and their family through a movie named “'Closer': A film dealing with autism” by Meghana Gulzar. (click on the picture for the movie page)

I was a bit confused first as I thought it may not be able to portray the real feelings of this group of population, but I am happy that it proved me wrong. As the movie started I was amazed to hear a voice of a mother who was explaining the story of her son Rahil, the emotions and the confusion she stated purely explains the mental status of the parents having children with Autism. As the story of these angels begins and further parents explains about their children, a voice again thrilled me and filled me with some anomic emotions, it was a poem, I don’t know about the poet but that poem is something I must share with you all:

Masuum ek ankh keh rahi hai kan mai,

Ik jahan aur bhi hai is jahan mai,

Dekha to hai magar use hum jante nahi,

Uski nazar ko theek se pehchante nahi

Hum panchi kehte hai jise wo macchi kehte hai

Ha meethi cheez ho to wo bhi acchi kehte hai

Hum sochte hai jabhi to budhi kho jate hai

Unke khyal shayad pet gudgudate hai

Wo chaand dekhe lagta hai kha jaye tod ker

Suraj chala gaya hai apna anda chood ker

Dilchasp hai wo duniya agar dil lagao to

Wo bhi tumhara hissa unko bulao to

Dono jahaano mai abhi zara si duri hai

Kuch aur pas aao parichaye jaruri hai

Masum ek ankh keh rahi hai kan mai,

Ik jahan aur bhi hai is jahan mai.

These lines were not just lines they were beyond it, and they actually made me think again and again about the social integration of these children, about the gap between them and the society, about the barriers they are facing everyday because of our lack of interest (as a whole society) in their integration. After this thoughtful session the movie touches other sensitive areas of their life. The area which invaded into my thought process was a question asked by a mother of a teenage, about the physical and mental needs of this group at certain age (described by her as “catch 22 situation”). I was actually thinking about this from long time after the movie “My name is Khan”, that they are also having some physical and mental needs (here I am talking about the sexual urges) which should be cater but in our society this area is still to be develop. The other question was a big one asked by the same mother –“what after us?” this wasn’t only her question it’s the question of all those parents living with this population group.

We have to think deeply about the socioeconomic development as well as psychosocial needs of this population to answer these questions. A same kind of approach is shown in the film also. The main part of the film (that is related to the treatment part) was somewhat satisfactory to me; they have opened a window for the parents and people related to the population having autism. And for me all that Occupational therapy approaches and activities described their brought a feeling which cannot be explained in words, but the only thing I feel that there is Occupational Therapy in words and activities but no OT was there to explain the OT domain in Autism. But still one of our Occupational Therapist Ms Bhawana Agarwal, passed out from Santosh Medical College, tried to give the possible answer to the above situation on behalf of all the Occupational therapists which I would I like to mention here as this would be the best way to give a beautiful and thoughtful end to this entry. It goes like this:

Us jahan se is jahan tak hum tumhe layenge,

Is jahan se hum tumhari pehchaan karwayenge.

Panchi aur machhi k antar ko tum pehchanoge,

Bas meethi cheez hi achhi nhi hoti ye bhi janoge.

Nahi kho jaoge fir tum har chhoti baat par,

Tum bhi cheezon ko thik se samajh paoge.

Chand ko khane ka dil phir nahi karega,

Janoge tum kyun jata hai suraj,kya chhod kar.

Hum tumhe bulate hain is duniya me aao,

Is duniya ko bhi tum dilchasp paoge.

Thaam lo hamari ungli aur mitao ye doori,

Kar lo pura vo parichay jo hai zaruri.

Us masuum ankh ko kaho,kahe hamare kaan me,

Wada hai us jahan ko le aayenge is jahan me.

Thursday, April 14, 2011

Autism: What they actually wants!!!!

Hello friends, today when I was looking a video regarding the success story of a girl child having Autism Carly, I thought of this blog. When we are talking about Autism, a lots questions arises, and a lot of myths also. By just listening the world Autistic for a child we make numerous assumptions about him, but do we really care about, what he wants and what he feels, the answer is No.

