Diagnosis
and Definitions
Q.
My friend has a younger sister, 14 years who always seemed odd to
me. I have known her since she was born and see her as if she were
my own sister. Lately another family friend of ours has been dating
a doctor, and as soon as he met my friend’s sister he noticed
that she suffered from a very mild form of Autism. So far no one has
told her parents or anyone in her family, because they would never
accept something like this. They would also never speak to whoever
told them for the rest of their lives. We are currently trying to
find a way to break it to them.
I just
wanted to ask if there is any advice about telling parents their child
is autistic. Also until someone finally tells the family, is there
anything that can be done to help her without the family’s knowledge?
A.
There are two things I understand you want to address: how
to tell the family and how to help the girl. It may not be possible
or appropriate to tell the family their girl has autism without a
formal diagnosis. And since the family is not willing to go for a
diagnosis this is obviously ruled out. An option might be to leave
information on the noticeable symptoms particularly of persons with
high functioning autism, in their home, for the family to come across
and come to their own conclusion.
Regarding
helping the young girl it depends on what specific and evident issues
she requires help on. Particularly given that she appears functionally
quite able we would need inputs on specific areas where she requires
support.
Q.
My son is 23 months old, but he has not started speaking.
But on his own he has learned certain things by observing other family
members. He is very active, enjoys playing with other children, loves
music and watching TV and builds with blocks at a good level. He feeds
himself. He tries to copy and do what others do. He is healthy and
has achieved all milestones except two:
1. His
speech is not clear except a few words like 'bye', and 'ma', and that
too not meaningfully sometimes.
2. He
follows only a few commands like ‘do’, and comes when
called. But if we show him something he does not pay attention. He
prefers to do what he wants: like he will bring rotis and serve you
if he sees that you have finished your roti and your plate is empty.
When he wants to eat something he will try and get it or he will point
to the objects and take us to the kitchen. He is able to make us understand
all his wants: whether he wants to go to the toilet or to the market.
I have no doubt about his intelligence as he leans very fast by observing
others. I just want to know what the real problem with my son is.
Are these the symptoms of Autism?
Finally,
can I undertake the proposed two year bio-medical programme of chelation
and HBOT for my son.
A.
It is difficult to say on the basis of your description whether your
son has autism or not, as for that it would be essential to make an
observation of your son’s behaviours and have an interview with
you and your wife. Receiving a diagnosis for your son’s condition
should be of top priority, as that would help direct you to an appropriate
treatment approach. If we know where you are based we could refer
you to a competent diagnostician, ideally a developmental paediatrician
or a child psychiatrist with extensive experience of autism.
As for
undertaking the advised bio-medical programme, perhaps you want to
first arrive at a diagnosis for your son’s condition before
you can consider whether to go for it or not?
Q.
My three
year old daughter is diagnosed 'Autistic Featured' by JSS Hospital
Mysore and KMC Hospital, Manipal, in their differential diagnosis.
She is taken for speech therapy to KMC regularly and I could notice
a slight change in her activities but not in her speech. Kindly suggest
for further steps that I can take to cure my daughter at the earliest
before it is too late.
A.
The purpose of a differential diagnosis is to rule out all other developmental,
neurological or genetic disorders which may show characteristics or
'features' that are similar to, or that may overlap with those seen
on the Autistic spectrum. From your letter, it appears your three
year old has been diagnosed as falling within the Autistic Spectrum.
Findings
suggest that giving speech therapy alone may be helpful; however,
progress can be limited due to the nature of the disorder. It is vital
for you to understand your child's difficulties. We suggest you speak
additionally to a special educator or psychologist, who has a sound
understanding of Autism and perhaps you yourself read up on autism
to help you understand your child better.
To date,
research indicates that giving early intervention in the form of specific
and appropriate training methods that are tailored to your child's
needs and learning style is the one way to help your child reach her
maximum potential. Prior to this, it is important that a special educator
take a detailed assessment of your child's strengths and difficulties
to develop an individual education plan for your child. There are
a number of intervention styles / methods, and you would want to choose
one that would benefit your child most.
Autism
is a complex lifelong developmental disorder, and has no cure, medical
or therapeutic. However, through early intervention, many children
have been able to lead productive and meaningful lives with support
from their family, friends and professionals. A number of other organisations
around India provide early intervention such as at Action For Autism.
Q.
I am
an insulin-dependent mother to a boy just turned three this November
[living in the Phillippines]. He has been diagnosed to have Global
Developmental Delay when he was a year old. Since then he has been
on occupational therapy, and just three months ago we have incorporated
speech therapy. What I noticed is that he frequently tiptoes and shakes
(or wiggles) his arms and hands. Could these be signs of autism? I
need some light on this please.
A.
The behaviours you mention may not mean anything. Or they may: only
a direct observation of your son can help clarify this.
What
would you say is your son's developmental age now? Supposing if he
is at an 18 month level physically, does he do other things a child
of 18 months would do?
Does
he look when you try to draw his attention to anything? When there
is an aeroplane in the sky and you say "look at the plane"
does he look or does he not respond? If you point to the aeroplane
with a pointed finger and say "Look at the plane" will he
look up directly at the sky or will he first look at your finger before
following the direction where you are pointing. A typically developing
child will be more apt to do the latter. Does he turn to look at you
when you take his name? When you come into the room after a period
and take his name does he look at you and then follow you with his
gaze as you move around the room? What does he do when there are other
children around?
Perhaps
the best way to clarify your doubts would be to contact the Philippines
Autism Society.
Q.
My daughter is 27 months old and still has a vocabulary of about 10
words. Recently she had some tests done in Ranchi (Jharkhand) for
hearing as well as brain scanning as suggested by a neurophysician.
She has been given medicines for Autism. We have not started the medicine
still. I want to get my daughter diagnosed to ascertain whether she
really has Autism. Please suggest where we should we take her for
diagnosis. Also if you can advise on Speech therapy centres in India.
A.
You can obtain a diagnosis for your daughter from NIMHANS in Bangalore,
PGI Chandigarh, All India Institute of Medical Sciences Delhi, Ummeed
in Mumbai, Hinduja Hospital Mumbai, as well as in most major hospitals.
In addition there are many individual professionals who can give you
a diagnosis. I would like to add that you do not require a brain scan
for a diagnosis of autism; however the scan can help rule out other
conditions. Also, there are no medications forAutism though there
are medications to help counter some of the symptoms of autism.
While
you want to get a diagnosis, it would be helpful to start teaching
skills to your daughter as soon as possible.
Q.
The last one week has been the most traumatic one for my husband and
myself. We discovered that our first and only child, who seemed so
completely normal to us has PDDNOS. It is devastating though we have
been trying to let it sink in. It only now occurs to us, that every
single task that our beautiful little girl performs on an everyday
basis must be painful for her physically and exhausting mentally.
Her therapist
said that she is a high functioning PDD child. We hope to God that
it can only mean that the best for her is yet to come.
As anxious
parents, we have several queries that we would like to bother you
with; maybe once too often. We have accepted that God has chosen her
in order to bring us closer together as a family and as friends. But
we are terrified of what the future holds for her. We also believe
that God works through people like yourselves. You are our Angels
of Hope. Please help us in any way that you can.
We realise
that the early evaluation of her condition and her high functioning
are positive signs for her development, but it still leaves us with
many fears and apprehensions.
Will
P ever lead a normal life in the company of normal people? Will she
find peers in school and college who will not pick on her and reduce
her selfesteem to dust? Can we find means in which at least her sleep
will be restful? Are there any handbooks for daily reference as to
how we can handle our dear child? Will reprimanding or removing privileges
when she has done something wrong cause her condition to worsen? Can
we just be normal with her or does she constantly require our undivided
attention?
