one-stop service for parents of newly diagnosed autistic children in singapore proposal

8/8/2019 One-Stop Service for Parents of Newly Diagnosed Autistic Children in Singapore Proposal

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A one-stop service to support parents of newly diagnosed autistic children (0 6 years old) in Singapore

1. Introduction

1.1 Health Problem to be addressedAutism Spectrum Disorder (ASD) was defined by the American Psychiatric Association (1994) as a

developmental disorder. It covers the main three groups of Autism, Aspergers Syndrome and PervasiveDevelopmental Disorder. This disorder is characterized by social interaction impairment (for example: lack of

emotion reciprocity), communication impairment (e.g. total lack or delayed development of verbal skills) and

notably restricted and repetitive patterns of behaviours and activities1. Only started to be studied in details in the1970s, ASD still remains as poorly understood. Children with autism are often presented with numerousdifficulties in communicating and learning. Because of that, many illnesses acquired by autistic children are

frequently overseen or missed: from normal developmental milestone in dental care too complex mental health.It is known that high proportion of autistic children had at least one psychiatric disorder besides autism

2. These

disorders are specific phobias, attention deficit hyperactivity (ADHD), separation anxiety, social phobias,bipolar and depression. Depression in autistic children and adolescent has been known to associate with the

likelihood of self-inflict or even suicidal attempts (Sovner & Hurley 1982a, 1982b cited by Lainshart & Folstein1994). In many countries, these autistic children grow up having with very limited life opportunities especially

in education and employment, which is the direct result of the social stigma of autism as a psychiatric condition.Therefore, there have been efforts ongoing to advocate for this group of population

3-5.

Moreover, several studies have associated taking care of autistic children parents depression, stress andanxiety

3, 6-8, especially during the early phrase after diagnosis. This difficult period has been known to affect the

parents mental health greatly with more severe impact on the mothers7. Furthermore, some parents of autistic

children described experiences of social rejection and subsequently social isolation. In some cases, family

break-down was noted when domestic violence and marriage failure occurred. The intense impact of autismdiagnosis and problems associated with the condition has been also expressed by siblings in the same family as

they were partly neglected9. Without an effective supportive network, the parents struggle to attain treatment

for their autistic child and at the same time, balance their work and carry out parenting tasks to other children10

.

1.2 Target population

The Republic of Singapore is the smallest South East Asia island state off the southern tip of Malay Peninsula.

As of 2009, Singapore population stood at 4.8 million with 36% was foreigners. The state is well-known for itsefficiency and stability. Singapore government provides an extensive education and health care system thatboasting 84% health insurance coverage.

According to estimation from Autism Association (Singapore), the autism prevalence rate in Singapore is

24,000 individuals, of which 5,472 are children under the age of 19 years. Furthermore, an approximation of216 new cases of children with autism is diagnosed annually. Due to the multiracial characteristic of Singapore,

most of the autistic cases detected in 2001 were of Chinese ethnic (85%), followed by 6% Malay, 5% Indianand 4% Eurasian

11.Most of the cases were diagnosed by psychologists or paediatricians. A large proportion of

the autistic children in Singapore are boys (81%), which is in agreement with the international report of 3-4boys to one girl ratio

11. Majority of the autistic children had very low or not at all verbal skill with 71% of them

spoke less than 5 words. In terms of the parents socioeconomic status, the number of cases increased withhigher income level of both working parents. Many of them reported frustration with dealing with their autistic

child.

Thus, the target population of this program are parents of newly diagnosed autistic children (0-6 years old)

1.3 Justification/Significance and Expected Outcome

Due to the lack of advocacy, there has been inadequate support and attention from government and community

to family and children with ASD. This is important as a number of studies mentioned the effectiveness offamily setting in helping autistic childrens development

4, 12-18. In a study by Bernard-Opitz (2001), verbal


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skills of the autistic children in Singapore were severely underdeveloped as the indirectly result of themultilingual context in Singapore in which a few languages can be used at home. In addition, 28% of the

autistic children were taken care of by foreign domestic workers who did not have language skills. The parentshave limited understanding of their childrens condition and so physical punishment was used frequently (69%

of child educating methods). Very few parents sought therapists to improve their childs sensory-motor andspeech skills. Instead, some parents were known to turn to religious/spiritual healers for help. Most of

Singapore autistic children were often neglected in which they were fed and put in front of TV for 8 hours

straight without much learning stimulation from their parents11. In term of the parents themselves, many studiesshowed high level of anxiety and depression while raising their autistic children

3, 5, 19-21. Furthermore, there has

been no public program actively seeks out and provides assistance for family with autistic child in Singapore.

