There are currently no schools or treatment centres in Malaysia that cater exclusively to children with autism. Therefore, it may not be wise or fruitful to just leave these children to kindergartens, schools or treatment centres. There is just too much diversity in children with autism. When it comes to treatment, parents have to be in the driving seat to make up for the lack of truly effective experts in Malaysia.
Learn about the various treatment methods available. Then decide on one primary treatment method. Pursue it with all the time and resources possible under your circumstances.
Regardless of what primary treatment method is chosen, consistency in carrying out the programme for a period of at least 6 months is very, very important.
Is Early Intervention IMPORTANT?
Definitely!
An early intervention programme (EIP) which comprises an educational programme and therapy must be implemented as early as possible. The chief aim of an EIP is to reduce the adverse effects of the underlying disabilily. While the degree of improvement and progress may differ, early intervention represents the best opportunity for the children to achieve their full potential and lead an independent life.
Why EIP?
A large majority of young children with autism who received early intervention showed significant improvements. More specifically, early intervention programmes based on principles and practices of behavioural intervention (or ABA - Applied Behavioural Analysis) tend to stand out with impressive results. (Click here)
The brain of a young child is believed to be sufficiently malleable. Intensive interaction can result in “rewiring” in the brain to compensate for some of the deficiencies associated with autism.
Inappropriate behaviour is easier to correct, and social behaviour easier to teach in younger children.
Normal children learn every minute of their waking hours whilst children with autism cannot learn effectively from the average environment. EIP can help create an environment in which children with autism can learn basic skills to lead lives as normal as possible. They need to be taught how to learn, how to have meaningful interaction and so on.
Starting early gives them a better chance of catching up.
How Early is Early?
Ideally intervention should start before the age of 5. The best results have been reported in children who started treatment as early as age 2. For some, an intensive and structured learning environment helps “rewire” the brain before these children withdraw themselves further into their isolated world of autism.
What about children older than 5?
Well, it is a case of “Better late than never”. There is no data available on how older children fare under intervention programmes, but some older kids also respond well to a behaviour modification programme.
Importance of Intensity & Consistency
Consistent goals, consistent teaching methods must be adhered to throughout the programme. For example, if the child goes to a speech therapist pius attends an early intervention centre, co-ordination among therapists, teachers and parents is critical. Otherwise, the child might be confused and improvements impeded.
One-to-one intervention with an individualised programme is highly recommended. The number of hours per week, competence of the therapist and the programme content itself are three important areas that would affect the child’s learning progress.
In the initial period, at least 30 hours per week of intervention is recommended in behaviour modification programmes. After six months, the intensity of intervention can be reviewed based upon the needs of the child.
Parental Involvement
No one knows the child better than his parents. Thus parents must be involved in drawing up a child’s programme goals, and in making decisions on the type of therapy and so on. Remenber, the intervention programme will become central to the child’s life.
Parental involvement is also important because learning must go on outside school or therapy sessions. Again, consistency cannot be overemphasised. If a parent helps the child learn consistently, throughout his waking hours, progress will be optimised.
Due to the lack of a strong support infrastructure for autism in Malaysia, parents must shoulder and spearhead the EIP for their children. It may not be possible for both parents to pursue a career and expect the E1P to succeed.
Cost
ETP costs seem to be prohibitive, but it balances out considering the gains that can be achieved. For children with autism and their families, the benefits of early intensive intervention are invaluable. Parents have a focus, a road map. They tend to be less stressed and less anxious in the long run.
After about 2 years of intensive intervention, there can be substantial cost reductions for most children.
Where?
A list of EIP centres in Malaysia and Singapore are given here
What Are The Various Treatment Methods?
A lot if you care to find out. BUT buyer beware!
Families typically feel the urgency to get treatment as soon as possible. It is however very important to spend some time exploring all options and gathering information. Talk to other parents and professionals who have used a particular treatment method.
Evaluate, rather than “shop” for treatments. Some parents go from one treatment method to another, putting their children through one programme after another. Precious time is wasted on ineffective treatment methods. The child might end up more confused, as the programmes may not be compatible.
Types of Treatments Methods Available Now
Different treatment methods are now available. Some are more controversial than others. One or two have been proven to be more effective than the rest. Many are a total waste of time and resources because they bring little long-term gain. Many have never been subject to any scientific studies. Quite often parents come across exotic claims and instant or miracle cures.
