Wednesday, April 4, 2012

World Autism Awareness Month 2012

During my school days, I volunteered at a special school and worked with children with developmental delays. It was a bittersweet experience. Although I had volunteered willingly, I was still afraid to apply myself fully to the endeavour. I was unnerved by the children who didn't do things the "normal" way and I was reluctant to open up to them because I found their behaviour unpredictable (at least to me).

Yes, I went in as an idiot. Thankfully, I "graduated" as a better person. I realised that I was the one who had to change, not them. The children were socially backward because they were wired that way. I was socially reluctant because of my prejudice. Slowly, I opened my mind and began to understand their point of view and, as I became more confident in interacting with them, I saw that they were just as beautiful as "normal" children are. Working with them, seeing them laugh and smile, and most enlightening of all - watching their parents love them without holding back - oh wow, it was an incredible lesson. My time there destroyed all preconceived negative notions that I had and made me truly, truly, truly understand that all that matters is the love for your child and to show that love to your child.

April is World Autism Awareness Month. World Autism Awareness Day 2012 was on 2 April 2012. I thought it would therefore be a good time to pen down some information on autism. I know there are many people who, without thinking, automatically reject anything suggesting that there might be a problem with their children, and I hope that these parents will change their mindset, for the sake of their little ones. It may be that the child is truly struggling and having difficulties in certain areas, and for the parents to brush it off without investigating deeper and checking if the child needs professional help, well, I think it is irresponsible parenting plus they are just being cruel to the child.

Awareness of the signs of autism is especially important for parents of children around Ryan's present age (3 years old) because this is when you can detect any danger signs. At this age, our children should be exhibiting certain behaviours and skill sets, regardless male or female. Milestones exist for a reason - if your child is not hitting the milestones for his age, that is a warning sign of a potential underlying condition which merits further investigation. If there is truly an issue, early detection is critical so that the child gets the treatment he needs before more damage results.

Autism is a pervasive developmental disorder (PDD) which involves delays in the development of many basic skills, most notably the ability to socialise with others, to communicate, and to use imagination. The earliest signs of autism (e.g. in babies) involve the absence of normal behaviours (not the presence of abnormal ones), so they can be tough to spot. For children at 2-3 years old, it is more obvious. These behaviours include:

- "Acts up" with intense tantrums
- Has a short attention span
- Has very narrow/limited interests (hard to get him interested in other things)
- Is overactive or hyperactive (or very passive)
- Shows aggression to others or self (e.g. enjoys throwing stuff around, hitting objects or people, rough with others/self/objects)
- Uses repetitive body movements or gets stuck on a single topic or task ("perseveration") (e.g. repeatedly climbing up and down furniture, repeatedly hitting objects, repeatedly jumping)
- Enjoys activities which involve deep pressure or vibration (e.g. enjoys being near the washing machine or dryer, enjoys massages)
- Enjoys watching moving objects (e.g. moving vehicles, elevators, ceiling fans)
- Shows a strong need for sameness (e.g. refuses to be corrected, shows distress if routines are changed, needs a long and gradual period of adjustment)
- Withdraws from physical human contact (because these children find it overstimulating/overwhelming)
- Has a heightened or low response to pain
- Shows unusual attachments to objects such as toys or strange objects such as keys, spoons, etc.
- Learns better through electronic media/video/audio books, rather than human interaction (because electronic media/video/audio books do not impose social demands)
- Is very sensitive to certain sensory stimuli, like the feel of paint on their hands, the rub of certain types of fabric against their skin, certain sounds/noises, and may get upset or start screaming to drown out the stimulation
    You do not have to tick off all the points above, not even half. If your child exhibits even just a few of these behaviours, get your child examined as soon as possible. Autism can range from mild to severe and no two children with autism have exactly the same combination of symptoms. Also, there are various types of autism, not just classic autism. For example, a child who has no problems with speech but exhibits signs of delay in other areas may be afflicted with "high-functioning autism", also known as Asperger's Syndrome. Only 20% of people on the autism spectrum have classic autism. The overwhelming majority fall somewhere in the milder range (instead of autism, these are usually referred to as autism spectrum disorders).

    Children with autism spectrum disorders (the milder cases) often suffer from one or more of the following problems (I've set these out separately because these are not used as part of the test for classic autism):

    1. Sensory problems - The children either underreact or overreact to sensory stimuli. At times they may ignore people speaking to them, even to the point of appearing deaf. However, at other times, they may be disturbed by even the softest sounds. If upset by external stimuli, they may respond by screaming or making repetitive noises to drown out the offending stimuli or covering their ears. They also tend to be highly sensitive to touch and to texture. They may cringe at a pat on the back or at the feel of certain fabric against their skin or having paint on their hands.

