Case study

This case study section consists of some Q&A relevant to ABA therapy and autism, these questions are common issues faced by our clients and netizens. Below is the table of content for this section:

Issue #101: Emotion regulation

Q: Hi Fit In, my child barely shows any emotions most of the time but sometimes will experience extreme emotions that last for a long period of time, is there anything I can do to help him regulate his emotions?

A: Autism children often have difficulty regulating their emotions, sometimes the emotions that they display are not what they are feeling. To help your child learn to label and express emotions, you can label emotions in a natural context. For example, when reading a story or watching tv, you can label the emotions of the characters, ‘look, Adie is sad?’, you can explain and elaborate on the character’s emotion to help your child understand better. After the child learns to label emotions, parents can proceed with social stories, this can improve his perspective-taking skills and understand how others and himself will feel in a specific social context.

In the ABA program, we teach the child to identify emotions. Therapists will start with labelling from cards and slowly progress to identifying in a natural context when the kids are able to generalize emotions learned to a real-life context. A social story is also another tool therapists use to teach social and empathy skills.

Issue #102: Eye contact issue

Q: Hi Fit In, my autistic child does not respond when his name is called, he did not even look at me, is there a way to improve his eye contact especially during social interaction?

A: Autistic children generally have difficulty in making or maintaining eye contact, some autistic children might even feel anxious to make eye contact. Neurologists suspected that the problem might be over-sensitivity of the parts of the brain responsible for emotional perception. In ABA, the therapists train eye contact by reinforcing the children when they look at the therapist, this can encourage and improve eye contact. Therapists will also praise and reinforce the behaviour with their desired toys or snacks to let the child understand that good behaviour will lead to positive consequences. Eye contact can be trained and improved with ABA therapy, the skill is important especially for the social development of the child, for instance, looking at the speaker provides many social cues for the listeners.

Issue #103: Question about Discrete Trial Training

Q: Hi Fit In, I’ve noticed that Discrete Trial Training (DTT) is included in many ABA programs, it is so robotic and repetitive, and does it actually help the child? If so, how would it help?

A: DTT is a branch of ABA that is being practised widely by many therapists as past evidence has shown strong support of improvement in teaching autism children with DTT. The DTT method focuses on breaking down skills into smaller chunks, utilizing reinforcement and repetition of trails, thus some criticized it for being too robotic. However, this is only the first step of learning. Generally, children will start with a structured and rote DTT. As they develop, they will transition to a more naturalistic learning style (e.g., NET, incidental teaching). DTT can significantly improve children's abilities in language, imitation, self-help, motor, and play skills. It is promising especially at the early stage of learning for autism children.

Issue #104: Question about sensory toys

Q: Hi Fit In, I’ve read an article that says fidgeting toys can actually help to calm my autistic child, is that true? How would it help?

A: Fidget toys can keep the hands busy, soothe nerves, help improve focus and occupy an active mind. It can also help autistic children with self-regulation and manage anxiety, some therapists use it to calm down the kid when dealing with a surge of emotions. The children can actually benefit from fidgeting especially when they are stimming. Therapists can train the child to replace stimming behaviour with other activities, for instance, fidgeting. Fidget toys do help some of the kids, however, it varies from person to person, as autistic children have different types of sensory issues. Therapists at Fit In will expose the children to different sensory plays, this can satisfy their sensory needs and improve their process and respond to sensory information.

Issue #105: Screen time and verbal repetition issue

Q: Hi Fit In, my child’s scripting behavior has increased a lot, I reckon it is due to MCO and his screen time has increased a lot at home. Should I reduce his screen time, is there any way to reduce his scripting behavior?

A: There are limited studies regarding the association between screen time and scripting behavior. However, children with autism are more vulnerable to various brain-related impacts of screen time, it can lead to hyperarousal and dysregulation. Thus, parents should monitor the screen time of children closely. As for scripting behavior it is disruptive for the development of the children and it is hard to replace with other behaviors. Parents can replace the behavior with something functional and equally valuable, for instance, therapists at Fit In practice manding, which can help the kids to make a request and express themselves, this helps with their initial stage of communication skill development and can efficiently reduce verbal stimming.

Issue #106: When should I send my child to school?

Q: Hi Fit In, my autistic son is 5 years old, should I send him to school? I’m feeling quite insecure, and not sure where I should send my kid to. 

A: Autism traits vary from person to person, in addition, Autism is a spectrum disorder, and individuals could be in the range from low functioning to high functioning. Autism kids will face more challenges that are related to cognitive processing delays which could affect the child’s ability to process verbal or written language. They could also have sensory perception issues, social skill deficits and motor skill challenges when writing their homework or taking tests. It is important for parents to prepare and rehearse with your kids before school, parents can visit the school and expose the kid to the school setting to help them get familiar with the place to ensure a smooth transition.