If her
playschool turns her down, is there any hope that she can be brought
up with the right conditioning?
Approximately
how many months or years of therapy would it take for her to progress
in a normal fashion? Well, there are several hundred queries that
come to mind as I write to you. Will she ever speak like you or I
do? I can not wait for her to tell me that she is hungry or happy
or hurting or just anything!
I am
sure that I have bombarded you with too many things too suddenly but
that is in the hope and belief
that you will support us in this long arduous journey.
A.
Receiving a diagnosis of autism for ones child can be a most painful
experience. But as we learn to deal with the pain we also begin to
accept that though that one moment when we receive the diagnosis seems
like the one defining moment in our lives; yet our child after that
moment is actually the same child who was there before. Nothing has
really changed except the way we view her.
Of course
the fact that our child is that bit different from typically developing
children with various complex needs means that we have to make adjustments
for that difference. Many adjustments. Not merely in our expectations.
But also in how we had planned our lives and what we might have to
do for her.
Yes life
with autism is a very complex situation for any individual to deal
with, just as it must be for P. We want to understand that and help
her, yet not teach P that hers is a terrible and difficult life. The
initial weeks and months after a diagnosis is always a period of confusion
and fear - fear of something we do not quite understand. But as our
understanding of autism grows that fear and trepidation is overcome
and replaced with the knowledge that yes there will be progress. How
much progress will vary from child to child and hard to predict, but
there will be considerable progress and we will learn to celebrate
every step that P takes towards that progress. Because she will be
putting in as much effort as any of us.
As parents
you will want to learn as much as you can about autism. There are
many good books available. Knowledge will lead to the confidence to
deal with P in a manner that will be most beneficial for her. There
are numerous books you can read up - and the Forum for Autism Mumbai
library will help you with that. So will the net. Learn from P's therapist
how you can help P and generalize her learning. For instance simply
removing privileges may not teach her anything. Whatever you do must
be based on sound scientific principles of behaviour modification.
Whatever methods you adopt to bring about behavioural changes must
make sense to you.
Finally,
P may or may not eventually go to a regular school, she may or may
not go to college, she may or may not speak like you or I do. But
she can be a happy child. And that will depend on us. P will always
have autism. Autism cannot be cured. But yes the symptoms are often
minimized through early appropriate intervention. So read up on autism,
help P have the best learning environment possible, and enjoy her.
Despite her diagnosis she is still the P you love.
Wishing
you a wonderful journey with your child.
Q.
Recently we came to know that our five-year-old son is autistic. The
symptoms are as follows:
He
learnt to speak very late, at three to four. Now he is five. He can't
speak fluently and often speaks in the third person. He can't mix
with other children and plays with unusual things, like a small stick
or paper pieces or broken wheel of his toy train and spends almost
the whole day with that. If he is asked ten questions, he answers
only one or two, either properly or improperly in spite of knowing
the proper answer. He does not respond to outsiders, does not even
make contact with them with his eyes. He protests if wearing a new
shirt or a pair of new shoes, or following a new path to his school
or to taste a new food. He likes to strike objects with his fingers
creating a sound and occasionally is found, rubbing both his jaws
together. He shows little interest in learning anything new, as a
result, neither can he sip water or milk, nor can he spit water out
from his mouth after brushing his teeth. He cannot tolerate the sounds
of horns. He is very restless, inside his home, but very calm outside.
Sometimes he laughs without any apparent reason and sobs for minor
causes.
His
memory is good and he seems quite intelligent. At the beginning of
his school, teachers complained about his non-cooperation. However,
at present, he is co-operative with them. He reads in nursery and
doing well with his studies in a regular school.
But
after knowing about his autism, we became anxious about his education
and future life. There is no special school in our town and we don't
want him to get admitted in Kolkata, far away from us. Kindly help
us with your advice for continuing his studies in the normal school
he is attending and regarding his other deficiencies.
From
the internet, we found the name of a book, "Biological Treatment
for Autism and PDD", authored by U.S. based scientist, William
Shaw, Ph.D, which claims dramatic improvement of autistic child by
biological treatment.
A.
As you can figure from observing your son, autism, unlike mental retardation,
is not a global developmental delay. Your son is young and of course
the best course is for you to educate yourself about autism in order
to facilitate your sons progress.
Autism
primarily affects the areas of communication, social skills, and thought
and behaviour. For instance your son cannot play with other children
or respond to adults. He appears to have difficulty looking at people
when addressed or when addressing them to get his needs met. He has
good speech, yet answers questions infrequently, and that too sometimes
incorrectly.
Play
is also affected, so that a child might not play appropriately with
toys and which is why M keeps himself occupied with sticks and odd
bits and pieces. Many individuals with autism have a good memory.
Others may be of average or above average intelligence. There is also
often a need for sameness. Which is why M has difficulty taking a
new route or trying new food. There may be differences in the use
of sensory modalities. So your son finds it difficult to tolerate
some sounds, yet enjoys striking notes and listening to them. Or rubbing
his jaws together.
You
son appears to be managing well in a regular school. Rather than look
for a special needs school to send him to, you want to focus on helping
him continue in his current setup. Take note of his strengths and
work to minimise his deficits.
On
improving his communication skills check the issue of Autism Network
Vol IV No 3 December 1997. M might have speech, know the answer to
a question, and yet when queried may not be able to come up with a
reply on every occasion. What you want to do is to provide the correct
response, so that he understands the function of speech. Example:.
"How many biscuits do you have?"
"Three."
Supposing you know that he will say "One," incorrectly when
he actually has three, you pre-empt his "One" with your
"Three".
Above
all, avoid asking him needless questions. For instance if he knows
his name and can answer "M" when asked his name, then you
do not want to ask him his name. Only let outsiders and visitors do
so. And if he then does not respond prompt him as mentioned earlier.
There is an entire range of exercises as well as things you can do
in the course of daily interaction with SR to help his communication.
To
help develop his ability to look at people when addressed try the
following:
When giving an instruction or telling him something first take his
name, pause for a couple of seconds, and then say the rest. For instance,
"M?" pause, "come have dinner."
When
giving him something - rather than just handing it to him - hold the
object between your and your sons eyes in the line of vision, such
that in order to look at the object and reach for it he has to inadvertently
look in your eyes. When addressing him, whenever you can, lower yourself
to his eye level in order to make it easier for him to look at you.
And whenever you get a spontaneous look from him acknowledge it. Avoid
telling him "Look", "Look", repeatedly. We often
fail to realise how irritating it can be for a child to be continuously
told to look when it is actually difficult and sometimes painful for
him to do so.
From
your account M is doing well in his class. As he learns and grows
be aware of a couple of issues. M has good memory. This is a strength
that you want to use and that will also enable him to learn well.
At the same time, good memory in our children can mask a learning
disability. So while he might learn to read and calculate, you want
to be aware to ensure that simultaneously his concepts are clear and
that he is not doing these things by rote, as a mechanical ability.
There
is currently a great deal of research being carried out on the biological
basis of autism. Some children have improved with changes in diets
and allied methods. Some do not show much improvement. You could give
those a try if you want to.
We do not have the book by William Shaw. However we do have something
on the subject by Paul Shattock which you can access at the AFA library.
You could also check out the following issues of Autism Network:
Vol VII No 3 December 2000, and Vol VIII No 3 December 2001.
Q.
We have a five-year-old son whose behaviour, intelligence, reflex
and mental expression are not like other children of his age. We were
informed of AFA by the Institute of Child Health, Calcutta, who say
he is autistic. Please advise us on what we can do to help our son:
1.
He learned to talk a bit late.
