Category: Behaviour

New Parents Special

May 7, 2022 Return

WORDS LIM TECK CHOON

Dr Yong Junina Fadzil

Consultant Paediatrician & Paediatric Cardiologist

Klinik Pakar Kanak-Kanak Junina

Parenting can be both a joyous and nerve-wrecking experience for a new parent In this special feature, we’ll share with you some of the things you can expect and how to make sense of the chaos in the first few weeks.

This feature is also a special celebration of a new phase in New Parents—we’re planning exciting events of which this feature is just a sample. Don’t forget to check out our Raising a Champ class, see the end of this feature!

MAKING SENSE OF parenthood

So that’s a baby. Your baby. Your heart is full to bursting with love, happiness and awe—and you may also be panicking inside. How will you be a good parent? Can you be a good parent? How about…

Relax. Calm down. Take it from a consultant paediatrician and mother-of-three: it’d be fine. More than fine, in fact – it’d be an adventure of a lifetime!

What is the one thing many new parents tend to overlook when they are embarking on the parenthood journey?

To have fun and enjoy being parents! Some parents view their babies as a project, and they do a lot of research beforehand. However, every baby has their own quirks and personality; what works for one baby may not work for another.

Therefore, don’t have a rigid viewpoint when it comes to the rules of parenting. Be flexible, go with the flow, and make changes as necessary to accommodate your baby.

What are some general rules of the thumb for parents?

Know the basics. Make sure you know the fundamentals, such as when and how to feed as well as how to keep your baby clean, when to give your baby their shots, etc.

Update your dos and don’ts. Recommendations on safe practices may change with new findings, and what was once practiced may now be considered potentially harmful, so keep yourself updated via books and the Web. Don’t blindly trust everything you read and hear, though – check and double-check the facts with relevant healthcare practitioners.

Monitor your baby’s growth. This can be done with the assistance of a paediatrician.

Do you have any advice for parents who are worried about their babies falling sick?

Always refer to a doctor. I’ve seen parents who prefer to post their concerns on social media, but the people responding to these concerns are often not medically trained. Also, they only have the parents’ words to go by—they do not see the baby and hence cannot make any proper diagnosis (if they are even qualified to do so). The advice given may be wrong and even dangerous for the baby.

The one thing parents need to be aware of is that a baby can become really ill in the blink of an eye, and there is rarely time for the parents to experiment on different types of medications.

Therefore, consult a doctor first and foremost when it comes to the baby’s health!

General practitioner or paediatrician—what’s the difference?

Paediatrician are doctors who, after graduating from medical school, spend a few more years training specifically to understand, diagnose, and manage health issues in children. That’s why they are also called ‘doctors for children’.

As a paediatrician’s patients are exclusively children, a paediatric clinic has equipment and devices designed to accommodate a child’s smaller size. The paediatrician’s clinic also dispenses medications with dosages that are adjusted for children.

General practitioners, also called family doctors, are not specialized in paediatrics. That’s not to say that they are unqualified to treat children—it’s just that a paediatrician is usually more well-versed to manage a child’s more serious or complicated health issues. Also, some parents may have better peace of mind knowing that their children are cared for by a dedicated children’s health specialist.

One last thing: let’s talk about the meddling parents…

It depends on the advice. If it’s sound advice, such as always boiling water before use, of course it’s worth following. When the advice is based on superstition, however, here’s a handy tip: use the paediatrician as your shield!

If the advice isn’t sound but you want to keep the peace, try saying that you have discussed with your paediatrician, who advised against it. Many paediatricians are familiar with the issue of good- intentioned, meddlesome parents with ill-informed advice (they may even have such parents!) and will likely take your side. If the parents are being difficult, try bringing them to the paediatrician’s clinic for a discussion.

WHAT’S GOING TO HAPPEN AS IT GETS CLOSER TO THE BIG DAY

Have you noticed how most information available on motherhood often leads up to the big day, only to then skip forward to after the baby has arrived? Instead of leaving you to rely on anecdotal stories from other people—which may be contradictory, exaggerated or even misleading—we’ll let you in on what really happens.

What’s Labour, Exactly?

Simply put, labour is the series of contractions in your uterus. It opens or dilates and thins or effaces in preparation for you to give birth to your baby.

How Else Does Your Body Prepare for Delivery?

