Parents-To-Know

According to the National Institute of Neurological Disorders and Stroke (NINDS), both genetics and environment may determine whether a person develops autism.

WHY MY KID IS HAVING ASD?

Autism spectrum disorder (ASD) is a developmental disability. 

Without monitoring from parents, electronic gadgets can have negative effects on children’s development (Sundus, 2018).

ARE DIGITAL GADGETS BAD FOR THE KIDS?

WITHOUT MONITORING from parents will lead to a negative effects on children’s development 
OVERUSE of gadget can cause speech delay, attention deficits, depression and anxiety 

WAYS OF PREVENTION

RESTRICTING SCREEN TIME for your child under 4 : 1 hour / day with filtered sensitive content 
GUIDING YOUR CHILD to use it in an educational purpose enhance their skills and knowledge 
 

YES. The impact of dietary intervention made using dietary guide books found to be useful to reduce various behavior symptoms among the selected autistic children (Nazni,Wesely,Nishadevi,2008)

DOES GLUTEN-FREE DIET WORKS FOR MY ASD/ADHD KIDS?

A gluten-free diet (GFD) is a diet excludes gluten, which is found in wheat as well as barley, rye, and oats. 
Common food with gluten: Bread, Spaghetti, Pancake 

The impact of dietary intervention to reduce various behavior symptoms among the selected for child with Autism. (Nazni, Wesely, Nishadevi,2008)

IMPROVEMENT IN BOTH CASEIN & GLUTEN FREE DIET

• attention
• anxiety 
• sleep
• hyperactivity 

Through diet modification program such as diminished carbohydrate & protein intake in diet, ADHD symptoms were improved. (Baki et al,2021)

According to DSM V, restricted behavior is one of the two criteria for diagnosis of Autism Spectrum Disorder (American Psychiatric Association, 2013).

IS PUTTING TOYS IN A LINE A SIGN OF AUTISM? 

• Sequencing toys is a normal behaviour occurred during early childhood (~18 months-age 5 or 6) 
• Repetitive behavior is 1 of the 2 criteria for diagnosis of Autism Spectrum Disorder 

If you frequently observed in your child, please seek advice from Pediatricians 

EARLY SIGNS OF AUTISM?

• NO EYE CONTACT
• POOR RESPONSE TO STIMULUS 
• SOCIAL WITHDRAWAL 
• LINING UP TOYS 

YES. The results of this study provide preliminary evidence that omega-3 fatty acids may be an effective treatment for children with autism (Amminger et al,2007).

CAN OMEGA FISH OIL IMPROVE MY KID’S CONDITION?

Studies shows fish oil may be an effective treatment for children with Autism. (Amminger et al,2007)
Example, omega 3 and omega 6

IMPROVEMENT IN 

• visual learning 
• attention & short-term memory 
• hyperactivity & impulsivity

AGHD is a frequent and debilitating childhood condition. Given disparaging feelings toward psychostimulant medications, omega-3/6 offers great promise as a suitable adjunctive therapy for ADHD. (Derbyshire,2017)

Studies show that adults with autism can continue to improve throughout their lives. As current federal support for people with autism ends after they reach the age of 21 (Daniel,2007).

My kid has ASD, will he get normal when he grows up into an adult? 

- YES. With the help of therapist & early intervention they can lead a meaningful &   functional adult life.

• Most teens and adults with autism have less severe symptoms & behaviors as they get older. (Daniel,2007)
• Helping your child live a “normal” adult life will mean ensuring that they can get dressed, meet new friends, and etc. 
• Independent living skills such as life skills, functional skills, social skills, recreational skills, are part of their education process.
• Symptoms may lose as some children grow older. (NIH,2013)
• The improvement did not mean that autism went away, or that patients recovered from disabling impairments. (Daniel,2007) 
• Adults with autism can continue to improve throughout their lives. (Daniel,2007)

NO, if your kids can’t perform in a normal school.

I do not want to place my kids in EIP program because he/she will lack opportunity to socialize with peers of similar age. Do you think it’s a good idea? 

