ASD is characterised by difficulties in social interaction and communication and by repetitive and stereotyped behaviours. It is amongst the most frequent and severe developmental disorders. 
Sidra Medicine’s Department of Psychiatry features Child and Adolescent Mental Health, Developmental Pediatrics and Adolescent Medicine services for the diagnosis, care and treatment of children and young people with ASD including other mental health support. 
Prof Mohamed Waqar Azeem, Inaugural Chair of the Department of Psychiatry at Sidra Medicine said: “Our team is committed to providing children and their families with quality mental health services and resources. This is particularly the case for children with ASD, to ensure that our support makes them feel safe, a part of society and respected. As a specialist healthcare organisation, Sidra Medicine is involved in a number of Autism related initiatives including Qatar’s National Autism Plan as well as a working group with the World Health Organisation to develop evidence based interventions for individuals with ASD. World Autism Awareness Day is a wonderful global effort to work closely with families, partners and the wider community in helping children with ASD to reach their very best potential.”
World Autism Awareness Day was first proposed in 2007 at the United Nations (UN), by Her Highness Sheikha Moza bint Nasser, the Chairperson of Qatar Foundation and Sidra Medicine. It was adopted by the UN in 2008 as a world observance and is annually marked on the 2nd of April.


Positive parenting
Dr Fatima Janjua, Division Chief of Developmental Pediatrics at Sidra Medicine said: “This past year has been a challenging time for parents the world over, and even more so for parents of children with ASD. The pandemic has disrupted their children’s routines and had taken away their sense of stability to their schedules. However, one year on, I must applaud parents who have overcome these challenges and worked in partnership with their children. One of the biggest strengths to have come out of these relationships is the impact of positive parenting.”
Positive parenting strategies for families with children with ASD, allow the child to feel secure, loved which in turn helps in their development. The process also helps the families to handle the challenges together and not feel overwhelmed, especially when tasks and routines become a shared responsibility. 
“We want to tell parents not to be too discouraged if their child has been diagnosed with ASD. While there is no cure for Autism, there are a lot of effective therapies and programmes available, many of which can start from the home and handled by the parents themselves. Autism has a very good prognosis, and while the child may have difficulties, with the right of intervention, they can improve enormously and go on to lead relatively normal lives,” continued Dr Janjua 
Dr Madeeha Kamal, Senior Attending Physician, Adolescent Medicine at Sidra Medicine said: “It was very promising to see how many families which children with ASD thrived in developing strong bonds during the pandemic. It was an opportunity for many parents, who while being at home, spent time talking to their children and helping them develop their speaking and interactive skills.”


Early identification and intervention
The Sidra Medicine experts advised parents who notice signs of ASD in their children, to seek assessment from their healthcare centre. Early signs of ASD in babies or toddlers can include lack of awareness of their surroundings; lack of eye contact or making very little eye contact; doesn’t respond to a parent’s reaction or facial expressions; doesn’t point to objects or respond to events when pointed out by the parent.
Dr Janjua said: “In Qatar, the first step for a parent who is concerned that their child is showing signs of ASD, would be to go to their local Primary Health Care Clinic, where the paediatricians have a screening questionnaire. If the questionnaire, shows any indication that the child might have ASD, they can make a referral to see the specialists either at Sidra Medicine or Hamad Medical Corporation. The earlier the intervention, the easier for the child to catch up with schooling, language development and social interaction.”
Dr Madeeha said: “Early identification and intervention are very important and parents play a critical role in identifying the key signs even before an official diagnoses is made. Parents are encouraged to regularly engage with their child through reading, talking and activities that will help promote the development of their child’s socio-communicative skills – a process referred to as parent-mediated intervention.”


Importance of maintaining a routine
For parents with children with ASD, keeping a routine is extremely important. Dr Janjua advises the use of a visual schedule which allows the children to see what their routine will be like. 
Dr Janjua said: “For children who cannot communicate verbally or have limited means of communicating, seeing their schedule visually helps them have some structure to their day. We recommend that parents show their child how their day will look like by creating a visual calendar that breaks down their daily activities in a sequence of events through photos, pictures and colours. For example, days for school work and weekends can be clearly marked with different images or colours. This may help children to predict what to expect day by day and is a particularly useful communication tool for children with ASD.”


Understanding triggers
Children with ASD behave in challenging ways because many of them have difficulty communicating their wants and needs, which can lead to frustration. This results in the child becoming highly anxious and stressed. Many children’s behaviours are triggered by disruptions to their routines; sensory sensitivities or overload; tiredness or if they have other conditions such as epilepsy and ADHD. 
Dr Madeeha Kamal said: “Why do children with ASD behave in challenging ways? Because many of them can’t communicate their needs clearly and any change in routine can trigger them. To change their child’s behaviour, parents need to understand what is triggering or causing it. This helps both the child and the parent, in how to manage the triggers.”
“We recommend identifying the triggers and keeping a diary to record their child’s reaction and behaviour. This information can then be used to make changes. For example, prepare your child for a change to their routine by giving them a five minute notice (like a visual of a clock) and then creating a photo series that will highlight the activity,” continued Dr Kamal.


Fares’ journey of care:
Najla Fathy, whose seven year old son Fares is a patient with the Adolescent Medicine clinic at Sidra Medicine said: “When we first came to Sidra Medicine late last year, it was a very difficult and challenging time for us as a family in dealing with our son’s ASD. We had a reached a stage where we just couldn’t manage his behaviour and how disruptive he was.”
“Within five months of being a patient at Sidra Medicine and thanks to a wonderful and caring team of experts, we have seen a dramatic transformation in Fares. We can’t believe it is the same boy! He went from being aggressive and hyperactive to a child who communicates and listens and is so much calmer. We are so grateful to Sidra Medicine and particularly to Dr Madeeha Kamal, whose exemplary care in dealing with our son and us as his parents, is life-changing.”
“I also felt that the advice and support I received as a mother was immensely helpful. The feeling of frustration in the beginning of his journey left me feeling very helpless. However the team at Sidra Medicine guided me through this process, as I learnt to recognise what were Fares’ triggers to ensure he had a set routine. I am so proud of my son. He teaches me every day how to be a better parent. This has been an incredible journey of growth, understanding and acceptance for all of us.”
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