Welcome to the second edition of Four! and to 2009! Thank you for all the comments we received from the 1st edition. We hope you enjoy this edition as we strive to improve as each one comes along. Remember if you have got any articles or comments to make, please feel free to pop us an email here

So get the kettle on, get a snack, kick back into the chair and enjoy!

That was the question posed on the second day of the joint Gheel / BILD / Studio III conference held in Tullamore, Co. Offaly, at the back end of last year. The motion for the debate was: "ABA Approaches represent the best way forward for the education of children with ASD". With strong opposition from the platform (Rita Jordan, Andy McDonnell) the proposers (Rita Honan, Ken Kerr) had their work cut out. It was the parents in the audience who sealed the argument by conveying a feeling that whilst ABA provided an autism friendly programme, particularly for the early years, it was difficult to rank as there were not many choices or alternative programmes to access in Ireland. Those opposing the motion expressed their discomfort about some of the terms bandied about, such as: 'cure', 'treatment', 'recovery' etc. It couldn't be said that ABA won the day but it was a close run race,

In fact the whole two-day event was about finding answers to important questions and the scene was set by our very own Dr McDonnell (aka Andy) who opened the conference by presenting a paper: "When it comes to Autism, what are the important questions?" The theme of the conference was based on the premise that the label 'autism' is a relatively new phenomenon and since Leo Kanner's original use of the term, it had become clear that a diagnosis of autism can have a wide range of complicated implications.

Over the years it has become apparent that autism is not a single entity but a complex continuum. As our knowledge of autism increases, its sheer complexity means that the provision of support and services must be flexible and varied. This means that parents, carers and professionals often face questions about autism that are difficult to answer easily.

The programme was packed with speakers and contributors who, between them, represented an eclectic range of opinions and expert knowledge and who went a long way to contextualise modern research and thinking within changing service provision.

There was a cultural side as well as Studio III, the NAS and BILD formed an impromptu choir to provide melodic (did I really use that word?) entertainment at the gala dinner held at the end of the first day.

Gravitas was restored the next day however as the ABA debate got underway with protagonists and detractors in even numbers. The programme was punctuated by an authoritative keynote from Professor Stephen Bustin during which he analytically exploded the myths around spurious MMR research that had erroneously linked the vaccine to autism. You could almost hear the palpable relief amongst the parents in the audience as the acquired emotions of years of misinformation were washed away.

The delegates at the conference comprised a rich mix of parents, professionals and service providers who gelled as a single body with a common thirst for knowledge and re-assurance. Like many, I suffer from CFS (Conference Fatigue Syndrome) but this event proved to be a rare antidote to this condition.

3 mountains, 2 days and 2 men.

An epic adventure just shouting out to be a Hollywood blockbuster. Well if they did make that film the two leading men must surely be our very own Dave Walker and Andy McDonnell who bravely took up the challenge to scale these 3 peaks of British biblical proportions! Click on this link to read about their exploits and also how to donate to worthy charities.

studio3.org/3peaks

As we read more of the emerging details of this tragic case, I'm reminded of a phrase that cropped up in a conversation I had some years back- "selective communication"

You always here "person centred planning." When do you here person centred action?

I watched McIntyre's Undercover programme with a group of students recently. Two things came to mind at the end.

I was facilitating a course on November 11th (Armistice Day) and we stopped for the 3 minutes silence. While contemplating the reasons why we observe this moment, I was drawn to how peaceful silence is. Within our profession and for the matter life in general do we actually get quiet time? It can be hard to achieve a complete quiet environment but the benefits for anyone who wishes to clear the mind and relax, surely it must be a goal worth attaining?

Travelling for work has many advantages. Every week is a different place, a different hotel and different people, all of which can be an interesting and enriching experience. There are also downsides to the open road occupation, and one of these can be loneliness. Of course at times this is fine, even longed for, the idea of finishing work, heading back to the hotel and holding up in your room with the TV, radio, a book or internet to pass the time away. Some would say this can be bliss. But there are those times when conversation and companionship is missed. So when we Trainers at Studio III get the opportunity to work together it is always looked upon as a "team jolly."

