About one in 150 children in Singapore has autism, which is clinically known as “Autism Spectrum Disorder”. Autism, along with Asperger and other syndromes are grouped as a disorder linked to neuro-development that affects how a person communicates, interacts and relates with others.
It is a “spectrum condition” as each individual is affected differently, and to different degrees. A child with autism may have a normal life except for a mild difficulty with holding a conversation, while another child may have a disability that is so severe as to require institutional care.
Causes of Autism
The causes of autism are still being researched, and has been linked to a combination of factors including genetics, advanced age of mother or father, maternal metabolic conditions and environment. There are also risk factors such as exposure to certain drugs or chemicals, such as alcohol and anti-seizure drugs used during pregnancy. However, autism is not linked to social background, parenting style or vaccination.
Spectrum of Autism
Generally, there are four different conditions to classify the disorders:
– Autism disorder refers to problems associated with social communication and interaction, and imaginative play in young children
– Asperger’s syndrome refers to children with above average intelligence, but have similar issues as children with autism disorder
– Pervasive developmental disorder is a category used for some autistic behaviors that are not typically seen
– Childhood disintegrative disorder refers to a rare condition characterized by a loss of previously acquired language and social skills (late onset at three to four years of age)
Indicators of autism in young children
Autism begins in early childhood, whereby symptoms often start within the first year of age. The symptoms may be more apparent in the second year, in areas such as:
Social Interaction and Communication
The challenges faced by an autistic child in social interaction and communication include:
– Inability to read facial cues and respond accordingly
– Inappropriately use people physically to assist with tasks
– Appear in his own world
– Appear to ignore the other person
– Inability to maintain eye contract or hold conversation
– Inability to use symbolic gestures like wave bye-bye or blow kisses
– Inability to understand emotions
– Some degree of speech difficulty, such as abnormal tone or rhythm
– Difficulty with using the right pronoun such as “you”, “me”, “us” and “them”
– Delayed learning of language
– Use of the same words repetitively
– Inability to understand concepts, nuance and inference in language/ communications
A toddler with autism may not be able to understand imaginative play; for instance, pretending to cook or be a doctor is difficult to understand and he may instead use the toy (such as rolling it around) in a repetitive manner.
An autistic child may have heightened sensitivity to certain noise or touch and find the stimuli to be painful or discomforting, while others may have too high a threshold before registering certain sensation. This can sometimes lead to tantrums (when the child is unable to cope with certain noise), or with embarrassing actions such as smelling, touching or staring at certain objects.
Repetition and Self-control
A toddler with autism may have repetitive movements such as hand flapping or spinning, or have difficulties with motor skills or body coordination. He may be easily disturbed by a slight change in his routine or ritual, or engages in activities that cause harm to himself such as biting or head-banging. There may also be a preference for only certain foods.
Information has to be first gathered before a diagnosis is made, and this includes gathering inputs from you, your child, your family history, your child’s doctor (developmental screening is carried out during regular checkups at 18-month and 24-month), school staff and assessments made by speech and language therapist. A physical examination will also be conducted to eliminate possible physical causes such as Down’s syndrome. Based on the above and further medical testing if necessary, a comprehensive evaluation will be undertaken by a multidisciplinary team that includes a pediatrician or child psychiatrist, a psychologist and a speech pathologist, or an occupational therapist. Generally, a diagnosis can be made when the child is around the age of two years although some children may only receive a final diagnosis at an older age.
It is researched that an earlier diagnosis allows for earlier intervention which increases the chance for the child to function better.
Help and Treatment for Children with Autism
As there is no “cure” for autism, and each child is affected differently, treatment plan needs to be personalized for the child. Moreover, the symptoms that a child displays, a well as the tasks and skills he needs to master are different as he gets older. Therefore, the treatment plan also has to change overtime to always be improving the ability of the child to function for his age.
A structured treatment plan is required and cover the following areas:
Behavioral training and management – To help the child improve his behavior and communication, through social skills training, sensory integration and self-help. Problem areas are identified and the treatment aims to help the child to overcome them. A common treatment is applied behavior analysis that helps the child to learn and apply new skills through a reward-based motivation system.
Speech therapy – To improve language and speech competency
Physical therapy – To improve coordination and motor skills
Occupational therapy – To improve information processing from the five senses and to manage daily activities
Family therapy – The family is involved in the therapy session to help the child manage certain areas of life
Medication – To treat anxiety, depression, hyperactivity or obsessive-compulsive behaviors. Keep a log of all medications and have a doctor review the existing medication whenever a new prescription is given to ensure no side effects from taking them together.
Community support – It can be very stressful and draining to care for an autistic child, and the problems encountered are not easily understood by friends or families without an autistic child. The organizations below offer support for families with autistic children:
Autism Association (Singapore)
101 Bukit Batok West Avenue 3
#01-01 Singapore 659168
Tel: 6774 6649
Autism Resource Centre (Singapore)
5, Ang Mo Kio Avenue 10
Tel: 6323 3258
St. Andrew’s Autism Centre
1 Elliot Road, Singapore 458686
Tel: 6517 3800