Autisme Team Noord-Nederland (Autism Team Northern Netherlands) The Autisme Team Noord-Nederland, often abbreviated to ATN, offers specialist ambulatory assistance to children, adolescents and adults with an autism spectrum disorder. The ATN is specialised in extensive diagnostics, customized treatment, consultation and improvement of expertise. The assistance does not only focus on the client. Parents, the partner or other family members may also be involved in the treatment, as well as other directly involved persons such as group leaders, teachers, mentors or work supervisors. ATN is part of the Jonx Autism care group within Lentis and is established at three locations: Groningen, Hoogeveen and Drachten. Friesland also has a number of walk-in consultation locations. The teams consist of (child and youth) psychiatrists, (healthcare) psychologists, remedial educationalists and pedagogical staff. The assistance is organised from the various locations, but is sometimes provided elsewhere, for example at home or in a day care centre.
Various target groups The ATN-locaties each have different target groups and treatment options.
Target group Groningen location ›› infants aged 0-4; ›› children and adolescents aged 4-18; ›› adults; ›› ASS+: children and adults with autism with an additional impairment (such as deafness, blindness or a mental impairment).
Target group Hoogeveen location ›› children and adolescents aged 4-18; ›› adults ; ›› all intelligence levels, unless the ASS+ team (Groningen) is more suitable.
Target group Drachten location ›› infants aged 0-4; ›› children and adolescents aged 4-18; ›› adults; ›› all intelligence levels, unless the ASS+ team (Groningen) is more suitable.
What is autism? Autism is a developmental disorder, which often manifests itself already in the first years of life. The development of the child is different in several developmental areas. Autism has many manifestations and may therefore express itself in each client differently. In one person you can see right away that something is wrong, while the other seems to live life without problems. There are several forms of autism. The term autism is an umbrella term for all disorders within the Autism Spectrum. The best known is the autistic disorder which presents problems in three areas:
1. Qualitative restrictions in social interaction People with autism have problems interacting with other people. The way in which they make contact is noticeable and they are often unable to form friendships and maintain them. They can not sense other people very well and show less consideration for others. Furthermore, especially with children, it is noticeable that they have difficulty making eye contact. In extreme cases they look past you. Laughing in response to some else's laughter also seems to develop less. 2. Qualitative restrictions in the communication The language development and the manner of communicating often deviate. An example is the development of spoken language which slows down or is disrupted. For people with autism, it is often hard to keep conversations going. The rather talk to someone than with someone. For example, they often talk about their own interests, without checking if the other person is also interested in it or even informed of that subject. The use of language may present peculiarities, such as regularly repeating certain words, noticeable accents or, on the other hand, speaking monotonously. Pronouns such as I and you, are used by some in reversed order. Children with autism often also play differently. No or fewer (spontaneous) ‘pretend’ and copying games are played. Imitating the behaviour of others is often difficult. Play often remains tangible such as stacking, ordering or letting toys move. Sometimes, on the other hand, there is too much phantasy, which makes it difficult for them to continue making a difference between phantasy and reality. 3. Restricted, repetitive stereotyp patterns of behaviour, interest and activities. Children and adults often continue to stick to routines and habits. In addition, there may be limited interests and/or preoccupations. A preoccupation is an excessive focus on a certain subject or (part of) a subject. Examples are the continuous turning of wheels of a toy car or lenghty talks about computers or trains. When routines become disrupted, this may be accompanied by considerable problems such as fits of anger or panick attacks. In addition, special movements may occur such as rocking, flapping of arms or making turning movements with hands or fingers. In addition, we see that people with autism can move stiffly, may have other sensory experiences (for example hypersensitive or, on the contrary, not sensitive at all to pain, cold and warmth) and make more use of proximity senses (such as licking, smelling and touching of objects). These characteristics usually become visible before the age of three. During the course of life, the problems change and some of the characteristics become less prominent. The problems with social interaction usually coninue to be the most striking, for adults as well. Apart from the autistic disorder, there are other, autism-related contact disorders such as Asperger's Syndrome or Pervasive developmental disorder not otherwise specified (PDD-NOS). These also present the above problems but to a lesser degree. In the years to come, following the renewed classification system of DSM V, no difference will be made anymore between the different types of disorders in the autistic spectrum. Instead of talking about autism, Asperger or PDD-NOS, we will call it autism spectrum disorder. Autism cannot be cured. When years go by, some characteristics may fade somewhat, also through compensation and masking, so they become less noticeable. Apart from an autism spectrum disorder, there may also be additinal mental problems such as mood or anxiety disorders.
