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    <font face="Times New Roman">Gentile sig. Enrico,<br>
      ha ragione, ma è difficile fare una graduatoria gerarchica delle
      cose che non vanno in Italia.<br>
      Vogliamo aprire una analisi sulle competenze dei docenti di
      sostegno in relazione alla Sindromi o Patologie?<br>
      Ho dato delle Tesi di laurea come ricerca inerente il lavoro dei
      docenti in relazione al disabile generico ed all'autistico, per
      apprezzare se e come ne percepiscono le differenze e le necessarie
      diverse strategie d'azione.<br>
      Quanti sanno o vogliono distinguere i deficit dai disordini?<br>
      naturalmente ci sono anche docenti prepareati, coscenzioosi ed
      interessati alla riflessione.<br>
      Lo spreco è anche di risorse intellettuali.<br>
      Ho scritto tempo fa che, con il consenso delle associazioni dei
      genitori, si sono de-specializzati i docenti di sostegno (da 3 ad
      una specializzazione), in totale controtendenza a quanto avviene
      nei sistemi lavorativi e professionali.<br>
      Piero Crispiani<br>
    </font><br>
    <div class="moz-cite-prefix">Il 21/03/2023 09:32, Enrico Toffolo ha
      scritto:<br>
    </div>
    <blockquote type="cite"
cite="mid:CAPJEzYoCdHYeUMnA4OmRhdv5T4uJTW8R7wiSm2FWHJTrNpkhMA@mail.gmail.com">
      <div dir="ltr">
        <div dir="ltr">Buongiorno,
          <div><br>
          </div>
          <div>prima di affrontare l'eventuale "spreco" di risorse
            destinate ad alunni senza autismo ritengo che la discussione
            vada indirizzata sulla qualità delle risorse attualmente
            impiegate nella scuola.</div>
          <div><br>
          </div>
          <div>Sulla qualità condivido un recente articolo sugli
            insegnanti di sostegno <a
href="https://www.facebook.com/APRI.ONLUS/posts/pfbid0fzeGWD2fy6Hfq4KkYYWScsVMnhTRtxnQGUsVtHYFSD7nkjuoTfwbTYLG7KheDmaol"
              moz-do-not-send="true" class="moz-txt-link-freetext">https://www.facebook.com/APRI.ONLUS/posts/pfbid0fzeGWD2fy6Hfq4KkYYWScsVMnhTRtxnQGUsVtHYFSD7nkjuoTfwbTYLG7KheDmaol</a></div>
          <div><br>
          </div>
          <div>Altro grande spreco per risorse non qualificate (per
            l'autismo è acclarato) sono gli stanziamenti per gli AEC:
            100 + 100 milioni <a
href="https://disabilita.governo.it/it/avvisi-e-bandi/nota-informativa-fondo-per-l-assistenza-all-autonomia-e-alla-comunicazione-degli-alunni-con-disabilita-e-piano-di-riparto-a-favore-dei-comuni-anno-2022/"
              moz-do-not-send="true" class="moz-txt-link-freetext">https://disabilita.governo.it/it/avvisi-e-bandi/nota-informativa-fondo-per-l-assistenza-all-autonomia-e-alla-comunicazione-degli-alunni-con-disabilita-e-piano-di-riparto-a-favore-dei-comuni-anno-2022/</a></div>
          <div><br>
          </div>
          <div>...invito a leggere i bandi comunali e a trovare la
            parola autismo e le relative norme.</div>
          <div><br>
          </div>
          <div>Poi se vogliamo recuperare risorse riflettiamo sul fatto
            del perchè ci siano oltre 5.300 segreterie e centrali
            d'acquisto solo per le scuole del I ciclo.</div>
          <div><br>
          </div>
          <div>Enrico</div>
          <div>un papà ex candidato ad insegnante di sostegno</div>
          <div><br>
          </div>
          <div><br>
          </div>
        </div>
        <br>
        <div class="gmail_quote">
          <div dir="ltr" class="gmail_attr">Il giorno lun 20 mar 2023
            alle ore 16:33 Piero Crispiani <<a
              href="mailto:pierocrispiani@gmail.com"
              moz-do-not-send="true" class="moz-txt-link-freetext">pierocrispiani@gmail.com</a>>
            ha scritto:<br>
          </div>
          <blockquote class="gmail_quote">
            <div> Gentili signori della Lista,<br>
              pochi mi conoscono e pochissimi sono interessati a ciò che
              dico e tantomeno ad interloquire. <br>
              Non è un problema. <br>
              Ciò detto vi informo che intorno all'Autismo o Spettro c'è
              grande confusione, in parte giustificata dalla fase di
              transizione teorica degli ultimi tempi (quindi
              giustificabile), ma in parte si deve alla certificazione
              frettolosa che generalizza categorie a danno di altre.<br>
              Accade che condotte critiche del linguaggio e della
              relazione - addebitabili al ritardo del linguaggio ed alle
              conseguenze strategie di difesa o di compensazione -
              diventino condizione autistica.<br>
              Non è un gioco di parole.<br>
              Tanti afasici o con ritardo dell'eloquio (neanche del
              linguaggio complessivo, ma solo della produzione verbale
              orale, cioè dell'eloquio) sono corredati della diagnosi di
              autismo, quindi Legge 104, se non da invalidità.<br>
              La disprassia comporta a volte tratti associabili
              all'autismo (ipersensibilità, motricità afinalistica,
              lento incipit, disorganizzazioni, realismo verbale, ecc.)
