Australian specialists providing help to autistic kids in Vietnam
Updated
The lives of children with autism and their carers are often made even more difficult because of a lack of knowledge in the wider community, and in Asia autism is only just beginning to be properly diagnosed and understood.
Two Melbourne speech pathologists have recently been working in Vietnam, with funding from the Royal Children's Hospital, to provide training and guidance at Hanoi's National Paediatrics Hospital.
Presenter: Sen Lam.
Speakers: Christine Kendall, Gloria Staios, directors Spectrum Speech Pathology Services
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STAIOS: Autistic children have three main areas of impairment. They have an impairment in socialisation, communication and they show repetitive stereotyped patterns of behaviour and so the earlier that we can make some diagnoses of children with autism and recognise these deficit areas, then the research now indicates that the much better the outcomes will be for these children in all these areas. There are autistic children in Vietnam, as there are all over the world, and that's now becoming an area of need that they have recognised and so we were there to help out.
LAM: Well, your both speech therapists, but I understand you don't speak fluent Vietnamese, so how do you deliver speech therapy in a language that you are not familiar with?
STAIOS: Well, first of all we're working with very, very young children, so the children were aged anywhere from about.
Around Christine?
KENDALL: Around 22 months I think was the youngest .
STAIOS: Right through till five years of age, so in that area of early intervention and those children with autism mostly don't have speech. So we were there to introduce training for the staff and teach them how to develop these children's early communication skills before they start to speak.
LAM: So, Christine, did you find any challenges there, the fact that you did not speak the lingo?
KENDALL: I think we provided a great deal of amusement to the staff with our attempts at Vietnamese. We had a wonderful interpreter that we were working with at every point of our work, so that helped us enormously and as Gloria just said, when you are starting working with young children who don't have speech and by and large the children that we saw didn't. There are a couple of children that had some. In the early stages, you are often working with alternative forms of communication, so that the amount of language that you would be using is actually quite minimal. You are using language but it is minimal. So we were able to get the staff and the interpreter to give us the words that we needed to be using, whilst we were using other forms of communication, so we were using objects and photos with the children as well.
LAM: And how responsive did you find the children?
KENDALL: Once we started working with them, very responsive. Our aim in working with the children initially was to try and demonstrate to the staff how to engage the children, because that is always a challenge with young autistic children and these children. This is their first interaction with a program of any sort, so they had just been at home and they come into the hospital for the program. There were challenges in terms of cultural understanding of play, for example, of understanding that you don't need to have very expensive materials to be working with. We spent one evening down at the markets with some of the staff showing them the sorts of toys that they could buy and to use with the children so they were not having to buy expensive educational toys, and just being aware that the level of understanding of the staff is not at our level, so that you have to give them a broader base of understanding first before you can expect them to develop big expertise in working with the children.
LAM: And Gloria, how important is to establish these channels of communication at a young age?
STAIOS: Look, it's very critical and all the research now indicates that the earlier the intervention, the better the outcomes will be and the programs that they have there, they have become very good at making the diagnoses, so we have found when we were working with the children there, that they were all accurately diagnosed. But what they did not have was enough background information into how to teach the children those very early communication skills of looking, using eye gaze, using objects, using photos, using pointing as a very early developmental stages of communication before speech kicks in and they found it enormously beneficial and it really complimented the programs that they were currently running. It was information that they did not have.
LAM: Well, at the risk of generalising, I know that you were mainly in Hanoi, but generally though, how do you think Vietnamese are coping with autism and autistic children?
STAIOS: Look, as we mentioned earlier, Professor Margot Prior, who is one of the earlier people involved in this program was there earlier to teach them and train them in diagnoses and they have done some very, very good work based on her training there and they are doing very well and are very aware that they need more training to continue to provide ongoing programs. So there were participants from Ho Chi Minh City, as well as from Hanoi, and they have particularly tried to provide access to the program to parents from the provinces who had additional skills, so that they could go back to the provinces and start to network in their own areas and pass on this knowledge.
LAM: So Christine, did you find that there was a lot of interaction with parents as well, how important is that?
KENDALL: Sen, what we did in the mornings was we would deliver lectures to a group of 20 people, five of whom were parents and then in the afternoons, we would work in the department in the psychology department in their program with the children that were involved in the programs. So we worked with a number of the children there and initially the staff would allow the parent of the child we were working with to come in and observe the session with the rest of them, but by the end of the first week, we had most of the parents of all the children in there observing, so we were working on the floor of the department and the parents and the participants would all sit around on the floor as we were working, we would discuss what we were doing, demonstrate with the children, and so we had a lot of parents involved, which was terrific...
STAIOS:...with the interpreter there so we could explain what were doing and what we were demonstrating and then he would then translate that for all the parents as well as all the staff to understand what in fact we were doing.