Most of the existing programs are fragmented, limit at day childcare or one day training by private consultancyservices

22. Moreover, the quality of these services has not been evaluated by any appointed government agency

up to date. Many parents voiced out concerns for a one-stop service program that could cover wider range ofsupport instead of the current patch-work services by different welfare volunteer organisations (WVOs) and

private consultancy companies23

.Recognizing an increasing trend of children with autism diagnosed every year in Singapore and their parents

need, this program is expected to provide a multi-dimensional service including counselling and support theparents of autistic children upon the child diagnosis. We aim to educate the parents of newly diagnosed autistic

children to understand autistic behaviours, be able to perform regularly home-centred method to stimulate theirautistic childs learning ability within 2 years from the beginning of the program and we also provide other

parents supports.

2.Goal and Objectives of the program2.1 Program goalThe long term goal is to decrease the number of highly dependent autistic individuals (above 19 years old) by

improving support to family with autistic children with early intervention so they will ultimately be able toadapt and live with minimal support within community in Singapore.

2.2 Objectives2.2.1 Objective 1

To strengthen understanding of at least 70% of parents of newly diagnosed autistic children (below the age of 6)

of autism in terms of common autistic behaviours, causes of autism, the childs strength and the importance offamily interaction by end of 2012.2.2.2 Objective 2

To empower and inform at least 70% of the parents newly diagnosed autistic children (below the age of 6)about all the 30 support services available for autistic children and encourage social interactions and

involvement in self-help parents group by December 2012.2.2.3 Objective 3

To equip at least 40% of the parents/caregivers with the suitable home training/ learning stimulation methods sothey can perform at least 2 methods at home regularly by December 2012.

2.2.4 Objective 4To improve at least 30% of the parents mental health by reducing stress through counselling on their childs

legal rights and financial support by end of 2012

3.Selection of strategies/intervention/methods

3.1 Program logic


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Table 1: Program Logic

Inputs Activities Outputs

Outcomes

ShortIntermedia

te

Long

PersonnelProgram managers

Experts (psychiatrists,developmental

paediatricians)Therapists (speech

therapists,occupational

therapists, nutritionists,sensory-motor

therapists.Training

moderators/facilitators

Legal aid personnelMaterialsPrinting and IT

equipmentsAudiovisualequipments

Seminar/small groupdiscussion rooms

StationeriesTransportation

Funding

Seminars forparents about

autism: cause,common

behaviours, andthe importance of

familyinteractions

Invitationcards/calls sent to

the parentsParents doubt

clarified byautism experts

Parents improveawareness of

their childscondition

At least40% of the

Singaporean parents of

newlydiagnosed

autisticchildren

educated to

understandtheir child

autistic

condition,be able to

performregularly at

least 2home-

centredmethods to

stimulatetheir

autisticchilds

learningability and

they areaware of

otherparents

supports

within 2years from

the

beginningof the

program.

The longterm goal is

to decreasethe number

of highlydependent

autisticindividuals

(above 19years old)