              ma comportano autismo solo nei casi severi.<br>
              Questa platea di soggetti con "disorganizzazione" (usiamo
              questa categorie provvisoria) è certamente in crescita (e
              per diversi motivi): ma si può dire ai genitori che si è
              di fronte all'autismo?.<br>
              Provo a sintetizzare alcuni assunti:<br>
              - ad oggi la diagnosi di autismo è sindromica, si fa dai
              sintomi (in realtà è così sin dal 1943 .. senza nulla
              togliere alle ricerche in ambito genetico, proteico ....),
              anche se a qualcuno non va bene (mi pare);<br>
              - la diagnosi di autismo è difficile e delicata ed ha un
              grande bisogno della "valutazione funzionale", per aree di
              funzioni, per funzionamento, competrenze, reattività,
              condotte....;<br>
              - l'autismo è sensibile all'educazione (terapia,
              trattamento, training ....), a volte in termini
              sorprendenti, non ai bypassamenti, al non fare, alle APP
              SUPPLETIVE, al condizionamento o allo Stimolo Avversivo.<br>
              <br>
              Infine:<br>
              la gravità della condizione è fattore fondamentale poiché
              rendeuna condizione diversa e diversamente rispondente,
              quindi grande rispetto all'autismo grave ed all'autismo in
              comorbilità con alterazioni psichiche o neurologiche
              cerebrali. In questi ultimi casi, e con gli adulti,
              valgono le pratiche suppletive fondate su rinforzo,
              condizionamento, avversione, ecc.<br>
              <br>
              Se fossi genitore di un caso "vero", contesterei lo spreco
              di risorse (ad es, i docenti di sostegno) per i casi non
              autistici.<br>
              Il dibattito è, comunque, di notevole interesse.<br>
              <br>
              Se può interessare: <br>
              Piero Crispiani -  maestro elementare, Direttore Didattico
              (di cui 18 anni Direttore di una grande Scuola Speciale
              Statale per gravi e pluriminorati), Ordinario di Pedagogia
              Speciale Università di Macerata, Libero Docente Università
              Politecnica delle Marche e Link Campus University di Roma.<br>
              <br>
              <br>
              <br>
              <br>
              <br>
              <br>
              <br>
              <br>
              <br>
              <br>
              <br>
              <div>Il 20/03/2023 11:35, <a
                  href="mailto:albertofagni@libero.it" target="_blank"
                  moz-do-not-send="true" class="moz-txt-link-freetext">albertofagni@libero.it</a>
                ha scritto:<br>
              </div>
              <blockquote type="cite">Brava Stefania. <br>
                Ormai è chiaro come, in questa discussione, alcuni
                professionisti vogliano difendere delle diagnosi che
                tali non sono e vogliano farci credere che per il bene
                del paziente, si debba accogliere la sua richiesta di
                avere una diagnosi di autismo.. E per chi non rientra
                nella diagnosi da manuale, l'unica esistente al momento,
                si gioca con le parole e, come più volte ho scritto nei
                miei interventi, si vendono loro per diagnosi di autismo
                quelle che sono semplicemente delle valutazioni di
                tratti autistici. <br>
                Hanno trovato il modo di vendere diagnosi di autismo
                senza disturbo o se preferite di livello zero. <br>
                Poco importa che si possano o meno definire diagnosi
                psicologiche perché NON SONO DIAGNOSI DI DISTURBO DELLO
                SPETTRO AUTISTICO e chi le ha non è definibile
                autistico. <br>
                Capisco che po' questa gente serva anche a perorare le
                vostre cause, come questa, cioè di banalizzare l'autismo
                vendendo "diagnosi" che non rientrano nei manuali. <br>
                Ma si genera confusione, nelle persone e anche nella
                ricerca. <br>
                <br>
                Quindi come te, Stefania, spero che qualche
                professionista si schieri o avremmo sempre più persone
                che si diranno autistiche per fare i video su tik tok. <br>
                E la colpa è di chi banalizza lo spettro. <br>
                Scusate l sfogo, ma questa discussione è un paradosso
                perché viene letta da chi i manuali diagnostici li
                dovrebbe difendere <br>
                <br>
                Saluti <br>
                Alberto Fagni<br>
                Inviato da Libero Mail<br>
                <br>
                <div class="gmail_quote"><br>
                  Il 19 marzo 2023 20:52:20 UTC <a
                    href="mailto:ftstellino@inwind.it" target="_blank"
                    moz-do-not-send="true" class="moz-txt-link-freetext">ftstellino@inwind.it</a>
                  ha scritto:
                  <table>
                  </table>
                  <blockquote class="gmail_quote">Scusate,<br>
                    Ma qui si rischia veramente di fare danni epocali. <br>
                    <br>
                    Come a dire che ad una persona con depressione che
                    va da un oncologo perché pensa/spera di avere un
                    tumore, che non ha, il medico glielo diagnosticasse
                    per farlo sentire meglio e magari provare a vedere
                    se "esce" dalla depressione.<br>
                    <br>
                    È assurdo parlare di funzionamento autistico.<br>
                    Così si ingenera solo confusione nella persona, che
                    tra l'altro ha evidentemente delle
                    problematiche/disturbi psichici. <br>
                    E poi ci ritroviamo a doverci confrontare con
                    persone che credono di essere autistiche, che
                    pensano di avere una diagnosi di autismo e che
                    pretendono di parlare a nome delle persone
                    autistiche, a volte anche aggredendo verbalmente
                    ritenendo di avere la 'luce della conoscenza'.<br>
                    <br>
                    Così rischiamo di fare danni epocali. Ripeto.<br>
                    Perché pure chi ci deve ascoltare per poter
                    indirizzare le politiche del welfare sanitario e
                    sociale va in confusione.<br>
                    <br>
                    Mi auguro che i tanti camici bianchi presenti ed
                    amici (perdonatemi la metonimia, ma è per meglio
                    identificarvi), non sostengano questa presunta
                    deontologia degli psicologi.<br>
                    <br>
                    Perdonatemi anche lo sfogo.<br>
                    <br>
                    Un caro saluto <br>
                    <br>
                    Stefania Stellino<br>
                    <br>
                    <br>
                    <br>
                    Inviato da Libero Mail<br>
                    <br>
                    <div class="gmail_quote"><br>
                      Il 19 marzo 2023 17:12:07 UTC David Vagni <a
                        href="mailto:david.vagni@gmail.com"
                        target="_blank" moz-do-not-send="true"><david.vagni@gmail.com></a>
                      ha scritto:
                      <table>
                      </table>
                      <blockquote class="gmail_quote">Cara Raffaella, 
                        <div>condivido quanto hai riportato anche se sai
                          bene che mi scontro con alcuni advocate, come
                          hai detto sono adulti autodeterminati ed
                          eventuali differenze di vedute non dovrebbero
                          far venir meno un clima di collaborazione tra
                          professionisti, famiglie e advocate.</div>
                        <div>Concordo sul resto dei punti della tua
                          risposta.</div>
                        <div><br>
                        </div>
                        <div>Vorrei approfittare dell’occasione per
                          specificare un aspetto che reputo rilevante
                          all’interno della discussione (non con te, ma
                          con chi dice che “non vanno fatte diagnosi") e
                          che reputo sia parte della confusione. Te sei
                          psicologa, come sono psicologi le persone che
                          fanno diagnosi presso il centro a cui sono
                          associato.</div>
                        <div>In quanto psicologi è un dovere cercare di
                          seguire la deontologia della propria
                          professione in accordo con i codici e pareri
                          dell’Ordine</div>
                        <div><br>
                        </div>
                        <div>A questo link c’è un parere a mio avviso
                          molto importante <a
                            href="https://www.psy.it/allegati/parere_diagnosi.pdf"
                            target="_blank" moz-do-not-send="true"
                            class="moz-txt-link-freetext">https://www.psy.it/allegati/parere_diagnosi.pdf</a> sulla
                          possibilità degli psicologi di fare diagnosi
                          psicopatologiche ma che, lateralmente, riporta
                          la più generale definizione di diagnosi.</div>
                        <div><br>
                        </div>
                        <div>[…] Il concetto di diagnosi ha vari
                          significati non univoci lungo un continuum che
                          va da un’accezione ristretta di
                          identificazione di una patologia ad <b>un’accezione
                            ampia di identificazione di un fenomeno
                            sulla base dell’individuazione dei fattori
                            che la caratterizzano </b>(storia del
                          soggetto, sintomi fisici e psichici, modalità
                          comportamentali, attività mentale,
                          informazioni ottenute con varie modalità di
                          valutazione). I<b>l concetto di diagnosi,
                            pertanto, non è univocamente ed
                            esclusivamente connesso a quello di
                            “identificazione di patologia”</b>, come
                          usualmente viene inteso poiché quest’ultimo
                          riguarda soltanto l’ambito biomedico e, anche
                          in ambito medico, è praticabile solo in alcuni
                          settori e per alcune patologie, non in tutte
                          le branche della medicina e per tutte le
                          malattie. <b>La diagnosi assolve molteplici
                            funzioni e compiti a più livelli: a)
                            necessità di categorizzare le informazioni,
                            b) facilitazione della comunicazione fra
                            addetti ai lavori, c) facilitazione della
                            comunicazione con il paziente, d)
                            orientamento delle scelte terapeutiche. In
                            questo senso, la diagnosi è, nell’accezione
                            ampia dei suoi significati possibili,
                            insieme un atto conoscitivo di raccolta e
                            categorizzazione delle informazioni ed un
                            atto pragmatico di comunicazione fra i
                            soggetti implicati a diverso titolo e
                            livello nel fenomeno oggetto di
                            osservazione </b><span>[…] </span>La
                          diagnosi psicologica può essere realizzata a
                          diversi livelli a seconda del contesto in cui
                          trova applicazione e in relazione alle
                          funzioni interessate, dall’ambito lavorativo <b>al
                            disagio psicologico di livello pre-clinico</b>,
                          alla psicopatologia maggiore, alle malattie
                          mediche <span>[…] </span>La diagnosi basata
                          sui sintomi non è tuttavia l’unico modo per
                          effettuare una diagnosi descrittiva, e anzi
                          questa modalità viene ampiamente criticata
                          dalla comunità scientifica internazionale.