We as a Therapist, as a parent, as clinician are just superimposing our thoughts and assumptions on the child. From my personal experiences since last 2 year with these angels, I actually realized that before starting with our therapeutic program, we have to understand them first, we have to understand their behavior, we have to understand their tantrums and we have to understand their basic needs. Look into their eyes there are numerous questions, study their tantrums, they actually telling you something, they actually want to express themselves but don’t know, how to do so. They wanted to enjoy life just like other children but something is their which is hindering their way, you have to find it out. Talk to them, it’s not like that they can’t understand you or it’s not necessary for them, it is actually necessary!!

They are like just another normal child, with some challenges and lots of abilities, but their abilities are sometimes masked by their challenges. We are very much interested in the triad of Autism and the word Autistic brings these three things in our mind:

  1. · See their social interaction is poor
  2. · They can’t even communicate
  3. · They must be having various compulsive and repetitive behaviors

And in these three challenges we overlooked their inherent capabilities. Once I was attending my Neurology lecture on Autism, there was one statement that took my attention-“Autistic children lack emotions and if they have they cannot express it” and suddenly a picture came into my mind of a child with Autism-Harsh. Harsh is a child with autism. He used to come for his therapeutic sessions regularly. The first thing he do, whenever he see me or my colleagues, is calling us with our Names. Once one of my colleague approached him and start talking, suddenly he looked toward her and said in a scanning tone with shaking head “Bhanu Madam, nai aayi thi, mai roya tha”( Bhanu madam, didn’t came, I cried). At that point of time we are feeling that we are Autistic as we are not able to express our emotions. Then we realized that what she had given him was Care and trust. So i must say, they are emotional and yes they can express their emotions also, but the way is a bit different, but does it really matters......I tried several times to be just empathetic and not emotional as emotions can hinder our therapeutic process, but with these children I have to support my therapy program with emotions, and I must say these emotions actually paid in the form of improvement in their personality. Around those days only I came across a book –“Ten things every child with Autism Wishes you know”, and this book helped me to understand them a bit batter. See they are not lacking in capabilities, they are lacking in finding the way to success, they need your help, so help them, and I can bet on this they will surely prove their worth.

Saturday, February 26, 2011

Ten things every child with Autism Wishes you know

Here I came across an awesome book written by Ellen Notbohm "Ten things every child with Autism Wishes you know" I thought of sharing those ten things with you people.. hope you will like them. So here comes the “Ten things every child with Autism Wishes you know”:

1. I am first and foremost a child. I have Autism. I am not primarily "Autistic".
"Defining me by one characteristic runs the danger of setting up an expectation that may be too low, and if I get a sense that you don't think i "can do it", my natural response will be: why try?”

2. My sensory Perceptions are disordered.
“This means that the ordinary sights, sounds, smells, tastes and touches of every day that you may not even notice can be downright painful for me.”

3. Please remember to distinguish between won’t (I choose not to) and can’t (I am not able to).
“It isn’t that I don’t listen to instructions. It’s that I can’t understand you”

4. I am concrete thinker. This means I interpret language very literally.
“Idioms, puns, nuance, double entendres, inference, metaphors, allusions and sarcasm are usually lost on me”
5. Please be patient with my limited vocabulary.
“I may be hungry, frustrated, frightened or confused but right now those words are beyond my ability to express.”
6. Because language is so difficult for me, I am very visually oriented.
“Please show me how to do something rather than just telling me.”

7. Please focus and build on what I can do rather than what I can’t do.
“Look for my strengths and you will find my potentials and capabilities. There is more than one right way to do most things.”

8. Help me with social interactions.
“ It may look like I don’t want to play with the other kids on the playground, but sometimes it’s just that I simply do not know how to start a conversation or enter a play situation.”

9. Try to identify what triggers my meltdowns.
“Meltdowns, blow-ups, tantrums or whatever you want to call them are even more horrid for me that they are for you. They occur because one or more of my senses has gone into overload.”

10. If you are a family member, please love me unconditionally.
“I did not choose to have autism. But remember that it is happening to me, not you. Without your support, my chances of successful, self-reliant adulthood are slim. With your support and guidance, the possibilities are broader than you might think. I promise you- I am worth it.

So if you like these thoughts I would highly recommend you this book to understand the inner sight of these little angels.