Causes The exact cause of autism has not yet been established. Different studies give rise to the presumption that autistic behaviour occurs because the brain functions differently. Biological factors, which are not yet exactly known, cause deviations in the functioning of the brain. There are strong indications that hereditary factors play a role in this as well. People with autism have difficulty ordering sensory information that enters the brain (by hearing, seeing or smelling et cetera). They can't make a meaningful whole of it. The world then consists of loose fragments that are hardly connected or connected wrongly. This makes life confusing and chaotic, to which people respond with so-called ‘autistic behaviour’.
Explanations From scientific research three theories have been formulated to be able to explain the behaviour of people with autism:
1. The weak theory-of-mind (TOM) The theory-of-mind concept refers to the skill of people to empathise with the feelings, thoughts and intentions of others. This is important to respond in a socially appropriate manner. People with autism lack an intuitive theoryof-mind. They struggle with several, varying emotions, for example funerals, sadness and small talk. They also take the interests of their interlocutor less into account, causing a possible lack of reciprocity in the contact. For the same reason, jokes, white lies or double entente may be hard to understand for people with autism. 2. The weak executive functioning theory (EF) Executive functioning refers to the skill to handle situations in which quick and routine solutions no longer work. They require planning and flexibility among others. People with autism find this difficult. For example, they continue holding on to a chosen solution strategy, even if it doesn't work anymore. In addition, doing several things simultaneously poses many problems for them. This may explain why people with autism like to hold on to routines and habits and are rigid in the way they act. 3. The weak central coherence theory (CC) Central coherence refers to the skill to attach meaning to (social) information. People with autism often pay special attention to irrelevant details and consider coherence less. They perceive reality in a fragmentary and litteral sense. As a result, they may show socially awkward behaviour. This theory does not only explain the weak points of people with autism. It also provides an explanation for the qualities of some people, such as a detailed knowledge of trains or dinosaurs.
A specialist team What does the ATN do? The assistance offer consists of the following options: ›› diagnostics (G/H/D); ›› psycho-education (G/H/D) information on autism, both individually and in groups; ›› medicinal treatment (G/H/D); ›› social skills training (G/H/D); ›› ENN model (G/D) Eclectic Northern Netherlands early intervention model; ›› play training (G) developmental stimulation of young children; ›› Parental guidance (G/H/D) ›› pedagogical guidance (G/H/D) support of parents and carers (for example group leaders); ›› part-time treatment (D) intensive treatment for adolescents and adults; ›› parental course (G/H/D) group parenting support for parents; ›› afternoon for brothers and sisters of children with autism (G/H/D) group transfer and exchange of information for brothers and sisters; ›› individual guidance (G/H/D) of young people, adolescents, adolescents and adults; ›› behavioural therapy (G/H/D) behavioural therapy aims to achieve more constructive behaviour through change of behaviour in children, adolescents and adults; ›› Light therapy (G/H/D) for seasonal depression or for delayed sleep phase disorder; ›› EMDR (G/H/D) EMDR is a therapy for people who continue to be troubled by a shocking experience (PTSS) ›› RelASS (G/H/D) if one of the partners has autism. RelASS can be offered to the couple or in a group; ›› consultation, both by telephone and face-to-face (G/H/D) for carers and other experts; ›› developing expertise (G/H/D) through courses and information; ›› interactive women's group (D) exchange of experience and knowledge of the various areas of life, specifically for women; ›› creative therapy (D) visual therapy is an experiential therapy, offered to individuals.