- NO. in comparison with schools, EIP offers:

• LESS STRUCTURED 
  academic focused & more curriculum schedule such as storytime and dramatic play 

• MULTIDISCIPLINARY APPROACH
  involvement of special educators & therapist has greater success

• STRONG PEER RELATIONSHIPS 
  taking turns & sharing are encouraged in classroom with smaller class size and more guidance from teacher (Toddler Town Daycare,2021)

• AFTER SCHOOL PROGRAM
  games & sports to improve their social environment/social interaction (Hussin,Hwa,Cheong,2020). 

With the early intervention program, a child will receive therapy and educational support services that are catered to his or her unique needs. This means that the child can have support to improve developmental outcomes, and he/she has a better chance of entering mainstream schools in the formal education system (MindChamps, 2018).

Should my kid attend EIP? 
What’s the difference between EIP and Preschool? 

“To improve developmental outcomes and a better chance of entering mainstream schools, a child should receive therapy & educational support that are catered to his/her needs.” (MindChamps, 2018)

No, not a must.

MY KID HAS ADHD, IS IT A MUST TO GO FOR MEDICATION TO NORMALIZE HIM? 

The actual time in treatment will also be relative to how many sound errors are being addressed in the treatment plan. The more sounds in error, the longer the duration of treatment (Speech and OT,2020).

My kid has speech delay; how long does he/she need to attend ST? 

• Until they can achieve independent language learning.
• Until they can monitor own speech sound error.
• May require social speech group therapy before discharge. 

: The more sounds in error the longer the duration of treatment. 
: Language Disorders, which have to do with cognition, expressive/receptive language skills as well as pragmatic language skills may take a longer period of treatment. 
: A-R-R

Most likely yes.

My kid has problem in writing, is that caused by his muscles?

- Most likely yes

• 87% have some sort of motor difficulty, ranging from an typical gait to problems with handwriting. (Bishop S.L. et al.,2017)
• The standard treatments typically include physical and occupational therapy. (Bhat A.N. et al.,2020)
• Gross-motor problems, such as a clumsy, uncoordinated gait and difficulties with fine-motor control, such as manipulating objects and writing. (Schenkman,2020)

Homework contract.

My kid does not do his homework at home, throw tantrum when he's being instructed to, how do I help him?

• A homework contract is an agreement that outlines what you and your child will do to make sure homework gets done on time and well.
• Tailor your contract to address specific homework challenges such as time management. Lay out the time of the day the homework needs to be done.
• Fill out the contract together so that your child understands what's being agreed on. Revisit the contract as the workload changes or when you find it ineffective.

(Dawson, P. 2001)

Parents and teachers may think that the students are just being lazy or not putting in enough effort because they are unable to finish their notes and homework. (Smitha Bhandari, 2020)

My kid writes too slow & takes 2 hours to complete his homeworks, how do I make him complete his homework quicker? 

• Inability to understand spacing - they find it hard to write in a straight line. (Smitha Bhandari, 2020)
• Trouble with maintaining the correct posture & arm position for writing, causing them to have a slow writing. (Smitha Bhandari, 2020)
• Handwriting at the 1st grade level are about 5 words per minute (WPM) on average, but by the end of elementary school at the 5th & 6th grade level are about 10-12 WPM. 

Screen time for children younger than 2 years is not recommended.

HOW MUCH TIME SHOULD I ALLOCATE FOR YOUTUBE SCREEN TIME?

Echolalia repeats noises and phrases that they hear people.

MY KID ALWAYS REPEATS SENTENCES AFTER ME, EVEN WHEN I ASK HIM/HER QUESTIONS, IS THIS NORMAL?

ECHOLALIA

People with echolalia repeat noises and phrases that they hear. Extremely common as part of language development and is usually seen in young toddlers who are learning to communicate.

By the age of 2, most children will start mixing in their own utterances along with repetitions pf what they hear.
By age 3, most children’s echolalia will be minimal at most. 

If echolalia still persist, please consult a Speech Therapist. 

We should not stop it but monitor the activity demands.

MY KID ALWAYS RUN AROUND AT HOME DUE TO MCO, SHOULD I STOP IT?

- WE SHOULD NOT STOP IT BUT MONITOR THE ACTIVITY DEMANDS. 

MY KID CANNOT FOCUS IN ONLINE CLASS, WHAT SHOULD I DO? 

