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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 God-given 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 lifelong 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:

• No fear of danger.

• Over or under sensitivity to pain.

• May avoid eye contact with you.

• May prefer to be by him/herself.

• Has difficulty expressing what they want or need – may then try to use gestures.

• May echo words or phrases.

• May have inappropriate attachments to objects.

• May spin his/herself or objects.

• Prolonged repetitive play.

• May insist on things/routines always being the same.

• May exhibit inappropriate laughing (laughing when not appropriate to the situation).

• May display tantrums for no apparent reason.

• May avoid cuddling.

• May exhibit self injurious behavior when upset i.e. biting selves or banging heads.

• 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.^{<href=”#cite_note-BangladeshStatPock2008-1″>[2]} It is the 9th largest city in the world^{<href=”#cite_note-5″>[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.^{<href=”#cite_note-Dhaka-31″>[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 : ASD, PDD

2. Geographical Coverage of Operation : Dhaka, Bangladesh

3. Sources of Funds : Students’ tuition and donation from

Members and parents of the students,

Donation private companies occasionally.

AWF Organizational Profile

1. Name of the Organization : Autism Welfare Foundation

2. Founder/ Chairperson : Dr. Rownak Hafiz, MBBS, DCH

3. Address : House No. 38/40, Road No. 04

Block-Kha, Pisciculture Housing Society (Sekhertek), Mohammadpur, Dhaka-1207

: Telephone: +88 028121759

: Fax: +88 028121759

: E-mail: rownak_awf@yahoo.com

: Website: www.awfbd.com

4. Established in : 2004

5. Registered Under : Society’s Registration Act with registration of Joint Stock Company

6. Registration no : 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 Organization is given following:

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 center

• 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