Due to the scarcity of literature on autism rehabilitation education and training in Mainland China, I must resort to my limited personal experiences (from the years 2000 to 2011) to describe the status of autism treatment in Guangzhou. Please note that inevitably there will be errors and omissions. According to the Guangdong Autism Rehabilitation Resource Guide published in March 2009 by the Guangzhou Organizing Committee of World Autism Awareness Day, there are only about 100 institutions in the Guangdong province that provide early training services for autism. As far as I know, autism rehabilitation for adults is still relatively unchartered territory in Guangzhou City and most of the institutions that provide early rehabilitation services are private non-profit enterprises ( PNPE). Only one institution, the Kangna School (previously known as Guangzhou Children's Autism Rehabilitation and Research Center) is directly operated by the government.
PNPEs are all confronted with the following issues:
- Although the government’s regulations for registering PNPEs are taking shape and temporary guidance is being provided, there is still a lot of grey area. For instance, it is not clear which governing body is in charge of PNPEs for autism. Is it the Civil Service Department? Or the Education Department? Or the Department of Health? Or the Disabled Persons’ Federation? Or the Department of Industry and Commerce? It remains unclear. As a result, even now some autism PNPEs have not been formally registered. Only a few have managed to obtain acknowledgement of governance from the Civil Service or Disabled Persons’ Federation and become legally registered as PNPEs.
- In response to the severe scarcity of early autism rehabilitation services, the PNPEs which are not officially registered assume the task of community rehabilitation. These PNPEs are mainly organized by parents of children with autism. Because the districts are not able to meet the demands of these autistic children, they are pleased to see the efforts of parents and seldom interfere.
- The qualifications of teachers vary tremendously. Because PNPE employees are not well-paid and handle heavy workloads, PNPEs often fail to recruit instructors, early childhood educators, therapists, and nurses with undergraduate degrees or general normal education diplomas. Even organizations that manage to recruit qualified employees find it difficult to retain them for extended periods of time. Small or financially-strained PNPEs are only able to employ those with no formal normal education or miscellaneous backgrounds. These employees generally lack basic knowledge about autism prior to employment. Once employed, they are not given adequate training and are therefore unable to meet the rehabilitation and education needs of the children with autism.
- Because some frontline employees work with autistic children with severe issues (severe behavior problems, physical disabilities, sensory integration dysfunction, allergies, and malnutrition issues) over a long period of time, they are often at their wits’ end. When it becomes obvious that their short-term training has been insufficient and ineffective, these employees lose their motivation. As a result, there is a high rate of attrition. Often these employees leave and switch to another line of work or senior employees are “poached” by better PNPEs.
- Many founders of these PNPEs for autism are parents of autistic children and other enthusiastic volunteers who lack knowledge of institutional operation and scientific management. The leaders of these PNPEs usually lack knowledge of the following critical areas: security design, nutrition, curriculum design, employee training, recruitment evaluation, quality of training, parent education, social integration, and community outreach.
- Another problem for PNPEs for children with autism is that their student population is unstable which can lead to financial difficulty for the organization. This is mainly because parents come into contact with different PNPEs at the same time, compare the performance of the PNPEs, and later leave one PNPE for a better-performing PNPE . Other families are forced to move to other districts due to changes in parents’ work location and sometimes financially-disadvantaged families become unable to afford the exorbitant fees (fees range from 1,000 to 3,000 Chinese yuan). In addition, PNPEs have to cope with rising costs, such as rent, employee salaries, social security, and other fixed energy and tax fees in Guangzhou. This results in some PNPEs experiencing constant financial struggle.
- As a result of the aforementioned financial challenges of the PNPEs, their sites lack proper maintenance and upgrading, and their employees, often in deflated spirits, tend to be lured away by other PNPEs offering higher salaries. All of this gives rise to undesirable phenomena such as unhealthy competition between PNPEs and “poaching” of each other's students.
- The variety of techniques currently offered here in the education and rehabilitation of children with autism is inadequate. Currently PNPEs for autistic children are still focused on applying structured teaching using the TEACCH Method. Other intervention models and techniques have yet to be explored here. Even if PNPEs wanted to apply different intervention and teaching models (for example, ABA, sensory integration therapy, multisensory therapy, music therapy, Floortime, sand play therapy, and art therapy), they lack the qualified professionals to do so.
- The transitional space for autistic children is not sufficient. Some children with autism show remarkable improvements after early intervention and should attend mainstream kindergarten or elementary education institutions. Unfortunately, however, they do not because many have behavior difficulties (interpersonal challenges, communication difficulties, or other “weird” behaviors) and teachers in mainstream classrooms lack the necessary knowledge and support to teach students with special learning needs. Despite the integrated education policy for learning in regular classes, autistic children are often refused by mainstream education institutions. Only one school, the Kangna School, is exclusively open to autistic children in Guangzhou. It accepts merely twenty students every year (according to statistics from 2010), far from enough to meet the demands.
- Home schooling, a model for parents to educate autistic children at home, can play an important role in the growth of autistic children. As home schooling is still a relatively new concept in Guangzhou, there have only been a few practices that have been successful in promoting home schooling. These include Yilin in Qingdao, Shandong Province, Humiao School in Huizhou, Guangdong Province, and the Louis Program in Hong Kong.
- The level of social integration of individuals with autism and level of public awareness of autism in Guangzhou are far from satisfactory. Outside of PNPEs and homes, autistic children need understanding, support and tolerance from greater society to achieve positive results in their education, rehabilitation, and growth.
Founder/Chairman, Autism Hong Kong
About the author: Sau-ying Yu, founder and chairman of Autism Hong Kong, is a registered social worker in Hong Kong with 26 years of social work experience. Sau-ying Yu is committed to working with disabled adults and in recent years has focused on promoting the movement of annual World Autism Awareness Day in Hong Kong and Guangdong province.
This article is based on the author's talk given in August 2009 at the Seminar on Social Services in Hong Kong Council of Social Service and Guangdong held by the Hong Kong Council of Social Service and the Bureau of Civil Affairs of Guangdong province. This article is an excerpt from the author's contribution to the Seminar.
The views expressed in this paper are those of the author(s) and do not necessarily represent the views of the NLM Family Foundation.