A report on autism

GENERAL OVERVIEW ON AUTISM INTRODUCTION In Bangladesh, the general attitude towards autism is mostly negative and it is seen as a social barrier. Even today, autism is considered a Godgiven curse and children with ASDs are taken as possessed by the Devil. Also bad parenting is accused: mothers going out to work still get the blame. As such the demands of living with a person with autism are great, and families frequently experience high levels of stress. The uniqueness of each individual with autism makes the experience of living with autism different for each family. There is no alternative but to live with autism for such families; but the concern is how better this living can be made. Recognizing and preparing for the challenges that are in store will make a tremendous difference to all involved, including parents, siblings, grandparents, extended family, and friends. AWF wants to promote autism awareness in the society and turn it suitable for living for the autistic children. AWF also wants to prepare families with some of the basic knowledge and working knowledge they may need to provide what their dear ones need.

Autism affects children of all races and nationalities, but certain factors increase a child's risk. Day by day increase autistic children in Bangladesh.Autism is burden for a country.It is threaten for the country like Bangladesh.The center and educational institution are not available for autistic children in Bangladesh. Autism is a brain disorder that often makes it hard to communicate with and relate to others. With autism, the different areas of the brain fail to work together.

Autism is a life long developmental disability that prevents individuals from properly understanding what they see, hear and otherwise sense.

This results in severe problems relating to social relationship, communication and behavior. [Autism is a Spectrum Disorder, which means that condition has wide ranging degrees of severity.] This is also a condition called Asperger Syndrome, which is a form of autism used to describe people at the higher functioning end of the Autism Spectrum. Here are some most important links of Autism: Autism is a physical condition linked to abnormal biology and chemistry in the brain. The exact causes of these abnormalities remain unknown, but this is a very active area of research. There are probably combinations of factors that lead to autism. Genetic factors seem to be important. For example, identical twins are much more likely than fraternal twins or siblings to both have autism. Similarly, language abnormalities are more common in relatives of autistic children. Chromosomal abnormalities and other nervous system (neurological) problems are also more common in families with autism. A number of other possible causes have been suspected, but not proven. They involve: • • • • •

Diet Digestive tract changes Mercury poisoning The body's inability to properly use vitamins and minerals Vaccine sensitivity

Autism is one of a group of serious developmental problems called autism spectrum disorders (ASD) that appear in early childhood — usually before age 3. Though symptoms and severity vary all autism disorders affect a child's ability to communicate and interact with others. The number of children diagnosed with autism appears to be rising. It's not clear whether this is due to better detection and reporting of autism, a real increase in the number of cases or both. While there is no cure for autism, intensive, early treatment can make a big difference in the lives of many children with the disorder.

OBJECTIVES  To know about Autism Welfare Foundation.  To pinpoint about their present activities.  To cluster information about autism.  To inquiry about characteristics, cause, sign and symptom of autism etc.  To know about communication problem  To collect information about the activities of AWF regarding the development of communication skill for children with autism.  How they get academic support through their behavior  How to manage adult children with ASD (Autism Spectrum Disorder) and adult vocational activity.  To know the level /criteria of child according to the classroom basis.  To gather knowledge about autism.  To identify the main problems in developmental domains of autistic children.  To get idea about the teaching and training methods used in AWF. TYPES OF AUTISM These are the most common disorders, all presenting in a somewhat similar manner, but having slight variations: Autistic Disorder As stated above, and defined by the Autism Society of America (ASA): "Autism is a complex developmental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities.

Autism is one of five disorders that falls under the umbrella of Pervasive Developmental Disorders (PDD), a category of neurological disorders characterized by “severe and pervasive impairment in several areas of development."

Pervasive Developmental Disorder (P.D.D) Pervasive Developmental Disorder Also called "Atypical Autism." Children with this disorder have many of the same characteristics of Autism, but not all the criteria associated with Autism.

Asperger's Disorder Children with this disorder do not have the usual language barriers associated with Autism and are generally very intelligent. However, they do tend to struggle with social interactions, and can fixate on a particular object or subject they take an interest in, and talk about it constantly.

Retts Disorder Retts is rather similar to Autism, but presents only in girls. The children begin to develop on target, but then begin losing some communication abilities. The symptoms of Retts can begin to occu.

Causes of Autism Autism has no single, known cause. Given the complexity of the disease, the range of autistic disorders and the fact that no two children with autism are alike, there are likely many causes. Scientists aren’t certain what causes autism, but it’s likely that both genetics and environment play a role. Researchers have identified a number of genes associated with the disorder. Studies of people with autism have found irregularities in several regions of the brain. Other studies suggest that people with autism have abnormal levels of serotonin or other neurotransmitters in the brain. These abnormalities suggest that autism could result from the disruption of normal brain development early in fetal development caused by defects in genes that control brain growth and that regulate how neurons communicate with each other. While these findings are intriguing, they are preliminary and require further study. The theory that parental practices are responsible for autism has now been disproved. These may include: •

Genetic problems- A number of genes appear to be involved in autism. Some may make a child more susceptible to the disorder; others affect brain development or the way brain cells communicate. Still others may determine the severity of symptoms. Each problem in genes may account for a small number of cases, but taken together, the influence of genes may be substantial. Some genetic problems seem to be inherited, whereas others happen spontaneously.

•



Environmental factors- Many health problems are due to both genetic and environmental factors, and this is likely the case with autism as well. Researchers are currently exploring whether viral infections and air pollutants, for example, play a role in triggering autism.

Other Cause  Prenatal environment  Infectious processes  Environmental agents  Other maternal conditions  Other in utero  Perinatal environment  Postnatal environment-- Mercury  Vaccines  Thiomersal  MMR vaccine  Autoimmune disease  Viral infection  Excessive hygiene  Oxidative stress  Amygdala neurons  Locus coeruleus–noradrenergic system  Lack of Vitamin D  Lead  Leaky gut syndrome  Paracetamol  Rain  Refrigerator mother

Charecteristics of Autism Each individual with an autism spectrum disorder (ASD) is unique and may demonstrate markedly different behaviors and skills. The following information provides an overview of some of the common characteristics seen in children with ASD. 1.Speech

Speech is likely to develop much more slowly than is the norm. Speech may remain absent, or appear in the small child and vanish by the age of four. Speech may include peculiar patterns or intonations.

2.Social Interaction Most often noticeable is the failure to form social bonds. The child who has ASD may not follow the parents or other children around the house or may cling to them. He may not go to others for comfort when hurt. The autistic child often avoids eye contact, resists being picked up, and does not seem to “tune in” to the world around him/her.

3.Sensory Differences The child with ASD may not react the same way to a variety of environmental stimuli. He may not respond to cold or heat or over-respond. The child may exhibit hypersensitivity to light, noises, touch, smells, and tastes.

4.Peak Skills The child who has ASD may have strong peak skills in areas such as computations in math, drawing, music, or memory of data, whether trivial or important. At the same time, he may not be able to discuss the weather, understand time, or easily comprehend what he has read.

5.Play A child with ASD may not initiate play with other children. The child may prefer to be left alone. There is a lack of imitation of other children’s or adult’s actions.

6.Need for Sameness and Routine Such a child may throw a tantrum that lasts for hours because the seating was changed in the family car. Or he may engage in stereotyped behavior, such as flicking or flapping a hand, lining up toys, drawing the same picture, or seeking repeatedly to do what he is unable to do at the time.

7.Behavioral Problems Children with autism spectrum disorders can be very passive or hyperactive. They may also demonstrate obsessive interests in objects or activities. Aggression towards others or themselves is a possibility, especially when frustrated. Generally, people with ASD prefer to maintain certain routines and may respond negatively when a routine is changed or disrupted.

8.Management of a Child who has Autism Spectrum Disorder The management of a child with ASD falls into two areas:

1) Providing understanding, training, and consultation for parents, teachers, and service providers as they seek to deal with the child’s atypical and problematic behavior, and 2) Providing a highly structured environment, including trained personnel, in which the child, adolescent, or young adult can learn.

Other Characteristics include: o No fear of danger. o Over or under sensitivity to pain. o May avoid eye contact with you. o May prefer to be by him/herself. o Has difficulty expressing what they want or need - may then try to use gestures. o May echo words or phrases. o May have inappropriate attachments to objects. o May spin his/herself or objects. o Prolonged repetitive play. o May insist on things/routines always being the same. o May exhibit inappropriate laughing (laughing when not appropriate to the situation). o May display tantrums for no apparent reason. o May avoid cuddling. o May exhibit self injurious behavior when upset i.e. biting selves or banging heads. o An overall difficulty interacting with others.