G = Groningen location H = Hoogeveen location D = Drachten location For more detailed information on the assistance offer, we refer to the available leaflets on the various forms of treatment. They can be requested via the various secretariats and can be viewed at www.jonx.nl.
Registration Registration is done in writing or digitally by doctors, GP's, mental health institutions and medical specialists. Children and adolescents can also be registered by the municipal authorities, Youth and Family Centre (CJG), mental health doctors or the Youth Care Agency. Direct registration by clients or parents themselves is not possible. The written registration contains previous diagnostic information (such as developmental anamnesis and psychological assessment) including: ›› reason for registration; ›› request for assistance of the client or the parents; ›› previous assistance provided. If necessary, the ATN will ask for additional information.
Consultation Requests for consultation can be made by (mental) health care professionals, carers of people with a physical or mental impairment or the youth care sector. You can contact the secretariat by telephone. After discussing it with the substantive issues teamleader, a written application may be required for an extensive consultation.
Intake and diagnostics As soon as a registration has been received, existing assessment information is requested, of course after permission of the persons involved. Depending on this information and that of the referrer, a decision is made to carry out a more or less extensive diagnostic examination. This is necessary to determine the nature of the disorder and exclude possible other disorders. The examination may consist of (child) psychiatric, pedagogical and psychological examinations. If needed, a referral is made for additional examination to, for example, the neurology department, the Centre for language and speech disorders or paediatrics department. Apart from a diagnosis and a treatment advice, the diagnostic examination also needs to provide an answer to the question if further assistance has to be provided by the ATN, or if it can be offered by regional care or treatment institutions.
Direct registration by clients or parents themselves is not possible.
Treatment Treatment of a child with autism focuses on the stimulation of a normal as possible development and on reducing specific problems. For adults, the assistance also aims at reducing autism-specific problemes and enhancing social skills. The persons directly involved often benefit from information and pedagogical or emotional support. Increasing knowledge of the problems and enhancing social skills is an important part of the treatment. The ATN considers the client him/herself, parents, partner and other directly involved persons to be part of her client's system. The exact content of the treatment depends on various factors such as the request for assistance, the degree of autism and the workload - capabilities ratio of the parents or the partner. When the targets set beforehand have been met and if there are no new requests for assistance, the ATN closes the treatment. The client (or the parents) and the GP receive a closing letter summarising the diagnosis and the course of the treatment. In some cases, a referral back to the regional mental health institution or to a diferent follow-up guidance is made. Should, at a later stage, the assistance of the ATN be required again, contact can be made again via the GP.
Deductible The treatment at the ATN is free of charge. As of age 18, however, the annual statutory deductible for medical coverage applies; this means that the treatment is included in this deductible as long as it has not yet been paid to your health insurer for other medical expenses. For more information on the deductible please ask your health insurer.
Information and referral? For more information on the ATN or questions on referrals, please contact one of the locations of Autisme Team Noord-Nederland.
Contact details Autisme Team Noord-Nederland (ATN) Groningen Laan Corpus den Hoorn 102-2 9728 JR Groningen Postbox 86 9700 AB Groningen Telephone 050 – 522 32 99 Fax 050 – 522 32 66 atngroningen@lentis.nl ATN Groningen has general consultaation hours from Monday to Friday from 9 -10 am. Autisme Team Noord-Nederland (ATN) Friesland Zuiderdwarsvaart 72 9203 JB Drachten Telephone 0512 – 33 49 50 Fax 0512 – 33 49 69 atnfriesland@lentis.nl ATN Friesland has general consultation hours from Monday to Thursday from 1 -2 pm. Autisme Team Noord-Nederland (ATN) Drenthe Crerarstraat 6c 7901 AE Hoogeveen Telephone 0528 – 22 99 30 Fax 0528 – 22 99 49 atnhoogeveen@lentis.nl ATN Drenthe has general consultation hours on Tuesday and Friday from 1 -2 pm. © Jonx|Lentis, 2015 No rights may be derived from this publication. J 0008 | 10-2015