By Dominique Ribeiro - Intern Educational Psychologist
What is Autism?
Autism Spectrum Disorders (ASD) and autism are both general terms for a group of complex developmental disorders that are characterised by difficulties with social interaction, verbal and nonverbal communication, repetitive behaviours and differences in sensory perception. It is estimated that these disorders affect 1 in every 161 children around the world. In South Africa alone, approximately 6230 children are born with ASDs.
What to look out for as a parent:
The earlier ASD is detected, the better! As a parent, you are in the best position to detect the earliest warning signs of ASD. You know your child best and you see the everyday behaviours and quirks that could be missed by a paediatrician during a regular consultation. It is important to understand the differences between typical and unusual signs during early childhood development.
The following are possible signs of ASD:
Communication - No babbling by 11 months: sounds like “bababa,” “deedeedee,” “mama” or “dada” - No simple gestures by 12 months: such as waving bye-bye or shaking the head for “no” - No single words by 16 months: easy words such as “baby” “up”, “doggy”, or “ball” - No 2-word phrases by 24 months: noun-verb combinations such as “baby sleeping”
Social Interaction - No response when name is called, possibly causing concerns about hearing - More interested in looking at objects than at people’s faces - Little to no eye contact when interacting with people - Doesn’t point to show things of interest - No attempts to gain parent’s attention - Does not play peek-a-boo - Rarely smiles socially - Prefers to play alone
Repetitive Behaviours/Sensory Difficulties - Odd or repetitive ways of moving fingers or hands - Oversensitivity to certain textures, sounds or lights - Preoccupations with unusual interests, such as light switches, doors, fans, wheels - Unusual play: like lining up, spinning, opening/closing parts rather than using the toy as a whole - Compulsions or rituals that cannot be interrupted: like performing activities in a special way or certain sequence
What to look out for as a teacher:
Teachers are important role players when it comes to identifying overlooked children on the autism spectrum. This is because while the symptoms of ASD are not always visible in early childhood, they will often begin to appear when children start school. Children on the spectrum struggle to adapt to the expectations held by this new environment.
The following are possible signs of ASD that teachers may come across at school:
Communication - Abnormal, delayed or absent speech, particularly in comparison to peers - Minimal reaction to verbal input, possibly causing concerns about hearing - Unusual interpretations/no understanding of facial expressions or gestures - Repetition of words, questions, phrases and/or sentences over and over again - Excessive conversations about special interests, without consideration of the listener - In verbal children, a flat, monotonous tone or inappropriate variations in tone are often noted.
Social Interaction - Little or no eye contact - Little awareness of others, or of their feelings - A preference for playing alone during break-time - A lack of reaction, or dislike, when being touched, hugged, or cuddled - Poor or no ability to make appropriate social contact/conversation - Difficulties in forming appropriate relationships with peers or others - In less severe cases, children passively accept social contact, but will not socialize spontaneously
Play and other Behaviour - Poor or no pretend-play: e.g. can’t play with blocks as if cars/imaginative scenes copied from TV - Repetitive and stereotyped patterns of play, or a tendency to repeat activities, and dislike of change - Easily distressed by changes in routine or environment: such as change in seating arrangement - Unusual habits such as rocking, spinning, finger-flicking, hand- flapping, fiddling with objects, spinning objects, tapping and scratching on surfaces, or arranging objects in lines or patterns - Odd responses to sensory input: e.g. covering of ears during story-time/music - Tendency to cry, laugh or tantrum for no apparent reason
So, where to next?
Screening and Diagnosis If you think your child, or a child you teach may have a difficulty with playing, learning, speaking, or acting, contacting a paediatrician, and sharing your concerns is your first port of call. If you or the doctor are still concerned, the child and their parents can be referred to a specialist who is able to do a more in-depth evaluation. Specialists who are able to make a diagnosis of ASD include developmental paediatricians, child neurologists, child psychologists, and the multidisciplinary team at Autism South Africa. An evaluation usually includes an ASD-specific screening tool such as the M-CHAT-R and one or more of several assessments such as the Griffiths Mental Development Scale or the Autism Diagnostic Observation Schedule. These measures help parents and teachers understand as much as possible about a child's strengths and needs. Remember, although daunting, diagnosis opens access to therapies and support that can improve the quality of life of a child on the spectrum.
Getting Support Once you have discovered that your child, or a child that you teach, has ASD, you may be faced with many more questions than you first realized. Friends and family might not be able to understand or appreciate your concerns. Important first steps include allowing yourself to process the diagnosis and receiving your own support.
There are many evidence-based, early intensive behavioural interventions available to children on the spectrum - such as ABA, TEACHH, PRT and Floortime. These interventions, which target the core symptoms of ASD, are often combined with treatments such as Speech and Language Therapy, Occupational Therapy and Sensory Integration Therapy, in order to combat the biological and medical conditions associated with ASD and to help children reach their full potential. The recommended number of hours of structured Early Intensive Behavioural Intervention ranges from 25 to 40 hours per week during the preschool period. While full recovery is relatively rare, with only 10% of children losing their diagnosis, all children with autism will benefit from intervention and all can make significant, meaningful progress.
Are you looking for a developmental or psycho-educational assessment? Do you need help processing the diagnosis of your child or a child you teach? Contact The Johannesburg Parent & Child Counselling Centre 011 484 1734