Sign of Autism There are three distinctive behaviors that characterize autism. Autistic children have difficulties with social interaction, problems with verbal and nonverbal communication, and repetitive behaviors or narrow, obsessive interests. These behaviors can range in impact from mild to disabling.

The hallmark feature of autism is impaired social interaction. Parents are usually the first to notice symptoms of autism in their child. As early as infancy, a baby with autism may be unresponsive to people or focus intently on one item to the exclusion of others for long periods of time. A child with autism may appear to develop normally and then withdraw and become indifferent to social engagement.

Children with autism may fail to respond to their name and often avoid eye contact with other people. They have difficulty interpreting what others are thinking or feeling because they can’t understand social cues, such as tone of voice or facial expressions, and don’t watch other

people’s faces for clues about appropriate behavior. They lack empathy. Many children with autism engage in repetitive movements such as rocking and twirling, or in self-abusive behavior such as biting or head-banging.

They also tend to start speaking later than other children and may refer to themselves by name instead of “I” or “me.” Children with autism don’t know how to play interactively with other children. Some speak in a sing-song voice about a narrow range of favorite topics, with little regard for the interests of the person to whom they are speaking.

Many children with autism have a reduced sensitivity to pain, but are abnormally sensitive to sound, touch, or other sensory stimulation. These unusual reactions may contribute to behavioral symptoms such as a resistance to being cuddled or hugged.

Children with autism appear to have a higher than normal risk for certain co-existing conditions, including fragile X syndrome (which causes mental retardation), tuberous sclerosis (in which tumors grow on the brain), epileptic seizures, Tourette syndrome, learning disabilities, and attention deficit disorder. For reasons that are still unclear, about 20 to 30 percent of children with autism develop epilepsy by the time they reach adulthood. While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which are not found in autism.

Symptoms of Autism For many children, autism symptoms improve with treatment and with age. Some children with autism grow up to lead normal or near-normal lives. Children whose language skills regress early in life, usually before the age of 3, appear to be at risk of developing epilepsy or seizure-like brain activity. During adolescence, some children with autism may become depressed or experience behavioral problems. Parents of these children should be ready to adjust treatment for their child as needed. The symptoms may vary from moderate to severe.

Communication problems may include: • • • • • • • •

Cannot start or maintain a social conversation Communicates with gestures instead of words Develops language slowly or not at all Does not adjust gaze to look at objects that others are looking at Does not refer to self correctly (for example, says "you want water" when the child means "I want water") Does not point to direct others' attention to objects (occurs in the first 14 months of life) Repeats words or memorized passages, such as commercials Uses nonsense rhyming

Social interaction:

• • • • • • •

Does not make friends Does not play interactive games Is withdrawn May not respond to eye contact or smiles, or may avoid eye contact May treat others as if they are objects Prefers to spend time alone, rather than with others Shows a lack of empathy

Response to sensory information: • • • • • •

Does not startle at loud noises Has heightened or low senses of sight, hearing, touch, smell, or taste May find normal noises painful and hold hands over ears May withdraw from physical contact because it is overstimulating or overwhelming Rubs surfaces, mouths or licks objects Seems to have a heightened or low response to pain

Play: • • •

Doesn't imitate the actions of others Prefers solitary or ritualistic play Shows little pretend or imaginative play

Behaviors: • • • • • • •

"Acts up" with intense tantrums Gets stuck on a single topic or task (perseveration) Has a short attention span Has very narrow interests Is overactive or very passive Shows aggression to others or self Shows a strong need for sameness

•

Uses repetitive body movements

Risk Factor of Autism Autism affects children of all races and nationalities, but certain factors increase a child's risk. They include: • •

•

•

Child's sex- Boys are three to four times more likely to develop autism than girls are.

Family history- Families who have one child with autism have an increased risk of having another child with the disorder. It's also not uncommon for the parents or relatives of an autistic child to have minor problems with social or communication skills themselves or to engage in certain autistic behaviors.

Other disorders- Children with certain medical conditions have a higher than normal risk of having autism. These conditions include fragile X syndrome, an inherited disorder that causes intellectual problems; tuberous sclerosis, a condition in which benign tumors develop in the brain; the neurological disorder Tourette syndrome; and epilepsy, which causes seizures.

Parents' ages- Having an older father (being 40 or older) may increase a child's risk of autism. There may also be a connection between children being born to older mothers and autism, but more research is necessary.

Tests and diagnosis Autism varies widely in its severity and symptoms and may go unrecognized, especially in mildly affected children or when it is masked by more debilitating handicaps. Doctors rely on a core group of behaviors to alert them to the possibility of a diagnosis of autism.

These behaviors are: * impaired ability to make friends with peers * impaired ability to initiate or sustain a conversation with others * absence or impairment of imaginative and social play * stereotyped, repetitive, or unusual use of language * restricted patterns of interest that are abnormal in intensity or focus * preoccupation with certain objects or subjects * inflexible adherence to specific routines or rituals Doctors will often use a questionnaire or other screening instrument to gather information about a child’s development and behavior. Some screening instruments rely solely on parent observations; others rely on a combination of parent and doctor observations. If screening

instruments indicate the possibility of autism, doctors will ask for a more comprehensive evaluation. Autism is a complex disorder. A comprehensive evaluation requires a multidisciplinary team including a psychologist, neurologist, psychiatrist, speech therapist, and other professionals who diagnose children with ASDs. The team members will conduct a thorough neurological assessment and in-depth cognitive and language testing. Because hearing problems can cause behaviors that could be mistaken for autism, children with delayed speech development should also have their hearing tested. After a thorough evaluation, the team usually meets with parents to explain the results of the evaluation and present the diagnosis. Children with some symptoms of autism, but not enough to be diagnosed with classical autism, are often diagnosed with PDD-NOS. Children with autistic behaviors but well-developed language skills are often diagnosed with Asperger syndrome. Children who develop normally and then suddenly deteriorate between the ages of 3 to 10 years and show marked autistic behaviors may be diagnosed with childhood disintegrative disorder. Girls with autistic symptoms may be suffering from Rett syndrome, a sex-linked genetic disorder characterized by social withdrawal, regressed language skills, and hand wringing.

Diagnostic criteria for autism For a child to be diagnosed with autism, he or she must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment. To be diagnosed with autism, a child must have six or more of the following symptoms and two or more of those symptoms must fall under the social skills category.

Social skills • • • •

Has difficulty with nonverbal behaviors, such as making eye contact, making facial expressions or using gestures Has difficulty forming friendships with peers and seems to prefer playing alone Doesn't share experiences or emotions with other people, such as sharing achievements or pointing out objects or other interests Appears unaware of others' feelings

Communication skills • • • •

Starts talking later than age 2 and has other developmental delays by 30 months, and doesn't make an attempt to communicate with gestures or miming Can't start a conversation or keep one going May repeat words or phrases verbatim, but doesn't understand how to use them Doesn't play make-believe or doesn't imitate the behavior of adults when playing

Behavior • • • •

Develops interests in objects or topics that are abnormal in intensity or focus Performs repetitive movements, such as rocking, spinning or hand-flapping Becomes disturbed at the slightest change in routines or rituals May be fascinated by parts of an object, such as the spinning wheels of a toy car

Treatment There is no cure for autism. Therapies and behavioral interventions are designed to remedy specific symptoms and can bring about substantial improvement. The ideal treatment plan coordinates therapies and interventions that target the core symptoms of autism: impaired social interaction, problems with verbal and nonverbal communication, and obsessive or repetitive routines and interests. Most professionals agree that the earlier the intervention, the better. * Educational/behavioral interventions: Therapists use highly structured and intensive skill-oriented training sessions to help children develop social and language skills. Family counseling for the parents and siblings of children with autism often helps families cope with the particular challenges of living with an autistic child. * Medications: Doctors often prescribe an antidepressant medication to handle symptoms of anxiety, depression, or obsessive-compulsive disorder. Anti-psychotic medications are used to treat severe behavioral problems. Seizures can be treated with one or more of the anticonvulsant drugs. Stimulant drugs, such as those used for children with attention deficit disorder (ADD), are sometimes used effectively to help decrease impulsivity and hyperactivity. * Other therapies: There are a number of controversial therapies or interventions available for autistic children, but few, if any, are supported by scientific studies. Parents should use caution before adopting any of these treatments.

