Grace Liew began her career as a psychologist at the National Autism Society of Malaysia. Now attached to the NASOM One Stop Centre in Shah Alam, Selangor, she shares with Thots n Tots how to help children with autism spectrum disorder (ASD) to become socially accepted by the community.
How long have you been a psychologist?
I have been a psychologist for 12 years now with NASOM, since I graduated from university.
Where did you study?
I did my first degree in children and family psychology at Universiti Sabah Malaysia and my master’s degree in educational psychology at Universiti Putra Malaysia.
Why did you decide to become a psychologist? Who or what influenced this decision?
Psychology has always been my interest. A curiosity to explore how people think and the reasons they behave in such a manner motivate me to gain further knowledge in this field.
What do you do, as a psychologist, in the field of childhood autism?
The work covers almost everything that a child with ASD and the family need. It includes studying the child’s behaviours to managing undesired behaviours; helping to plan and identify strategies to support the child to function better in their daily routines; and helping the child make sense of relationships with people.
The work also involves supporting the child in his social behaviours with different strategies and tools such as social stories, cartooning, cognitive behaviour therapy and so forth; helping to plan and support the child in academic achievements; supporting the family to handle the child’s difficult behaviours; and helping to improve the child’s relationships with family members.
A psychologist does more than all this but, overall, my job is to support the child with ASD to be socially accepted in the community.
What is your role at NASOM One Stop Centre?
At present, I have six students coming to me for regular behaviour therapy to learn expected ways to behave at home and in school. I plan the therapy sessions based on the parents’ concerns and the child’s needs.
For example, if the child refuses to sit on a chair to learn or is hitting others or himself, then my work is to find out the triggers and plan strategies for the child to overcome them.
Refusing to sit on a chair could be due to many factors such as body posture problem, avoiding tasks, tasks that are not challenging enough, hyperactivity, impulsiveness, sensory difficulties, etc. If the child is not able to sit due to a body posture problem, I would advise doing some exercise to improve the posture. If it is an issue with the task, then I will adjust the difficulty level of the task to help the child achieve the learning goals.
Usually after every therapy session, there will be some “homework” for parents – things that need to be practised at home with the child. When the intervention strategies are practised consistently, the child will show significant improvement. The parents’ role is very important as the child spends more time with his parents than his therapist.
Apart from conducting therapy sessions, I also have assessment appointments with children suspected to have ASD.
What is your greatest job satisfaction?
It’s that moment when I receive feedback from parents that their ASD child is now able to play like the other children around him. Looking at the child able to confidently express his feelings and needs – that’s the biggest return.
What are the signs and symptoms of suspected ASD? What can parents do?
One of the early signs is that the child is not able to play interactively with another person (adult or peer). The child also has delayed speech and language development, or has normal speech and language development but fails to have a normal conversation with another person, or has odd language use.
Some children have obvious repetitive behaviours such as turning in circles, flapping hands at the side of body, tiptoe walking, flicking fingers, etc. Some show repeated meaningless routines or play with an object or toy in an odd and meaningless way.
From your experience, how long before parents can expect to see improvements in the child’s behaviour?
The improvement will depend on the child’s ability and the consistency of the intervention with correct strategies. If the child is receiving consistent intervention both at home and in school, the child will show dramatic improvements in the first six months and gradual improvements thereafter. Working on the child’s ASD characteristics as early as possible is key to helping the child lead a more normal life.
Tell us about the latest developments in autism/ASD research from around the world.
ASD research has always been difficult due to many ethical and sampling issues. Nonetheless, the Centers for Disease Control and Prevention (CDC) of the US has announced the latest statistics for 2018, that one in 59 children (one in 37 boys and one in 151 girls) has been diagnosed to have ASD. The latest changes in diagnostic criteria also enable children to be identified much earlier and easily so that they receive early intervention which is key to helping them lead a more normal life.
Recently, many methods were discussed as ways to help autistic children. NASOM was involved in some of the research such as robotic intervention, neurofeedback and a pilot project on Lego-based therapy.
What is your advice to parents of autistic children?
My advice is to take a deep breath and be clear that you are not helpless. ASD is not that scary. Your child can be trained to cope. There are many strategies to improve the child’s behaviours.
Children with ASD will have lifelong difficulties. Then again, a typical child will also have crises to deal with. A child with ASD just perceives the world a little differently. Every effort of yours will make a difference to the child and that’s definitely worth it.
ASD is not a disease that can be cured by medication or therapy. The behaviours of a child with ASD can only be improved to nearly typical like those of regular children of a similar age.
Generally, children with ASD have difficulties in understanding and relating to people socially. This condition will always affect their quality of life because as they grow up, they will face different social situations. Such children need a long time to “learn” social situations and generalise these “learnt” social behaviours.
If you could invent something child-related, what would it be and why?
It would be a tool to teach parents how to play with their children because I am discovering that more and more parents do not know how to do that. Parents also have a misconception that it’s not necessary to play with their kids in order for them to grow up well, and they usually say, “I have no time to play.”