Katherine, a home-maker, did not notice anything wrong with her firstborn Michael until he was about three years old. She recalls, “He did not hold eye contact with people who were talking to him, and showed signs of regression in his motor skills. For example, he started to tip-toe instead of walking normally and also lost his ball skills.” He also had constant tantrums, up to five times a day.
Katherine brought Michael to a child psychologist and after undergoing a full range of tests, Michael was found to have autism spectrum disorder (ASD), on the higher functioning end of the spectrum, as well as speech delay. High-functioning autism (HFA) is a term applied to people with autism who have a IQ of above 70. With this they are deemed to be cognitively “higher functioning”.
After learning about Michael’s condition, Katherine researched treatment and therapies available, as well as therapy centres that she could turn to. She then enrolled him in a private special-education school that bases its curriculum on Applied Behavioural Analysis (ABA) techniques. Michael attends this school on weekday mornings. He also receives speech therapy weekly.
Every child enters this world with a huge array of needs. These range from basic physiological needs for warmth and food, to social and emotional needs such as love, touch, and human interaction. According to the Center for the Improvement of Child Caring, a child with special needs is “a child who, because of his or her unique medical or developmental difficulties, has needs in addition to those of his or her peers.”
What is a special need? How do I know my baby has a special need?
Special needs can fall under these broad categories:
- intellectual or physical disabilities such as Down Syndrome, mental retardation and physical handicaps
- illnesses such as epilepsy, diabetes, and cerebral palsy
- learning disabilities like dyslexia, hearing and speech problems
- developmental disorders such as autism and ADHD (attention deficit hyperactivity disorder)
Special needs may range from mild (e.g., children with mild learning disabilities or food allergies) to the more severe (e.g., children requiring regular medical attention).
Some tell-tale signs include:
- extreme tantrums, non-compliant behaviour
- delay in development of speech, gross or fine motor skills
- regression in physical development
- dietary sensitivities and allergies
- sensory sensitivities (e.g. to touch, heat, and sound)
Tsui Hung, 45, a home-maker and mother of two, first noticed that her second-born son, Marcus, was different when he was about one year old. He cried frequently, showed zero or little compliance to the instructions that she gave him, and could not speak. She brought him to the Child Development Unit at the KK Women’s and Children’s Hospital, and after a assessment, he was diagnosed with autism.
Adeline, 36, Senior Manager and mother of two, realised her 22-month-old daughter Carla was using very little speech. The teachers at the childcare that she attended advised Adeline to seek a professional opinion as Carla also exhibited some behavioural issues at school, such as extreme tantrums and breakdowns.
She brought Carla to a private clinic, where she found out that it was too early to have an accurate diagnosis. She was, however, advised to start speech and occupational therapy. Adeline also brought her child to see a speech therapist, who informed her of the possibility of Carla having pervasive developmental disorder not otherwise specified (PDD-NOS), which is classified as an autism spectrum disorder.
Where can I find help?
Diagnosis can be inaccurate for children under five, as it takes a long time for a young child to warm up to a stranger and be able to respond to the various tests that have to be administered. At the same time, it is advisable to seek help early as most therapists and medical practitioners advise starting therapy at an young age when the child is more malleable.
Here are the various avenues to seek professional help if you suspect your child has a special need.
For assessment and diagnosis:
- Child Development Unit at KKH
- Children’s Specialist Clinic at the National University Hospital (aged 7 and above)
- Child Guidance Clinic at Institute of Mental Health
- VWOs such as Feiyue Community Services and St Andrew’s Autism Centre
Early Intervention Programmes for Infants and Children (EIPIC) centres:
- Society of Moral Charities EIPIC
- Rainbow Centre
- Autism Association of Singapore
- Autism Resource Centre
- AWWA Early Years Centre
- Spastic Children’s Association of Singapore EIPIC
- Feiyue Community Services
What are some of the challenges I can expect?
1. Behavioural issues
Some common ones are tantrums, anxiety and low self-esteem. Katherine shared that it helps to avoid trigger situations which can cause sensorial overload (noisy places and large crowds), and to equip your child with expressions such as “I feel scared” or “I want to go” so that you are aware of what’s happening and can take swift, appropriate action. She also said that it would be advisable to maintain a calm composure and voice, as children can pick up tension or anger easily, and react negatively as a result.
2. Medical issues
Children with medical issues may face frequent hospitalisation or long-term medication. Their diet may require special attention as well.
3. Financial strain
One parent shared that an entire care package (inclusive of childcare and daily therapy sessions) for her five-year-old sets her back about $3,200 a month.
Another parent shared that after the age of seven, government subsidies kick in for public institutions such as Rainbow Centre. These have helped to reduce the cost of education for her son, who is 12 this year.
Based on anecdotal evidence, it appears that public institutions and centres are facing a dearth of resources. They tend to have a longer waiting period due to a lack of trained therapists, resulting in less one-to-one time and slower treatment for the children. This is also something you may want to expect and be prepared for.
4. Emotional / physical exhaustion
It can be physically and emotionally challenging to be the main carer for a child with special needs. Do not be afraid to ask for help, or to take time-out. Your family and your child will stand to benefit if you take time to do the things that you enjoy.
5. Social restrictions
A mother of a 12-year-old with autism shared how much it means to have the understanding from family or neighbours on why her child behaves differently from others. She said, “Sometimes at the playground, other children would call him names like ‘monster’ because he’s older and acts differently from the rest. I really wish there could be more understanding in society, even for adults to help their children understand, so that people with special needs do not feel so ostracised.”
Due to increasing awareness about autism and other special needs, Singaporeans today do tend to show more tolerance and acceptance for such children. One parent said that as long as she sets a good example of interacting with neighbours and friends, she paves the way for her child to warm up to these neighbours and grow more trusting of people.
It is helpful to find a support group of parents with children in similar situations to share information, resources and to share mutual encouragement and support. Katherine said that she received much support from close family members and friends in church. She also joined a support group of mothers with special needs children. She said, “It was great to be around like-minded mums, get support from those who understood my struggles and also support others.”
Some organisations provide parental support groups, such as:
- SPARK (Society for the promotion of ADHD research and knowledge)
- PILLAR by Rainbow Centre
- St Andrew’s Autism Centre
There is also a support group in our forum for parents of children with ADHD / ADD.
6. Enjoying your child
Amidst all the trouble-shooting, it can be hard to remember that your child is simply your child. So allow yourself to take time off therapy or worries, and just enjoy and play with your child as he or she is. Adeline was particularly inspired by her counsellor who reminded her, “How much our children accept themselves depends on how much we accept them first as their parents.”
* Some names have been changed to protect the identity of the interviewees.