Location, Extension and Accessibility of the study area Dhaka is the capital of Bangladesh and the principal city of Dhaka Division. Dhaka is a megacity and one of the major cities of South Asia.

Located on the banks of the Buriganga River, Dhaka, along with its metropolitan area, had a population of over 16 million in 2011, making it the largest city in Bangladesh.[2] It is the 9th largest city in the world [6] and also 28th among the most densely populated cities in the world. Dhaka is known as the City of Mosques and with 400,000 cycle rickshaws running on its streets every day, the city is also described as the Rickshaw Capital of the World.

Dhaka is located in central Bangladesh at 23°42′0″N 90°22′30″E, on the eastern banks of the Buriganga River. The city lies on the lower reaches of the Ganges Delta and covers a total area of 360 square kilometres (140 sq mi). It consists of eight principal thanas –Lalbagh, Kotwali, Sutrapur, Ramna, Motijheel, Paltan, Dhanmondi, Mohammadpur, Tejgaon – and 16 auxiliary thanas – Gulshan, Mirpur, Pallabi, Shah Ali, Turaag, Sabujbagh, Dhaka Cantonment, Demra, Hazaribagh, Shyampur, Badda, Kafrul, Kamrangir char, Khilgaon and Uttara. In total the city has 130 wards and 725 mohallas.[32] Dhaka district has an area of 1463.60 square kilometres (565 sq mi); and is bounded by the districts of Gazipur, Tangail, Munshiganj, Rajbari, Narayanganj, Manikganj. Tropical vegetation and moist soils characterize the land, which is flat and close to sea level. This leaves Dhaka susceptible to flooding during the monsoon seasons owing to heavy rainfall and cyclones.

Introduction Name of the Organization: ‘Autism Welfare Foundation’institution located in Dhaka.

13/38,Shakhertak, Road No:4,Mohammadpur, Dhaka-1207.

Back ground of the Organization: Autism welfare foundation was established on April 4, 2004. It is non-profitable, non-government, voluntary welfare organization aiming to train and educate the autistic children to perform their maximum strengths and interests and making them able to support themselves.AWF is dedicated to increase public awareness about autism.

The training and education centre of AWF provides intensive training and education for autistic children and adults. This training and education centre emphasizes on a highly structured program where teacher and student ratio is 1:1. This program also gives emphasis on social, communication, behavioral and functional skills.

The foundation also runs a vocational training center for students above 10 years of age. Other activities like secretarial job, work in cafeteria, gardening etc are also performed by them.

1. Area of Work 2. Geographical Coverage of Operation 3. Sources of Funds

: ASD, PDD : Dhaka, Bangladesh : Students' tuition and donation from members and parents of the students, Donation private companies occasionally.

AWF Organizational Profile 1. Name of the Organization 2. Founder/ Chairperson 3.

Address

: :

Autism Welfare Foundation Dr. Rownak Hafiz, MBBS, DCH :

House No. 38/40, Road No. 04 Block-Kha, Pisciculture Housing Society (Sekhertek), Mohammadpur, Dhaka-1207 : Telephone: +88 02 8121759 : : :

4.

5.

6.

Established in Registered Under Registration no

Fax: +88 02 8121759 E-mail: rownak_awf@yahoo.com Website: www.awfbd.com : 2004 : Society's Registration Act with registration of Joint Stock Company : S-3821 (610/2004)

Objectives of the Organization: AWF is dedicated to increase public awareness about autism. The Training and Education Center of AWF provides intensive training and education for autistic children and adolescents. This training and education center emphasizes a highly structured program where teacher student ration is 1:1.

This program also gives emphasis on communication skill, behavior and functional academics.

The foundation also funds a vocational training center for students above 10 years old. Other adult activities are secretarial jobs, work in cafeteria, gardening etc.

Organizational Structure: Autism welfare foundation was established on April 4, 2004. It is non-profitable, non-government, voluntary welfare organization aiming to train and educate the autistic children to perform their maximum strengths and interests and making them able to support themselves.AWF is dedicated to increase public awareness about autism.Their main activities are in the institutional level.

The Organigational structure are given below: Chairperson

Tregear

Organizational members

Co-ordinator

Class Incharge

Teachers Staffing pattern of the Organization: Autism welfare foundation is non-profitable, non-government, voluntary welfare organization aiming to train and educate the autistic children to perform their maximum strengths and interests and making them able to support themselves.The doctors, Psychologist, Therapist, Co-ordinator, Class Incharge, Teachers and third and forth classes workers work here.All of them are works are finished with their own responsibility.

Table 01: The staffing pattern of the Organigation is given following: 01 Principal

Consultant

01

No. of Teachers

52

No. of Psychologist

01

No. of Occupational Therapist

01

No. of Office Staff

02

No. of Attendant

15

No of Guard & Peon

03

Regular Activities of AWF 1. Outing 2.Report presentation 3.Member’s meeting 4.Group Discussion session 5.Participating various common national & international events Description of participants Training and present activities of the Organization: Training They have provided training to several of their staff as well as undergraduates, masters and PhD from home and abroad. present activities of the Organization: • Creates mass awareness among parents, professionals, social worker, and general public for better understanding for autism • Offers diagnosis and assessment of autistic children • Runs education and training centre • Runs Early Intervention Program for children below the age of 5

• • • • • • • • • •

Runs Adult Activity Program and Vocational Training Program for older children and adolescents with autism Arranges Teacher Training Program Arranges Parent Training Program Arranges Parent-Teacher Workshop Arranges seminars, workshop Offers package program for autistic children and adolescents from different areas of Bangladesh who are unable to attend the Training Centre of AWF Provide outing program for students of AWF for improving social behavior Publishes News Letter Integrates more able autistic children into normal school.

Offer free services for poor autistic children

Description about the works: 1) Running Education & Training Program: Educating children with autism is a challenge for both parents and teachers. These children are individuals first and foremost with unique strengths and weaknesses. Some may be of average to above-average intelligence, while others may be below average. Academic goals need to be tailored to that individual's intellectual ability and functioning level. Understanding this reality, AWF started an education and training center named “Kanon”. The aim of this school is to provide a safe and secure learning environment for students with autistic spectrum disorders. In order to provide a high-quality and relevant education for children and young adults with autism, a combined program including education and training has been introduced. AWF has its own course and curriculum to provide education of these autistic children. An Individualized Education Plan (IEP) is prepared on the basis of functional assessments. Currently, the School has Eleven sections in which around 148 children aged 3 – 15 are placed in two shifts (morning & day) depending on their abilities, needs, and chronological age. In the early years the emphasis is on developing communication, as well as building basic interaction skills, pre-reading and writing skills and concept building.

Concepts are taught in one-on-one sessions, while group activities are used to develop social skills. Alongside, the child’s abilities to work independently and interpret instructions in a general environment are developed and strengthened. Gradually, the children learn independent work behaviors that enable them to learn vocational skills. Children, who are ready, move on to mainstream classrooms. The school combines group activities and one-on-one teaching, as well as music therapy, computer and sensory integration.

A total of 57 teachers, 1 psychologist, and 1 occupational therapist are engaged in conducting the education courses through the education center where 138 autistic children are enrolling every year. As the education program is highly structured, the teacher, student ratio is 1:1.

AWF is also running two pre-normal class called “Nayantara” & "Malati" where the students are taught national course curriculum, aiming to

enroll them in normal school. A total of 14 students have already been admitted to normal school in last 4 years and this year 2 students are ready to go.

Table 02: Number of Students & Teachers in AWF

Year

Shift

Number of Students

Number of Teachers

2004 2005 2006

Morning Morning Morning Day Morning Day Morning Day Vocational

44 58 60 50 61 54 63 60 3

23 34 45

2007 2008

52 57

2) Social skill development: The most important barrier the family comes across in every day situation is poor social skill of their autistic children. AWF arranges many social skills program besides classroom based social skill training. For example, students go for shopping, or eat in restaurants, visit parks, zoos etc twice a month. Students participate in different cultural programs. AWF arranges a handicrafts fair twice every year which enhances the social skill of each student in AWF. 3) Vocational training program: AWF runs a vocational training program named "Krishnochura" where there are 20 students aged 15 years and above, whom are directly involved for making potteries, products adorning block prints and boutique, candles, bag-making, necklaces etc. for selling purposes. About 16 students are given hand on training to make them independently work for vocational products.

