FREQUENTLY ASKED QUESTIONS
Developmental Milestones are very clear in typically developing children and it is critical that we monitor developmental milestones in each child especially from birth to three. The deficits or delays that a child with autism demonstrates are usually very clear making a confident diagnosis of autism accurate by the age of 18 months.
It is also very important to note that the younger a child is when autism is identified, the increased potential for the child to catch up as:
- The developmental gap is smaller;
- The inappropriate behaviours a child may demonstrate are not as established in comparison to an older child
- Most importantly a younger child’s brain is still developing and much easier to rehabilitate.
2. But every child develops differently and my relatives (parents, grandparents, aunties, uncles etc) say that I/my husband spoke much later as well.
There is a significant increase in early childhood developmental disorders over the years in comparison to previous generations and therefore it is always better to be ‘safe than sorry.’ There is no harm or danger in seeking a professional diagnosis but there is a significant risk to ignore red flags and symptoms as time is of the essence in treating autism as early as possible.
Ultimately, it is not so much about the label but the diagnosis in order to provide the most effective treatment as soon as possible. We do understand that unfortunately, there is still a stigma when it comes to inidviduals of different abilities. As we strive to creating and influencing a more accepting society, we do maintain strict privacy and confidentiality for all our clients. It is also important to note that almost 50% of individuals with autism who have received good quality ABA treatment will often not meet sufficient symptoms of autism any longer.
The symptoms of autism and the challenges that are present itself in autism are quite specific and an experienced clinician conducting the diagnostic evaluation will evaluate based on typical developmental milestones which have factored in slight differences based on personality or culture or rate of learning.
Typically if a child is just ‘shy’, he would still be able to articulate fluently with people he is comfortable with or in a home setting. If a child is just very ‘particular’ or ‘choosy’ then the other symptoms of autism would not present itself – e.g. the challenges with language and communication as well as socialising with others.
5. Could this be reflective of a different disorder such as ADHD, or OCD or just a speech delay, or sensory processing disorder?
This is the reason why it is very important for a thorough diagnostic evaluation utilising the DSM-5 be conducted by an experienced clinican over a 2-3 hour period in order to rule out other differential diagnoses or the possibility of comorbid disorders.
Although many movies and TV shows have highlighted individuals with autism who have genius talents, only 10% of the autism population are ‘savants’ which are individuals who have these rare genius talents, be it music, art or mathematics.
It is important to note that autism is a spectrum disorder and some individuals are more affected than others and that autism impacts language, social skills and presents challenging behaviours in most of those affected by it.
Children with autism have the potential to live as typical a life as possible with the right intervention. As autism is a spectrum, some individuals are affected minimally, moderately or severely.
Based on the level of autism in a child as well as the treatment they receive, research shows that almost 50% of children who receive good quality ABA therapy at an early age are able to catch up to their developmental age. These children may still require support socially in some areas as well as at certain critical stages of their lives such as school transitions and puberty.
The other 50% who are not able to catch up are still able to learn to their best potential which includes reducing challenging behaviours, increasing functional communication, independence and overall life skills.
The most important is that every child with autism receives sufficient support in order for the individual and their family to live as meaningful a life as possible.
1. All the parent support groups are recommending so many different types of treatments and there is so much research ongoing?
It is important to find out more about the research:
- Is it truly scientific research, were the reliability and validity scores met for the research?
- Is it published research in reputable journals?
- Has this research been reviewed and replicated?
Most importantly as a parent, does the treatment make common sense and does it address all the complex challenges that come with autism.
2. Wouldn't 1:1 therapy further isolate my child? Some doctors recommend to just include my child in a group environment.
Initially, most children with autism do not present the foundational skills for learning – i.e. the ability to cooperate, imitate or attend. These 3 foundational skills are critical for a child to learn additional skills that are more complex such as speech.
When in a group environment (such as a daycare or school), even the best teacher is unable to give a child with autism the full attention he requires in order to thoroughly occupy his time, teach him new skills and prevent him from participating in self-stimulatory behaviour.
Furthermore, our expectation would be for a child with autism to be able to learn naturally from the group but this a core deficit of most children with autism as they are not able to ATTEND (e.g. they are focused on other things) nor IMITATE from others (e.g. they are in their own world or not interested in other children or teachers) and so the child may end up being physically present in the school but not maximising their learning potential.
Often times, when a child is not ready for a group environment, we may see an increase in inappropriate behaviour such as self-stimulatory (stimming), aggressive behaviour towards others or learning that they just go to school but not have to cooperate or attend.
This is often recommended and can be effective if practiced intensively and by a good quality speech/occupational therapist.
At EAP, our comprehensive programme targets speech and language and more importantly functional communication right from the start. The difference would be that instead of 1 hour of Speech Therapy a week, we would implement speech targets throughout every single hour 35 hours a week.
We often work together with good quality Speech Therapists and Occupational Therapists to incorporate additional strategies they may have into our ABA therapy hours.
4. I have been advised to get my child into as many therapies as possible and so my child's schedule is filled with a variety of therapies every week - Speech Therapy, Occupational Therapy, Music Therapy, Art Therapy and Horse-Riding. Wouldn't this give my child the best opportunity to learn?
Children with autism have a small window of opportunity to learn rapidly. As clinical practitioners, we are fighting against time to help our children catch up as quickly as possible. It is of a child’s best interest that he receive a strong treatment programme that covers all areas of development systematically and as consistently as possible in order to promote rapid learning.
Having an eclectic multiple practitioner approach can be counterproductive as each practitioner has their own priorities and can be ultimately confusing for the child. As the old saying goes, ‘Too many cooks may spoil the soup.’
Well in general good quality ABA treatment is expensive mainly because:
- ABA treatment is provided on a one-to-one basis;
- Additionally the efficacy of ABA is dependent on the intensive hours, ideally 35 hours a week;
- Each programme needs to be personalised to the individual child, requiring high quality clinical expertise and more time;
- In order to ensure the quality of the ABA programme, multiple levels of supervision is required;
- This includes BCBA qualified clinicians from the USA.
2. There are other centers who claim to provide the same services as EAP but their fees are lower. Why is that so?
3. What about hiring free-lance therapists? Some of whom have worked with EAP before or have attended a training workshop/been an intern at EAP?
The concern would be the governance of practice. When any therapist in any field works on their own without ongoing supervision and training, there is a limitation to their level of knowledge and expertise. This becomes particularly risky in the field of autism as the spectrum is so wide and it requires years of supervised experience in order to become an expert in the field.
At EAP, each of our therapists adhere to a strong code of ethics and practice and are regularly supervised during fortnightly overlaps and team meetings in order to ensure clinical quality. Each therapist attends monthly Team Clinics where further clinical training is provided as well as EAP’s 3-level Certified Training which takes place 6 times a year.
Our EAP therapists are supervised by EAP Supervisors who report weekly to EAP Senior Supervisors who then report to our international BCBA Consultants.
It is our multiple-level of supervision that ensures the provision of good quality ABA therapy and we are not willing to risk the progress of the children entrusted to us by compromising this quality.
The practice of ABA has evolved signficantly over the last 40 years and incorporates a lot more naturalised teaching, naturalised reinforcement, a significant emphasis on play and generalisation as well as incorporating other complementary techniques.
Additionally unfortunately due to the lack of governance of ABA practice in Malaysia, when ABA is practiced by individuals who are not sufficiently supervised and trained as well as lacking supervised experience, they may practice certain elements of ABA such as the discrete trial protocol which they may have learned in a workshop.
Good quality ABA should be practiced in natural and generalised environments and maximising the learning potential of every child.