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Pembinaan Instrumen Saringan (Screening) bagi

Kanak-kanak Sindrom Asperger dan Manual

Kod Penyelidikan / Research Code : 2015-0082-107-04

Tajuk Penyelidikan / Research Title : Pembinaan Instrumen Saringan (Screening) dan Manual bagi Kanak-kanak Sindrom Asperger

Ketua Penyelidik / Principal Researcher : Assoc. Prof. Dr. Siti Rafiah Abd Hamid

Penyelidik Bersama/Co-researchers :

1) Prof. Dr Nik Ahmad Hisham Ismail

2) Assoc.Prof.Dr.Haniz Ibrahim

3) Assoc.Prof.Dr.Nik Suryani Nik Abd Rahman

2) Asst.Prof.Dr.Supiah Saad

3) Asst.Prof.Dr.Khamsiah Ismail

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Development of Screening Instrument and Manual for

Children with Asperger Syndrome (ISSAKKM / SIMCAS)

Final Inception Report

Prepared by

SIMCAS Team

International Islamic University Malaysia (IIUM) & Sultan Idris Education University

(UPSI)

Table of content Page

Chapter 1:

1.0 Introduction 5

1.1 Executive summary 6

Chapter 2:

Overview of Literature Review 8

2.0 Background 9

2.1 Parental Awareness 9

2.2 Characteristics of Autism 10

2.3 Asperger Syndrome 11

2.4 Importance of Early Intervention 15

2.4.1 Benefits of Early Intervention 15

2.4.2 Early Childhood 15

2.5 Special Education 17

2.6 Effectiveness of Early Intervention 20

2.7 Diagnosis & Proposed Intervention of Asperger

Syndrome 24

2.8 The Problem Statement 29

2.9 The Proposed DSIMCAS 30

2.10 Objectives of DSIMCAS 32

2.11 Scope of Study 33

2.12 Research Objectives 33

2.13 Study Framework 34

Chapter 3:

3.0 Introduction 35

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3.1Research Methodology 35

3.2 Sampling Procedures & Data Collection 36

3.3 Data Analysis – Framework 36

3.4 Scope of Final Report 37

3.5 DSIMCAS Team 38

3.6 Research Team 38

3.7 Project Steering Committee 38

3.8 Pilot Study for SIMCAS 38

3.8.0 Introduction 38

3.8.1 Domains & Constructs 38

3.8.2 Pilot Study 40

3.8.3 Reliability Estimates of the ISSAKKM / SIMCAS 41

3.8.4 Means & Standard Deviation of Measures 42

3.8.5 Validity of ISSAKKM / SIMCAS items 43

3.8.6 Face Validity 43

3.8.7 Content Validity 43

3.8.8 Construct Validity 44

3.8.9 Summary of Analysis 45

Chapter 4:

4.0 Findings from Focus Group Discussion (FGD) 46

4.1 Difficulties in Identifying Asperger Syndrome & Other

Disorders 48

4.1.0 Students’ Attitude 48

4.1.1 Teacher’s Knowledge of AS & Type of Disorders 49

4.1.2 Useful Information from other sources 51

4.1.2.0 Parents as the source of information 52

4.1.2.1 Subjects learnt – source of information 52

4.1.2.2 Cultural Belief & Practices –

source of information 53

4.2 Least Exposure to Instruments 54

4.2.0 Unfamiliar to any related instruments 54

4.2.1 The Need for ISSAKKM / SIMCAS 55

4.3 RQ2 - Findings from Confirmatory Factor Analysis – CFA 56

4.3.0 Validating Social Interaction & Language

Difficulties Constructs 58

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4.3.1 Validating Cognitive Difficulties 61

4.3.2 Validating Senses Sensitiveness 63

4.3.3 Validating Limited Interests & Rigidity in

Daily Routines 65

4.3.4 Validating Motor Skills Difficulties 69

4.4 RQ3 – Estimating the Prevalence Rate of Asperger syndrome

among Malaysian mainstream children 71

4.4.0 Setting the ISSAKKM / SIMCAS Benchmark 72

4.4.1 Reliability & Validity of ISSAKKM / SIMCAS 74

4.4.2 Benchmark for ISSAKKM / SIMCAS 74

4.5 Summary of Findings for RQ1, RQ2 & RQ3 75

Chapter 5: Discussion & Recommendations 77

5.0 Introduction 77

5.1 Limitations & Delimitations 79

5.2 Future Research 80

List of Figures:

Figure 1: Overview of DSIMCAS 31

Figure 2: The Framework of the Study 35

Figure 3: Limited Interests & Rigidity in Daily Routines 69

List of Tables

Table 1.0: Social Interaction & Communication. 14

Table 2.0: DSIMCAS Components 31

Table 2.1: ISSAKKM / SIMCAS Benefits to ECE Field. 32

Table 2.2: Examples of ISSAKKM / SIMCAS Reporting 32

Table 3.0: Sampling Procedure & Data Collection 36

Table 3.1: Domains, Constructs & Items in ISSAKKM / SIMCAS 39

Table 3.2: Internal Consistency Validity – ISSAKKM / SIMCAS

Domains for pilot study 1 & 2 42

Table 3.3: Means & Standard Deviation for the Six (6)

Domains 42

Table 3.4: IDEAS Autism Centres & Tadika Bitara –

Pilot Study 1 44

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Table 3.5: NASOM Centres – Pilot Study 2 45

Table 4.0: Findings for Thematic Analysis for

Research Question 1 – RQ1 47

Table 4.1: General Findings for RQ1 47

Table 4.2: Difficulties in Identifying Asperger Syndrome 48

Table 4.3: Useful Information from other resources 52

Table 4.4: Effects of Exposure to Experiments 54

Table 4.5: Domains & Constructs Undertaken by the study 57

Table 4.6: Factor Loadings 59

Table 4.7: Correlations Across Factors/Constructs 60

Table 4.8: Confirmatory Factor Analysis -CFA (Group 1 & 2) 61

Table 4.9: CFA – Analysis for Cognitive Issues 62

Table 4.10: CFA - Cognitive Issues - Goodness of fit measures

Across two groups 63

Table 4.11: CFA – Senses Sensitiveness 64

Table 4.12: Correlations Across Constructs – Senses

Sensitiveness 64

Table 4.13: Goodness of fit – Senses Sensitiveness 65

Table 4.14: Limited interests & Rigidity in Daily Routines 66

Table 4.15: Correlation Across Limited interests & Rigidity

in Daily Routines 67

Table 4.16: Correlations Across Motor Clumsiness Construct 70

Table 4.17: Goodness of Fit – Motor Clumsiness 70

Table 4.18: ISSAKKM / SIMCAS Internal Consistency 75

Table 4.19: Determining Criteria & Potential AS via ISSAKKM /

SIMCAS 75

References: 81

Appendixes:

Sample of ISSAK / SIMCAS 87

Note:

ISSAKIM stands for the name of screening instrument in Bahasa Malaysia and

SIMCAS is the English version

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Chapter 1

1. Introduction

Development of the screening instrument and manual for Children with Asperger

Syndrome (DSIMCAS) is an EPU funded project to produce user-friendly documents for

the screening of Asperger’s Syndrome for children at an early age (5 years old and

below). The purpose of this inception report is to simplify the objectives, methodology,

and scope of the final report and research team of this study. A group of experts, relevant

stakeholders and assistant researcher for preliminary conceptualization of DSIMCAS is

set out for implementation of the study.

1.1 Executive summary

Children with Asperger syndrome (high-functioning autism spectrum disorder) develop

into adulthood along diverse paths, and some often experience problems in school or

occupational settings despite their high intellectual or language abilities. Better quality

of life was associated with factors such as suitable medication, mother’s support and

early diagnosis, while poorer quality of life was associated with the presence of

aggressive behaviors. In line with the development of special education programmes for

children with special needs, early detection of asperger syndrome cases could help the

ECCE program provider to cater for early intervention program for children with

asperger syndrome. Early intervention serves as a meaningful starting point in providing

an appropriate program for children with asperger syndrome.

This study will utilize the mixed method approach. In the initial stage instrument

development (items/variables development) the qualitative approach (interviews) was

employed with clinical experts in this area in order to gauge variables affecting asperger

syndrome and as well as the asperger syndrome attributes. Series of observation were

conducted on children at the age of five (5) and below at Permata Childcare Centres and

other centers established by goverment agensies as well as private schools. The end

product or contribution of this research is the validated instrument for screening asperger

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syndrome based on the Malaysian experience and subjects and as well as the

development of Malaysian asperger syndrome manual which can be referred to by special

needs practitioners in the Malaysian context.

The establishment of this instrument/questionnaire and interview protocol (focus group

purposes), special needs educators and child caretakers will create awareness of this

problem among children at the preschool level. Such awareness will enable teachers and

childcare takers to select suitable teaching-learning strategies and resources. Teachers

will also be capable of catering the emotional and social needs of these children. As for

serious Asperger cases, these potential cases will be referred to the medical practitioners.

Standardized screening instrument for AS have been developed in other countries and

they are not exactly suitable because of cultural differences. So far not many (if any),

screening instrument for early detection of Asperger syndrome based on the Malaysian

norms can be found in Malaysia. As such this study is important and pertinent to child

caretakers and teachers so that they will be able to ascertain that these children’s

emotional and social needs are met.

This study was lead by Dr Supiah Saad initially and later taken over by Dr Siti Rafiah

Abd Hamid later on due to inevitable circumstances. This team is supported by a host of

experts which include psychologists, early childhood professional, clinical psychologists

and special education profesional from IIUM and UPSI. The objectives of this study are

to develop items for the instruments and validate the instrument for screening children

with Asperger syndrome (SIMCAS) below 5 years old. The other objective is to generate

comprehensive and integrated report for policy makers and intervention / programme

providers as well as to provide insights of the degree of AS related behaviors in children

at five years old and below based on statistical data and qualitative data.

The objectives of having SIMCAS which is reflective of DSIMCAS study:

1. To explore preschool educators’ knowledge, skills and awareness related to children

with Asperger Syndrome.

2. Identify the capability of SIMCAS in assisting educators and childcare takers in

screening children with Asperger Syndrome develop and validate SIMCAS

(develop and validate SIMCAS)

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3. discover the prevalence rate of potential Asperger syndrome in Malaysian children

aged 5 and below.

4. Outreach information related to Asperger syndrome to educators/caregivers

An instrument will be developed and is known as the Screening Instrument and Manual

for Asperger Syndrome (SIMCAS). It will be validated before the real data collection.

This instrument may be regarded as one of the significant contribution of this study.

Since this study is based on broad field work procedures, the methodology used may

contribute some background for further inquiry by researchers who are interested in

special needs education.

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Chapter 2

Literature Review

2.0 Background

Asperger syndrome is part and parcel of the pervasive developmental disorder. It

resembles the classic autistic pattern of behavior. However, children with Asperger

syndrome exhibit high cognitive ability and verbal communication ability together with

the selected area of communication (based on their interest). According to Teitelbaum,

Benton, Shah, Prince and Kelly (2004); Russel and Sofronoff (2005); and Moyes (2002)

children with Asperger syndrome typically have normal or high IQ but they lacked

emotional intelligence and social skills. Most of these children were found as high

functioning children however the Asperger symptoms deter them from achieving

optimum level of performance in school. As a result, these symptoms sometimes overlap

with the expected developmental milestone of any typical child. As reported in many

literatures, late detection results in the children deprived the rights to get special

education provision in mainstream classroom. As such the screening tool based on

Malaysian norms necessary to identify the attributes and subject to diagnosis by the

qualified personnel. Once diagnosed, these children can be referred to MOE for

educational provisional suitable for their needs. In April 2012, a proposal was submitted

to seek funding allocation to carry out this study. However due to inevitable

circumstances, the real study was embarked in July 2015.

2.1 Parental Awareness

Parents are experts on their own children and nobody else would. If parents suspect that

there is something wrong about the child, they are on the right track in seeking

professional help. On the contrary, figuring what the real underlying problem is may be

a problem for many parents and as well as where to get professional help. The difficulty

is often in working out what the problem might be, how serious it is and with whom to

check out your worries. Most parents would discuss these anxieties with their family and

friends instantly and later consult a health professional (such as a health visitor or doctor)

if their concerns still remained. Often parents are reassured and, either quickly or

gradually, the behaviours that were of concern to us disappear. If the child’s behaviour

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display a recurring pattern, parental worries may remain. In most cases, most parents may

need to consult a health professional again.

2.2 Characteristics of Autism

Autism Spectrum Disorder (ASD) is a developmental disorder that normally becomes

evident in the first three years of a child’s life (Williams & Wrights, 2004). Current

estimates are that ASD including all the spectrum diagnoses occurs in approximately two

to seven per 1000 person. It is about one-tenth of this for the severe end of the autism

spectrum. This varies depending on which research you read and also in which countries

the research was carried out; it is also probably to do with the way diagnosis is made and

the criteria used. It is about three to four times more common in boys than in girls. ASD

affects communication, social interaction, imagination and behaviour. It is not something

a child can catch. Parents do not cause it. It is a condition that carries on into adolescence

and adulthood. However, all children with ASD will continue to continue to make

developmental progress and there is a great deal that can be done to help.

The children with autistic personality disorder and remarkably perceptive description of

the children’s difficulties and abilities; delayed and some aspects of their social abilities

were quite unusual at any stage of development; had difficulty making friends and they

were often teased by other children; impairment in verbal and non-verbal

communication, especially the conversation aspects of language (Attwood, 2007). The

children’s use of language was pedantic, and some children had an unusual prosody that

affected the tone, pitch and rhythm of speech.

Autism Spectrum Disorder is the term that is currently used to describe the broad range

of pervasive developmental disorders. These disorders include Autistic Disorder,

Aspergers Disorder (also referred to as Asperger's syndrome), Rett's Disorder, Childhood

Dis-integrative Disorder, and Pervasive Developmental Disorder Not Otherwise

Specified (PDD-NOS (Dawson & Toth, 2006). According to the researchers, Autism

spectrum disorders involve impairments in reciprocal social interaction and

communication and the restricted, stereotyped, and repetitive interests and behaviors. Of

these three symptom domains, impairments in social interaction are considered a primary

feature of these disorders. These impairments include a lack of social and emotional

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reciprocity; atypical nonverbal behaviors such as atypical eye-to-eye gaze, facial

expressions, body postures, and gestures to regulate social interaction; lack of interest

and/or difficulty relating to others, particularly peers; and a failure to share enjoyment

and interests with others. A great deal of heterogeneity exists among the Autism spectrum

disorders in terms of the number and severity of symptoms across the three domains

(social, communication, and stereotyped/restricted interests and behaviors) and in

cognitive and adaptive functioning. Further, within each diagnostic category,

impairments differ across individuals and, for any given individual, symptoms may

change across the life span.

Autism is a severe, chronic development disorder, involving marked retardation of

aptitudes for social interaction, communication and play. The detection of autism and

other general developmental disorders in very young children is quite difficult since

delayed development may not be identified until the child is given the opportunity to

interact in social environments other than the family setting. In addition, at the most

severe levels, the differential diagnosis between autism and mental retardation is more

difficult, especially among children of preschool age (de Bildt, Sytema, Ketelaars,

Kraijer, Mulder, Volkmar, & Minderaa. (2004). As in autism, Asperger syndrome shows

impaired reciprocal social interaction and restricted, repetitive or stereotyped patterns of

behavior, interests and activities. Unlike autism, intellectual ability and syntactical

speech are normal (Berney, 2004).

2.3 Asperger’s Syndrome

Parent of a young child with Asperger’s Syndrome often question if their child’s

behaviour and is within the “normal” range. The world of the young child is a rich and

complicated place with so many things happening developmentally. Given the

complexities of the world of the young child, we feel that it is important to develop a

shared understanding of the developmental tasks salient at this age. What can make this

time period both rewarding and challenging for parents, teachers and children in that the

children are undergoing major charges at varying rates in differing areas of development

(Leventhal-Belfer & Coe, 2004). With this in mind we will examine the developmental

task which are characteristic of the Asperger’s such as sensory-motor development,

communication, cognition, play, emotional and social functioning, relationships with

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caregivers and peers and the child’s capacity to cope with stressful events.

