The mental health issue we had identified, ASD, was relevant to our programme. Even though we did not handle any children diagnosed with ASD, there was a child in the group that displayed an ASD symptom: deficits in developing, maintaining, and understanding relationships (American Psychiatric Association, 2013). This looked different from my learning materials, which often suggested that children with ASD were disinterested in interaction. He threw tantrums when he did not get what he wanted. For example, there was an instance during session 2 when he wanted to be picked for the activity ‘Tempers in a Jar’. This occurred with all the children and facilitators present. After a few rounds of not being selected, he became upset and non-responsive even when we told him that he could have his turn after the current turn. The other children who were used to his outbursts looked on while we tried to coax him to rejoin.

We ended up ignoring him and continued on with our activity without his participation, waiting until he had calmed down again and was willing to engage us again. This follows the Lovaas Treatment of ASD that we had been taught in ABNPSY lectures and makes use of behavioural conditioning, where ‘high rates of aggressive and self-stimulatory behaviors were reduced by being ignored; by the use of time-out; by the shaping of alternate, more socially acceptable forms of behavior’ (Loovas, 1987). We often used this treatment throughout the programme: when he ended up having more two outbursts and intentionally popped balloons, we either ignored him again until he calmed down or explained to him the issue with his behaviour while acknowledging his feelings. The other children learnt from us: when he was upset again, another child in our group tried to persuade him to join instead of simply ignoring him or even complaining about him.
I became better at dealing with difficult children. Before the programme, I would often be unable to discipline children if they were being uncooperative as I would be hesitant to discipline and simply ignore a distressed child. However, afterwards, I understand that being firm with children on what is acceptable is crucial to building a relationship of mutual respect between a child and I so goals can be best achieved. Through this, I learnt that I am generally conflict-adverse and I need to be more assertive in nature so as to cultivate mutual respect and concern in my personal relationships, to ensure that programme goals are not compromised.

I learnt that mental health issues, especially internalizing problems such as depression, are prevalent in Singaporean children (Woo, Ng, Fung, Chan, Lee, Koh & Cai, 2007). Carter, Wagmiller, Gray, McCarthy, Horwitz and Briggs-Gowan (2010) reported that among school-age children under 9 surveyed, ‘when impairment was required, 21.6% met criteria for any disorder’. In addition, low SES is a risk factor for mental health issues among children, (American Psychological Association, n.d.) including autism (Karimi, Kamali, Mousavi & Karahmadi, 2017). I also learnt more about increased local initiatives to enroll ASD children into mainstream schools (Lim, 2016) but also how they are still excluded from their peers and may not get the support that they require (Sin, 2019). Based on these findings, I would recommend to have increased support for children with ASD in student care centres – namely, by raising awareness of autism among their children and promoting better peer support as they are often bullied for their disorder (Ministry of Social and Family Development, n.d.). For example, primary school children could be taught more about how autistic children may act and that we should not treat them as fundamentally different from others, but instead be accepting and welcoming of them.

As a result of completing this reflection:
1.    I learnt that the Lovaas Treatment and behavioural conditioning can be used to reduce problematic behaviour and promote positive behaviours in children.
2.    I learned assertiveness when I had to confront the children on negative and uncooperative attitudes. This learning of assertiveness matters because it is important to establish mutual respect in relationships in general.
 

In light of this learning, in the future I will be more upfront and assertive to build healthy balanced relationships.