There are in fact no less than 200 known treatment methods available. This booklet covers information on the relatively better known ones:
Most treatment methods can be broadly classified into five main groups according to
approaches adopted:
Biomedical approach
Psycho-dynamic approach
Education approach
Neuro-sensory approach
Other approaches
There is no single treatment method that is helpful for all children with autism. Some parents and professionals use one principal method complemented by one or two other methods having different approaches. Nonetheless, parents should be aware that if they implement methods which are based on different philosophies, the child may end up more confused. (in particular educational methods e.g. ABA, OT and SLT)
Biomedical Approach
This approach includes the pharmacological method or the use of drugs and medication as well as dietary intervention (special diets, use of vitamin!multi-vitamin supplements, DMG etc).
All forms of treatments using biomedical approaches must be closely supervised by qualified medical personnel.
Pharmacological method
With this method, medication is used in the treatment of autism. Over the years many types of drugs have been used. These can broadly be classified as follows:
Scientists have found that medications developed to treat other disorders are sometimes effective in treating the symptoms and behaviours in autism. It is believed that autism and certain disorders (e.g. anxiety, depression and obsessive-compulsive disorder etc) may share similar problems in the functioning of the neurotransmitter serotonin. In this case anti anxiety and anti- depression medication appears to help.
Anti depressant drugs are sometimes referred to as serotonin selective reuptake inhibitors (SSRJ’). Some individuals with autism have been known to have high blood serotonin concentration. Serotonin is a brain chemical released by neurons and reuptaken by neurons. The SSRI drugs acts to decrease blood serotonin by modifying the serotonin uptaking mechanism.
Clomipramine has been well researched and shown to reduce the repetitive thoughts and behaviour and improve social relatedness in adults with autism.
Stimulant drugs (e.g. methyiphenidate - Ritalin which include amphetamine, amantidine and fenfluramine, detroamphetamine - Dexidrene, pemoline - Cylert)
Some children with autism experience hyperactivity, the frenzied activity that is seen in people with attention deficit hyperactivity disorder (ADHD). Stimulant medication affects children in an opposite way. They slow the children down. In addition, since stimulant drugs like Ritalin are helpful in treating many people with ADHD, doctors have tried them to reduce hyperactivity in some children with autism.
Opiate blockers (e.g. naltrexone - Trexan)
Because many children with autism have sensory disturbances and often seem impervious to pain, scientists are also looking for medications that modify transmission of physical sensations.
Endorphins are natural painkillers produced by the body. But in certain people with autism, the endorphins seem to go too far in suppressing feeling. Scientists are exploring medication that block the effects of endorphins, to see if they can bring the sense of touch to a more normal range. Such medication may be helpful to children who experience too little sensation. Once they can sense pain, such children could be less likely to bite themselves, bang their heads, or hurt themselves in other ways.
Some scientists believe that the behaviour of some children with autism resemble the behaviour of people on hard drugs (heroin, morphine etc) They show little sociability, little or no pain, no interest in outside world, and are in state of euphoria etc. It has been suggested that children with autism have an excess of pleasure, painkilling hormones in the brains such as endorphins to which they are addicted. As a result, they may require or desire a minimum dose daily and that self-stimulatory and/or self-injurious behaviours may be ways to produce these hormones and satisfy the craving.
Opiate blockers (e.g. naltrexone) which block the effect of drugs such as heroin on the brain should therefore block the effect of natural hormones such as betaendorphins.
Some researchers believe that epileptic like conditions may cause some autistic symptoms. Tiny mini-seizures may have created sensory processing problems, self-injurious behaviours and sudden aggressive outbursts (sometimes for no apparent reason). Anti convulsant drugs an sometimes help to normalise electrical activities in the brain.
They act by blocking the Dopamine receptors in the brain, thereby reducing the excess dopaminergic activity which gives rise to psychotic symptoms.
Risperidone (Risperdal) is an atypical anti-psychotic which has lesser side-effects compared to the traditional drugs. Research in people with autism showed it can enhance social behaviours, reduce repetitive thoughts and behaviours, particularly ritualistic behaviours in those who have developed Obsessional Compulsive Disorder and who do not respond to Fluoxetine. However, one of the disturbing side effects is excess saliva production, which can be helped by either using an anti-dote like Artane or anti-cholinergic agents, or stimulating exercises to the cheek and chin muscle to promote swallowing.
