Dr. Shah's Advice: A More Detailed Account

 The first thing I want to do now is to give a more detailed recap of the treatment advice given in Dr. Shah's book (Catatonia, Shutdown, and Breakdown in Autism). I avoided getting into too much detail originally because I didn't want to be plagiarizing the book. But I think I was overly cautious in this respect, to the point of not sharing much information. I do recommend that people purchase and read the whole book; I couldn't possibly summarize everything in it that I found useful. But in the meantime I'll include what I can here. In particular, I'm going to discuss much of the content of Chapter 7, "The Psycho-Ecological Approach," which details the Shah model of recovery. What follows here will likely take the form of a reading journal: I'm going to work through many of Dr. Shah's recommendations, point by point, and discuss my experiences with them where relevant. However, I'm going to save a lot of my ruminations until the end/until a future series of posts, as I want to present Dr. Shah's advice here as clearly and concisely as possible. I'm also going to do my best to ensure that my language here, and my overall discussion, is as accessible as possible. 

12 components of the psycho-ecological approach. 

1. Psychological assessment 

a. Profile of catatonia, shutdown, and breakdown.

b. Profile of individual's autism and vulnerability.

c. Ecological and milieu factors

d. Interpretation and formulation

2. Identifying individual stress, anxiety, and non-coping

Environmental stressors/preventing relapse (104). 

3. Increasing awareness and avoiding misdiagnosis.

4. Psycho-education and receiving 

5. "Culprit" meds

6. Early identification

7. Increasing structure, routine, and consistency.

8. Implementing immediate strategies of support.

a. Support, assistance, and help.

b. Prompting, cognitive refocusing (distraction), and other activities. 

c. One-to-one support. 

9. Activity and stimulation therapy.

10. Reducing decision making. 

11. Management of specific problems:

     a) eating

     b) speech (having to verbalize decisions)

     c) difficulty w/walking

     d) incontinence

     e) standing still

     f) catatonic excitement

12. Psychological interventions and support for the high functioning individual. 

Dr. Shah suggests that these interventions should unfold in four stages:

Stage 1: Response. 

Stage 2: Short-term strategies.

Stage 3: Long-term strategies and management plan.

Stage 4: Management and maintenance.


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