                          Pertanto anche la diagnosi differenziale
                          basata sui sintomi non è l’unica possibile.
                          Modalità alternative di effettuare la diagnosi
                          descrittiva e differenziale sono state a più
                          riprese proposte alla comunità scientifica e
                          si basano sull’osservazione e
                          l’identificazione <b>delle funzioni
                            psicologiche che sottendono i fenomeni
                            clinici osservati,</b> e non
                          meramente sull’osservazione e
                          l’identificazione dei sintomi. […].</div>
                        <div><br>
                        </div>
                        <div>Riporto questo per dire che, se una persona
                          va da uno psicologo e gli chiede “aiutami a
                          capire come funziono” rilasciare in una <b>diagnosi</b> (perché
                          comunque è una diagnosi il documento che si
                          rilascia): “non hai nessun disturbo, quindi
                          non hai niente”, <i>forse </i>può essere
                          accettabile per un medico che opera
                          all’interno di un modello medico, ma
                          sicuramente non è deontologicamente corretto
                          per uno psicologo.</div>
                        <div>Riportare che la persona ha un
                          “funzionamento cognitivo autistico pur in
                          assenza di difficoltà clinicamente rilevanti
                          che costituiscono un disturbo” o che “soddisfa
                          i criteri dell’autismo ma <i>al momento</i> non
                          sono presenti difficoltà rilevanti nel
                          funzionamento adattativo” o qualsiasi simile
                          definizione (e spiegando in cosa, perché, in
                          quali processi emotivi, cognitivi, etc.) è un
                          <i>atto dovuto</i> da un punto di vista etico
                          e deontologico a mio avviso e ritengo che
                          contestarlo significhi non capire in cosa
                          dovrebbe consistere il lavoro di un psicologo,
                          che in primo luogo dovrebbe riguardare il
                          comprendere e aiutare le persone e solo in
                          quanto funzionale a questo scopo, determinare
                          se è presente o meno un disturbo. </div>
                        <div><span><br>
                          </span>
                          <div>
                            <div><br>
                              <blockquote type="cite">
                                <div>Il giorno 14 mar 2023, alle ore
                                  09:55, Ambulatorio Autismo <a
                                    href="mailto:ambulatorioautismoadulti@gmail.com"
                                    target="_blank"
                                    moz-do-not-send="true"><ambulatorioautismoadulti@gmail.com></a>
                                  ha scritto:</div>
                                <br>
                                <div>
                                  <div><br>
                                    <div>Buon giorno a tutti,</div>
                                    <div>mi fa piacere che il Sig. Fagni
                                      condivida anche lui che l’autismo
                                      0 non esiste, quindi penso che
                                      possiamo  bandire per sempre dai
                                      nostri discorsi  questa
                                      definizione  sbagliata che può
                                      fuorviare chi non ha le giuste
                                      conoscenze.</div>
                                    <div><br>
                                      <div>Posso comprendere le sue
                                        perplessità e i suoi dubbi ma
                                        vedo che la sua mail è piena di
                                        criticità e sfiducia verso
                                        l’operato dei clinici.
                                        Naturalmente fra gli esseri
                                        umani ci sono delinquenti di
                                        tutti i tipi, persone poco
                                        professionali e persone che
                                        cerano di approfittare
                                        economicamente della loro
                                        posizione. Credo che questo tipo
                                        di persona sia ben distribuita
                                        in tutte le professioni, i tutti
                                        i contesti sociali e
                                        in qualsiasi tipo di
                                        funzionamento umano. Quindi ce
                                        ne sono sicuramente anche fra
                                        psicologi psichiatri e
                                        neuropsichiatri. Ma questa
                                        considerazione non dovrebbe a
                                        mio modo di vedere portarci a
                                        una sfiducia così grande come
                                        quella che traspare dai suoi
                                        commenti. Comprendo i suoi dubbi
                                        ma  francamente trovo difficile
                                        interloquire su una posizione
                                        così general generica che
                                        riguarda l’umanità tutta.</div>
                                      <div><br>
                                      </div>
                                      <div> Su tre cose non sono invece
                                        assolutamente d’accordo con il
                                        Sig. Fagni:</div>
                                      <div>1. dire che se "uno ha sempre
                                        avuto le capacità di superare le
                                        sue difficoltà, senza fare
                                        nessun tipo di terapia ed avere
                                        nessun tipo di supporto,
                                        significa che il criterio D non
                                        è soddisfatto” è proprio
                                        sbagliato. La sofferenza
                                        psichica lascia sempre una
                                        traccia che il clinico deve
                                        saper valutare e comunque è
                                        sempre necessario che si chieda
                                        come sta e quanta fatica faccia
                                        la persona nel presente. A parte
                                        il fatto che in genere le
                                        persone adulte che arrivano al
                                        percorso diagnostico hanno già
                                        fatto prima percorsi di supporto
                                        psicologico di cui non sono
                                        soddisfatte, ci possono essere
                                        innumerevoli  motivi per cui una
                                        persona non ha richiesto aiuto,
                                        da quello economico alla
                                        sfiducia nel lavoro psicologico,
                                        dall’orgoglio a forme di
                                        malessere tanto forte da
                                        impedire di attivarsi, dal non
                                        vedere riconosciuto il proprio
                                        bisogno al sentirsi dire che non
                                        c'è necessità di terapia. E
                                        sicuramente ce ne sono
                                        tantissimi altri. Non è detto
                                        che non avere o non aver avuto
                                        una terapia  sia indice di
                                        mancanza di bisogno. È compito
                                        del clinico valutare la
                                        sofferenza e il bisogno ed è suo
                                        compito dotarsi delle capacità,
                                        della formazione e degli
                                        strumenti per saperla
                                        riconoscere e saperla
                                        comprendere. Posso capire la
                                        sfiducia nella capacità dei
                                        clinici di fare valutazioni di
                                        questo tipo ma trovo sbagliato
                                        fare una generalizzazione così
                                        negativa. </div>
                                      <div>Negli anni ’90 c’erano
                                        pochissimi clinici capaci di
                                        diagnosticare l’autismo, oggi
                                        proliferano i servizi e
                                        naturalmente è difficile
                                        scegliere e può essere difficile
                                        valutare la competenza di un
                                        clinico. Ma io sono contenta che
                                        i servizi prolifichino perchè
                                        questo stimola la crescita
                                        professionale. </div>
                                      <div>E inoltre naturalmente  ogni
                                        adulto che si deve occupare
                                        della salute dei suoi cari deve
                                        impegnarsi a ricercare il
                                        clinico migliore. Non è una cosa
                                        che riguardi solo l’autismo.</div>
                                      <div><br>
                                      </div>
                                      <div>2. Lo stesso vale per quando
                                        scrive “ E  i vari test sono
                                        facili da  indirizzare. Io posso
                                        decidere il punteggio che voglio
                                        avere in un test  che voglia
                                        "misurare" i miei sintomi
                                        autistici, ma se si vuole
                                        valutare il mio autismo sul
                                        presente un clinico non potrebbe
                                        mai darmi una diagnosi…”. Il
                                        Sig. Fagni, come del resto
                                        chiunque,  può al massimo
                                        scaricare i test
                                        autosomministrati e se vuole
                                        manipolarli  basta che scarichi
                                        i punteggi o li cerchi nei libri
                                        in cui sono pubblicati.  Così
                                        certamente si,  potrebbe
                                        manipolarli. Ma un clinico serio
                                        non farebbe mai la diagnosi
                                         solo ed esclusivamente su quel
                                        tipo di test, proprio perchè
                                        essendo facilmente reperibili
                                        sono anche facilmente
                                        manipolabili. Nonostante questo
                                        le ricerche scientifiche ci
                                        dicono che comunque alcuni di
                                        questi test, come la RAADS-R,
                                        per esempio, sono molto forti ma
                                        naturalmente si parte
                                        dall’assunto che chi compila lo
                                        faccia rispondendo in modo
                                        onesto. Per fortuna non abbiamo
                                        a disposizione solo test
                                        autosomminstrati, questi non
                                        sono gli  unici test
                                        disponibili. Un clinico
                                        competente dovrebbe sapere  che
                                        ci sono test che raccolgono
                                        altri tipi di informazioni che
                                        non sono soggette a punteggi
                                        tipo “risposta giusta o
                                        sbagliata” o con i criteri dei
                                        test disponibili on line. Ci
                                        sono interviste alle famiglie,
                                        interviste ad altri operatori e
                                        test che riflettono il parere
                                        del clinico. È l’insieme dei
                                        risultati di questi test che un
                                        clinico esperto dovrebbe saper
                                        valutare. In ogni caso mi pare
                                        evidente che si continui a
                                        sottovalutare il fatto  che la
                                        diagnosi è sempre clinica perché
                                        non esiste un test che possa
                                        considerarsi completamente
                                        sicuro al 100%. Questa cosa è
                                        ampiamente dichiarata e
                                        documentata anche
                                        scientificamente ovunque.  I
                                        test possono sostenere il
                                        giudizio diagnostico ma questo
                                        è, alla fine, sempre e solo del
                                        clinico. Questo significa che
                                         la diagnosi riflette sempre  il
                                        parere professionale del
                                        professionista, anche
                                        indipendentemente dall’esito dei
                                        test. Questo da una maggiore
                                        responsabilità al clinico che
                                        dovrebbe quindi essere molto
                                        attento. Naturalmente il Sig.