Originally, some of theses anti neuroleptic drugs are used to treat hallucination in schizophrenics. These powerful drugs are sometimes given to people with autism to temporarily reduce agitation, aggression, and repetitive behaviours. Since they can produce serious and sometimes permanent side effects, they should be prescribed and used with extreme caution.
Hormone (e.g. melatonin).
Melatonin is a hormone that helps controls one’s sleep cycle. It is sometimes given to children with autism that have sleeping disturbance. Lately, there have been some claims about the benefits of melatonin for a variety of things other than sleeping disorders.
Steroid (e.g. Prednisone).
Steroids are sometimes used for children with autism having Landau Kleffner
Syndrome (LKS).
These may be classified as a form of anti anxiety medication. Some doctors recommend that tranquillisers be avoided although others may use them if anxiety is a prominent sympton in the a child.
Benzodiazepines is best avoided because in cases, the person may become more restless instead of being calmed down. If there is a need to sedate, it is better to use anti-histamines or other anxiolytics like beta-blockers.
Blood pressure medication (e.g. beta-blockers and clonidine - Catapres)
It has been reported that beta blockers and clonidine are helpful in reducing anxiety level and sensory overload and thus aggressive behaviour of some individuals with autism. They have improved behaviour and social interaction.
Notes:
IMPORTANT!
No medication is able to fully correct the brain structures or impaired nerve connections
Find out as much as possible about the medications and drugs given. (e.g. possible side effect, short/long acting, addiction, tolerance etc).
All medications and drugs are to be used under strict supervision and regular consultation with qualified medical doctors. Supervision may involve periodic monitoring via EEG, EKG and blood tests. Side effects have to be carefully monitored (see example below). Dosages must be given in small incremental amounts. Too high a dosage may cause agitation, insomnia, aggression and excitement.
Some medications and drugs must be used with caution in persons with EEG and/or EKG abnormalities
Proper use of medication can be part of an autism programme but never a substitute for proper education and social programme
a medication or drug which works for one individual with autism may be worthless for somebody else
Here is an example to help monitor any side effects of Ritalin:
First ,observe how often the behaviour occurs after medication is started.
Keep a record of dosage used.
Discuss it with your physician if you are concerned over the effects observed.
Possible side effects:
1. Stares a lot or day dreams
2. talks less than usual with other children
3. not interested in other children
4. poor appetite
5. irritable
6. complains of stomach ache
7. complains of headache
8. drowsy
2. looks sad, miserable
10. crying spells
11. looks anxious
12. seems unsteady
13. excited
14. angry
15. has trouble getting off to sleep
16. has nightmares
17. displays twitches (tics)
Dietary Intervention Method
This method is based on claims that there exists a relationship between diet and behaviour. It has been shown that some children with autism are sensitive towards certain types of food or food groups while others obviously lack certain enzymes that help them to complete certain metabolic processes.
Over the years, parents and professionals have come up with various dietary regimens. The more famous and common are the elimination diets, the gluten free diet, the casein free diets, Sara’s diet and the Feingold diet.
These dietary programmes generally involve elimination of certain food groups and are implemented together with intake of various supplements (vitamins B6, DMG, calcium, folic acid etc). There is growing evidence that such special diets work to some extent. However, no published scientific studies have proven conclusively that special diets can help ALL kids with autism.
It is important to mention that dietary intervention method should match the individual needs of the child. If a child already has a limited diet, it may be very difficult to place them on any type of dietary intervention method. Furthermore, it would be very difficult (but not totally impossible) to make a transition from zero hours of intervention to e.g. 30-hours of ABA PLUS a highly restrictive diet.
However, it is helpful to keep a food diary on everything that the child eats or drinks. This includes food ingredients and amount of supplements taken. A record of behaviour that covers sleeping, tantrums, mood swings, attention, speech, play, social interaction etc should be kept along with the diary. This information may be useful in later analysis.
Never make more than one change in supplements/diet or supplements/diet amountat any one time. Some parents in PR4A have experience in dietary intervention. Contact PR4A for more details.
Elimination Diet This method of dietary intervention involves in tracking down hidden food allergies by careful elimination of suspected food items.
There are two ways to go about this:
If you have no time and patience but can afford it financially, do the necessary medical tests to ascertain if the child lacks something in his body or if he reacts abnormally in his metabolism. Refer to the DAN (Defeat Autism Now) protocol, which is a consensus among some experts on which tests can and should be done. Contact PR4A or Autism Research Institute of San Diego, USA for further information.
