For the past four years, senior psychologist Rafizah Begum Mohamed, 30, has been devoting her life to working with children and adolescents suffering from a range of behavioural issues. This includes Autism Spectrum Disorder (ASD) and Attention-Deficit-Hyperactivity Disorder (ADHD).
She likens her reason for choosing this profession as a calling. Growing up with a younger brother with developmental disorders, Rafizah saw the positive impact therapists, psychologists and special needs teachers made in his life ― as well as within her family.
Eager to do the same, Rafizah made a natural instinctive decision to become a psychologist. “And I’ve not had a moment of regret!” she adds.
At Dynamics Therapy Centre for Kids where she works, Rafizah spends days conducting one-on-one therapy sessions with her young clients and their families. She does behavioural assessments, makes school visits and holds discussions with other educationists and therapists.
Rafizah zooms in on specific behavioural challenges such as toilet training, school refusal, sleep problems, picky eating, anger management, aggression, self-stimulatory behaviour* and socialisation issues.
She then customises the therapy that builds on the child’s interests, promotes self-esteem and offers the child and family a predictable schedule.
It’s tough work, but Rafizah wouldn’t have it any other way. “The self-doubts I have and the tired muscles fade away when I hear anecdotes of success from parents and teachers. Or when I see them meeting their goals for therapy. I get to the immediate consequences of my efforts. Not many people can say that about their jobs!”
What do you love most about working with children with ASD?
I work with some of the most adorable, smart, creative, curious, interesting and diverse group of children you could think of. Autism affects each child differently, and the more children I work with, the more I get to see its many facets.
During therapy, I teach skills that these individuals may use for the rest of their lives. That 4-year-old girl and her parents whom I helped toilet train has learnt the first step towards leading an independent life. It’s a skill that will remain with her for the rest of her life and I had a small part in that.
My biggest reinforcement is turning an anxious, screaming child into a calm and happy child who can communicate her wants and needs. As family interactions improve, stress levels decrease and parents feel empowered when they succeed in implementing strategies and techniques.
“The self-doubts I have and the tired muscles fade away when I hear anecdotes of success from parents and teachers. Or when I see them meeting their goals for therapy.”
What are some of the challenges you face?
The biggest challenge I have is with communication. Although children with ASD may show a wide range of language skills, their ability to communicate is almost always impaired. This means that it’s very difficult for my clients to understand my instructions.
More significantly though, because of their difficulty with expressive language skills or speech, it’s also difficult for me to understand them! This makes the initial sessions confusing, frustrating and often emotional. Over time, however, this improves. I also make it a point to always prioritise improving a child’s communication skills before working on other skills.
Another big challenge is one which is common in Singapore ― families with parents working full-time. As therapists, ideally, we wish that the parents would be able to apply all the strategies we teach at home. However, realistically, in Singapore especially, most parents are working full-time and during most parts of the day, the children are left under the care of their grandparents or domestic helpers. It’s unfair to expect the same level of commitment and understanding from these alternative caregivers.
Therefore, the extra step I usually take is to maintain regular communication with the main caregivers and parents to ensure that the strategies I teach are easily applicable and that they are not overwhelmed.
How do you approach an autism assessment?
The most important things I look into first would be the child’s physical well-being – medical history, medications, allergies plus the family and child’s history of developmental, mental or health issues.
I will also conduct a school visit and speak to the child’s teachers because it’s important to observe the presence of the behaviours across different settings. Next, I will conduct developmental and cognitive tests,followed by the diagnostic testing procedures for autism.
Subsequently, I may also recommend the parents visit a speech-language pathologist to evaluate the child’s communication and social skills and an occupational therapist, who can further evaluate the child’s sensory and motor issues.
Following the diagnostic evaluation, my team will provide the family with comprehensive feedback. This will include a written report that fully explains all test results in terms they will understand, followed by recommendations for parents on what they can do to help their child.
* Repetition of physical movements, sounds, or repetitive movement of objects common in individuals with developmental disabilities, but most prevalent in people with autistic spectrum disorders.
Read on to find out what ASD misconceptions Rafizah would like to put to rest…
What common misconceptions about ASD would you like to see changed?
There are so many! First, that children with autism are all with mental retardation. Or that all children with autism are gifted. The truth is, if you’ve met one kid with autism, you’ve only met one kid with autism. Autism really is a spectrum disorder and can range from a huge spectrum of issues.
Even within the same family, people can have different autism symptoms and still be on the spectrum. A firstborn child with autism could be completely nonverbal, have epilepsy and an IQ of 90. The other child could just be a bit quirky, spin and flap when excited and not do social situations well. Or he or she could be like Sheldon Cooper from The Big Bang Theory and be super intelligent, but have to have a gazillion rules in place to function.
One particularly insidious belief is that children with autism will be dependent on their families and the society for the rest of their lives. With this belief, they then start expressing their sympathy towards the parents, without acknowledging the challenges the child faces, nurturing the child’s independence or even treating the child as an individual.
Working with special needs kids must take a toll on you emotionally. How do you cope?
Self-care is very important for me. I do regular self-checks to ensure I’m not burning out. I speak to my colleagues and supervisors regularly to get fresh perspectives on my intervention. I take a break when I have to, such as when I feel like I am about to fall sick. I add enjoyable activities into my routines and I stick to them. It is my responsibility to give my best to my clients.
Care to share a memorable anecdote about a client?
My most memorable client was also my most challenging one to date. I was working with a non-verbal child who was exhibiting self-injurious behaviour. She would rap her forehead with her knuckles whenever she was frustrated. It got to a point where she had bruises on her forehead and callouses on her knuckles.
I collaborated with my colleague, a speech and language therapist to introduce her to PECS, a card exchange system for communication. Then I worked with her and her mother on some anger-management strategies ― detecting her anger symptoms, breathing exercises etc.
My proudest moment was something her mother shared with me recently. While waiting for her turn at a slide in a water park, her mother spotted her implementing the breathing exercises herself!
“From them [children with autism], I have learnt the virtues of patience and how the little things in life, like playing with bubbles can bring so much joy.”
What have your autistic patients have taught you?
I have been fortunate to have crossed paths with the most tenacious, strong-willed yet most loving individuals in this world. From them, I have learnt the virtues of patience and how the little things in life, like playing with bubbles can bring so much joy.
What are some things you wished people knew about an autism therapist?
As much as we wish we did, we do not have all the answers and solutions. We believe that parents are the experts of their child’s (our client’s) experience, besides our clients themselves, of course. Which is why it’s so important to work with parents as a team.
Complete these sentences…
The one superpower I would like to have is… The gift of communication. I’d love to be able to speak freely with everyone in the world, without language as a barrier.
Having autism is not the end of the world, it is instead… A test. People are tested in many different ways in life. When you strive hard and get good support from people who care, you will succeed.
I often tell my patients… That I LOVE them and am proud of them!
I am happiest when… my clients apply the skills I’ve taught them outside of our sessions. Often these come in the form of videos and pictures from very happy parents.
If I wasn’t a child psychologist/autism therapist I would be a… Traveller, or I will be working with elephants. I’ve always believed that I will only spend my time and effort in pursuit of something I truly enjoy and am passionate about.
Photos: Rafizah Begum Mohamed
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