                                        Fagni non è un professionista e
                                        quindi non conosce i test e non
                                        sa quale tipo di lavoro deve
                                        fare il clinico quando li
                                        somministra. Ma proprio per
                                        questo trovo che sia fuorviante
                                        che faccia affermazioni di
                                        questo tipo con tanta sicurezza
                                        invece, magari, di chiedere
                                        qualche informazione in più.</div>
                                      <div>Vorrei anche sottolineare che
                                        se una persona che richiede un
                                        parere diagnostico mente, la
                                        responsabilità primaria è sua
                                        perché così facendo distrugge la
                                        relazione con il clinico. Ci
                                        possono essere innumerevoli
                                        motivi per cui una persona mente
                                        oltre a quelli che il Sig.
                                        Fagnmi descrive nella sua mail e
                                        ci sono anche tante persone che
                                        cercano in tutti i modi di farsi
                                        togliere la diagnosi di autismo
                                        cercando in tutti i modi di
                                        apparire neurotipiche.  In ogni
                                        caso, poiché non esiste un test
                                        incontrastabile, come potrebbe
                                        essere un test genetico, se un
                                        paziente mente bene potrebbe
                                        comunque indurre un parere
                                        sbagliato nel clinico. I clinici
                                        devono stare attenti e dotarsi
                                        di strumenti, della formazione e
                                        della supervisione che serve per
                                        contenere questi problemi ma
                                        naturalmente potrebbero comunque
                                        cadere vittima dell’imbroglio.
                                        Ma se è imbrogliato il clinico è
                                        la vittima e non il responsabile
                                        della menzogna. Chi mente è
                                        responsabile.</div>
                                      <div><br>
                                      </div>
                                      <div>3. Infine quando dice che non
                                        è mutata la diagnosi di autismo
                                        per i vari manuali. In realtà il
                                        DSM-5 segna un cambiamento
                                        epocale perché definisce i
                                        Disturbi del Neurosviluppo, che
                                        prima non erano definiti, e pone
                                        le basi per un’unica diagnosi di
                                        autismo escludendo in modo
                                        definitivo la disabilità
                                        intellettiva e il disturbo del
                                        linguaggio dai sintomi di
                                        autismo. Un grande cambiamento
                                        che suscita ancora molte
                                        discussioni come del resto si
                                        evince dallo scambio nato dalla
                                        mail di Carlo Hanau.</div>
                                      <div><br>
                                      </div>
                                      <div><br>
                                      </div>
                                      <div>Per quanto riguarda
                                        Neuropeculiar: il Sig. Fagni si
                                        sbaglia, io non ho sollevato
                                        nessun discorso né punto nè
                                        domanda su questa associazione
                                        né sui suoi soci in questa sede
                                        né in altre e non ho posto
                                        alcuna domanda per cui lui, o
                                        chiunque altro, mi debba
                                        risposte. </div>
                                      <div>Non ho mai preso  le loro
                                        difese perché non ho mai pensato
                                        che ne abbiano bisogno. Sono
                                        persone adulte autonome e
                                        autodeterminate, responsabili
                                        delle loro scelte e delle loro
                                        posizioni.  </div>
                                      <div>Preciso che,  insieme ad
                                        altri colleghi, faccio parte del
                                        Comitato Scientifico
                                        dell’Associazione. Io mi
                                        confronto spesso con loro  e non
                                        ho mai avuto problemi a trovare
                                        un piano di confronto rispettoso
                                        delle posizioni personali, anche
                                        quando non siamo d’accordo.
                                        Ritengo quindi che chiunque
                                        possa trovarlo se lo desidera.
                                        Mi pare però poco corretto porre
                                        queste critiche in una sede dove
                                        nessuno di loro è presente non
                                        permettendo nessun tipo di
                                        confronto che consenta alle
                                        altre persone della lista di
                                        conoscerli e di poter fare le
                                        proprie valutazioni.</div>
                                      <div><br>
                                      </div>
                                      <div>Infine vorrei dire a Carlo
                                        che  trovo grave questa
                                        scollatura fra genitori e
                                        persone autistiche, saper
                                        accettare che ci siano diversi
                                        livelli di ricaduta sulla
                                        qualità di vita dovrebbe
                                        rassicurare sul fatto che non
                                        verranno trascurate le persone
                                        che hanno dalla loro condizione
                                        gravi ripercussioni sulla
                                        qualità di vita e
                                        sull’indipendenza e l'autonomia,
                                        ma per garantire che ciò accada
                                        non serve litigare, servirebbe
                                        invece promuovere la formazione
                                        dei clinici. Perché è da loro
                                        che dipende la valutazione della
                                        ricaduta sulla qualità di vita e
                                        sono loro che dovrebbero saper
                                        spiegare chi quando e perché ha
                                        bisogno di incerto tipo di
                                        aiuto. Card si possa trovare un
                                        giusto equilibrio fra ascoltare
                                        i clinici e ascoltare le persone
                                        autistiche e ascoltare i
                                        genitori. Ma anche ascoltare
                                        chiunque avario titolo voglia
                                        zarlaredi autismo. Paleseante
                                        nessuno può parlare per tutti e
                                        forse tutti dovrebbero parlare.
