Taweesak Siriratrekha, M.D.
Child and adolescent psychiatrist
Autism does not make any difference but every child is different.
We should learn and understand individual differences.
Typically, children with autism have difficulties building relationships with people around them, inappropriate social skills and repetitive and restricted behaviors. If they do receive early intervention on behavior modification with proper trainings on social skills and are allowed to live peacefully in the society, they will be able to develop their full potential and live in the community accordingly.
What are children with autism? How do we know that a kid is autistic?
Autism is a developmental disorder that possesses unique symptoms apparently characterized by impaired social interaction, improper verbal and non-verbal communication in accordance with their ages, and by repetitive pattern of restricted behaviors and interests. Such problem occurs since young age but more apparently when they are growing up with more expectations of the society.
Each individual with autism displays many patterns of symptoms. Ten children have 10 different styles. Hundred people show 100 patterns of behaviors. However, they have a common characteristic called autism. Children are in the world of themselves, independent, more than paying interests in the surroundings. Some attributes include impairments in communication, babbling, talk with their own language, not turning to a call, no eye contact, indifference, no interaction, improper play, no imagination, repetitive pattern of activities, inflexibility and obsession in something useless. In a case, an individual who lives in his own world, he will stimulate himself by turning his body around and flicking hands. In a case, a few symptoms are found, a child can talk and learn normally up to great, but he often has difficulty developing social skills and inflexibility in doing activities and interests.
How to know whether a child is autistic or not?
If symptoms are more severe, it is easy to detect. However, if the symptoms are slight, it is very difficult to diagnose. Several evaluations by experts such as a child psychiatrist need to be sought as to conclude that whether a child is autistic or not.
Children who lack a lot of stimulation like those in a foster home or orphanage may have similar symptoms of autism as well. However, if they receive full stimulation, they can become normal while children with autism, although full stimulation is applied, some symptoms still exist.
When an autistic child is found, how should we treat him?
Children with autism have feelings just like normal kids but they cannot express them properly. They also need love, understanding, and acceptance as well. So we should treat them like normal children as equal as human being but more care and understanding. Advice and guidance are given according to their problems and needs.
The more you are trying to understand them, the more you know how much special care is needed. You should understand what they improperly do and say it out is because the kids do not really understand. It's not a bad habit or they pretend to do. When you have good understanding, it makes no sense to blame them and instead you want to help them.
Observing the behavior of children with autism, at what age will the symptoms become apparent?
When it is found that a child has a developmental delay or he is different from other children at the same age, whether the child is autistic or not, consult a specialist to promote the development to help him urgently. Initial support, especially during the first 3 years, is proofed very effective. Do not be afraid to know what your kid is diagnosed, or you will lose the opportunity to help him develop properly.
The observation of a childs behaviors whether he is autistic or not during the first year shows very little difference. He might be less responsive than normal; no eye contact, no smile and no verbal communication, but the child is not found any abnormality. Most autistic children will show differences explicitly from other children. A child cannot utter any single word; show no response as it should be, and play alone. If children age one and a half years, are found with the above symptoms, it is assumed that they are likely to have autism. If a child has the symptoms like playing with other children but cannot do the imaginary play, cannot point to show his needs, lack of interests to engage with other children. If children have 2 out of 4 among these symptoms, they will urgently need to be taken to meet the experts directly.
For a verbal communication, wait and see until the child is one and a half years old. If he has not yet produced a single meaningful word, he should be taken to see an expert to determine the cause and appropriate care. In fact, some children may speak slowly. Everything was fine once he normally does it later or known as late talker or "Paaknak". However, not everyone is lucky like that. If your thought is wrong, everything is too late to fix. Waiting might not make everything better except giving an early intervention.
What are causes of impairments in autism?
The exact cause of autism is currently unclear. According to medical research studies, it is agreed that autism is caused from the malfunctions of the brain and some parts of the neural system. It is clearly evident that it is not associated with improper parenting. A child with autism is autistic even how good parenting is given. However, providing good nurturing will help him develop much better, reduce the severity of the problems and allow him to live in society peacefully.
