Wed, 07 May 2003

Autistic children can live happy, productive lives

Sheila S. Quarles van Ufford-Thomson, Contributor, Jakarta,

A wealth of evidence currently exists to suggest that autistic children who are exposed to early behavioral interventions will lead happier and more productive lives.

Jakarta resident Marie-Claude Osterrath, mother of Matthew, an autistic three-year-old boy, believes unequivocally in this theory. She explained, "some doctors worldwide don't feel comfortable diagnosing children with autism until they are 5 or 6 years old, but by then it is too late to intervene effectively. Eighteen months is the optimum age to begin therapy."

Diagnosed with autism at the age of one-and-a-half, Matthew has undergone intensive therapy for the past two years.

"Our goal is for Matthew to go to school and be indistinguishable from his peers. We want him to be happy and to have healthy relationships," explained Osterrath.

Autism is a neurological dysfunction that is severely incapacitating. According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (4th Edition), widely used by medical personnel to diagnose the condition, autistic people are diverse, yet share three common behavioral characteristics: social difficulties, impaired communication skills and specific behavioral patterns.

Autistic children often show little interest in other people. "When someone new entered the room, Matthew never looked at that person. Normally a child will look at a stranger and then turn away out of shyness, but Matthew simply never looked," said Osterrath. "He was always content to play on his own."

"At first I just thought he was keras kepala (stubborn) because he never accepted any instructions. I couldn't teach him to wave to me. He also never responded to his name, although I knew that he wasn't deaf," explained Osterrath.

Impaired communication skills are a second characteristic common to autistic people, 50 percent of whom never develop spoken language skills.

"By the age of 17 months, Matthew had stopped speaking altogether. He was my first child and people kept telling me not to compare him with other children, as every child develops at a different speed," said Osterrath.

"Everyone says that boys develop more slowly than girls, so I wasn't too worried. We were also introducing two languages at home and I thought that this was causing a retardation in his speech."

"Only when I spoke to a pediatric neurologist did I realize that Matthew had stopped saying 'mama'. I was living the life of a busy mother and hadn't realized that after developing normally, he had suddenly stopped saying 'mama'."

Autistic people also display specific behavioral patterns. They find change distressing and develop repetitive motor mannerisms.

"My son was obsessed with spinning the wheels of his toy car. Although many boys spin wheels, Matthew could do it incessantly without regard for hunger, thirst or anyone around him," explained Osterrath.

After conducting considerable research into autism, Osterrath and her husband, Mark Oliver, decided to design their own in- house program for Matthew. He now undergoes a 35-hour-per-week Applied Behavioral Analysis (ABA) program, the most scientifically proven successful method of treatment for autism.

Developed by Dr Ivar Lovaas, ABA is based on discrete trial teaching. New skills are broken up into small components and students are set up for success. They are then rewarded with something tangible that they like.

"In order to teach Matthew to clap his hands," explained Osterrath, "I would say, 'Clap your hands, Matthew'. Then I would bring his hands together so they 'clapped' and reward him with a treat, as well as a lot of praise. Eventually the tangible reward was taken away and the words of praise became effective in their own right."

In addition to discrete trial teaching, ABA requires that the autistic child practice the skills learned in the therapy room, in a variety of 'natural' settings. Only with the help of trained and fully supportive family members and teachers, will discrete trial teaching be effective.

"My husband and I interact with Matthew in a meaningful way every moment that he is awake. He is never left idle, not even for a minute. It's exhausting but we have no choice. I am going to get my son out of this. I know that we can do it and that it will take time. I feel so lucky to have been given the chance to have had an early diagnosis."

Diet is another factor that can heavily influence the behavior of an autistic child. Matthew's parents had blood tests done for his food allergies and found that he had several.

"Matthew is now on a gluten-free, casein-free (GFCF) diet. As he is also allergic to corn and rice, we make almost all of his food from scratch," explained Osterrath.

"The change in diet has made a huge difference to Matthew's behavior. He used to wake up in the middle of the night, screaming in terror, and 'squishing' his head between objects. This has stopped since we introduced the new diet and he now sleeps through the night. Also, since the diet change, Matthew has more eye contact with others; he is more aware of his environment and his learning curve has increased considerably."

Matthew undergoes an hour of occupational therapy each day to enhance his gross and fine motor skills. His senses are also stimulated during these sessions in order to improve his attention during the ABA therapy.

"Matthew craves pressure and so we do deep-pressure brushing on his body to reduce this craving," explained Osterrath. "This improves his concentration and allows him to learn new skills. Otherwise, he would be fixated on rubbing his arms or legs."

All of the hard work done by Matthew, his parents and his therapists are paying off. Although each skill has sometimes taken months to develop, Matthew now has a wide range of them. He can eat by himself, dress himself and wash his own hands. Socially, he says hello to strangers, he answers basic questions about himself and he can make his basic needs known through speech.

Physically, Matthew is at par with other three-year-olds. He swims alone and rides and steers a bicycle on his own. His vocabulary has improved and he now understands hundreds of words and can speak more than 50 words well. He has also just begun to construct full sentences.

The positive attitude of Matthew's mother, in particular, has played a crucial role in his recovery. "We are involved in a race against time," said Osterrath.

"As autistic children get older their rituals and repetitive behavior become set, and almost impossible to change. There is no time to grieve. We have to cherish even the smallest of victories and just get on with it!"

Valuable resources on autism and ABA include the following:

* Let Me Hear your Voice by Catherine Maurice (book)

* The Me Book by Ivar Lovaas (book)

* Behavioral Intervention for Young Children with Autism by Catherine Maurice (book)

* (website)

* (website)

* Lembaga Pelayanan Anak Raja (

* Yayasan Autisma Indonesia (

* Dr Rudy Sutadi, Jakarta Medical Center

* Fajar Nugroho, school for autistic children, Yogyakarta

Sheila S. Quarles van Ufford-Thomson,, 08174903670.