                                        Per sé o per le proprie
                                        associazionni o gruppi.</div>
                                      <div><br>
                                      </div>
                                      <div>Io credo che i clinici
                                        possano definirsi davvero
                                        competenti di autismo se lo
                                        conoscono in tutte le sue
                                        declinazioni, stili di
                                        funzionamento cognitivo, se lo
                                        conoscono nei bambini così come
                                        negli adulti, se hanno potuto
                                        interagire in diversi contesti
                                        non solo in quello clinico.</div>
                                      <div><br>
                                      </div>
                                      <div>Quando sono stata alla
                                        Divison TEACCH alla fine degli
                                        anni ’90 ho capito che l’autismo
                                        era qualcosa di molto più vasto
                                        e complesso di quello che noi
                                        percepivamo in Italia e ho
                                        capito che non avevamo alcuna
                                        idea di cosa fosse quello che
                                        allora chiamavamo autismo HF
                                        (High Functioning). Alla
                                        Division TEACCH già da almeno un
                                        decennio  avevano servizi
                                        differenziati anche in base alla
                                        ricaduta sulla qualità di vita e
                                        sull’autonomia, avevano gruppi
                                        diversificati per stile di
                                        funzionamentocognitivo e
                                        collaboravano non solo con i
                                        genitori ma anche con le persone
                                        autistiche, io stessa sono stata
                                        parecchio tempo con persone
                                        autistiche che mi hanno
                                         spiegato il loro stile di
                                        funzionamento e il lavoro
                                        clinico di cui godevano. Era la
                                        prima volta che mi accadeva d è
                                        stata un’esperienza che ha
                                        segnato le mie scelte.</div>
                                      <div>Proprio allora ho fatto
                                        alcune scelte professionali che
                                        hanno dato una direzione al mio
                                        lavoro: ho scelto di tradurre
                                        con altri colleghi i test gold
                                        standard in Italiano, di
                                         promuovere la formazione su
                                        come fare la diagnosi, e ho
                                        scelto di approfondire la
                                        diagnosi nelle direzioni più
                                        complesse: nei bambini molto
                                        piccoli e negli adulti senza
                                        disabilità cognitiva. Proprio
                                        grazie a queste scelte, posso
                                         affermare di essere  certamente
                                        stata uno dei primi clinici
                                        italiani a fare al diagnosi ad
                                        adulti senza compromissione
                                        cognitiva che si chiedevano se
                                        potevano essere autistici. Ma
                                        prima di allora avevo lavorato
                                        per moltissimi anni solo con
                                        persone autistiche  disabili
                                        intellettive e lavoro con loro
                                        tantissimo ancora oggi. Io so
                                        bene che è proprio perché ho
                                        lavorato tanto con loro che ho
                                        imparato molte cose che mi sono
                                        state molto utili per
                                        comprendere meglio le persone
                                        autistiche senza compromissione
                                        cognitiva. Allo stesso modo
                                        poter  ascoltare persone che
                                        possono descrivere il proprio
                                        mondo interno mi ha permesso di
                                        imparare  cose utilissime anche
                                        per le persone con disabilità
                                        intellettiva. </div>
                                      <div><br>
                                      </div>
                                      <div>Io ho fatto scelte su cui ho
                                        sempre messo la faccia e ancora
                                        oggi mi impegno al meglio che
                                        posso per tenere aperto uno
                                        stabile confronto con le persone
                                        autistiche che si occupano di
                                        advocacy così come con
                                        moltissime altre persone
                                        autistiche molto meno presenti
                                        sui social, così come con tanti
                                        genitori con cui lavoro
                                        quotidianamente e, anche se
                                        indirettamente, osservando i
                                        bambini e tutte quelle persone
                                        autistiche di ogni età e stile
                                        di funzionamento che non possono
                                        descriverci il loro mondo
                                        interno ma ci mostrano come
                                        agiscono. Mi confronto con
                                        colleghi di tutti i tipi, leggo
                                        i loro libri, anche quelli dei
                                        professionisti psicodinamici. </div>
                                      <div>Ascoltare, leggere e
                                        confrontarsi  sono per me
                                        strumenti di conoscenza.
                                        Naturalmente rivendico
                                        l’originalità del mio pensiero e
                                        rifiuto assolutamente di
                                        prendermi la responsabilità di
                                        cose che non ho mai detto né
                                        affermato.  Se promuovo qualcosa
                                        che dice un’altra persona, sia
                                        essa un clinico, un genitore o
                                        una persona autistica vuol dire
                                        che quel contenuto mi è piaciuto
                                        e che l'ho trovato stimolante.
                                        Solo di quello che condivido e
                                        di ciò che dico personalmente mi
                                        prendo la responsabilità.</div>
                                      <div>Ritengo che soprattutto in
                                        questo momento storico in cui i
                                        criteri diagnostici si son tanto
                                        allargati, sia importantissimo,
                                        anche essenziale, per clinici
                                         osservare e ascoltare per
                                        imparare.</div>
                                      <div>Ma andrebbe ricordato che
                                        osservare e ascoltare non
                                        significa aderire a qualsiasi
                                        cosa, significa raccogliere
                                        elementi per poter pensare e
                                        fare le proprie riflessioni e le
                                        proprie scelte in una visione
                                        più ampia.</div>
                                      <div>Giudicare senza un confronto
                                        induce sempre e solo a grandi
                                        tensioni.</div>
                                      <div><br>
                                      </div>
                                      <div>Buona giornata a tutti</div>
                                      <div>Raffaella Faggioli </div>
                                      <div><br>
                                      </div>
                                      <div><br>
                                      </div>
                                      <div>
                                        <div><br>
                                          <blockquote type="cite">
                                            <div>Il giorno 9 mar 2023,
                                              alle ore 11:24, <a
                                                href="mailto:albertofagni@libero.it"
                                                target="_blank"
                                                moz-do-not-send="true"
                                                class="moz-txt-link-freetext">albertofagni@libero.it</a>
                                              ha scritto:</div>
                                            <br>
                                            <div>
                                              <div>
                                                <p>Dottoressa Faggioli, <br>
                                                  <br>
                                                  io sono d'accordo con
                                                  lei quando dice che
                                                  NON esiste l'autismo
                                                  di livello ZERO ,
                                                  termine che
                                                  probabilmente ho
                                                  iniziato ad sare io,
                                                  per spiegare come ci
                                                  siano troppi autistici
                                                  o comunque persone che
                                                  si dichiarano tali, ma
                                                  che non rientrano nei
                                                  criteri della
                                                  diagnosi. <br>
                                                  E come lei sono
                                                  dell'idea che non si
                                                  possa usare il termine
                                                  autistico come
                                                  semplice aggettivo al
                                                  di fuori di una
                                                  diagnosi medica.<br>
                                                  <br>
                                                  Questo punto per me è
                                                  basilare perché troppe
                                                  volte leggo di
                                                  diagnosi "senza
                                                  disturbo" cioè senza
                                                  che il criterio D sia
                                                  soddisfatto, nei tanti
                                                  gruppi di autismo e
                                                  vengono difese dagli
                                                  stessi professionisti
                                                  .<br>
                                                  Con Vagni ho avuto una
                                                  discussione su questo
                                                  punto sul mio profilo
                                                  Facebook <br>
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                                                  <br>
                                                  In quella discussione
                                                  David ha difeso la
                                                  possibilità di fare
                                                  diagnosi psicologiche
                                                  di autismo senza
                                                  disturbo e di poterle
                                                  definire diagnosi e
                                                  non valutazioni . Ciò
                                                  ovviamente genera
                                                  confusione e molti
                                                  penseranno di avere
                                                  una vera diagnosi e
                                                  non di avere solamente
                                                  dei tratti autistici e
                                                  al limite essere
                                                  subclinici. <br>
                                                  <br>
                                                  Adesso leggo che
                                                  entrambi riteniate sia
                                                  corretto fare diagnosi
                                                  prendendo in
                                                  considerazione tutti
                                                  quelli che raccontano
                                                  di aver affrontato
                                                  difficoltà nella vita
                                                  per cavarsela ed
                                                  essere autonomi, basta
                                                  che questa sofferenza
                                                  sia dovuta ad alcuni
                                                  tratti autistici.<br>
                                                  Lei afferma in una sua
                                                  risposta che chi cerca
                                                  una diagnosi vada
                                                  accolto perché cerca
                                                  risposte a delle
                                                  difficoltà. <br>
                                                  Concordo, ma ciò non
                                                  significa che tutte
                                                  siano da accogliere
                                                  con delle diagnosi .<br>
                                                  Perché se uno ha
                                                  sempre avuto le
                                                  capacità di superare
                                                  le sue difficoltà,
                                                  senza fare nessun tipo
                                                  di terapia ed avere
                                                  nessun tipo di
                                                  supporto, significa
                                                  che il criterio D non
                                                  è soddisfatto. <br>
                                                  Perché se la diagnosi
