No immunisation link for autism – director

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QUOTE: ‘Many studies show first born of mother aged more than 35 years old and father aged more than 40 years are at the risk of having a child with autism.’

Dr Norhayati Nordin, Director of Hospital Mesra Bukit Padang

KOTA KINABALU: Parental age is among the most consistently studied risk factor of autism, or Autism Spectrum Disorders (ASD).

Immunisation is not a factor in the development of autism, said Dr Norhayati Nordin, Director of Hospital Mesra Bukit Padang.

Dr Norhayati, who is also the Consultant Child and Adolescent Psychiatrist at the hospital, said there are some parents rejecting immunisation for their children because they have been reading misleading information on the Internet about autism.

“Parents must know that studies conducted in many countries indicate older parents are more likely to have a child with autism than are younger parents.

“Many studies show first born of mother aged more than 35 years old and father aged more than 40 years are at the risk of having a child with autism.

“Apart from that, prematurity, which is less than 37 weeks of gestation, and in particular those born less than 33 weeks are at risk of developing autism. This is something that parents should know to reduce the possibility,” she added.

Dr Norhayati said she has repeatedly advised parents to give their children immunisation according to the procedures given at all government clinics to protect against diseases.

In conjunction with the Autism World Week, Dr Norhayati shared some information about autism.

She said autism is a neurodevelopmental disorder characterised by impairments in communication, behaviour and social functioning beginning in childhood.

There is no local epidemiological study on autism prevalence in Malaysia. However, in a feasibility study on the use of Modified Checklist for Autism in Toddlers (M-CHAT) among children of 18 to 36 months of age in child health clinics by Ministry of Health Malaysia, the prevalence of autism in Malaysia was approximately 1.6 in 1,000.

In the USA, the overall prevalence of autism is 14.7 per 1,000 (one in 68) children aged 8 years and the prevalence shows an increasing trend over the years.

Clinicians have been seeing an increasing number of children with speech delay and social communication difficulties who require further assessment.

Children with speech delay and behavioural issues are frequently placed in special education classes without an accurate diagnosis. While waiting for diagnosis to be established, these children should be referred for the relevant interventions.

“Early diagnosis and prompt intervention of children with autism is crucial for the best outcome. The importance of early recognising and initiation of early referral to optimise the child’s potential must be emphasised,” said Dr Norhayati.

Felny Bansi, an occupational therapist at the Child Intervention and Enrichment Centre (CIEC) of Hospital Mesra Bukit Padang, cases of autism in Sabah are on the rise.

In 2011, 50 new autism children were registered at the centre, and the number has increased to 70 in 2012, 105 in 2013, 129 in 2014 and as of March 2015, there were 58 children registered at CIEC Hospital Mesra.

“Children registered with CIEC would be given a one-and-half hour weekly therapy session, but those who are from outside Kota Kinabalu are given monthly therapy sessions. We receive children all over Sabah including Lawas, Miri and Limbang of Sarawak,” she said.

“Our therapy is comprehensive according to the guidelines given by the Ministry of Health. We are responsible for developing their fine motor, gross motor, multisensory and even allow them to play to stimulate their overall development,” she said.

Felny said the therapy in CIEC also includes multisensory learning activity, functional academic training, handwriting training and pre-school writing skills.

To ensure children with autism are able to manage themselves, the centre also give training in personal care and hygiene, feeding, dressing and toileting according to their abilities with their parents’ supervision.

Felny said it is important for the parents to learn how to teach them basic living skills.

“We have three rooms in the centre, namely multisensory therapy room, cognitive and perceptual room and playroom. The cognitive and perceptual room will teach these children with basic concepts, memory training, copping skill, educational activities, concentration and attention training, cognitive stimulation, reality orientation, sequencing and categorization and also left and right discrimination.

“Children who were registered with the centre as early as two years old will have the highest chance to learn more things, and easier for the parents to handle,” she said.

Felny pointed out that if a child with any disorder diagnosed at older age, there are challanges in the behaviour modification.

However, the centre also provide behavioural modification technique and social skill training.

In some cases, Felny said medication is needed if the children are having unmanageable behaviour. However, giving medication to children is the last option.

CIEC is also giving therapy to other children with specific learning difficulties, adjustment disorder, learning disability, dyslexia, attention deficit hyperactivity disorder (ADHD), mental retardation and intellectual disability.

In conjunction with the World Autism Day this week, Felny is hoping that the public is accepting children with autism and other disorders, and also give more respects and understanding to the parents.

“We always receive complaints from parents that the public is still not aware about autism, where most parents were accused of not giving discipline to their children.

“It is widely known that children with autism dislike following rules, they dislike long queue, they express their anger in public and many other behaviour that might make people not comfortable. Public should know that, and not being very judgmental to parents. These children are often judged as ‘bad kids’ because of their delinquent behaviour and refusal to accept rules.

“Negative feedback from the public is not giving any good to the children. Many parents are shy and not having the courage to bring their children attending birthday party or play with other normal children in the playground.

“Is this the society we want to see, especially with the increasing trend of children having behaviour disorders? Felny asked.

She also advised parents who have unmanageable child to refer to the clinic for a behaviour screening in case they need help.

According to her experience, every child with abnormal development, especially having unmanageable behaviour might need medical attention.

She stressed that all young children can be naughty, defiant and impulsive from time to time, which is perfectly normal.

However, some children have extremely difficult and challenging behaviours that are outside the norm for their age.

“Ignoring complaints from teachers and friends is not helping. Try to accept complaints from surrounding and monitor the children behaviour. Remember that early intervention is the best,” she added.

Speaking of challenges in running the centre, Felny said there are only two occupational therapists at the CIEC assisted by three nurses and one health care assistant to manage a total of 245 children registered in the centre.

“In 2012 we handled 147 children in a year, but it increased to 219 in the following year. Last year, a total of 256 children registered in CIEC, while as of end of March, the total number is already 245. We are facing staff shortage, small space and not enough chairs and other equipment.

“Although we are treating children up to 12-year-old only, but the number of children referred to us is keep increasing annually. There must be something need to be done to address all these barriers,” she added.

Most of the children registered to the Hospital Mesra CIEC were referred by the district hospitals for further intervention.

“Families and the communities, if they are working together I am positive that it can help children with behaviour disorders to be accepted in the real world.

“It is up to us, whether we want to be part in accepting these children, support them… or continue to be judgmental,” she said.

Felny who was posted at Hospital Mesra in 2003 was transferred to the centre since 2006. With almost a decade experience in giving therapy to children with behaviour disorders, she reiterated her call to treat their children as early as two years old for the best result.