Category: Behaviour

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.

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.

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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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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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.