Aug 1, 2008
Dear Mr Lee,
I apologise that Sulabha was trying to protect the time of our consultants and it is true they have multiple tasks – we just took over the running of another special school for kids with autism, in addition to Pathlight School etc etc. It is true we have numerous requests for information, research projects, CIP projects and visits every day and not able to respond to all of them as we are only a charity with very little resources. Your request of 31 July Thurs asking for a response by Tues 5 Aug is not exactly giving much time for a very stretched charity. Nonetheless, I sense your keen interest and I will try my very best to briefly respond to your questions. All the consultants are not in today, they are out serving the kids. Hope this is acceptable to you.
Please do visit also our websites and also the links especially eg National Autistic Society in the UK to get some very good info. The MCYS Enabling MasterPlan for the Disabled Chapter 3 on Early Interevention and Education of Special Needs students might also be a helpful resource. Looking at your questions, you seem to be interested in the Early Intervention group and the MCYS, NCSS (Disability Sector) and the DIRC or Disability Information and Referral Centre have a lot of the macro information – hopefully you can get a response from them (may not be as fast as Sulabha :o).
If you have more time and if your classmates are still interested, please also go to ARC website and click on Training Calendar and join some of the trainings.
1. How many children in Singapore are diagnosed with this disorder today?
Is this an increasing trend, and if so, what rate of increase are you seeing?
· Not sure about the latest diagnosed numbers but 2 years ago, KKH CDU claims they diagnose 260 new cases from their CDU alone.
· General incidence rates quoted worldwide now is 1 in 167.
2. Are there sufficient places in autism schools today to cater to children
of 2 to 6 years of age who are diagnosed with this condition? If not, how
many more schools are needed to cater to this need?
· There are now 11 Early Intervention Centres and nearly all of them profess they cater to children with autism. This excludes the private sector.
· I don’t think more schools are needed. I believe consistency of quality is the issue.
3. What is the impact on language and social development for these children
and what has ARC or your school been doing to cater to the reduction of such
an impact? Eg, do you have special programs to mitigate such impacts on
their language development and social enhancements?
· All our programme curriculum includes addressing the functional social and communication needs of children with autism. Our EIP leading autism consultant is Ms Anita Russell, who is trained in speech pathology and an autism expert.
4. Are there any form of treatment that you have found most effective
for children with autism, either medically or otherwise?
· We found Structured Teaching (University of North Carolina TEACCH Division) and appropriate ABA teaching methods useful.
· For a full list of treatment approaches and even ratings, pls go to ResearchAutism website , part of the NAS UK network. Very good info there.
5. What can childcare centres today do to help children with autism?
Do you think they are doing enough to assist in these areas?
I believe all pre-school educators should have some fundamental knowledge of common learning disorders like autism, dyslexia, ADHD. They can then help to identify the more obvious cases. They can also learn classroom management strategies that will be useful to the milder ones who can then be more effectively integrated in the mainstream pre-school setting.
Today, I don’t think there is any clarity and priority of this need. Everyone is doing their own thing and sometimes a little knowledge is a dangerous thing.
On behalf of the kids with autism, thanks for your interest.
Regards,
denise
Denise Phua
President, Autism Resource Centre (Singapore)
Supervisor, Pathlight School & Eden School Boards
6, Ang Mo Kio Street 44
Singapore 569253
Tel: (65) 64599951
Fax: (65) 64593397
http://www.pathlight.org.sg/http://www.autism.org.sg/On 8/1/08
Dear Sulabha,
It is disappointing that in the time you had spent in crafting your reply, you
would probably had been able to answer 3 or 4 out of the 5 questions, perhaps
through a simple phone chat with one of your staff/consultants.
We are adult students of early childhood, wishing to genuinely understand
autism in children here in Singapore, so that we can be active participants
when we front preschool children everyday, and not just be active observers.
26 of us will graduate in 9 months' time, which means that there will soon
be 26 more new pairs of eyes to look out for autism in children,and thus potentially
activate early intervention, which we understand is so crucial in helping
children with autism to be successful in their adult lives.