2. His fondness of music, TV programmes, general play and interest
in nature and animals, trees, the moon and sky is day by day decreasing.
3. He was admitted to a local nursery school but in no way is he having
any interest in books, writing or drawing.
4. Only he loves to play with toy buses.
5. He has some hand mannerisms that are peculiar as well as strange
sounds he makes with his mouth.
6. He responds to only such talk as he likes.
7. Sometimes he does mischief, drawing the attention of elders.
A.
Let me explain a little about the nature of autism; it will help
you understand why your son behaves in the way he does.
Autism
is a lifelong condition. When a person has autism there are difficulties
in three main areas. They are: communication, social skills and imagination.
Many
children with autism do not develop speech at all. Some of those who
do, may speak very little and their speech is mostly need based that
is they speak when they need or want something. They will ask for
things they need like "water" or "food". Other
times they may use words which seem to make no sense to us. All this
is because they have difficulty in understanding how to use language.
A
child with autism may not respond to certain questions because it
makes no sense to him, like "what is your name?", "what
happened at school?" etc. But if someone said "do you want
a toy bus?" it would be meaningful because he likes playing with
toy buses.
Children
with autism have few social skills. Therefore they very often do not
interact in socially appropriate ways or know how to draw attention
to themselves.
How
would a child without autism draw attention to himself? He may do
something that he knows his parents want him to do. He may draw a
nice picture, or recite a poem, or sing a song. But a child with autism
does not know how to get attention and like any other child he wants
attention or wants to be able to manipulate his environment in some
way. Therefore he may do something which will seem a mischief. He
may be scolded but to him it is still attention, therefore even though
he anticipates a negative reaction to his behaviours he may want to
do it. Therefore you could try and totally ignore what mischief your
son has done. But when he is behaving in a way you like, let him know
this. Praise him, give him attention - then he will learn to get attention
in an appropriate manner.
You
have mentioned that your son only plays with toy buses. What you can
do is to join him in his play. Talk to him clearly about the buses.
Where are they going? Who is sitting inside? Tell him, but avoid asking
questions. Just make comments. By joining him in his play you will
be interacting with him in a way he understands. Then slowly you can
teach him other forms of games.
In
your letter you have said that your son has certain mannerisms and
makes peculiar sounds. You may see many children with autism who have
what are known as sensory difficulties. We all take information about
our environment in through our senses. In children with autism, one
or more of the senses may be over sensitive or under sensitive. So
a child may cover his ears to cut out a sound or make strange sounds
with his mouth to cut out a particular sound. Children with autism
often flap their hands or hop to help them to deal with sensory difficulties,
and this in some way relaxes them.
Q.
I have a worry about a niece of my husband's who is 18 months
old. She is a beautiful child but I see symptoms that I have seen
before. I help part time in a school for children with behavioural
problems and have helped with children with autism. Little S shows
a lot of the same traits as in other children with autism. I know
that time is a great benefit on the road to helping in problems like
this. However, I cannot find a way to tell my family of my fears.
Should I leave things until someone of the medical profession notices?
Please help.
A.
Since you know about autism you are also aware that the earlier a
child receives help the better the prognosis. I dont think you want
to wait for the family to happen to meet a medical professional who
will then inform them of their child's condition. Many parents lose
precious years of their child's life for the same reason.
You
are in a difficult situation. I think what you could do is leave some
literature around that lists some of the traits your niece exhibits
so that they come to her parents notice. Maybe a list of behaviours
that are the red flag for an autism diagnosis.
Could
you not talk to your husband about it and share your concern? Since
it it his family he might have a better idea how to deal with the
parents.
Whatever
you do - just do it. The parents might find it hard to forgive you
for it now, thats understandable, but in a few years they wil be grateful
for the years you saved them. In addition, check to see if your area
has a helpline run by a local society that could guide you.
Q.
I am a resident of Kolkata. I have a child of two years of age. As
per the Doctors she has some abnormality in responding to our spoken
speech. Though she sometimes responds to our spoken speech but she
has not yet developed speech and only utters fragmented words like
"Dada", "Baba", "Kaka", "Ma' etc.
Otherwise she continues to utter words as per her own. In this circumstance
we are very upset as some of the doctors have said that she may have
some symptoms of Autism. Please provide us information on this subject
like:
1.
The symptoms of Autism
2. Its treatment and chances of recovery
3. Whether autistic child can lead normal life as others
A.
From the information about your daughter that you have provided it
is possible your child does have Autism. Autism is a behavioural syndrome
and by the age of two you can see symptoms in the social, communicative
and play behaviours. There are a wide range of these behaviours and
all children do not show all of these, as Autism is a spectrum disorder.
You
have asked about the treatment and the chances of recovery. Autism
is a life long developmental disorder but with an early diagnosis
such as your daughter has received, and an intervention (training
and teaching) that is very specific to the special needs of your daughter
you can help her to progress towards her maximum potential.
Many
people with autism can lead a fairly independent life but that depends
to a great extent on the degree of autism and the kind of the training
that is given. Training, not only refers to teaching but also the
comfort and acceptance from people in the child's immediate environment.
This is of course true for every child whether typically developing
or not. But for the child with autism, living in a confusing world
where social rules appear so arbitrary and confusing, we believe that
comfort and acceptance is crucial.
One
of our therapists shall be visiting Calcutta at the end of December
for a two-week period. If you want to contact her, do get in touch
with us for details.
Q.I
came to know of Action For Autism from the local pediatrician. It
restored my courage to some extent. My son aged three years and four
months has provisionally been diagnosed as autistic at PGIMER, Chandigarh
in September 2000. The tests done were MRI, EEG, besides which the
psychiatrist asked questions to arrive at her diagnosis. Before diagnosis
my son had no proper training due to lack of knowledge and lack of
infrastructure. He wasn't pointing or speaking much, had almost no
eye contact, and was hyperactive and restless. He has been taking
a herbal medicine since June 2000.
After
diagnosis the boy was sent to his uncle's place where unlike my home,
there are boys of his age and his mother did as much as she could
do to teach and train him. Within fifteen days he improved remarkably,
such as using finger pointing, eye contact, language etc. From mid
October he has joined a play school as directed by the psychiatrist
and according to feedback received from the school he plays with other
boys .
I
have gone through your URL which is in question and answer format
and it helped me a lot to clear my doubt but also created confusion.
For example it suggests that autistic boys may be very sensitive to
noise, touch, that they have sleeping problem etc. I also read this
on the web site of TEACCH. This is not present in my son.
A.
I am glad to know that you found our website useful, and that it 'restored
your courage.' It is so important for parents to have hope and to
know that though autism is a serious developmental disorder, with
appropriate intervention all children with autism can move forward.
As you have noted yourself, your son made progress when put in a stimulating
positive environment. This progress can be accelerated by a focussed
and structured program that uses things in his environment that motivate
him, to teach him to communicate and interact. Many parents all over
the world have successfully carried out home programs to help their
children and there is no reason why you and your wife should not be
able to do the same. AFA will be very glad to help you do so, as this
is our focus.
For
parents who live outside Delhi, we offer one week and three month
outreach services. During this period, the parents can come in daily
with their child, and while the child attends our model school, the
parents observe and get training from our staff. We also have a Mother-Child
Program, where mothers run a day school program where they work with
their children and get feedback and suggestions from our staff.
You
said you were confused by some statements on the web site that did
not apply to your son. Autism is a spectrum disorder i.e. children
with autism can have varying skill levels in different areas. What
is common is difficulty in communication and social skills - but this
too can manifest itself in very different ways. Many children with
autism have problems in processing sensory information, in different
ways. Some may have acute hearing, which may cause them pain. Some
may have tactile issues, leading to sensitivity to textures or pain
insensitivity, or difficulty with hair cuts or nail cutting or bathing.
