Work at NCRC is aimed at complex correction of motor, psychoemotional, cognitive, speech disorders leading to social maladjustment in children and adults with nervous system pathology.
In order to provide rehabilitation assistance to patients diagnosed with “Childhood autism”, NCRC on its own initiative in 2014 began training specialists to work with children with special needs, in particular those diagnosed with “Childhood autism”, and in 2015 opened 10 specialized beds for their inpatient rehabilitation. During this time, they underwent complex inpatient rehabilitation in 2015 – 74 children, 2016 – 142, 2017 – 155, 2018 – 214, 2019 – 263 children, and in less than 6 months of 2020 – 156 children. The number of children hospitalized increases every year.
All conditions have been created for the rehabilitation of children diagnosed with “Childhood autism”:
- Specialists (psychologists, defectologists, speech therapists, game therapists, music therapists, neurologists, occupational therapists, tutors, educators) have been trained. Mentors from leading foreign clinics of the world (Slovenia, Russia, USA) have been repeatedly invited, master classes have been held with the participation of foreign specialists.
- Specially equipped rooms for working with children with special needs have been opened (rooms for a psychologist, a game therapist with a Gesell mirror, sensory integration rooms, etc.).
- One of the first in the country that has introduced inclusive education at the school of NCRC, tutors for working with children with special needs have been trained.
- Along with the newly opened centers, among the first, our correctional teachers and doctors have mastered and are developing methods for diagnosing autism: the Autism Diagnostic Observation Schedule – ADOS, the Autism Diagnostic Interview-Revised – ADI-R, the Childhood Autism Rating Scale – CARS, the Modified Checklist for Autism in Toddlers, Revised – M-CHAT-R.
- NCRC correctional teachers were among the first in the country who have introduced such methods of correction and rehabilitation as: ABA – therapy (Applied Behavior Analysis), Cognitive Behavioral Therapy (CBT), alternative communications, Picture Exchange Communication System (PECS), visual support, sensory integration methods, the JASPER (Joint Attention, Symbolic Play, Engagement & Regulation) approach, the adaptive and inclusive sports indicated in the parents’ appeal were introduced by our employees at the “Balbulak” RC in Almaty and in NCRC in Nur-Sultan city even before admitting patients diagnosed with “Childhood autism”, and many other techniques.
- Nutritionists of NCRC daily develop dietary meals for children with “Childhood autism” (from 30 to 70 children) and food selectivity.
- The management of NCRC has made a decision to provide all carers (100%) with a free bed.
The results of the work of our specialists with children with special needs are regularly discussed in the medical councils of NCRC, reflected in quarterly, semi-annual and annual reports. According to the analysis of work with patients with special needs, the coverage of children with rehabilitation activities specified in the rehabilitation protocols, as well as the above-mentioned modern specific methods of correction, remains at a very high level.
Attention is drawn to the fact that the effectiveness of corrective rehabilitation work was high in young children. Older children do not want to stay in stationary conditions for 25 days (this is how long one course of rehabilitation at NCRC lasts), round-the-clock stay worsened their health (along with behavioral disorders, children also refused to eat, go to bed, to classes and rehabilitation procedures, etc.), in connection with that the parents were forced to leave after 3-5 days, which prompted us to direct all efforts to young children.
According to the literature and analyzing the experience of other centers dealing with the problem of autism, we would like to note that for children with special needs, the duration of the rehabilitation course lasts 7-8 weeks in an outpatient stay or a day hospital (A.Subbotina, “Kuzminki” Moscow rehabilitation center). O.Vlasova from the Moscow Center for psychological, medical and social support for children and adolescents of the Moscow State University of Psychology and Education gives the classification adopted by them: ECA (early childhood autism) – F84.0 in children from 4 to 10 years old, atypical autism – F84.1 in children from 10 to 14 years old.