• Dedicated study space, quiet area. 
• Make a schedule ans stick to it. 
• Turn off the TV, silence cell phones, & if possible, limit people coming & going in the room or around the space. 
• Brain break in between. Pushing up & Jumping jacks. It’s bad for vision to have continuous long hour online class. 

Recheck trigger.

TEACHERS HAVE BEEN COMPLAINING MY KID CANNOT SIT STILL IN CLASSROOM. WHAT SHOULD I DO? 

If problem persists, consult a Child Development Specialist.

Identify trigger.

MY KID SCREAMS WHEN I TOOK HIM TO BARBER. WHAT SHOULD I DO? 

Identify the trigger. 
Normally sound by razor, change to scissors. 

Change environment, do it during shower time, do it in bathtub while he is playing with water toys. 

Find a distraction for them to perform. Sticker games, favourite toys, gadget time.

Role play with toy scissors with parents.

DIY. Do it in stages by yourself, break into 3/4 session on different days. 

Teach them to label emotions when they are experiencing. create emotional awareness.

MY KID ALWAYS CRIES/THROWS TANTRUM WHEN SOMETHING ISN’T IN HIS WAY. HOW DO I STOP HIM FROM BEING EMOTIONAL AT SUCH MOMENTS? 

Teach them to label emotions when they are experiencing
Explain physical characteristics of each emotions to create emotional awareness

Discipline behavior
BUT NOT emotions

Avoid reinforcing outburst, reward only when calm down
(misinterpret crying behaviour=getting reward).

No medication that can cure autism spectrum disorder (ASD).

ARE THERE ANY PRESCRIBED MEDICATIONS TO TREAT AUTISTIC CHILDREN? 

No medication that can cure autism spectrum disorder (ASD).

Medications only can help to treat specific behaviors associated with ASD such as to reduce self-injury or aggression.

Involvement of behavioural intervention and Occupational Theraphy. Will produce a more effective result. 

Consultations with doctors about using medications on autistic children are vital. (LeClerc & Easley, 2015). 

To ensure the child can benefit from early interventions to improve the daily living skills and social behavior.

Why early diagnosis of autism in children is important? 

• To ensure the child can benefit from early interventions to improve the daily living skills and social behavior. 
• To improve quality of life for child with ASD. (Elder et al., 2017)

Studies found that interventions implemented before age 4, can improve the cognition, language and adaptive behavior. 
The earlier an intervention is started, the better and effective long-term outcomes for the child. (Patrick & Richard, 2020)

WHAT ARE THE LEVELS OF AUTISM SPECTRUM DISORDER?

ACTIVITIES TO IMPROVE VESTIBULAR OR BALANCE SENSORY INPUT. 

1. Swinging
2. Sliding
3. Riding Vehicles
4. Rocking
5. Walking/ Jogging on Unstable Surfaces
6. Riding/ Balancing on a Seesaw
7. Tummy Down, Head Up 

HOW TO IMPROVE A CHILD’S ATTENTION?

• Make eye contact when talking to a child. 
• Set up routines and schedules.
• Do one task at a time.
• Allow break time in between the tasks.
• Reward and reinforce positive behavior.
• Start with simple and easy task. 

It can be started when the child is conscious of their own need to pee/poo and can initiate the act without being reminded or prepared by parents. (Mota & Barros, 2008)

WHEN SHOULD I START THE POTTY TRAINING? 

- It can be started when the child is conscious of their own need to pee/poo and can initiated the act without being reminded or prepared by parents. (Mota & Barros, 2008)

Signs of toilet-training readiness: 

• Able to put on and remove clothes 
• Able to follow parents into bathroom and express interest in the toilet
• Has regular and predictable bowel movements
• Able to imitate parental behavior 
• Able to indicate the need to pee/poo by using words, facial expressions or movements.
• Able to stay dry for two hours at a time or is dry following naps

No specific timeline.

HOW LONG DOES MY CHILD NEED TO ATTEND THE THERAPY? 

- No specific timeline. 

• The intensity, duration and timing of the therapy session is based on individual child and family goals. No one size fits all model used. 
• Attending therapist will plan the treatment plan and recommend the therapy session depending on the problems and needs of each child.
• Consistency is the key to achieve a meaningful and effective progress.