4) AWF also runs a cafeteria: Where students work for preparing different food items, serving them to customers, washing dishes, involve in exchanging and counting money.

All 148 students of Kanan take snacks in cafeteria during snack time and eat in a group which increases their social skills.

5)Distant package program: AWF offers distant package programs for autistic children, adolescents and their families from all over Bangladesh who cannot avail any teaching program or schooling for their children. Home based programs are given for autistic children in package program and guidelines are given regarding different techniques and strategies for enhancing communication and play skills for children who come from distant areas.

Parents also come for regular follow-up. AWF extends services for package program for 4 children per day for 4 days a week.

Parents as co-therapists: Specialty of AWF's education training program is that we include parents of autistic children directly in our program by: 1. Extensive interview from parents while making IEP for each student 2. Regular counseling and interaction with parents when needed 3. Classroom visits are compulsory for parents every year 4. Home visits are done by teachers 5. Including parents in many programs of AWF. Training and workshop: Throughout the year, AWF arranges training program for parents and teachers by extensively explaining them the strategies of teaching techniques of autistic children so that they can successfully apply it to their child/student.

AWF Services offered : Assessments (a) Diagnostic Assessments Autism Welfare Foundation (AWF) knows that Autism is treatable. Children do not "outgrow" autism, but studies show that early diagnosis and intervention lead to significantly improved outcomes. Screening and diagnostic assessments are made here following detailed observations of and interactions with the child, as well as comprehensive interviews with family members. Internationally standardized diagnostic criteria (DSM 4 TR) and a variety of standardized screening / diagnostic instruments including Checklist for Autism in Toddlers – Modified (M-CHAT),

Psychological Assessment are administered here. Determining related disorders and differentiating ASD from other disorders is part of this process. The parents are provided information on autism and services necessary to start intervention from AWF. (b)Functional Assessments Autism is marked by the development of an uneven profile of skills. Functional assessments provide an insight into the current level of performance of the child in various skill areas such as motor, speech, communication, imitation, cognition and activities of daily living. The assessment is made over multiple sessions through a series of direct work sessions with the child, observation and discussion with the family. (c) Occupational and Sensory Assessment A detailed assessment is made based on a sensory profile questionnaire which addresses all the sensory systems in depth. A comprehensive evaluation of the child is done using observation and feedback from parents. The assessment provides a base for all subsequent interventions for the child. (d) Follow Up After a child is diagnosed, the child can begin benefiting from one of the many specialized intervention approaches to treatment and education.

In this case, follow-up service is very important since these children need regular follow-up. So AWF has also a provision of follow-up services to the Children so that parents can bring their children at AWF clinic as per given schedule. (e) Distant Package Program for Out Station Families Patients living outside of Dhaka city can not attend the clinic regularly. For them, AWF extend their services outside of Dhaka city. Outstation families often visit AWF and receive an intensive program of observation, counseling, work sessions with the child. Depending on their duration of stay and where families so require, assessments and curriculum planning may also be carried out. Because the characteristics and behaviors of people with autism vary so widely, the individualized nature of these programs is particularly crucial, and parents are encouraged to stay in touch with AWF to make modifications and implement additional skills. Till now about 1600 patients have already received the services under outdoor package services.

A table is shown below giving the Number of patient receiving outdoor service in package: Table 03: Number of outdoor package patients

Year New Old Total Station Patient Patient of the patient 2004 100

200

300

2005 500

300

800

2006 74

145

219

2007 120

225

345

2008 148

200

348

Dhaka & Out side of Dhaka

MORNING SHIFT ROUTEIN

DAY

8.00-8.20

8.208.40

8.40-9.10

9.109.30

9.3010.10

10.1010.30

Suvo sokal

Communicat ion

Lakha pora

Tiffen

Berote

SUNDAY

Jateo sanget Jateo sanget

Suvo sokal

Communicat ion

Lakha pora

Tiffen

MONDAY

Jateo sanget

Suvo sokal

Communicat ion

Lakha pora

Tiffen

TUESDAY

10.30-10.50 Aso Neja Kore

Berote Aso Neja Kore Berote Aso Neja Kore

10.5011.20 Aso Chobe Ake Aso Chobe Ake Aso Chobe Ake

11.20-12.00 Khala dula Exercise Exercise

WEDNESD AY THURSDA Y

Jateo sanget

Suvo sokal

Communicat ion

Lakha pora

Tiffen

Jateo sanget

Suvo sokal

Communicat ion

Lakha pora

Tiffen

DAY SHIFT ROUTEIN

ď ś Off day-Friday and Saterday

Berote

Berote

Aso Neja Kore Outing, shopping or extra curricular activities.

Karegore Shekha

Exercise

My Activities Of Morning Shift: The school established by Autism Welfare Foundation is a dream land of the small lovely kids who can be called as angels.Iam very fortunate because I have been associated witn the Institute for one month with this kids.Ihad know previous knowledge on autism or autistic children.What I knew was that Autism is mental retardation.Here I have come to across a lot of lovely kids,looking handsome but who are self centered or introvert.They do not share their joys and sorrow and feeling with others.The teachers of this school are dedicated.They do lot for this school.So far Iam concerned because of their help Ican perform my duties properly.With in few days I could get attached with the children. AWF children can perform ADL routein.

AWF started an education and training center named “Kanon” and I worked in their educational program as a vocational teacher.I have analysis 4 students between 4 different class in morning shift and I have collect the information from this 4 parents.I finished my internship work by 30 days.My shedule time is 8:00a.m to 12:30p.m.At first I signature my attendence khata then I attend in assembly and help for PT my fixed class student.When finished assembly then I go to class room.Then I participate shuvu sokal with student by flash card and help their communication.Then start reading and writing.Then start tiffin hour this time I go to cafeteria with children Where students work for preparing different food items, serving them to customers, washing dishes, involve in exchanging and counting money then they return in classroom and they rest sometimes this time they wash their hands.Then I help their own work and help drawing picture.Next start play And then they participate singing class and sometimes story telling, dance class, vocational training and golpobola.Then last 5 minutes I prepared children for going home and when ring the bell they are hand over their gardian.

My Activities Of Day Shift AWF started an education and training center named “Kanon” and I worked in their educational program.I have analysis 4 students between 4 different class in day shift and I have collect the information from this 4 parents.I finished my internship work by 30 days.

My shedule time is 1:00p.m to 5:30p.m.At first I signature my attendence khata then I attend in assembly and help for PT my fixed class student.When finished assembly then I go to class room.Then I participate exchange greeting with student by flash card and help their communication.Then start reading and writing.Then start tiffin hour this time I go to cafeteria with children Where students work for preparing different food items, serving them to customers, washing dishes, involve in exchanging and counting money then they return in classroom and they rest sometimes this time they wash their hands.Then I help their own work and help drawing picture.Next start play And then they participate singing class and sometimes story telling, dance class, vocational training and golpobola.Then last 5 minutes I prepared children for going home and when ring the bell they are hand over their gardian.

Follow this routine I finished my work and this work complete by30 days.

Case Study-1 Name:Avishak Sharkar Fathers Name: Aset Ranjon Sharkar Gender: Boy Fathers Occupation: Business man Age: 4+ Mothers Name: Noboneta Pal Class: Rojone gondha(Morning) Mothers Occupation: House Wife Blood Group:A+ Economic Status:Higher class Past History: Avishak mother has no complication during pregnancy period but he get bain injury fall in sofa then he was senceless. Poor eye contact and no speech,hyporactive,No response when calling name.

INTERVIEW QUESTION 1.Any problem during fetus?

-NO 2.Any problem during delivery?

- No 3.When you understand your baby is autistic?

-During 2 years old 4.What are the problem present in your child now?

-Poor eye contact, Restless,Lack of attention, Talking inabilities, Communication problem,can not talk,hyper active.

5. What are the like & dislike of child?

Like: - Favourate place-Fathers university, - Favourate food- Chicken,fish, egg,milk.

- Favourate person-House tutor - Favourate toy-lipstick, pen seizer, body lotion,car.