The placenta and umbilical cord send nourishment to the baby
The amniotic sac (bag of water) holds the fluid that surrounds your baby
The perineum is the area between the vaginal opening and the anus
The vagina is the birth canal
The pubic symphysis joint lies between the pelvic bones and allows the baby to pass through
The cervix is the narrow opening of the uterus
The mucous plug helps keep bacteria out of the uterus

Challenging positions

If your baby is not in a safe position for birth, or if there is a problem with the placenta, you may need special care. A caesarean section may also be needed. Common problems include:

Cephalopelvic disproportion (CPD): Baby’s head is too big for the pelvis.

Breech position: Baby is positioned with feet or buttocks first.

Transverse position: Baby lies horizontally the pelvis.

Placental abruption: Placenta separates from the uterus.

Placenta previa Placenta blocks the cervix.

Your baby moves into position: Babies often move down between the pelvic bones (descend) before birth. If this is your first pregnancy, this may happen 2-4 weeks before labour. With repeat pregnancies, the baby may not ‘drop’ until labour begins. The baby usually moves down head first. When the baby drops, you may find it easier to breathe. You may also feel more pressure on your bladder, causing you to urinate more often.

THE MOM’S GUIDE TO STAYING SANE & HEALTHY IN THE EARLY DAYS OF MOTHERHOOD

If you can’t love yourself, how can you love anybody else? RuPaul Andre Charles

A GUIDE TO FEELING LIKE YOUR OLD SELF AGAIN

Go with the flow. Plans and schedules usually get thrown out the window during the early days, so prioritize the bare essentials of keeping yourself and your baby well. The rest? Well, just go with the flow. You’ll figure out a routine eventually!

Keep track of medical matters. Speaking of schedules and plans, it will be good to record all required medical matters such as doctor’s appointments (for you and your baby) and medical check-ups (Pap smear, mammogram, etc). That way, you are less likely to overlook health-related matters.

Move, move, move! Exercise energizes you and helps you get back to your pre-pregnancy weight, and it is also a good pick-me-up activity. Sneak walking into your daily routine as much as possible, or join a yoga class.

Eat well and healthily! It can be tempting to skip meals when you are busy, but don’t. You
need to keep eating healthy, balanced meals like you used to, so that you can stay healthy and energized for both you and your kid.

Keep in touch with yourself. Don’t lose yourself in the bustle of TLC for the baby, your job, household chores, etc. Take some time out every day for you and you alone, such as having a cup of your favourite coffee or catching up on shows on Netflix while the baby is asleep. Devote an evening once a week just for you and your partner.

Keep in touch with the outside world. It can be tough to deal with the chaotic newness of
parenthood when you let your new, busy schedule cut you off from your other family members and friends. Try to devote some time once a week, or if that’s not possible, once a month to catch up with them. If you can’t leave the house to meet them,
invite them over for a meal.

Don’t skimp on sleep. It may be tempting to sleep less when you have so much to do, but remember, sleep recharges and reenergizes your body. Take a nap whenever you can during the day to make up for sleepless nights. It is also good to avoid cigarettes, alcohol and other substances that can affect your ability to sleep well. HT

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Fasting for Children

May 3, 2022 Return

Dr Yong Junina Fadzil Consultant Paediatrician

Once again, the holy month of Ramadan is upon us. For parents with young children, fasting is the time to impress upon them the empathy one feels for the less fortunate. It is also a time for spiritual reflection – for many Muslim children, their early experiences in fasting can build a lifelong foundation for virtuous living.

“Ideally, if you follow religious standards of Islam, children should start fasting only when they reach puberty. However, in our society, many children wish to follow what their parents do and are curious about fasting. They may want to try fasting at a younger age,” says Dr Yong Junina Fadzil, a consultant paediatrician.

She adds that the most important thing is to make sure that children want to fast on their own will without being forced by their parents. “You need to allow them to explore their curiosity and support them.”

For example, children might start fasting later in the day and buka puasa earlier. “It’s actually all right to let them do that,” she says.

Eat and drink well

Dr Junina advises that children aged 9 years old and above, and who have not attained puberty can fast, provided their weight is within the healthy range and they don’t have any chronic illnesses like diabetes.

Parents can wake their children as late as possible before imsak and serve them a proper meal like rice with dishes. If their children want to break fast at lunchtime, they should be allowed to do so. When encouraged thus, children may want to extend their fast over time.