However not all children with autism, have these issues, and if your
child does not have it - just be grateful! It is useful to know that
these may exist, so that if you see some unusual behaviour, you can
know that this might be a possible cause, and you will know how to
deal with it.
There
is no medicine that can cure autism. Products such as the one you
refer to should be viewed as tonics at best, not medicines. The only
proven method of intervention is a structured program based on behavioural
principles. Your son will benefit, and you will feel more empowered
by getting more informed and aware about autism.
We
have a large collection of books on autism at our center where you
may read at no charge. You can also access a lot of information on
the net - but do try and visit good peer reviewed sites, or you can
get overwhelmed by all the unproven theories on autism treatment that
you may encounter on the internet.
Q.My
four year son is suspected to have autism. He has been provisionally
diagnosed by the All India Institute of Speech & Hearing, Mysore,
as having autistic features. We had also taken him to AIIMS, New Delhi
where Doctors are not too sure whether he can be termed as a pure
autistic child. It is the opinion of some of the Doctors that he is
a borderline case of autism, which can be cured by proper Behaviour
Therapy. We are taking him to a clinical psychologist in Bhopal where
we are currently staying.
I
have heard lot of good things about AFA and would like to benefit
from your experience in this field. Please advice and counsel me as
a worried father of an autistic child.
A. Having conflicting diagnoses can be very confusing and distressing,
but hard though it may be - it is important for your son's sake that
you focus on what is important. It is not the label that matters but
figuring out what your child needs and finding a way of helping him
to compensate for or develop the skills he lacks. As autism is a complex
disorder as well as being a spectrum disorder it is important for
parents to spend some time understanding the ways it is likely to
affect their child, so that if the child has a challenge in a particular
area, then appropriate intervention can be delivered. Unlike a disability
like blindness - where the skill area that is lacking is easy to understand,
autism can effect the child
in so many different subtle ways that the parent needs to develop
expertise to figure out the specific areas of challenge for their
child. The good news is that with appropriate intervention all children
with autism make progress - some more than others. It is hard to give
a definitive prognosis for any child because each child's skill levels
are different, and the environment the child lives in has an enormous
impact on the child's progress. Rather than searching for a cure -
look instead to train yourselves in affective teaching methodologies
that have had proven success so that you can help your child compensate
and develop the skills he lacks step by step, perhaps for a good part
of his life. We would be very willing to help you and be your partners
in your journey.
Language
and Communication
Q.
My baby is not yet signing but I’ve started trying
to introduce a few signs. I do have a question though and am wondering
if you have any advice. My wife speaks Hindi and is trying to teach
it to our son. She speaks only Hindi and I speak English to him. But
I am wondering how to fit signs into this. Whether I just use the
signs with the English words or also with the equivalent words in
Hindi as well?
I had a thought that if I was to teach the sign for
the word in English and then in Hindi, it might be too confusing and
our son might be at the risk of using neither languages and just signing.
A. Good question! Research has shown that sign language
actually helps children learn more than one language simultaneously.
I would suggest using the signs along with both the English words
AND with the equivalent words in Hindi – this way the signs
will help bridge the gap between the two languages and your baby will
learn that signs and words are symbols for objects and concepts.
One parent in a bilingual family could show their
child a ball while at the same time showing the sign for “ball”
and then another family member could sign “ball” while
saying the word in the other language. Seeing the same sign while
hearing different words helps children understand the meaning of the
concepts behind the words and the signs. Using sign language in this
way has also been helpful for families who speak two or more languages
or for families who have adopted children from another country who
speak a different language.
Sometimes children who learn two different languages
will mix up the words from both languages at first, simply because
they don’t yet know enough words to separate the languages.
But it won’t be long before these children will learn to code-switch,
or separate their languages and use each one appropriately in the
correct setting.
Q.My
daughter P has difficulty connecting with people. NIMHANS has diagnosed
deficiencies in eye contact and speaking ability and advised us to
improve eye contact first. After certain efforts we have observed
some improvement in her eye contact. Her tantrums have been reduced
to some extent. But there is no change or improvement in speech and
she is not speaking a single meaningful word.
I am
working in Airports Authority of India and presently posted at Guwahati
with all India transferable service. I will be transferred out from
Guwahati within one or two months. I am a Bengali with mother tongue
Bengali but not settled in any one place due to the nature of my service.
I am in a confused state to decide my next posting either at Delhi
or Kolkata. Except that in Kolkata my mother tongue will be used,
Delhi will be better in all other respects including facilities available.
I will be thankful if you kindly advice me for the following: is the
mother tongue environment is essential for my daughter to develop
speech.
A.Is
it most useful to have an environment that only uses the child's mother
tongue? That is a difficult question to answer. If your job profile
is such that you have to travel around and mostly be posted to larger
cities, then chances are you will be mostly in multilingual environments.
Whether you communicate with P in her mother tongue or otherwise,
what is perhaps most helpful is to communicate in the language that
is used the most around her. So as you say her mother tongue is Bengali,
but most people in her environment speak Hindi for instance and Hindi
is the language she hears the most, then Hindi is the language that
would be most useful to use, initially.
Not all
will agree with this view: but as I said this is a difficult question
to answer.
However,
what is even more crucial is that P understands the purpose of communication.
For you see, it is not so much that she cannot speak, as that she
does not understand that she could use speech to regulate her environment.
Therefore, when she says "Baba" you want to act as though
she is addressing you, and respond accordingly. When she says "Ma"
her mother has to act as though she has been addressed, and respond
accordingly. In addition, keep providing her the words she needs to
use in various situations. When P begins to use speech she may begin
to follow, and later perhaps may use, more than one language.
Q.
After six years of marriage God blessed us with a beautiful daughter
L. We are thankful to God for the precious gift he has given to us.
Now she is three and a half years old. From the fourth month onwards
my daughter was suffering from seizure disorder - epileptic attack
- it was regular and for long periods. Through the medication and
medicines it is now under control. Now this epileptic attack happens
only once in 5-6 months.
After
one year of age she was trying to talk. Then it stopped and we noticed
some of her actions are different. We felt something else is wrong
with her. After a check up and assessment from Hinduja Hospital Mumbai
we learnt she is autistic. We are again thankful to God for throwing
a special challenge in our life. It is his wish and his decision.
He will have his own plans
.
We
wish to have your support and help to go through the special challenge
in our life. Kindly give us the information that will shape her future
about teaching speech, medicines, and schools in Mumbai.
A.
It was humbling to read your letter of total acceptance of your daughter.
Most of us have so much difficulty in accepting our children. We believe
we love the child we have when actually we love the image of what
we want our child to be. Your total acceptance of the 'special challenge
in your life' is very special, an example to families, and will enable
you to help your daughter far more effectively.
The
main areas of difficulty for a child with autism are communication
(not just speech), social interaction, and imagination. In addition
children have difficulties in processing sensory information. Your
daughter had speech but lost it with the manifestation of Autism.
What you will want to work on is teaching her communication. You can
teach her to communicate with a cause and effect approach, so that
she comprehends the function behind speech..
For
example, a child might bang on the door when he wants to go out. Usually,
as soon as we have figured out what the child wants we provide the
want. So when the child cries so as to be taken out, she is at once
taken out. This reinforces the behaviour which means the child learns
that when I want to go out I have to cry. Instead, when the child
bangs on the door I first provide the word/words that should be said,
and then provide the consequence. The child then learns that these
words precede the need being met. So child bangs on the door:
I first say "Go out." Then I open the door.
Again,
say the child takes my hand to the water bottle to indicate that she
wants water:
I first say "Paani." Then I give some water.