Now isn't that worth re-juggling your "multiple tasks" for perhaps 20minutes
of someone's precious time, to answer 5 not-too-onerous questions on autism
from an authority on autism like you?
regards,
George Lee
(a previous donor to autism causes)
-----------------------------------------------------------------------------------
date
Aug 1, 2008 6:54 PM
subject
2nd RE: Research on Autism in Singapore
GEORGE, THE FOLLOWING IS FROM THE NATIONAL AUTISTIC SOCIETY WEBSITE, ARC’S MAIN GLOBAL PARTNER. HOPE THIS ALSO HELPS.
DENISE PHUA/SU
PS: We find the prevalence rate of 1:100 abit high but that’s what UK and Australia are claiming.
There is a variety of approaches that people may use to help with various difficulties their child has related to their autism spectrum disorder (ASD). Before starting any intervention it can be useful to find out some more information and research relating to that particular approach. Call the Autism Helpline on 0845 070 4004 to talk through any particular approach.The charity Research Autism has been set up specifically to look at approaches, therapies and interventions. Find out more by following the link at the bottom of the page in "Related resources'.
Questionnaire on autism interventionsHave you had difficulty finding high-quality information about autism interventions? The charity Research Autism is running a survey to hear about your experiences.
Can The National Autistic Society recommend any specific therapies?There is a wide range of views on the best way to treat people with autism. Some approaches are based on very specific theories as to the possible causes of autism spectrum disorders.
Before choosing an approachBefore using any particular method it is best to find out as much information as you can about it. Any approach should be positive, build on strengths, discover potential, and increase motivation.
Behavioural interventionsInterventions which are designed to change an individual's behaviour.
Diets and supplementsInterventions based on the deliberate selection of foods and supplements.
Physiological interventionsInterventions based on the mechanical, physical and biochemical functions of the body.
Relationship-based interventionsInterventions which seek to encourage attachment, bonding and a sense of relatedness.
Service-based interventionsInterventions based around the delivery of services, including education and parental support services.
Skills-based interventionsInterventions which aim to develop, maintain or support specific skills.
Standard therapiesInterventions based on standard healthcare therapies ie therapies which are accepted and used by the majority of healthcare professionals.
TechnologyInterventions which are mainly based around the use of technology.
Combined interventionsInterventions that use a combination of other interventions and approaches.
Statistics: how many people have autistic spectrum disorders?
Print this page"How many people have autism?" is one of the most frequently asked questions and unfortunately it is also one of the most difficult to answer. There is no central register of everyone who has autism, which means that any information about the possible number of people with autism in the community must be based on epidemiological surveys (ie studies of distinct and identifiable populations).
It is more than 50 years since Leo Kanner first described his classic autistic syndrome. Since then, the results of research and clinical work have led to the broadening of the concept of autistic disorders. As a result, estimates of prevalence have increased considerably. This process has occurred in stages, the start of each of which can be linked to particular studies. The history is summarised and the most up-to-date figures are given below.
Kanner syndrome
1943 The specific pattern of abnormal behaviour first described by Leo Kanner is also known as 'early infantile autism'. Kanner made no estimate of the possible numbers of people with this condition but he thought that it was rare (Kanner, 1943). Over 20 years later, Victor Lotter published the first results of an epidemiological study of children with the behaviour pattern described by Kanner in the former county of Middlesex, which gave an overall prevalence rate of 4.5 per 10,000 children (Lotter, 1966).
The triad of impairments in children with learning disabilities
1979 In 1979 Lorna Wing and Judith Gould examined the prevalence of autism, as defined by Leo Kanner, among children known to have special needs in the former London Borough of Camberwell. They found a prevalence in those with IQ under 70 of nearly 5 per 10,000 for this syndrome, closely similar to the rate found by Lotter. However, as well as looking at children with Kanner autism, Wing and Gould also identified a larger group of children (about 15 per 10,000) who had impairments of social interaction, communication and imagination (which they referred to as the 'triad' of impairments), together with a repetitive stereotyped pattern of activities. Although these children did not fit into the full picture of early childhood autism (or typical autism) as described by Kanner they were identified as being within the broader 'autism spectrum'. Thus, the total prevalence rate for the spectrum in all children with special needs in the Camberwell study was found to be approximately 20 in every 10,000 children (Wing and Gould, 1979). Gillberg et al (1986) in Gothenburg, Sweden, found very similar rates in children with learning disabilities There has been a number of other epidemiological studies in different countries examining the prevalence of autism (but not the whole spectrum). These results range from 3.3 to 60.0 per 10,000, possibly due to differences in definitions or case-finding methods (Wing and Potter, 2002).