When breaking fast, children can be given dates to increase their blood sugar levels. This must be followed with a proper balanced meal consisting of carbohydrates, protein, fats, vegetables and fruits.

After breaking fast, children should drink a lot of plain water, malted drinks and milk to prevent dehydration. It’s best to avoid caffeinated beverages. Caffeine causes them to urinate often, becoming easily dehydrated. Before they go to bed, they can have supper consisting of beverage and kuih.

Children with illnesses must take medications regularly. Islam allows such children to be excluded from fasting, says Dr Junina.

The meaning of fasting

Fasting is generally synonymous with abstinence from food but it’s actually more than that – it’s a whole way of life. Besides abstaining from food, children should also be taught to abstain from other things like hurting their siblings and eating in public.

“The benefits of fasting for children are spiritual, so ideally, when you expose them to the practices of Ramadan it is to create an awareness of how fortunate they are and how less fortunate some people are,” says Dr Junina. “This will teach them the meaning of compassion.”

For children who are too young to understand the concept of fasting, they may feel that the fasting month is a month of torture. They will resort to cheating by eating in their bedroom or bathroom, and drinking tap water when they take ablution.

“Respect their limitations and encourage them to do the best they can,” advises Dr Junina. Parents do not have to worry or fret if their child is unable to do everything right, as the time will come when they reach puberty. With puberty comes the maturity to accept, understand and better practise the act of fasting. They will do what is needed for them throughout the fasting month often on their own free will.”

Tips for parents

Wake your children up for sahur as late as possible.
Make sure they drink enough water, as well as nourishing drinks like milk.
Make sure they eat enough – buka puasa and sahur should consist of 2 main meals like dinner and lunch, with healthy snacks in between.
Always encourage and support their efforts – don’t judge them. Instead, let them break their fast when they want to, at their own pace and capability.

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KITCHEN TIME WITH THE TODDLER

April 29, 2022 Return

WORDS LIM TECK CHOON

There are a few good reasons to share your kitchen time with a toddler. One, seeing their parent prepare the foods will increase the toddler’s interest in their foods come mealtime. Two, it’s another opportunity to bond with the little one. Finally, three—by aiming for the long run and cultivating your toddler’s interest in foods and food preparation, you are raising a child who would one day be able to cook for themselves, their own families… and you!

Get a high chair
Place your toddler in a high chair in a safe corner of the kitchen. That way, you can both keep an eye on your kid and get meals ready for the family.

Let the kid think they are helping
If your kid insists on wanting to help (or, in some cases, taking over from you), you can let them feel important by giving them very simple chores.

For instance, if your kid shows interest in your efforts while stirring a pot, you can give them a small bowl of cool gravy and let them have fun stirring it from the safety of the high chair.

When they are older, let them help

Let them do simple chores, such as passing over a fruit for you from the fridge, helping you wash the vegetables and setting the spoons and forks on the dining table.

You can also look up simple recipes that you and your kid can prepare together.

Also, don’t forget to get them to help in the cleaning up! HT

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The Butterfly Children

April 29, 2022 Return

Children who have epidermolysis bullosa (EB for short) go by names such as ‘cotton wool babies’ and ‘crystal skin children’. Closer to home, we have opted for the term ‘butterfly children’. While these names sound like something straight out of a children’s storybook, their ‘cutesy-ness’ belie the dangerous nature of this skin disorder.

Those of you who do not have any inkling of what EB is may be thinking, ‘Why haven’t I heard about this if it’s such a serious condition?’ Consultant Paediatrician Dr Leong Kin Fon clarifies, “EB is extremely rare. The World Health Organization reports that for every 1 million Malaysians, only 10 have EB. This means there are now approximately only 300 Malaysians with EB.”

Epidermolysis bullosa explained

So, what is EB really? And why are kids with EB called ‘butterfly children’? “The term ‘butterfly children’ came about because the skin of an EB patient is very tender and fragile like a butterfly’s wings,” Dr Leong explains. “Our skin is divided into 2 layers – the epidermis and the dermis. Normally, situated between these 2 layers are anchor-like structures which prevent them from moving independently from each other. But in individuals with EB, these ‘anchors’ are either relatively fewer or not present at all. As a result, any movement (eg, scratching, rubbing or injury) that causes trauma or friction between the layers can induce painful sores and blisters.”