At
the same time, whenever I make a request or give an instruction I
ensure that the child follows through. We might need to prompt the
response in the initial stages. For instance I ask the child to "sit"
and she continues standing. I then 'follow through' on my request
by making her sit and then of course always reinforce the behaviour.
Acknowledged
teaching techniques that are effective with children with autism are
based on principles of behaviour analysis. Every child needs a structured
behavioural program keeping in sight the individual's strengths and
needs. There is no medication to treat autism. Medication can be used
to alleviate symptoms of the condition if it comes in the way of the
child learning skills, and along with structured behavioral teaching.
Medication cannot be used in place of teaching.
In
Mumbai there are a number of schools that take in children with Autism.
For detailed information you would be best served by contacting the
local, very active parents group:
Forum
for Autism, 2nd Floor, Block A, Jyeshtaram Baug, Dr.Ambedkar Road,
Dadar, Mumbai 400014, Email: forumforautism@hotmail.com
They would be able to give you more information about services available
in Mumbai.
Q.My
grandson is autistic and cannot talk though he is four and a half
years old. He used to talk when he was two years old. He has had a
traumatic birth, and stopped talking or even babbling after an occasion
when my daughter insisted that I take him for a holiday to my beach
bungalow, where he played hell with me and kept crying the whole night.
Next I knew that he was running high fever and became very sick. I
packed him to his mother the next day early morning, but I have noticed
ever since then he stopped talking or even babbling. Though after
surfing the net, I have a feeling that autism may be because of neglect
by the parents. He has also had a trauma because of his teeth which
had to be capped and a tongue tie which had to be clipped.
My
daughter had been taking him to a speech therapist. We have now put
him on to a homeopath doctor, and there are signs of improvement.
Eye contact is slowly improving and he is responding to actions. But
he likes to open and close doors, and is very aggressive with the
younger sister who is two years old. He will suddenly push her down
or pull her hair. He even does this to other little children and some
of us in the family. I would like to know whether he should be corrected,
by reacting in the same way towards him. My daughter does that, and
I tell her constantly not to shout or yell at him or lift her hand
on him, but to talk to him firmly and lovingly. I believe the teacher
in his school has told her to react in this fashion. Please enlighten
us. Will he turn normal like other children?
A.
It is clear that you are a very concerned grandmother, and have
good instincts about appropriate ways of helping your grandson. You
can be a huge help to him and his mother. However it will require
that you spend time understanding the complexity of the handicap your
grandson has, and are able to be patient and understanding with your
daughter, while she takes time coming to terms with her grief, and
is able to help her son in a positive manner.
I
need to first correct some misconceptions that you seem to have about
autism. Autism is a neurological developmental handicap that primarily
affects the social and communication skills of the child. As such
it is fairly common, that the signs begin to be noticed only around
the age of two, and parents typically think that the child has regressed
at that time, and tend to blame myriad circumstances that coincidentally
happened at that point of time, as the reason for the regression.
Thus
a new sibling, an illness, a change of diet or place of stay, the
mother going back to work etc are often erroneously thought to be
the reason why the child suddenly seems unresponsive. Actually it
is just that the child's lack of social reciprocity is more apparent
at the age of two when a neuro-typical child starts using a lot of
functional forms of communication to explore his world. Thus a single
visit to your beach bungalow, or your perceived parental neglect or
the dental and tongue tie issues could not be the reason for his autism.
On
the other hand his autism could well be the reason why he 'played
hell' with you - as children with autism often have difficulty coping
with a change in schedule or surroundings. His lack of social reciprocity
would make it difficult for his parents to be warm and affectionate
with him. Children with autism often battle with sensory defensiveness
- i.e. a hyper sensitivity to certain textures, sounds, tastes etc
- which may have made him resistant to hugs and the typical social
overtures that parents make, that gradually build the bond between
them.
Autism
effects the ability to understand social rules and both verbal and
non-verbal communication. It would have been hard for your daughter
- without an understanding of why her child was not responding to
her overtures, and the usual means of engaging his attention and getting
him to listen to her - to not get dejected and feel unable to cope
with the stress of bringing him up. The diagnosis of autism with the
typically bleak prognosis that is usually given, would have only deepened
her level of distress, and that would explain why she reacts in inappropriate
ways to his behaviour even though she has been told more appropriate
ways of dealing with the issues.
This
is where you can play a huge role. By being supportive and understanding,
perhaps giving your daughter some respite, and by becoming more and
more knowledgeable about autism and the effective behavioural intervention
methods that exist for working with children with autism, you can
be a real support and help for her. Give her time to come to terms
with her very real grief, and also give her hope.
With
a sustained, consistent, structured behavioural intervention program
all children with autism show real progress. How much each child progresses
is dependent on that child's ability and the environment the child
is growing up in. What we can do is maximize his potential by giving
him the most positive and nurturing milieu in which he can do so.
For us to make that possible it is important that we deal with our
stresses, come to an aware acceptance of autism, and decide to do
whatever needs to be done in a truly positive way.
Q.
My three-and-a-half-years old son has not started speaking yet. We
are in touch with a speech therapist. In her opinion he is not yet
ready to start therapy
A.
Lets put it this way: Z is ready for intervention right now. The sooner
you start the better. He does not require 'speech therapy' so to speak.
Children with autism usually do not have any physical difficulties
with regards to speech. Put simply, it is more an 'autistic inability'
in using speech. What they really require is communication therapy
rather than traditional speech therapy. However some speech therapists
do figure out appropriate methods of teaching. If your speech therapist
says he is 'not ready to learn' either she is not well aware of autism,
or is not comfortable working with a child who is not easy and compliant.
Which is fair enough, because we all have different teaching styles.
What you can do is try and find a therapist or special educator who
will be comfortable working with your son, and has a clear understanding
of autism.
But
finally, given the levels of misinformation regarding autism, you
have to be knowledgeable about the disorder and about teaching methods
because only then would you be able to tell whether what is happening
with Z is appropriate or not.
Q.
Akash has a problem with language, started talking at three and a
half but now his vocabulary is impressive - it doesn't take him long
to learn anything new - visual and auditory memory is very good, but
he can't really use language to communicate. He still doesn't respond
to "what is your name", but can answer, if asked, "what
is the colour of...? Or will ask, "please give me water"
etc. when he wants something. He repeats words and phrases quite often.
He's going to a mainstream school since June and since August is quite
adjusted after he was moved down from KG to Nursery and has a maid
attending class with him. Any suggestions?
A.
Akash's inability to respond to "what is your name? " unlike
"what is the colour of...", is understandable. When we ask
'what is the colour of' the response is unchanging. Always the same,
if it is red to me, so is it to you and to Aakash. But when someone
uses the phrase "what is your name? ", the response could
as easily be 'Carol' as ' Shanti' as 'Aakash'. It's a fairly unpredictable
scenario.
With
kids who have ASD you often have to teach them spontaneous communication.
You will want to teach him to respond to his name. Have one person
ask the question as another facilitates. For instance you stand directly
in front, or better still kneel down to his level directly in front
of him and say 'What is your name? '. Have another person who is standing
behind Akash, respond immediately from behind Aakash's head, "Aakash".
Not "Say my name is Aakash", not "Say Aakash",
but simply "Aakash". Rope friends and relatives into the
act. Teach them how, and when they visit get them to ask, and you
respond. Very soon you will have Aakash pick up the cue and respond
with an "Aakash".
Once he gets the idea he will move on to responding spontaneously.
It might take a while, but it will work.
Over
time you will want to vary the question and teach him to respond with
an "Aakash" to that too. There are a number of excellent
manuals that you can refer to, to help you develop Aakash's language
such as 'Teach Me Language' by Sabrina Freeman and Lorelei Dake.