The characteristics that define Asperger's Disorder include intact formal language skills

(e.g., vocabulary, grammar), with impairments in the social use of language and in

nonverbal expression, social awkwardness, and idiosyncratic and consuming interests

(Volkmar & Klin, 2001). Although motor clumsiness is not a defining feature of

Asperger's Disorder, it is often observed (Volkmar & Klin, 2001). The DSM-IV

diagnostic criteria for Asperger's Disorder include at least two symptoms in the domain

of social interaction and one symptom in the domain of restricted interests and behaviors.

Further, individuals with Asperger's Disorder do not demonstrate clinically significant

delays in general cognitive ability, self-help skills, and adaptive development (Dawson

& Toth, 2006). Differentiating Asperger's Disorder and high-functioning Autism is often

difficult to do clinically, and the empirical validity of such a distinction has not yet been

unequivocally established (Ozonoff & Griffith, 2000; Volkmar & Klin, 2001). Asperger's

Disorder was included as a separate diagnostic category only in the more recent revisions

of the DSM IV and ICD-10 classification systems, and epidemiologic data on this subtype

of Autism Spectrum Disorder are scarce. The first systematic epidemiologic study of

Asperger's Disorder was conducted in Sweden and yielded a prevalence rate of 28.5 per

10,000 (Ehlers & Gillberg, 1993).

In a review of epidemiology surveys, Fombonne and Tidmarsh (2003) concluded that the

number of children with Autism was five times that of children with Asperger's Disorder,

on average, suggesting that the prevalence of Asperger's is approximately two per 10,000.

The authors note that future studies should focus on slightly older children (ages 8 to 12

years) as Asperger's Disorder is often diagnosed much later than Autism. According to

Fombonne and Tidmarsh (2003), Asperger syndrome (AS) is a developmental disorder

that is marked by:

i.limited interests or an unusual preoccupation with a particular subject to the

exclusion of other activities

ii.repetitive routines or rituals

iii. peculiarities in speech and language, such as speaking in an overly formal manner

or in a monotone, or taking figures of speech literally

iv.socially and emotionally inappropriate behavior and the inability to interact

successfully with peers

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v.problems with non-verbal communication, including the restricted use of gestures,

limited or inappropriate facial expressions, or a peculiar, stiff gaze clumsy and

uncoordinated motor movements

Asperger syndrome is an autism spectrum disorder (ASD), one of a distinct group of

neurological conditions characterized by a greater or lesser degree of impairment in

language and communication skills, as well as repetitive or restrictive patterns of thought

and behavior. Other ASDs include: classic autism, Rett syndrome, childhood dis-

integrative disorder, and pervasive developmental disorder not otherwise specified

(usually referred to as PDD-NOS).

Parents usually sense there is something unusual about a child with AS by the time of his

or her third birthday, and some children may exhibit symptoms as early as infancy.

Unlike children with autism, children with AS retain their early language skills. Motor

development delays – crawling or walking late, clumsiness – are sometimes the first

indicator of the disorder. The incidence of AS is not well established, but experts in

population studies conservatively estimate that two out of every 10,000 children have the

disorder. Boys are three to four times more likely than girls to have AS.

Studies of children with AS suggest that their problems with socialization and

communication continue into adulthood. Some of these children develop additional

psychiatric symptoms and disorders in adolescence and adulthood. Although diagnosed

mainly in children, AS is being increasingly diagnosed in adults who seek medical help

for mental health conditions such as depression, obsessive-compulsive disorder (OCD),

and attention deficit hyperactivity disorder (ADHD). No studies have yet been conducted

to determine the incidence of AS in adult populations. (Available at:

http://childdevelopmentinfo.com/child-psychology/autism-aspergers/asperger/).

Asperger syndrome comes not only with its own characteristics, but also with a wide

variety of comorbid conditions such as depression, anxiety, obsessive–compulsive

disorder, attention-deficit hyperactivity disorder (ADHD) and alcoholism, and

relationship difficulties (including family/marital problems). It may predispose

individuals to commit offences and can affect their mental capacity and level of

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responsibility as well as their ability to bear witness or to be tried (Tantam, 2003). The

syndrome can color psychiatric disorder, affecting both presentation and management,

for children and adults across a wide range of functional ability. Families have taken an

active legalistic approach, alleging misdiagnosis and mistreatment and demanding clarity

as to the relationship between Asperger syndrome and other diagnostic concepts. The

characteristics of Asperger syndrome in adulthood (Gillberg, et al. 2001) which includes

at the childhood onset are listed in Table 1.0 below:

Table 1.0: Limited Social Relationship

No. Social Relationship

i. Few/no sustained relationships; relationships that vary from too distant to too

intense

ii. Awkward interaction with peers

iii. Unusual egocentricity, with little concern for others or awareness of their

viewpoint; little empathy or sensitivity

iv. Lack of awareness of social rules; social blunders Problems in communication

v. An odd voice, monotonous, perhaps at an unusual volume

vi. Talking ‘at’ (rather than ‘to’) others, with little concern about their response

vii. Superficially good language but too formal/stilted/pedantic; difficulty in

catching any meaning other than the literal

viii. Lack of non-verbal communicative behavior: a wooden, impassive appearance

with few gestures; a poorly coordinated gaze that may avoid the other’s eyes or

look through them

ix. An awkward or odd posture and body language Absorbing and narrow interests

x. Obsessively pursued interests

xi. Very circumscribed interests that contribute little to a wider life, e.g. collecting

facts and figures of little practical or social value

xii. Unusual routines or rituals; change is often upsetting

Asperger syndrome, a form of autism with normal ability and normal syntactical speech,

is associated with a variety of comorbid psychiatric disorders. The disorder is well known

to child psychiatry, and we are beginning to recognize the extent of its impact in

adulthood. The article reviews the diagnosis and assessment of Asperger syndrome and

its links with a wide range of psychiatric issues, including mental disorder, offending and

mental capacity. It also describes the broader, non-psychiatric management of Asperger

syndrome itself, which includes social and occupational support and education, before

touching on the implications the disorder has for our services (Berney, 2004).

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2.4 Importance of early intervention

2.4.1 Definition of early intervention

Early intervention is defined as the experience and opportunities afforded infants and

toddlers with disabilities by the children’s parents and other primary caregivers that are

intended to promote the children’s acquisition and use of behavioural competencies to

shape and influence their pro-social interactions with people and objects (Dunst, 2007).

There three principles that guide the ways in which early intervention is operationalized

and practiced such as principle 1: The experiences and opportunities afforded infants and

toddlers with disabilities should strengthen children’s self-initiated and self-directed

learning and development to promote acquisition of functional behavioural competencies

and children’s recognition of their abilities to produce desired and expected effects and

consequences; principle 2. Parent-mediated child learning is effective to the extent that

it strengthens parents’ confidence and competence in providing their children with

development-investigating and development-enhancing learning experiences and

opportunities; and principle 3. The role of early-intervention practitioners in parent-

mediated child learning is to support and strengthen parent capacity to provide their

children with experiences and opportunities of known qualities and characteristics (i.e.,

evidence based) that are most likely to support and strengthen both parent and child

capacity.

2.4.2 Early childhood and the Malaysian Experience

Malaysia has always place great effort in ensuring education and care for all children.

These efforts are manifested through the many sectors involving in ECCE and the amount

of allocation given to ECCE each year. ECCE in Malaysia is broadly divided into two

main groups, which is the 0-4 years old and the 4-6 years old. In Malaysia, early

childhood care and family development is the jurisdiction of the Ministry of Women,

Family and Community Development (MWFCD). MWFCD is the coordinator for

national programs on the growth and development of children. Through its Department

of Social Welfare, MWFCD registers all Childcare centers (TASKA, an acronym in the

local language). TASKA offers care and education for children in the age group of 0-4

years old (Ministry of Education Malaysia (2007).

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Early childhood education for the 4-6 years old group falls under the responsibilities of

three Ministries, i.e. Ministry of Education, Ministry of Rural and Regional

Development, as well as Department of National Unity and Integration under the Prime

Minister Department. Ministry of Rural Development is the pioneer in setting up

preschools in Malaysia (beginning early 1970‟s), currently there are 8307 preschools set

up by this Ministry which are commonly known as the KEMAS preschool. KEMAS

preschools are located in rural or suburban and are set up based on request by the local

authority. In the late 1970‟s Department of National Unity and Integration set up

preschools in the urban areas where there are, Rukun Tetangga’, a friendly neighborhood

scheme, these preschools are generally known as the PERPADUAN preschools,

PERPADUAN preschools must accept students from the different races, currently, there

are 1496 PERPADUAN preschools.

Ministry of Education (MOE) is the latest in setting up preschools. In the year 1992,

preschool was set up by MOE in the form of pilot project as an annex to the existing

primary school, in the year 2003, MOE preschool project was rolled out to whole nation;

currently there are 5,905 of these preschools which are situated all over the country. Other

than MOE, KEMAS and PERPADUAN, other providers of preschool education include

also the State Religious Department (JAIN) and the Islamic (ABIM). There are various

kinds of childcare centers in Malaysia, these centers are generally named as TASKA.

Categories of childcare centers found in Malaysia are as Government own childcare

center (TASKA dalam komuniti) (since 2006); Workplace childcare center; Institutional

childcare center; Plantation childcare center; and Home based childcare center

(Gallagher, Clifford, & Maxwell, 2004).

The development, care, and education of children from birth to age 5 has been the focus

of rapidly increasing public interest, and numerous early childhood public policy

initiatives have focused attention on a major problem of coordination and collaboration

of services for young children. Four segments of services for young children—(1) child

care, (2) Head Start, (3) services for children with disabilities, and (4) preschool

programs—have all been major players in providing services for differing, and

sometimes overlapping, populations of young children.

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Each group has a similar mission: to help children (most often with special needs or

limited opportunities) master the skills and knowledge needed to adapt effectively to

kindergarten at age 5. Each group has its own history and has developed more or less

independently of the others. Because the groups developed independently, they have

overlapping personnel preparation programs, evaluation efforts, and data systems. This

paper explores some strategies for moving from independent and overlapping services

toward a seamless system of early child care and nurturance provided by these four

diverse players (Gallagher, Clifford & Maxwell, 2004). Voluntary collaborations between

these players seem unlikely because of self-interest and bureaucratic challenges. Barriers

to reform exist in institutional, psychological, sociological, economic, political, and

geographic domains. This paper proposes that four engines of change namely legislation,

court decisions, administrative rule making, and professional initiatives - be energized to

move toward a seamless system. Such collaboration can begin by merging support

systems such as personnel preparation, technical assistance, and evaluation. The paper

concludes with specific recommendations for achieving an integrated early childhood

system.

2.5 Special Education in Malaysia

Cabinet Committee Report 1979 stated that special children education is the responsibility

of the government and NGOs are to be involved in this endeavour (Ministry of Education

Malaysia, 2007). Education for the special children are taken care of by both the Ministry

of Woman, Family and Community Development as well as the Ministry of Education.

Ministry of Education is in charge of program in the special schools and also in the special

integrated primary schools for children. Ministry of Woman, Family and Community

Development will be in charge of the other special programs. Since 2000, the existing special

schools then have started early intervention program for the 4-6 age group on their own

initiative (Ministry of Education Malaysia, 2007). These programs run without any

allocation or training for the teachers specifically to teach preschool. In the year 2003, MOE

has approved the conversion of these early intervention programs in the 28 special schools

to preschool programs for special need children.

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These 28 programs made up of 22 for the hearing impaired, 5 for visually impaired and 1 for

learning disability The program run by the Department of Social Welfare, Ministry of

Woman, Family and Community Development are specially for the severely disabled

children. The purpose is to enhance the quality of life of these people. The National Welfare

Policy and National Social Policy has been introduced to serve this purpose. There are also

special grant given to the NGO‟s to help run these special programs for special children

below four (4) years old.

We now know that professionals can diagnose children with autism when they are as

young as 2 years of age (Lord, 1995). Screening and the role of the pediatrician have

become even more critical as we have recognized the stability of early diagnosis over

time and the importance of early intervention. At this point, experts working with

children with autism agree that early intervention is critical (Corsello, 2005). There is

professional consensus about certain crucial aspects of treatment (intensity, family

involvement, focus on generalization) and empirical evidence for certain intervention

strategies.

However, there are many programs developed for children with autism that differ in

philosophy and a lack of research comparing the various intervention programs

(Corsello, 2005). Most of the programs for children with autism that exist are designed

for children of preschool age, and not all are widely known or available. While outcome

data are published for some of these programs, empirical studies comparing intervention

programs are lacking. In this review, existing intervention programs and empirical studies

on these programs will be reviewed, with a particular emphasis on the birth to 3 age

group.

There has been a dramatic rise in the number of children being diagnosed with autism

spectrum disorders (ASD), which has led to increased attention paid to assessment and

intervention issues (Koegel , Koegel , Ashbaugh & Bradshaw, 2014). This manuscript

agrees with Camarata (2014) that the evidence base for early assessment and intervention

should be expanded. However, it disagrees with Warren et al. (2011) assumption that

there are not empirically validated early interventions. Reliable diagnosis has been

documented during infancy and toddler hood, and evidence suggests that the earlier the

onset of intervention, the greater likelihood of an improved developmental trajectory.

19

It is argued that early intervention is more costly and time efficient than a “wait and see”

approach. With regard to published studies, the large amount of heterogeneity in the ASD

population supports the use of rigorous single case experimental design research. It is an

error to limit empirical evidence for treatments to only randomized clinical trials, which

have the weakness of masking individual differences.

Single case experimental designs examine the effects of intervention beyond typical

maturation by allowing for clear estimations of developmental trajectories prior to the

onset of intervention, followed by evaluation of the impact of the intervention. This

commentary discusses the short- and long-term benefit ts of early diagnosis and

intervention.

According to Dawson and Toth (2006) some parents of children whose children are

disgnosed with Autism Syndrome were concerned about their child's development since

birth, and, by 18 months, most parents raise concerns with their primary health care

provider (Howlin & Asgharian, 1999; Rogers, 2001; Siegel, Pilner, Eschler, & Elliot,

1988). However, the age at which a diagnosis is confirmed tends to be much older. In a

survey of 770 parents of children with Autism and Asperger's Disorder, the average age

at which a formal diagnosis was confirmed was 5.5 years for Autism and 11years for

Asperger's Disorder (Howlin & Asgharian,1999). Refining methods of early

identification and diagnosis allows for early intervention and better outcomes for young

children with these disorders

Early social and language input is critical for normal brain development (Dawson & Toth,

2006). If Autism can be identified early and intervention can begin during the first few

sensitive years of life, there is the greatest potential for having a significant impact on

the developing nervous system and improved social and behavioral outcomes for children

with Autism (G. Dawson Ashman, et al., 2000; Rogers, 1998).As summarized by G.

Dawson and Osterling, Green, Brennan, and Fein (2002), Rogers, and the National

Research Council (2001), although intervention approaches have varied across different

outcome studies, most have several features in common:

20

i. A focus on the curriculum domains of attention, imitation, language, toy play,

and social interaction;

ii. Programs that incorporate developmental sequence;

iii. Teaching strategies that offer a high level of support for the child, many of which

rely on principles of applied behavioral analysis (see later discussion);

iv. Specific strategies focused on reducing interfering /problem behaviors;

v. A high level of involvement of parents;

vi. Careful transitioning from one-to-one teaching to small groups;

vii. Highly trained staff;

viii. High levels of supervision of therapists;

ix. Intensive intervention consisting of about 25 hours a week of structured

intervention lasting for at least 2 years; and

x. Onset of intervention by 2 to 4 years.

2.6 Effectiveness of early intervention

There has been a heated debate over the last several decades about when the education

of young children should begin, with many researchers claiming the growth and

development starts at birth or even during the prenatal period. Regardless of the earliest

starting point, scientists who carry out brain development research have at least

concurred with one key finding: learning during the early years is critical (Lee & Hayden,

2009). The consensus seems to be that early exposure to learning experiences in a

stimulating environment will lead children to perform better in primary schools. In time

these individuals become more productive, healthier citizens in democratic society (Lee

& Hayden, 2009). Researchers have determined that the long-term effect of early learning

and education can be observed in all children with varying abilities, including those with

or at risk of developmental delay.

This movement in education has been almost universal. Many developed countries have

begun to turn their attention to “very early” education of children from birth to pre-

primary ages. By drawing on a variety of funding resources, effort have focused on

generating and choreographing various early childhood education programs. The

introduction of universal preschool programs in North American and West European

countries is one example. In addition, more early childhood professionals have involved

21

families and communities in order to improve quality care and development of young

children especially from birth through age three. Due to the proliferation of the variety

of such programs it has become critical to ensure program quality and administration.