Elaborating further, he says, “The amount of blisters present depends on the severity of a patient’s EB. Some will get only a few blisters but others can experience a lot. Blisters typically form on the hands and feet but they may also appear on the inside of the oral cavity like the mouth, stomach and oesophagus (the tube which connects the mouth to the stomach). Those with more severe forms of EB also experience blistering in other body parts including the nails, teeth and hair.”

And then, there were three types

Delving into the various kinds of EB, Dr Leong says, “There are 3 main types: EB simplex, dystrophic EB and junctional EB. International data shows that out of these 3, the most common one is EB simplex in which blistering affects the epidermis (upper layer of the skin). Out of 100 patients, 90 have EB simplex.”

What about Malaysian data, then? He says, “I work in a paediatric ward so most of the cases which I come across are either dystrophic EB or junctional EB. For both dystrophic EB and junctional EB, blistering occurs in the basement membrane of the dermis (deeper layer of the skin). Junctional EB affects the middle part of the basement membrane whereas dystrophic EB strikes at the lower part of the basement membrane. Junctional EB is the rarest of the 3.”

It runs in the family

If you are a parent, you may now be wondering how to protect your child from this dreaded condition. However, it is not something which can be prevented like the common cold or measles. Dr Leong says, “EB is a genetic disorder. It’s most often inherited from parents; the parents either have EB or are carriers of the faulty gene. But sometimes – though, very rarely – the genetic fault occurs spontaneously.”

Does that mean people with EB should avoid starting a family? He advises, “Well, it boils down to the type of EB. In the case of EB simplex, the symptoms are milder so I wouldn’t go as far as to stop couples (where one or both partners have EB simplex) from having kids. This is because even if their child does end up with EB simplex, the condition is still manageable with the appropriate lifestyle modifications.”

What about couples with more severe forms of EB, then? “For these couples, I’d recommend genetic screening. There are prenatal tests such as amniocentesis which can test the unborn child for EB at the 11th week of pregnancy. If the child is confirmed to have EB, these couples are then offered counselling. We have professionally trained counsellors who are more than ready to assist and advise them on how to cope.”

It’s complicated

Touching on the complications of EB, Dr Leong recalls, “It differs from one person to another. I have friends in Singapore who never showed any symptoms of EB until they enrolled for military service. Blisters only began developing on their bodies especially their feet because of the intense physical training. For people like them, EB isn’t much of a hindrance unless when performing physical activity.”

However, things aren’t always so easy for other EB patients. “Blisters which develop on the skin of children with severe forms of EB don’t heal as quickly – hence, increasing their risk of infections such as sepsis which can lead to organ failure.”

Sepsis aside, other complications which can arise include:

Deformed limbs

“The toes or fingers of someone with severe EB can fuse due to excessive scarring. Should that happen, surgery is necessary to remove the scar tissue and to restore mobility.”

Malnutrition

“Scarring doesn’t merely occur on limbs. Over time, scarring may also develop in the oesophagus. I’ve had patients in their early teens whose oesophagus had narrowed over the years so much so that they are incapable of swallowing anymore. We have to resort to connecting a feeding tube to their stomach – a procedure known as gastrostomy. This way, patients can be fed directly into their stomach.”

Death

“Severe forms of EB do increase one’s mortality risk. For instance, babies who are unable to breathe and eat normally due to excessive blistering are likely to die in childhood.”

‘Is there a cure?’

Dr Leong is no stranger to this question as it is no doubt on the mind of every parent with a child who has EB. “It’s the question that I get asked most frequently.” And his answer is the same every time. “There isn’t a cure for EB but that doesn’t spell the end. EB is incurable but it is manageable,” he says encouragingly.

“The main goal of EB treatment is to avoid blisters and its related complications. This is why parents or caregivers need to be well-versed with the proper methods of wound care,” he stresses. He cites some examples:

Use silicone dressing on blister-induced wounds instead of a normal dressing as the latter can further aggravate the wounds
Apply substances with strong hydrating properties like petroleum jelly to keep the wound area constantly moisturized
Puncture blisters with a sterile needle to stop blisters from spreading.

In addition to wound care, ensuring your child has regular check-ups is another aspect of EB management. “Regular visits to the dentist are important to check for blisters or irritation in the child’s mouth.”

“Wound care is tedious and can seem like a lot to take in at the beginning but remember that your child’s doctor is always there to guide you. In time, you’ll get better at taking care of your child,” he assures.