In medical aspect, it is found that autistic children involve the dysfunctions of the frontal lobe which manages systematic process of thinking, decision making and a tiny part of the brain called cerebellum which controls the body movements and balance.
In addition, it is also found that the genetic abnormalities of a certain genes can cause some of the unique problems but we still have not known which gene is now. The causes of these disorders and the forms of transmission or the mutation of genes are left unresolved.
In some cases, it is also found that most children have common symptoms of abnormal electrical wave in brain, but the links of these anomalies associated with these common symptoms are unclear.
However, it is commendable that though a definitive cause of autism cannot be found, there are several ways to help the child to get better today.
Behavioral modification and learning enhancement in autistic children
Behavior modification is a training to maintain appropriate behaviors while stopping inappropriate ones and build up new desirable behaviors by using a variety of techniques including positive and negative reinforcement as well as punishment.
Adults should learn types and magnitudes of what the children like or dislike. Then, prioritize the attributes to use as reinforcement. For example, if the children love ice cream, we may reward them when they can work out well in what we have told them, together with hugs, kisses, hand claps and compliments. Proper rewarding not only enhances the communication process, but it also enhances the learning process.
Most of the experts in children's behavioral modification are nurses, but the psychologists and occupational therapists who are well trained and worked in this field can be specialists in behavior modification as well. What to be emphasized on behavior modification is regular practice everyday as well as the training and advice from the experts.
A guide to raising children with autism at different ages
Raising children with autism, in principle, it is common like feeding a baby in general, but additional stimulation of particular trouble areas is emphasized. Promoting his talent in order to develop it concurrently in each range of ages is also important. There are many critical parts to variedly emphasize as follows.
During the first 5 years of early childhood since the autism is aware, take a kid to attend the intensive program of behavior modification in order to get intensive intervention of development, correct communication skills, and get trained on self-care and age appropriate social skills.
Start with prompting children to respond to stimuli regularly. Call and turn to induce their eye contacts. Play to interact with each other can urge them to leave their world and realize and pay more attention to the external environment. If they are allowed to follow their natural way, they will be more in their world and indifference. Their symptoms will get worse by by rocking their body, playing hands, making voice in their own language and finally, refuse to learn the outside world.
The foundation for learning should be prepared for autistic children by getting them trained to understand and follow the simple commands such as requesting, raising hands, folding arms over the chest, sitting, etc. They should also concentrate on activities long enough, not restless.
During the school age, autistic kids should be trained more on social skills as to be able to join group activities with their friends. They should be able to wait, know the rules of the game and take turns to play. They are the basis for understanding the rules of society afterwards.
During adolescence, there is a lot of changes in both physical and emotional aspects. They begin to recognize and understand the differences between themselves and their friends. It is necessary to provide the information and teach them to understand the changes and differences among individuals in advance so that they can adapt appropriately.
Caring for children with autism is difficult, but it's not too difficult because all the efforts dedicated to them are fruitful. Even though it takes long time, these changes and development are apparent.
How to promote learning development?
The basis of learning is to understand, follow simple commands and have concentration to some extent. If the children do not understand simple instructions, not follow what has been taught, they cannot fully respond to learning. Thus, these basic skills should be constantly set by providing an intensive behavioral modification.
If a child cannot concentrate, it is difficult for him to learn because children cannot filter out the data stored in their memory of the brain. So getting them trained to concentrate on activities according to their abilities at each age will enhance their learning.
How to enhance the movement development?
Some children with autism are affected with slow development in all areas. Intervention should be promoted in all aspects together.
The gross motor usually does not have problems; walking and running fine while the common problems of fine motor are frequently found. For instance, children may look bearish, difficult to handle things and the coordination of muscle movements is not good.
Enhancing the development of the muscles focuses on main problems such as training to increase muscular strength; squeezing, pulling, cutting, lifting, the practice of using fingers to grip the beads, putting balls in the pole, painting in the frame, etc. Eating with a spoon is a good practice because the children have to do regularly everyday.
How to promote the social development?