It had been awhile since Rob and I had worked away together, so we were looking forward to our little trip over to Cork to deliver two courses simultaneously at the end of August last year.

The experience of an overseas trip can be a frustrating and tiresome one when travelling solo, with the airport and flight, but all this went by very quickly when you can catch up with a colleague and chat away. We appeared to breeze through the experience and within a few hours we had parked the hire car outside the hotel and were checking in. The hotel itself had an interesting past. A rather grand looking place, it had previously been a home of one of the local shipping magnates and it had impressive views of Cork Harbour.

Rarely for us, we were travelling on the back end of a bank holiday so we had the whole afternoon and evening to ourselves, so a quick recce to see where we were training was the first priority. Second was to eat!

Priority 1 was dealt with quickly. Very quickly in fact as we discovered the venue was literally next door to the hotel! So priority 2 was swift in commencing.

I had never been to the Cork area before. The 2nd largest City in the Republic and twinned with the cities of Coventry and Swansea. This extra time in Cork itself was looked upon as a getting to know the area as well. This is always a worthwhile exercise for trainers to do when you can, because at times you can end up in places in the dark and knowing the area is always reassuring especially after weary journeys.

After a fine meal and a stroll around the town centre we returned to the hotel to freshen up for a hour or two, before we'd go out to "mooch" around the area some more, seeing we were in the final flings of the summer.

Our trip landed us in Cobh (pronounced Cove), and we ended up outside a bar as you do. We decided to conduct a not so clinical research based experiment, but we felt an important one. Murphy's (brewed locally) or Guinness – which is best? Conclusion….we don't know; jury still out.

Next day we turned up to do what we do best…train!

Scoil Triest Special School is a purpose built school, built in 1998, catering for a maximum of 72 children and adolescents with autism and communication disorders. We were to train staff including the teachers, special needs assistants, speech / language and occupational therapists. Even though this was the first opportunity the staff had to come together after their summer break, everyone was looking forward to easing back into work and onto a new school term the following week. Una O'Donnell who is the School's Deputy Principal gave us a brief tour of the school and settled us down into our training rooms and ensured that we had everything we needed.

The first morning of any course can be like that first few moments on a gym's treadmill, a slow start until you get into the stride. But both groups were very "on the ball" from the off and the morning appeared to fly by.

One thing we trainers appreciate is lunchtime and it has to be said, in Ireland, we do tend to get looked after rather well. Proper dinners are always welcomed more than a sandwich, although it has to be said, a sandwich is always appreciated rather than nothing at all!

The afternoon also flew by for both myself, Rob and the two staff groups. We both commented we had two lovely groups and that set the tone for the remaining two days.

That evening we had another bonus. Tim another of our colleagues, was also in the area with another service so the three of us met up for dinner and the evening passed with conversation and company. We even made a call to another colleague, Linda, who was over in the Dublin area, on her own unfortunately but she was enjoying having a walk along the beach. We also picked up on our previous night's research project to try to nail this stout debate but to no avail.

The second days training went by quickly and pleasantly. When teaching any staff group physical skills it can be a balancing trick to manage their fears, concerns, confidence and emotional wellbeing. Thankfully this group of staff appeared to have bonded as a team. Teamwork is always important and integral in the support of individuals when they become distressed and so staff supporting each other in the training environment is always a positive and reassuring sign for trainers.

With the second days training dispatched, we next moved onto the subject of what to do with our evening. We decided on the recommendation of the school's staff, to travel down to Kinsale which is known for its gourmet restaurants and beautiful harbour. After wandering around the little streets, we decided on having a gourmet supper of fish and chips on the harbour bay wall seeing it was a rare glorious summer evening.

Training staff to be confident and competent in very stressful times when individuals are at crisis can be hard physically and emotionally for those staff. But as this staff group had proved over the previous two days with their teamwork, the final days training went by as well as any trainer would wish for. In the summary both groups appeared to be very appreciative of our time. Una O'Donnell stated "All had very positive feedback on the course and will find it very valuable in the day to day activities in school."

