Autism

Autism - What it is

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Autism Spectrum Disorder (ASD) is a developmental condition that can be identified in early childhood. The word ‘spectrum’ is used as individuals on the autism spectrum show varying levels of autism-related behaviours and abilities. Whilst some children with autism have learning difficulties and intellectual challenges, there are others with normal or exceptional cognitive abilities. Autistic children may or may not present with language delay. Signs of autism can be noticed in children from as young as 12 months old. Autism-related differences or difficulties often persist in adulthood, although these can change as a child grows and develops.

Children with autism show differences in how they communicate and interact with people. Some may use people as a ‘tool’ to obtain certain things, e.g. pulling an adult's hand to objects they want without a word or glance. Some children tend to be ‘in their own world' – preferring to be alone most of the time with very little interest in others. Some children want to interact with others, but do not know how to. Children on the autism spectrum often have difficulties keeping to-and-fro play or conversations going. They may not use eye contact or gestures much. They do not learn social behaviours as naturally as other children and may unknowingly cause social offence.

Children with autism also show restricted interests or repetitive behaviours. They may be repetitive in their speech or actions, prefer sticking to fixed routines, have unusually high or extremely focused interests, or have sensory experiences that are different from others. These autism differences affect how they learn and go about everyday activities as expected for their age.

Even so, autistic children have their unique strengths. They can learn, thrive, and grow up to be happy, healthy, and achieving adults. Knowing if your child has autism, understanding his/her needs, giving your child the right support through early intervention, and helping your child find the right fit for themselves in the community, gives your child a good chance for better outcomes.

Signs of Autism

For very young children between 1 and 3 years old, signs of autism include:

Little or no use of speech for communication
Reduced response to name being called
Difficulty in following instructions or looking at something being pointed out
Avoidant or fleeting/brief eye contact most of the time
Little or no imitation of others’ words and actions
Lack showing objects to share interests or get attention
Reduced interest in social play with others
Little or no use of social smiles or gestures for communication (e.g., pointing, waving goodbye, head nodding, head shaking)
Repetitive movements (e.g. hand flapping, tiptoeing, spinning oneself)
Repetitive play (e.g., lining of toys, opening and closing doors, spinning objects)
Difficulty in coping with transitions or changes in routines
Unusually focused interests (e.g. wheels of toy vehicles)
Unusual reactions to the five senses (e.g., oversensitivity to sounds, staring closely at spinning things, tendency to sniff things, very picky with food and difficult to feed)

For older children and children with more fluent speech, they may show any of the above signs as well as the following:

Echolalia (i.e., repeating words or phrases when not meant to)
Use of scripted speech (i.e., ‘learnt’ or mimicked phrases, such as from shows)
Pronoun confusion (e.g., referring to self as ‘you’ instead of ‘me’)
Difficulty in holding conversations (e.g., talking ‘at’ others instead of engaging in a two-way conversation)
Difficulty in understanding social cues and social norms
Difficulty in understanding abstract concepts (e.g., sarcasm, metaphors)
Preference to play or be alone, or difficulty making friends
Preoccupation with specific topics (e.g., planets, transport, numbers, alphabets)

Screening for Early Signs of Autism

The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F; Robins, Fein, & Barton, 2009) is a parent-report autism screening tool to assess the likelihood of autism in 16- to 30-month-old toddlers. The results will indicate whether further evaluation may be needed. You may use the results from this screener for discussion with your child’s doctor.

Please scan the QR code below to access the online M-CHAT-R/F.

Alternatively, you may click on this link: Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) (dcd.com.sg)

If the M-CHAT-R/F screen is negative but you still have concerns that your child may have autism, please continue to seek professional advice from your child’s doctor.

Some groups of children are at higher likelihood of having autism. As such, screening for autism is recommended for the following:

Children with an older sibling who has autism, or multiple family members with autism
Children born before 35 weeks’ gestation or who weighed under 2.5 kg at birth
Children with known genetic conditions such as Down Syndrome
Children whose mothers took antiepileptic medication during pregnancy
Children whose parents were over 40 years old when the child was born

How Can I Seek Help?

If you have concerns that your child may be on the autism spectrum or notice some of the signs listed above, you are encouraged to speak to a polyclinic or private general practitioner (GP), or your child’s paediatrician. A referral may be made to one of the following specialist services for further evaluation and support.

For preschool children (6 years and below or not yet in Primary One), they may be referred to:

KK Women’s and Children’s Hospital (KKH), Department of Child Development (DCD)
Tel: +65 6394-1543/7216
Email: kkh.dcd@kkh.com.sg
Website: www.kkh.com.sg/patient-care/areas-of-care/childrens-services/Pages/child-development
or
National University Hospital (NUH) Child Development Unit (CDU)

For school-age children (i.e., Primary One and above), they may be referred to: