Autism: What have we learnt so far?


Autism is a neurodevelopmental disorder in which individuals have difficulties with social interactions and communication and a reliance for routines and/or repetitive behaviours (Read this NIH fact sheet for more information). Individuals with autism also tend to display sensory seeking behaviour and according to more recent scientific endeavours, experience high rates of gastrointestinal issues.

It’s a disorder which receives much attention in both the press and in research. But research findings, despite advancing at the pace of greyhounds chasing a bunny on the race track, don’t always accompany news stories. The public’s understanding and awareness of this disorder is still work-in-progress, even though local resources for autism has vastly improved.

Research links the use of joint attention — the ability to use gaze and gestures to share attention — to autism, but a recent study points to a more accurate red flag for autism — a social smile during joint attention. This 2014 study observes that infants at 8 months tend to look at an object of interest and then smile at the person they are interacting with, before looking back at the object of interest, during joint attention. In contrast, infants at risk for autism tend not to direct the social smile at the other person in between looking at object and at the other person.

Other research has established that individuals with autism find faces aversive, and as a result have difficulties recognising the emotions of others (more about their difficulties with empathy here). In fact, a hot-off-the-press study finds that individuals with autism focus on areas of contrast and colour of real photographs and the centre of the image, whereas those who don’t have autism look almost exclusively at faces in the same photographs. And this tendency emerges at a young age: a 2014 study observes infants at 6 months to fixate on faces when someone is speaking. In contrast, infants diagnosed with autism later look away from the eyes and mouth when someone is speaking.

Recent research has also identified two other markers useful for screening autism among children aged 9 to 12 months. A 2014 study finds that babies with a head circumference that is at or higher than the 75th percentile at 9 months and infants who fail the tonic neck reflex (also known as the head tilt reflex) are at a higher risk for autism.

With slightly older children, nonverbal screening tools may be useful. A 2015 study proposes a novel way of screening for autism: It turns out that individuals with autism don’t reduce their sniffing of unpleasant smells (and conversely increase their sniffing of pleasant ones). In contrast, their peers who don’t have autism “stop” a wiffy smell in about 305 ms. Another 2015 study finds a higher proportion of children who are subsequently diagnosed with autism among families where parents voiced concerns about their child’s sensory and motor abilities from the age of 6 months, and their child’s language and social communication abilities from the age of 12 to 15 months. So although autism cannot be diagnosed till 2 years of age, there are clear indications and red flags which are proving to be effective for screening autism at a much younger age.

Screening for autism aside, there are still no clear answers to what contributes to autism. Recent research does however indicate differences in brain structure between individuals with autism and peers who don’t have autism. Apart from differences which have been observed in the brain structures which connect the two brain hemispheres to each other, a 2014 study observes a lack of neural pruning — the process by which neural connections which we don’t use are eliminated — among children with autism (for a more in-depth discussion, read this article). Genetic factors are acknowledged to contribute to autism, but environmental factors are also considered to play an important role. Increasing evidence that the composition of gut bacteria differs in individuals with autism from that of their peers who don’t have autism, has led some to suggest that gut bacteria to be a possible contributing factor to autism. While a 2015 study definitively excludes MMR vaccines as a contributing factor to autism (read more about the study here), another 2015 study speculates that other chemicals, such as solvents and pesticides, to which expectant mothers may have exposure, can adversely affect foetal development.

Despite the mixed findings about the cause of autism, more recent research does offer some promising news about effective interventions and strategies found to be useful for helping children and adolescents with autism. Just as children who don’t have autism can be trained to enhance their ability to identify emotional expressions and young preschoolers with autism can be taught social skills, recent research demonstrates that early intervention programmes play an important role in helping children with autism improve their social skills, as well as cognitive and language abilities.

One 2012 study has reported that an intensive programme comprising 20-hours-a-week one-to-one training with interpersonal exchanges over a period of 2 years, yields improved brain responses to faces among infants with autism aged 12 to 30 months. Use of this therapeutic intervention by parents has been shown to be effective on even young infants with autism. In this 2014 study, at-risk 6-month-olds, who showed signs of autism at the start of intervention (e.g., a lack of interest in social interactions and communication), had better cognitive and language skills 12 to 30 months later. In a follow-up study of these infants, further improvements were observed after 2 years of intervention. Infants’ cognitive, communication, and adaptive skills (skills for everyday living) were observed to undergo greater improvement compared to peers with autism who attended a preschool programme and who were given speech therapy.