Children with autism often isolate himself, have not eye contact, and does not talk to anyone. How can we persuade him to change this behavior to participate in the community? Children with autism tend to be in their world more and more if we dont intervene. When it is let go naturally, the problem is even more severe.
Persuasion alone would not be effective. The program for behavioral modification should be added by bringing learning theories into practice to reinforce the behaviors, such as compliments, hugs and giving rewards once the kids show interests and follow the instructions with good responses.
Do not leave the kid alone like playing, talking or watching TV alone all day long because he will be even more in his isolating world. Persuade him to stay with family members as much as possible. Turn off the television or limit time to the least for watching TV; however, talk and play with him more.
How to manage time to children with autism and teach them to help themselves?
The more you spend time to teach and play with children, the more you can help children with autism develop better and faster.
Teaching children to help themselves in their daily life is very important. Start from training your child to drink from a glass and grapping a spoon to eat. Do not feed him even it is spilled around. Do not rebuke him because letting him to do by himself will make him confident. As long as he feels he can do it he will want to continue doing it, and finally he can do gradually. Get him trained how to use the toilet at a regular time when he shows a gesture of feeling like peeing or excreting. Teach him to collect and store toys in place when he stops playing. At the early stage, hold his hands to do, but insist that he has to do it. Give him a prize, hand clap, hug or snack that he likes so he will feel like doing it again next time.
If there is time for him to get fully trained, he will develop better and gain more age appropriate development then he can live in society as usual.
Obstacles that children with autism will face and how to fix them
Caregivers of children with autism often have difficulties periodically, but they can always overcome the obstacles. Each time they have seen more advanced development which will encourage the caregivers to further their task well.
The major obstacle in training children in the first stage includes their resistance and no cooperation as well as no evident quick changes. This causes parents discouraged. Many parents have gone through this already, and many are going through. Keep going!
Do not set goals too high. At the beginning, it is a step by step process for development. There is neither shortcut nor tool to go up quickly. If you expect a kid to be able to say within one month, it is discouraging. However, if you expect children to understand and follow simple commands, it is a pleasure to fight on. Once he can do it, then, increase the expectation on other areas afterwards.
Another major obstacle is the exhaustion from the training. Sometimes, it is common to feel tired, bored and discouraged after hard and continuous training. Rest when you are fatigued. Cheer yourself up and then come back on with a new starting point. Do not feel guilty at some dedications given because the engine is not running through at all time, without a break. Sometimes, children also exhibit a regressive development, but when they are stimulated, they will get to normal state quickly. This is because what they used to be able to do, they will be able to do it again. It will not go away.
Every problem has a solution, but it might take long time. There is not stalemate. Just only at some point, we might have not seen the way out. Try to figure out and analyze a problem carefully and look around, then we will find a solution eventually.
Social skill is of great importance for children with autism.
Social skill is a significant impairment of children with autism, so it must be specially trained. The focus lies upon eye contact, smile, cooperation, listening, continued conversation, attention, empathy and properly emotional responses which are done by simulations of social situations in order for them to practice until they become skillful. Teach them to memorize the dialogues in various scenarios for the purpose of direct use in their daily life.
Of teaching social stories, Carol Gray, a starter, defines the original stories or social scenarios to teach children with the emphasis on important social interactions that are expected to occur in normal children and children with autism. This should include the reasons why they react like that as to help them to be able to understand the situation occurred, aware of the emotions of others and how to behave appropriately in social situations .These help autistic children adapt themselves by reducing their problem behaviors.
Social stories being brought to teach should be events that are currently found. Use the first personal pronoun to tell. If there are illustrations, it will be easier to understand the social stories. Examples include;
"Most children are very determined to finish their homework earlier before playing."
"I will try to walk quietly in a row, no break up."
"When I make a loud noise in the classroom, it will annoy friends. The teacher is also unhappy with what I do."
Books and reading as a key to enhance skills for children with autism.
The learning process of children with autism is impaired and different from normal children. According to a medical research, it has shown that if parents, caregivers and people around stimulate them properly, they can gain the development to the great extent. The frequent use of media such as books is effective. Reading to kids is a simple mean that can be started from the age of 6-8 months. It takes about 10-15 minutes per day, at a time when the kid is in a good mood. He will gradually absorb and remember as well as become happy.