byimproving

support tofamily with

autistic

childrenwith earlyintervention

so they willultimatelybe able to

adapt andlive with

minimalsupport

withincommunity

inSingapore

Organizingintroducing

sessions and trip

to the supportfacilities

Sessionsconducted and

trips completed

Parents ofautistic children

aware well of

facilitiesavailable andutilize them

Workshop ofsmall group of

parents to discusseffective daily

routine andappropriate

dietary regime

Workshopconducted

regularly byfacilitator/nutritio

nist for activelyinvolved parents

Parents are ableto plan suitable

routine and dietfor their autistic

child

Introduction

workshop abouthome-based early

interventionmethods

Workshop held

regularly by afacilitator

Parents gain

awareness ofavailable

learningstimulating

methods toapply at home

Workshoptraining for small

group ofparents/caregiver

s on suitable

home-basedinterventionmethods

Workshopconducted by

autism expertsand therapists

Trained parentsare able to

perform at least2 methods at

home regularly

Counsellingsessions for

individual orsmall group of

parents regardingtheir child legal

Sessionconducted

regularly andupon request by

legal aidpersonnel

Increaseaccessibility and

awareness ofparents to

understandingof their childs


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rights legal rights

Counsellingsessions for

parents onmanaging

financial andseeking financial

support forraising children

with specialneeds

Sessionconducted

regularly andupon request

Parents are ableto manage their

finance andknow where to

seek assistanceif they need to

Organize parentsself-help group

roundtable toexchange ideas

Roundtable talksheld with actively

engaged parents.

Parents meet,share their

concern andencourage one

another

3.2 Description of strategies

Up to date, there has been no substantial evidence for any cure for autism24

. Many programs such as theHolding Therapy, Daily Life Therapy/Higasi School, Option Approach, etc have claimed to effectively enable

the autistic children to live independently by putting them through vigorous school curriculum or creatingfamiliar environment. However, research is still required to evaluate the long term outcome and the

applicability of these programs16

.Other therapies involving drug treatment, special dietary and intensive appliedbehaviours analysis focus on the child have been known to be effective to certain extents, especially study trials

by Lovass (1987) and Koegel & Koegel (1995). Whilst the programs were effective, their high cost has been ofconcerns to many autism experts and parents. In concordance with other studies, these programs however

emphasized the importance of early intervention with the parents playing a changing agent role12, 18, 25-26

Therefore, family-based and parent-focused intervention methods are the backbone in this program.

Strategy for objective 1: strengthen understanding of parents of newly diagnosed autistic children (below theage of 6) of autism

Upon diagnosis of a child, each family reacts differently. More often, the parents have difficulty in diagnosisresolution; are devastated and helpless. Many parents voiced up their needs of having detailed explanations by

experts in term of information provided specifically of their childrens behaviours and strategies to support thetreatment that child might need to undergo

27-29. Therefore, there should be engagement of the professional in

delivering the initial and subsequent assistance to the parents at early stage. This method was employed withsome success by The Help! Program constructed by the United Kingdom National Autistic Society

16. Once the

parents gain better understanding of their autistic childs behaviours, they could reduce physical punishment inchild up-bringing, which was very high among Singaporean parents (69%)

11.

Strategy for objective 2: empower and inform parents about all the support services available for autisticchildren and encourage social interactions and involvement in self-help parents groupEstablishing a suitable intervention for a specific child is never easy for both professional and the decision

maker the parents of the child. Without experts help, besides trying to understand the condition by siftingthrough mountain of literature on results of different treatment trial, the parents need to identify available

outpatient psychotherapy and other therapies. This challenge could be overcome with an effective system ofdelivering information from our program. This strategy enables and widens familys choices of support and

assists them in navigating the service system that can be overwhelming at the time16, 30

. Furthermore, theinvolvement of parents into self-help group allows them to discuss freely and communicate about their concerns


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of their children with certain common level of understanding31

. Therefore, the program can provide someflexibility and encourage the parents to be more socially active.

Strategy for objective 3: equip parents/caregivers with the suitable home training/ learning stimulation methodsso they can perform at least 2 methods at home regularly

Because most of autistic children were diagnosed early in Singapore (60% by the age of three years), it is stillpossible to improve their delayed development progress. Home-centred early intervention methods have been

employed with positive outcomes in many well-known programs such as the Hanen Program (Canada), or

Oregon Statewide Regional Program Autism Training Sites (the US) and the EarlyBird (the UK, New Zealand).Funded by Canadian government, The Hanen Program has been known to specialize in training parents to assistchildren with learning disabilities such as Downs syndrome and ASD. The program offers practical tools to

parents/caregivers so that daily activities could be learning stimulation for their autistic children and thusenhance the childrens communication development

32. Similarly, the EarlyBird was designed to facilitate

parents understanding and good handling of their autistic childrens behaviours with methods suitable for dailyschedule

12, 16, 31-32.