Your friend
Amit Kochhar Occupational Therapy Student

Sunday, November 7, 2010

guys its for those who feels its difficult to describe OT amongst Indian Population in Hindi

ऑक्यूपेशनल थेरपी अथवा व्यवसायिक चिकित्सा एक ऐसा व्यवसाय है जो किसी भी व्यक्ति के जीवन में आई मानसिक, शारीरिक, व्यवसायिक एवम सामाजिक समस्यायों के कारण उत्पन्न हुई रुकावटों को दूर करके एक स्वतन्त्र जीवन व्यतीत करने में सहायता करता है|
ऑक्यूपेशनल थेरपिस्ट तीन प्रकार से इन रुकावटों का समाधान करता है: पेहेला ऑक्यूपेशनल थेरपिस्ट जड़ समस्या को दूर करने मई सहायता करता है अर्थात वह शरीर में उत्पन्न इन समस्याओं को अपने उपचार की विधियों द्वारा सुधरने का प्रयास करता है, दूसरा ऑक्यूपेशनल थेरपिस्ट मूल्यांकन करके देखता है की यदि समस्या का समाधान संभव नहीं है अथवा उपचार में बहुत समये लगेगा तो वह व्यक्ति को इस प्रकार के उपकरण एवम विधियाँ सिखाता है जिनसे वह स्वतन्त्र जीवन का निर्वाह कर सके, तीसरा यदि व्यक्ति को वह उपकरण देना एवम वह विधियाँ सिखाना संभव नहीं है तब ऑक्यूपेशनल थेरपिस्ट उस व्यक्ति के वातावरण में इस प्रकार के परिवर्तन केर देता है जिसे अपनी समस्याओं के बावजूत व्यक्ति स्वतंत्रता से जीवन निर्वाह केर सके|
ऑक्यूपेशनल थेरपिस्ट अक्षमता में क्षमता को देखते है| उनके अनुसार विकलांगता व्यक्ति में नहीं वातावरण एवम समाज में है क्योंकि वह उस व्यक्ति को ऐसा वातावरण प्रदान नहीं कर पा रहे जिसमे वह अपने व्यक्तित्व का विकास कर सके|
ऑक्यूपेशनल थेरपिस्ट बहुत सारी समस्याओं में अपनी सुविधाएँ प्रदान करते है जिनमे से कुछ समस्याए है:
१: बच्चों का विकास न होना (developmental disorder)
२: जन्म से उपस्थित कमजोरी एवम विकलांगता( congenital Deformity )
३: सेरेब्रल पाल्सी
४: लकवा( Paralysis )
५: शारीरिक कमजोरी
६: रीढ़ की हड्डी की चोट
७: हड्डियों का टूटना
८: लिखावट में समस्या
९: पढाई में समस्या
१०: जोड़ों का दर्द
११: मानसिक कमजोरी
१२: गठिया
१३: मांस पेशियों से सम्बंधित समस्याएं
१४: व्यवसाय का चुनना( समस्याओं के बाद एवम साथ)
१५: सर्जरी एवम ऑपरेशन के बाद
और भी बहुत कुछ....यदि सूचि बनाई जाये तो लगभग सभी समस्याओं में ऑक्यूपेशनल थेरपिस्ट प्रत्यक्ष एवम अप्रत्यक्ष रूप से सहायता करता है|
आशा करता हूँ की हिंदी भाषा में ऑक्यूपेशनल थेरपी की यह परिभाषा आपको एक आम आदमी को इसके स्वरूप एवम विस्तार को समझाने में मदद करेगी|
अमित कोचर
ऑक्यूपेशनल थेरपी विद्यार्थी

Friday, August 20, 2010

Diagnostic Criteria for 299.00 Autistic Disorder

[The following is from Diagnostic and Statistical Manual of Mental Disorders: DSM IV]

(I) A total of six (or more) items from (A), (B), and (C), with at least two from (A), and one each from (B) and (C)

(A) qualitative impairment in social interaction, as manifested by at least two of the following:

1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
2. failure to develop peer relationships appropriate to developmental level
3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people, (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)
4. lack of social or emotional reciprocity ( note: in the description, it gives the following as examples: not actively participating in simple social play or games, preferring solitary activities, or involving others in activities only as tools or "mechanical" aids )

(B) qualitative impairments in communication as manifested by at least one of the following:

1. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime)
2. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
3. stereotyped and repetitive use of language or idiosyncratic language
4. lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level

(C) restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at least two of the following:

1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
2. apparently inflexible adherence to specific, nonfunctional routines or rituals
3. stereotyped and repetitive motor mannerisms (e.g hand or finger flapping or twisting, or complex whole-body movements)
4. persistent preoccupation with parts of objects

(II) Delays or abnormal functioning in at least one of the following areas, with onset prior to age 3 years:

(A) social interaction
(B) language as used in social communication
(C) symbolic or imaginative play

(III) The disturbance is not better accounted for by Rett's Disorder or Childhood Disintegrative Disorder

Thursday, August 19, 2010

"Restricted" barrier free environment in Delhi

In Delhi while looking at the roads, footpaths, overhead bridges and subways one question always arises in my mind , that our PWD department is full of "good" mechanical, civil and architectural engineers and designers having "great" knowledge of ergonomics, barrier free environment and universal designs, but why the structures they are making are so restricted in their Barrier free Domain......?

Stairs of bridges are combined with slope for wheelchair with such an angle that it is almost impossible for the differently abled people like wheelchair users to use them effectively... I haven't seen any underground subway with barrier free designs... and about foot paths, oh they are really shocking, let me explain this with an example of braille tiles installed at foot paths, these barrier free structure are installed in such a way that if visually challenged people will follow this, their life would be in danger... as these structures are opening into open gutters , pillars and trees....

The biggest reason behind this problem is lack of practical environmental assessment and architectural evaluation... And the one who performs these assessment is no where in the PWD team and that is none other than Occupational therapist... our Govt. is very indifferent toward Occupational therapy and its services... and this is the main reason that even after spending billions the out come is still negative and the dreams of disability free India is no where coming into practical environment....

So lets unite and tell this Govt. about great and divine domains of occupational therapy so that the dream of disability free India will come true in coming future.....

I'll soon upload pics of these great "Restricted" barrier free environment in Delhi


(Why Occupational Therapy is neglected after all these instructions which can be fulfilled with this Profession Only do they have any answer)


1.9.1 SSA will ensure that every child with special needs, irrespective of the kind, category and degree of disability, is provided education in an appropriate environment. SSA will adopt ‘zero rejection’ policy so that no child is left out of the education system.

1.9.2 Approaches and Options:
The thrust of SSA will be on providing integrated and inclusive education to all children with special needs in general schools. It will also support a wide range of approaches, options and strategies for education of children with special needs. This includes education through open learning system and open schools, non formal and alternative schooling, distance education and learning, special schools, wherever necessary, home based education, itinerant teacher model, remedial teaching, part time classes, community based rehabilitations (CBR) and vocational education (WHO WILL PROVIDE THIS REHABILITATION??)and cooperative programmes.

1.9.3 Components: The following activities could form components of the programme:
(a) Identification of children with special needs: Identification of children with special needs should become an integral part of the micro-planning and household surveys.(WHO WILL IDENTIFY??) A concerted drive to identify children with special needs should be undertaken through PHCs, ICDS, ECCE centres and other school readiness programmes.

(b) Functional and formal assessment of each identified child should be carried out.(WHO WILL ASSESS FUNCTIONALLY???)A team(WHO WILL BE THE MEMBERS OF THIS TEAM????) should be constituted at every block to carry out this assessment and recommend most appropriate placement for every child with special needs.

(c) Educational Placement: As far as possible, every child with special needs should be placed in regular schools, with needed support services(WHICH SUPPORT SERVICES???).

(d) Aids and appliances: All children requiring assistive devices should be provided with aids and appliances(aids & appliances given…end of the needs of the special child??WHO is gonna TRAIN THEM WITH SUCH AIDS & APPLIANCES???) , obtained as far as possible through convergence with the Ministry of Social Justice and Empowerment, State Welfare Departments, National Institutions or NGOs.

(e) Support services: Support services like physical access, resource rooms in the existing BRC/ CRC, special equipment, reading material, special educational techniques, remedial teaching, curricular adaptation, adapted teaching strategies and other services like physiotherapy, occupational therapy, speech therapy could be provided (STILL THEY ARE USING THE WORD ‘COULD’!!!???!!)