Moreover, early intervention is also important to develop the skills of the child, for instance, ABA therapy can improve the child’s cognitive processing, motor skill and social skills. Occupational therapy is also a good choice to improve their sensory issues.

Issue #107: When should I start toilet training with my kid?

Q: Hi Fit In, my autistic son is already 5 years old, he has limited speech and he still cannot go to the toilet independently and has to wear pampers every day. When can I start training him to go toilet and how can I do it?

A: Toileting is indeed one essential life skill, there are several signs that signify that children with ASD are ready for toilet training. These signs include that your child is able to tell you by using sign, gesture, et cetera, your child will be able to follow simple instructions like ‘sit on the toilet’, ‘pull down pants’ and your child has enough bladder control to stay dry for at least one hour during the day. If your child has limited verbal skill, you can use visual aids to guide him. When it comes to communication, less is more, so make your instruction short and understandable. Parents can also use encouragement, rewards and social stories for toilet training. 

Here at FIt In, ABA therapists will put the child on the toilet at regular intervals and break down the toileting routine, for example, ‘remove pants’, ‘sit on the toilet’, ‘wash hands’ and ‘wear pants’. Therapists also will reinforce the child if the child follows the routine well.

Issue #108: Which therapy should I choose for my child?

Q: Hi Fit In, there are many different therapies available, can you briefly explain the differences and recommend a therapy that is appropriate for my 2 years old autistic kid?

A: There are many different therapies available out there, however, most are not based on scientific or empirical evidence, thus parents should choose wisely. Generally, scientifically proven methods include Applied Behavior Analysis (ABA), speech therapy and occupational therapy. Speech therapy focuses on communication and interaction aspects, whereas occupational therapy addresses sensory issues and motor skill, lastly ABA focuses on shaping the behaviours and teaching new skills which include communication, social skills and life skills. 

Which therapy to choose depends on the child’s issue or the goals set by the parents. We strongly encourage parents to send their child to ABA first, as it fosters a strong foundation of skills in different aspects and shapes appropriate behaviors that can be crucial for the child’s development, it is the first stepping stone for autism child. Moreover, ABA is known as the ‘Gold standard’ for the treatment of ASD, the child’s progress is tracked and measured, thus it is believed to be the most efficient intervention.

Issue #109: Mainstreaming  

Q: Hi, I plan to send my 3-year-old daughter with autism to mainstream school next year. However, I worry that it will be difficult for her to cope with mainstream education and at the same time not getting substantial support in school. May I have some suggestions from you?

A: Inclusion of special needs children in mainstream school may seem challenging, but you may consider ABA therapy in order to equip your child with school readiness skills before sending them to mainstream school. For example, ABA therapy can help them to improve their communication and social skills, to follow instruction, and to reduce problem behaviors. You may also consider having a shadow aide to support your child in the school.

Issue #110: Rigidity on food

Q: Hi, my autistic son eats a narrow diet, which he will only accept a few types of food. When I want him to try on a new food, he will start to cry and refuse to eat it. I worry that he might not get enough nutrients for his growth, do you have any advice on this issue?

A: All of us have food preferences but children with autism tend to have extra strong preferences for certain foods and it was very difficult for them to accept new foods. You may introduce new foods to your child through gradual exposure. For example, you may begin to introduce new food with a minuscule amount and increase the portion gradually. You may also consider introducing new foods that are similar to foods that your child already liked. For instance, going from chicken nuggets to trying steam chicken. 

Issue #111: Sleep problem at night

Q: Hi, I am a mother of a 5-year-old autistic kid. My kid has been facing the issue of difficulty falling asleep at night. This issue has affected his daytime functioning, in which he tends to be sleepy during lessons and his problem behaviours started to increase. May I know if there are any tips on this issue?

A: Children with autism may be more sensitive to stimuli such as sounds and lights. You may try to keep the sleeping environment quiet, cool and dark, as this may help them to relax. In addition, you may try to create a regular bedtime routine and do some relaxing activities with them before bedtime (e.g., listening to relaxing music or reading storybooks).

Issue #112: Sensory meltdown 

Q: Hi, my child is having sensory processing issues. Whenever I bring her to crowded places such as playgrounds or shopping malls, she will have meltdowns and it turned out to be a bad experience every time. Could you please help me on this issue? Thanks!

A: Sensory overload may happen when your child is in an overcrowded place, as the noise, smell, lighting or the people might overstimulate her senses. You may prepare a bag with things that help to calm your child. For example, noise-blocking earmuffs, fidget spinner or her favourite toys, which can help her to feel at ease. If it is really too overwhelming for her, it’s time to exit that place. 