Our Flight home was not till late that evening so we decided to head back over to Cobh as we did not have chance to view it in the daylight. When we arrived we had a treat in that an Ocean Liner was docked and was preparing to leave so we were able to see her off on her voyage. Cobh is an island in Cork harbour reputedly the worlds 2nd largest natural harbour in the world (after Sydney, Australia) and was a famous transatlantic port in years gone by. The most famous of vessels to dock here was RMS Titanic. On April 11th 1912 Cobh was the final port of call for the Titanic as she set sail on her ill-fated maiden voyage. We also had a look around the harbour museum and we also paid a visit to the St. Coleman's Cathedral which is a magnificent building perched overlooking the town and bay.

As we left the town we commented on how misty it was getting. That mist grew thicker as we returned the hire car at the airport. Of course the departure lounge and waiting in it can be a torturous experience when you just wanting to get home, but this was eased when there are two of you. We sat down and for the last time, had a pint of Murphy's and the conclusion Rob felt it was the winner for him. For me the judgement still out! As we sat waiting we called our colleague Steve Allison who was also in Ireland and mocked him on the fact his plane was delayed, which for Steve is a common event.

But Steve had the last laugh as our flight was also delayed due to fog. In fact it was delayed by over 4 hours! We landed back at Birmingham in the early hours of Saturday morning. The fact we did a near 7 hours of airport and flight together and not on our own eased the unfortunate calamity ending of the trip!

Rob and I would like to thank the staff of Scoil Triest Special School for their hospitality and permission for this article.

Steve Gorman,
Lead Trainer.

Rob Whiskens

Position: Lead Trainer

Brief Background History:

Pre Studio III Rob was the regional co-ordinator for an Asperger Syndrome specific outreach team based in the West Midlands. Prior to this he had worked for several large Autism / Asperger specific services around the country. Each service provided its service users with a slightly different model of support. The people he has supported have varied greatly in age, need and ability, but all could present behaviour that may be described as being challenging, should the conditions be right.

How long have you worked for Studio III?

I've worked for them for about 4 years, I joined June 2004.

What is your job title and your role within Studio III?

I'm a trainer with Studio III Training Systems, which provides a non aversive approach to challenging behaviour. We offer criterion-based training, working with staff to develop specific skills to meet the particular needs of the service user. It is essential that the background to the service user's problems are understood by all staff and that this understanding is used to define the direction in which these problems may be addressed. Studio III is not a provider of generic physical intervention strategies as the majority of our work is designed to promote the management of challenging behaviour in a totally non-violent, gentle and dignified way by the use of 'low-arousal' techniques and gentle physical skills. Training is specifically designed to support the service user and the staff.

I work with a number of different clients groups and staff teams, providing 3 day training courses, and some follow up / refresher training.

What do you find challenging about your job?

Probably the fact that every day is different, and you never know what you are going to be walking into!

What is your favourite aspect of your job?

The challenges I face every day make things interesting, and I like that. I also like working with a really good group of people in terms of the other Studio III staff. Although we all work independently, you can always get loads of help, support and ideas, and there is always someone at the end of a phone.

What is your least favourite aspect of the job?

Having to eat hotel / pub food all the time!!! I know to some people that might sound strange, but for most people, going to the pub or a hotel is a bit of a treat. We stay in hotels all the time. So when I'm at home and my wife or friends want to go out for a pub meal, I think, 'oh no, not again'!

What do you see as being the future for physical interventions?

It's funny really, as a trainer everyone expects physical interventions to be what it's all about. However the physical interventions aspect is actually such a small part of my job, in many ways. I guess for me, the future is about building on current standards, and ensuring that other organisations are supported to get through the BILD process. Hopefully, this will help to ensure that standards are raised and certain essential criteria are met.

It was with a mixture of excitement and trepidation that I set off on my South African odyssey. Bryan Evans from the NAS and I had been asked by Autism South Africa to deliver a series of one day workshops on Autism and Challenging Behaviour travelling from the East to West coast and back. The workshops were mainly for parents and families of children and young people with ASD although we also had many professionals attending. Both Bryan and I have a child with ASD and we were able to bring this experience to our training.