If you are not so well off but have plenty of time, start a special diet programme. Many parents in the USA have carried out such elimination programmes. But be warned that such programmes require careful thought, strict discipline and a vast amount of relevant knowledge. Such programme should only be carried out under the supervision of a doctor.
Gluten and Casein Free Diets This involves eliminating all the gluten sources and casein sources from the child’s diets. This covers food/drink items made of wheat, oat, rye, barley and milk, cheese, margarine, ice cream etc.
Certain food substances and antibiotics can cause the leaky gut syndrome (intestinal permeability) which in turn allows improperly digested peptides to enter the bloodstream and then cross the blood-brain barrier. These peptides then mimic certain neurotransmitters thus causing sensory scrambling in the brain (as if the kid is on drugs).
Feingold diet
Some individuals with autism suffer from phenolsulphurtransferase (PST) enzymes deficiency which affects sulphate metabolism which in turn results in inability to get rid of amine and amine compounds from the body. Food groups eliminated in this dietary treatment method include all artificial ingredients, and salicylates. Anti-yeast free diet
Some children with autism are victims of candida infection. With this dietary intervention method, gluten, casein, sugar and fungilmouldy food items are totally eliminated. Supplements recommended include anti fungal mediation (e.g. ketoconazole
- Nizoral, Nystatin, Diflucan), omega-3 Essential Fatty Acid (EFA) and probiotic. Sara’s diet
This special dietary programme is based on the belief that autism is a metabolic disorder of the immune system which perceives certain carotenoid and pigment as antigens. Food groups eliminated include food containing pigments and a host of others depending on the child. Supplements that have been found useful include cod liver oil, primrose oil, molybdenum and DMG. Hjgh Dosage of Vitamin and DMG
This dietary intervention programme involves the use of high dosage of vitamin B complex and DMG.
Vitamin B6, taken with magnesium, is being explored as a way to stimulate brain activity. Because vitamin B6 plays an important role in creating enzymes needed by the brain, large doses might foster greater brain activity in people with autism. However, clinical studies of the vitamin have been inconclusive.
It has also been observed that DMG sometimes helps to promote speech and increase attention span. Reason being that oxygen uptake by the blood stream is increased by
DMG.
Like drugs, vitamins change the balance of chemicals in the body and may cause unwanted side effects. For this reason, large doses of vitamins should only be given under the supervision of a doctor. Food Supplements
Some parents of children with autism find that certain food supplements help but no
systematic studies are known. They include the following:
• Gingko biloba
• Folic acid
• Calcium
• Dimethyl amino ethanol (DMAE)
Enzyme Potentiated Desensitisation Shot (EPD)
This is one of the methods practised in USA that aims to help the body to desensitise toward foodlenvironmental allergies/sensitivities. Shots are given on a regular basis for a period of time. This method is not available in Malaysia.
Epsom Salt Bath
This is classified as dietary intervention because it is related to phenolsulphurtransferase (PST) deficiency. Some individuals with autism have been known to be deficient in an enzyme (PST-P) that uses sulphate. This deficiency leads to the inability to get rid of amines and phenolic compounds. These stay in the body and create adverse effects even in the brain. Epsom bath helps to increase sulphate. It has been suggested that baking soda be added to the Epsom salt bath though the amount should be carefully determined.
Some parents in PR4A have experience in using Epsom Salt bath. Contact PR4A for more details.
Intravenous Inununoglobulin (IGIV, 1gW or IVIG) and Intravenous Gamma Globulin (IVIgG)
This treatment method is based on the theory that autism can be caused by an autoimmune condition in the brain. With this method, an intravenous (1V) solution is given to the body (similar to blood transfusion). These methods are very expensive an1 involve some degree of risk in blood contamination. At present it is not available in Malaysia.
Secretin infusion
Secretin is a hormone found in the human body. It may help certain children while others may be adversely affected. It has only been used to “treat” children with autism recently and has created much excitement for a while. Its effectiveness has not been proven after more tests have been carried out in USA. Secretin infusion is not availablein Malaysia.
Psycho-dynamic Approach
Consistent goals, consistent teaching methods must be adhered to throughout the programme. For example, if the child goes to a speech therapist pius attends an early intervention centre, co-ordination among therapists, teachers and parents is critical. Otherwise, the child might be confused and improvements impeded.
One-to-one intervention with an individualised programme is highly recommended. The number of hours per week, competence of the therapist and the programme content itself are three important areas that would affect the child’s learning progress.