Other groups of researchers have also shown that parent training is also an effective way to improve the quality of social interactions between parents and infants with autism. A 2014 study has shown that teaching parents to support their children’s learning during everyday activities results in better language and social communication among toddlers with autism. In another recent study, one-year-olds with autism whose parents received coaching on how to attract their infant’s attention and interest their infant in social interaction games produced better outcomes than peers receiving community-based early intervention and monitoring. A separate 2015 study has also shown that the benefits of parent training over a period of 24 weeks to include a reduction in disruptive and aggressive behaviours among children with autism aged 3 to 7 years (Supernanny also some useful tips…). It’s evident that there are various effective therapeutic options available to families of children with autism.

Interventions which reduce the severity of children’s autistic behaviours are important. But support for families are as, if not more, important. This is particularly true for caregivers and parents of children with autism, who experience a high level of caregiving stress on a daily basis and can be at risk for caregiver burn out. Journal writing has been found to help mothers manage their stress levels, while mothers are less likely to experience depression if their partners share the burden of caregiving. But it’s often easier said than done. Respite care — which provides parents and caregivers with time off to take of themselves — can play an important role for helping parents and caregivers manage their stress. And more public awareness won’t do anybody any harm either.

World Autism Awareness Day is a few months away but there’s no time like the present to support a greater public awareness of autism.

10 Things To Know About Caregiving

The current ratio of adults aged 20 to 64 years to older adults aged 65 years and above is 6.4, according to the Department of Statistics Singapore, although a recent news article (“Fast-ageing Singapore, fewer to support aged; Trend worries experts”, The Sunday Times, 27 Sept 2013) put this figure at 5.5. Concerns about an ageing demographic aren’t solely a local concern. According to the facts and figures from WHO, life expectancy and medical advances make this issue in other countries too.

It should be pointed out that its entirely arbitrary that we should support someone at age 65 but not the year before. But nevertheless, ageing is a pressing issue. Consequently, ageing issues receive much media attention, with recent special reports such as those listed below, putting the spotlight on caregivers.

While it’s reassuring to know that one isn’t alone in the sandwich generation of being a parent of young (and not-so-young) children and being a caregiver of parents (and for some, siblings), it may be useful to have the resources one needs or will eventually need, when caregiving needs arise.

As full-time employees, we may be only part-time caregivers, but we are still caregivers in some capacity or other nonetheless. Given that the mental wellbeing of caregivers is important, here’s 10 things you should know about caregiving:

  1. Most caregivers in Singapore are employed. You’re not alone.

    According to a 2010 survey, almost 75% of individuals who said they provided regular assistance to friends or family were employed (Singstat Singapore Newsletter, Sept 2011). That means that many caregivers endeavor to manage their time between work, caregiving and others responsibilities at the home.

  2. Caregivers may experience high levels of stress.

    Research shows that caregiver stress increases with the physical dependency of the care receipient. As reported in a 2007 NCSS Social Service Journal, research shows that care receipients who have lower scores on Activities of Daily Living tend to have caregivers who experience higher levels of stress (Mehta & Joshi, 2001). Specifically, those who look after care receipients who have dementia tend to have high levels of stress (Kua & Tan, 1997). Don’t be surprised when this turns up as one of the WHO’s 10 Facts About Dementia!

  3. There are many resources available for caregivers. Several local organizations also have online caregiving resources.

    These include among others: a fact sheet about dementia (WHO), the 10 early warning signs (Alzheimer’s Association), books on coping with caregiver emotions and stress from the US National Institute of Aging, useful tips and facts for caregivers from the US Family Caregiver Alliance. 

  4. Touch Caregivers Support

    Touch Caregivers Support provides useful Caregiver Tips, runs courses and talks, and counselling services. Their website also has resources in Chinese.

  5. Caregiving Welfare Association

    The Caregiving Welfare Association has an free online counselling service for caregivers providing care to older adults with physical or mental disabilities, where caregivers are residents of Singapore and above 18 years of age.

  6. WINGS

    WINGS organizes regular exercise programmes, talks and workshops, and other activities to support women in ageing successfully.

  7. Council for the Third Age

    Council for the Third Age has resources for helping seniors with lifelong learning. Modules include resources for tech topics, library resources, recommended reading and videos. 

  8. AWWA

    Caregivers Connect is a community network for caregivers by caregivers through events organised each quarter and on online forums. Other services offered by AWWA include a Caregiving Life Skills Training programme.

  9. Tsao Foundation

    The Tsao Foundation has caregiving resources on caring for the frail, looking after your emotional wellbeing and physical health, and financial security, as well as information about TCM and acupuncture.

  10. SG Family Caregivers

    Information about caregiver stress is also available at Singapore Family Caregivers’ website.