In accordance with the recent change in the climate of early childhood education, this

trend seems to be spreading to developing countries as well. According to UNESCO the

global pre-primary gross enrolment ratio grew from 33% to 40% between 1999 and 2005

(United Nations Educational Scientific and Cultural Organization (UNESCO), 2008).

The data confirms that more countries are advocating the compulsory pre-primary

education programs of 5-year-old children, specifically before their entrance into formal

primary education. In addition, these developing countries have further expanded their

public childcare, family and social and welfare services. These services target lower-

income families and working parents as well as private early childhood programs in

urban cities for families with more resources.

The primary goals of early intervention for children with developmental disabilities or

delays are to enhance the quality of life for individual children and their families and to

increase opportunities for developmental progress (Lee & Miller, 2009). In Washington,

the Infant Toddler Early Intervention Program (ITEIP) provides a framework for services

for children with developmentally disabilities and developmental delays, aged birth to

three. ITEIP is governed under the federal Individuals with Disabilities Education Act

(IDEA), Part C, which enables states to receive federal funding to “maintain and

implement a statewide, comprehensive, coordinated, multidisciplinary, inter-agency

system to provide early intervention services for infants and toddlers with disabilities and

their families”. Through the ITEIP program, children and their families may receive a

variety of individualized services, depending on a child’s needs. These services can

include:

i. Assistive technology devices and services

ii. Audiology (hearing)

iii. Occupational therapy

iv. Family resources coordination

v. Family training, counseling, and home visits

vi. Medical services only for diagnostic or evaluation purposes

22

vii. Nursing services

viii. Early identification, screening, and assessment

ix. Physical therapy

x. Psychological services

xi. Social work services

xii. Special instruction

xiii. Speech-language pathology

xiv. Transportation and related costs necessary to enable receipt of early

intervention services

xv. Vision services

Services for infants and toddlers are funded through public education, county human

service agencies, and the Department of Health. In addition, Medicaid funds and military

and private health care coverage are often utilized for these services (Lee & Miller, 2009).

ITEIP is the payer of last resort. The aim of ITEIP is to reduce the need for special

education services when the child becomes three years old.

According to ITEIP records, 27 percent of the children who transitioned out of early

intervention services from October 2007 through September 2008 did not need special

education at age three.

Research on interventions for infants and toddlers with developmental disabilities is

limited. Most studies on early intervention focus on “at-risk” populations, such as infants

in impoverished families, or those biologically at-risk (e.g., born pre-term or at a very

low birth weight). Well-controlled comparison group studies have shown long-term

educational, economic, and other societal benefits of some early intervention programs

for these at-risk populations Ethical and legal considerations may pose obstacles to the

study of treatments for infants and toddlers with developmental disabilities.

In some instances, these obstacles can be overcome when opportunities for comparison

group research naturally arise. For example, there may be insufficient resources to treat

all children with a particular intervention. A researcher could randomly assign clients to

a “treatment” group or to a “service as usual” group, measure the clients at intake, then

23

track the outcomes of both groups over time. Alternatively, clients could be randomly

assigned to a waiting list to receive the treatment at a later time. Research as devised

above would enable researchers to draw conclusions about the relative efficacy of

different interventions

Focused development of early childhood education programs is now in demand. The

general disposition is that the age-scope of early childhood education should extended

from preschool and pre-primary ages to all young children from birth. Due to the wide

gap among these young children development and learning, a variety of childcare and

educational models has been proposed in all countries (Gallagher, Clifford, & Maxwell,

2004). Bearing in mind the importance of family involvement in this age group, there is

an ongoing reification of programs that are family-based, community-based, or parenting

education programs versus traditional center-based preschool programs.

Furthermore, instead of replicating the program models from developed countries, these

developing countries’ programs tend to consider the individual families’ culture and

background (Gallagher, Clifford, & Maxwell, 2004). For example, it is acknowledged

that families in many Middle Eastern and Asian countries particularly favor home-based

childcare services rather than center-based services until children are provided with

compulsory primary education (UNESCO, 2008). Thus, the great need of early childhood

care and education programs should not overshadow the method used. Actual

implementation should be carefully planned based upon each country’s culture, rather

than counting on the idea and belief projected by developed countries’ research.

This study investigated the unique contributions of joint attention, imitation, and toy play

to language ability and rate of development of communication skills in young children

with autism spectrum disorder (ASD). Sixty preschool-aged children with ASD were

assessed using measures of joint attention, imitation, toy play, language, and

communication ability (Toth , Munson, Meltzoff & Dawson, 2006). Two skills, initiating

proto declarative joint attention and immediate imitation, were most strongly associated

with language ability at age 3–4 years, whereas toy play and deferred imitation were the

best predictors of rate of communication development from age 4 to 6.5 years.

24

The implications of these results for understanding the nature and course of language

development in autism and for the development of targeted early interventions are

discussed. the results of the present study shed light on the relationship between early

skill domains and the development of language and communication in young children

with autism, and suggest specific targets for early intervention (Toth , Munson, Meltzoff

& Dawson, 2006). Early abilities involved in social exchange and communication,

namely, joint attention and immediate imitation, appear to be important for setting the

stage for early language learning in autism, while representational skills, demonstrated

through toy play and deferred imitation, contribute to the continued expansion of

language and communication skills over the preschool and early school age years. Each

of these skill areas represents an important target for early intervention programs that

promote communicative competence and improved outcomes for young children with

autism.

2.7 Diagnosis and Proposed Interventions of Asperger syndrome

Clinical and practical knowledge about Asperger syndrome is accumulating, but we do

not yet know how frequent Asperger syndrome is (Uta, 2004). Of course, we can only

know how many cases there are if we know what a case is! There is reason to believe

that in current clinical practice the label Asperger syndrome is used rather

indiscriminately. Asperger syndrome has a special cachet that hints at superior

intelligence and perhaps even genius. The label high- functioning autism, because it is

sometimes applied to individuals who are only relatively high functioning, possibly

carries less of such an implication. In reality, the label is given to many children and

adults on the autism spectrum who are simply atypical in their presentation, talkative

rather than withdrawn, but not necessarily of high ability. Asperger syndrome, or high-

functioning autism as identified in many clinics today, comprises a far too heterogeneous

group, including cases of well below average ability and poor social adaptation, as well

as those of superior intelligence and good social adaptation.

According to Dawson and Toth (2006), the Diagnostic and Statistical Manual of Mental

Disorders, fourth edition (DSM-IV; American Psychiatric Association, 1994) and the

International Classification of Diseases, 10th edition (ICD-10; World Health

Organization, 1992) suggests two widely used systems for diagnosing Autism spectrum

disorders.

25

Although much research has been done, concerns and issues in early childhood education

exist throughout the world. Most importantly, the quality of these early childhood

education programs needs to be examined (Lee & Hayden, 2009). Although the

development and expansion of early childhood programs has greatly increased (Barnett,

1995), there have been only limited number of instruments to monitor their

implementation and measure their overall quality (NICHD Early Child Care Research

Network, 2000).

It remains unknown how these early childhood programs are operated and if they are

truly offering learning experiences and environments for young children growth and

development. Improve and systematic program evaluation and monitoring are needed.

As a result, professional teacher training and development programs have been targeted

for analysis. Secondly, more support and advocacy in the field of early childhood

education and development is needed in today’s political climate. In order to promote

early childhood programs and their quality, it is necessary to provide a policy framework

of standards and norms that serve as the foundation of those programs. Based on this

framework, then, increased government budgets or other alternative financial resources

may in due course become available. Lastly, within the international context of early

childhood education, a greater attention to diverse, particular populations should be

given. These groups include indigenous populations, low income families, rural

communities, and groups from non-mainstreamed cultures, among others.

This study investigated child-assessment practices in the context of Korean early

childhood education and care settings (Nah & Kwak, 2011). Interviews with educators

and documents obtained from educational and care settings were analyzed. In general,

the results support the rigorous implementation of child-assessment procedures since the

recent implementation of kindergarten evaluation and childcare accreditation by the

government.

However, some settings have not implemented these procedures systematically, resulting

in wide variation in the types of assessment conducted and the forms used across

environments, as well as superficial goals and limited information regarding children

(Nah & Kwak, 2011). To enable efficient child assessment and the transfer and sharing

of information about each child among providers and schools, a common framework

26

should be provided, with common tools and recording forms, together with guidelines

for child assessment and training services for educators and staff.

The most effective evaluation of young children utilized both formal and informal

assessments, including information from standardized tests, such as medical check-ups

that assess physical development, personal reports, tests created by teachers, work

samples, and/or observations of children during activities, which represents the most

informal approach to assessment (Nah & Kwak, 2011). The use of informal assessment

to obtain information to inform teaching and decision making about young children has

been widely accepted (Morrison, 2009), and observation has emerged as one of the most

widely used methods of informal assessment (Beaty, 2006; Mindes, 2003). The context

of assessment can affect the performances of young children, who can perform best when

they work in familiar, comfortable, natural, and informal settings (Cazden, 2001).

Thus, information used to assess young children must be gathered not only during adult-

led activities, but also during free play, everyday routines, and child-initiated activities.

Observation of daily activities, play, and work is more appropriate than formal tests using

structured tasks in assessments of young children (Schweinhart, 1993; Hills, 1993;

Pellegrini, 2001).

This study aimed to identify what and how often quality control practices are

implemented in Early Intervention (EI) centers (Jeanette, 2010). Focus group discussions

(FGDs) among 22 participants yielded several aspects of early intervention in four

domains: the child and the EI program; parent-professional collaboration; government,

non-government, and community linkages; and legislation and societal values. Results

were used in constructing a 50-item survey questionnaire, administered to 30 respondents

working in 17 EI centers for different age groups. Results showed that almost all the EI

centers had these daily activities: development of self-help skills, use of sensorial

materials, parent-teacher consultations, and beginning reading, writing, and numeracy

lessons. In general, the EI centers concentrate on direct instruction of the child but do not

prioritize macro components such as implementation of accessibility laws.

Recommendations include standardization of quality control in EI centers, especially the

requirement of a transition plan upon exit from the EI program.

27

The high-functioning Autism Spectrum Screening Questionnaire (ASSQ) is a 27-item

checklist for completion by lay informants when assessing symptoms characteristic of

Asperger syndrome and other high-functioning autism spectrum disorders in children

and adolescents with normal intelligence or mild mental retardation (Ehlers, Gillberg,

& Wing (1999) . Data for parent and teacher ratings in a clinical sample are presented

along with various measures of reliability and validity. Optimal cutoff scores were

estimated, using Receiver Operating Characteristic analysis. Findings indicate that the

ASSQ is a useful brief screening device for the identification of autism spectrum

disorders in clinical settings.

To examine the concurrent and criterion validity of the Autism Behavior Checklist

(ABC). Methods: Three groups, comprising 38 mothers of children previously diagnosed

with autism (DSM IV-TR, 2002), 43 mothers of children with language disorders other

than autism, and 52 mothers of children who had no linguistic or behavioral complaints,

were interviewed (Marteleto & Pedromonico, 2005). In order to minimize the effect of

maternal level of education, the questionnaire was completed by the researcher.

To determine the concurrent validation, ANOVA and discriminant analysis were used.

The ROC curve was used to establish the cutoff score of the sample and to examine the

criterion validity. Results: The mean total score was significantly higher in the group of

mothers of autistic children than in the other groups. The ABC correctly identified 81.6%

of the autistic children. The ROC curve cutoff score was 49, and the sensitivity was

92.1%, higher than the 57.89% found when a cutoff score of 68 was used. The specificity

was 92.6%, similar to the 94.73% obtained with a cutoff score of 68. Conclusions: The

ABC shows promise as an instrument for identifying children with autistic disorders,

both in clinical and educational contexts, especially when a cutoff score of 49 is used

(Marteleto & Pedromonico, 2005).

Diagnostic Observation Schedule-Generic (ADOS-G) and clinical classification was

studied in 184 children and adolescents with Mental Retardation (MR). The agreement

between the ADI-R and ADOS-G was fair, with a substantial difference between younger

and older children (5–8 vs. 8+ years) (Bildt, Sytema, Ketelaars, Kraijer, Mulder, Volkmar,

& Minderaa. (2004). Compared with the Diagnostic and Statistical Manual of Mental

Disorders-IV-TR (DSM-IV-TR) classification of Autistic Disorder (AD) and Pervasive

28

Developmental Disorder (PDD), both instruments measure AD or PDD validly and

reliably. Even in low-functioning children the interrelationship between the instruments

and the clinical classification was satisfactory (Bildt, Sytema, Ketelaars, Kraijer, Mulder,

Volkmar, & Minderaa. (2004). . The combination of ADI-R and ADOS-G identifies AD

or PDD, as described in the DSM-IV-TR, most appropriately. Both instruments seem to

be of great value in the diagnostic process of PDD in children and adolescents with MR.

Early diagnosis is very important since the sooner the recommended orientation of

procedures is carried out, the more likely it is that such children will develop social and

communicative skills, and the less stereotyped their behavior will be (Bildt, Sytema,

Ketelaars, Kraijer, Mulder, Volkmar, & Minderaa. (2004). .

Several psychiatric conditions, both internalizing and externalizing, have been

documented in comorbidity with Asperger Syndrome (AS) and High Functioning Autism

(HFA) (Mazzone, Ruta & Reale, 2012). In this review we examine the interplay between

psychiatric comorbidities and AS/HFA. In particular, we will focus our attention on three

main issues. First, we examine which psychiatric disorders are more frequently

associated with AS/HFA. Second, we review which diagnostic tools are currently

available for clinicians to investigate and diagnose the associated psychiatric disorders

in individuals with AS/HFA. Third, we discuss the challenges that clinicians and

researchers face in trying to determine whether the psychiatric symptoms are phenotypic

manifestations of AS/HFA or rather they are the expression of a distinct, though

comorbid, disorder. We will also consider the role played by the environment in the

manifestation and interpretation of these symptoms. Finally, we will propose some

strategies to try to address these issues, and we will discuss therapeutic implications

(Mazzone, Ruta & Reale, 2012) .

Although Head Start has a mandate to serve children with disabilities as at least 10% of

its population, few systematic data are available on identification of children in various

disability categories in the years immediately following their preschool experience

(Forness, Ramey, Ramey, Hsu, Brezausek, MacMillan, Kavale & Zima, 1998). In an

extensive study, a team of researchers (Forness, Ramey, Ramey, Hsu, Brezausek,

MacMillan, Kavale & Zima, 1998) identified children in various disability categories in

the years immediately following their preschool experience.

29

Two cohorts of 4,161 children across 30 sites were followed through first grade as part

of a larger study on transition assistance in which at-risk status was assessed at the

beginning of kindergarten by developing research diagnostic criteria (RDC) for four

major special education categories using clinical cut-off points on language, achievement,

and social skills measures and indicators of speech or mental health problems on parent

interviews. The school identification of study participants in each RDC was determined

by a search of school archival records in the spring of first grade. It was found that only

26% of the children meeting RDC in the four major categories were identified by the

schools, and little concordance was observed among categories. Findings assume that

there was an under identification of children with emotional or behavioral disorders.

However, the identification of children with disabilities in the schools has changed

substantially, however, since the original studies evaluating Head Start, especially in the

largest and most controversial special education categories such as mental retardation

(MR), learning disabilities (LD), speech or language impairments (SL), and emotional

disturbance (ED) (U.S. Department of Education, 1995).

Scott at.el (2002) conducted a pilot and follow-up study of the preliminary development

of a new tool to screen for Asperger syndrome (AS) and related social and communication

conditions (the Childhood Asperger Syndrome Test, CAST) in children aged 4–11 years,

in a non-clinical setting. In the pilot study, parents of 13 children with AS and of 37

typically developing children completed the CAST. There were significant differences

between the AS and typical sample means. The pilot was used to establish preliminary

cut-off scores for the CAST. In the main study, parents of 1150 primary-school-age

children were sent the CAST, and 174 took part in the full data analysis. Results suggest

that compared with other tools currently available, the CAST may be useful for

identifying children at risk for AS and related conditions, in a mainstream non-clinical

sample.