‘You aren’t alone’

“Living with EB can be very stressful for both parent and child. As if the physical suffering brought on by EB isn’t enough, they have to deal with stigma and social isolation as many people still have the misconception that if they were to touch someone with EB, they will be infected with it. Then, there’s also the financial burden that comes along with treatment. Bandages and dressings can be expensive,” says Dr Leong.

This is why patient and caregiver support is so vital. Dr Leong who is also President of DEBRA Malaysia, a non-profit organization which offers support to the EB community by funding research and by providing free services for patients who are in need, advises, “EB is a life-long disease. Although it cannot be cured, it can be controlled with proper care. The blisters can actually decline over the years if they are tended to accordingly. Therefore, don’t be afraid to seek help if your child has EB. Talk to your child’s paediatrician about your concerns or you can get in touch with DEBRA Malaysia. We at DEBRA Malaysia will do our best to help you and your child. Remember, you aren’t alone.”

Should you have enquiries, you can contact DEBRA Malaysia at:

Tel : + 603 9283 2868 or +6012 3913328
Email : debramalaysia@gmail.com
Address : D-5-1, Block D, Menara Uncang Emas, Jalan Loke Yew, 55200 Kuala Lumpur.

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Does Your Child Have a Lazy Eye?

April 28, 2022 Return

Karen Mcmain Orthoptist, Dalhousie University, Canada

Recently, orthoptist Karen McMain from Dalhousie University, Canada, visited Tun Hussein Onn National Eye Hospital (THONEH) to train and share her experiences with local eye care specialists. Despite her busy schedule, Ms McMain managed to find some time to share with us some insight on lazy eye.

HT: In the old days, lazy eye was considered by superstitious people to be a “curse” or the result of sinister supernatural forces. What is lazy eye, actually?

KM: Lazy eye, also known as amblyopia, is a common childhood eye condition in which a child’s sight in one eye does not develop as it should.

I personally feel that the term “lazy eye” is inaccurate, as the eye is not really lazy. It would be more accurate to say “lazy brain” as amblyopia, the medical term for lazy eye, is actually a developmental problem within the brain.

What happens is that, normally, the brain and the eyes work together to produce vision. When a child has amblyopia, the brain does not acknowledge the vision from the lazy eye and focuses on the vision from the other eye. If the lazy eye is not stimulated properly, the visual brain cells do not mature normally.

HT: What are the causes of this condition?

KM: Most commonly, it is due to the misalignment of the two eyes – a condition called strabismus. As a result of strabismus, the eyes are not aligned in the same direction, the eyes can cross in (esotropia) or turn out (exotropia). This misalignment prevents the eyes from focusing together on an image and may cause double vision. To overcome the double vision, the child’s developing brain chooses to ignore the image from the eye that is not straight, causing the vision in that eye to become lazy.

Differences in the way each eye processes vision can also be a factor, such as when one eye suffers from nearsightedness, farsightedness or astigmatism.

Sometimes but very rarely, the condition can also be caused by obstruction or cloudiness that prevents light from getting through one eye. Such obstructions can be due to cataract, eye tumours or droopy eyelids. Such amblyopia is called deprivation amblyopia.

HT: What happens if the condition is left untreated?

KM: Amblyopia is the most common cause of partial or total blindness in one eye, affecting 3% of children. Studies have shown that sufferers also face a significantly higher risk of losing vision in their good eye, either from injury or eye disorders such as macular degeneration.

HT: What are the treatment options for this condition?

KM: The most common treatment for amblyopia is to force the brain to start using the ‘bad’ eye.

This is done by first correcting any underlying problem in that particular eye. Then, we either put a patch over the ‘good’ eye or blur the vision in the ‘good’ eye with eye drops, to force the ‘bad’ eye to be used. The eye drop method is less commonly used in countries like Malaysia, which has a very sunny climate, as these drops dilate the pupil making the eye very sensitive to bright light.

Treatment is often helped by having the ‘bad’ lazy eye do periods of close work such as drawing or reading. The child will wear a patch over the ‘good’ eye during these activities.

Most children with amblyopia will also need glasses to help them focus their vision.

The doctor will discuss with parents what treatment is most appropriate for their child and their type of amblyopia.

HT: Do you have any advice for parents worried about their children’s eye health?