Strategy for objective 4: improve parents mental health by reducing stress through counselling on their childslegal rights and financial support

A number of studies have demonstrated that parents of autistic children are under tremendous stress rearingchildren with special needs. Therefore, this strategy is to help the parents to manage other aspects of bringing up

a child with certain disabilities. Based on a similar notion, a program by Monash University called Pre-Schoolers with Autism was developed to focus on the parents and has shown significantly positive outcome

5

Another model with the whole-life approach is TEACH (Treatment and Education of Autistic and RelatedCommunication Handicapped Children) by University of North Carolina. The program caters to young children

and their family up to their adulthood and has been shown to have great impact on the autistic individuals andtheir family

16. Therefore, providing legal information and counselling will be a part of this programs strategy.

4.Log frame

Table 2: Log Frame

Performance Indicators Mean of verification Assumptions

Goal:To decrease thenumber of highly

dependent autisticindividuals (above 19

years old) byimproving support to

family with autisticchildren with early

intervention so theywill ultimately be able

to adapt and live withminimal support

within community inSingapore.

Lower percentage ofinstitutionalized autisticindividuals

Higher number ofemployed autistic people

Increase in number ofautistic students in higher

educationinstitutions/vocational

training schools

Data from the Institute ofMental Health

Data from ENABLE fundreport

Data from MYCS

Data from VWOs

Continuous supand funding fromgovernment

Reduced sigma femployer encourmore autistic ad

in workfoparticipation

Purpose:

Effective training andcounselling of parents

of newly diagnosedautistic children in

At least 50% of the parents ofthe autistic children can

understand the developmentaldisorder well and can apply at

Questionnaires indifferent languages

Videotapes of home-

The children are to learn skills (ve

or mcoordination)


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Singapore so they can

be self-reliant inmanaging and

assisting their autisticchild

least 1 teaching method in

educating and managing theirautistic child

teaching sessions The parents engin the prog

regularly and able to perf

acquired learnstimulating met

in long term at ho

Objectives:1. To strengthenunderstanding of at

least 70% of parents ofnewly diagnosed

autistic children(below the age of 6) of

autism in terms ofcommon autistic

behaviours, causes ofautism, the childs

strength and theimportance of family

interaction by end of2012.

Score on questionnaire

Percentage of parentsunderstand their childsautism behaviour pattern

and can identify theirchilds strength

Number of questionnairescompleted

The parents are wilto do questionnaire

participate in trainsessions

2. To empower and

inform at least 70% ofthe parents about all

the 30 support servicesavailable for autistic

children and

encourage socialinteractions andinvolvement in self-

help parents group byDecember 2012

The usage of supportfacilities (frequency and

duration)

Score on questionnaires

Record of usage fromthe support service

facilities

Feedback on the serviceavailability from the

parents

Parents actively uti

the support facilities

3. To equip at least40% of the

parents/caregiverswith the suitable home

training/ learningstimulation methods so

they can perform atleast 2 methods at

home regularly byDecember 2012

Specialists evaluation onparents understandingand performance during

interaction with theparents

The number of methods

introduced The parents can perform 2

or more different methods

Experts/Specialistsreview report

Verified checklist ofteaching methods

conducted

Specialists available

The parents corporative

4. To improve at least30% of the parents

mental health byreducing stress

through counselling on

Scores on stress arousalchecklist*

Score on the parentingstress at the beginning and

end of program to

Record of checklist

Form documented bycounsellor

The parents willing to do surve

Family well-being5 years


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their childs legal

rights and financialsupport by end of 2012

evaluate improvement of

the parents mentalwellbeing Index form 6

Outputs:1. The parents

understanding of theircircumstances:

