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Autism Spectrum Disorder, Giftedness and Social & Emotional Development: Interview with Dr Cheryl Dissanayake

Yvette Vignando: Dr Cheryl Dissanayake is the founder and director of the Olga Tennison Autism Research Centre, La Trobe University, Melbourne.  It's the first dedicated autism research centre in Australia.  One of your focus areas is early identification.  Why is it so important to look at early identification of children who may have Autism Spectrum Disorder?

Cheryl:    Early identification is important for early intervention which serves to normalise a child’s development. …. We've shown that it is possible to identify very young children as having an Autism Spectrum Disorder.  And when we follow these children up until they're 24 months, we find that 81% of them referred to us by (specifically-trained) nurses are indeed meeting criteria for an Autism Spectrum Disorder.  Our previous research also shows that there's a drop off of skills between 18 to 24 months of age.    

What kind of skills are you talking about?

Social and communication skills  …  If you can intervene before you get that loss of skill, it means that you can do so much more with the young developing child … you can move that child to a more normal developmental trajectory by intervening and altering the environment.    
What kinds of intervention are used?

You're trying to simulate an environment that is normative; to direct the child to attend to other people, to build turn-taking behaviours, to help the child to communicate with other people. And you do this by making interactions rewarding for the child. We know that the typical developing baby is very sociable; at a very young age a baby seeks social contact – s/he looks at other people's faces right from birth.  This is important for learning. I would expect that child with Autism isn't doing that, isn’t seeking out and responding to social stimuli.

So what you're talking about is developing their social abilities?

That's right, their social and emotional abilities, and these are important for their communication ability. We work with them to highlight the need to communicate and give them the skills to communicate from very early on in life.
Many children don’t get a diagnosis of Autism Spectrum Disorder until they are a little older. What interventions are useful at that age for a child?

Intervention at any age is important and useful for children with Autism. All is not lost if your child is not diagnosed early.  Every child is different; parents will often find that some interventions aren't suiting their family or child but most interventions that work have certain characteristics in common.  

One of the characteristics is that it's a structured intervention and you're working one-to-one with the child.  Most interventions that work have a strong behavioural component but the one-to-one interaction is very important.  Interventions need to be intensive; the amount of time that is relevant will change depending on the age and developmental level of the child. …And most interventions work around promoting social and communicative behaviour because these are necessary in order to learn.  
Do you have suggestions for things that parents should be doing with their children particularly in the area of developing social and emotional skills?

Interventions won't work without the parents also being part of the intervention so that there’s consistency also carried through the home.  

When we see families here we recommend the Hanen Program and the book designed specifically for children with Autism - called More Than Words.  It's a book that I recommend to give parents very simple ways of how to work with their child, how to facilitate communication development in their child, how to interact so that you make interaction relevant for the child

There are many programs that focus on helping parents.  The Monash University team headed up by Prof Bruce Tonge and Dr Avril Brereton have developed a parent based intervention program – Pre-schoolers with Autism – an Education and Skills Training Guide for Parents.  
…another very useful resource, is called the Australian Autism Handbook and it's written by two mums of children with Autism.  …I think it will be a terrific resource for families who have just had a child diagnosed with Autism so they can read about the diagnosis, what that will mean for them and their family, it's a very practical approach.  It talks about the type of resources for young children, the different types of intervention programs, and so on.
Especially relevant for Australian parents is (a section on) the Raising Children Network-Autism website; it has a lot of useful information for parents raising a child with an Autism Spectrum Disorder.

You've written that children with Asperger’s syndrome have a high level of social understanding yet they don't appear to use it in social situations.  

Yes, one of the key differences seems to be the better verbal skills in a child with Asperger’s disorder. These children appear to be able to use their good cognitive skills and their good verbal skills to boost some of their social understanding.  But in the real world when things are happening in real time, such as in the playground, they don't seem to be able to use that understanding to interpret social situations. I would recommend social skills training to parents of children with high functioning Autism and Asperger’s disorder to try and equip them with skills to help them with more ready responses.

You often get calls from parents who believe their child may be gifted, parents of quite young children, and you're asked to advise them as to what they might do…  

Yes, what I found is that many times I end up referring the family for a developmental assessment. …parents ring up because they identify their young child as having lots of knowledge about something, and having knowledge about specific interests. So a parent might call me about a child who knows all about all the different shapes like hexagons and octagons and so on and because the child is very verbal they want to know what they can do to facilitate the child’s development even further.

One of the first questions I ask is ‘What are your child’s social skills like? Is he interested in other children, does he like being around other children, does he like social contact?’  These children …are often later diagnosed with Asperger’s disorder… and are generally diagnosed even later than children with Autism, because children with Autism generally have delays in language and that's generally the first sign that gets them into the referral process.  

…We now know that the best predictors of long term developmental outcomes for all children, (not just children developing normally but also children developing with a disability), is their social and emotional development.
…Helping the child with their emotional regulation is extraordinarily important; temperament is a strong factor in there of course and working with a typically developing child is the same as a child with a disability - to really reach their social and emotional milestones is very important for long term developmental outcomes.
Thank you very much Cheryl, we really look forward to following the work of the Centre.