KM: I recommend all children to be screened for amblyopia, preferably at specialist centres, before they are school-aged. Young children have the greatest potential for successful treatment even though recent studies show that treatment in older children can also improve their vision.

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Helping Children with Dyslexia: I Have Dyslexia

April 28, 2022 Return

A dyslexic student’s diagnosis of her condition is both empowering and reassuring.

Blair Kenney was in her second year of Yale University when she was diagnosed with dyslexia.

She had always read more slowly than her peers. Her parents would dismiss her concerns by telling her that she worried too much and she should not compare herself to other people. Blair would also spend so much time checking and re-checking her written answers that she would always be the last person to finish her tests. Yet, her teachers did not feel that anything was amiss; they told her that she was just a “stressed-out overachiever”.

As a result, Blair saw herself as someone with below-average intelligence, always struggling to keep up with her peers. It was only when she saw a learning specialist and received an official diagnosis that her confidence received a much-needed boost.

“When I first heard that I had dyslexia, I was overwhelmed with emotions; I was angry, sad, and very confused,” she wrote in an article for the Yale Centre for Dyslexia and Creativity. “With time, I began to see my diagnosis as a self-affirmation. I had been correct in suspecting that I had a problem with learning, when many of the adults around me said that the only issue was my anxiety.”

The diagnosis gave Blair the confidence to accept her weaknesses and explore ways to overcome them. She wrote, “Instead of criticizing myself for being slow in school, I started to explore how I was different; and I began to see these differences as a reflection of the unique way my mind worked, not as a lack of intelligence.”

Education was also a little less stressful as she felt comfortable enough about her dyslexia to laugh at her mistakes and would cut herself some slack now and then.

Spurred by her experiences, she intended to carve a career for herself by helping other children who may need support in developmental and learning issues.

How about your child?

Blair managed to find herself and embraced her strength after becoming diagnosed with dyslexia. Clearly, the diagnosis gave her a better understanding of her condition and the confidence to reach for her dreams despite her condition.

Does your child have learning problems? Do you suspect that he or she has dyslexia? In this Mini-Report, qualified and experienced educational and clinical psychologist Selina Ding Wai Eng will share with you how you can help a dyslexic child to also achieve his or her dreams.

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Autism Spectrum Disorder – At a Glance

April 27, 2022 Return

WORDS HANNAH MAY-LEE WONG

Gan Huey Sien

Ms. Special Education, BCBA

It is estimated by the World Health Organization that 1-in-160 children worldwide has autism spectrum disorder. Over the past 50 years, this number seems to be increasing. In this Part 1, an expert explains the increase in prevalence can be attributed to factors such as improved awareness, better diagnostic tools and the expansion of diagnostic criteria.

In 2008, the United Nations General Assembly declared April 2nd as World Autism Awareness day. The reason behind this initiative was to reaffirm and promote the importance of equal rights, especially among those with disability. The end goal is the hope that all children and adults with autism can lead full and meaningful lives. Although awareness on autism spectrum disorder (ASD) has improved significantly over the years, stigma, discrimination and unmet health needs are still challenges that persist among those with autism. This month, we highlight ASD once more, as we have a chat with special education specialist, Gan Huey Sien.

WHAT IS ASD AND WHAT ARE THE SYMPTOMS?

Autism is a developmental condition. It affects how a person communicates and how they relate to people. But, while people with ASD may all share similar characteristics, there are different levels of severity to autism. Thus, autism is named autism spectrum disorder. Common characteristics of people with ASD include difficulty in communication, delay in speech and language, and having problems with social skills. Some of them have challenging behaviours, but most of the time, these behaviours are a result of their inability to communicate and relate to people.

“THE EXACT CAUSE OF AUTISM REMAINS UNKNOWN”

It’s common for people with ASD to have repetitive behaviour, for example, hand flapping or rocking. Some may display peculiar play patterns, for example, liking to watch a certain part of a video repeatedly. Some kids with ASD who have less difficulty in language may perseverate, which is to talk about the same topic they are interested in over and over again.

WHAT CAUSES AUTISM?

The exact cause of autism remains unknown. However, we do know that it’s a combination of genetic and environmental factors. People who are born with certain genes are at higher risk of developing autism. Environmental factors such as advanced age of the parents when they conceive and exposure to certain medication or chemicals during pregnancy are risk factors of having a child with autism.

IS THERE A CURE?