Dislike: - Unknown person,crowd area.

6.Can your child perform any creative work?

-No 7.How your child spent his most of the time at home?

-make sound in table, aimless walk in room to room,watch tv.

8.Which activity is enjoyable for your baby?

-watch tv advetise,music and when same age friend come in home.

9. Which activity is irritable for your child?

-While chid hear any loud sound, hungry,physically illness.

10.How your child express about toileting?

-By pulling others hand if he need.

11. Have any special quality is enjoyable for other?

-No. 12.Have any problem during sleep?

-No 13.How child spent his lazy time?

-watching tv program especially add.

14.How your child communicate with other?

- By pulling others hand he communicates with them.

15.When your child disturb you how you control your child?

-By body massage,recite,singing.

Comments: Avishak is inactive.He want live alone for behaviour problem.Always he caught his own ear.He can not speak He dont tolerate any type of loud sound.When he goes to crowed place then he start crying.He likes school teacher. His autism level is severe.

Case Study-2 Name:Sahil siddiqe Fathers Name: Golam Mowlla Siddique Gender: Boy Fathers Occupation: Service holder and Business Age: 3+ Mothers Name: Sammemun-Nessa Class: Rojone gondha(Day) Mothers Occupation: House Wife Blood Group:o+ Economic Status:Higher class

man

Past History: Pregnancy period is complicated.He was stubborn for outing.Poor eye contact and no speech,hyperactive,unstedy,fickle-minded.impatience INTERVIEW QUESTION: 1.Any problem during fetus?

-First baby abortion and when second baby conceved then create hormonal problem.

2.Any problem during delivery?

- Cezar in 8th month 3.When you understand your baby is autistic?

-During 2 years 21 days old 4.What are the problem present in your child now?

-Poor eye contact, Restless,Lack of attention, ,can not response,hyper active,Delay speech.

5. What are the like & dislike of child?

Like: - Favourate place-Shesu park,Shopping Mall,tour - Favourate food- All kind of sweet food,oilly food - Favourate person-Father,mother,All school teachers and friend - Favourate toy-Puzzel,ball Dislike: - Unknown person,crowd area.

6.Can your child perform any creative work?

-No 7.How your child spent his most of the time at home?

- watch tv – NXM channel.play with toys in play ground 8.Which activity is enjoyable for your baby?

-play with cousin and maid servent,raceing and touching game Ringa Renga,Pupil game.

9. Which activity is irritable for your child?

-When dont hear his speech.

10.How your child express about toileting?

-Self dependent.

11. Have any special quality is enjoyable for other?

-No. 12.Have any problem during sleep?

-No

13.How child spent his lazy time?

-watching tv program especiallyNXMchannel.

14.How your child communicate with other?

-By speech.

15.When your child disturb you how you control your child?

- By singing and story telling.

Comments: Sahil is active for all type of activities. He want live togethert with teacher. Always he can not tolerate unknown person He can speak all type of word.Now he share his toy with other. He likes school teacher.His autism level is mild.He is captain in class and he follow all command and help and encourage his friend for work.

Case Study-3 Name:Abid-Ur-Rahman Abir Fathers Name:Ahmed Mamunur Rashid Gender: Boy Fathers Occupation:Govt.empolyee Age: 6+ Mothers Name: Mehnaj Nasrin.

Class: Rangon(Morning) Mothers Occupations:Housewife Economic Status: Higher class Past History: Poor eye contact and no speech,hyporactive,No response when calling name.

High fever age is 9 month this time convulsion occur. self stimulates behaviour INTERVIEW QUESTION: 1.Any problem during fetus?

-NO 2.Any problem during delivery?

- No

3.When you understand your baby is autistic?

-During 1 years old 4.What are the problem present in your child now?

-Speech problem,no eye contact,no toilet training,no expression,do not respone any command,self stimulates behaviour.

5.What are the like & dislike of child?

Like: - Favourate place-Shishu Park,Chinese resturent - Favourate food- Fried- Choccolate,Fruits,Chicken,rich food,sweet Favourate person-Father,Mother,mama, mame.

- Favourate toy- ball,puzzles.

Dislike: -Discipline.

6.Can your child perform any creative work?

-No 7.How your child spent his most of the time at home?

-Playing with father,stay alone,fight his sister.

8.Which activity is enjoyable for your baby?

-make fun,listening song.

9. Which activity is irritable for your child?

-While take any decision aganist his command.

10.How your child express about toileting?

-Maintain a specefic time for toileting.

11.Have any special quality is enjoyable for other?

-No.

12.Have any problem during sleep?

- Sometimes he wake up at midnight.

13.How child spent his lazy time?

-sitting alone 14.How your child communicate with other?

- Sometimes by pulling others hand he communicates with them.

15.When your child disturb you how you control your child?

-By singing,recite, pupil game.

Comments: Abir do not always attend in school.He likes see any kind of books and picture. He likes chocklateb run. He likes class teacher than his mother.He can cycleing by help.He done work by commad. He is absent minded. Riem can not speak. His autism level is moderate.

Case Study-4 Name:SK Arib Rayhan Fathers Name:Sk Zakir Hossain Gender: Boy Fathers Occupation: Business man Age: 3yr and 9 months Mothers Name: Saifun Jahin .

Class: Rangon(Day) Mothers Occupations:Housewife Blood Group:o+ Economic Status: Higher class Past History: Speech delay,Learning disorder,Attention sicking behaviour,Insecure feeling,sleep disorder,Bed sensitive,Intellectual disabilities, Behaviour disorder,Communication deficiency,Temper tentraum, INTERVIEW QUESTION:

wetting,Mood

disorder,Over

1.Any problem during fetus?

-Mother have dibetics mellitus during pregnancy period.

2. Any problem during delivery?

- Blueish apperance at birth for this reason prescribe antibitic.

3.When you understand your baby is autistic?

-During one half years.

4.What are the problem present in your child now?

- Mood disorder.Hyperactive,He is not interested in school and any kind of work ,attention sicking behaviour.

5.What are the like & dislike of child?

Like: - Favourate place-Own house,Play ground,Open place,Wonderland,Shopping mall.

- Favourate food- Chanachur,sauce,soft drink,mango juice,chips - Favourate person-Father,Mother,Khala,Khalu,Nanu - Favourate toy- ball,puzzles.jumping,running,play with water.

Dislike: -Discipline.

6.Can your child perform any creative work?

-No 7.How your child spent his most of the time at home?

-Watching tv,play with water,sometimes play with toys.

8.Which activity is enjoyable for your baby?

-Play with father and mother,music(robindro sanget) 9. Which activity is irritable for your child?

-With out any reason he lay down in floor,Throwing object,

10.How your child express about toileting?

- By pulling others hand if he need.

11.Have any special quality is enjoyable for other?

-No. 12.Have any problem during sleep?

- Late night sleep and wake up at midnight 13.How child spent his lazy time?

-Play with water and toy.

14.How your child communicate with other?

- Sometimes by pulling others hand and speak own language.

15.When your child disturb you how you control your child?

-By singing,recite, sometimes givee punishment,telling story Comments: Arib follow teachers command.Now he likes book. he has aggressive behaviour. Sometimes he heat other and sometimes he can not understand his problem.

Case Study-5 Name: Sabab Gender: Boy Mothers Name:Samoli aktar Class: Malote(Morning) Blood Group:AB+

Fathers Name:Qazi Assaduzzaman Fathers Occupation:Service holder Mothers Occupations: Housewife Economic Status: Higher class

Age: 10

Past History: Do not sleep at night,Restless,He heat in wall,absence eye contact,Inattentive .He has aggressive behaviour. he heat and bite other.

INTERVIEW QUESTION: 1.Any problem during fetus?

-Pressure 2.Any problem during delivery?

- oxygen problem.

3.When you understand your baby is autistic?

-During 4 years old.

4.What are the problem present in your child now?

-Speech elay, poor eye contact,slike playing alone,do not understand anything,do not respone any command,sieeping problem,aggresive behaviour,Bite other person.

5.What are the like & dislike of child?

Like: - Favourate place-Shesu park,swiming pool.

- Favourate food-All type of food - Favourate person-Father,Mother - Favourate toy-fan,skeletal,lighting, pellow Dislike: - Discipline.

6.Can your child perform any creative work?

-Art in computer.

7.How your child spent his most of the time at home?

-Art. sitting alone.