                                                  dovesse premiare
                                                   tutti quelli che
                                                  raccontano sofferenze
                                                  e difficoltà superate,
                                                  nessuno sarebbe esente
                                                  da diagnosi. <br>
                                                  Aggiungo che spesso
                                                  queste persone hanno
                                                  delle difficoltà che
                                                  sono ascrivibili a ben
                                                  altre diagnosi dalle
                                                  quali provengono, ma
                                                  che trovandole più
                                                  stigmatizzanti della
                                                  diagnosi di autismo (e
                                                  meno fighe) cercano di
                                                  rifugiarsi in quella
                                                  di autismo. <br>
                                                  Ora con tutta la
                                                  fiducia che posso
                                                  avere nei clinici, se
                                                  la diagnosi si fa solo
                                                  sul racconto di
                                                  difficoltà superate,
                                                  non sarà difficile per
                                                  ch conosce lo spettro
                                                  avere una diagnosi di
                                                  autismo (oramai anche
                                                  on line) <br>
                                                  E  i vari test sono
                                                  facili da
                                                   indirizzare. Io posso
                                                  decidere il punteggio
                                                  che voglio avere in un
                                                  test  che voglia
                                                  "misurare" i miei
                                                  sintomi autistici, ma
                                                  se si vuole valutare
                                                  il mio autismo sul
                                                  presente un clinico
                                                  non potrebbe mai darmi
                                                  una diagnosi , né io
                                                   vorrei mai una
                                                  diagnosi che mi limita
                                                  e che non mi darebbe
                                                  alcun supporto utile,
                                                  visto che sono
                                                  completamente
                                                  autonomo. <br>
                                                  E se fossi altro ,
                                                  cioè bipolare,
                                                  depresso etc etc ,
                                                  comunque una diagnosi
                                                  non pertinente, per
                                                  quanto più figa, mi
                                                  allontanerebbe dai
                                                  supporti e dalle
                                                  terapie corrette. <br>
                                                  Io temo che oramai chi
                                                  ha avuto difficoltà
                                                  nella vita legate alla
                                                  propria omosessualità,
                                                  alla propria
                                                  depressione o per
                                                  qualsiasi altro
                                                  motivo, può  spingere
                                                  per avere una diagnosi
                                                  di autismo . <br>
                                                  Senza voler accusare
                                                  nessuno mi chiedo e vi
                                                  chiedo se non ci sia
                                                  il rischio che molti
                                                  da clinici si stiano
                                                  trasformando (in modo
                                                  anche inconsapevole)
                                                  in VENDITORI di
                                                  diagnosi ? <br>
                                                  <br>
                                                  Altro punto al quale
                                                  vorrei rispondere è
                                                  sul fatto che lei
                                                  dottoressa ha preso le
                                                  difese dei vari
                                                  attivisti , i quali si
                                                  lamentano che qualcuno
                                                  possa mettere in
                                                  dubbio le loro
                                                  diagnosi. <br>
                                                  Siccome sappiamo
                                                  benissimo che la
                                                  critica è rivolta
                                                  soprattutto a me da
                                                  parte dei suoi
                                                  pazienti di
                                                  Neuropeculiar (mi
                                                  piace essere molto
                                                  diretto) , faccio
                                                  notare alcune cose : <br>
                                                  <br>
                                                  - Io non metto in
                                                  dubbio le loro
                                                  diagnosi ,ma come
                                                  descrivono le
                                                  diagnosi, che
                                                  vorrebbero slegare dai
                                                  vari manuali
                                                  diagnostici. Sono loro
                                                  a metterle in dubbio
                                                  casomai. <br>
                                                  - Alcuni di quelli che
                                                  loro invitano ai loro
                                                  convengni e che si
                                                  definiscono autistici,
                                                  hanno ammesso di non
                                                  avere una diagnosi e
                                                  che non l'hanno mai
                                                  cercata non avendo
                                                  bisogno di supporti. <br>
                                                  - Visto che usano la
                                                  loro diagnosi per
                                                  vendersi come formato
                                                  come se fosse un
                                                  titolo di studio, non
                                                  vedo perché non
                                                  dovrebbero renderla
                                                  pubblica ? ( Questa è
                                                  una mia provocazione,
                                                  ma davvero chi ha una
                                                  diagnosi può fare il
                                                  formatore senza
                                                  avrebbe i titoli? )<br>
                                                  <br>
                                                  - Le stesse persone
                                                  che si lamentano che
                                                  le loro diagnosi siano
                                                  messe in dubbio, sono
                                                  quelle che attaccano i
                                                  genitori, dicendo loro
                                                  che un genitore NON ha
                                                  alcun diritto di
                                                  parlare di autismo, ma
                                                  solo loro possono in
                                                  quanto autistici...
                                                  Come se loro potessero
                                                  sapere come pensa e,
                                                  cosa pensa e cosa
                                                  prova un autistico non
                                                  verbale. <br>
                                                  <br>
                                                  - Sempre loro hanno
                                                  creato un clima di
                                                  guerra alle
                                                  definizioni mediche e
                                                  corrette , tanto che
                                                  molti professionisti
                                                  hanno smesso di
                                                  scrivere e non si
                                                  espongono per non
                                                  essere attaccati
                                                  .Proprio durante
                                                  questa discussione
                                                  alcuni professionisti
                                                  mi hanno scritto in
                                                  privato, dicendosi
                                                  d'accordo con la mia
                                                  posizione, ma che non
                                                  avrebbero scritto
                                                  poiché stanchidel
                                                  clima di attacco alle
                                                  posizioni corrette e
                                                  mi hanno anche fatto
                                                  notare che sono sempre
                                                  meno i professionisti
                                                  che si espongono nelle
                                                  discussioni su questa
                                                  lista . <br>
                                                  Non è un caso che a
                                                  farlo siate stati
                                                  soprattutto in due ,
                                                  entrambi molto vicini
                                                  alle posizioni di
                                                  questi attivisti o
                                                  comunque li si voglia
                                                  definire. <br>
                                                  <br>
                                                  Quindi non è mutata la
                                                  diagnosi di autismo
                                                  per i vari manuali, ma
                                                  sta mutando perché si
                                                  è creato un mercato ,
                                                  si è creato il bisogno
                                                  di ricercare una
                                                  diagnosi. <br>
                                                  <br>
                                                  Saluti <br>
                                                  Alberto Fagni<br>
                                                  (mi scuso per gli
                                                  errori, ma preferisco
                                                  non rileggere ) </p>
                                                <blockquote type="cite">
                                                  <div> Il 08/03/2023
                                                    11:15 Raffaella
                                                    Faggioli <<a
                                                      href="mailto:ambulatorioautismoadulti@gmail.com"
                                                      target="_blank"
                                                      moz-do-not-send="true"
class="moz-txt-link-freetext">ambulatorioautismoadulti@gmail.com</a>>
                                                    ha scritto: </div>
                                                  <div> <br>
                                                  </div>
                                                  <div> <br>
                                                  </div>
                                                  Ciao David,
                                                  naturalmente è
                                                  necessario tenere
                                                  conto che abbiamo
                                                  professionalità
                                                  diverse,  sensibilità
                                                  diverse e
                                                   responsabilità
                                                  diverse. Naturalmente
                                                  io sono principalmente
                                                  un clinico impegnata
                                                   stabilmente nella
                                                  valutazione
                                                  diagnostica di persone
                                                  di tutte le età e di
                                                  tutti i funzionamenti
                                                  cognitivi  e solo in
                                                  seconda battuta sono
                                                  una ricercatrice
                                                  (nella pratica
                                                  quotidiana, io produco
                                                  idee di ricerca e una
                                                  montagna di dati che
                                                  altri leggono)
                                                  <div> <br>
                                                  </div>
                                                  <div> Magari mi
                                                    sbaglio ma mi sembra
                                                    che anche sui i
                                                    bambini in realtà
                                                    siamo d'accordo nel
                                                    momento stesso in
                                                    cui scrivi: <span>Il
                                                      problema è che tu <strong>sai</strong> che <em>prima
                                                        o poi quel
                                                        bambino cadrà</em>.