The most commonly used screening tool for Autism Spectrum Disorder is The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) (Robins, Fein, & Barton, 2009).

WHAT ARE COMMON SCREENING TOOLS FOR AUTISM THAT ARE USED TODAY?

• The most commonly used screening tool for Autism Spectrum Disorder is The Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) (Robins, Fein, & Barton, 2009). 
• The M-CHAT-R/F is designed to be used with The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) which is valid for screening toddlers between 16 and 30 months of age. 
• It is a 2-stage parent-report screening tool to assess risk for Autism Spectrum Disorder (ASD). 

WHAT ARE MYTHS ABOUT AUTISM? 

• Avoid social contact
• Cannot lead to independent and successful lives
• Result of bad parenting 
• Have special talent
• Avoid eye contact
• Unable to talk
• Can be outgrown 
• Can be cured (Autism Resource Centre (Singapore)., 2019)

ALL PEOPLE WITH AUTISM : 

Do not feel emotions
Truth: NOT TRUE, they also experience and feel emotions. The difference may be in how they express their emotions

Unable to empathize 
Truth: NOT TRUE, they are usually weak in understanding other people’s specific emotional states and how to respond appropriately. They requires more time to learn & understand the appropriate response compared to normal kids. 

Have special talent or skills. 
Truth: NOT ALL, every child has various different cognitive level. Some has stronger skillset than others. These skills can include a special talent in art or music but can also be skills in memorizing facts, visual symbols or long passages, etc. 
(John et al., 2018)

ASD is frequently associated with intellectual impairment and structural language disorder.

CAN AUTISM COMORBID WITH OTHER COGNITIVE AND PSYCHOLOGICAL DISORDERS? 

• ASD is frequently associated with intellectual impairment and structural language disorder. 
• About 70% of individuals with ASD may have one comorbid mental disorder, 40% may have tow or more comorbid mental disorders.
• Specific learning difficulties (literacy and numeracy) are common, as is developmental coordination disorder. 
• Medical conditions associated with ASD are 
  • Epilepsy 
  • Insomnia
  • Constipation

Avoidant-restrictive food intake disorder is a fairly frequent presenting feature of ASD and persistence of extreme and narrow preferences of food is possible
(Diagnostic and Statistical Manual of Mental Disorders Fifth Ediition., 2013)

MY CHILD HAD BECOME STAGNANT IN ACADEMICS. WHAT CAN I DO?

• Look for opportunities for your child to pursue his interests outside of school and meet other kids who share his interests.
• Communicate with their teachers to utilize school resources that enable them to play to their strengths. 
• Get involved with your child: 
  • do homework with them and let them know that you are available to answer questions, 
• Social reinforces like praises, hugs & high fives works as extrinsic motivation that will eventually be internalized by your kid. 
• Reward their effort rather than the outcome.

BREAKING RIGIDITY TIPS

• Tweak the routine 
  Rather than doing everything exactly the same way each day, make small tweaks to the routine here and there. 
  For an example, shower before dinner some nights, showing them it is completely alright to do things in a different way (Hurley, 2016)
• Play games with constant change of rules.
  The purpose is to show a child that transitions and changes can be fun rather than anxiety-provoking (Gutstein & Sheely, 2002). 

AS A PARENT, HOW CAN I FACILITATE MY CHILD’S LEARNING AT HOME FOR BETTER PROGRESS?

• Reading to your child beginning when she or he is born.
• Practise counting together. 
• Listening and responding to your child as he or she learns to communicate.
• Creating a stable home with routines and support. 
• A good child care or preschool program. 
• Pointing out and talking with your child about the names, colors, shapes, numbers, sizes, and quantities of objects in his or her environment. 

A short writing tool combined with a vertical surface can influence the grasp of young children (Yakimishyn & Magill-Evans, 2002).

HOW TO IMPROVE PENCIL GRASPING AND WRITING SKILLS?

A short writing tool combined with a vertical surface can influence the grasp of young children (Yakimishyn & Magill-Evans, 2002). 