Selection of books suitable for his age deems necessary. At the first year of life, virtual pictures with nice views and a few words are required.
Children at ages 2-3 years up will enjoy many different stories. Many children like a story with rhymes while others like a story about animals close to them. Parents must keep noticing what the child likes and respond to that need. Above all, creating the atmosphere of love, tie and happiness are necessary to make him warm and memorable. Children age 4-6 years will enjoy more exciting stories.
Furthermore, when the child grows up, parents can use books to weave a continuous bond. Children with autism can use books to reinforce appropriate behavior and social skills. Many families find a great success in creating their own books to motivate the children to develop or modify their behaviors.
The use of books and reading materials to enhance the skills of children with autism
The social stories reinforce social skills. These books are for reading together between children with autism and caregivers who may be parents, teachers, nurses or professionals with the aim to adjust the undesirable behaviors that occur in various situations in the society. They are intended to express the appropriate social skills through stories, to promote positive thinking by explaining the actual situation in the society, enhance skills and appropriate responses to the situation, expectation and response of people in the society, such as the development of appropriate interaction with others, and exhibit proper etiquette in the society and proper daily activities, etc.
Tales that reinforce social skills.
Social stories can be compiled in a variety of forms such as the following books.
Short stories with illustrations
Symbols and descriptive explanation
Picture books
or CD, DVD footage and animation
Writing stories to enhance social skills and creativity
A story should be written from the child perspectives.
Language and terminology used must be appropriate to the age of the child.
Illustrations should communicate to be consistent with the narrative language used so that the children can easily understand.
Specific method of writing a story for reinforcing social skills development
Social stories will take 6 forms of sentences below.
1) Descriptive sentences will explain the situations of who, what, where, when
and why. Examples include:
The bell rings for the students to stop playing, line up and walk back into the classroom.
2) Perspective sentences will tell or explain the feelings of children and others.
Especially, the feelings or responses of others in that situation like this.
Teachers are happy to see students lining up and walking into the classroom neatly.
3) Directive sentences will introduce children to say what they should do in that situation. For example;
When the bell rings, I will stop playing and walk quietly into the classroom with friends. Upon entering the classroom I'm going to sit at the table and listen to a teacher.
4) Control sentences are written in child's perspective in order to help stimulate him to memorize data and understand what they should do in a certain situation like;
I remember that when the bell rings, the break time is up. Then, I will stop playing and walk into the classroom with my friends.
5) Cooperative sentences will be the expressions what others act on children. For instance,
The teacher admired me that I was good to line up and walked into a classroom with friends properly.
6) Affirmative sentences will highlight the desired behavior as an important thing, such as walking into a classroom orderly is a good thing to do.
How to effectively use stories to enhance the social skills?
When a caregiver notices inappropriate behavior that occurs in various situations, one way that can be used to modify that behavior of children with autism is the creation of a story to reinforce social skills and develop them properly. Then, take that book to read together with a kid at the time spent together on a regular basis.
Reading books together can be done after the inappropriate behavior arises or to read together in several occasions such as early morning or before bed time or while doing activities. Reading together should be done regularly until the child can express appropriate behaviors according to that story.
How to persuade children to read books to build social skills?
1. Build interest to children before reading
- Let children choose a story book honing social skills that a child needs to be directed to select at least one book of social stories.
- Read when a kid is in a good mood.
2. Reading duration
- Read each story for not over 10 minutes.
- Can read as many times in one day
3. Continuity
- Should read everyday
- Should continue reading for at least 2-4 weeks per 1 story
4. How to read as to promote social skills?
- Persuade the child to sit next to you or opposite to you or lie down to read together if comfortable.
- Solicit a child to associate the images or hold his hand to point at the picture or tell him to point at the alphabet if he cannot read the book himself.
- Reading voice should not be too soft or too loud, make a low or high tone somewhat to make it appealing.
- In children who can speak or say a little bit, they may be stimulated to speak or say after you or leave the final word for them to continue telling the story.
- Keep an eye on how much the kid pays attention and concentration on reading.