                                                    </span>Ed è
                                                    esattamente per
                                                    questo che non
                                                    esiste il livello 0
                                                    nei bambini perché
                                                    noi sappiamo che
                                                    prima poi, hai
                                                    ragione spesso ai
                                                    cambi di ciclo
                                                    scolastico, ci sarà
                                                    qualche cosa che lo
                                                    porterà alla
                                                    sofferenza e a
                                                    sentirsi in dovere
                                                    di mascherarsi, a
                                                    non sentirsi
                                                    “normale” e a
                                                    percepire una
                                                    diversità che lo
                                                    farà  sentire solo
                                                    al mondo (un
                                                    extraterrestre,
                                                    metafora molto
                                                    significativa,
                                                    chiara e diretta
                                                    usata da moltissime
                                                    persone autistiche)
                                                    e quindi anche poco
                                                    amato. Non basta
                                                     questo come
                                                    ricaduta sulla
                                                    qualità di vita? Io
                                                    direi proprio di si.
                                                    La sofferenza
                                                    testimoniata da
                                                     tanti adulti
                                                    autistici, l’intenso
                                                    lavorio interiore
                                                    che devono fare gli
                                                    adolescenti, che
                                                    magari non si
                                                    mettono sui social,
                                                    ma che noi terapeuti
                                                    che li seguiamo
                                                    costantemente ben
                                                    conosciamo e che
                                                    conoscono i loro
                                                    genitori, non
                                                    dovrebbe lasciarci
                                                    indifferenti. </div>
                                                  <div> <br>
                                                  </div>
                                                  <div> Naturalmente
                                                    anche per me, con un
                                                    bambino l’approccio
                                                    clinico è molto
                                                    diverso da quello
                                                    con gli adulti ed è
                                                    naturale che un
                                                    clinico possa avere
                                                    dubbi, io stessa li
                                                    ho e quando li ho mi
                                                    prendo il tempo per
                                                    definire il mio
                                                    giudizio
                                                    diagnostico. Ma la
                                                    diagnosi a un
                                                    bambino è una
                                                    proiezione in avanti
                                                    che influenzerà
                                                    tutta la sua vita:
                                                    una volta fatta ci
                                                    aspettiamo e anche
                                                    pretendiamo che il
                                                    mondo intero tenda
                                                    ad  adattarsi al suo
                                                    stile di
                                                    funzionamento e che
                                                    gli adulti che si
                                                    occupano della sua
                                                    educazione  mettano
                                                    in atto strategie
                                                    educative più
                                                    mirate, strategie di
                                                    conversazione più
                                                    adatte al suo stile
                                                    di funzionamento,
                                                    protezione
                                                    dall’esposizione
                                                    incontrollata e
                                                    costante a stimoli
                                                    sensoriali e sociali
                                                    inadeguati e forieri
                                                    di sofferenza e
                                                    stress. Quanti
                                                    adulti autistici ci
                                                    dicono che quando
                                                    stanno in un gruppo
                                                    intento in una
                                                    conversazione si
                                                    sentono stabilmente
                                                    in allerta? Vogliamo
                                                    “regalare” questo
                                                    tipo di sensazioni e
                                                    queste fatiche ai
                                                    bambini?.   </div>
                                                  <div> Sappiamo che
                                                    questo tipo di
                                                    sforzo e di
                                                    sofferenza porta in
                                                    adolescenza a
                                                    problematiche
                                                    psichiatriche. La
                                                    diagnosi deve quindi
                                                    a mio avviso essere
                                                    pensata anche per
                                                    contenere questa
                                                    inutile
                                                    devastazione. La
                                                    diagnosi dovrebbe
                                                    proteggerli da
                                                    eccessivi sforzi di
                                                    mascheramento così
                                                    come dal non
                                                    sentirsi accettati
                                                    per quello che si è
                                                    o dalla sensazione
                                                    di essere
                                                    extraterrestri.
                                                    Dovrebbe permettere
                                                    agli adulti che si
                                                    occupano della loro
                                                    educazione di farli
                                                    crescere il più
                                                    confidenti possibile
                                                    in sè stessi, con
                                                    meno sensazione di
                                                    estraniamento, più
                                                    legittimati. Una
                                                    diagnosi sbagliata
                                                    nei bambini, anche
                                                    in quelli in plus
                                                    dotazione e con un
                                                    linguaggio
                                                    pienamente fluente,
                                                    avrà una ricaduta
                                                    sulla salute
                                                    psicologica, sulla
                                                    sofferenza psichica
                                                    e sull’esposizione a
                                                    non sentirsi
                                                    compresi. Inoltre
                                                    avrà una ricaduta
                                                    sulla possibilità di
                                                    autodeterminarsi.  </div>
                                                  <div> Se esito a fare
                                                    la  diagnosi a un
                                                    bambino non è perché
                                                    lo vedo a livello 0,
                                                    che ribadisco non
                                                    esiste, ma perché ci
                                                    sono situazioni in
                                                    cui i sintomi sono
                                                    difficili da
                                                    decifrare in pochi
                                                    incontri ed è
                                                    necessario
                                                    conoscerlo meglio e
                                                    in modo più
                                                    profondo. </div>
                                                  <div> Ci possono
                                                    essere molti motivi
                                                    per cui il suo stile
                                                    di funzionamento
                                                    autistico non è
                                                    immediatamente
                                                    apprezzabile e la
                                                    conoscenza, stare in
                                                    relazione è, in
                                                    questi casi, l’unica
                                                    strategia che
                                                    abbiamo per capire. 
                                                  </div>
                                                  <div> <br>
                                                  </div>
                                                  <div> Ma non è mai
                                                    quello che viene
                                                    proposto come il
                                                    livello 0  per gli
                                                    adulti, anzi se mai
                                                    ci sono bambini,
                                                    soprattutto piccoli,
                                                    anche chiaramente
                                                    autistici che non
                                                    hanno una vera e
                                                    propria ricaduta
                                                    sulla qualità di
                                                    vita al momento
                                                    della diagnosi, ma
                                                    possiamo ben
                                                    prevedere che ne
                                                    avrà e la diagnosi
                                                    dovrebbe servire a
                                                    tutelarli e a dargli
                                                    un mondo sociale più
                                                    capace di capirli e
                                                    più adatto al loro
                                                    stile di
                                                    funzionamento.
                                                    Esattamente come
                                                    dici anche tu. </div>
                                                  <div> È un diritto
                                                    inalienabile dei
                                                    bambini che gli
                                                    adulti si muovano in
                                                    questa prospettiva
                                                    protettiva. Quindi
                                                    io non ritengo
                                                    affatto di “forzare”
                                                    il sistema, credo
                                                    sia giusto porre le
                                                    basi per aiutare il
                                                    bambino a crescere
                                                    il più sereno
                                                    possibile. </div>
                                                  <div> <br>
                                                  </div>
                                                  <div> E il criterio D
                                                    non può e non deve
                                                    essere inteso solo
                                                    come “il tuo stile
                                                    di funzionamento
                                                    autistico ti
                                                    impedisce di
                                                    lavorare e di essere
                                                    autonomo” ma anche
                                                    come ricaduta in
                                                    termini di
                                                    sofferenza e  di
                                                    disagio psichico.