We were met by Claudia from Autism South Africa who was to take us to our first host's house where we were to stay for the first three nights. As we drove into Jo burg we were greeted by the vast Corrugated Iron shanty towns. I had seen them on news programmes but nothing could prepare you for the reality; it was hard to imagine that anyone could live in such a place long term let alone bring up a child with Autism there but as we found out this was certainly the case. Although this was a real culture shock it was not quite as shocking as driving through Jo burg seeing the big houses with 12ft high walls, covered in razor wire, electronic gates and with big signs saying "Armed Response". The gap between the 'have's' and the 'have not's' is huge, and consequently the crime rate in the cities is pretty high. But everyone we met was incredibly friendly. Our hosts could not have been kinder; we were royally entertained and we delivered our first workshop in Pretoria and our second in Jo burg itself; both were well received. We then we flew onto East London where we stayed in a lovely lodge where again the hospitality was overwhelming. From there we flew to Cape Town and were lucky enough to be given rooms at the Five Star Table Bay Hotel courtesy of the Manager who's son has autism. My room looked directly on to Table Mountain, and the weather was beautiful and so we were able to make the trip to the top where the views were spectacular. We had the Sunday off and were taken on a wine tasting tour of the cape which as you can imagine was very well received! Our next port of call was a beautiful town called George which was very sedate and where again we stayed in a beautiful lodge. Our next stop was Durban, which was much more tropical and we were hosted by the chair of Autism South Africa and his family and again we could not have asked for more considerate hosts. But just in case you're thinking it was just one big holiday, we did actually do some work and the schedule was pretty hectic!!

Autism specific services are pretty thin on the ground with only a handful of specialist schools across the country, and no autism specific adult services at all. Parents were having to pay to get a decent education for their child and many were worried for the future, as unless they could make provision for their child when they became an adult, then the future is uncertain at best and pretty bleak if services do not improve. Many of children are home educated and there are some pretty dubious practices occurring.

Some things we found shocking, such as the parents of a two ½ year old boy telling us that when their son was diagnosed three months previously the psychiatrist had prescribed Rispiridone (an anti psychotic drug) as a routine medication. I dread to think what long damage this is doing to a young child's developing brain. Sadly this was not unusual and it seems that prescribing drugs to children in this way is the norm.

Autism is a great leveller and the audiences we got at the workshops came from the shanty towns, the squatter camps and the big gated houses, all united by one thing; the need to understand their child. We were constantly amazed at the resilience of the people living in some pretty dire situations and their willingness to take on board our ideas and suggestions.

South Africa is a beautiful country full of contrasts and contradictions and as a nation they have a long way to go to solve the legacy of apartheid but I for one can't wait for a return visit.

Linda Woodcock,
Trainer.

If you only have read one book on psychology / psychotherapy with a good dose of spirituality then this is the book you must read. It's an absolute classic that's almost impossible to put down. Above all it has an extraordinary message about the meaning of life, its psychological importance and the ability of some people to pull through no matter what is thrown at them. For those of us working with people who have suffered horrendous abuse and neglect it's a real lantern in the dark reminding us that some, although maybe not all, of our clients will survive and move forward despite their past.

Viktor Frankl was a Jewish psychiatrist living in Nazi Germany who like many of his contemporaries was swept up by in the Nazi's final solution. Most of Man's Search for Meaning focus's on his autobiographical account of his experiences of his three years in Auschwitz, Dachau and other concentrations camps, between 1942 and 1945 and it's quite stomach wrenching. There are not that many books that have reduced me to tears but this was one of them. I can sometimes only stop and wonder how human beings can be so awful to other human beings. I know all the theories but when you see it reduced to actual dreadful practicalities you do start to wonder what life is all about.

For those prisoners weren't sent to the gas chambers at the initial selection, the conditions in the camp were both physically and mentally extremely brutal. The prisoners faced terrible undernourishment whilst having to do incredibly hard manual labour for a minimum of 12 hours a day. In winter, this would mostly be in sub-zero temperatures, with no winter clothes. Prisoner's died where they stood, they died where they slept. Prisoners were threatened by death daily and hourly. And they had no news of any other members of their family, who had either been sent to another camp or gassed immediately. Viktor Frankl's parents, brother and pregnant wife all lost their lives. As you would expect, the survival rate was very low, only 1 in 28 survival. Life was almost worthless but individual moments could be golden.