LAM: And Gloria, what cooperation did you get with the local staff? Did you find that they were receptive to the new ideas that you were imparting?
STAIOS: They were just so excited to have us there. I mean it was really wonderful. It is great to work with a group of people who just have such a thirst for knowledge and that was one of the things that struck us. We were so impressed with how dedicated the staff were and how hardworking and how they really were trying very, very hard to expand on their knowledge base and implement it and it was just very impressive.
LAM: And what were the conditions like at the hospital there?
STAIOS: The hospital is being rebuilt isn't it Chris? They have got some parts of the hospital that are now beautiful and new and we of course were housed in the psychology department where we were demonstrating with the children and that's all been newly built, so that was fantastic in terms of the facility. But certainly in terms of equipment, there really was not very much there and one of the fortunate things for us was that when we were asked by the Royal Children's Hospital International program and invited to go to Vietnam to present this training, we actually said that it would not be worth their money spending it unless they were also able to finance the resources, the software, the training manuals, the DVDs, the toys, the equipment, so that once we used all of that to demonstrate, we could leave it behind for them. And they were really receptive to that. So all of the people in Vietnam were just so excited to have then suddenly have got all the brand new resources that they could just run with straight away once we left.
KENDALL: And Sen the other thing that we did was we videoed or recorded in the afternoons the demonstration clinics that we were running with the children and we have left that behind for the staff to refer to as well as an ongoing training, so they were very pleased to have that as well.
LAM: And Chris, run through some of the exercises for us, like in dealing with the children, for instance. What do they do?
KENDALL: What we're aiming to do with young children like this is develop an understanding of communication and so young children with autism do not understand that often that you need to engage another person when you want something, and one of the things that you are trying to do is actually teach the children to actually come to a person when they want something. So we were demonstrating how you would do that. And one of the challenges of working with children on the autism spectrum is that they are not always interested in many of the toys and interactions that other children are, so that what you are trying to do is show what we were trying to do is demonstrate how you would actually effectively do this with the children. For those children who did understand those sorts of things or who are a little bit further down the track, we would then be using perhaps photos, so that the children would handover a photo of the toy or the item that they wanted and teaching them to come to us to do that. So part of what we were doing was demonstrating that, showing the staff how you would actually go about implementing that and then just simple interactive skills, and again it can be hard to engage children with autism, so we would demonstrating to them that these are the ways that you could do it with the children.
LAM: Well Gloria, you mentioned earlier that autism is the same, it's a universal condition, regardless of which country you are in. But were there any cultural considerations that you had to be aware of when you were in Vietnam?
STAIOS: I think one of the things that struck us in Vietnam was that the parents particularly were very anxious about their child's behaviour and autistic children can sometimes demonstrate unusual behaviours, challenging behaviours that may in fact draw other people's attention to them. And one of the things that the parents were very concerned about was how can we stop these behaviours so other people do not think that I am a bad parent, that I am not parenting properly. And because I guess the thing about children with autism is that they don't look obviously disabled or impaired and so they can just look like a very naughty little child.
LAM: I guess my next question is how aware are people in Vietnam about autism?
STAIOS: Chris?
KENDALL: There is very limited awareness of autism. It is a very much a new field.
LAM: So that would add to the difficulties as well?
KENDALL: Very much so, yes. And I think once the children reach school age, if they have difficult behaviour if they are not talking or they are clearly behind, delayed, then they have trouble accessing schools as well.
LAM: So of course, that kind of ignorance would I imagine impact on attitudes as well?
KENDALL: Very much so, yes, and I think that is why one of the aims of the program is to develop networks in the provincial areas and between Hanoi and Ho Chi Minh City, so that there is sort of more universal awareness in the country of the problems that ...
LAM: Yes, I was going to say, are they or did you see any attempts of Vietnamese of local authorities or health authorities trying to reach out to people in provinces, for instance, who might not have such easy access and to help?
KENDALL: Yes, very much so. In fact the head of the psychology department where we were had. We met her on the first day and then unfortunately she had to go into the provinces and she had to spend the next month in the provinces training the local doctors and local paediatricians in how to assess children with autism. So there is a program by the Vietnamese Government to actually develop these skills and the National Hospital of Paediatrics in Hanoi is actually very supportive of that program too.
LAM: And just to sum up, Gloria now that you have delivered this program, what now, what's the next step?
STAOIS: Well, obviously we're reporting back and we probably one of the recommendations is that we go back in may be six months to review now that they have had the training how they have been able to implement it, to just review how they are going and to perhaps then take them to the next step to see what kind of outcomes they have achieved so far, where they perhaps need to expand on their skills, where may be they need a shift in focus or some guidance to take them to the next level.
LAM: And Christine, you are looking forward to going back?
KENDALL: Oh very much so, yes, yes. We also are looking at developing protocols for the department to use in developing communication skills in children with autism.