It
is great that you have got Aakash into a regular school that is friendly.
Its great if one can find a friendly regular school that our kids
can go to and work on their deficits simultaneously at home where
the parent has the time and resources to do so.
Q.
Our 3 year old child is found to be autistic. A detailed assessment
will be ready shortly. Doctors have said it is high functioning autism.
Our problem is the child gets done from us everything she wants by
means of holding our hand and taking it to the object. She does make
eye contact.
She
has no speech, except that she can utter many unspecific words. We
make a request to advise us what treatment/therapy could be adopted
and how we could go about it.
A.
It is good that you have had a detailed assessment done, as that will
help you in deciding on the programme for your daughter.
The
behaviours you have mentioned in your child are ones that are common
to young children with autism. You have by now read up a fair amount
of information on autism; the more you understand about the disorder
the more you will be able to help her. As you are aware, your daughter
has an impairment in understanding communication as well as in conveying
her needs and feelings. As a result though she has speech she uses
it in 'unspecific' ways. You can do a few things to help her improve
her communication.
When
your daughter looks at something or otherwise appears to be interested
in something, label that object. So if she is playing with a piece
of string, point to it and say 'string'. Similarly if she is looking
at a car on the road, say 'car'. Verbally label whatever she is looking
at. When she wants something like say water, and leads you to it by
hand then before you hand her the glass of water say - 'water' and
then give her the glass. Remember to keep all your communication simple
and clear. Avoid using too many words. If you want her to remove her
shoes before coming into the house you want to just say 'remove shoes'
versus saying 'Take off your shoes before coming in. They are dirty,'
or any such complicated instructions.
It's
great that she already has good eye contact. What you want to check
out is if it is on the same level as other kids or it is less. If
less than you want to work on that too.Your daughter may have a few
sensory difficulties as a result of which perhaps she does not want
to take solid food. Keep trying to introduce new foods, but you do
not want to force her. If she resists the new food, drop it for some
more time and come back to it after another ten days or so. Food sensitivities
come and go, but they all reduce with age and the more comfortable
we are the sooner.
Finally,
keeping in mind that the one strategy that is effective with all children
with autism is structured behavioral teaching; perhaps you could check
out your neighbouring countries for training for yourself? Additionally,
if you visit India, check out page 13 of this issue for details of
our Annual Training Workshop, that we believe you will find useful.
Q.Please
give me guidelines in improving P's communication.
A.
You have mentioned that he communicates his need by pointing or using
single words. Keeping in mind his autism where communicative skills
are impaired, and his age, he does communicate a fair bit. This is
something that you definitely want to encourage. Praise and encourage
him whenever he communicates spontaneously.
Equip
him with language - Since he already uses single words, build on his
language by introducing two word phrases where he uses single words.
For example, "give water", "eat banana" etc.and
continue to provide him with the appropriate words to use when he
does not know what to say. Even if he does not repeat the words immediately,
it is necessary to provide the words. Avoid saying " Say Hello
" or "Say Give biscuits" because there is the chance
that he will learn to say "Say Give biscuits" instead of
"Give biscuits."
Just
one question about his pointing. Does he point with a single finger
or does he point generally in a particular direction. If he points
specifically then that is great. If not, then you could get him to
do so by moulding his hand in a pointing manner and then help him
to point to the item he desires.
Follow
through your instructions - Because of the communication impairment
in Autism, very often the person with autism does not understand either
the purpose or the meaning of words used. They do not understand that
when something is said, something happens. So to help them understand
both these, it is very very important to always follow through an
instruction. If you tell you son to pick up a toy, make sure that
he eventually does it. There will of course be days when he does it
immediately and other days when he won't. Tell him once. And wait.
Tell him again and wait. If he is still unable to comply then you
physically prompt him to respond. If he still does not do it, physically
walk him through he activity and then praise him as if he has done
it himself. This again needs to be done with a lot of comfort.Aside
from teaching him the purpose of language it will also teach him that
when you say something you mean it. Not carrying through instruction
teaches him that you will try a couple of times and eventually do
it yourself so why should he bother at all.
Acknowledge
- Always acknowledge any attempt to communicate especially when it
is spontaneous. Sometime it may not be possible to speak to the child
if you are busy or talking to someone else. What you can do is just
stop for a second and tell you son, " I'll speak to you in just
a minute", finish what you are doing and then respond to him.
You could also tell him, "Papa is busy, go tell mama", thereby
acknowledging his attempt to communicate but doing what you have to
do as well.
Talk
to him - As often as possible talk to him. Use very simple language
and tell him things that are happening in his surrounding, tell him
details about what he is dong what you are doing, things that you
see while travelling by bus or car, that you watch on TV. The important
thing here is that you talk about things only while he can see them
or while he is doing them, like talking about eating during meals.
"Rayan is having lunch"
"eating rice and dal
with a spoon"
"sitting with papa and eating"
"papa eating bhindi with rice" and so on. Keep it very concrete
and factual and specific to the situation, the reason being that it
is sometimes difficult for autistic people to make connections between
words spoken and objects or situations so as to use them appropriately
in the future. Talking about a situation while in it helps them to
make these connections
About
himself - Teach him to learn basic things about himself like his name,
the names of his family members, parts of his body, names of objects
in everyday use by frequently repeating the information to him. You
could also ask him simple questions like "What is your name?"
and then take his finger and point to himself and say "P".
This will give him both the correct words to use as well as teach
him how to respond to such questions.
Create
opportunities for him to communicate - Most often when we have children
with communicative difficulties we feel like we need to figure out
what the child wants every time he comes near. We anticipate their
needs even before they have thought about it. But if we anticipate
each need the child has, we really never give the child the opportunity
to communicate. The child learns that if he waits long enough someone
or the other will eventually give him what he wants and he learns
not to make an effort. So do not anticipate needs. Leave the situation
open for him to communicate to you in any way that he can find and
then respond to him. Of course do not forget to provide him the appropriate
words to use in that situation before you respond. As an example,
when he comes into the kitchen looking for biscuits instead of just
giving it to him, stop and ask him, "What do you want?"
Then say "Biscuits" and give him some.
Back
to top
Socialization
Q.
I have a question regarding the Turn Taking procedure that you have
outlined on your website – I find it incredibly helpful and
was hoping for some clarification around what the visual should look
like for turn taking between two or more children.
A.
Not sure which article you might be referring to. However, here is
an illustration of where two children Tia and Sunny take turns throwing
a ball. Each is to take three turns. First Tia, then Sunny, then Tia,
then Sunny again, and so on. As each child takes a turn they strike
out one of the balls on the illustration (or the facilitator may do
it for them). This gives a clear indication of whose turn next and
how many turns left etc. Trust this is what you wanted:

(see
December 2006 Autism Network for original
image)
Q. Our five-year-old son has been diagnosed as mild to moderate
autism and we have been working with him since last one and half years.
We had been to your workshop in Mumbai and we have benefited from
the same. During this summer vacation we want to organize some sort
of a playschool with such children between the age group five to eight
and restricting the group to four or five children only. I would request
you to give your valuable inputs as regards how we should proceed
and what are the things we should do, our primary focus being improving
socialization in our children and making them more self-reliant in
day-to-day activities.
A.
It is a great idea to run a summer play group. First and foremost
you will want to identify families that are genuinely interested in
such a play group and not merely look on it as a place to leave their
child somewhere for a few hours. Decide how many hours you would be
able to comfortably run it every day or how many days in a week. Depending
on this you can plan group activities involving music, art and craft,
pretend play and drama, picnics and outings to parks, restaurants
etc. Since many
of our kids love watching television you can have video shows for
them in a group. The program could include the following:
o Sit down group activity including painting, music, pasting, colouring,
story telling, pretend play
o Relaxing time with massages, music, and other sensory input like
trampoline, therapy ball, water play
o Physical group activities involving throwing ball at a target, walking
on elevated path, climbing and reaching at targets, pulling, pushing
weighted baskets or cartons across a demarcated area
o Snack time involving opportunities to communicate for desired food
items
o Free play time on a mat or a carpet with freedom to choose a desired
toy or object.
o Class time if the children in the group are going to a school. In
this session you can revise previously acquired concepts.
These
are just a few of the things you could do.
Other
suggestions
o Perhaps have a therapist observe the group and suggest additional
activities.
o If possible get an Occupational Therapist, a Music Therapist, an
Art and Craft Teacher to visit for short periods.
o Mothers can (in most cases will have to!) be the main teachers.
o Mothers can take a break once a week or however it suits the group.
o Include Siblings, kids from neighborhood.
o Look for young people to work as volunteers as many of them are
keen on such summer holiday projects. Chose friendly and active people.
Since
Social Interaction is your focus turn taking activities, going to
a shop, visiting one child's house once every week for a small well
planned party and organizing a cultural program such as a dance, play,
fancy dress, on a terrace or veranda or a living room. All these could
be done with your kids together with the regular kids.Use a lot of
visuals such as pictures, objects, visual time table with pictures
denoting activities to take place that day, in all activities.
Remember
the 3E's Enthusiasm, Energy, Excitement!
And of course Fathers to join on holidays and stay cool!
Best of Luck
Q.
I have a 20 year old student who was just recently diagnosed with
autism. Until this time he was treated as someone having mental retardation.
My question is: How does one teach someone with moderate to severe
autism the concept that stealing is not a good thing to do?
A.
The concept of theft is a very abstract concept. It also requires
an ability to read minds in order for me, for instance, to understand
how a person would feel if I stole her favourite table linen since
it was her mother who had embroidered and gifted it to her. For a
person with moderate to severe autism, this level of understanding
of minds might be difficult. Therefore rather than trying to teach
that 'stealing' is 'bad', what one would have to teach is the concept
of 'mine' and 'not mine' and that I do not take something that is
'not mine' without asking or without being asked to. Such a concept
would perhaps be easier to teach.
Q.
The National Geographic aired a programme called Dogs with Jobs. It
was about a 7 - 8 year old severely Autistic boy. They strapped the
boy at the waist with the dog and the dog controlled him. He used
to run here and there uncontrollably on roads. After a few days he
started showing affection towards the dog and playing with him. After
a few months they showed him playing on the slide along with other
children very much like typical children.
Now
as for my son he can manage the studies in school. But somehow inspite
of being with children he is not social. He wants to be social but
then he has a limited language so he is left out. I was wondering
if keeping a dog at home can make a difference at this stage because
he is still very small and if it gets corrected now it would be great.
Dogs do not speak so he will have to talk. Has anyone else tried it?
The
psychologist who helps me in school says that he might get stuck to
the dog and not talk to people. I doubt so. Lately he has been spending
too much time on the computer and piano so his behavior regressed
during the winter break. Now we have removed them. Tell me would it
be a good idea to keep a dog or would it have an adverse effect.
A.
That's an interesting letter! That R does not become sociable despite
being around other children is to be expected. Being around other
children can help if R is facilitated in his social interaction. It
would be hard for him to make connections on his own. And even when
he does try it may not be on a level that other kids his age understand
and therefore they may not respond to his overtures unless facilitated
by an adult. I don't know whether being around a dog will make R speak
more. I am not aware of any research findings on the subject. But
it will help him in other ways as he will learn companionship and
caring.
You
could view having a dog like having an interaction with a child older
or younger than oneself! The dog does not speak or make verbal demands
on the child as a peer age child might. And at the same time it is
very undemanding and accommodating like an older person! I don't think
having a dog will get R 'stuck to the dog and not talk to people'.
That has not been our experience or the experience of any other family
with a dog that we know of. We do believethat it is not beneficial
to spend too much time on the computer. Of course our kids are good
at the
computer. And of course we can use it as the amazing educational tool
that it is. But computers also are so predictable that our kids get
hooked on it. However computers do not provide social interaction
time. So while it is good to use computers, it helps to limit the
time spent on it for more interactive time. So I would suggest get
a dog definitely if you can, and keep an eye on time spent on the
computer.
Q.I
am a mother of a four year old autistic son. Both of us parents work
in Guwahati. Our son was diagnosed with autism by a pediatrician in
Guwahati, Dr. Sabinah Ahmed, when he was two-and-a-half years old.
From the age of three years he is being trained by a psychologist
specializing in developmental delays of children. My son is not retarded
and in fact is quite smart. Hence we have been able to teach him a
few things. He is also very emotional. He does everything possible
to keep me from getting annoyed. Therefore he is more than compliant.
Due to the progress made by him in academics we have been able to
get him admitted to a regular school. He is quite gentle with other
kids and does not hurt them.
The
problem is that his odd behaviour and responses to touch etc appear
very bizarre to his own peers. He gets over-stimulated by external
stimuli, like touch, sound and sight. I do not want him to be shunned
by his classmates and hence I need to modify his odd behaviours with
more appropriate behaviours. If we can help him manage his over sensitivities,
I am sure he will improve a whole lot more, especially in social aspects.
He likes his classmates, but really does not know how to approach
and behave with them and does not realise that his odd responses puts
some of his friends off. Kindly let me know if we can become a member
of AFA and how we could benefit.
A.
It is wonderful to learn of the progress your son is making. You have
indeed taken him very far on his developmental path and helped him
cope with a regular school. You refer to some difficulties he is having
with his peers at school because of the unusual ways he expresses
excitement. You naturally want him to learn more regular ways of doing
so and generally learn to control himself. As you are aware, individuals
with autism spectrum disorders may have sensory difficulties. As a
result they may respond in unusual ways to touch, or sound etc. Your
son could benefit from desensitizing exercises. Your letter does not
explain in what way your son responds to over stimulation. Without
this information it is difficult to suggest exercises that can help
him. Perhaps you could write in with a few specific examples.
In
addition you want to teach your son alternative behaviours for when
he is excited. For instance if his unusual behaviours are to do with
his hands: give him something to do with his hands when he is excited.
Teaching the concept of private and public in relation to behaviours
can also be helpful. He thereby learns that it is okay to have certain
behaviours when he is on his own, and not when he is in company. Try
also using social stories to help him learn appropriate behaviours
in specific situations (see Autism Network Vol VI No 3 and Vol VII
No1). Social stories can be amazingly effective when well written
and used. You might consider discussing with the principal, the possibility
of giving a talk to the kids at his school to create awareness about
disability and help his classmates see the reasons behind your son's
behaviours. Kids can be very unaccepting, but they can be great buddies
also if an adult can facilitate them well.
Action
For Autism is a parent organisation. Its aim is to create a society
that is inclusive of our children. AFA is a movement aimed towards
this end, through the creation of awareness, developing teaching methods,
imparting training, facilitating the formation of parent support groups,
changing legislation, and so on. Every member contributes directly
or indirectly to this goal and a brighter future for our children.
Should you decide to become a member you will be part of this pioneering
movement.
Q.
It has been one year since I put my son on GFCF Diet. The improvement
I see is from his two or three word sentences he can speak much more.
He is able to recall events, read story books. His grip is weak but
by making him write everyday he has improved. He draws and colours
and can write fairly well. I am working on teaching him taking others
perspective and predicting events, WHY which is most difficult to
teach.
I
used to call children home for play sessions during the summer vacations.
