Vårdmiljö eller lärandemiljö? : om personer med autism inom vuxenpsykiatrin

Sammanfattning: The research field of the thesis is clinical adult psychiatry and it focuses on the treatment of patients with autism spectrum disorders. Before the publication of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) in 1994 intellectually high-functioning patients with autism have not been included in diagnostic manuals and received appropriate treatment in adult psychiatry. In recent years it has become evident that these patients have long existed in psychiatric settings with other diagnoses than autism. This group of patients is poorly understood by their staff and the treatment they receive is seldom related to their specific difficulties.

The aim of the thesis is to contribute with theoretical and practical knowledge explaining the specific difficulties patients with autism have with contact, communication and cognition. Persons with autism have since early infancy not been able to profit from social learning and social interaction, which results in a psychological development different from normal developmental rules. Individuals with autism do not automatically include the perspectives of others in their communication and cognition. In psychiatric treatment it is normally taken for granted that all patients follow the same psychological rules.

Methods used are qualitative. A contextual analysis is made of eight psychiatric clinics, the staff members´ ideas about treatment, their understanding of their patients and their reorientation related to the patients with autism. Observations and semi-structured interviews are used in order to receive background information about the psychiatric contexts in which the patients with autism are treated. Learning theories about social learning in early infancy are used to explain the different psychology of adults with autism. Learning theories about adult learning are used when designing an education on autism. Documentation received by the staff members, describing their learning process, is analysed and put in relation to the results their learning had for the patients.

The staff of eight psychiatric clinics has received an education on autism, specially designed for their educational needs. The specific difficulties patients with autism have are explained. When alternative explanations are given to those of the autistic patient´s behaviours, which are regarded as problematic or enigmatic by the staff members, a reorientation process begins in the understanding of the patient.

Eight patients with autism are presented as case studies, giving examples of how the reorientation process of the staff members gives new perspectives to the patients´ problems and results in new treatment approaches. The results for most of the patients were spectacular – all patients, who had earlier had diagnoses other than autism, were better understood from the autism perspective. The need for re-diagnosis became apparent. All patients were better understood and received more individualized treatment after the education. One long-term patient was discharged after 25 years in forensic psychiatry.