2.8 The problem statement

Characteristic features of Asperger syndrome that predispose to criminal offending

(Berney, 2004):

i. An innate lack of concern for the outcome can result in, for example, an assault

that is disproportionately intense and damaging. Individuals often lack insight

30

and deny responsibility, blaming someone else; this may be part of an inability

to see their inappropriate behavior as others see it.

ii. An innate lack of awareness of the outcome that allows individuals to embark on

actions with unforeseen consequences; for example, fire-setting may result in a

building’s destruction, and assault in death.

iii. Impulsivity, sometimes violent, can be a component of comorbid ADHD or of

anxiety turning into panic.

iv. Social naïvety and the misinterpretation of relationships can leave the individual

open to exploitation as a stooge. Their limited emotional knowledge can lead to

a childish approach to adult situations and relationships, resulting, for example,

in the mistaking of social attraction or friendship for love.

v. Misinterpreting rules, particularly social ones, individuals find themselves

unwittingly embroiled in offences such as date rape.

vi. Difficulty in judging the age of others can lead the person into illegal

relationships and acts such as sexual advances to somebody under age.

vii. Overriding obsessions can lead to offences such as stalking or compulsive theft.

Admonition can increase anxiety and consequently a ruminative thinking of the

unthinkable that increases the likelihood of action.

viii. In formal interviews, misjudging relationships and consequences can permit an

incautious frankness and the disclosure of private fantasies which, although no

more lurid than any adolescent’s, are best not revealed.

ix. Lacking motivation to change, individuals may remain stuck in a risky pattern of

behaviour.

2.9 The Proposed DSIMCAS

The idea of DSIMCAS is the development of a screening instrument for children with

Asperger syndrome and its manual. The development of this instrument is proposed with

consideration that it is high time for early detection of Asperger syndrome children in

supporting the implementation of effective early intervention programs for children with

special needs. Appropriate intervention with support at early age could lead the child to

engage in learning process successfully. The right and effective instrument is needed for

early detection process. DSIMCAS is expected to produce the user-friendly instrument.

The data from this study are expected to be the initial figure of the young children with

Asperger syndrome in Malaysia.

31

The suitability and practicality of SIMCAS, is critically important if it is to be promoted

as a standardized instrument (after further research) and it can be used in child care

centers for early detection purposes. Overview of DSIMCAS is as in Figure 2.1.

Figure 1: Overview of DSIMCAS

The component of the DSIMCAS comprising mainly the information related to the

child’s behaviors. Particulars about parents, teachers/caregivers, childcare centers, and

institution related to ECCE are also relevant. Table 2.0 is describing about the

DSIMCAS.

Table 2.0: DSIMCAS components

Components Detail contents

ECCE target group Children 5 years old and below

Workshop Confirmatory Factor Analysis (CFA) & Rasch Model

Development Items of SIMCAS

Pilot testing Two tiers of pilot testing of SIMCAS items pilot

testing.

Tier 1 with trained & qualified educators in Autism at

IDEAS & NCDRC (for expert views via interview

with teachers for level of difficulties and constructs) –

UPSI.

Tier 2 with NASOM centers in Lembah Klang &

Ipoh.

Real data collection:

quantitative via

1,100 children in mainstream preschool were

identified via multistage random sampling procedure

and were observed by their classroom teachers and

PERMATA

ECCE

E

I

Early Detection Through Screening

OTHER AGENCIES

INTERVENTION

32

questionnaires –

SIMCAS

assessed. 1,041 questionnaires were returned (return

rate is 95% - 95% confidence interval with +/ - 3)

Analyses of data SPSS package

Qualitative data analyses – Verbatim & Major & sub

themes

Identification ECCE children with potential AS

The data derived from SIMCAS will benefit several stakeholders of ECCE field. Table

2.1 shows how SIMCAS will assist the stakeholders.

Table 2.1: SIMCAS Benefits’ to ECCE Field

Stakeholders Benefits

Government

(MOE)

i. Early childhood education planning

ii. special education policies

Teachers/childcare

takers

Early intervention planning

Parents Early detection

Institutions Teachers/caretakers qualifications and

competencies

DSIMCAS also able to generate reports related to insights in special educational needs

in ECCE. Table 2.2 shows some of the examples.

Table 2.2: Example of DSIMCAS Reporting.

Reports Type of reports

Instrument (SIMCAS) Training in implementation of SIMCAS;

Psychometric property;

Teachers/child caretakers Asperger

syndrome awareness level

Inclusive education and teachers’ training

Prevalent rate of potential Asperger

syndrome

Special education programme for children with

autism in Malaysia

Research in special education SIMCAS in assisting educators and childcare

takers in screening children with Asperger

syndrome?

2.10 Objectives of DSIMCAS

The establishment of DSIMCAS aims to fulfill two main objectives, namely:

i. develop and validate the instrument for screening children with Asperger

syndrome (SIMCAS) below 5 years old.

33

ii. generate comprehensive and integrated report for policy makers and intervention /

programme providers

iii. provide insights of the degree of AS related behaviors in children at five years old

and below based on statistical data and qualitative data

2.11 Scope of Study

The scope of this study explain in this section covers the objectives, methodology,

sampling and data collection as well as the framework of the quantitative and qualitative

data analyses.

2.12 Research Objectives

This study intent to develop and validate the instrument for screening Malaysian children

with Asperger syndrome for five (5) years old and below. The study aims to develop an

instrument and manual for screening of Malaysian children with Asperger’s syndrome at

the age of five years old and below. As this instrument intended to be utilized by the

Malaysia educators and childcare takers, this study will verify the extend the developed

instrument capable of assisting educators and childcare takers in screening children with

Asperger syndrome. Basic empirical statistics of Malaysian children with reference to

Asperger characteristics.

The collected data is expected to give insight of the tendency of children AS in age group

below 5 years old. The construction of the instrument will be based on a review that

provides an indication of the symptoms of Asperger’s. This will be incorporated within

the qualitative data (observation and interview) in order to seek new insights of the degree

of AS related behaviors in children at Tabika.

i. To review the standardized instrument for screening AS used at the international

level and discovering relevant facts from the experts and selected stakeholders

regarding evaluation of AS cases in Malaysia via:

a. Round-table discussion

b. Library search

c. Small scale seminar

ii. Field work:

The number and scoring of items chosen should be easier to manage.

34

2.13 Study Framework

Initially, the duration of this study is set for 12 months from 1st April 2015 to 31st

March 2016. However, the real study was approved and embarked in July 2015 and

extended to 21st November 2016 due to inevitable circumstances.

35

Chapter 3

Methodology and Instrumentation

3.0 Introduction

This study employed both qualitative and quantitative approach. At the initial stage of

the items development, focus group discussion (FGD) with early childhood practitioners

and caretakers was conducted to gauge in-depth understanding of what special needs

concepts is all about and knowledge and awareness related to Asperger Syndrome. In the

second stage of this study interview was conducted with NASOM educators to tap

insights related to autism and Asperger syndrome as experienced by these educators. The

final stage of this study is developing the items based on six (6) domains and

administering two pilot tests at special needs centers in Wilayah Persekutuan Kula

Lumpur and Perak. Finally, it involved real data collection at identified preschools via

stratified sampling procedure (at government-run preschools and private child-care

centers) throughout Peninsular Malaysia. This chapter discusses the methodology

employed by this study in detail.

3.1 Research Methodology

Mixed method study was utilized by this study. The framework is as displayed in the

Figure 2 below.

Figure 2: The Framework of The Study

DSIMCAS Quantitative data Qualitative data – Focus

Group Discussion (FGD) -

accomplished

1100 children (SIMCAS ) - Observed by 200 teachers /caregivers

Select 20 potential AS –

next study using

different research grant

Non potential AS Potential AS – 9

children identified

50 parents of children with potential AS

(to be conducted in the next study) Observations (20

selected children) - NIL

Interviews protocol

(respective parents and

teachers) -NIL

36

As illustrated in Figure 2 there are four instruments that is needed in the study. The

screening instrument (SIMCAS) will be used to collect quantitative data from

teachers/childcare givers and parents. The qualitative data will be collected through

individual and focus group interviews (FGD – using interview protocol) with selected

respondents (early childhood practitioners namely caregivers, teachers and parents) and

observation of children’s behavior. The items in the instruments intent to gain

quantitative data include demographic background, Asperger syndrome symptoms

exhibited by the child (as rated by their teachers/childcare givers).

Pilot studies will be carried out to determine the scoring profile of the instrument and

procedures developed for data collection. Eight (8) teachers/care givers from selected

programs will be involved in the pilot study. In pilot study 1, five teachers were involved

in the observation of children who have diagnosed from mild to severe autism at IDEAS’

Autism center, Rawang, Selangor and Tadika Bitara, NCDRC – UPSI childcare center.

Pilot study two (2) covered quite a number of NASOM childcare centers in the Klang

Valley and Ipoh, Perak. The teachers and childcare practitioners were required to observe

and rate the children whom they have known for at least six months. Test re-test

reliability study with two weeks’ interval was utilized by this study.

3.2 Sampling Procedure and Data Collection

Respondents for quantitative data collection are amongst teachers and caregivers. A

number of 200 teachers/caregivers are expected to do the rating for minimum of 10

children under their care. The collected data will be analyzed and the children (with

positive cut-off point) will be shortlisted for random sampling for participants of second

phase of the study, structured observations and interviews. A total of 22 children were

involved for observations and their teachers / caregivers will be interviewed (done during

the tier 1 pilot study). Table 3.0 show the sampling and data collection in this study.

Table 3.0: Sampling and Data Collection

Data Preschool/play

school Children

Teachers /childcare

givers

Parents

SIMCAS rating 1100 children (5 yrs and

below)

200 teachers/childcare givers

from permata negara centers

and other agencies

50 parents of children

rated by teacher as

potential AS – to be

conducted in the

follow-up study

Observation 20 children rated as

potential Asperger

37

syndrome (AS) – will be

conducted in the next

study using different

research grant

Interviews – next study 20 teachers/childcare givers

with potential AS children

20 parents with

potential AS children

3.3 Data Analyses Framework

Quantitative approach in the main data collection using Asperger syndrome screening

instrument will be analyzed using SPSS package. The distribution of the scores of each

item in the instrument is expected to give the pattern for subscale of behaviors related to

AS symptoms (derived using factor analysis). Statistical analyses are used to draw the

psychometric properties of the instruments.

Children rated with high score will be short listed for qualitative data collection and 20

children will be selected at random for observation. The data collected will be analyzed

using standard qualitative data analysis procedures.

3.4 Scope of Final Report

The final report will consist of;

i. The current scenario of special needs children in Malaysia – FGD findings –

RQ1

ii. Asperger syndrome in young children and the new diagnostic criteria via CFA

analysis (DSM- IV and DSM-V) – RQ2

iii. Terms of reference and objectives of study – items selected representing

Asperger attributes – Asperger Syndrome Screening Instrument and Manual

iv. Data analysis and findings

v. Implication of study – liability versus asset to the nation

vi. Recommendation and conclusion – this is preliminary findings, thus further

refinement of the DSIMCAS and testing on random and bigger sample are

necessary

38

3.5 DSIMCAS Team

The study team consist of research adviser, research leader, consultants (child

psychologist, language experts, special needs education, autism - Asperger Syndrome

experts), technical assistant, research assistants.

3.6 Research Team

Asst. Prof. Dr. Supiah Saad (Special Education-IIUM)

Asst. Prof. Dr. Khamsiah Ismail (Clinical Psychology – IIUM)

Assoc. Prof. Dr. Siti Rafiah Abd Hamid (Educational Psychology - UM)

Prof. Dr. Nik Ahmad Hisham Ismail (Social Psychology -IIUM)

Assoc. Prof. Dr Haniz Ibrahim (Special Education- UPSI)

Assoc. Prof. Dr.Nik Suryani Nik Abd Rahman (Maths Education - UM)

3.7 Project Steering Committee

The steering committee comprises of representatives from Ministry of Education and

UPSI. The study team reports directly to the committee chair person about the progress

of the study.

3.8 Pilot Study Report for Asperger Syndrome Screening Instrument

3.8.0 Introduction:

In developing this screening instrument, literature review (Scott, Cohen, Bolton, Brayne,

2002; Williams, Scott, Stott, et al., 2004; Mayes, Calhoun, Murray, Morrow, Yurich,

Mahr, Fauzia, Cothren, Purichia, Bouder, & Petersen, 2009; Robins, Fein, & Barton,

2009; Squires & Bricker, 2009; Helland, 2014) was undertaken to identify empirical

domains and constructs (reliable and valid) which represent Asperger Syndrome. In this

search six domains were identified and were later six constructs as explained in the

following section.

3.8.1 Domains and Construct in Asperger Syndrome Screening

Instrument

The items in Asperger Syndrome Screening Instrument were categorized into six

domains. They are:

39

i. Social - measures difficulties in reciprocal social interactions particularly the

ability and the desire to interact with same-age peers.

ii. Language - measures impairment in language skills. This domain is refers to three

areas which are difficulties in interacting with people and language processing;

iii. Interest and routine - measures limitation in interest and rigidity in routines, which

include rigidity in worldview, obsession and abilities in following routines and

order.

iv. Motor clumsiness - difficulties with motor functioning and planning that focus on

difficulties gross and fine motor skills respectively.

v. Cognitive issues - measures children ability to make inferences about what another

person is thinking; cognitive flexibility; impairment of imaginative play; visual

learning strength and specific strengths in cognitive areas.

vi. Senses sensitives - measures abnormalities of the senses an individual may have

which are visual, auditory, olfactory, tactile and gustatory areas respectively.

The following Table 3.1 provides details of the constructs found in each domain in

SIMCAS.

Table 3.1: Domain, Constructs & Items in SIMCAS

Domain Constructs No. of Constructs Items

1. Social Interaction i. Inability and/or a lack of desire to

interact with peers (1-i)

3 1 – 73 = 73

ii. Socially and emotionally

inappropriate behaviors (1-ii)

iii. Limited or abnormal use of nonverbal

communication (1-iii)

2. Language Skills i. Inability use to in interact

/communicate with other people, and

difficulties in semantic and poetic

language (2-i)

2 74 – 113 =

39

ii. Difficulties in language processing (2-

ii)

3. Interest & Routine i. limitation in interest and rigidity in

routines (3-i)

1 114 – 143 =

29

4. Motor Skills i. Difficulties with motor functioning

and planning that focus on difficulties

gross and fine motor skills (4-i)

1 144 – 156 =

12

40

3.8.2 Pilot Study

Prior to the actual study, pilot study were conducted at two special needs centers in

Selangor and Perak respectively. This procedure was conducted to establish the internal

consistency of the 213 items pilot-tested on a sample of n = 22 children aged between three

to nine years old from IDEAS Autistic Center, Rawang, Selangor and Tadika Bitara –

NCDRC – UPSI. The main intention of this study was to gauge experts’ views on what autism

is all about and also to tap information on high functioning autism among the children

observed. Most of the educators at IDEAS Autism Centre, Rawang are trained, experienced,

qualified and specialized in Autism. The items in the Asperger Syndrome screening

instrument were developed from Autism items and were adopted and adapted for the

Asperger Syndrome Screening Instrument. The internal consistency reliability / Cronbach’s

alpha obtained for pilot 1 was α = .77 and an alpha based on standardizing the items was α

=.77 classified under six domains (6).

Pilot study two (2) was conducted at the National Autism Society of Malaysia or NASOM

(basically in Klang Valley and Ipoh). Approximately 114 children in the centers were

observed by their class teachers who have known them for a minimum duration of 6 months.

The NASOM centers were selected because they are mainly managed by practitioners and

5. Cognitive Issues i. Ability to make inferences about what

another person is thinking - inability

to distinguish the relationship between

internal and external situations (5-i)

5 157 – 210 =

53

ii. Lack of cognitive flexibility – ability

to solve problems; engage in and

maintain mental planning; to exert

impulse control; to be flexible in

thoughts and actions, and to stay

focused on a goal until its completion

(5-ii)

iii. Impaired imaginative play - ability to

create and act out novel play

scenarios (5-iii)

iv. Visual learning strength (5-iv)

v. Specific strengths in cognitive areas

(5-v)

6. Senses Sensitiveness i. Visual areas (6-i)

ii. Auditory areas (6-ii)

iii. Olfactory areas (6-iii)

iv. Tactile areas (6-iv)

v. Gustatory areas (6-v)

41

volunteers who have vast experience in handling children with autism. As for the Asperger

Syndrome screening instrument, the items were adopted and adapted from Autism items

and were refined and validated for the Asperger Syndrome Screening Instrument. The next

step was to identify double-barrel items which were further breakdown, simplified and

translated from English language to Malay Language (Bahasa Malaysia) and back to

English (back translation) and became a bilingual survey. The idea of conducting “back

translation” is to keep the original meaning intact. Warwick and Osherson (1973) advised

researchers not only to get respondents’ answers but also to get the interpretation of the

meaning of the items, which are unclear to them. In addition to that, the pilot study was

intended to examine the relevancy of the items and terminologies found in the instruments .