- Keep children involved in helping to flip the page.
5. Follow up
- Notice that how much attention and concentration the child pays on reading.
- Observe the childs behavior while reading together to see how much cooperation a kid is.
- Observe the targeted behavior to see whether the children get better changes or not.
- Take reading notes every time or keep in the form if it is available.
- Take reading notes and the story to show a doctor on the next visit.
Agencies associated with the care of children with autism and special children
Diagnosis of Child Psychiatry
Yuwaprasat Waitayopatham Hospital, Tel. 02-394-1845, 02-384-3381-3
Rajanukul Institute, Tel. 02-248-8900
Rajanagarindra Institute of Child Development, Chiangmai, Tel. 0-5390-8300-49
Northeast Child Development Institute, Khonkaen, Tel.0-4391-0770-1
Child Psychiatry, Chulalongkorn Hospital, Tel. 02-256-5176, 02-256-5183
Child Psychiatry, Siriraj Hospital, Tel.02-411-0241
Child Psychiatry, Ramathibodi Hospital, Tel. 02-246-1073-99
Child Psychiatry, Srithanya Hospital, Tel. 02-528-7800
Child Psychiatry, Somdej Chaopraya Hospital, Tel.02-437-0200-08
Child Psychiatry, Childrens Hospital, Tel.02-246-1260
Child Psychiatry, Bhumibhol Hospital, Tel.02-531-1970-99
Smitivej Hospital, Tel. 02-392-0010-19
Smitivej Hospital, Srinagarindra, Tel. 02-731-7070-2
Sukhumvit Hospital, Tel. 02-392-0011
Wichaiyut Hospital, Tel. 02-271-0125-9
Praram 9 Hospital, Tel. 02-248-8020
Chaopraya Hospital, Tel.02-434-0117
Happy Home Medical Clinic, Tel. 02-835-3537, 08-2014-7272
Places where intervention, therapy and rehabilitation are available.
Yuwaprasat Waitayopatham Hospital, Tel. 02-394-1845, 02-384-3381-3
Rajanukul Institute, Tel. 02-248-8900
Rajanagarindra Institute of Child Development, Chiangmai, Tel. 0-5390-8300-49
Northeast Child Development Institute, Khonkaen, Tel. 0-4391-0770-1
Saengsawang Institute Foundation, Tel. 02-381-5362-3
Ruamphanya Foundation, Nonthaburi, Tel. 02-903-6744, 02-903-6750
Ruamphanya Foundation, Ladprao, Tel. 02-538-7495
Dept. of Special Education, Suan Dusit Rajabhat University, Tel 02-241-1401, 02-241-4401
Dept. of Special Education, Srinakarinwiroj University, Tel. 02-664-3820 ต่อ 5631
Happy Home Central Plaza, Chaengwattana, Tel. 02-835-3537, 08-2014-7272
Happy Home, Muang Ek, Tel. 08-4086-8796
Baan Oun Rak, Suan Siam, Tel. 02-906-0335, 02-919-9321
Baan Oun Rak, Thonburi, Tel. 02-885-8720, 02-803-1715
Child Psychiatry, Chulalongkorn Hospital, Tel. 02-256-5176, 02-256-5183
Child Psychiatry, Siriraj Hospital, Tel. 02-411-0241
Child Psychiatry, Ramathibodi Hospital, Tel. 02-246-1073-99
Child Psychiatry, Srithanya Hospital, Tel. 02-528-7800
Child Psychiatry, Somdej Chaopraya Hospital, Tel. 02-437-0200-08
Child Psychiatry, Childrens Hospital, Tel. 02-246-1260
Child Psychiatry, Bhumibhol Hospital, Tel. 02-531-1970-99
Smitivej Hospital Tel. 02-392-0010-19
Smitivej Hospital, Srinagarin, Tel. 02-731-7070-2
Sukhumvit Hospital, Tel. 02-392-0011
Wichaiyut Hospital, Tel. 02-271-0125-9
Praram 9 Hospital, Tel. 02-248-8020
Chaopraya Hospital, Tel. 02-434-0117