There is no cure for autism, but there are treatment and intervention options available including: applied behaviour analysis and early intensive behavioural treatment. These can be done in-collaboration with occupational therapy and speech therapy, to overall help children with ASD get better at everyday tasks. That said, it is important that parents are aware whether the treatment and intervention methods chosen for their child is evidence based. For more information, check out: https:// asatonline.org. HT

References: 1. United Nations. World Autism Awareness Day. Retrieved from: http://www.un.org/en/events/autismday/background.shtml 2. WHO. Autism Spectrum Disorders. Retrieved from: https://www.who.int/en/news-room/fact-sheets/detail/autism-spectrum-disorders

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ABA and Autism

April 27, 2022 Return

WORDS HANNAH MAY-LEE WONG

Applied Behaviour Analysis (ABA) is a therapy for autism, which applies the principles of learning and behaviour, to help reduce negative behaviour and increase positive ones in those with autism. Through the ABA, individuals with autism may improve in their language, social and living skills. Gan Huey Sien, a BCBA certifed special education specialist tells us more.

Every child is unique, and this also holds true for children living with autism spectrum disorder (ASD). As the name suggests, autism is a spectrum, which means each individual affected by it may: have a varying level of severity, display different symptoms, and have unique characteristics. Thus, treatment and intervention for autism is specific and should cater to each individual’s needs.

There is a variety of intervention options available for children with autism. These should help them lessen their symptoms and learn to better their skills. Thus far, the ABA is one of the very few, and most widely accepted, evidence-based interventions for autism.

AT WHAT AGE SHOULD A CHILD START THE ABA?

ABA is most effective when therapy starts from young. Most kids receiving therapy range between preschool to primary school age, but those beyond that age can still receive therapy.

It can be carried out at home or at school, either individually or as a group. It is quite intensive and time consuming, thus, therapy is often expensive. At Seed Autism, the centre which I run, the ABA program can range from 9 hours per week to 30 hours per week or more. Parents can also be trained to use the ABA method, so that they can carry on teaching their child and reinforce positive behaviours at home.

HOW LONG IS EACH PROGRAMME, TYPICALLY?

It depends on the needs and progress of the child. But we typically don’t have children stay with us for more than three to four years.

“THERE IS A VARIETY OF INTERVENTION OPTIONS AVAILABLE FOR CHILDREN WITH AUTISM”

HOW ARE THE TEACHERS/THERAPISTS ACCREDITED?

The accrediting body for ABA is called the BACB (Behavior Analyst Certification Board). There are different levels of therapists who work with the kids. These include registered behaviour technicians (RBT), board certified assistant behaviour analysts (BCaBA) and board-certified behaviour analysts (BACB). This board exists to protect consumers, to ensure that qualified therapists practice ethically, and information disseminated is accurate. For more information, go to www.bacb.com.

PLEASE TELL US HOW THE ABA PROGRAMME WORKS

Children planning to undergo the ABA programme are first put through a comprehensive assessment. Characteristics such as language, communication, social, play, self-help and leisure skills are considered during this assessment. Thereafter, each child’s designated therapist will work out a tailor-made lesson plan, which would be updated and re-evaluated as the child progresses.

If a child comes in with many challenging behaviours like screaming, tantrums, biting, pinching etc., the priority would be to work towards reducing these behaviours. Most of the time, we find that these behaviours happen because of a skill deficit. That means, it may be that the child can’t tell you when he or she doesn’t like something. It could be the TV playing too loud or they’re hungry.

We identify the reason behind each behaviour, bearing in mind that sometimes, kids do things just for attention—they may want mummy or daddy’s attention but don’t know how to get it. Therefore, we teach them appropriate skills for communicating what they want by using methods of reinforcement and prompting. For example, if a child sees that mummy is busy, we prompt the child to give mummy a tap on the shoulder (getting attention appropriately). Mummy then turns and looks at the child, and this reinforces the child because the child got what he wanted.

Once we reduce the challenging behaviours (also called barriers because these hinder the child’s development), we move on to the learning part. We build on their language, with a focus on communication. Note that not all kids with ASD can communicate vocally through words. They can communicate by showing you a sign, a picture or through gestures.

As the child gets older, things get a little bit more complex. We teach them what kids at their age should be able to do, like asking for specific things, sitting in a group, sharing with their friends and more.

WHAT ARE THE MAIN IMPROVEMENTS YOU HOPE TO SEE IN A CHILD WHO WENT THROUGH THE ABA?