The teachers at NASOM centers were also interviewed and consulted for the simplicity

and level of difficulties of the items found in the improved and refined instrument. In pilot

study 2, n = 114 and the six (6) domains remained intact. The internal consistency reliability

/ Cronbach’s alpha obtained for pilot 2 was α = .913 and an alpha based on standardizing the

items was α = .916.

3.8.3 Reliability Estimates of SIMCAS

The reliability of a measurement is indicated by its consistency (Shaughnessy & Zechmeister,

1997). In other words, reliability refers to the attribute of consistency in measurement

(Swerdlik, Sturman & Cohen, 2012). It indicates the degree to which a test consistently

measures whatever it is measuring (Gay, Mills & Airasian, 2012). Two types of reliability tests

to estimate the internal consistency of the scales. Cronbach alpha reliability coefficients were

used on the Asperger Syndrome Screening Instrument as this screening tool used Likert scales.

Items were deleted as the deletion increases the Cronbach alpha value of the scales, and

subsequently dropped from further analyses. Comparatively, data obtained from the two pilot

studies showed tremendous improvement in terms of its internal consistency reliability

estimates. Overall for the two pilot studies the instrument has a high internal consistency

reliability estimate value of α = .84. This suggests that all items are valid and reliable to

be utilized in the actual study. Reliability analysis was also conducted on the instrument

based on the six domains mentioned above. The results demonstrate high reliability indices

for all components that ranged from a low α = .65 to a high α = .77 (in pilot study 1).

Comparatively, in pilot study 2 the range of alpha is from a low α = .88 to a high α = .91

Refer Appendix 1 for details of the reliability indices of all items Table 3.2 below provides

summary of the alpha values of the instrument.

42

Table 3.2: Reliability Estimates of the Domains in SIMCAS for Pilot Study 1 & Pilot

Study 2

Domains Reliability

(α) for

Pilot Study

1

No.

of

Items

Reliability (α)

for Pilot

Study 2

No.

of

Items

1. Difficulty in Social

Interaction &

Communication

.753 43 .898 73

2. Impairment in Language

Skills

.734 34 .909 39

3. Narrow Range of Interest

& Insistence

.726 28 .900 29

4. Motor Clumsiness .725 12 .894 12

5. Cognitive Issues .766 51 .882 53

6. Sensory Sensitivities .652 39 .903 34

Overall (all items) .770 207 .913 240

3.8.4 Means and Standard Deviations

Descriptive analyses were employed to obtain means and standard deviation the

measures used in this study. Sum of the scores of each measure were computed and the mean

scores of each scale was obtained by dividing the sum of the total score with the number of

items in each of the respective scale. Table 3.3 summarizes the means and standard deviation

of the measures.

Table 3.3: Means and Standard Deviations for the Six Domains - Pilot Study 1

& Study 2

No. Domains Range of Means Range of Standard

Deviation

Pilot 1 Pilot 2 Pilot 1 Pilot 2

1. Difficulty in Social

Interaction

3.95 4.32 .976 1.57

2. Impairment in Language

Skills & Communication

4.28 5.00 1.71 1.94

43

3. Narrow Range of Interest

& Insistence

3.33 4.40 1.14 2.05

4. Motor Clumsiness 3.70 3.93 .965 1.82

5. Cognitive Issues 3.62 4.83 .765 1.81

6. Sensory Sensitivities 3.21 3.99 .921 1.87

Overall (all items)

3.8.5 Validity of SIMCAS Items

Validity concerns with the appropriateness of the interpretations made from the test (Gay, Mills

& Airasian, 2012). “Traditionally, validity has been defined as the extent to which a test

measures what is designed to measure” (Aiken, 2003, p. 94). In view of that, the concept of

validity refers to the appropriateness, meaningfulness, and usefulness of the specific inferences

from the test scores (American Psychological Association, 1985).

Four types of validity were determined for the measures utilized in for the purpose of

the this study: (1) face validity (2) content validity, (3) criterion-related validity, and (4)

construct validity.

3.8.6 Face Validity

Face validity “pertains to whether the test ‘look valid’ to the examinees, the administrative

personnel who decide on its use and other technically untrained observers” (Anastasi & Urbina,

1997). It refers to the degree to which a test appears to measure what it claims to measure (Gay

& Airasian, 2003).

Briefly, for face validity, the instrument used in this study was purposely developed for

measuring the traits of Asperger Syndrome among children and adolescents. Literature review

(Scott, Cohen, Bolton, Brayne, 2002; Williams, Scott, Stott, Allison, Bolton, Cohen, & Brayne,

, 2004; Mayes, Calhoun, Murray, Morrow, Yurich, Mahr, Fauzia, Cothren, Purichia, Bouder,

& Petersen, 2009; Robins, Fein, & Barton, 2009; Squires & Bricker, 2009; Helland, 2014)

have provided empirical evidences of the items. Determining face validity though is not a

psychometrically sound way of estimating validity. Hence, face validity of the instrument is

established.

44

3.8.7 Content Validity

Content validity concerns with whether the content of a test elicits a range of responses that are

representative of the entire domain, or universe skills, understandings, and other behaviours,

the test is supposed to measure (Aiken, 2003). Conceptually, this type of validity describes “the

degree to which a test measures the intended content area” (Gay & Airasian, 2003, p. 136).

Nonetheless, responses to the sample of items on a well-designed test are presumably indicative

of what the responses would be to the entire universe of behaviours of interest (Aiken, 2003).

As mentioned above, numerous literature reviews supports content validity established in the

instrument. This questionnaire including the translated version has been validated by two

experts (Dr. Haniz Ibrahim – UPSI and Dr. Supiah Saat - IIUM) who are senior lectures and

have doctorate degree in special educational need and have a lot of experience working in

numerous special education settings.

3.8.8 Construct Validity

Construct validity is the extent to which an instrument measures the construct that it is

intended to measure. This type of validity requires a definition with clearly specified

conceptual limits (Newman, 2002) and concerned with the primary attributes rather than with

the scores the instrument produces (Salkind, 2000). Analysis of validity using Pearson’s

bivariate correlations was performed on the data of pilot study to provide preliminary

evidence of convergent and discriminant validity of the instrument.

45

Table 3.4: IDEAS Autism Centre & Tadika Bitara (Pilot Study 1; n = 22)

**Correlation is significant at p = 0.01 level (2-tailed)

Table 3.4 and Table 3.5 demonstrate details of bivariate correlations of the constructs in

Asperger Screening Instrument from IDEAS and NASOM data respectively.

Result of the analyses shows that the correlations between the constructs range between r =

.526 p < .001 and r = .813 p = <.001 for Pilot Study 1. Consistently the results for Pilot Study

2 also demonstrates correlations of between r = .635 p < .001 and r = .821 p = <.001. In sum,

the result of bivariate correlation analysis indicates that the constructs in the instrument are

measuring different aspects in the spectrum of Asperger Syndrome.

Table 3.5: National Autism Society of Malaysia or NASOM (Pilot Study 2; n = 114)

1 - Social Interation and

Communication difficulties

2 - Language difficulties

3 - Limited interests and

rigidity in daily routines

4 - Motor Clumsiness

5 - Cognitive Issues

6 - Senses Sensitiveness

1 - Social Interaction & Communication difficulties

1.00 .78 .58 .64 .74 .53

2 - Language difficulties

.78 1.00 .56 .48 .75 .39

3 - Limited interests & rigidity in daily routines

.58 .56 1.00 .66 .68 .69

4 - Motor Clumsiness

.64 .48 .66 1.00 .76 .78

5 - Cognitive Issues .74 .75 .68 .76 1.00 .67

6 - Senses Sensitiveness

.53 .39 .69 .78 .67 1.00

** Correlation is significant at p = 0.01 level (2-tailed)

Domain Social

Interaction

Language &

Communication

Cognitive

Issues

Motor skills

(gross & fine)

Limited

interests

& Rigidity in

Daily Routines

Senses

Sensitiveness

Social Interaction

1.00 .63 .16 .65 .09 -.24

Language &

Communication

.63 1.00 .59 .61 .50 .23

Cognitive Issues .16 .59 1.00 .18 .45 .62

Motor skills

(gross & fine)

.65 .61 .18 1.00 .14 .20

Limited interests

& Rigidity in

Daily Routines

.09 .50 .45 .14 1.00 .58

Senses

Sensitiveness

-.24 .23 .62 .20 .58 1.00

46

4.3.10 Summary of Analysis

Results of the preliminary analysis of the instrument or rather pilot study involving 213 items,

categorized into six domains on 22 children in pilot study one (1) from two autism centres

indicated sound psychometric properties. The reliability indices of the domains are high enough

to suggest that all items can be utilized in the actual study. Similarly, in pilot study two (2)

which observed 214 children from NASOM centres in the KLang Valley and Ipoh, Perak and

engaging 240 items. As for construct validity, no correlation between the domains exceeds the

correlation value of .90 that could indicate pattern of multi-collinearity (Hair et al, 1998) among

the domain measured. This demonstrates that the domains are measuring different factors in

traits of Asperger.

47

Chapter 4 – Findings

4.0 RQ1 (FGD) Degree of AS related behaviours in Students as Perceived by Preschool

Practitioners

In addressing research question 1, a focus group discussion (FGD) was held with six educators

who were involved directly or indirectly with AS students. From the data analysis, seven

categories have emerged and they were further categorized into three general themes.

Table 4.0: Thematic analysis of Research Findings

Research

Question

Themes Categories

How do you

identify AS and

other disorders?

Difficulties in

identifying Asperger

Syndrome and other

disorders

Students’ attitude

Teachers’

knowledge on AS

and other

disorder

Useful information

from other sources

Parent as a source

of information

Subject learnt as

a source of

information

Cultural belief as

a source of

information

What do you know

about any

instrument for AS

and other

disorders?

Exposure to

instruments No specific

instrument

The need of

instrument

Some of the respondents had similar experiences in handling students with AS and

other disorders as well as the instruments, while others did not. It can be seen from

table below.

48

Table 4.1: General findings from Focus Group Discussion – FGD (Qualitative

Approach)

Themes Categories S

R

A

D

F

A

I

Z

P

U

S

D

Difficulties

in

identifying

AS and

other

disorders

Students’

attitude

Teachers’

knowledge

on AS and

other

disorder

X

X

X

X

X

X

X

Useful

information

from other

sources

Exposure to

instruments

Parent as a

source of

inforation

Subject

learnt as a

source of

inforation

Cultural

belief as a

source of

information

No specific

instrument

The need

of

instrument

X

X

X

X

X

X

X

X

X

X

X

X

X

X

4.1 DIFFICULTIES IN IDENTIFYING AS AND OTHER DISORDERS

There are two difficulties found by the educators in identifying Asperger Syndrome

(AS) and other disorders as summarized in Table 4.2 below.

Table 4.2: Difficulties in identifying AS and other disorders

Theme Categories

Difficulties in identifying

Asperger Syndrome and

other disorders

Students’ attitude

Teachers’ knowledge on AS and

other disorder

49

4.1.0 Students’ Attitude

One of the factors that the educators face difficulties in identifying the Asperger

Syndrome (AS) as well as its symptoms among their students is regarding the students’

attitude towards them. From the interview, it is believed that some of the students behave

differently in school as compared to the way they interact with their parents at home. It

can be illustrated through some of the respondents’ statement below. (Refer to the

Discourse Unit as attached in Appendix).

“Ha, dia jadi macam passive, orang kata behaviour yang kedua. Dia ada

dua, dua personality la. Lepas itu bila mak dia, kan haritu ada Report

Day kan, mak dia cerita kata kat rumah dia banyak sangat cakap sampai

ke malam. Tapi dia dekat sekolah dia diam…” (IZ/ DU 39)

From the above statement, it can be seen that the students show different acts in front of

the teacher at the school. It is undeniable that this kind of barrier would be faced by most

of the early childhood teachers as these students may perceive them as strangers in the

beginning of meeting. Hence, the teachers would also face difficulties when reporting to

the parents regarding their children’s progress at school. This is due to some of the

students are very responsive in doing their homeworks at home but they are not

responding to the teachers at the school during the lesson. It can be illustrated through

the statement below.

“Mungkin dia (ibu bapa) akan cakap, oh kenapa dekat sekolah jadi

macam ini. So macam bila ada, kita akan tahu selama ini yang kita ajar

budak itu dapat ke tak. Sebab tak semua budak yang akan jawab bila kita

tanya.” (FA/ DU 34)

This statement indicates that the teachers face difficulties in detecting any symptoms

from the students due to this incompatible information.

4.1.1 Teachers’ Knowledge on AS and Other Disorders

Throughout the focus group discussion, questions regarding teachers’ knowledge on the

AS and other disorders are also being asked by the researchers. Majority of the

respondents agree that they only know some of the symptoms of AS and other disorders

such as Autism Spectrum Disorder, and Dyslexia.

As for Autism Spectrum Disorder (ASD), the teachers’ knowledge about this can

be illustrated through the following statements.

“and personality budak tu pun kita dah tahu dia adalah Autism. Dia

dengan dunia dia sendiri, ha ikut dia lah…” (IZ/ DU 83)

50

Similarly, another respondent also noted the symptoms of ASD as described in the

following statement.

“Sampai lah sekarang still, masa dia 7 years old, dia still tak boleh jalan,

duduk atas wheel chair, itu memang yang very low functioning, memang

eye contact apa semua tak ada.” (PU/ DU 194)

Both of these statements show that the early childhood teachers do have some knowledge

about the ASD, but perhaps it is incomprehensive.

Other than that, some of the teachers also noted the symptom of Dyslexia however it is

interconnected with slow learner students. It can be described through the statement

below.

“Kadang-kadang macam tengok bila macam reading tu kan susah nak

dapat. Satu satu tu, macam, a i u, kadang-kadang kita ulang banyak kali

pun dia macam susah nak tangkap. Kadang-kadang macam dia tulis pun

macam terbalik, macam A terbalik,” (IZ/ DU 110)

Similarly, the teachers do have some knowledge regarding psychological disorder

particularly Dyslexia among children, yet it is confused with other learning disability.

Above all, majority of the respondents indicate that they have similar knowledge in

identifying the symptom of Asperger Syndrome (AS). It can be best illustrated through

the following statement.

“Yang saya faham it is one kind of Autism Spectrum disorder lah.

Because they have high functioning mild functioning. But this one

categorized under high functioning, not mild functioning, tak tahulah

kalau saya silap. Ada special interest, their problem is the communication

skill, no social interaction, no eye contact with people, lepastu dia tak

boleh pergi tempat yang ramai-ramai orang, semua ini. Basically that is

what I know lah. They are very very good in certain thing. And mostly tak

tahu kenapa they are very good in English, mostly kalau dia speak

English dia akan guna American slang.” (PU/ DU 170)

Based on this statement, some of the respondents indicate that AS is a type of Autism

Spectrum Disorder and some of them do not mention that AS is categorized under high

functioning. The teachers also notice that students with AS have very low eye-contact

with other people. Interestingly, majority of them noted similar concern on one of the

symptoms of AS which students with AS are believed to have high interest in one thing.

51

Regarding this matter, another example of students with AS who have special interest in

certain subject can be described as the following statement.

“Tapi dia akan ada satu benda yang akan show dia punya attention lain,

contohnya ada anak itu dia lebih kepada Math. So dia akan sangat expert

dalam Math.” (SD/ DU 93)

Other than Mathematics, students with AS are also being reported to be expert in other

subjects such as English, Music as well as Drawing.

Teachers’ knowledge on psychological disorder among children is quite important as it

may affect the education of these students. One of the respondents indicates about this

matter as stated in the statement below.