At the end of 2019, the number of children population is 5 784 800 children (from 0 to 18 years old), including 84 944 children with disabilities who need certain rehabilitation services. In the Republic of Kazakhstan there is no reliable statistics on children with autism. In 2017, world statistics noted that 1 child in 50 children is autistic. According to various sources, from 1920 to 3000 children are officially registered in Kazakhstan. According to the World Health Organization, the number of children with autism is growing annually by 13%. Kazakhstan is no exception.
The number of beds in NCRC is 300. Annually, for 25 days, NCRC can accept 14 arrivals of 300 children, a total of 4200 children per year, which is insufficient nationwide taking into account the above number of children with disabilities who also require rehabilitation measures.
NCRC does not completely refuse to accept children with special needs, but in 10 specialized beds intended for children with autism for 14 arrivals, NCRC can accept 140 children diagnosed with “Childhood autism”, which is also not enough for the whole country. But, despite the lack of trained specialists, the center annually accepted up to 263 children instead of 140 children. There are many examples when medical institutions specialize depending on the equipment, the presence or absence of trained personnel, bed capacity, according to the programs themselves developed (independently or with the help of foreign colleagues), the effectiveness of which is designed for a certain age, have departments for children from 0 to 1 year old, from 0 to 3 years old, for infants, from 1 to 14 years old, etc. Taking into account this circumstance, as well as the availability of trained personnel in the NCRC specifically for work with young children, as well as special programs for work with children with “Childhood autism” under 7 years old, developed together with specialists from Russia and Slovenia (A.Sorokin; E.Zhestkova; the Soča University Rehabilitation Institute of the Republic of Slovenia), it has been decided to focus on young children (expanding the age instead of the recommended 7 years to 10 years), which corresponds to the principle of early intervention. For older children, we consider it advisable to undergo a course of correctional care in a day hospital and an outpatient complex of correctional work, without violating their usual conditions of stay, diet, selectivity in food and, most importantly, without worsening their health. But, despite this, and also taking into account the numerous requests of the parents of children diagnosed with “Childhood autism”, NCRC decided to admit all children of childhood within the available beds.
We would also like to draw your attention to the fact that only on the example of Nur-Sultan city, there are specialized centers with well-trained personnel working with children diagnosed with “Childhood autism”: “Alua” center for children with autism, “Asyl Miras” Autism Center, “Zhasyl Zhailau” center for children with autism, the ABA-center for children with autism and other disorders, etc., where children can undergo a qualified rehabilitation course both in daytime and outpatient conditions. We express our great hope that these centers, as well as NCRC, work under the state order, provide free services to children with autism, where all conditions have been created for the rehabilitation of children with autism, adhere to the principles of the UN Convention on the Rights of Persons with Disabilities, and new approaches to teaching children with special needs are being developed, inclusive education has been introduced, social integration has been introduced, conditions for adaptive and inclusive sports have been created for children, about which the authors of posts on social networks write.
In conclusion, we would like to express the hope that all problems associated with the diagnosis, treatment, rehabilitation and correctional classes with children with autism will be solved not only at the expense of NCRC, but by joint efforts of various institutions (healthcare, educational, social protection authorities), non-governmental public associations, and by the opening of new rehabilitation centers in the regions, and by training personnel, where it is necessary to pay great attention to compliance with all the principles of rehabilitation (three aspects: medical, social, psychological and pedagogical): accessibility, early start, succession, continuity, consistency, individuality, multidisciplinarity, complexity, stages, patient and family involvement.
And National Children’s Rehabilitation Center of “University Medical Center” Corporate Fund will fulfill own mission within the limits of it’s bed capacity, competence and specialization, also as the main educational and methodological center continue to train personnel for the rehabilitation service of the entire republic by organizing full-time, correspondence (online), field training courses, annual scientific and practical conferences with international participation, provide methodological guidelines, rehabilitation protocols. And we expect only support and respect for our work from the public and government authorities.
“University Medical Center” Corporate Fund