8.Which activity is enjoyable for your baby?

-Like to roam,stand over bridgeand train journey 9. Which activity is irritable for your child?

-Hot weather.

10.How your child express about toileting?

- Maintain toileting.

11.Have any special quality is enjoyable for other?

-Art. 12.Have any problem during sleep?

-Incomplete sleep,late night sleep.

13.How child spent his lazy time?

-sit alone.

14.How your child communicate with other?

- He communicates with other by calling.

15.When your child disturb you how you control your child?

-By love,break concentretion, Comments: Sabab is regular student in school.He has lack of interest in work.Excess demand in food. He do not want to work.He has eye problem.Last 2 years he can not speech. He learn by KG syllabus.Glucoma problem in his eye always he is laughing with out any reason.

Case Study-6 Name: Arafat Hasan Amlan Gender: Boy

Fathers Name:kamrul Hasan Fathers Occupation: Real State Business

Age: 9+ Mothers Name:Moyna Class: Malote(Day) Mothers Occupations:House Wife Blood Group:B+ Economic Status: Middle higherclass Past History: Sezerian and over weight baby. No toilet training, Repetative behaviour, INTERVIEW QUESTION: 1.Any problem during fetus?

-NO 2.Any problem during delivery?

- Sezerian and over weight baby.

3.When you understand your baby is autistic?

-During 4.5 years old 4.What are the problem present in your child now?

- Repetative behaviour, social interaction problem ,behaviour problem.

5.What are the like & dislike of child?

Like: - Favourate place- Grand father house - Favourate food- All type of spicy food.

- Favourate person-Nanu, father, mother - Favourate Toy-Ball Dislike: - Outdoor game.

6.Can your child perform any creative work?

-Vocational work,study.

7.How your child spent his most of the time at home?

-Play with brother,study,watch tv.

8.Which activity is enjoyable for your baby?

-Listening song, shoping mall,shesu park.

9. Which activity is irritable for your child?

-While take any decision aganist his command.

10.How your child express about toileting?

-Maintain toileting.

11.Have any special quality is enjoyable for other?

-Any type of block and puzzel can matching.

12.Have any problem during sleep?

-No. 13.How child spent his lazy time?

-Study,watch tv.

14.How your child communicate with other?

- Use word 15.When your child disturb you how you control your child?

- By leave his alone Comments: Amlans main problem is repetative behaviour.Every time message his hand and clean the hand. He is regular student.He makes many peculiar sound such as ‘’ta ta ta ta’’ .He learn by KG syllabus.Sometimes he is continue laughing with out reason.

Case Study-7

Name: Esam Fathers Name:Mahather Mohammad Gender: Boy Banker Age: 5+ Mothers Name:Rowson Akhter Class: Paddo (Morning) Mothers Occupations: Housewife Blood Group:A+ Economic Status: Higher class Past History: High raise fever at 7th day after delivery.Speech problem,sudden aggressive behavior,sudden beating any one.

INTERVIEW QUESTION: 1.Any problem during fetus?

-NO 2.Any problem after delivery?

- No 3.When you understand your baby is autistic?

-During 2.5 years old 4.What are the problem present in your child now?

-Speech problem,excess crying,always carry object,hyperactive.

5.What are the like & dislike of child?

Like: - Favourate place-Any open place - Favourate food- Spicy food,fruites.

- Favourate person-Mother,Father,Nanu - Favourate toy-any object,car,ball Dislike: - Crowded area.

Fathers Occupation:

6.Can your child perform any creative work?

-No 7.How your child spent his most of the time at home?

-Television watching.

8.Which activity is enjoyable for your child?

-listening song,singing class,roaming with parents.

9. Which activity is irritable for your child?

-absence and missing object.

10.How your child express about toileting?

- By pulling others hand if he need.

11.Have any special quality is enjoyable for other?

-No. 12.Have any problem during sleep?

-No. 13.How child spent his lazy time?

-Listening song,Watching TV. 14.How your child communicate with other?

- By pulling others hand he communicates with them.

15.When your child disturb how you control your child?

-By leave her alone.

Comments:

When Esam start crying then he cries continuously. He has sensory motor problem.He do not want to stand for long time.He has less attentive.He participate in vocational training. He is regular student.He can not speak Case Study-8 Name: Munsat Rabeb Gender: Boy Age: 9 Class: Paddo (Day Blood Group:A+

Fathers Name: Abdul Salam Fathers Occupation: Banker Mothers Name:Tahmena Akter Mothers Occupations: Housewife Economic Status: Higher class

Past History: High fever age is 8month this time convulsion occur. Speech problem, hyperactive.Poor eye contact,No response,.

INTERVIEW QUESTION: 1.Any problem during fetus?

-NO 2.Any problem after delivery?

- High fever age is 8month this time convulsion occur.

3.When you understand your baby is autistic?

-During 2 years old 4.What are the problem present in your child now?

-Speech problem, hyperactive.Poor eye contact,No response,No toilet training,Increase stubborn,He is afraid by any kind of sound 5.What are the like & dislike of child?

Like: - Favourate place-Shopping mall - Favourate food- Spicy food, - Favourate person-Mother

-

Favourate toy-any object,car,ball

Dislike: - Crowded area.Sheshu park 6.Can your child perform any creative work?

-No 7.How your child spent his most of the time at home?

-Television watching,Play with water.Jaring water pot.

8.Which activity is enjoyable for your child?

- Like to roam around by rickshaw or car.

9. Which activity is irritable for your child?

-Make different sound.

10.How your child express about toileting?

- By pulling others hand if he need.

11.Have any special quality is enjoyable for other?

-No. 12.Have any problem during sleep?

-No. 13.How child spent his lazy time?

-Play with water.

14.How your child communicate with other?

- By pulling others hand he communicates with them.

15.When your child disturb how you control your child?

-By leave her alone.

Comments: He can not speak.Sometimes he can not follow any command. he is regular student in class. He can cycleing by help.

There are no medical tests for diagnosing autism. An accurate diagnosis must be based on observation of individual's communication, behavior and development levels.

Autism is a life long developmental disability known as the autism spectrum disorders (ASDs).It is not a mental illness.The degrees of characteristics differ from person to person, but all those affected have impairment in social interaction, social communication and imagination.

This is referred to as a triad of impairment Social Communication (difficulty with verbal and non-verbal communication) Social Interaction (difficulty with social relationship) Imagination (difficulty in the development of play and imagination

Communication problem with autism The communication problems of autism vary, depending upon the intellectual and social development of the individual. Some may be unable to speak, whereas others may have rich vocabularies and are able to talk about topics of interest in great depth. Despite this variation, the majority of autistic individuals have little or no problem with pronunciation. Most have difficulty effectively using language. Each person with an ASD has different communication skills. Some people can speak well. Others can’t speak at all or only very little. About 40% of children with an ASD do not talk at all. About 25%–30% of children with an ASD have some words at 12 to 18 months of age and then lose them.1 Others might speak, but not until later in childhood.

Examples of communication issues related to ASDs: .

Delayed speech and language skills • Repeats words or phrases over and over (echolalia) • Reverses pronouns (e.g., says “me” instead of “I”) • Gives unrelated answers to questions • Does not point or respond to pointing

• • • •

Uses few or no gestures (e.g., does not wave goodbye) Talks in a flat, robot-like, or sing-song voice Does not pretend in play (e.g., does not pretend to “feed” a doll) Does not understand jokes, sarcasm, or teasing

Stage of comminication for autistic children 1. Own agenda stage: * Low communication skill. * Nothing understands. * Play without toys.

2. Requester stage * Communication with symbolic way. * Try to gesture or sound. * Understanding known routine steps.

3. Early communicator stage * can meaningful communication. * known person with known place shown favorable behaviour. * Understanding known word and easy question.

4. Partner stage * Play with other child. * Communication do for different cause. * Can tell short story. * Understanding many word.

Be short of communication Most signs or characteristics of Autism are evident in the areas of speech or communication (verbal and non-verbal).

• The child does not respond to his/her name.

• The child cannot explain what he/she wants.

• • • • • • • • • • • • • • • • • • • • • • •

Language skills or speech are delayed.

The child doesn't follow directions.

At times, the child seems to be deaf.

The child seems to hear sometimes, but not others.

The child doesn't point or wave bye-bye.

The child used to say a few words or babble, but now he/she doesn't.