“Tapi masa dia tadika memang cikgu-cikgu tak tahu kan, so memang

selalu lah sampai report kata memang tak pay attention tak belajar tak

buat kerja, so all the negative remarks daripada cikgu-cikgu. Cikgu tak

tengok apa yang positif daripada dia. So memang focus on negative

negative remarks kan. Sampai dia jadi memberontak lah tak nak pergi

sekolah semua. So bila masuk Darjah 1, cikgu dekat situ dia ada PPKI

kan, so cikgu ni is quite aware pasal Dyslexia apa semua ini, so cikgu ni

observe lepastu cikgu ni inform kita punya kawan tu dia kata most

probably macam mana symptoms Dyslexia.” (PU/ DU 246)

Other than above information, majority of the respondents also mention that they are not

provided with training to cater these students. Therefore, there is a need for knowledge

regarding this matter especially among early childhood teachers so that the future of these

students will be guaranteed. Plus, early interventions could be carried out to these

students if the teachers become more aware of the symptoms.

4.3 USEFUL INFORMATION FROM OTHER SOURCES

Other than the teachers’ existing knowledge in identifying the symptoms of AS and other

disorders, they also reported to have some sources of information on the psychological

disorders. There are three sources of information about this matter as summarized in the

table below.

52

Table 4.3: Useful information from other sources

Theme Categories

Useful information from

other sources

Parent as a source of

information

Subject learnt as a source of

information

Cultural belief as a source of

information

4.1.2.0 Parent as a Source of Information

Based on the information given, some of the respondents indicate that they get the

information regarding the students’ background from parents. It means that parents bring

some documents regarding their children’s problem to these early childhood teachers so

that it would be easier for the teachers to cater these students in the classroom. It can be

illustrated through the following statement where one of the respondents claims to have

received the medical record from the parents.

“Parents tu sendiri, ha dia bawa lah dari segi medical record, and

personality budak tu pun kita dah tahu dia adalah Autism. Dia dengan

dunia dia sendiri, ha ikut dia lah…” (IZ/ DU 83)

“Saya kena isi, saya kena isi very detail, semua the symptoms of physical Other than

that, parents also need to fill up a form regarding their children in the enrolment day.

Statement below described about some of the details of the children.

development, social development, semua kan.” (PU/ DU 42)

It shows that the teachers are receiving some particular details about the students during

the beginning of the school. They also reported to have information regarding students’

interest from parents which may help them a lot in the learning session.

4.1.2.1 Subject Learnt as a Source of Information

Second source of information about any symptoms of AS or other disorders is through

revising the subject that these teachers have learnt during their Diploma. However, there

is only one subject that they have learnt regarding psychological disorders among

children. For example, one of the respondents describes about the subject in the following

statement.

53

“Apa yang penekanannya dalam subjek itu sendiri adalah kita identify ja

semua jenis disorder. Sebab kita ada disability dan disorder kan.

Disability kita senang sebab kita tengok dari segi physical, tapi kalau

disorder ini complicated lah sebab dia termasuk semua tu. Semua jenis

difficulty macam Dyslexia, Autism, ADHD and then dia complicated bila

dia bergabung, ADHD contoh nya macam Autism ataupun ADHD

campur Dyslexia.” (SD/ DU 153)

Other than this, they also reported to have learnt about early childhood education and

children development. Hence, some of the symptoms among the children are noticed by

these teachers in the school based on theories of various types of disorder.

4.1.2.2 Cultural Belief as a Source of Information

The last source of information regarding AS or any other disorders known by the teachers

is through the cultural belief. This is refers to Malay culture in explaining the causes of

any illness. According to one of the respondents, a pregnant mother must be careful in

speaking because it may affect the child after birth according to Malay culture. It can be

described through the statement below.

“Orang cakap, jangan cakap benda tak baik, so nanti effect pada anak.

Tu Malaysian punya, ye lah tu. Masa pregnant memang kena jaga kata-

kata perbuatan semua.” (SD/ DU 213)

Likewise, another respondent also indicates that there is a cultural belief among

Malaysian regarding the causes of an illness. The following statement described on how

marriage can be one of the reasons of any illness among children after birth.

“Kalau macam apa ni, what happen to my nephew ada orang tua-tua

cakap sebab ‘panas’. Sebab Puteri ni kahwin dengan Megat. Dia kata

‘panas’ tu. Tu anak jadi macam tu.” (PU/ DU 222)

Therefore, cultural belief also becomes an indicator of any disorder including AS among

children as stated by the teachers.

54

4.2 LEAST EXPOSURE TO INSTRUMENTS

The last theme that has derived from the focus group discussion is exposure to

instruments. This is refers to whether the teachers know any instrument especially

regarding the screening the symptoms of Asperger Syndrome (AS) and other disorders.

There are two categories under this general theme as summarized in the table below.

Table 4.4: Exposure to instruments

Theme Categories

Exposure to

instruments No specific instrument

The need of instrument

4.2.0 Unfamiliar to any related Instrument

Based on the information given by the teachers, they are reporting that there is only one

instrument that they had used in collecting the data about students’ background during

the Enrolment Day. For example, the early childhood teachers claim to have an

instrument as stated in the statement below.

“Dekat enrolment ini lah, memang ada. Kira tu first thing lah.”

(IZ/ DU 48)

The respondents claim that this instrument is used to identify the students’ health problem

during the Enrolment Day. They further say that the instrument contains the details on

students’ regular behaviour and special interest. This instrument is believed to be filled

up by the parents during that day.

However, some of them also indicate that there is no specific instrument for

screening the symptoms of AS and other disorders among these students. The teachers

are reporting about their observations on the children’s behaviour in the classroom which

can be illustrated in the following statement.

“Sebab kita tak dedahkan diaorang kepada instrument. Maybe setiap

centre itu instrument dia berbeza-beza kan. Jadi itulah yang kita boleh

beri dengan student kita. Jadi bila student ini ternampak oh ini early

symptoms of Dyslexia jadi bila dia berdepan dengan real experience, dia

syak… So apa dia perlu buat dia kena kumpul bukti. Evidences. Masa

Report Day dia kena tunjuk. Parents dia bukan based on dia punya

personal judgement tapi dia based on dia punya pemerhatian.” (SD/ DU

153)

55

This statement summarized that the early childhood teachers are not exposed to any kind

of instrument especially in screening the AS and other disorders. It also stated that these

teachers only do some observations on the students in the classroom and they will report

their observations to the parents later on.

4.2.1 The Need of Asperger Syndrome Screening Instrument

Based on the above information, it is believed that the early childhood teachers need to

be exposed to the instrument especially in doing screening the symptoms of AS and other

disorders among their students. Majority of the respondents agree that it would be a great

help if they are exposed to the instrument. The following statement indicates about the

need of instrument.

“Misalnya dapat membantu dari segi pendidikan budak-budak juga tapi

improve dia punya behaviour, emotional, semua. Dan dia akan memberi

membantu ibu bapa lebih faham lah. Tapi bagi saya okay lah bagus lah

dia punya semua tu.” (AD/ DU 199)

Above statement indicates that the instrument could help the development of the children

especially in terms of their behaviour and emotional as well as provide an insight for the

parents regarding the development of their children.

Some of the respondents agree that the instrument would provide an insight for the

parents as well, however some of them only stress on improving teachers’ knowledge

regarding AS and other disorders. It can be illustrated in the statement below.

“It is good untuk cikgu punya knowledge. Tapi bukan untuk cikgu share

dengan parents sebab dia macam taboo ya untuk cikgu nak sampaikan

kepada parents. Tapi bila dengar kata daripada expert daripada HKL tu

balik, it takes time for him to accept. Sampaikan *marah marah doctor

tak boleh terima, so apatah lagi kalau daripada cikgu.” (PU/ DU 207)

Therefore, the usage of the instrument should be only among the teachers as to gain some

insight regarding the AS and other disorders as well as to improve their skills in dealing

with these students.

56

4.3 RQ2: Quantitative – Confirmatory Factor Analysis (CFA) – Validating the

Factors

Research question 2 was meant to develop and validate the instrument for screening

children with Asperger syndrome below 5 years old. The following is the structure of

Research Question 2:

“To what extent is the screening instrument developed capable of assisting educators

and childcare takers in screening children with Asperger syndrome?”

To address Research Question 2, a series of Confirmatory Factor Analyses (CFA) have

been carried out to validate all the constructs. The constructs are as follow and

accompanied by formulated hypotheses:

(i). Social and Language were combined as a four-factor construct. Thus, the alternative

hypotheses were formulated as the following and further tested.

HA: Social and Language interactions is a four-factor measurement model.

HB: The four-factor measurement model of Social and Language interactions fits

across two sets of data

(ii). Cognitive difficulties are a three-factor model. Thus, the alternative hypotheses

were formulated as the following and further tested.

H2A: Cognitive difficulties is a three-factor measurement model

H2B: The three-factor measurement model of Cognitive difficulties fits across two

sets of data.

(iii). Senses Sensitiveness is a five-factor model. Thus, the alternative hypotheses were

formulated as the following and further tested.

H3A: The Senses Sensitiveness construct is a five-factor measurement model

H3B: The Senses Sensitiveness measurement model fits across two sets of data.

(iv) Limited Interest and Rigidity in Daily Routine, thus the hypotheses were formulated

as the following and further tested.

H4A: Limited Interest and Rigidity in Daily Routine is a two-factor model

(v) Motor Clumsiness or difficulties is a two-factor model.

H5A: Motor clumsiness is a two-factor model

57

H5B: The motor clumsiness two factor model fits in both data sets

The following Table 4.5 tabulates the 6 domains and constructs:

Table 4.5: Domains and Constructs of this study

Constructs Section Domains No.

of

Items

Social IA Difficulties in Social

Interaction

13

IB Socially and

Emotionally

Inappropriate Behavior

4

IC Limited or Abnormal

Use of Non-Verbal

Communication

9

Language

Limited

Interests &

Rigid

Routines

IIA Difficulties in Oral

Communication

5

IIB Difficulties in Semantic

and Poetic Language

5

IIC

Difficulties in Language

Processing

6

IIIABC Worldview, Interests,

Regulations & Routines

10

Psychomotor IVAB Retardation in Motor

Development - Gross

and Fine Motor Skills

10

Cognitive VA "Buta Minda" Inability

to relate to internal and

external situations

5

VB Lacked of Cognitive

Flexibility - lacked

focus - Rigid - one way

of problem solving

14

VC Cognitive Issues - Weak

Imaginative Play

4

VD Strength in Visual

Learning

5

VE Specific Cognitive

Strengths

5

Senses VIA Difficulties in Sight 4

VIB Difficulties in

Managing Sound

5

VIC Difficulties in Olfactory

Aspects

5

58

VID Difficulties in Touch 10

VIE Difficulties in

Managing Sense of

Taste

11

4.3.0 Validating the instrument of Asperger Syndrome in Social and Language

Difficulties

HA: Social and Language interactions is a four factors measurement model has been

accepted

The instrument measuring Asperger Syndrome (AS) specifically detecting social and

language difficulties has been postulated to be in four constructs namely lack of interest

to interact with peers, showing inappropriate behaviors socially and emotionally, having

abnormality in non-verbal communication and difficulties to communicate from the

aspects of semantic and poetic language.

Based on the inability to interact, three items were detected to explain the

construct of lack of interaction with IA2a (unable to interact orally – inefficient in using

language in social communication); IA2b (lacked of skills in initiating communication);

and IA2c (unable to understand the flow of discussion). IA2b (lacked of skills in initiating

communication) determines the highest squared multiple correlations which indicates the

highest contribution of 82.4% to the construct. IBa (display of strange behaviors), IBc

(passing inappropriate remarks) and IBd (display anger when someone disobey the rules

and regulations) explain inappropriate behavior. IBc contributes to the next highest

explanation of inappropriate display of social behavior marked by 68.8%. IC1b (unable

to understand body language), IC1c (facial expression doesn’t correlate well with

emotional display), IC1d (lacked of facial expression when communicating with others)

and IC1e (unable to understand others’ facial expressions) determine difficulties in

abnormal non -verbal communication. ICId (lacked of facial expression when

59

communicating with others) contributes to the highest explanation of the construct with

72.5%.

The last construct (weak in communicational skills) is determined by four items namely

IIDa (unable to distinguish relevant from irrelevant information during information

processing), IIDc (easily irritated by surrounding stimulants), IIDd (late in responding to

questions asked) and IIDe (difficult to stay focused). IIDd (late in responding to questions

asked) indicates the highest explanation with 74.1% to its construct. The correlations

show distinct factors where they fall below .85 as suggested by Hair,et.al. (2005). Thus,

the factors in the hypothesized model have accomplished discriminant validity. However,

it is imperative for the researchers to address the factors seriously as “difficulties in

language processing” and “abnormality in non-verbal” as they are considered weak with

a high association of .806. This indicate that some closely related factors may tend to

measure similar construct. Thus, future research needs to address the matter and more

empirical evidence is needed to further validate the findings.

Table 4.6: Factor Loading

Items Factor/construct Loadings

IA2a lack to interact .853

IA2b lack to interact .908

IA2c lack to interact .815

Iba inappropriate behaviour .519

IBc inappropriate behaviour .830

IBd inappropriate behaviour .705

IC1b abnormal nonverbal .831

IC1c abnormal nonverbal .766

IC1d abnormal nonverbal .851

IC1e abnormal nonverbal .833

IIDa difficult in language_ processing .716

IIDc difficult in language_ processing .726

IIDd difficult in language_ processing .861

IIDe difficult in language_ processing .840

60

Table 4.7: Correlations between factors/constructs

Factors correlations

abnormal

nonverbal <-->

difficult in language_

processing .806

inappropriate

behaviour <--> abnormal nonverbal .555

lack to interact <--> inappropriate behaviour .392

inappropriate

behaviour <-->

difficult in language_

processing .564

lack to interact <--> difficult in language_

processing .626

lack to interact <--> abnormal nonverbal .655

HB: The four-factor measurement model of Social and Language interactions fits in

both sets of data has been accepted.

The comparison of results reveals a slight change in normed relative chi-square with

group 2 (500 sample size) is higher than group 1 (537 samples). The results have

proven that by cross validating with another set of data yield almost similar results that

satisfy the model fit for a four-factor model of Asperger Syndrome in social and

language difficulties.

Table 4.8: RMSEA, CFI, TLI & CMIN/df

Group 1 Group

2

RMSEA .77 .68

CFI .951 .950

TLI .937 .936

CMIN/df 4.14 4.89

61

Table 4.8: Confirmatory Factor Analysis (CFA) for Group 1 & Group 2

CFA in group 1 CFA in group 2

4.3.1 Validating the instrument of Asperger Syndrome in Cognitive Difficulties

H2A:cognitive difficulties is a three factor measurement model has been accepted.

The construct of Mind Blindness is denoted by perceiving the world in black and white;

demonstrated lack of empathy towards others; don’t realize words can hurt other

people; not realizing the word forgiveness means a lot to people.

The construct of lack of cognitive flexibility is determined through the items related to

having difficulties in organizing skills and how to do it; difficulties in arrangement and

sequences; and difficult to take instructions.

The construct of imagination in playing games is determined through the items include

attempt by others to change the game is opposed strongly; involve in imagination of

lack to interact

inappropriate behav

abnormal nonverbal

.73

IA2a e1.85

.82

IA2b e2.91

.66

IA2c e4

.81

.27

IBa e5.52

.69

IBc e7.83

.50

IBd e8

.71

.69

IC1b e10.83 .59

IC1c e11.77

.73

IC1d e12

.85

.69

IC1e e13

.83

difficult in language

processing

.51

IIDa e19.72

.53

IIDc e21.73

.74

IIDd e22

.86

.71

IIDe e23

.84

p=.000

rmsea=.077

cfi=.951

tli=.937

.81

.56

.39

.56

.63

.66

lack to interact

inappropriate behav

abnormal nonverbal

.77

IA2a e1.88

.76

IA2b e2.87

.80

IA2c e4

.89

.47

IBa e5.68

.78

IBc e7.88

.47

IBd e8

.68

.75

IC1b e10.87 .72

IC1c e11.85

.80

IC1d e12

.90

.72

IC1e e13

.85

difficult in language

processing

.57

IIDa e19.76

.74

IIDc e21.86

.75

IIDd e22

.86

.79

IIDe e23

.89

p=.000

rmsea=.088

cfi=.950

tli=.936

.78

.64

.61

.52

.67

.71

62

playing games but actually copying from the media; focus interest specifically with the

intention to dominate the activity and games selected.

