Autism is a lifelong developmental disorder that affects the way a person communicates and relates to people around them. Children with autism have impairments in social interaction, social communication and imagination. They are also likely to have stereotypic or ritualistic behaviour and sensory sensitivities. These children tend to have learning difficulties and many of them are intellectually deficient.

Autism is a neurodevelopmental disorder of the brain that starts to manifest during infancy or early childhood. Parents generally seek medical consultation when there is speech and language delay when their child is around 2-3 years of age. Diagnosis is usually made around the age of 3 years. Autism affects boys 4 times more than girls. Although children with autism vary widely in their abilities and behaviour, they generally present with varying degrees of difficulties in the following areas of development (hence, being better labelled as an 'autistic spectrum disorder' or 'ASD').

Social Interaction

Children with ASD encounter difficulty in interacting with their peers. They prefer to be alone most of the time and seem to have very little interest in other people, often described as 'being in their own world'. Response to others' attempts to engage them is poor and inconsistent. Some ASD children may often appear interested in interaction, but clearly do not have the 'know-how' when attempting to engage others. They do not register social cues and may frequently irritate others. They have difficulty understanding and expressing emotions and tend to use people as a "tool" (e.g. pull the adult's hand to the object he wants without a word or glance). Yet others may interact well with adults but have difficulty amongst their peers.

Speech, Language and Communication Development

Approximately 40% of children with autism do not acquire speech at all. Most would have some degree of speech and language delay. Many of those who do speak have echolalia (i.e. parrot-like imitation of what has been said to them). They may recite phrases from television commercials or the computer ('scripted language'), but cannot use speech to communicate meaningfully or effectively. Eye contact is poor or absent. They may use illogical words repetitively and have little understanding of abstract concepts (e.g. danger) or symbolic gestures (e.g. waving bye-bye), often known as 'poor symbolic communication'. This is often manifested at a younger age by poor referencing and pointing (object labelling) skills. They have difficulty using pronouns (e.g. I/You) and controlling the pitch and volume of their voice. They tend to be literal in their understanding of language and cannot 'read between the lines'.

Imaginative Play

A child generally learns to play imaginatively from the age of 2-2½ years. This is usually demonstrated by play with toys such as 'masak-masak' (cooking toys), toy guns and doctor sets. The child with ASD has poor imaginative skills and often plays in an unusual way. He may spin an object or play in a repetitive manner (e.g. lining up cars and blocks). Some children with ASD may appear to play imaginatively but often in a learnt or restricted manner (e.g. always in the same scenerio).

Abnormal Responses to Sensory Stimulation

Autistic children may over-react to certain sensory stimuli or have no reaction at all. They have difficulty "filtering out" extraneous noises in the environment (e.g. air-con) and may throw a tantrum until the stimuli is removed. They may be fascinated with lights or colours and pre-occupied with tapping certain surfaces. They may frequently smell objects. Some may spin themselves without getting dizzy while others have a great fear of movement (e.g. swings).

Atypicalities in Development

An autistic child's motor skills may be relatively normal; however, many of them are clumsy or may have poor fine motor skills. Some children with ASD may have 'hyperlaxia' - when young, although clearly delayed in speech and language development and unable to communicate even simple needs, an ASD child may be able to recognise and be fascinated with letters and numbers. At an older age, he may be able to read complex words like "Universe" and the newspaper but without understanding the meaning of the words that he can read. At the same time, he continues to have difficulties communicating with others, although this skill may have improved with age. Skills may appear at the appropriate time and then disappear (e.g. a child may start saying "pa-pa" at one year old and then stop at age 2), a characteristic known as 'regression of skills'. They may have specialised skills in certain areas (e.g. puzzles, numbers or music) but their language and communication skills remain far below age level.

While the autistic child may manifest varying degrees of the symptoms described above, not all the features listed may be present. Nevertheless, all autistic children will have difficulties in the key areas of social interaction, communication and imagination.

If your child has the symptoms described above and you suspect autism or ASD, you may make an appointment for your child to see a developmental paediatrician at the Child Development Unit (CDU) at KK Hospital. At this consult, the need for further assessment will be evaluated. Should the developmental paediatrician deem it necessary, your child may then be seen by the psychologist or therapists (speech and language, occupational or physical therapists). These people will assess your child to determine his level of function, need for intervention and subsequent educational placement. The professionals, co-ordinated by the developmental paediatrician, who will be your child's case manager, work as a team to formulate plans to optimise your child's development.

Parents may also become members of the Autistic Association of Singapore (AAS) or join the library at the Autism Resource Centre (ARC) and be more informed about this disorder.