Frequently Asked Questions About Autism
From Indian Families:
Helpline Compilation

In each issue of our journal, Autism Network, we answer as many questions about autism, dealing with behaviors, and other issues raised by families in India. Below is a partial compilation of these questions and answers. We have sorted these by general topic, but you will find comments on multiple behaviors and concerns within a given question and answer as well. We have been told that browsing through these questions is also a good way to better understand the concerns and situation for parents of autistic children in India.

See also: Original full-length articles by or for AFA

 

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.

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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 'don’t 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