    2. Emotional difficulties - These children may have difficulty regulating their emotions or expressing themselves appropriately. For instance, they may start to yell/scream, cry or laugh hysterically for no apparent reason. When stressed, they may exhibit disruptive or even aggressive behaviour, e.g. throwing or breaking things, hitting others, or harming themselves (like running into a wall).

    3. Uneven cognitive abilities - Autism spectrum disorders occur at all intelligence levels. Even children with normal or high intelligence may have unevenly developed cognitive skills. Still, verbal skills tend to be weaker than non-verbal skills. In addition, children with autism spectrum disorders typically do well on tasks involving immediate memory or visual skills, while tasks involving symbolic or abstract thinking are more difficult (e.g. learn better through using memorisation, flashcards or images rather than through understanding and applying concepts and formulae).

    When screening for autism, there are typically three categories that are investigated. Although there are enormous differences in the severity and combinations of symptoms and patterns of behaviour, the signs and symptoms of autism generally include problems with (1) social skills, (2) speech and language, and (3) restricted activities and interests. Specifically, children with autism typically have difficulties in:

    Pretend play
    Shows little pretend or imaginative play. Prefers solitary or ritualistic play. Has difficulty in using imagination (e.g. he may not understand why we talk to our pets/animals/toys, he may not understand fairytales, he may not be able to act out, on his own, a scene where he has to pretend to do an activity or act in a role)

    Social interaction
    Does not seem to hear when others talk to him. Does not consistently respond to his name when called. Does not establish friendships with children his own age (does not know how to connect or play with them). Treats others as if they were objects. Does not enjoy interactive games with others. Is withdrawn in a group of peers or prefers to spend time alone (e.g. in a group setting such as a classroom, he may prefer to stay at the back of the classroom). Does not respond to eye contact or smiles (or avoids eye contact). Shows a lack of empathy (has difficulty understanding another person's feelings, such as pain, anger or sorrow). Appears disinterested or unaware of other people or what's going on around him. Prefers not to be touched, held, or cuddled. Has trouble understanding or talking about feelings, Does not offer to share enjoyment, interests or achievements with others (toys, drawings). Does not use gestures independently (e.g. does not wave bye-bye without being told to, or without copying someone else who is waving)

    Verbal and non-verbal communication
    Does not understand simple directions, statements or questions. Is slow in learning to talk (or not at all). Communicates more with gestures (like pointing) instead of words and gestures are limited. Speaks in an abnormal tone of voice, or with an odd rhythm or pitch (e.g. ends sentences as if asking a question). May come across as cold or "robot-like". Has problems taking steps to start a conversation. Has difficulties continuing a conversation after it has begun. Does not refer to self correctly or refers to self in the third person (e.g. says "he wants water" when he means "I want water"). Has difficulty communicating needs or desires. Repeats words or memorized passages or even noises (repeats over and over a phrase heard previously - "echolalia"). Uses facial expressions that do not match what he is saying or has limited facial expressions. Does not pick up on other people's facial expressions, tone of voice, mood, and gestures. Abnormal posture, clumsiness, or eccentric ways of moving.

    If your child ticks off more than one symptom in each category, please consider getting him/her screened.

    Remember:

    - Monitor your child's development. Autism involves a variety of developmental delays, so keeping a close eye on when (or if) your child is hitting the key milestones (social, emotional and cognitive) is an effective way to spot the problem early on. While developmental delays do not automatically point to autism, they may indicate a heightened risk.

    - Take action if you are concerned. Every child develops at a different pace - so you do not need to panic if your child is a little late to talk or walk. When it comes to healthy development, there is a wide range of "normal". Nevertheless, bear in mind the milestones for each age (which already take into account the wide range of developmental pace) and, if your child is not meeting the milestones for his age, or if you suspect a problem, share your concerns with your child's doctor immediately. Don't wait.

    - Don't accept a wait-and-see approach. Many concerned parents are told, "Don't worry" or "Wait and see". But waiting is the worst thing you can do. You risk losing valuable time at an age where your child has the best chance for improvement. Furthermore, whether the delay is caused by autism or some other factor, developmentally delayed children are unlikely to simply "grow out" of their problems. In order to develop skills in an area of delay, your child needs extra help and targeted treatment.

    - Trust your instincts. Ideally your child's doctor will take your concerns seriously and perform a thorough evaluation for autism or other developmental delays. But sometimes, even well-meaning doctors miss red flags or underestimate problems. Listen to your gut if it's telling you something is wrong and be persistent. Schedule a follow-up appointment with the doctor, seek a second opinion, or ask for a referral to a child development specialist.

    I've compiled the information above from several resources, including the following websites:


    If you are a parent, I hope that you take some time to consider all this!

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