By Dr. Fauziah Zainal Abidin
Consultant Paediatrician with Special Interest in Developmental Paediatrics
Gleneagles Kota Kinabalu Hospital
Most parents would welcome a therapy that would alleviate all the challenges that make life difficult for their child with Autistic Spectrum Disorders. Unfortunately, there are not any magical pills or herbal concoction remedies to swallow in one go. Just as a child with Autism faces challenges which can’t be summed up in a word, they can’t be remedied with one therapy. Each challenge must be addressed with an appropriate therapy. No single therapy works for every child. What works for one child for a period of time may stop working.
Some therapies are supported by research showing their efficacy, while others are not. However, early intervention does work and increases the likelihood of a favourable outcome. Thus, regular screening of infants and toddlers for signs and symptoms of autistic disorder is crucial because it allows early detection of these children.
Individualised intensive interventions, including behavioural, education and psychological components, are the most effective treatments of autistic disorder. Prior to this a thorough assessment of all symptoms must be done. The evaluation must examine the behaviour, currents symptoms, communication patterns, social competence and neuropsychological functioning are usually done by a Developmental Paediatrician, Child psychiatrist or a child psychologist. These professionals will guide the parents with the options of treatment based on their child’s needs. Its important to look at the strength and weaknesses of each child in all areas.
An effective treatment programme may include parents as part of the treatment process, build the child interests, promote self-esteem, and offer predictable outcomes. Such programmes also teach task as a series of simple steps, this actively engages the child’s attention, helps include the child in a typical social environments and provides regular reinforcement of behaviour.
OPTIONS OF TREATMENT INCLUDE:
1.) Social Skills training and Speech-Language Therapy
Therapist teach social skills using visual techniques such as social stories or using exercises that involve the children in various social situation. Speech and Language therapy helps children to speak better, correct awkward methods of speaking such as monotone, help them understand better and interpret the speech and communication signals of others such as humour, eye contact and hand gestures. They may also learn Assisted communication by using keyboards, letter boards and other devices (eg Picture Exchange Communication System-PECs)
2.) Applied Behavioural Analysis (ABA)
Since the early 1960s, Applied Behaviour Analysis have been used by therapists to teach communication, play, social, academic, self care, work, community living skills and to reduce problem behaviours in children with autism. There is now numerous literature that proves ABA is effective at improving children’s outcomes especially their cognitive and language abilities.
Over the past several decades, different models using ABA have emerged, all of which use behavioural teaching. They all use strategies that are based on the work of BF Skinner. ABA methods use the following three step process to teach:
1. An antecedent, which is a verbal or physical stimulus such as a command or request. This may come from the environment or from another person or be internal to the child.
2. A resulting behaviour which gouverns the child’s response or lack of response.
3. A consequence which depends on the behaviour. The consequence can be positive reinforcement for the desired behaviour or no reaction to the incorrect response.
ABA targets the learning of skills and the reduction of challenging behaviour. Most ABA programmes are highly structured and based on establish curriculum. Each skill is broken down into small steps, and taught using prompts which are gradually eliminated as steps are mastered.
Each time the child achieves the desired result, he will receives positive reinforcement such as a verbal praise or something that the child finds very motivating. Its is also important to apply these programmes in school settings or the home so that the child learns in a natural environment. Facilitated play with peers is often part of the intervention and success is measured by direct observation, data collection and analysis. If the child is not making satisfactory progress, adjustments are made.
3.) Sensory Integration/Occupational Therapy
Many children with Autism have problems with motor skills or issues with their senses. In sensory integration therapy, occupational therapists work with the children to stabilise their senses and their reactions to external stimuli. This therapy can help children gain better control over their bodies and thus reduce clumsiness, instability and improve hand eye coordination. SI Therapy can also reduce anxiety in children with autism by improving their responses to particular sounds or touches. They have better control of their senses, they are better able to control their movements, sounds and emotion. This leads to reduced awkwardness and improved social skills.
4.) Medications
No medications is effective in the treatment of the core behavioural manifestations of autistic disorder but drugs maybe effective in treating associated behavioural problems for example hyperactivity, attention deficit disorder, depression and anxiety. These associated conditions can often be more debilitating than the core problems of austism especially in older children.
Lastly, parental education and training is often beneficial to the improvement of children with Autistic Spectrum disorders. If caregivers such as parents, grandparents, siblings, babysitters are fully aware of and understand the strengths and deficits of the child, they will be able to incorporate aspects of treatment options like social skills training into the child’s life at home, treatment then becomes consistent and routine for these children and they are more likely to improve. This itself promotes better bonding, reduces the feeling of helplessness, gives a sense of pride and accomplishment for the parents and caregivers in their effort to give the best for their children.
Should you need more information about this topic and other related information, you can call Gleneagles Kota Kinabalu Hospital at 088-518888 or to book an appointment call 088-518810.
Website: http://gleneagleskk.com.my/