Table 4.9: CFA Analysis for Cognitive Issues

Correlations show significant associations between Cognitive Issues and Lacked of

cognitive flexibility (r=.72); inability and cognitive issues (r=.79), Inability to relate and

lacked of cognitive flexibility (r=.78). The constructs accomplish discriminant validity.

F1

.35

VAa e1.59

.64

VAc e3.80

.67

VAd e4

.82

.69

VAe e5

.83

F2

.75

VB1a e6.76

VB1b e7

.50

VB1e e10

.87

.87

.70

F3

.63

VCb e12.66

VCc e13.59

VCd e14

.79

.81

.77.72

.78

.79

VAa <--- Inability to relate to internal and external situations .594

Vac <--- Inability to relate to internal and external situations .800

VAd <--- Inability to relate to internal and external situations .816

VAe <--- Inability to relate to internal and external situations .833

VB1a <--- Lacked of Cognitive Flexibility .867

VB1b <--- Lacked of Cognitive Flexibility .873

VB1e <--- Lacked of Cognitive Flexibility .704

VCc <--- Cognitive Issues - Weak Imaginative Play .812

VCb <--- Cognitive Issues - Weak Imaginative Play .792

VCd <--- Cognitive Issues - Weak Imaginative Play .766

63

H2B: The three-factor measurement model of Cognitive difficulties fits across two sets

of data.

The hypothesis has been accepted since both data accommodates the model with only a

slight difference for all the indices tested.

Table 4.10: Goodness of Fit for Cognitive Issues Across 2 Groups of Data.

Group IFI TLI RMSEA CMIN/DF

1 .962 .946 .084 4.741

2 .986 .981 .058 2.666

CFA in

CFA in group 1 CFA in group 2

4.3.2 Validating Senses Sensitiveness – It is initially a five-factor model. Thus,

the alternative hypotheses were tested.

H3A: The Senses Sensitiveness construct is a five-factor measurement model

The factors or constructs involve “difficulties in vision, hearing, smell (olfactory),

touch, and taste”.

The construct of difficulties in vision include “not having sharp vision, avoid confronting

eyes to eyes and difficulties to stand too close with others”.

64

The construct of hearing is determined by “closing eyes when hearing something, show

extreme fright when hearing unexpected sound, not able to focus when hearing

unexpected sounds; not able to focus when a few sounds are at similar time, purposely

run away from sounds and lastly scared of specific sounds”.

The construct of difficulties in smell is indicated by the items of can detect certain smell

when it is strong and unpleasant, can sense the smell faster than others; must smell certain

thing before using it. The construct of difficulties in touch shows the items difficult to be

touched and pinched; show anxiety when touch something at sudden; and difficult with

plated short or with tagging.

The construct of difficulties in taste is determined by making limited choice of food, only

accept food with certain texture and colour and must touch the food before eating.

Table 4.11: Senses Sensitiveness

Table 4.12: Correlations Across constructs of

Senses Sensitiveness

Codes Items Loadings

VIAa <--- Difficulties in vision .717

VIAb <--- Difficulties in vision .803

VIAc <--- Difficulties in vision .686

VIBa <--- Sensitive to noise .756

VIBb <--- Sensitive to noise .853

VIBc <--- Sensitive to noise .852

VIBd <--- Sensitive to noise .876

VIBe <--- Sensitive to noise .855

VICa <--- Sense of smell .706

VICc <--- Sense of smell .757

VICe <--- Sense of smell .857

VIDa <--- Sense of touch .863

VIDb <--- Sense of touch .832

VIDe <--- Sense of touch .725

VIEa <--- Sense of taste .725

VIEb <--- Sense of taste .877

VIEc <--- Sense of taste .724

F1 <--> F2 .629

F2 <--> F3 .547

F3 <--> F4 .560

F4 <--> F5 .644

F3 <--> F5 .512

65

No correlation is found to be more than .08. Thus, all the constructs are discriminant.

H3B: The Senses Sensitiveness measurement model fits across two sets of data

Table 4.13: Goodness of Fit for Senses Sensitiveness

Group IFI TLI RMSEA CMIN/DF

1 .930 .912 .085 4.582

2 .944 .929 .078 4.566

Both models have shown goodness of fit where only a slight change in fit indices. The

items were detected to show similarities in both models.

CFA in group 1 CFA in group 2

F2 <--> F5 .493

F1 <--> F5 .571

F1 <--> F3 .488

F2 <--> F4 .641

F1 <--> F4 .730

66

4.3.3 Validating – Rigidity, Limited Interest & Daily Routine

H4A: Rigidity, Narrow Range of Interest and Daily Routine - A three-factor

measurement Model has been accepted.

The rigidity, limited interest and daily routine construct are explained by three measurement

factors which are: a) rigidity in the thinking process, b) limited interests, and c) inability to

adhere to rules and daily routines.

In general, behavioral rigidity refers to a child’s difficulty in maintaining appropriate

behavior in new and unfamiliar situations. The opposite of rigidity would be flexibility,

which enables children to shift effortlessly from task to task in the classroom, from topic to

topic in conversation, from one role to another in games, etc.

Rigidity can also affect thinking. Cognitive rigidity occurs when the child is unable to

consider alternatives to the current situation, alternative viewpoints, or innovative solutions to

a problem. The child with rigid thinking tends to view things in “either-or” terms (e.g., things

are either right or wrong, good or bad). He or she wants concrete, black and white answers.

The “gray areas” of life are very uncomfortable (e.g., often has an exact way of doing things

with no variations).

Children with Asperger’s (AS) and High-Functioning Autism (HFA) often demonstrate

extreme forms of rigidity or inflexibility. This may manifest itself as (a) difficulty

ending an intense emotional feeling, (b) making transitions during the school day (e.g.,

from lunch back to the classroom), and (c) tolerating changes in schedules or everyday

routines.

Children with Asperger Syndrome display narrow range of interests and insistence on

Set Routines – These set of attributes address the Aspergers child’s rigidity, obsessions,

perseverations, and need for structure/routine/order. Rules are very important as the

world is seen as black or white:

i. Takes perfectionism to an extreme — one wrong answer is not tolerable, and

the child must do things perfectly

ii. Has difficulty with any changes in the established routine

iii. Has a set routine for how activities are to be done

iv. Has rules for most activities, which must be followed (this can be extended to

all involved)

Children with Asperger syndrome too have few interests, but those present are unusual

and treated as obsessions:

i. Patterns, routines, and rituals are evident and interfere with daily functioning

(note: this is driven by the child’s anxiety; the world is confusing for her; she is

unsure what to do and how to do it; if she can impose structure, she begins to

have a feeling of control)

67

ii. Has developed narrow and specific interests; the interests tend to be atypical

(note: this gives a feeling of competence and order; involvement with the area

of special interest becomes all-consuming)

iii. Displays rigid behaviour

Findings for goodness fit of model for group 1 and group 2 via CFA analysis is

tabulated as the following Table 4.14.

Table 4.14: Goodness of Fit for the three factors measurement model of

Rigidity, Limited Interests & Daily Routines

Group IFI TLI RMSEA CMIN/DF

1 .930 .931 .090 5.33

2 .980 .966 .080 4.22

The correlation of items across three constructs are tabulated in Table 4.15 below.

Table 4.15: Correlations Across Constructs of Rigidity (F1),

Limited Interest (F2) & Daily Routines (F3)

Codes Items Estimate

IIIAa <--- F1 .73

IIIAb <--- F1 .86

IIIBa <--- F2 .69

IIIBb <--- F2 .71

IIIBc <--- F2 .75

IIIBd <--- F2 .77

IIIBe <--- F2 .76

IIICa <--- F3 .75

IIICb <--- F3 .77

IIICc <--- F3 .82

68

Group 1

RIGIDITYIIIAa e1

.73

IIIAb e2.88

INTEREST

IIIBa e3.69

IIIBb e4.71

IIIBc e5.75

IIIBd e6

.77

IIIBe e7

.76

ROUTINES

IIICa e8.75

IIICb e9.77

IIICc e10.82

.84

.81

.77

69

Group 2

Figure 3: Three Factors Model for Limited Interests & Rigidity in Daily Routines for

Group 1 and Group 2

H4B: The Limited Interests, Rigidity and Daily Routines constructs as a three factor

model fits in both data sets has been accepted based on overall results. However, the

results are weak due to relative chi-squared (CMIN/DF) for group 1 is greater than

accepted threshold value of less than 5.00. Further RMSEA values for both groups are

within the acceptable low and high range. The correlation remains high at .084 for group

2. Thus, the three-factors model is relevant to be explained by the items and factors

involved.

70

4.3.4 Validating - Motor Clumsiness or difficulties is a two-factor model.

H5A: Motor clumsiness is a two-factor model has been accepted.

Motor clumsiness is explained by two factors namely “difficulties in rough motor

skills” and “soft and delicate motor skills”. The items of “awkward body movement

when moving, difficulties in catching and throwing ball, difficulties in body

coordination explain the rough motor skills”. The soft motor skills are explained

through the “difficulties in writing, holding pen or pencil, and too fast in completing a

task”.

Table 4.16: Correlations Across Constructs of Motor Clumsiness

Codes Items Estimate

IVAa <--- F1 .688

IVAc <--- F1 .886

IVAd <--- F1 .904

IVBa <--- F2 .814

IVBb <--- F2 .891

IVBc <--- F2 .660

Correlation between both constructs is .85 (highly correlated). The constructs are not

discriminant and the hypothesis of two factor model can be rejected.

H5B: The motor clumsiness as a two factor model fits in both data sets has been accepted

based on overall results. However, the results are weak due to relative chi-squared for

group 2 is greater than accepted value of less than 5.00. Further RMSEA also shows

greater than expected value of less than .08 in group 2. The correlation remains high at

.084 for group 2. Thus, the two-factor model is not relevant to be explained by the items

and factors involved.

Table 4.17: Goodness of Fit – Motor Clumsiness

Group IFI TLI RMSEA CMIN/DF

1 .985 .971 .084 4.811

2 .967 .982 .098 5.815

71

CFA in group 1 CFA in group 2

4.4 RQ3 : Estimating the Prevalence Rate of Asperger Syndrome Among Malaysian

Mainstream Children

In addressing research question three, ie. to estimate the prevalence rate of children with

potential Asperger Syndrome, new criteria have been set to ascertain the Single Spectrum but

Significant Individual Variability which is based on DSM 5. The criteria include:

i. Severity of ASD Symptoms

ii. Pattern of Onset and Clinical Course

iii. Etiologic factors

iv. Cognitive abilities (IQ)

v. Associated conditions

72

Under the current DSM-5, the diagnosis of autism requires that at least six developmental and

behavioral characteristics are observed, that problems are present before the age of three and

that there is no evidence of certain other conditions that are similar.

There are two domains where people with ASD must display persistent deficits namely:

i. challenges with social communication and social interaction

ii. restricted and repetitive patterns of behavior

Specifically, people with ASD must demonstrate (either in the past or in the present) deficits in

social-emotional reciprocity, deficits in nonverbal communicative behaviors used for social

interaction and deficits in developing, maintaining and understanding relationships. In

addition, they must show at least two types of repetitive patterns of behavior, including

stereotyped or repetitive motor movements, insistence on sameness or inflexible adherence to

routines, highly restricted, fixated interests, hyper or hypo reactivity to sensory input or unusual

interest in sensory aspects of the environment. Symptoms can be currently present or reported

in past history.

4.4.0 Setting the SIMCAS Benchmark

Before embarking on this study, the rule thumb was set in that the preschool teachers need to

know the children under observation not less than six (6) months. Further, based on the 6 points

Likert Scale in SIMCAS, any child with a score on the SIMCAS’s item between the Likert

Scale of 5 and 6 were taken into consideration as having the AS criteria whereas the score of 1

through 4 are considered as free from the established norms of Asperger Syndrome. The cut-

offs points were chosen from each item to be calculated to approximately 0 .7% of the children

undertaken by the study. In one epidemiological study estimating a population prevalence rate

of 0.7% (Ehlers, Gillberg, 1993) in a clinical work-up - a minimum prevalence of 3.6 per 1.000

children (7-16 years of age) was adopted using Gillberg and Gillberg's criteria and a male to

female ratio of 4:1. This also includes suspected and possible Asperger syndrome cases, the

prevalence rose to 7.1 per 1.000 children and the male:female ratio dropped to 2.3:1. These

findings are discussed as they relate to previously published results in the field and to findings

obtained using Szatmari et al.’s and ICD -10 draft criteria for the disorder (Ehlers S, Gillberg

C. (1993).

73

Criteria for Screening Asperger Syndrome follows the “Golden Standard” namely:

i) Difficulties in social interaction and communication.

ii) Limited interests and rigidity in daily routines.

iii) Display normal cognitive and language development

iv) Difficulties in gross and fine motor skills

v) Senses sensitiveness

(cited in the American Psychiatric Association, 2000; Szatmari, Bremner, Nagy,1989;

Gillberg & Gillberg, 1989).

In this study, the SIMCAS is a 44-item rating scale that requires the respondent to indicate the

presence or absence of behaviors indicative of Asperger syndrome. The SIMCAS contains five

subscales:

i. Social Interaction and Communication,

ii. Difficulties in Language development (excluded in the final calculation of AS),

iii. Limited Interests and Rigid Daily Routines (were included back again)

iv. Gross and Fine Motor Difficulties

v. Cognitive Issues (excluded in the final calculation AS),

vi. Sensory Sensitiveness

All raw scores were added (by excluding scores for Cognitive issues and Language

Development domains which must yield zero “0” score) within the six (4) domains. The items

were added (using SPSS -summation notation analysis) for the entire scale to yield an Asperger

Syndrome scores.

Findings from this analysis indicated that of the 1041 respondents examined by this study, 9

children (8 Males:1 Female) were identified as having the potentials of Asperger Syndrome

criteria. The prevalence rate is 0.86% which is slightly higher that rate found by other studies.

Hence, another follow-up study employing bigger sample size which includes Sabah and

Sarawak has to be undertaken. This must also include interview with the children identified as

having Asperger Syndrome potentials.

74

4.4.1 Reliability & Validity of the SIMCAS

Table 4.17 tabulates the SIMCAS’s internal consistency rate for each construct.

Table 4.18: The SIMCAS Internal Consistency

4.4.2 Benchmark for ISSAK / SIMCAS

DSM-IV criteria for Asperger Syndrome (AS) was used as the yardstick against which the

SIMCAS was evaluated. The development of screening questionnaires is important because all

diagnostic interviews involve a lengthy assessment those who are highly likely to have an AS

go through this diagnostic process. SIMCAS was developed for possible cases of Asperger

Syndrome in Malaysia. But this screening questionnaire is a non-clinical instrument designed

for use with young children (3-5 years) and is a user-friendly for preschool educators and

parents alike.

i. Educational services to assess for the possibility of Asperger Syndrome screening at

an early stage

ii. able to identify those children who are most likely to have potential AS

iii. results should support the SIMCAS as a useful screening instrument in school settings

for early identification.

iv. SIMCAS has acceptable properties to allow it to be used as a screening instrument in

educational settings

TOTAL

SIMCAS

Social

interaction

Language Interest Motor

development

Cognitive Sensory

No of cases 1041 1041 1041 1041 1041 1041 1041

No of items

(clean set)

44 9 3 0 6 9 17

Alpha .94 .84 .82 .80 .86 .89

No of item

(Original set)

130

items

26 items 16 items 10 items 10 items 33 items 35 items

.99 .96 .95 .92 .95 .95 .97

75

Table 4.18: Determining Criteria & AS Potential - Identified via SIMCAS (30 items sample –

Malaysian Study)

Criteria (N=1041) N % _ve Notes

1. No of cases without language symptoms

(without score 5 or 6) 26 items

628 60.3 413 0

1-16

2. No of cases without cognitive symptoms

(without score 5 or 6) 33 items

420 40.3 621 0

1-32

3. No of cases with at least 2 symptoms in Social

interaction (with score 5 or 6) 10 items

373 35.8 668 0-1

2- 10

4. No of cases with at least 1 symptoms restricted

interest, obsessive, etc.

