Autism Spectrum Disorder

1. What is Autism Spectrum Disorder?

Autism is derived from the Greek word ‘autos’ or ‘self’ which refers to someone who ‘lives in a world of his own’. Autism spectrum disorder (ASD) refers to a broad range of neurodevelopmental conditions that affect a person’s ability to make sense of the world and relate to other people.

The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fifth Edition, refers to ASD as a single condition with different levels of severity. It’s also associated with other conditions such as anxiety, aggression, attention deficit hyperactivity disorder and obsessive-compulsive disorder.

ASD is characterised by persistent deficits in social communication and interaction. It’s also linked to restricted and repetitive patterns of behaviour and interests that manifest during the early developmental stages of a child’s life. 

The Centre for Disease Control and Prevention states that generally 1 in 68 children have been identified to be in the spectrum. In Singapore, 1 in 150 children has autism, which is a higher rate than the World Health Organisation’s global figure of 1 in 160 children. Fortunately, early detection and early intervention programmes improve functional outcomes.

2. What are the early signs of ASD?

It’s true that children grow and develop at different rates. But, it’s equally important to know the developmental milestones for each age and stage of a child’s development. Parents should be keen to observe if their children are reaching their milestones.

Red flags may seem hard to spot to an untrained eye, but there are some early signs that may indicate ASD. Generally these include, but are not limited to the following:

Sources: 1, 2

If ASD is suspected, refer the child to his/her paediatrician or to appropriate specialist centres as soon as possible. 

ASD Diagnosis

3. What is developmental screening?

When you’re concerned about certain delays in your child, a developmental screening comes first. It takes a closer look at how your little one is developing through tests, formal questionnaires, and checklists that are based on research. 

The questions are designed to look into the child’s development, language, movement, thinking, behaviour, and emotions. It’s usually conducted by a doctor, a nurse, and other qualified professionals in the healthcare, community, or school settings. 

A good assessment not only provides a better understanding of your child’s strengths and needs, but also answers the key question – what’s next? That means, it should point to suitable interventions.

4. When is a developmental screening necessary?

Developmental screening is the best pathway to identifying children who may have ASD because it takes a closer look at how your child is developing. It’s a regular part of some of the well-child visits for all children even if there is no known concern. In fact, the American Academy of Pediatrics (AAP) recommends developmental and behavioural screening for all children during regular well-child visits at 9, 18, and 39 months. In addition, AAP recommends that all children be screened specifically for ASD during regular well-child doctor visits at 18 months and 24 months. 

Additional screening might be needed if a child is

• at high risk for ASD (e.g., having a sister, brother or other family member with an ASD)
• exhibiting behaviours that are sometimes associated with ASD
• at higher risk for developmental problems due to preterm birth, low birthweight, environmental risks like lead exposure, or other factors
• existing long-lasting health problems or a diagnosed condition, the child should have developmental monitoring and screening in all areas of development, just like those without special healthcare needs.

If your child’s healthcare provider doesn’t periodically check your child with a developmental screening test, you can ask that it be done.

5. What to expect in a developmental screening?

It is important to understand that developmental screening isn’t simply administering a test. There’s no such thing as an ASD test or an ADHD test to label your child’s developmental challenges. Rather, experts triangulate the evidence gathered to make an accurate assessment and diagnosis. That involves differentiating and ruling out other possible causes that may show symptoms that mimic these conditions. 

The assessment tools will be customised for each child after an initial consultation. Typically, it can take more than two to three sessions, and it’s usually more than an hour long. At AutismSTEP, we use well-established standardised assessment tools that will help us gather information about your child’s views and perspectives.

Read: Autism Consultation Explained: What You Need To Learn About Screening and More

6. Are there any potential barriers to standardised testing in children with ASD?

Yes, there are certain impediments that may affect standardised testing especially with kids who have developmental delays. We’ve specified them in the table below.

Interventions for Children with ASD

7. Can autism be cured?

There may be no cure for autism, but early diagnosis and treatment can reduce its severity. However, addressing the needs of a child who is in the spectrum takes no cookie-cutter approach. An individualised treatment plan is necessary to meet their unique characteristics and challenges.

Here are some common interventions that can promote progress among children who are in the spectrum:

• Applied Behavioural Analysis (ABA) 
• Speech and Language Therapy
• Music Therapy
• Cognitive Behavioural Therapy (CBT)
• Occupational Therapy

Read more about these interventions in our blog here: 6 Common Autism Treatment Options Available in Singapore

ABA Therapy

At AutismSTEP Singapore, we primarily use ABA therapy for our Home Programs. We believe that the principles behind it can help us assist children in overcoming challenges. 

8. What is ABA Therapy?

ABA is a scientific approach to understanding behaviour. It’s a type of therapy that helps reinforce desired behaviours and discourage unwanted ones.

The term behaviour refers to their skills and actions that are needed to talk, play, and live. The goal of ABA is to establish and enhance socially important behaviours to improve the child’s quality of life. It can help increase focus and attention, improve on-seat behaviours, and also reduce obsessions and rigidity.