(f) Teacher training: Intensive teacher training should be undertaken to sensitise regular teachers on effective classroom management ( Again teaching the management : OT field) of children with special needs. This training should be recurrent at block/cluster levels and integrated with the on-going in-service teacher training schedules in SSA. All training modules at SCERT, DIET and BRC level should include a suitable component on education of children with special needs.

(g) Resource support: Resource support could be given by teachers working in special schools. Where necessary, specially trained resource teachers should be appointed, particularly for teaching special skills to children (SPECIAL SKILLS..!!SPECIAL EDUCATOR’S WORK??????!!)with special needs. Wherever this option is not feasible, long term training (WHO WILL TRAIN THE ‘SPECIAL SKILLS’ TO THESE REGULAR TEACHERS WHO ARE GOING TO TEACH THEM TO THE SPECIAL CHILDREN?????) of regular teachers should be undertaken.

(h) Individualised Educational Plan (IEP): An IEP should be prepared by the teacher for every child with special needs in consultation with parents and experts. Its implementation should be monitored from time to time. The programme should test the effectiveness of various strategies and models by measuring the learning achievement of children with special needs periodically (WHO IS GOING TO CONDUCT THIS TEST???), after developing indicators.

(i) Parental training and community mobilization: Parents of children with disabilities should receive counseling and TRAINING (MY GOD..!! NOW WHO IS GOING TO COUNCEL THEM..????WHO IS GOING TO TRAIN THEM TO FULFILL THE SPECIAL NEEDS OF THEIR CHILDREN?????)on how to bring them up and teach them basic survival skills. Strong advocacy and awareness programmes should form a part of strategy to educate every child with special needs. A component on disability should be included in all the modules for parents, VEC and community.

(j) Planning and management: Resource groups should be constituted at state, district levels to undertake effective planning and management of the programmes in collaboration with PRIs and NGOs. An apex level resource group (WHO WILL BE THE MEMBERS OF THIS ‘APEX LEVEL NATIONAL GROUP’….DOES ANYONE QUALIFIES EXCEPT OCCUPATIONAL THERAPISTS…???????)at the national level to provide guidance, technical and academic support to children with special needs under SSA may be constituted.

(k) Strengthening of special schools: Wherever necessary, special schools may be strengthened to obtain their resource support, in convergence with departments and agencies working in that area. ((seems like Shakespere’s thoughts to me!!!))

(l) Removal of Architectural barriers: Architectural barriers in schools will be removed for easy access. Efforts will be taken to provide disable-friendly facilities in schools and educational institutions. Development of innovative designs for schools to provide an enabling environment for children with special needs should also be a part of the programme. All new school buildings should be constructed with barrier- free features.

(m)Research: SSA will encourage research in all areas of education of children with special needs including research for designing and developing new assistive devices, teaching aids special teaching material and other items necessary to give a child with disability equal opportunities in education (now what to say…!!!!DID THEY HAVE ANY IDEA WHO IS GOING TO ACCOMPLISH THIS TASK WHEN THEY WERE PLANNING FOR IT???????) .

(n) Monitoring and evaluation: On-going monitoring and evaluation should be carried out to refine the programme from time to time. For this, appropriate monitoring mechanisms should be devised at every level and field tested at regular intervals. (THEY ARE PLANNING TO DEVICE SOMETHING NEW..!!!)

(o) Girls with disabilities: Special emphasis must be given to education of girls with disabilities.

1.1.1. Convergence: All activities, interventions and approaches in the area of education for children with special needs will be implemented in convergence with existing schemes like Assistance to Disabled Persons for purchase/fittings of Aids/Appliances (ADIP), Integrated Education of the Disabled Children (IEDC) and in coordination with the Ministry of Social Justice and Empowerment, State Department of Welfare, National Institutions and NGOs.

1.1.2. Expenditure up to Rs.1200 per disabled child could be incurred in a financial year to meet the special learning needs of such children. The ceiling on expenditure per disabled child will apply at the district level. (THEY ARE READY TO EXPEND AT DISABILITY….!!BUT THEY DON’T WANNA SPEND A PENNY ON THE PROFESSIONS DEALING WITH IT..!!!)





Visit to know more (high court orders to appoint a special educator in every CBSE school)

-thanks & regards

Rishu Khurana
Amit Kochhar