I have been invited several times to China for the purpose of discussing health care delivery options for autistic individuals. In my most recent trip I had the pleasure of touring several hospitals and special education institutions. Some of the innovations that I observed while touring these institutions are well worth publicizing and implementing in our own country.
My first stop in China was at the Beijing Haidian Special Education School. Its formal name is less appealing in Western cultures, “The School for the Mentally Retarded at Haidian District Beijing”. We were met by Yan Cao the director of teaching who led us around the campus. The school serves over 300 children with special needs of which 140 have a diagnosis of autism spectrum disorders (ASD). This is a massive 3 story building complex spanning the different sides of a large rectangle capable of harboring a football field. This government based school provides individualized education in classrooms having 5 or fewer students per teacher. The school covers grades K-9 and they partner with another school that serves the high school years.
I was very much impressed by the facilities at the Beijing Haidian School. All of the classrooms were quite modern being equipped with projectors and smart boards. Classroom are protected with electronic locks and 4 or 5 video cameras which are always recording. The teaching staff seemed rather young but well versed in modern teaching methods. Story telling was stressed with pictures explaining the chores each student would be doing throughout the day. As the students completed chores, they gained tokens which they could use at school.
Although it could have been that the teachers knew I was going to visit, they were well read in regards to my own research. Furthermore I was surprised to discover that they had a transcranial magnetic stimulation (TMS) machine which was being used as part of their educational process. They were also thinking of introducing virtual reality as a desensitization technique for social phobia.
Contrary to many schools in the US that emphasize earth tones for painting the walls, colors at the Beijing Haidian Special Education School and other institutions that I visited were quite vibrant. Furthermore,contrary to the emphasis on incandescent lights in the US, all ceiling lights were fluorescent. Neither the colors of the walls or ceiling lights seemed to bother the students in any way.
The Haidian Special Education School emphasizes a traditionally Chinese art program that was also meant to improve fine and gross motor skills. One innovation that I noticed was a small chair designated as “the autism chair”. This was a rather austere looking piece of furniture whose seat was angulated slightly forcing the thigh muscles into the abdomen. The teachers said the small amount of pressure created by the chair was reassuring and calming to the autistic children.
The Haidian school is in a special District where most of the affluent Chinese society live. I thought that since the school served the children of the higher class that it would someway bias the government services in their favor. This was not apparently the case and several of the other institutions that I visited were equally impressive.
Following my visit at the Haidian school I visited a pediatric hospital in another part of Beijing, the Fengtai Maternal and Child Health Hospital. We were met by a most gracious superintendent of the hospital Dr. Xiaonian Wang. The hospital served a large number of autistic children including some 200 of them considered adolescents (12 to 18 years of age) that were receiving not only health services but also special education at the facility. This was a new concept to me, a hospital that also serves as a school and research facility.
As with the Haidian School I was taken by surprise that the hospital had implemented rTMS as part of the treatment regimen for autism following a protocol derived from several of our publications. They used their own Chinese device, called Mind Touch which can deliver low frequency pulses capable of inducing inhibition in a given area of the cerebral cortex. The hospital also promoted music therapy for autism and apparently had its own band of kids playing percussion instruments. Inside of the hospital was a very large facility, built as a playground, where kids received physical therapy aimed at improving their motor skills.
At the hospital I was struck by an area called the “Sand Therapy” room. The room boasted several large sand boxes and a large stand filled with figurines. Kids loved playing with the sand and learning from its texture. The figurines allowed them to build scenarios which they could discuss with their therapists. After learning the basics of the technique, parents were invited to participate in the therapy.
Another of the special education schools that I visited was near the airport and far removed from downtown Beijing. Again, this was a huge facility which at the time we visited had some 300 kids in attendance. The school may have gained some international reputation and was attended by a significant percentage of foreigners, primarily Russians. For those kids coming from afar or needing intensive treatment, they had in-grounds accommodations. Including room and board, the total cost of care was less than $700 per month. Although this was a good amount by Chinese standards it pales with the tuition paid in similar institutions within the United States.
I was told that about 140 of children in attendance were diagnosed or suspected of having autism. Those classified as suspect cases had exhibited some developmental delays and were at high risk for the condition, having had a prior sibling thus diagnosed. Some of the children we saw receiving therapy were as young as 1 year of age. The interval from the time when the parents suspected something was wrong with their children to the time when they received therapy was extremely short.
I was impressed by the fact that even though labelled a school, the organization provided a large number of medical interventions. They emphasized massage therapy as a way of desensitizing autistic children and usually started the day with this therapy. They also had acupuncture, acupuncture with electricity and something called electroacoustic therapy. The latter has a different meaning as used in the US. In China it is meant to describe a procedure where an individual is grounded at a different potential than the masseuse. In applying this technique the masseuse uses his hands to transfer electricity to the patient thus making different muscles contract. I had the opportunity to receive the massage and can clearly say that it works.
In all the institutions that I visited the presence of parents was quite noticeable. Parents are required to stay with their children in all cases, with the exception of the very high functioning ones. In the case of music therapy, they were even members of the music band.
The Chinese government is taking a proactive stance supporting special education needs throughout the country. China has 290 million children under 14 years of age, making it the largest population in the world. Since 2005 they have a nationwide longitudinal study that has randomly screened over 95,000 children age 6 to 15 in 31 provinces. The data thus far collected makes them believe that the rise in prevalence is quite real and not one due to changing diagnostic criteria.