Before children grasp a pencil, it is essential for them to engage in activities that promote their fine motor development. When all the skills are learnt, children are then prepared to properly grasp markers, pencils or other writing utensils as they engage in writing activities (Huffman & Fortenberry, 2011)

SOME OF THE ACTIVITIES THAT ENGAGE CHILDREN IN DIFFERENT LEVELS OF MOTOR DEVELOPMENT IN PREPARATION FOR WRITING: 

• Using tongs: pick up items and sort them into separate compartments or containers. 
• Clip it: Clipping doll hair activity using hair fasteners or elastic bands. 
• Button drop: sort the buttons by color and drop them into the appropriate containers. 
• Lock & Keys: determine which keys work with which locks and unlock them. 
• Sponge squeeze: transfer the water from side to side by dipping and squeezing the sponge. 

HOW TO IDENTIFY RISK OF DELAYED DEVELOPMENT FOR MY BABY OR TODDLER?

A developmental delay means that your baby or toddler is behind in gaining the skills required by a certain age. 

Some of the risk factors you can look out for are: 

• Complications at birth.
• Premature birth, low birth weight or not getting enough oxygen at birth. 
• Environmental issues: Exposure to alcohol or drugs before birth or trauma. 
• Other medical conditions: Chronic ear infections, vision problems; illnesses, conditions, or injuries. 
• Other red flags that might pose a risk for your baby or toddler are:
  • Poor listening skills
  • Poor eye contact 
  • Babbles or is unusually quiet 
  • Seem disinterested or detached during play time

MY CHILD IS NOT SPEAKING LIKE THE OTHER CHILDREN OF HIS AGE. WHAT SHOULD I DO? 

You know your child best. 

You don’t have to wait and see if you think there might be a problem. If your child is having difficulty communicating, it’s best to bring them in for an evaluation with your child psychologist or pediatrician. 
Depending on the evaluation, your child can be further referred to do an audiology tests, speech language pathologist or an occupational therapist. 

WHAT CAN A 18MONTHS OLD TO 24 MONTHS OLD TODDLERS DO IN TERMS OF SPEECH. 

You will notice that your toddler will start talking a lot during at this age.
You’ll most likely hear a mix of babbling and real words. 

At 18 months old, your toddler is learning words all the time. Your toddler might name and point at familiar objects, people and body parts for example, ears, nose or eyes. Your toddler might also make or imitate animal sounds like “moo”, or say the same sound or word over and over. 
They’re getting better at understanding simple sentences and instructions like “Bring it to Mummy’ or “Let’s throw the rubbish’. You’ll be able to understand more of what your toddler says to you. 
By 24 months, your toddler might be able to use sentences with 2-3 words for example/ “Mummy car” or “yummy apple”. 
 

No, there is no specific diet as every child is different.

IS THERE ANY SPECIFIC DIET IF MY CHILD HAS ORAL MOTOR SENSORY ISSUES? 

- No, there is no specific diet as every child is different. 

However, children having issues with oral motor sensory may either be:-

• very sensitive (hypersensitive) to tastes, textures, temperatures and foods
• under sensitive (hyposensitive) to these same objects. 

Explore new foods with no pressure to eat them.

Experiment with different foods color, texture, and smell. 
Doing this will help to desensitize the oral sensory input. 

Use a firm pressure when brushing teeth, brush cheeks, tongue, and along gums. 

WHAT CAN I DO AT HOME TO REDUCE THE ECHOLALIA?

Echolalia (n) - People with echolalia repeat noises and phrases that they hear. 

Have your child look directly at what is happening (joint attention). Then use simple language that talks about what is being done.
Make sure that the language you use literally and directly relates to the ongoing activity. 
Model the language or activity many times. 
If your child still repeats the question, say the sentences with a little more emphasis and stop doing the action. Pause and ask the question again. Wait to see if your child repeats the question or gives the answer. 

MY CHILD HAS DIAGNOSED AS DOWN SYNDROME. HE HAS POOR MEMORY, WHAT CAN I DO? 

If you notice your child has a hard time following multi-step directions, try 

• Breaking tasks down into smaller, more manageable steps. 
• Be consistent:
  Routines should be just that routine. 
  Find a pattern that works and stick with it. 
• Use verbal and visual cues:
  Help kids understand routines by adding verbal and visual backups.

