Autistic Spectrum Disorder

Autism Spectrum Disorder is a developmental condition characterized by persistent deficits in social communication and restricted, repetitive patterns of behaviour and interest.

The word ‘spectrum’ is used as individuals on the autism spectrum show varying levels of autism-related behaviours and abilities.

Signs of autism can be noticed in children from as young as 12 months old. Autism-related differences or difficulties often persist in adulthood, although these can change as a child grows and improves.

Children on the autism spectrum can be very different in their cognitive abilities and everyday living skills for independence and group learning. Whilst some children with autism have learning difficulties and intellectual challenges, there are others with normal or exceptional cognitive abilities.

Even so, children on the autism spectrum have their unique strengths. They can learn, thrive, and grow up to be happy, healthy, and achieving adults. 

Signs of Autism

For very young children between 1 and 3 years old, signs of autism include:

• Little or no use of speech for communication
• Reduced response to name being called
• Difficulty in following instructions or looking at something being pointed out
• Avoidant or fleeting/brief eye contact most of the time
• Little or no imitation of others’ words and actions
• Lack showing objects to share interests or get attention
• Reduced interest in social play with others
• Little or no use of social smiles or gestures for communication (e.g., pointing, waving goodbye, head nodding, head shaking)
• Repetitive movements (e.g. hand flapping, tiptoeing, spinning oneself)
• Repetitive play (e.g., lining of toys, opening and closing doors, spinning objects)
• Difficulty in coping with transitions or changes in routines
• Unusually focused interests (e.g. wheels of toy vehicles)
• Unusual reactions to the five senses (e.g., oversensitivity to sounds, staring closely at spinning things, tendency to sniff things, very picky with food and difficult to feed)

For older children and children with more fluent speech, they may show any of the above signs as well as the following:

• Echolalia (i.e., repeating words or phrases when not meant to)
• Use of scripted speech (i.e., ‘learnt’ or mimicked phrases, such as from shows)
• Pronoun confusion (e.g., referring to self as ‘you’ instead of ‘me’)
• Difficulty in holding conversations (e.g., talking ‘at’ others instead of engaging in a two-way conversation)
• Difficulty in understanding social cues and social norms
• Difficulty in understanding abstract concepts (e.g., sarcasm, metaphors)
• Preference to play or be alone, or difficulty making friends
• Preoccupation with specific topics (e.g., planets, transport, numbers, alphabets)

There is no known way of preventing autism.

In most cases, no cause may be identified. Genetics play an important role, as autism is more common in some genetic conditions and in families who already have one child with autism. Autism is also more common in children born before 35 weeks’ gestation or who weighed under 2.5 kg at birth. Parents over 40 years old are also more likely to have a child with autism. Importantly, parenting styles and vaccines do NOT cause autism.

Screening for Early Signs of Autism in Children

The Modified Checklist for Autism in Toddlers, Revised with Follow-up (M-CHAT-R/F; Robins, Fein, & Barton, 2009) is a parent-report autism screening tool to assess the likelihood of autism in 16- to 30-month-old toddlers. The results will indicate whether further evaluation may be needed. You may use the results from this screener for discussion with your child’s doctor.

Please scan the QR code below to access the online M-CHAT-R/F.

Alternatively, you may click on this link: Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F) (dcd.com.sg)

If the M-CHAT-R/F screen is negative but you still have concerns that your child may have autism, please continue to seek professional advice from your child’s doctor.

Some groups of children are at higher likelihood of having autism. As such, screening for autism is recommended for the following:

• Children with an older sibling who has autism, or multiple family members with autism
• Children born before 35 weeks’ gestation or who weighed under 2.5 kg at birth
• Children with known genetic conditions such as Down Syndrome
• Children whose mothers took antiepileptic medication during pregnancy
• Children whose parents were over 40 years old when the child was born

There is no known cure for autism. However, with appropriate education and early intervention, children on the autism spectrum can maximise their communication and interaction skills. Due to the wide spectrum of abilities and support needs, some autistic children may be able to integrate into mainstream schools whereas others may need the specialised support offered by special education (SPED) schools.

Medication is only used in autism to manage associated conditions such as attention-deficit/hyperactivity disorder (ADHD), epilepsy or irritability, but many autistic children may not have these associated conditions at all. There is no evidence that special diets or supplements can improve autism symptoms – in fact, it is more important that autistic children eat a healthy, balanced diet.

How Can I Seek Help?

If you have concerns that your child may be on the autism spectrum or notice some of the signs listed above, you are encouraged to speak to a polyclinic or private general practitioner (GP), or your child’s paediatrician. A referral may be made to one of the following specialist services for further evaluation and support.

For preschool children (6 years and below or not yet in Primary One), they may be referred to:

1. KK Women’s and Children’s Hospital (KKH), Department of Child Development (DCD)
   Tel: +65 6394-1543/7216
   Email: kkh.dcd@kkh.com.sg
   Website: www.kkh.com.sg/patient-care/areas-of-care/childrens-services/Pages/child-development
   or
2. National University Hospital (NUH) Child Development Unit (CDU)

For school-age children (i.e., Primary One and above), they may be referred to:

1. Child Guidance Clinic at Health Promotion Board or Sunrise Buangkok
   Tel: +65 6389-2200 (same number for both)
   Website: www.imh.com.sg
   

For further information, you may also refer to the Academy of Medicine, Singapore’s 2023 Clinical Practice Guidelines on Autism Spectrum Disorder in Children and Adolescents at the QR code below, or at this link:

2023 GUIDELINES ON AUTISM SPECTRUM DISORDER IN CHILDREN AND ADOLESCENTS :: Latest News :: AMS - Academy of Medicine, Singapore