The child throws intense or violent tantrums.

The child has odd movement patterns.

The child is hyperactive, uncooperative, or oppositional.

The child doesn't know how to play with toys.

The child doesn't smile when smiled at.

The child has poor eye contact.

The child gets "stuck" on things over and over and can't move on to other things.

The child seems to prefer to play alone.

The child gets things for him/herself only.

The child is very independent for his/her age.

The child does things "early" compared to other children.

The child seems to be in his/her "own world."

The child seems to tune people out.

The child is not interested in other children.

The child walks on his/her toes.

The child shows unusual attachments to toys, objects, or schedules (i.e., always holding a string or having to put socks on before pants.)

Child spends a lot of time lining things up or putting things in a certain order

Actions of AWF concerning the development of communication skill for children with autism.

1.Signing 2. Pictographs (line drawings) 3. Photographs and Objects 4. Picture Exchange Communication System (PECS) 5.Increase communications in different domains.

6. Increase story telling skill.

How to create self-independent of Autism child At first autistic children should learn normal work for daily life. This work are complete according to their age. Example- eating , toileting, brushing , bathing wearing etc Another activities continue besides that. Autistics children are face different kinds of problem every step in their life. All this are toilet training problem. eating problem and brushing problem are very critical.

1)        

Eating problem: Sensory problem.

Do not want eating.

Ignore new food.

Motor planning of difficulties.

Touch sensitive.

Don't want own hand for eating.

Many of them more eating but do not understand quantity.

Avoid eating according to social rules.

Suggestion:          

All family members eating together in one place.

Find out cause of eating problem.

Removing for eating problem care about -selection of food, identify new food and time fixing.

Make eating demand.

Happiness environment.

At first giving dislike food then gives like food.

To identify any problem with teeth, tongue, and throat.

Step by step moves slowly.

Consult with speech therapist and occupational therapist.

Use flash card

2) Toilet training:

 Toileting is a major problem for autistic children in different activities to daily life. If a autistic child have no proper toilet training then another activities are complete too critical. So an autistic child at first giving toilet training then others training.

Factor of toilet training:  Sensory problem  Motor planning problem  Lack of communication.  Feeling of toilet is painful for autistic children.  Don't understand pressure of toileting.

Suggestion:  Rule making.  Use toilet sign.  Reserve record.  Ensure happiness environment for toilet training.  Use flash card.  Teaching toilet training step by step.  Toilet training should not begin before 18th months of age.  Beyond 4 years of age toilet training should become a priority.  Schedule training is the easiest way to begin toilet training.

3) Teeth brush problem: Teeth brush problem are seen many autistic children. Mainly brushing problem are seen because of sensory problem. Such as: Somebody dislike smell of paste, depending on their sensitivities.  Brushing with paste creates some froth which may feel awful.  Somebody eating froth of paste.  Don't want opening mouth wide.  Somebody dislike toothbrush touches the gums or the tongue.  Saliva pooling near the back of the mouth.  Physical problem.  The taste of tooth paste can also be strong and unpleasant.  They can not brush the teeth and also cannot wash their muscle of gum properly.

Suggestion: Experiment with different paste.

If no toothpaste tolerable then try brushing his teeth with baking soda and water.

Try different kinds of brushes from soft to harder.

Use flash card.

Happiness environment.

Imitation Slowly touch the brush.

Play in Children with Autism  There is no question that play is an integral part of child development.  Typically, children with autism demonstrate marked impairment in developing play skills in a socially meaningful context.  They also show differences in the way they play. They may have trouble with functional play, or using toys and objects.  Different pattern of play development in kids with autism:  Repetitive and stereotyped play with toys  Difficulties learning imitation and learning through observation  Difficulties with pretend play Play in children with Autism is often described as:  Play in children with autism spectrum disorders is often solitary. They prefer to play alone.  Children with autism often lack age-appropriate, purposeful play skills.  Lack of cooperative group play.  They have Lacking in imagination  Does not understand ‘cause and effect’  They show repetitive and stereotyped play with toys  Difficulties learning imitation and learning through observation.  Difficulties with pretend play.  Children with autism often exhibit atypical play behaviors that are nonfunctional.  The child shows unusual attachments to toys and objects.

Why is play difficult for children with ASD?

Several factors contribute to the lack of play  Language (communication deficits) – individuals with autism have communication deficits. They may not understand the language or social cues of peers, or have the ability to express their feelings effectively with others.  Social interaction (restricted and unusual interests) – unwillingness to allow others to share experience. Lack of understanding of thoughts, feelings and intentions and Facial expressions.  Imagination – difficulty in understanding imaginary situations. Often leading to repetitive, obsessive actions that mean something only to the child.

Table 04: A child with autism play is different for them Children without aChildren developmental disorder disorder

with

a

developmental

 Voluntary



Stereotyped

 Spontaneous



Can be non-functional

 Internally Reinforcing



Limited interests

 Flexible



Rigid

 Creative



Repetitive

Play is important for Children with autism  Play allows a child with autism to learn and practice new skills in all areas.  Play provides a vehicle to interact with people and objects in their environment.  Play builds confidence and competency.  For a child with autism learning how to play appropriately with toys.

           

Most important, IT’S FUN!!!

To promote social interaction To promote motor activity Promote eye contact Decrease self stimulation and bad behavior Learn new ways of talking, listening and communicating Through play children also learn: appropriate behavior Imagination and creativity building relationships imitation Various color, texture, shape, and size

Teaching Play Skills to Children with Autism Some ideas to enhancing play skills and interests include:  Select a motivating toy.  Use toys that are related to the child’s INTERESTS.  Choose toys that correspond to child’s developmental level.  Using bubbles to create rainbow-colored visions stimulates the autistic child's brain.  Read books to the autistic child that have some texture to them. Flashcards can also engage the child through the sense of touch.  Sing songs and play games that allow the autistic child to interact with other children.  Always maintain eye contact with the autistic child.  Musical instruments are excellent toys for children with autism.  Positive reinforcement (e.g., verbal praise) should be implemented along with the prompting and used to reinforce the desired play behaviors.

Training of play skills in AWF  AWF give opportunity to play in both indoor and outdoor.  AWF initially trained a child to identify play objects and toys.  Give training to choose toys that are interested to the child.  Give emphasis to Improve communication skill through various type of play.  Improve their interest to the cooperative group play through interesting game.

 AWF give emphasis to Imitation activities that are motivating for the child.

Behavioral issues  Autism Spectrum Disorders can lead to a wide variety of behavioral issues emerging as a child develops.  Problem behaviors of children with autistic spectrum disorders are the most challenging and stressful issues faced by schools and parents.  Problem behaviors such as:  property destruction,  physical aggressiveness,  self-injury, severe tantrums and destructiveness are major barriers to effective social and educational development.  Such behaviors put children at risk for exclusion and isolation from social, educational, family, and community activities.

Common behaviors problem  Causes injury or harm to self, others, and/ or property  Children with Autistic Spectrum Disorder (ASD) exhibit a wide range of challenging behaviors: – Avoiding eye contact; averting gaze – Staring at objects excessively – Flicking fingers rapidly – Unusual eating habits (e.g., eating only one type of food) – Licking, tasting, and/or attempting to eat inedible objects – Excessive smelling or sniffing of objects – Spinning objects – Rocking back and forth; making rapid darting movements – Prancing (walking on tiptoes) – Flapping hands or fingers in front of face or at sides – Making self-stimulatory high-pitched sounds or other vocalizations – Self-injurious behaviors such as biting, slapping, hitting self; banging head.

– May seem oblivious to pain Common self-stimulatory behaviors:  Hand flapping  Rocking back and forth  Spinning in a circle

            

Finger flicking Head banging Staring at lights Moving fingers in front of the eyes Snapping fingers Tapping ears Scratching Lining up toys Spinning objects Wheel spinning Watching moving objects Flicking light switches on and off Repeating words or noises

Causes of Behavior Problems  Lack of speech and communication  Hormonal change  Puberty and adolescence change  Pain and discomfort from illness  Medication side effects  Environmental Factors  Inability to Meet Basic Needs  Sensory Impairment  Individual factors  Factors related to caregiver  Feeling upset, anxious or angry.

Some effects:  Risk of physical harm,  lack of social development leads to isolation,  skill acquisition deficits,

 independent skill deficits (long term care),  family stress.