In the initial period, at least 30 hours per week of intervention is recommended in behaviour modification programmes. After six months, the intensity of intervention can be reviewed based upon the needs of the child.
General
This approach includes all forms of psychotherapy and psychoanalysis methods. It regards a child with autism as being psychotic and tries to understand why the child is psychotic. To a psychoanalytical proponent, autism is a manifestation of an ego problem. The therapists normally would gently lead the child in sand play etc while trying to communicate love, understanding and total acceptance of the child.
Examples of treatment methods that adopt this approach are as follows:
Holding Therapy
Holding Therapy suggests that if parents hold their child very tightly and sometimes forcibly if required, for a long time (even if the child resists), the child will emerge from his world. Proponents of this therapy believe that autism results from a failure to bond with the child. This therapy will forge a closer bond between the therapist (usually the parent) and the child. The child will finally know that she is loved. Some proponents of this therapy believe that this therapy also provides some form of sensory stimulation.
There is however no scientific evidence to support claims of its efficacy..
Option Therapy
Option Therapy has been described in a book called Son Rise. It is based on a true story about how two parents, in particular the mother, found a way to enter the world of their son with autism. They managed to reach out to him and bring him back to the real world with unconditional love and total acceptance. After the recovery of their son, the couple set up the Option Institute, giving workshops on this method. Charges are extremely high and no records of further validated successes have been published.
Play Therapy
With this therapy, the therapists play with the child while talking to the child and trying to induce the child to talk. The goal is to help the child acquire language and a working knowledge of every day. Play is used as it is a major component of a typical child’s language acquisition.
An example of play therapy is the floortime approach (popularised by Dr S Greenspan). Children with milder form of autism or children that have completed ABA programme or in the advanced stage of ABA programme may consider the floortime approach
Education Approach
General
There are many methods & techniques used in the education of children with autism. Many teachers use a variety or combinations of methods. Some teachers attempt to identify an individual student’s learning style and modify the curriculum and materials to suit the student’s learning style. For example, many children with autism are visual learners: Teachers will use pictures, charts and visual representations when teaching. Materials developed for children with learning disabilities who are visual learners are often helpful to such learners. Teachers also use sensorial materials (e.g. Montessori materials) for students who learn well through their tactile senses. However, it is to be noted that Montessori approach may be too unstructured for children with autism to learn in.
People with autism don’t generalise very well. They should be given the opportunity to learn and practise skills in real situations, not mock-ups. Use real money to teach about money, use real food to teach about food, cooking, and nutrition, use real public places (stores, libraries, etc) to teach public behaviour.
Common to the various methods using the education approach is the heavy emphasis placed on structured learning. It is believed that structure allows children with autism to make sense of their environment and thus facilitate learning.
Behavioural Modification Therapy
Intensive Behavioural Intervention
One of the most effective method using behavioural approach was pioneered by Dr Ivar Lovaas of University of California, Los Angeles (UCLA) about 25 years ago. This method is also known as the Lovaas method.
This is one of the very few treatment methods born out of scientific research and has undergone vigorous scientific testing and review. This treatment method remains the only method with documented proof using controlled scientific studies. Using ABA/DTT teaching methods under very well controlled learning environments, it has been demonstrated that as high as 47% of the children recovered from autism (i.e. they become indistinguishable from peers). For further details, Click here. A list of papers and articles on ABA is available from PR4A.
The strategy in this ABA/DTT behavioural approach is briefly as follows.
Start early with one to one, intensive, highly structured and repetitive sequences in which a child is given a command and rewarded each time he responds correctly or nearly correctly. Typically 30 to 40 hours a week is spent in teaching sessions and a child starts as early as 2.5 year old. Example of teaching a young boy to sit still may be as follows:
A therapist might place him in front of chair and tell him to sit. If the he doesn’t respond, the therapist nudges him into the chair. Once seated with or without help, he is immediately rewarded in a big way. A reward might be a bit of cookies, a sip of coke, a hug, or applause-whatever he really enjoys. The process is repeated many times over a period. Eventually, he begins to respond without being nudged and sits for increasingly longer periods of time. Rewards (for sitting) is also faded progressively. Learning to sit still, follow directions and imitate etc are being taught on similar principles. This newly acquired skill then provides a foundation for learning more complex behaviours essential for a child to fit in the school environment.
