Over the past several months, I have been critically thinking about how we can deliver optimal active treatment and behavioral services. In my interactions with clinicians, managers, assistant managers and direct care staff over the years, I have observed that there are various ways in which we attempt to improve our clinical services. For example, I have found that in the course of their work, staff members and clinicians try to incorporate their own set of beliefs and expectations about the autistic populations – that are not necessarily evidenced based - with the purpose of bettering their quality of service. The set of principles that we have derived from our experiences with working with this population, undoubtedly guide the nature of the services we provide. For this reason, I think that amongst these principles we should focus on the underlying learning processes of individuals with autism.
According to the theory of mind mechanism hypothesis (ToMM), autistic individuals develop thoughts, feelings and communication as part of the core architecture of the human brain. There is an empirical association between their impaired developments of this mechanism and their intellectual and cognitive deficits, behavioral problems, and difficulties in communication and social interaction. The notion behind this association is that the impairment in intellectual functioning affects the ability of the autistic individual in aspects of acquired knowledge, information processing, and communication. With regards to their ability to acquire knowledge, for instance, they are generally deficient in their understanding of the thoughts, emotions, attitudes, and intention of others. Researchers have recognized these characteristics as “mind blindness”. This relationship between the deficits in brain function and development may be thought to explain for concomitant problems regarding their ability to plan, flexibility of thought and action, set shifting, inhibition, attention, working memory, and verbally mediated skills.
The theory of mind mechanism hypothesis (ToMM) has been important in our interpretation of the language, communicative and social interaction impairments in autism. Through ToMM, we can come to understand that one of the central difficulties encountered by autistic individuals is in their cognitive ability to use language appropriately in social contexts with intention and practical purpose. Deficits in particular aspects of pragmatic functioning are evident at all developmental stages, even in highly verbal adults with autism.
In adapting the ToMM hypothesis to the QSAC adult programs, we are incorporating what is referred to as the Neuro-Behavioral Model, whose focus lies in stimulating consumers’ areas of the brain that are more developed, and utilizing these strengths to work to improve their weaknesses.
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