The most effective model for managing behavior is the ABC approach: A – Antecedent --what triggers the behavior What usually happens before the behavior, and may set off the behavior?

B – Behavior--what is the actual behavior that results What actually happens during the behavior?

C – Consequence--what happens in response to the behavior A behavior program can work on these 3 steps: 1. minimizing the triggers for a behavior, 2. shaping more appropriate behavior in the child, and 3. Manipulating the consequences to encourage more appropriate behavior.

Best Practices  Research suggests that early, intensive behavioral interventions may improve outcomes for children with autism.  Integration and interpretation of Sensory stimulation.  Ignore inappropriate behaviors  Be an effective communicative partner  Speak slowly, clearly, and specifically  Be aware of sensory over-reaction and under-reaction  Positively reinforce positive behaviour  Task will become more meaningful to accomplish  Decrease anxiety  Promote independence  Do not raise your voice, grab, or threaten the child  Provide Attention  Reinforce Instruction-Following  Teach a Better Behavior Social interaction:

• • • • • • •

Does not make friends Does not play interactive games Is withdrawn May not respond to eye contact or smiles, or may avoid eye contact May treat others as if they are objects Prefers to spend time alone, rather than with others Shows a lack of empathy

Recent studies strongly suggest that some people have a genetic predisposition to autism. In families with one autistic child, the risk of having a second child with the disorder is approximately 5 percent, or one in 20. This is greater than the risk for the general population. Researchers are looking for clues about which genes contribute to this increased susceptibility. In some cases, parents and other relatives of an autistic child show mild impairments in social and communicative skills or engage in repetitive behaviors. Evidence also suggests that some emotional disorders, such as manic depression, occur more frequently than average in the families of people with autism.

Studies show that people who have autism can improve significantly with proper education. Early diagnosis and intense behavioral intervention can have a significant and lasting positive impact on Autistic Children. Autistic children can benefit from placement in a good educational program.

[With intense intervention, 50 percent of children diagnosed with the disorder before the age 5 go on to attend main stream school] Through specially trained teachers, using specially structured programs that emphasize individual instruction, persons with autism can learn to function at home and in the community

Conclusion:

AWF is a very new organization. Even though small scale research is regularly conducted by the specialists, teachers and the parents involved with the organization. The researches mostly concentrate on developing modified teaching techniques and also newer indigenous version of low cost teaching aids. The organization regularly shares the findings with the parents to deliver them the best. The foundation is capable of conducting large scale research on Autism in Bangladesh and is in search of financial sponsorship to exhibit that.

Autism is complexes develop mental disability that typically appears during the first three years of life and is the result of a neurological disorder that affects the normal functioning of the brain, impacting development in the areas of social interaction and communication skills. Both children and adults with autism typically show difficulties in verbal and non-verbal communication, social interactions, and leisure or play activities.

Autism (or ASD) is a wide-spectrum disorder. It is not a mental illness. There is wide variation in symptoms among children with autism, from mild to severe. Autism is a life long developmental disability known as the autism spectrum disorders (ASDs). Autism is an organic disorder affecting several areas of a child's development. Autism remains throughout the individual’s lifetime, although with proper diagnosis and treatment symptoms can be lesson.

Child playing with puzzle Children with an ASD develop at different rates in different areas. They may have delays in language, social, and learning skills, while their ability to walk and move around are about the same as other children their age. They might be very good at putting puzzles together or solving computer problems, but they might have trouble with social activities like talking or making friends. Children with an ASD might also learn a hard skill before they learn an easy one. For example, a child might be able to read long words but not be able to tell you what sound a "b" makes.Children develop at their own pace, so it can be difficult to tell exactly when a child will learn a particular skill.

But, there are age-specific developmental milestones used to measure a child’s social and emotional progress in the first few years of life. To learn more about developmental milestones, visit “Learn the Signs. Act Early,” a campaign designed by CDC and a coalition of partners to teach parents, health care professionals, and child care providers about early childhood development, including possible ”red flags” for autism spectrum disorders. There’s no way to prevent autism. Autism can be treated, and children can have improved language and social skills with treatments. If a child is diagnosed with autism, talk to a child's doctors about creating a treatment strategy for your child. Keep in mind that you may need to try several different treatments before finding the best combination of therapies for your child. There are many disabled and crippled personnel in our society. If they are properly trained, they can substantially contribute instead of becoming burden. In developed and developing countries, Government takes the responsibility for training and rehabilitation of them. In Bangladesh, our Government has also taken many measures of this kind, though not enough.

Although we have many organizations in Bangladesh which work in various fields but there is hardly any quality training institution yet to develop exclusively for the autistic children.

Recommendation 1.GET INVOLVED There are many ways to get involved in the autism community. Being involved you can educate yourself about the most appropriate treatments and resources available. As the parent of autistic children or as a sensible citizen you can get involved with us in any of the following ways: Be a Member if the Foundation You can become a member of the foundation and work closely for the development of the children on Autism Spectrum.

Be a Volunteer Worker In Bangladesh offering volunteer service to the autistic children is not a common practice, whereas in developed countries it is a common phenomenon. As a responsible citizen you can give part time voluntary service to autistic children getting involved with AWF. Reach Out to Your Local Community If you are not in a state to give volunteer service to the organization you can at least learn about autism and try to impart your knowledge to the unaware parents or guardians of Autistic Children around your place.

Raise Voice for Autism You know the rights of autistic children’s are not being maintained properly in our society. You can stand beside the autistic children where their rights are violated. You can also be part of the movement to accomplish the rights of the autistic children by raising your voice in favor of them wherever you can.

Attend an Event You can keep an eye on the events related to autism taking place around you; be it a seminar, rally, workshops, cultural program etc. You can attend in any of such event and get involved in the fight against autism.

Autism Welfare Foundation it is a non profitable foundation here many students as like me can skilled myself by their knowledge,instruction,training & other oppertunities.But from my point of view the Autism Welfare Foundation adopt some things regarding the following issues: 2. At first known the child’s like and dislikes.

3. Making friendly relation with child.

4. To know child how to learn to like.

5. Making meaningful environment for communication.

6. Give the child to way of like.

7. To actively play with child.

8. The like of object in front of child but maintain distance.

9.Both the Autism Welfare Foundation & depertment of child devlopment & social relation can jointly work to improve of the students knowledge about autism.

10.To devlop individual research unit needs to involve in devloping research protocols by the student in the field of child devlopment & social relationship.

11.Making linkage between the institution of National Home Economics College & Autism Welfare Foundation in analogous activity.

REFERENCE: Autism welfare foundation Magazine Autism welfare foundation-Manuals and Papers internet wedsite-www.autism welfare foundation.com News letter, Autism welfare foundation Auguest-November-2011 www.awfbd.com Williams DL, Goldstein G, Minshew NJ. Neuropsychologic functioning in children with autism: further evidence for disordered complex information-processing. Child Neuropsychol. 2006;12(4–5):279–98.

Kanner L. Autistic disturbances of affective contact. Nerv Child. 1943;2:217–50. Reprinted in Acta Paedopsychiatr. 1968;35(4):100–36.

Landa RJ. Diagnosis of autism spectrum disorders in the first 3 years of life. Nat Clin Pract Neurol. 2008;4(3):138–47. doi:10.1038/ncpneuro0731. PMID 18253102 Minshew NJ, Williams DL. The new neurobiology of autism: cortex, connectivity, and neuronal organization. Arch Neurol. 2007;64(7):945–50. doi:10.1001/archneur.64.7.945. PMID 17620483.

Jeste SS, Nelson CA 3rd. Event related potentials in the understanding of autism spectrum disorders: an analytical review. J Autism Dev Disord.

2009;39(3):495–510. doi:10.1007/s10803-008-0652-9. PMID 18850262.

CDC Data "Autism Spectrum Disorders - Data & Statistics". Centers for Disease Control and Prevention. May 13, 2010. Retrieved December 25, 2010.

Minshew NJ, Williams DL. The new neurobiology of autism: cortex, connectivity, and neuronal organization. Arch Neurol. 2007;64(7):945–50. doi:10.1001/archneur.64.7.945. PMID 17620483.

Autism in Bangladesh.

Retrieved February projekti/the_prerona_project/autism_in_bangladesh.

5,

2011

from

http://www.autismiliitto.fi/projektit/bangladesh-