Issue #113: Aggressive behaviour (yelling, scratching, pushing) 

Q: Hi, I realized that my child is having some aggressive behaviours such as hitting and pushing other people, as well as yelling to get the item he wants. I am really worried about this issue, may I know what can I do to help him?

A: Aggressive behaviours might be an inappropriate way that your child uses to express his emotions. First, try to stay calm whenever he shows aggressive behaviours. Do not give in to those behaviours because that might reinforce the inappropriate behaviours. You may also reward your child for good behaviours. If the situation seems unmanageable, you may seek help from professionals such as pediatric psychologists or therapists.

Issue #114: Should I stop my child’s stimming behavior?

Q: “Hi Fit in, can ABA help to eliminate my child’s “stim” behavior? I am concerned that my child would be bullied or treated differently by his classmates because of it.”

A: Unless a stim behavior is dangerous, instead of working on decreasing minor stim behavior (rocking, moaning, scripting, etc.) directly, ABA therapists will focus on improving language and learning skills that will eventually replace those stim behaviors. The key to stopping a stim behavior is not to focus solely on stopping one behavior. Instead, work towards reducing stimming and replacing the behavior with something functional and equally valuable.

If there is a known trigger that begins or worsens stimming, it may be helpful if you try to remove or alter the situation to reduce anxiety and stress. For example, if a child flaps their hands when they feel stress or anxious, encouraging them to squeeze a stress ball or a soft toy rather than waving their arms about may be a more appropriate option.

Issue #115: When can my child receive an assessment?

Q: Hi, I am very concerned for my 15-month-old child as I noticed that he does not respond to his name and he displays little eye contact. I suspected that he might have autism, may I send him to your centre for a screening?

A: Hi, the symptoms of autism typically surface by 18 months of age or earlier. However, current recommendations suggest screening for autism starting at 18 months, as standardized screening tools for autism have not been validated in children under 18 months. If you send your child which is under 18 months old for screening, there might be a possibility of getting a false-positive result, and the result may be less reliable and accurate.

Issue #116: When will I be able to see the progress of my child?

Q: Hi, may I know when will I be able to see my child’s progress after he starts receiving therapy?

A: Every child's development is unique and affected by various factors. For instance, a child’s ability to learn a concept, skills that the child had mastered before, as well as the cooperation of parents will influence the progress of the child. At Fit In, an Individual Education Plan (IEP) that is tailored to the child’s needs will be designed by our team for each child. The IEP will be reviewed every three months and you can compare the recent IEP with earlier reports to monitor your child’s progress. In addition, a session note will be sent to you after every session to keep you updated about what your child has learned or done in the session.

Issue #117: Suggestion from school teacher to see a doctor

Q: Hi Fit In, my son is 8 years old. Recently, his school teacher has reported to me that he learns at a slower than average rate and his attention is very low when he learns. Hence, she suggested me to bring him to see a doctor. What should I do? Is there really a need for him to go for a doctor?

A: Hi, many parents are worried about ‘labelling’ their child, but an appropriate screening may help to know the progress of the child as well as understand what is going on for your child. What you can do is, first, understand more detailed information from the school. For example, the observation from teachers in various settings (e.g., classroom, playground). In addition, you may also ask the school to address their concerns and expectations of your child. If you’ve decided to bring him for screening or assessment, you may bring as much information as you can with you to discuss with the professionals.

Issue #118: Unsure if my child has autism

Q: Hi, I’ve observed that my daughter may have some symptoms of autism, but I am not very sure about it. For example, she does not respond to her name and she will grab my hand to reach the items she wants instead of requesting it nicely. However, she does enjoy playing with a variety of toys and the companion of other people. I feel confused and may I know what should I do?

A: If you’ve observed red flags for autism or other developmental disorders in your child, but you’re not sure about it, you may consider having a proper screening or assessment for your child. This may help to understand the development of your child and to see whether your child hit the developmental milestones on schedule. You may also address the issues that you are concerned about during the assessment to help you get a clearer picture of what is going on. If there is a need for your child to receive any kinds of help or support, early intervention can improve a child’s overall development and skills.

Issue #119: Non-verbal child who can emit sound

Q: Hi, I’ve referred to the developmental milestones checklist and I realized that my son is at the age where he is supposed to be able to say eight or more words, but he is not able to do so. However, I noticed that he can emit sound. Hence, may I know what I can do to help him?

A: Hi, you may expose your child to the activities that they are interested in and motivate them to label the items in the activities they chose for. Be mindful of the words you choose to practice with your child. You may consider choosing words that are easy for your child to imitate and understand. Using single words such as ‘car’ and ‘ball’ are encouraged. If you still feel struggling with this issue, you may consider seeking help or advice from a professional.

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