* Has been changed to protect the identity of the minor

*Alex, an adorable 5 years old boy, was diagnosed with Autism Spectrum Disorder (ASD) in early 2011 after his kindergarten teachers realized that something was different about his behaviours.  *Alex’s parents were in disbelief with the news, and had no idea what to do to help their son. A family member, whose child was receiving therapy then at The Children’s Therapy Centre, got to know about *Alex’s situation and referred him to the centre.
 
Together with his parents, *Alex came to the centre where the Case Manager (CM) carried out an assessment to test *Alex’s current speech ability and behaviour. The CM gave *Alex activities to do which tested his cognitive and communication abilities based on his condition of ASD.
 
The assessment indicated that *Alex was non-verbal, which means he is unable to communicate with others using speech. He was inattentive, had difficulty completing a task independently, and was easily frustrated. Often, his eyes would dart around, and would grab toys randomly. He never once looked at the CM when she withheld a toy that he wanted badly. He simply tried to wring it away from her fingers, failing which, he decided to abandon the toy and walk away. He vocalized occasionally when walking around aimlessly, making cooing or pleasure sounds that resembles a 4-6 month old baby. The CM tried getting him to copy some actions, but he did not imitate at all. Other than grabbing and crying erratically, *Alex had limited means of communicating with other people.

According to the CM, intervention for ASD cases should ideally begin as early as possible in the child’s life, with some research even suggesting 2-4 years of age. However due to *Alex’s parents’ belief that their child would start speaking one day, the delay in seeking intervention might make *Alex’s learning process of the new therapeutic ways more frustrating after his 5 years of self-taught “communication”.

Nonetheless, *Alex’s parents are still hopeful that he can eventually learn to talk like any other child. After all, talking is the most natural form of communication. But if a child can talk, and has no psychological issues or vocal structural damage, why wouldn’t he? Moreover with research findings that up to 50% of children with ASD do not develop speech at all, the most important and urgent thing now to do would be to help *Alex find an alternative way to communicate, rather than emphasizing on the “talking”. The CM explained to *Alex’s parents that even without verbal speech, *Alex should never be deprived of a means to communicate. He can explore communication through other means, such as waving, pointing, looking at pictures, writing and drawing.
 
Hence, the CM recommended a Picture Exchange Communication System (PECS) program as an initial start for *Alex. PECS is a form of augmentative and alternative communication system. It is developed to help children and adults with communication difficulties to learn how to initiate communication by means of a simple book, with pages of nicely-laminated pictures that can help *Alex communicate, and in the long run, reduces his frustrations.
 
His parents agreed to give it a try, but upon being notified that *Alex requires intensive therapy to support his communication needs, his parents started worrying about the cost of attending the therapy sessions as they were struggling to make ends meet despite *Alex being their only child.
 
Fortunately, The Children’s Therapy Centre provides subsidies to support low income families like themselves, so that less privileged children such as *Alex can be given the opportunity to attend regular therapy sessions. *Alex’s therapy sessions were subsidised to an affordable rate, enabling his mum to bring him on a 45 minutes journey from their home to the centre for speech therapy twice weekly.
 
During the first therapy session, *Alex was obviously unhappy. He had to learn to use a picture to exchange for something that he wants. *Alex has been used to grabbing to get what he wants or needs, which were all attended to by his dedicated mother, without him having to request. Now, he is made to “ask” for things. He was crying and pulling mum away from the chair. His intention was clear; he wanted to leave. However, *Alex’s mother and the therapist persisted with the session.
 
Nonetheless, *Alex has proved himself to be a smart boy. Very quickly after a couple of therapy sessions, he understood the concept of exchanging pictures to get the desired item he wants. He was able to give that 1 available picture of toy car to his speech therapist in exchange of a toy car without grabbing like he used to.

Can *Alex have a voice? Check out on *Alex’s progress in 6 months’ time.