Asperger syndrome
The studies described above identified autistic disorders in children, the great majority of whom had learning disabilities and special educational needs. However, in 1944, Hans Asperger in Vienna had published an account of children with many similarities to Kanner autism but who had abilities, including grammatical language, in the average or superior range. There are continuing arguments concerning the exact relationship between Asperger and Kanner syndromes but it is beyond dispute that they have in common the triad of impairments of social interaction, communication and imagination and a narrow, repetitive pattern of activities (Wing, 1981; 1991).
1993
In 1993, Stephan Ehlers and Christopher Gillberg published the results of a further study carried out in Gothenburg in which they examined children in mainstream schools in order to find the prevalence of Asperger syndrome and other autistic spectrum disorders in children with IQ of 70 or above. From the numbers of children they identified they calculated a rate of 36 per 10,000 for those who definitely had Asperger syndrome and another 35 per 10,000 for those with social impairments. Some of the latter may have fitted Asperger description if more information had been available, but they certainly had disorders within the autistic spectrum. The children who were identified were known by their teachers to be having social and/or educational problems but the nature of their difficulties had not been recognised prior to the study.
1995
For over 30 years, Sula Wolff, in Edinburgh, has studied children of average or high ability who are impaired in their social interaction but who do not have the full picture of the triad of impairments. In her book giving results of her studies (Wolff, 1995), she emphasises that the clinical picture overlaps with Asperger syndrome to a large extent. However, these children represent the most subtle and most able end of the autism spectrum. The majority become independent as adults, many marry and some display exceptional gifts, though retaining the unusual quality of their social interactions.
Why include them in the autism spectrum? As Sula Wolff points out, they often have a difficult time at school and they need recognition, understanding and acceptance from their parents and teachers. The approach that suits them best is the same as that which is recommended for children with Asperger syndrome and high-functioning autism.
In her discussion of prevalence, Sula Wolff quotes Ehlers and Gillberg's study. She considers that their total figure of 71 per 10,000, includes the children she describes.
Autism spectrum disorders
2005
A survey by the Office of National Statistics of the mental health of children and young people in Great Britain found a prevalence rate of 0.9% for autism spectrum disorders or 90 in 10,000 (Green et al, 2005). These were not differentiated into autism, Asperger syndrome or any type of autism spectrum disorder.
2006
Gillian Baird and her colleagues published a report of a prevalence study which surveyed a population of children aged 9-10 years in the South Thames region. All children who either already had a diagnosis of autism spectrum disorder or were known to child health or speech and language services as having social and communication difficulties were selected for screening. Children considered to be at risk of being an undetected case because they had a statement of special educational needs were also selected. Diagnoses were based on ICD-10 criteria. The results showed a prevalence rate of 38.9 in 10,000 for childhood autism, and 77.2 in 10,000 for other autism spectrum disorders, giving an overall figure of 116 in 10,000 for all autism spectrum disorders (Baird et al, 2006).
In this study very few children were identified with Asperger syndrome. The authors acknowledged that some children in mainstream schools who did not have a statement of special educational would have been missed, because of the selection criteria. The authors note that the prevalence estimate found should be regarded as a minimum figure (Baird et al. 2006).
There may be another reason why Asperger syndrome was rarely found in the study. ICD-10 diagnostic criteria for Asperger syndrome are such that a person who would be diagnosed with Asperger syndrome using the criteria used by Gillberg, would probably receive a diagnosis of childhood autism or atypical autism using the ICD-10 criteria.
