What is Autism

What is Autism?

Below is the excerpts from the Ministry of Health Malaysia (MOH) about Autism Spectrum Disorder 

1. What is Autism (Introduction)

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterised by impairments in communication, behaviour and social functioning beginning in childhood. There is no local epidemiological study on ASD prevalence in Malaysia. However, in a feasibility study on the use of Modified Checklist for Autism in Toddlers (M-CHAT) among children of 18 to 36 months of age in child health clinics by Ministry of Health Malaysia, the prevalence of ASD in Malaysia was approximately 1.6 in 1,000.

In the USA, the overall prevalence of ASD is 14.7 per 1,000 (one in 68) children aged 8 years and the prevalence shows an increasing trend over the years. Clinicians have been seeing an increasing number of children with speech delay and social communication difficulties who require further assessment. Children with speech delay and behavioural issues are frequently placed in special education classes without an accurate diagnosis. While waiting for diagnosis to be established, these children should be referred for the relevant interventions.

Early diagnosis and prompt intervention of children with ASD is crucial for the best outcome. The importance of early recognising and initiation of early referral to optimise the child’s potential must be emphasised. 

2. Risk Factors 

The aetiology of ASD is unclear. It is multi-factorial which includes both genetic vulnerability and environmental factors. 

• Advancing Parental Age 

• Prematurity 

• Neonatal Encephalopathy 

• Genetic Risk 

7. Treatment 

Early Intervention Programmes (EIP) are advocated strongly, especially for children below the age of three to improve outcomes. However, all children should be offered EIP upon diagnosis. Policy makers play an important role in the implementation of services for children with ASD. Ideally, children with ASD should be managed by a multidisciplinary team consisting of :

• Family Medicine Specialist 

• Paediatrician 

• Psychiatrist / Child and Adolescent Psychiatrist 

• Clinical / Educational Psychologist or Counselor 

• Occupational Therapist 

• Speech-Language Therapist 

• Medical Social Worker 

• Educational Officers 

Parents or carers should actively participate in any intervention offered to children with Autism Spectrum Disorder (Recommendation from MOH). 

7.1 Non-Pharmacological Treatment

a. Applied Behavior Analysis (ABA)

Applied Behaviour Analysis (ABA) is the application of behavioural principles to everyday situations, that will over time increases or decreases targeted behaviours. This intervention is widely used in the management of children with ASD, and recognised as a safe and effective intervention.  Although there are a number of ABA approaches, the Lovaas method is the most well-known and extensively researched.

Lovaas therapy is superior to standard care or regular instruction. In comparison to special education, Lovaas therapy significantly improves among others, social communication skills, language and daily living skills. 

There is inadequate evidence to pin-point specific behavioural intervention approaches to be most effective for individual child with ASD. Lovaas therapy and early intensive behavioural intervention variants, and the Early Start Denver Model result in improvements in cognitive performance, language skills, and adaptive behaviour skills in some children.

*Applied Behaviour Analysis should be considered in the management of children with autism spectrum disorder. (Recommentation by MOH)

b. Speech, Language and Communication Interventions

Children with ASD may have limited or no speech, poor joint attention and pragmatic skills, as well as difficulty in understanding and interacting with others. Those who receive speech and language therapy between two to three years of age show improvement in expressive language at four years of age. 

It is important for family members to be active participants in speech therapy sessions. Parent's involvement in therapy of ASD children :-

● increases the number of communication acts and use of communication means 

● decreases autism behaviour and increases typical communication 

*Children with autism spectrum disorder should receive speech, language and communication interventions as needed. (Recommendation from MOH)

c. Occupational Therapy 

ASD may affect the child’s self-care ability, play, academic performance and social activities at home, school and in the community. Sensory processing dysfunction or sensory integration dysfunction are also affected in 50% - 90% of children with ASD. Children with ASD have motor impairment in motor skill development when compared to their typically developing peers.

Occupational therapy provides assessment and intervention to maximise activities of daily living. The interventions provided by occupational therapists include social skills, self-help skills, sensory integration therapy, perceptual motor skills, sensory-motor skills, as well as behavioural and developmental interventions.

*Occupational therapy should be offered to children with autism spectrum disorder (Recommendation from MOH)

d. Other Interventions 

• Social Stories 

• Developmental, Individual-Difference, Relationship-Based (DIR) / Floortime 

• Music Therapy 

• Parent Education and Support 

• Cognitive Behavior Therapy (CBT)

• Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH)

We at Auesome Kids Behavioral Services are offering all the non-pharmacological interventions that are strongly recommended by the Ministry of Health Malaysia. Register with us and we'll provide a beautiful developmental journey for the children!