Helping Autistic Children Gain Independence Through Behaviour Therapy: Founder of Therapy Kidz Eileen Su

What are the other signs of autism?

Autistic children can also have very intense obsessions — I know a child who can recite the mass rapid transit stations from the first to the last terminal. They have fixations on how things should be done. They need to go through each day in a specific order: A, B, C.

Why is that so?

They have formed a way to make sense of their environments and have learnt how to navigate and do things. They know that this order of A, B, C is safe, and that nothing bad will happen so long as they stick to it. So, when you do things in a different order, it throws them into a world of uncertainty.

That’s not so different from the rest of us, isn’t it? That need to feel safe. Some adults I know need coffee to start their days, if not their whole day is off kilter.

Yea, it isn’t that different. It is just that we are able to cope with a different ritual, such as getting our coffee fixes later in the day. We have developed the skill either naturally or learnt it from someone. For autistic children, they need to be taught explicitly how to cope with it. When it comes to rigidity, I do desensitisation by changing the order during a session. Instead of going with the usual order of puzzles, vocabulary and matching, I’d perhaps go with matching first. When I go to a child’s home, instead of sitting on the blue chair as I usually do, I may decide to sit on the pink one. The child can throw tantrums, but I do not give in. After a while, he will realise that throwing tantrums does not help his cause — he’d still have to sit on the blue chair. And nothing bad happens as a result of his sitting on the blue chair.

Rigidity in itself is not bad — it can be beneficial as well. I teach teachers in mainstream schools how to establish routines that will help the child function better. Doing things the same way frees them up as they won’t have to supervise the child as closely.

The stereotypical perception of autistic children is that they display odd demeanour or that they are usually the ones disrupting the class. What is the reason for that?

Yes, a lot of times they get scolded for their behaviours. They tend to have sensory processing issues. Loud noises, bright lights — these stimuli overstimulate their senses. Sometimes, certain situations arise and they feel unable to handle them: they’re denied access to something they want, or perhaps someone took something of theirs. It can also be that another child is intentionally antagonising them. They begin to stim, which is a form of self-soothing mechanism. They flap their arms. They rock forwards and backwards. These repetitive actions, whether they are physical gestures or verbalisations, calm them down and make them feel comfortable.

If you think about it, stimming is a rather normal reaction — we twirl our hair when we’re nervous or bite our nails when we’re stressed. It’s how we soothe ourselves. The difference is that we may only perform these actions privately and not in a social setting. We are also conscious of the fact that we are doing these actions. For autistic children, they may not even be aware that they are stimming. During a session, we teach them when the right time to stim is. For example, while in a class, no stimming is allowed. They can stim during breaktime.

What about tantrums? Is that a form of stimming?

No. Tantrums are a learned behaviour. For example, when a child wants access to a snack, and that request is rejected, he may start to cry. After ten minutes, his parents relent and give the snack to him. He learns that crying gets him what he wants, so he repeats this behaviour in future. The trigger is his craving for a snack. The learned behaviour is crying for the snack. But if he still doesn’t get the snack, despite crying louder or longer, when this negative behaviour goes unrewarded, the possibility of his repeating it is reduced.

Have there been any incidents where you got hurt as a result of a child’s tantrum?

Oh, plenty of times. Once, I was headbutted (laughs). The child was on a different set of medications, so his home routine was thrown into disarray. He was upset about everything, and he had sensory processing issues and was very impulsive. His emotions were poorly regulated that day. We were doing matching assignments when he got very upset. He threw everything on the floor. That’s when I had to do corrective behaviour with him. I told him to pick everything up and place the things on the table nicely. As he was doing that, he threw another tantrum and just plonked down on the floor. I stood behind him and was trying to guide him up when he suddenly shot up and hit my nose. Now, I don’t think he was deliberately trying to hurt me. He was simply struggling, and his tantrums were a learned behaviour — throwing tantrums is the best way for him to cope with his emotions.

How do we help autistic children to manage tantrums?

The reason they scream is because that is the only way they know how to release the rage in them. There are many ways to regulate emotions. I will say, ‘I can see that you’re angry. Let’s count to ten.’ And I’ll lead the child in the counting. Some of the children may follow suit, which is great because then they are practising the technique; even if they don’t, it’s okay. There are also other ways — taking deep breaths, going to a corner, drinking a cup of water or hugging a bear.

Again, these are very common techniques that everyday people like you and I use to regulate our emotions. I’m getting the sense that we aren’t so different from people with special needs. The triggers for our emotional outbursts are the same; the techniques we use to calm ourselves down are the same.

That’s right. For children, as they are still developing, it helps to teach them all these skills, so that they have more tools in their boxes to face their everyday challenges. The only difference is that with autistic children, you have to be extra patient, and reinforce these techniques quite often until they get them.

What are the specific approaches you use when working with autistic children?

When teaching new skills, we break down a task into smaller steps to facilitate learning. Take for example tying a shoelace. We teach a child how to tie the first knot, then the second step of making a rabbit ear. Then comes the tying of the two ears. Likewise for speech development. We build up a child’s language skills by increasing the number of words he can use. For example, we show him a picture of a dog. He will say, ‘Dog.’ When he does so, we’d then teach him to say: ‘It’s dog.’ Slowly, he will progress to a fuller description of ‘It’s a brown dog’.

It’s the same linear approach we use when teaching other children; just that teaching an autistic child a skill is not as straightforward, because he may have a short attention span, or he may get frustrated easily. It requires more time and patience, but it is achievable. We also have to figure out his learning style — is it visual or auditory? To increase his motivation to learn, we use positive reinforcement— rewarding him with a toy or desired item or a movement break. We get him to pick his desired toys and games. From the completion of one task we then move on to two before giving him the reward, thereby extending the amount of time he can stay seated and sustain attention. As mentioned earlier, when a child can stay seated for a longer period of time, learning can take place.

Naturalistic learning is another approach we use. It entails following the lead of the child to teach him knowledge and skills that will be meaningful to him in his daily life. For example, if he shows interest in animals, we’ll teach him animal names. It is highly tailored to his different likes and dislikes, strengths and struggles. It’s one of the first questions I ask parents when they enrol their children into the programme.

Being diagnosed with autism does not mean that a child cannot learn. Many of them grow up to be successful adults, and some are the greatest scientists and engineers the world has ever seen.

Temple Grandin, Anthony Hopkins, Susan Boyle are just some of the successful maestros who have autism. Even Albert Einstein, Isaac Newton and Lewis Carroll were reportedly known to have displayed signs of autism.

Yes, their wonderful memory is a superpower. When they develop an interest in something, they can have intense obsessions. This makes them a walking encyclopedia on certain topics. They are very smart.

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