For me it was especially upsetting when Viktor Frankl talked about being crammed into a locked train and on the way to another concentration camp actually passing his house by the side of the railway line and being able to see it through a small gap in the side of the wagon. He describes his sense of wonder and hope for the future whilst I experienced a sense of desolation at our inhumanity.

Viktor Frankl talks about needing a lot of luck to survive. You had to avoid random killings. You had to avoid being selected for a work party with particularly hard labour or a particularly nasty foreman or Capo. You had to avoid getting frostbite in addition to the usual sores and injuries that went untreated for years. As allied forces advanced towards the camps things became increasingly dangerous especially when he decides to stay in the camp rather than leave with a group of camp guards and inmates they have 'freed.' Frankl later finds out that the guards shoot the prisoners.

The book stands out from other survival books in that it also takes time to focus on Viktor Frankl's psychological survival techniques that he calls logo therapy. It's based on existential psychotherapy and positive psychology and feels very real and realistic. Frankl recognises that survival is based on a complex set of interactions at three key levels. Each needs a degree of 'luck.' Firstly, Frankl often uses a quotation from Nietzsche: 'He who has a why to live can bear with almost any how.' Having this 'why', a 'why' for one's existence, is having meaning in one's life – without meaning there is no point. Secondly, the drive towards having meaning in one's life, the will to meaning, as Frankl calls it, is the primary motivation in humans. Frankl see's this all around him in the concentration camps – those who have a will to see the meaning of life in even the smallest way are more likely to survive. Thirdly, Frankl writes that there are three sources of meaning. The first is love. This is exemplified strongly by the experiences in the camp. In Frankl's own case, it's clear that it his love for his wife. Frankl mentions other examples of prisoners who, he claims, were able to survive the extreme conditions because of their connection to a loved one.

The second source of meaning is work. This too is exemplified strongly by Frankl's own experience as a prisoner. After a manuscript for his first book on logotherapy, is confiscated by a guards Frankl realises he has a very concrete meaningful activity to try to reconstruct the manuscript on scraps of paper he finds around the camp just in case he should live to be freed. Writing the manuscript gives him a 'why' for his existence. It is amazing when he contemplates that perhaps there is some value in the banner over the concentration camp entrance 'arbeit macht frei.' Perhaps work does make you free? He draws it all together when he writes 'A man who becomes conscious of the responsibility he bears toward a human being who affectionately waits for him, or to an unfinished work, will never be able to throw away his life. He knows the "why" for his existence, and will be able to bear almost any "how".

Although both these concepts are not surprising the third part of Viktor Frankl's survival strategy is. In fact I found it pretty remarkable as for Frankl the third source was unavoidable suffering. There are two reasons why suffering can be a source of meaning. Firstly, because our inner freedom -- our 'spiritual freedom', as Frankl occasionally calls it -- to choose the attitude we have to things is absolute, as it were, we can choose which attitude to take to suffering. No one can tell us how to feel. Secondly we can choose to see suffering as our 'task'. This 'task' of suffering, the 'task' of bearing one's cross, enables us to suffer 'proudly'. For Frankl life is about 'transforming a personal tragedy into a triumph' and he sees it time and again in the lives of the prisoners around him. They suffer hugely and can do nothing about it apart from use their own 'spiritual freedom' to change their attitude to their suffering so as to make it into a source of meaning. Those prisoners who didn't do this would often just give up remaining in their bunks, lying in their own urine and excreta, disobeying all orders to get up, smoking their last cigarette, generally just waiting for death. As I read this part of the book I was reminded about two young women who I work with who have both experienced horrendous and quite similar abuse. In many ways their outcomes should be so similar but in reality they are so different – one is bolshy and rude often obnoxious, she talks about what has happened, she recognises the effect but also of her need to move on. The other has retreated into a world of silence and resignation. Which one will make the most of her life? Which one is the luckier or do we in fact make our own luck?

At the end of the day this is a book about hope. It's not bombastic or academic, it crosses so many boundaries and should be read by everyone at least once in their life. It's not religious but it is deeply spiritual, it's not psychological but it is about the thought processes that underpin our very survival. Read it and hope that, unlike Viktor Frankl, you'll never need to experience its message to his extreme.

David Walker,
Director.