We aim to teach them positive behaviours that are important, and skills that are socially significant, so that they can live a meaningful life. Lesson time is expensive, so we make sure we teach them things that are applicable. The end goal is that the child would be able to transition into a mainstream school, with as little assistance possible. However, this depends on the severity of ASD the child has. Transitioning to a mainstream school doesn’t happen for everyone, and each child’s pace is different. HT

Reference: 1. WebMD. Therapies for Autism Spectrum Disorder. Retrieved from: https://www.webmd.com/brain/ autism/ss/slideshow-autism-overview.

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Of Whiplash and Skullbreaker: Getting dumber and dumber

5 Facts About Obstructive Sleep

March 13, 2020 Return

WORDS PANK JIT SIN One of our readers forwarded us a video of three kids jumping, the ones on both sides then stopped and kicked the legs of the kid in the middle as he was mid-way jumping up, causing him to fall flat on his back and hit his head on the floor. It is truly painful to watch, and I can only imagine it must be more painful for the kid experiencing the fall. This is the newest Tik-Tok© challenge and might be the most dangerous to date. It is known as the Skullbreaker Challenge, for good reason. It can cause a multitude of injuries ranging from a simple bruise to concussion and possible death. The biggest concern is that the victim of a Skullbreaker Challenge will experience skull fracture or concussion. A fracture of the head is a medical emergency as the skull protects the soft brain form injury. A fracture of the skull is commonly accompanied by loss of consciousness, severe headache, nausea and vomiting, weakness, and cold sweat. Concussion is an injury to the head region which can lead to loss of awareness and alertness for a period of time ranging from minutes to hours.¹ Due to the speed at which the head hits the ground and all the force transferred to the neck, the victim could also suffer from whiplash, an injury to the neck caused by a forceful jolt or snap due to trauma. Whiplash frequently happens to those in motor accidents and extreme sports, and of course, it can happen to someone falling suddenly on their head and back. The sudden jerking motion causes injuries to the joints between the neck bones, discs, ligaments, muscles, and nerves around the neck.² These injuries tend to take a long time to heal and cause a great deal of pain and discomfort.¹

We spoke to a few general practitioners (GPs) and doctors in government hospitals in the Klang valley and it seems the trend has not picked up as they have not reported any patients coming in with “skullbreaker” injuries. Checks at a local international school and a government school also turned up no evidence of the challenge taking place in schools. Let’s hope this trend never takes hold in Malaysia. Please warn your child to never get involved in such a challenge. In any case, if your child comes home complaining about nausea, vomiting, or headache, it is a good idea to ask if they’ve been a victim of the challenge or if they’ve experienced a knock to their head, and to quickly bring them to see a doctor and monitor their progress.

References:
Johns Hopkins Medicine. Head Injury. Retrieved on 19 February from https://www.hopkinsmedicine.org/health/conditions-and-diseases/head-injury. Cleveland Clinic. Whiplash. Retrieved on 19 February from https://my.clevelandclinic.org/health/diseases/11982-whiplash.

BAD BOSS

June 25, 2020 Return

WORDS LIM TECK CHOO

Kevin Kruse, business speaker and co-author of We: How to Increase Performance and Profits through Full Engagement has a few ideas on how to work under a bad boss.

Are you the only one with issues with the boss?
Do you find that all the bosses you’ve worked with are terrible?
If you answer yes to any of the above— or to both questions—it may be worth considering that perhaps you, not your boss, are the one with the issues here. It may be time to adjust your expectations more realistically when it comes to your boss. If you think your boss is the problem,read on!

Talk it out!
Your job as well as your boss’s are a shared accountability—it is within your right to ask for a meeting with them to discuss your performance. Bring up how well you are performing in certain areas of your job and how you believe things can be improved. Use some diplomacy and even cunning to persuade your boss that the implementation of your ideas would be beneficial for the both of you.

Think positive.
If your boss is uncooperative or too difficult to talk to, examine the positive aspects of your job. Are you learning new and marketable skills? Is the salary worth the trouble? If the good outweighs the bad boss problem, it may be worth hanging on for a little longer.

How long will the boss be around anyway?
UIf you are working in a large company that changes bosses every few years, it may be worth hanging on until a hopefully better boss steps in.

If all else fails, it’s time to look for a new job.
At the end of the day, your mental and physical health is more important! HT