1.1 90% of theparents are able to

understand the causesof autism and stop

blaming themselves

The parents resolution basedon assessment by interviewer

Number of the parents answercorrectly on autism fact quiz

Pre- and post- counsellingquestionnaires filed in

progress report for each case

There is a hpercentage of pare

participation and thave limited knowle

on the nature of disorder

1.2 80% of the parentsare able to identify

common behaviours inautistic children in

general and their child

in particular

Number of the parentsanswer correctly onautism fact quiz

Scores on the behaviourrepertoire checklist

Behaviour diary

Checklist filed with otherquiz results to be reviewed

mid-term and end-term

The parents might hobserved their c

without knowing howdifferentiate betw

normal and auti

behaviours1.3 80% of the parentsare able to understand

family membersinteractions

Family Relation Scale

Counsellors assessmenton the parents

The parents are able tooutline daily routine

Filed assessment

Counsellors report

The parents ooverlook their fami

interactions and impact of those to

the children

2.1 CommunitySupport awareness

All available supportfacilities will be

introduced to 100% ofthe participated

parents

The number of servicesavailable and theirlocations island-wide

The usage of these

facilities

Data from the serviceprovided recorded pre andpost induction

If the parents knmore about

facilities, they actively utilize th

and inform oparents

3.1 Training the

parents the home-teaching techniques so

that 60% of the parentsare able to perform at

least two introducedmethods

The number of coachingsessions

Performance of theparents to be graded by

unbiased evaluator

Record of coachingsessions

Parents performancegrading form filed

The parents are wil

to learn and ableperform and practic

home

4.1 50% of the parentsfeel less stress when

able to cope after 1year and 2 years of

training

Score on Stress ArousalChecklist

Parents feedback on theprogram

Documented score at thebeginning, mid and end of

the program

The parents will filthe form hone

without embarrassmor under pressure by

program coordinator

Activities:1.1.1 Collecting

updated prevalenceand demographic data

of autistic children inSingapore regularly

Inputs:Manpower, stationary,

computer for database,transportation

Through data from the

Institute of Mental Health,2 Child Development

Units and the VWOs

Permitted access to

database of IMH CDUs

Parents are aware their childs diso


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once every 4 months before the child i

years old

1.1.2

Sending invitations orcalling in to the

parents of newlydiagnosed autistic

children to ask forprogram enrolment

once every 4 months

Manpower, transportation,stationary, computer

Number of invitations sentout, emailed / calls made

Parents are willingrespond and enrol in

program

1.1.3

Organize seminarsabout the causes of

autism one every 4months

Autism experts such aspsychologist,developmental

paediatrician, therapist

Venue, audio equipment

Leaflets, booklets

Manpower

Refreshment

Meeting minutes or report

Training attendance form

Availability presenter budget/funding

Parents are wilto participate seminar

Availability

seminar venue

1.1.4

Counselling theparents in private if

they are still in doubtor they have not

resolved on monthlybasis or upon request

Counsellor, venue, stationary Counsellors report The parproactively seek h

Counsellors available

1.2.1Small group of 5-10

parents discussion onautistic behaviours &

their childsbehaviours monitored

by professional permonth

Reading materials on

recognition of autisticbehaviours and check list

Moderator, venue,stationary

Moderators note

Number of participantrecorded sheet

Number of discussionsessions

Parents are wilto participate

discussion

The availabilitycounsellors


parents discussion ontheir family

interactions monthly

Moderator, venue, stationary Moderators report

Number if participantrecorded sheet

The parents feedbacks


discussion



parents discussion onrecommended daily

routines and dietregime once every 2

months

Autism counsellor

Nutritionist

Stationary, venue

Daily routine charted

Recommended dietcompleted

Stationary, venue

Number of participantrecorded sheet

Parents are wil

to participate discussion



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2.1.1

Write contract andcontact supporting

services by the WVOsand 2 Child

Development Units(CDUs) in KK

Womens andChildrens Hospitaland National

University Hospital

Manpower

Stationary, library access

Contract write-upcompleted

Appointment with thesupporting facilities

confirmed

The committee charge

supporting facilagree to meet

2.1.2Presentation and sign

contract of partnershipwith the supporting

services by the WVOsand 2 Child

Development Units

(CDUs)