Continue with one to one instructions to teach the child a wide range of pre-academic skills and knowledge. The necessary skills include all the basic learning skills (attending, following simple instruction, imitating), cognitive skills, basic play skills and social skills
Generalise the skills/knowledge learnt so that the child can apply them to different. people, places and times.
When the child is ready for kindergarten/school, mainstream the child into a normaLltypical school gradually. In the beginning, trained shadow aides may be. necessary, later the aides are faded.
Most of the parents using this method generally see their children improving greatly if the children start young and the programme is intensive, implemented properly and supervised by experts who are up-to date in their knowledge. Using this approach for up to 40 hours a week, some children may be brought to the point of near-normal behaviour. Some parents have reported “recovery” i.e. the children become indistinguishable from their peers. -
It is important to note that the Lovaas 1987 study also reported that 10 % of the children under similar intensive treatment did not show any noticeable improvement. It is believed that severity of the condition also plays a part in improvement gained.
While PR4A does not endorse ABA/DTT as the only effective treatment method for autism, it is PR4A’s belief that this method is scientifically proven, and is a highly effective method to teach children with autism essential skills and general knowledge. This in turn will increase their chance of leading an independent life. However, running an ABAJDTT programme is a very demanding undertaking. In Malaysia, where there is practically zero support infrastructure it is extremely taxing on the parents. While improvements will definitely be seen, they will not happen overnight.
PR4A intends to compile a separate booklet giving detailed information on this particular treatment method using ABA principles. In the meantime, parents who are interested can do one or more of the following:
Contact PR4A members. Some of the members have been running home based ABA programmes.
Read and learn from books on ABA/DTT (Click here).
Observe an actual ABA/DTT session to see how it is being done.
Search the Internet for more information. (Click here)
Natural Language Paradigm (NLP) or Pivotal Response Training (PPD
This is another form of behavioural intervention that is different from the Lovaas method. The main proponent for this method is Dr Robert Koegal of University California-Santa Barbara. In this approach, the child is shown a variety of toys and other items and allowed to play with any one that interests him. Then the therapist encourages the child to name the toy and answer simple questions about it in a more relaxed, “natural” type of teaching interaction than is usually seen in ABA treatment. This approach tends to be helpful with children at more advanced level. Natural Environment Teaching (NET) or Verbal Behaviour (VB) Methodology
This method has been made popular by Sundberg and Partmgton. It is ABA and uses DTT method. There is a heavy emphasis on functional use of language and creating a language rich environment. It is regarded by some parents as being better in promoting language and communication. This method has several different approaches compared to the Lovaas method.
TEACCH programme
TEACCH stands for Treatment and Education of Autistic and Related Communications Handicapped Children. This is a statewide teaching programme originally implemented in North Carolina, USA. It is also available in other parts of the world (e.g. Taiwan). In Malaysia, Hua Ming (See Appendix 5) is known to implement an education system based on TEACCH methods.
The TEACCH method is regarded to be the most influential special education programme serving children with autism in the USA. Though they draw upon behavioural procedures to teach self care skills and manage disruptive behaviours, the programme rejects many of the other aspects of behavioural treatments especially in areas related to teaching language.
With the TEACCH programme, children with autism are being taught to make use of skills they already have in sheltered environments (rather than helping the children enter into the normal/typical environment). In most cases, such children are taught not together with normal children but with children having autism or other developmental disorders.
Contact parents using the Hua Ming Association in Malaysia for more information
Higashi School (aka Daily Life Therapy)
This is based in Japan but there is also a large Higashi school in Boston. The Higashi School method shares some common features with DTT (use of prompt, and reduction of undesirable behaviours). However, it is different from DTT in that discrete trials and language training are not emphasised as much. The emphasis is on discipline and plenty of exercises.
Social Skill Training and Social Stories
This method aims to teach individuals with autism (especially those high functioning individuals and Aspergers individuals) many of the unwritten social rules and body language signals that are common in social interaction and conversation. Carol Gray uses a technique called Social Story to help illustrate these social rules in a variety of settings and appropriate social responses to other people. Written scripts are sometimes used for non-verbal individuals to teach appropriate responses. With some young children, scripting may be in the form of photographs or pictures. Social stories are something that parents can learn to compose to help their special children to acquire the essential social skills.
It should be noted that this method requires certain prerequisites before it can be effective
For example, social stories require the child to have a certain level of comprehension.
PECS (Picture Exchange Communication System)
PECS was first developed at the Delaware Autistic Programme. It is an alternative communication system developed for young children with autism and other social- communication deficits. It teaches the child to get things he wants by giving a picture of the item to an adult.