                                                    D’altronde qualche
                                                    volta la sofferenza
                                                    può essere così
                                                    forte da impedire di
                                                    realizzarsi e di
                                                    diventare autonomi.
                                                    E la sofferenza
                                                    psichica non è
                                                    sapere psichiatrica.
                                                  </div>
                                                  <div> È  ora di
                                                    riconoscere e dare
                                                    valore anche a
                                                    questo aspetto con
                                                    buona pace di chi
                                                    pensa che psicologi
                                                    e psichiatri siano
                                                    (non)professionisti
                                                    facilmente
                                                    abbindolabili e
                                                    incapaci di
                                                    riconoscere la
                                                    sofferenza
                                                    psicologica e la
                                                    ricaduta che questa
                                                    ha sulla qualità di
                                                    vita e
                                                    sull’autodeterminazione.
                                                  </div>
                                                  <div> <br>
                                                  </div>
                                                  <div> Raffaella  </div>
                                                  <div> <br>
                                                  </div>
                                                  <div> <br>
                                                  </div>
                                                  <div> <br>
                                                  </div>
                                                  <div>
                                                    <div> <br>
                                                      <blockquote
                                                        type="cite">
                                                        <div> Il giorno
                                                          1 mar 2023,
                                                          alle ore
                                                          17:37, David
                                                          Vagni <<a
                                                          href="mailto:david.vagni@gmail.com"
target="_blank" moz-do-not-send="true" class="moz-txt-link-freetext">david.vagni@gmail.com</a>>
                                                          ha scritto: </div>
                                                        <div>
                                                          <div> Cara
                                                          Raffaella,
                                                          <div> a parte
                                                          l’avere idee
                                                          diverse
                                                          sull’unitarietà
                                                          dell’autismo,
                                                          concordo sul
                                                          resto del tuo
                                                          discorso ma
                                                          vorrei
                                                          aggiungere un
                                                          commento alla
                                                          tua ultima
                                                          parte:
                                                          <div> <br>
                                                          </div>
                                                          <div>
                                                          <div>
                                                          <blockquote
                                                          type="cite">
                                                          <div> Inoltre
                                                          dovrebbe farci
                                                          riflettere che
                                                          questo
                                                          problema non
                                                          esiste quando
                                                          parliamo di
                                                          bambini esiste
                                                          solo per
                                                          quanto
                                                          riguarda gli
                                                          adulti. Ma
                                                          questi adulti
                                                          sono stati
                                                          bambini e
                                                          adolescenti
                                                          che
                                                          probabilmente
                                                          hanno sofferto
                                                          per non
                                                          sentirsi né
                                                          capiti né
                                                          integrati e
                                                          per una
                                                          diversità che
                                                          li ha sempre
                                                          fatti sentire
                                                          estranei. </div>
                                                          </blockquote>
                                                          </div>
                                                          <br>
                                                          </div>
                                                          <div> Come sai
                                                          non faccio
                                                          diagnosi
                                                          (ripeto, sono
                                                          un ricercatore
                                                          non un
                                                          clinico) ma
                                                          partecipo a
                                                          tantissime
                                                          valutazioni.
                                                          Devo dire che
                                                          anche se è
                                                          infrequente,
                                                          mi è capitato
                                                          più di una
                                                          volta di
                                                          osservare
                                                          situazioni di
                                                          "autismo si,
                                                          autismo no,
                                                          autismo forse”
                                                          <strong>anche
                                                          nei bambini</strong>,
                                                          relativamente
                                                          al criterio
                                                          del
                                                          “funzionamento”.
                                                          </div>
                                                          </div>
                                                          <div> <br>
                                                          </div>
                                                          <div>
                                                          Purtroppo nei
                                                          bambini,
                                                          ancora più che
                                                          negli adulti,
                                                          è difficile (e
                                                          rischi di
                                                          essere preso
                                                          per pazzo o
                                                          peggio) fare
                                                          diagnosi in
                                                          presenza di un
                                                          buon
                                                          funzionamento,
                                                          perché se sono
                                                          in un ambiente
                                                          “protetto”,
                                                          l’ambiente
                                                          stesso tende a
                                                          mascherare le
                                                          difficoltà
                                                          (genitori
                                                          iper-presenti,
                                                          piccola scuola
                                                          privata,
                                                          etc.). </div>
                                                          <div> <br>
                                                          </div>
                                                          <div> Il
                                                          problema è che
                                                          tu <strong>sai</strong> che
                                                          <em>prima o
                                                          poi quel
                                                          bambino cadrà</em>.
                                                          Perché il
                                                          problema è che
                                                          quando i
                                                          tratti
                                                          autistici ci
                                                          sono, anche in
                                                          presenza di un
                                                          buon
                                                          funzionamento
                                                          (e magari
                                                          momentaneamente
                                                          anche in
                                                          assenza di
                                                          stress
                                                          psicologico),
                                                          prima o poi
                                                          quella cosa
                                                          che ti fa
                                                          crollare la
                                                          trovi. Spesso
                                                          è il passaggio
                                                          da un ciclo
                                                          scolastico
                                                          all’altro o un
                                                          trasloco. </div>
                                                          <div> <span><br>
                                                          </span> </div>
                                                          <div> In
                                                          generale in
                                                          quei casi
                                                          spesso uno
                                                          scrive “ci
                                                          sono marcati
                                                          tratti… ma il
                                                          funzionamento
                                                          al momento….”
                                                          “si consiglia
                                                          di tenere
                                                          sotto
                                                          osservazione”…”si
                                                          consiglia
                                                          ugualmente di
                                                          fare un
                                                          parent-training”,
                                                          etc. </div>
                                                          <div> Ma
                                                          spesso bambini
                                                          nello spettro
                                                          hanno
                                                          genitori,
                                                          almeno con una
                                                          gamba nello
                                                          spettro ed il
                                                          pensiero
                                                          dicotomico la
                                                          fa da padrone
                                                          e viene
                                                          ulteriormente
                                                          incentivato da
                                                          un sistema
                                                          sociosanitario
                                                          pensato per la
cura/assistenza molto più che per la prevenzione.  </div>
                                                          <div> <br>
                                                          </div>
                                                          <div> Il
                                                          risultato è
                                                          che
                                                          frequentemente
                                                          in quei casi
                                                          non fanno
                                                          nulla e poi
                                                          ritornano dopo
                                                          2, 4, 6 anni,
                                                          quando scoppia
                                                          il problema. </div>
                                                          <div> <br>
                                                          </div>
                                                          <div> Questo
                                                          penso dovrebbe
                                                          far ragionare
                                                          su una cosa,
                                                          medici e
                                                          psicologi, di
                                                          cosa si
                                                          occupano?
                                                          Della malattia
                                                          o della
                                                          salute? Perché
                                                          se ci
                                                          occupiamo
                                                          della salute
                                                          dovremmo
                                                          impegnarci <em>primariamente</em><span> nella
                                                          </span><em>prevenzione</em>.
                                                          Ma
                                                          il “sistema”
                                                          non lo
                                                          consente.  </div>
                                                          <div> <br>
                                                          </div>
                                                          <div> Quanto è
                                                          lecito forzare
                                                          il sistema per
                                                          fare
                                                          prevenzione? </div>
                                                          <div> <br>
                                                          </div>
                                                          <div> Questa
                                                          penso sia una
                                                          domanda
                                                          interessante
                                                          da porsi e a
                                                          cui non ho una
                                                          risposta. </div>
                                                          </div>
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