9. How is ABA Therapy Beneficial for Children with ASD?

ABA Therapy is an internationally recommended treatment for Autism Spectrum Disorder and is also recognised by the Singapore Ministry of Health. It offers several advantages for children with ASD, and it includes the following:

• It’s an evidence-based treatment.
• ABA teaches kids early functional skills.
• It helps the child to communicate verbally.
• It helps children establish friendships.
• It helps foster independence.
• ABA decreases behavioural problems.
• It helps overcome difficult obstacles.
• It prepares kids for school and “real-world” experiences.
• It helps the child to be the best version of themselves.
• It teaches parents how to help children with disabilities.

ABA is an umbrella term for a collection of procedures or interventions, each of which has been demonstrated to be effective in reducing unwanted behaviour and teaching new skills. Some of the common components used are briefly described in the table below.

Sources: 1, 2, 3

Read: 5 Components of Applied Behaviour Analysis for Children with ASD

10. Is there an age limit for ABA Therapy? 

ABA Therapy is helpful across both the autism spectrum and the lifespan. ABA works with people of all ages, but it is best to start as early as possible.

Most children are between ages 2 to 6 years old when they begin ABA treatment. When they start early, ABA can help foster better communication skills, improve their ability to follow directions, and obey simple commands. For older children and even adolescents, ABA can be integrated into their education to teach adaptive skills. Doing so will help them meet the standard of personal independence that is expected at that age.

11. What can be expected in an ABA Therapy session?

Therapy sessions range anywhere from 1.5-3 hours in length. The length of these sessions vary from one child to another. It is carefully and compassionately designed so that your child’s time is used in an appropriate and effective manner. Sessions are programmed in a way that it also respects the child’s time and well-being.

The behavioural therapist will build rapport and to conduct a preference assessment (to determine what the child enjoys playing). This helps your child make positive associations with their therapist, and it will also motivate them to participate.

Visuals are also critical components in each session because these can be used as prompts so the child will know what is happening and what is expected of him/her. Our therapists always come in prepared with their selection of materials (toys, life skill items, etc.) that will be used during the session. 

Our home sessions might include, but are not limited to, the following activities:

• Play time
• Eating programme
• Language development
• Cognitive skills
• Visuo spatial skills
• Social skills
• Self-help skills
• Activities of daily living
• Potty training
• Fine motor activities
• Gross motor activities

You can best expect that each ABA program is customized for each child to target specific skill deficits. Everything that is taught during these sessions will be recorded. The decision to move to the next skill or activity is based on the data we’ve recorded which will reflect the child’s progress. 

Read: 4 Types of ABA Therapy Sessions

12. How does ABA teach new skills and how is it different from other methods of instruction?

ABA therapy uses the principles of behaviour to teach skills. 

In this method, each skill is broken down into component parts and each part is systematically taught with a prompting process and reinforcement plan. These skills are arranged in a way that the successful completion of one will lay the foundation for the next skill in the series. This is what sets ABA apart from other teaching methods. It is systematic, time-bounded, and it uses reinforcements if a child is unable to respond within a specified amount of time. 

13. Is there parent involvement in ABA therapy? 

The answer may vary for each provider, but with AutismSTEP, we highlight the importance of parent involvement for the success of our therapies. We provide opportunities for the parents to observe, and even share tools or teach hands-on strategies which they can use in their own time. We don’t operate in silos. Rather, we want parents to be our partners in this journey. Since they know the child better, we want them to have a voice in goal-setting and be fully aware of what’s going on during therapy. 

14. Is ABA used to remove certain behaviours? 

ABA strategies like behaviour modification and positive reinforcement can be used to decrease challenging behaviours in children with ASD. These include aggressive or self-injurious behaviours. We will try to get to the root of the problem so we can introduce positive behavioural interventions and support strategies when they face certain triggers.

Read: 9 Ways ABA Therapy Techniques Can Help Manage Your Child’s Tantrums

15. What should you look for in an Autism Therapist for your child’s ABA sessions?

An ABA program is often as good as the therapist implementing it. Therefore, it pays to know what the necessary qualifications are in a good ABA Therapist. The following criteria should be a good start: 

• Previous Experience. Being an effective therapist has to do with one’s level of experience. You can always ask the centre about the therapist’s training background.
• Personality. While the right educational background is essential, it’s also important for the therapist to be fun, engaging, and able to take initiative while also following directions. A therapist without a dynamic personality may find it difficult getting through a 2-year-old child who learns through a play-based program. 
• Certification. It pays to have a Registered Behaviour Technician (RBT). RBTs assist in areas such as delivering direct behaviour-analytic services, aiding in implementing behaviour plans which are developed by the BCBA or BCaBA, and collecting data.
• Your Gut Feel. You’re entitled to a trial period where you get to see how the therapist is interacting with your child. Make sure that you set clear expectations, and if you’re not comfortable it’s better to move on. Remember that you’ll be entrusting your child for several hours to this therapist, hence it’s worth getting it right.

Read: What You Need to Look For in An Autism Therapist in Singapore

We hope that we were able to help you with your concerns. If you think we missed some important questions, you may drop them all HERE, or call us directly at +65 6456 9950 for a consultation.