What is Autism?
“It’s a brain disorder that results in behaviour disorders,” says Dr. Joseph E. Morrow, Professor Emeritus and professor of psychology and behaviour analysis at the California State University in Sacramento, USA. Autism is a wide spectrum disorder – which means that the symptoms and severity vary greatly.
“Some children may be non-verbal even till they enter late childhood, while others may have language skills but lack appropriate communication because the language may be odd or inappropriate. Some children may have reduced eye contact; others not at all,” explains Dr. Chong Shang Chee, head and consultant at the Child Development Unit of the University Children’s Medical Institute at National University Hospital (NUH). “Generally, learning can be affected to various degrees, and some can have low cognitive (intellectual) function, while others maintain average – or may even have above average – cognitive abilities.”
Then, there’s Asperger’s Syndrome, which Dr. Morrow terms “high functioning autism”. These kids have normal IQ and may have very rich vocabularies when it comes to their favourite topics, but have poor social skills. For instance, they may interpret what you say too literally and respond in a manner you don’t expect. Many have talents in a specific area, adds Dr. Chong. Asperger’s itself is a wide spectrum disorder. Only 5 to 10 percent of people living with autism are “savants” with exceptional skills, like the character in the movie Rain Man.
While there are no clear figures locally, Dr. Chong says NUH and KK Women’s and Children’s Hospital see about 500 new cases of autism a year in preschoolers. The US Center for Disease Control estimated in 2009, about one in 110 individuals may be autistic.
“Parents should look for signs that the child is not imitating, not interested in pleasing you and, most importantly, not developing speech. They should be looking at these things at least by 18 months,” says Dr. Morrow. He recommends The Chat (Checklist for Autism in Toddlers) test.
Dr. Chong says some symptoms may appear earlier than age 2, like not responding when his name is called, even though he has normal hearing. “Many mothers report that their babies seem very passive,” he adds. “These children may not enjoy play with the parents or with other kids, have lack of imitation of actions, have few gestures which they perform or understand, and do not enjoy being bounced on the knee, playing social games like peekaboo or demonstrating affection to their caregivers.”
They may prefer what she calls “non-functional play”, like repeatedly spinning toys and lining up objects, and have body mannerisms like hand flapping and spinning around. They may take interest in things that are usually not attractive to others. If they’re older, parents or teachers may notice that they don’t like playing with other kids, or that their play lacks imagination and symbolism, which should be clear by age 3.
According to clinical psychologist Vyda S. Chai, early warning signs of autism from the age of 12 months may include the following:
• No eye contact (for example, looking at you when being fed)
• Doesn’t smile when smiled at or react positively to a smile
• Doesn’t respond to his name or to the sound of a familiar voice
• Doesn’t follow objects visually
• Doesn’t follow the gesture when you point things out
• Doesn’t make noises to get your attention
• Doesn’t initiate or respond to cuddling
• Doesn’t imitate your movements and facial expressions
• Doesn’t reach out to be picked up
• Doesn’t play with other people or share interests and enjoyment
The Applied Behavioural Analysis (ABA) approach is currently the gold standard for treatment of autism. The system uses positive reinforcement and rewards to shape desired behaviour.
It has the best research evidence and is proven to have the best results. And, it’s also recognised by Singapore’s Ministry of Health, according to clinical psychologist Vyda S. Chai. Children on ABA therapy are recommended to go through 20 hours of therapy per week. However, there are alternative programmes such as The Son-Rise Programme, developed by the American parents of Raun K. Kaufman, who was diagnosed as severely autistic as a child, then went on to graduate from an Ivy League college with a degree in Biomedical Ethics and become a lecturer and author.
Raun believes that all parents should get a chance to choose a therapy programme – whether it’s mainstream or not – that works best for their child. For instance, instead of discouraging his repetitive behaviour – a common symptom of autism called “stimming” – Raun’s parents would join him in spinning plates over and over again. This “joining” technique, which is the opposite of what mainstream therapy does, is now one of the most controversial techniques of The Son-Rise Programme, which is offered at the Autism Treatment Center of America in Massachusetts.
Once the child is sufficiently engaged, he is offered activities designed to stretch his social interaction, says Raun. “People said that (joining in with the stimming behaviour) was the worst thing my mum could do, that it would make me do it more. I’m so grateful that she didn’t listen, because that created a breakthrough. I began to look and smile at her, and engage in reciprocal play with her,” he says.
But, Principal Daryl Duane Van Hale of Melbourne Specialist International School (MSIS), a school in Singapore for foreign students with special needs, cautions that there are no “quick and easy answers” to autism.
“There are many methods in working with those with autism, and all have their strengths and drawbacks. In my experience, children with autism can become much more social and interactive, but the process takes time and work,” he says. “Unfortunately, there is no magic pill.”
What should you do if your child is diagnosed? Ask your doctor about early intervention, recommends Daryl. “Evidence shows that the sooner you begin working with special needs children, the better the results. Understand that your child will have challenges that other children do not have. Growing up with them will be different than a neurotypical child, and at times difficult. It will also be full of joy, surprises and fun.”
Need more help? Try these associations and groups instead:
- Autism Association (Singapore) is a charity under the National Council of Social Services. It offers early intervention programmes and a youth centre, and operates Eden School for those with moderate to severe autism.
- Autism Resource Centre (Singapore) is a non-profit organisation with information and services like assessment and diagnosis, early intervention programmes and therapy. It started Pathlight School. ABC Center Singapore is the local branch of Dr. Morrow’s company, Applied Behavior Consultants. It offers applied behaviour analysis services for autism and other developmental disabilities.
- Embrace Autism is a non-profit group founded by parents and volunteers working together to promote Autism Awareness and foster community among families and professionals. It is guided by the trainings of the Autism Treatment Center of America, home of The Son-Rise Program.
- Think Kids specialises in implementing customised treatment plans for children and individuals with special needs aged from 18 months to early adulthood, and advocates for Early Intensive Behavioural Intervention in young children with Autism Spectrum Disorder.
- World Autism Awareness (Singapore) aims to raise awareness about the needs of persons living with autism, as well as in celebration of their strengths.
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