Manpower

Stationary

Transportation

Contract signed Other suppor

facilities agree partnership

2.1.3

Briefing about theavailability of

supporting servicefacility to parents once

every 2 months

Venue, presenters fromrespective organization

Stationary

Record of participation

Number of seminars held


discussion

2.1.4

Visiting trips to thesefacilities once a month

on Saturday morning

Facilitators

Transportation

Transportation record ofthe support facilities

visitFacilities guest log book

Long tpartnership with

facility operaestablished

3.1.1

Preparation oforientation program

booklet and parentsmanual to intervention

methods

Manpower

Stationary

400 booklets and 400parents manual printed

The number newly diagno

cases is about 2per annum

3.1.2

Preliminary

orientation program tointroduce to availablehome-oriented

intervention methodsand expected roles of

the parents once every2 months

Facilitators

Venue, stationary Booklets

Number of orientation

programs heldRecord of participation

Completed attendance

forms

Reports from facilitators

Parents are wil

to participate discussion

The availabilityfacilitators

3.1.3

Comprehensive Instructors (psychiatrists, Record of participation Parents are wil


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instruction of selected

method for smallgroup of parents (3-6

participants) inlanguage, mortor &

cognitivedevelopmental tools to

conduct home-basedlearning stimulationonce every 2 months

psychomotor therapist,

speech therapist)

Venue, stationary

Teaching equipment: audiosystem for demonstration

Parents manual of themethods

Completed feedbackforms

Reports from instructors

to participate

discussion

The availabilityinstructors

The parents are to understand methods

3.1.3

Assessment of parentsdemonstration of

selected method whenthe parents are ready

Grading of the parentsperformance by instructors(psychiatrists, psychomotor

therapist, speech therapist)or other participating

parents

Venue, stationary

Camcorder

Evaluation report ofobservers on theperformance of the

parents participation

Videotapes of assessmentsessions

The parents willing to

observed/taped wapplying learn

stimulation metinto interaction w

their autistic child

4.1.1Counselling the

parents on financialconcerns associated

with raising an autisticchild once every 2

months or based onrequest

Venue, stationary

Counsellors

Counsellors report Counsellors

available

4.1.2

Counselling theparents of legal rights,especially education,

medical support andfuture employment

opportunities onceevery 2 months or

based on request

Venue, stationary

CounsellorsCounsellors report Counsellors

available

4.1.3

Organize regular self-help parents

roundtable discussiononce every 4 months

Venue, stationary

Facilitators

Facilitators report Facilitators available

*: Diggle et al 2009: Lloy & Abidin 1985

: (Hk 1992)

: Including management of problematic behaviours such as tantrum, non-compliant, bedtime problems; and

anxiety or phobias.

5. An implementation plan with the implement schedule


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Table 3: Gannt chart

References

1. APA, ed Diagnostic and Statistical Manual of Mental Disorder Fourth ed1994.

2. Leyfer O, Folstein S, Bacalman S, et al. Comorbid Psychiatric Disorders in Children with Autism: Interview

Development and Rates of Disorders. Journal of Autism and Developmental Disorders. 2006;36(7):849-861.

3. Bitsika V, Sharpley F. Stress, anxiety and depression among parents of children with Autism Spectrum Disorder.

Australian Journal of Guidance and Counselling. December 2004 2004;14(2):151-161.

4. Edwards B. Reaching their Potential: Teaching Kids with Autism. Teacher: The National Education Magazine. Dec

2008 2008:44-45.

5. Tonge B, Brereton A, Kiomall M, Mackinnon A, King N, Rinehart N. Effects on parental mental health of an

education and skills training program for parents of young children with autism: A randomized controlled trial.

Journal of the American Academy of Child and Adolescent Psychiatry. 2006 2006;45(5):561-569.

6. Lucille W, Samuel N, N FS, Mark S. Brief Report: Psychological Effects of Parenting Stress on Parents of Autistic

Children. Journal Autism Developmental Disorder. 1989;19(1):157-166.

7. Gray DE. Ten years on: a longitudinal study of families of children with autism. Journal of Intellectual andDevelopmental Disability. Sept 2002 2002;27(3):215 -222.

8. Milstein S, Yirmiya N, Oppenhein D, Koren-Karie N, Levi S. Resolution of the Diagnosis Among Parents of children

with Autism Spectrum Disorder: Associations with Child and Parent Characteristics. Journal of Autism and

Developmental Disorders. 2010;40:89-99.