The autistic population
It is possible that there are real differences in prevalence of autism spectrum disorders in different parts of the world, even in different parts of the same country, and at different times. An epidemic of encephalitis, for example, could increase the number of affected children. However, it is very likely that some, even most, of the variation is due to differences of definitions and the difficulty of defining the borderlines of sub-groups within the whole autism spectrum (Wing, 1996). There are no sharp boundaries separating 'typical' autism from other autistic disorders, including Asperger syndrome. [For a complete overview of the problems of establishing prevalence rates and the difficulties of diagnosing and defining autism, see Wing and Potter (2002)].
The best estimates of the total prevalence of autism spectrum disorders are those based on studies that focused on the whole spectrum and not just specific sub-groups.
Estimated prevalence rate in the UK
The indication from recent studies is that the figures cannot be precisely fixed, but it appears that a prevalence rate of around 1 in 100 is a best estimate a best estimate of the prevalence in children. No prevalence studies have ever been carried out on adults.
Estimated population of autism spectrum disorders in the UK
The estimated numbers have been worked out from the population of the UK as given in the 2001 census: 58,789,194, of whom 13,354,297 were under 18.
The figure for children is based on the 1 in 100 prevalence rate and corrected to the nearest 100. The estimated number of children under 18 with an autism spectrum disorder (ASD) is 133,500.
Given that there is no prevalence rate for ASD in adults, the figure for the whole population is a very rough guide, but we estimate that there could be over 500,000 people who have an ASD.
Estimates of the proportion of people with autism spectrum disorders (ASD) who have a learning disability, (IQ less than 70) vary considerably, and it is not possible to give an accurate figure. It is likely that over 50% of those with ASD have an IQ in the average to high range, and a proportion of these will be very able intellectually. Some very able people with ASD may never come to the attention of services as having special needs, because they have learned strategies to overcome any difficulties with communication and social interaction and found fulfilling employment that suits their particular talents. Other people with ASD may be able intellectually, but have need of support from services, because the degree of impairment they have of social interaction hampers their chances of employment and achieving independence.
References
Baird, G. et al (2006). Prevalence of disorders of the autism spectrum in a population cohort ofchildren in South Thames: the Special Needs and Autism Project (SNAP). The Lancet, 368 (9531), pp. 210-215.
Ehlers, S. and Gillberg, C. (1993). The epidemiology of Asperger syndrome. a total population study. Journal of Child Psychology and Psychiatry, 34 (8), pp. 1327-1350.Gillberg, C., Grufman, M., Persson, E. and Themner, U. (1986). Psychiatric disorders in mildly and severely mentally retarded urban children and adolescents: epidemiological aspects. British Journal of Psychiatry, 149, pp. 68-74.
Green, H. et al (2005). Mental health of children and young people in Great Britain, 2004. Basingstoke: Palgrave Macmillan.Available to download at
www.statistics.gov.uk/statbase/Product.asp?vlnk=14116Kanner, L. (1943). Autistic disturbances of affective contact. Nervous Child, 2, pp. 217-250.Lotter, V. (1966). Epidemiology of autistic conditions in young children, I. Prevalence Social Psychiatry, 1, pp. 124-137
Wing, L. (1981). Asperger's syndrome: a clinical account. Psychological Medicine, 11, pp. 115-129. Available from the NAS Information CentreWing, L. (1991). Asperger's syndrome and Kanner's autism. In: Frith, U., ed. Autism and Asperger Syndrome. Cambridge: Cambridge University Press. Available from the NAS Information CentreWing, L. (1993). The definition and prevalence of autism: a review. European Child and Adolescent Psychiatry, 2 (2), pp. 61-74.
Available from the NAS Information Centre
Wing, L. (1996). Autism spectrum disorders: no evidence for or against an increase in prevalence. British Medical Journal, 312, pp. 327-328. Available from the NAS Information Centre
Wing, L. and Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. Journal of Autism & Developmental Disorders, 9, pp. 11-29.Available from the NAS Information CentreWolff, S. (1995). Loners: the life path of unusual children. London: Routledge.
World Health Organisation (1992). International Classification of Diseases. 10th ed. Geneva: WHO.