GOING OUT OR HAVING NORMAL FAMILY LEISURE TIME IS DIFFICULT WITH AUTISTIC CHILD. ANY TIPS?

For children with autism, social stories can be particularly helpful in conveying your expectations. You can tailor your social story to the kinds of public situations you and your child often encounter. 

• Role play going to a store, library, and restaurant or wherever you plan to take your son. Have him practice good behaviour during the role play. 
• It’s best to start small when you go on a new outing or return to one after a long break. So on your child’s first trip to a restaurant, have dessert or drink, then leave. 
• Have distractions ready. For any child, a small toy or gane can help make the inevitable waits more tolerable.
• Reward good behaviour. In addition to clear expectations, provide a clear reward for good behaviour. For example, let your child know that if he had quite hands and quiet voice at the grocery store, he gets 15 minutes of a favourite activity when he gets home. The positive anticipation can help motivate him. 

MY KID ALWAYS CLIMBS ONTO BED AND JUMPS DOWN FROM DANGEROUS HEIGHT, HOW DO I LET HIM KNOW IT’S DANGEROUS?

Step 1 - Parents should stop the child and strictly explain to them the risk and consequences of their actions.

Step 2 - Provide safe environment or find a compensatory activity for them such as trampoline jumping. 

Step 3 - Impose punishment to avoid them from repeating dangerous behaviour if they continue. Punishment can be adding something unpleasant to the child. 
eg. reprimand or taking away something pleasant from them 
eg. keeping away favourite toy. 

MY KID IS SLOW TO TALK, HOWEVER, THE SPEECH THERAPIST REFER ME TO OT INSTEAD, WHY IS THAT?

• When a child is struggling with their speech skills, he or she may also be having short attention focus span. 
• It might also be your child having sensory issues. 
• Child is in these dysregulated states and are overwhelmed with processing them, the child struggle to focus on speech therapy. 

HOW DO I STOP MY KID FROM PLAYING FINGERS AND FLAPPING HANDS? 

Playing fingers and flapping hands = 2 factors : - 

• Inaccurate expression of emotions (anxious/excited).
• Sensory processing disorder.

Expression of emotion 
Teaches social appropriateness, the right way to express.
eg: hand clap when excited 

Sensory processing disorder 
Exposing the child with other alternative sensory stimulation as compensatory activity
eg: ball tapping

It takes time and effort before the child can slowly f=get used to not entertain the desire to play with their hands. 
(Tse, Liu & Lee, 2021). 

MY KID LIKES TO THROW OUT THE TOYS AND MAKE THE ROOM MESSY, WHAT SHOULD I DO? 

1. Introduce him/her the correct way of playing the toys. 
   Recognize the behavior is a call for help or trying to communicate something. (Toddler Approved, n.d.). 
2. Communicate and give choices. 
   Clearly explain to the child what they CAN or CANNOT do with the object that they are throwing. (Toddler Approved, n.d.).
3. Don’t take behavior personally.
   Taking behavior personally will cause you react more emotionally, sometime may harm the child, reinforce the behavior and cause it to happen more frequently. (Toddler Approved, n.d.). 

MY KID LIKES TO SPIN HIMSELF ON MY OFFICE CHAIR, WHAT SHOULD I DO?

Step 1:
Identify the purpose of the Behavior
Spinning associated with vestibular seeking behaviour. (McLaughlin & Fleury, 2020).

Step 2:
Create a Plan to Address the Behavior
Provide alternative for child that serves the same function as the stereotypic behavior. (McLaughlin & Fleury, 2020). 

Step 3: 
Respond to Stereotypic Behaviors
Interrupting and redirecting him/ her to engage in more appropriate, alternative behavior. (McLaughlin & Fleury, 2020).

NO

EATING SUGARY OR SWEET FOODS MAKE MY CHILD HYPERACTIVE? 

NO

There is no evidence-based research proven that sweet or sugar cause hyperactivity (Del-Ponte et al., 2019). 
If the kid behaves hyperactively after eating sugar, other factors such as moods, emotions, daily routine or even parental belief will contribute to it.
However, too much of sugar sweetened food can cause kids to have a lack of healthier food choices which causes imbalance diet among children. 
Moderate consumption of sugar is encouraged with parent’s monitoring.