Initially he resisted but then started enjoying. He liked the action
games like follow the leader, jumping over, statue. He shows little
interest in board games. In mainstream school he would be required
to follow instruction in a group which it seems he is not responding
so well. What can I do about it. Is there any book in AFA regarding
social skills that would be helpful in school?
A.
It is good to learn that your son is doing so well. Regarding predicting
events, to do this a certain amount of visual clarity is required.
How are you doing this? Are you using calendars and, if it is events
in the same day, may be schedules? He needs to know and understand
how his own time is organised before he can start predicting events.
Also
your son can be taught to take other people's perspective but first
he needs to identify his own emotions and then those of others. There
are books and activities on this subject. Your son enjoys action games
because it is clear what he has to do and the enjoyment is immediate,
but board games where the aim is winning is rather an abstract concept.
You could get him to play some structured physical games first and
then move on to simple table top games where it is very clear what
he is supposed to do.
You
will also need to work on joint attention especially if you want him
to sit in a group and pay attention. There are a number of things
one can do to enhance social skills some of which we have discussed
in earlier issues of the journal.
You
will also find useful material in the AFA library.
Q.
My son likes to be on his own. How do I change this?
A.
We don't know how much time you are able to spend with your son daily.
If, say, you are able to devote about one hour one-on-one with him
on a daily basis, then you may want to break this time into shorter
periods: of interaction based on your son's attention span, and periods
of being left alone. If, for example, your son's attention span extends
to about ten minutes, plan on an interaction lasting 8-9 minutes.
Give him total attention during that time. Engage in activities that
are to his liking. Just have fun with him singing/chatting, playing
games/rough and tumble, reading, colouring. At the end of the period
tell him that he can be on him own for a specified time, maybe 3-4
minutes. Mark a clock to show him the specified time when you want
him to rejoin you. If he joins you on him own after the given time,
acknowledge. If not, remind him by showing the clock. Repeat the process.
Once he is comfortable with this arrangement, you may want to shorten
his time to be alone and increase his time to be with others. This
will allow him to enjoy the company of others as well.
Q.
My child is unable to make friends in school. She cannot play or talk
with others. Please give a few suggestions.
A.
Although your daughter wants to have friends she is unable to initiate
and/or sustain her friendships. Also due to her communication difficulties
she will be unable to initiate and sustain a conversation over a length
of time like other children of her age. You might want to assist the
process by inviting just one child of her age to your home and organise
games, which involve each child talking in turn. This will help your
daughter join into a shared activity and learn to enjoy this simple
social interaction.
Teach
her also how to play simple turntaking games.
A simple one could be one in which each child takes a turn to fit
one block onto another to build a tower. If there are no other children,
you could take the place of the second child. Say "lets play
a game. Mama will take one turn and then N will take one turn, then
Mama, then N, until all the blocks are fixed onto the tower."
Ensure you put all the blocks to be used in a tray or box next to
the two of you. In any case, avoid spreading them out on the floor
or a table. The game ends when the all the blocks have been fixed
into the tower and the tray is empty. Please be careful never to add
more blocks half way through. The game must end when the number of
blocks in the tray or box is exhausted. Remember, if the activity
is an endless one, your daughter is likely to feel de-motivated.
When
N is with her friends, she would have a genuine difficulty trying
to find the right words to use. As you know, Autism is a communication
disorder and not just a speech disorder. Therefore though she may
have the ability to speak and a wide vocabulary, she would be unable
to use the words appropriately (the right words for the right situation).
You can start by teaching her some very basic social communicative
skills like greeting people or saying goodbye. When there is a visitor
to your home for instance, position yourself behind her and say "Hi"
or "Hello" or "Namaste" to the other person as
though she herself were speaking. Avoid prompting with a "Say
Hi" or "Say Namaste." You want to prompt with a simple
"Hi" or "Namaste." Similarly, when the visitor
leaves or you are leaving after a visit, have someone bid goodbye
to your daughter, stand behind her and prompt with a "goodbye"
and raise her hand and wave it appropriately.
We
hope these suggestions help you make a start in dealing with your
daughter's requirements.
Q.
Please give me guidelines in improving P's socialisation.
A.
It is great that your child is very fond of you all and likes to interact.
An important note - people with autism do interact, though often not
in a manner that is appropriate, or rather appropriate to their age.
They seem to interact mostly when they choose and not when others
do. What we want is to teach him to interact in a manner similar to
that of other children his own age or simply in a manner that will
be socially acceptable
and to enjoy the interaction.
Make
times of interaction fun and exciting so that he continues to want
it. Use every opportunity to initiate contact. Continue to include
him in as many family activities as possible and get him to help around
the house
taking in clothes when they are dry, clearing the table
after a meal, putting by newspapers neatly. This will help him to
feel a useful part of the family as well as teach him the joy of doing
things together with someone.
Many
children with Autism find it hard to wait. Along with being a social
concept waiting also has to do with time which is an abstract concept
and so autistic children find it difficult to understand the purpose
of waiting. But since this is a very important learning for them,
we need to teach it early. To begin with specify the waiting period
by marking it with a clear end. The cue to mark the end should be
concrete and preferably visually clear. For example, you are talking
to a visitor and your son wants your attention. You could tell him,
" I will speak to you when I finish drinking my tea", or
"
when I finish talking to Uncle". Keep the waiting
period very short at first and gradually extend it. A half minute
to a minute to two minutes to three and so on. The important thing
is to make sure you keep your word. If you have told him you will
get up in two minutes then you have to regardless of who you are with
or what you are doing. (So keep your waiting period realistic. Do
not promise to get up after the tea is finished if you cannot).
Play
a lot of turn-taking games with him. They can but need not be the
conventional games that we find. Turn-taking can be incorporated into
any activity
like peeling peas, picking up toys, fitting blocks,
shaking sound producing toys, throwing a ball (or crumpled pieces
of paper) into a basket, sorting onions and potatoes etc. The idea
is for him to do his bit and then wait until the other person has
finished before starting again.
In
connection with both communication and socialization, provide him
with the appropriate word to use in that context each time he makes
an attempt to initiate an interaction by saying one word or pointing.
For eg. If he is asking for a toy by pointing to it, you can say "Give
car" and then give it to him.
Q.
My eight year old son Rahul always laughs when other children
cry. This habit is very disturbing to his mother and the parents of
the child he is laughing at. How do I teach him not to laugh?
A.
This is a comment we often hear from parents. We also have parents
say that they have felt frustrated when they have hurt themselves
and their autistic child doesn't even seem to notice. This apparent
lack of empathy is very much related to the way autism affects a child.
Keep in mind that autism is largely an impairment in social communication;
people with autism often have difficulty interpreting facial expressions,
gestures, and other forms of non-verbal communication. In addition,
we know that people with autism often are unable to take the perspective
of another person, called the "theory of mind." Therefore,
try to understand what is happening from Rahul's perspective: he sees
his cousin standing in the middle of the room with "water"
coming from his eyes, making strange faces, and loud noises. All the
while, his cousin's face is turning more and more red and he starts
to jump up and down. Perhaps this scene even looks funny to Rahul,
and he laughs. You may think, "but Rahul understands what crying
is! He uses it all the time when he doesn't get what he wants!"
However, remember that Rahul may not be associating what he does with
what another child does, since he likely has an inability to put himself
in their position. If he is confused at all, he becomes anxious from
his lack of understanding, and begins laughing, which may well be
a sign of stress. In fact, it commonly occurs among all people that
upon hearing terrible news, or when something bad happens, the person
begins laughing instead of crying.
Avoid
making comments such as 'dont you know how he feels?' or 'how
would you like it if he laughed at you when you were crying!' Instead,
try to teach the