PECS begins with teaching functional communicative skills. It aims to help the child to develop spontaneous verbal communicition.
Some parents in PR4A have been using PECS. Contact PR4A for more information.
Speech and Language Therapy (SLT)
Most children with autism have difficulties with language. They may require many hours a week of instruction in order to achieve significant gains in language. This traditional treatment method of SLT which emphasises mastery of the formal properties of language may not be intensive enough to bring about change in the children’s behaviour. Children with autism need to learn not just how to speak but how to use language to communicate socially. Some may be non-verbal, and some who are verbal may be unable to use language in a meaningful way. However, SLT can be an effective complement to other methods
The difficulty is finding speech and language therapists who have experience with children with autism. Teaching methods used during such therapy should be compatible with the main programme implemented for the child.
A list of SLT specialists in Malaysia and Singapore is provided in Appendix 5.
Occupational Therapy (OT)
OT offers specific exercises/activities to correct certain deficits in children with autism. It focuses on improving fine motor skills (e.g. brushing teeth, feeding, and writing) and/or sensory motor skills (e.g. balance, awareness of body position, touch). After a therapist identifies a specific problem, therapy may include sensory integration activities such as:
massage, firm touch, brushing etc (Click here)
A list of OT specialists in Malaysia and Singapore is provided in Appendix 5.
Physical Therapy
This treatment method specialises in developing strength, co-ordination and movement.
Therapists work on improving gross motor skills. This therapy is concerned with improving function of the body’s larger muscles through physical activities including exercise.
Examples are the Glenn Domann method (aka Domann-Delacato) in which participants are encouraged to crawl and move as they did in the early stage of their development (in an attempt to learn the missing skills. The Glenn Domann method imposes extremely heavy demands on the parents, caregivers and the children. . There is however no scientific evidence to support the effectiveness of this treatment method for autism. This method is available in Malaysia (See Appendix 5)
Music Therapy
Music therapy involves using music to establish a trusting relationship between the therapist and the child. From there, through music, the child is encouraged to interact and eventually to work towards the therapeutic goals.
It is believed that music therapy is particular useful for children with autism, owing in part to the non-verbal and non-threatening nature of the medium of instruction. However, its effectiveness in teaching any new functional behaviour remains to be demonstrated. This method is available in Malaysia (Click here)
Neurosensory Approaches.
Auditory Integration Training (AlT)
It involves “training” the hearing of person with autism to hear more fully and accurately by reducing the child’s sensitivity towards some frequencies/pitches. This is achieved with the use of sound filtering and modulation. Many different types of methods have evolved from the initial very expensive (e.g. Berard method, Tomatis method, HAILO programme) to the one you can do at home using a multimedia PC (the EASe programme). Some children with autism have been helped by AlT. This treatment method is available in Malaysia and Singapore (Click here)
Facilitated communication (FC)
It involves holding or supporting a child’s hand or arm, steadying it to enable the child to type on a computer keyboard or some portable communication devices. The FC proponents claim that this will enable the child to type out her inner thoughts. Several studies have however shown that the typed messages reflect the thoughts of the person who is providing the support/holding, and not the child’s thoughts. It remains controversial but can be considered for children who are completely non-verbal.
Visual Therapy
frlen Lenses
This was originally developed to treat dyslexia and other learning disability arising from sight deficiencies. This method which uses coloured lenses to treat the visual processing problems is relatively new. The method was popularised by Donna Williams, a renowned author with autism. Scientific studies on children with autism are lacking.
Prism Lenses
This involves the use of lenses that are prisms that are thicker at one edge than the opposite edge.
Parents please note that it is important to have tests done by suitably qualified specialists to rule out any vision problems that may be hampering the learning process.
Sensory Integration Therapy (SIT)
It is based on the understanding that children with autism do have some sensory processing abnormalities (hyper- or hypo-sensitivity to touch, light or other senses). With SIT, the child develops better modulated sensory responses and thus may improve his/her learning, social and communicative ability.
SIT may involve massaging, brushing of skin and deep pressure, joint compression, gross movement (run, jump, climb, obstacles course, tug-of-war). These are some of the activities in a typical “sensory diet”. These activities seem to help calm, the child but usually provide only temporary improvement in problem behaviours.
It is to be emphasised that SIT should only be carried out under the supervision of a qualified occupational therapist that has undergone the necessary training.