9. DeMyer MK, ed Parents and children in autism. New York: Wiley; 1979.

10. Bengt S. Family System and Coping Behaviors. The National Autistic Society. 2002;6(Autism 6):397-409.

11. Bernard-Opitz V, Kwook K, Sapuan S. Epidemiology of autism in Singapore : findings of the first autism survey.

Vol 242001:1-6.

12. Birkin C, Anderson A, Seymour F, Moore DW. A parent-focused early intervention program for autism : who gets

access? Journal of Intellectual and Developmental Disability. June 2008 2008;33(2):108-116.

13. J C. Autism : from clinic to classroom. Teacher Learning Network. Winter 2008 2008;15(2):16-18.14. K W, K S, J S, R SM. An exploration of parental attributions within the autism spectrum disorders population.

Behaviour Change. 2008 2008;25(4):201-214.

15. Reffert LA. Autism education and early intervention: What experts recommend and how parents and public

schools provide. Dissertation Abstracts International Section A: Humanities and Social Sciences; 2008:2008.

16. Roberts, Jacqueline, Prior M, Trembath D. A review of the research to identify the most effective models of

practice in early intervention for children with autism spectrum disorders. Canberra, ACT: Department of Health

and Ageing; 2006 2006. 1741861942.

17. Whitelaw C, Flett P, Amor D. Recurrence risk in Autism Spectrum Disorder: a study of parental knowledge.

Journal of Paediatrics and Child Health. 2007 Nov 2007;43(11):752-754.

18. Diggle T, McConachie HR, Randle VR. Parent-mediated early intervention for young children with autism

spectrum disorder. Cochrane Database of Systematic Reviews. 2003(1):CD003496.

19. V B, F SC. Stress, anxiety and depression among parents of children with Autism Spectrum Disorder. Australian

Journal of Guidance and Counselling. December 2004 2004;14(2):151-161.

20. Trute B, Hiebert-Murphy D. Predicting family adjustment and parenting stress in childhood disability services

using brief assessment tools. Journal of Intellectual and Developmental Disability. 2005;30(4):217-225.

21. Whitaker P. Supporting families of preschool children with autism. The National Autistic Society. 2002;6(4):411-

416.

22. Ministry of Community YSS. Early Intervention and Education for Children with Special needs. Singapore: Ministry

of Community, Youth and Sports;2006.


12/12

23. Ministry of Community YSS. Empowering the Family as the First Line of Support - Caregiver Support and Financial

Security. Singapore: Ministry of Community, Youth & Sports;2006.

24. Howlin P. Practitioner Review: Psychological and Educational Treatments for Autism. Journal of Child Psychology

and Psychiatry. 1998;39(3):307-322.

25. Schreibman L, Kaneko WM, Koegel RL. Positive affect of parents of autistic children: A comparison across two

teaching techniques. Behavior Therapy. 1991;22(4):479-490.

26. Phil R, A OL, Mark C. Brief Report: Relative Effectiveness of Different Home-based Behavioral Approaches to

Early Teaching Intervention. Journal Autism Developmental Disorder. 2007;37:1815-1821.27. Autistic SN. The impact of autism on the family2006.

28. Sullivan O, Wills D, Jackson R, Chalmers R. The issues of early intervention: Children and families influenced by

the developmental spectrum of conditions known as Autism. Australian Institute on Intellectual Disability.

2008;21(2):10-22.

29. Rogers SJ, Vismara LA. Evidence-based comprehensive treatments for early autism. Journal of Clinical Child &

Adolescent Psychology. 2008;37(1):8-38.

30. Brookman-Frazee LI, Taylor R. Characterizing Community-based Mental Health Services for Children with Autism

Spectrum Disorders and Disruptive Behavior Problems. Journal of Autism and Developmental Disorders. 2010.

31. Mason A. It takes two to talk : the Hanen Program. Learning Links News. 2004 2004(1):12-13.

32. Wearne P, Forsingdal S. Tips for running It Takes Two to Talk Program - The Hanen Program for Parents. ACQ:

ACQuiring Knowledge in Speech, Language and Hearing. 2004 2004;6(3):164-166.

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