This method is available in Singapore (Click here)
Others approaches
Craniosacral Therapy
This is a form of “myofacial release” performed by physical therapists, osteopaths and chiropractors. It supposedly involves unlocking certain areas in the body that are blocked in order for the cerebral spinal fluid to flow correctly. This method is available in Singapore (Click here)
Dolphin or Dolphin Assisted Therapy
Individuals undergoing this therapy method swim along or play with dolphins. It is claimed to have helped children with a variety of disabilities (including Down’s syndrome, ADD, autism, muscular dystrophy and spinal cord injuries).
Snoezelen Room Therapy
This therapy involves a host of sophisticated gadgets and equipment placed in a room - the Snoezelen Room. The development of the Snoezelen concept came as an alternative therapeutic activity for primary stimulation. The tools used in this room were designed to stimulate the five basic senses: touch, sight, smell, taste and sound.
The concept was developed in Holland during the late 1970s to provide appropriate relaxation and stimulation in a multi-sensory environment for children who have both sensory and learning disabilities. It can be used as part of a programme for therapy or education. This is available in Malaysia.
Words of Advice on Selection of Effective Treatment Methods
In trying to do everything possible to help their children, many parents are quick to try new treatments without much thought. Some treatments may be developed by reputable therapists or by parents of a child with autism, yet when tested scientifically, cannot be proven to help. Before spending time and money as well as risk slowing the child’s progress, talk to other parents having children with autism, professionals and experts
It is critical that parents obtain reliable and objective information before enrolling their child in any treatment programme. Programmes that are not based on sound principles and tested through solid research can do more harm than good. Such programmes may frustrate the child and cause the family to lose money, time, and hope.
Parents are often disappointed to learn that there is no single best treatment for all children with autism. Even after a child has been thoroughly tested and formally diagnosed, there is no “right” course of action. The diagnostic team may suggest treatment methods and service providers, but ultimately it is up to the parents to consider their child’s unique needs, research the various options, and decide.
Above all, parents should trust their own sense of what will work for their child. Keeping in mind that autism takes many forms, parents need to consider whether a specific programme has helped children with traits similar to their own child. Remember, “parents know their child best!”
There does not appear to be any “Magic Bullet” treatment available today for autism. It is also unlikely that parents can find a truly outstanding specialist who can provide highly effective treatment to ALL children with autism. The experience of most parents having children with autism is that under Intensive Intervention Programme, progress is usually incremental with spurts of improvement now and then. Occasionally for some children, there is regression.
Parents must be prepared for the long haul.
In considering the various treatment methods, parents may find the following questions helpful:
How successful has the programme been for other children?
How many children have gone on to placement in a regular school (mainstreaming) and how have they performed?
Do staff members have training and experience in working with children and adolescents with autism?
How are activities planned and organised?
Are there predictable daily schedules and routines?
How much individual attention will my child receive?
How is progress measured? Will my child’s behaviour be closely observed and recorded?
Will my child be given tasks and rewards that are personally motivating?
Is the environment designed to minimise distractions?
Will the programme prepare the parents and other caregivers to continue the therapy at home?
Will the parents be allowed to observe and learn during the treatment?
What is the cost, time commitment, and location of the programme? Can I afford it?
What Are the Services Available In Malaysia and Singapore?
What Are the Services Available In Malaysia and Singapore?
It is always helpful to remember the following three basic things when dealing with the professionals:
Parents are the experts on their child. No one else knows as much about him.
The professional is an expert in his/her own right.
Sometimes you will know more about some aspects but the professional’s knowledge is broad.
Together you and the professional form a team, with different roles. Never surrender your role as a team member and become the professional’s servant. Work together with the professional..
If you are unhappy with or disagree with the professional, ask questions and discuss the matter. Let him/her know that you are not sure and need more explanation. If you are still not satisfied, consider seeking alternatives. Talk to friends and parents of other children with autism. Take your time before deciding.
Try not to use several professionals of the “same” speciality at one time. Each piece of the advice given by the professionals may have merit on its own but various bits from different persons will usually not fit together well.
Tell professionals about successes and victories as well as about problems and frustrations. Like the rest of us, they need positive reinforcement and feedback too.
Be tolerant Professionals are human too! They have their share of good and bad days. They have doubts and make mistakes. The good professional acknowledges these and works to overcome them.
Keep the professional informed. For example, share copies of other assessment reports (with the consent of the report iters) and details of your Intervention programme.