(with score 5 or 6) 45 items

317 30.5 724

No of students with all in criteria 1- 4 9 0.86 1032

4.5 Summary of Findings for RQ1, RQ2 & RQ3

In summary, several conclusions can be derived from the data analysis in chapter 4 and it

is simplified in Table 4.19. Similarly, the recommendations are suggested side by side for

the ease of reading:

Table 4.19: Summary of Findings for RQ1, RQ2 & RQ3

Research

Questions

Findings

RQ1:

Focus

Group

Discussion

(FGD)

Major Themes:

4.5.1 Difficulties in identifying

Asperger Syndrome and other

disorders

4.5.2 Useful information from other

sources

4.5.3 Exposure to instruments

Sub Themes:

a) Students’ attitude

b) Teachers’ knowledge

on AS and other

disorder

a) Parent as a source of

information

b) Subject learnt as a

source of information

c) Cultural belief as a

source of information

a) No specific instrument

b) The need of screening

instrument user-

76

friendly for parents

and teachers alike

RQ2:

Development

of DSIMCAS

Validating

The domain &

items

i. High internal consistency rate for the

two studies:

ii. Confirmatory Factor Analysis (CFA)

indicted that:

iii. Items clustered under the six

domains – analyzed & reduced via

CFA & identified using Malaysian

norms are:

a) Pilot study 1 at IDEAS

Rawang & Tadika

Bitara (n = 22; α =

.77)

b) Pilot study 2 –

NASOM Centers (n =

114; α = .93).

a) Motor Clumsiness is a

2 Factor(s)

measurement model &

constructs include:

difficulties in gross &

fine motor skills.

b) Limited in Interests &

Rigidity in daily

routines is 2 Factor(s)

model -

c) Cognitive Issues is 3

Factor(s) Measurement

Model & Constructs

include; Mind

Blindness (,); Lacked

of Cognitive

Flexibility (,) &

Imaginative Play (,)

d) Difficulties in Social

Interaction &

Language processing

(combined) is a 4

factor(s) model.

e) Senses Sensitiveness

is a 5 Factor(s) model.

RQ3:

Crosstabulation

& Percentages

i. Prevalence rate for potential

Malaysian children with Asperger

Syndrome.

iii. Breakdown / Ratio of male: female.

- The prevalence rate is

0.86% which is

slightly higher that rate

found by other studies.

- Findings from this

analysis indicated that

of the 1041

respondents examined

by this study, 9

children (8 Males :1

Female) were found

having the potentials

of Asperger Syndrome

criteria.

77

Chapter 5

Discussion & Recommendation

5.0 Introduction:

This study was undertaken when the existence of Asperger Syndrome instrument based

on Malaysian norms is almost non existence. Prior to this, a meta analysis of studies

related to Asperger Syndrome and children was conducted. The findings indicated that

there is a gap in the development of Asperger Syndrome screening instrumentbased on

the Malaysian children and Malaysian norms. Hence, it is imperative for this study to

examine the special needs education practitioners as regard to their needs which include;

1) their awareness of what is classified in DSM IV as Asperger Syndrome, 2) their

knowledge and experience related to Asperger Sydrome, 3) their experiences in handling

special needs children of any kind, 4) their source of references and information, and

finally, 5) availability of any support system for children identified as having Asperger

Syndrome in this country.

This study employed the mixed method in which the qualitative data was obtained via

focus group discussion and the quantitative data was collected through the survey

method. The focus group discussion, probive insights from the special needs education

practitioners. The sharing session highlighted; i) the practitioners’ difficulties in

identifying Asperger Syndrome and other disorders as children do not display the traits

until they are diagnosed clinically by certified psychitrists, or professionals in the related

field, ii) inadequate information from other sources such as parents, subjects learnt and

cutural beliefs, iii) lacked of exposure to screening instruments for Asperger Syndrome

among Malaysian children.

As RQ2, quantatively the findings demonstrated that there was a high internal

consistency rate for the instrumentas examined in two pilot studies. Confirmatory Factor

Analysis on the other hand, suggested the following:

i) Two-factor measurement model for motor clumsiness – difficulties in gross &

fine motor skills

ii) Two-factor model in rigidity in daily routine and limited interests

78

iii) Three factor model in cognitive issues – mind-blindness, lacked of cognitive

flexibility & imaginative play

iv) Four-factor model for difficulties in social interaction & language processing

v) Five factor model for senses sensitivity

In addressing RQ3, quantitative analysis was again utilised. The result indicated that the

prevalence rate for potential Malaysian with Aspeger Syndrome is 0.86%. This means

that approximately 9 children (8:1) 8 males and 1 female of 1041 respondents examined

were found having asperger syndrome potentials.

According to de Bildt, Sytema, Ketelaars, Kraijer, Mulder, Volkmar, and Minderaa.

(2004), the characteristics that define Asperger’s Disorder include intact formal language

skills (e.g., vocabulary, grammar), with impairments in the social use of language and in

non-verbal expression, social awkwardness, and idiosyncratic and consuming interests

(Volkmar & Klin, 2001). Although motor clumsiness is not a defining feature of

Asperger's Disorder, it is often observed (Volkmar & Klin, 2001). Further as reported in

many special needs journals, parents usually sense there is something unusual about a

child with AS by the time of his or her third birthday, and some children may exhibit

symptoms as early as infancy. Unlike children with autism, children with AS retain their

early language skills. Motor development delays – crawling or walking late, clumsiness

– are sometimes the first indicator of the disorder.

The DSM-IV diagnostic criteria for Asperger's Disorder include at least two symptoms

in the domain of social interaction and one symptom in the domain of restricted interests

and behaviors.

The practitioners’ inability to identify and screen may dampen or impede the child’s

rights to early intervention and tutelage under trained professionals in Asperger

Syndrome. Early intervention is defined as the experience and opportunities afforded

infants and toddlers with disabilities by the children’s parents and other primary

caregivers that are intended to promote the children’s acquisition and use of behavioural

competencies to shape and influence their pro-social interactions with people and objects

(Dunst, 2007).

79

The lack of exposure and knowledge as regard to what is known as children with

Asperger Syndrome is a big concern especially for parents and special needs educators

in Malaysia. Workshops on Asperger Syndrome and related skills in handling children

with Asperger Syndrome is crucial and critical especially to special needs educators,

childcare-minders, practitioners and parents.

Exposure and knowledge related to Asperger Syndrome is pertinent to parents and

teachers alike. According to Dawson and Toth (2006) some parents of children whose

children are disgnosed with Autism Syndrome were concerned about their child's

development since birth, and, by 18 months, most parents raise concerns with their

primary health care provider (Howlin & Asgharian, 1999; Rogers, 2001; Siegel, Pilner,

Eschler, & Elliot, 1988).

However, the age at which a diagnosis is confirmed tends to be much older. In a survey

of 770 parents of children with Autism and Asperger's Disorder for instance, the average

age at which a formal diagnosis was confirmed was 5.5 years for Autism and 11 years

for Asperger's Disorder (Howlin & Asgharian, 1999). Empirically it is quite impossible

to ascertain that a child is having Asperger Syndrome when the ripe age for detecting it

is only at 11 years old as reported by many medical research journals. As such screening

children for Asperger Syndrome at the age of 6 years old and below may not yield

positive outcomes.

As for SIMCAS, the screening instrument for Asperger Syndrome based on Malaysian

norms, it is still premature to conclude that the items developed may correctly screen the

Asperger Syndrome traits or attributes as the AS traits may only be visible when the child

turns 11 years old. The Confirmatory Factor Analysis for example, employed by this

study to screen “limited interests and rigidity in daily routines” among mainstream

Malaysian children didn’t indicate the presence of such traits. Hence, this finding is

consistence with findings from other studies that such AS traits may only reveal itself at

the onset of adolescence (Howlin & Asgharian, 1999).

80

5.1 Limitation

Limitation of the study includes:

i) pool of items were too large in that it was too taxing for the class teachers;

ii) many teachers and parents were reluctant to participate in the survey as they associate

the information collected with “stigma and labelling” – issue of confidentiality;

iii) double-barrel items and lengthy statements – items were adoptedand adapted from

existing instruments used for children in the western culture, hence simplification of

the items and adapting them according to the local culture and understanding took

longer time.

5.2 Future Research

Further duplicate study is imperative to cross-validate the findings but it has to be with

larger sample size that comprehend all children in West and East Malaysia randomly

81

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Tanda tangan penilai Tarikh:

___________

_________________________________

KOD

A. MAKLUMAT DEMOGRAFI:

(Bahagian ini perlu diisi oleh guru: Sila baca setiap pernyataan dengan teliti dan

tandakan jawapan anda).

1. Nama Murid: _______________________________________

2. Jantina: 1. Lelaki

2. Perempuan

3. Nama sekolah: ___________________________________________

4. Tarikh penilaian: ____________________

5. Umur pada tarikh penilaian: tahun ______bulan ________

6. Nama guru

penilai:_______________ _________________________

7. Tempoh penilai mengenali pelajar: ______________________________________

8. Kategori ketidakupayaan /

kecacatan (jika ada) : 1. Pendengaran

2. Penglihatan

3. Pertuturan

4. Fizikal

5. Masalah pembelajaran

6. Mental

7. Pelbagai ketidakupayaan

8. Lain-lain. Sila jelaskan: __________

9. Masalah Pembelajaran : 1. Lewat perkembangan global

2. Sindrom down

3. ADHD

4. Austisma

5. Kurang upaya intelektual

6. Masalah pembelajaran spesifik

88

BAHAGIAN B: PEMARKAHAN

(diisi oleh penilai)

Jumlah Ya Tidak

(5 & 6)

1.Interaksi Sosial : Skor bagi konstruk 5 & 6

(item 1 – 10)

2.Kemahiran Bahasa : Skor bagi konstruk 5 & 6

(item 11 – 13)

3.Rutin Harian & Minat : Skor bagi konstruk 5 & 6

(item 14 - 22)

4.Kemahiran Motor : Skor bagi konstruk 5 & 6

(item 23 - 28)

5.Sensorideria : Skor bagi konstruk 5 & 6

(item 29 - 43)

6.Kognitif : Skor bagi konstruk 5 & 6

(item 44-52)

BAHAGIAN C: PELAJAR YANG BERPOTENSI DIKELASIFIKASIKAN SEBAGAI

SINDROM ASPERGER (SA)

(disaring oleh penilai)

1. Interaksi Sosial – jumlah skor 5 & 6 – minima 2 item ke atas.

2. Kemahiran Bahasa – jumlah skor 5 & 6 – MESTI sifar (0).

3. Rutin & Minat, Kemahiran motor & sensori - jumlah skor 5 & 6 – minimum 1 item

4. Kemahiran kognitif - jumlah skor 5 & 6 - MESTI sifar (0).

BAHAGIAN D:

(diisi oleh penilai berkaitan)

Rumusan

Murid berkemungkinan mempunyai sindrom Asperger

Murid berkemungkinan tidak menpunyai sindrom Asperger

Tandatangan : _________________________

Nama : __________________________________________

Disahkan

Tandatangan Guru Besar: _________________________ Cop Sekolah

Nama : ________________________________________________

89

I. INTERAKSI SOSIAL DUA HALA

A. Ketidakupayaan dan/atau kurang keinginan untuk berinteraksi dengan rakan sebaya.

1.Kurang mahir menggunakan bahasa dalam hubungan sosial. 1 2 3 4 5 6

2.Kurang berkemampuan untuk memulakan perbualan. 1 2 3 4 5 6

3.Kurang keupayaan memahami aliran perbualan (Contoh: ini menyebabkan salah

faham dalam berinteraksi)

1 2 3 4 5 6

B. Tingkah laku yang tidak sesuai secara emosi atau sosial.

4.Tingkah laku pelik (Contoh: Ketawa terhadap sesuatu yang menyedihkan,

bertanya soalan yang terlalu peribadi).

1 2 3 4 5 6

5.Tidak menyedari akan peraturan yang tersirat (Contoh: 'melaporkan' perbuatan

rakan sebaya, melanggar 'kod rahsia' yang ada menyebabkan orang lain marah

kepadanya).

1 2 3 4 5 6

6.Bertindak balas dengan marah apabila orang lain tidak mengikut peraturan

(Contoh: Mendisiplinkan orang lain mengikuti gaya guru atau ibu bapa).

1 2 3 4 5 6

C. Penggunaan komunikasi bukan lisan yang terhad atau tidak normal.

7.Tidak memahami isyarat bahasa badan orang lain. 1 2 3 4 5 6

8. Ekspresi muka tidak sama dengan emosi yang ditonjolkan. 1 2 3 4 5 6

9. Kurang ekspresi muka ketika berkomunikasi. 1 2 3 4 5 6

10.Tidak berupaya memahami ekspresi muka orang lain 1 2 3 4 5 6

II. KEMAHIRAN BERTUTUR

A. Kurang upaya dalam pemprosesan bahasa.

11.Sukar membezakan antara maklumat yang relevan dan tidak relevan semasa

pemprosesan bahasa.

1 2 3 4 5 6

12.mudah terganggu oleh rangsangan persekitaran 1 2 3 4 5 6

13.Sukar mengekalkan tumpuan ( mudah terganggu). 1 2 3 4 5 6

III.PILIHAN KEGEMARAN/MINAT

A. Peraturan amat penting apabila dunia dilihat dalam bentuk hitam (buruk) dan putih (baik).

14.mengamalkan kesempurnaan yang melampau. 1 2 3 4 5 6

15.Menghadapi kesukaran untuk merubah rutin sedia ada. 1 2 3 4 5 6

B. Individu mempunyai minat yang terhad.

16.Telah membentuk minat yang atipikal (Contoh: khusus, sempit, dan perasaan

cekap dan terkawal).

1 2 3 4 5 6

17.Bermain dengan alat permainan secara berulang-ulang. 1 2 3 4 5 6

18.Menyusun objek dalam cara yang khusus. 1 2 3 4 5 6

90

19.Tidak boleh menukar cara yang telah dipelajari bagi menyelesaikan

sesuatu tugas.

1 2 3 4 5 6

C. Kegagalan mengikuti peraturan dan rutin menyebabkan masalah sikap.

Ini mungkin termasuk:

20.Keresahan. 1 2 3 4 5 6

21.Bersikap tentarum (contoh: menangis, kekasaran, memusnahkan barang, 1 2 3 4 5 6

menjerit, perbalahan lisan) 1 2 3 4 5 6

22.Tidak mampu mengelak sikap reaksi melampau(contoh: tidak mampu

menggunakan teknik menenang atau menyesuaikan diri.

1 2 3 4 5 6

IV. KERENCATAN PERKEMBANGAN MOTOR.

A. Kesukaran dengan kemahiran motor kasar

23.Ayunan badan yang pelik ketika bergerak. 1 2 3 4 5 6

24.Kesukaran ketika membaling atau menangkap bola (kelihatan takut kepada

bola tersebut).

1 2 3 4 5 6

25.Kesukaran dalam mengkoordinasi anggota badan yang berlainan (mengikat

tali kasut, mengayuh basikal).

1 2 3 4 5 6

B. Kesukaran dengan kemahiran motor halus.

26.Kesukaran dalam kemahiran menulis. 1 2 3 4 5 6

27.Cara memegang pensel/pen yang pelik. 1 2 3 4 5 6

28.Tergesa-gesa dalam menyiapkan tugas yang membabitkan motor halus. 1 2 3 4 5 6

V. SENTITIVITI DERIA.

A. Mempunyai kesukaran dalam aspek penglihatan

29.Membuat renungan yang tajam. 1 2 3 4 5 6

30.Mengelak daripada bertentangan mata. 1 2 3 4 5 6

31.Berdiri terlalu dekat pada objek atau orang. 1 2 3 4 5 6

B. Mengalami kesukaran dalam aspek bunyi.

32.Menutup telinga apabila bunyi tertentu dihasilkan. 1 2 3 4 5 6

33.Tidak mampu memberi tumpuan kepada beberapa jenis bunyi yang berlaku pada

masa yang sama

1 2 3 4 5 6

34.Takut kepada bunyi-bunyi khususnya yang dihasilkan objek tertentu (mesin

hampagas, pengisar, pencuci debu)

1 2 3 4 5 6

C. Mengalami kesukaran dalam aspek olfaktori (penghiduan).

35.Merasakan sesetengah bau terlalu kuat atau tidak enak sehingga berasa mual. 1 2 3 4 5 6

36.Boleh mengenalpasti bau lebih cepat daripada orang lain. 1 2 3 4 5 6

37.Perlu mencium bau bahan tertentu sebelum menggunakannya. 1 2 3 4 5 6

91

D. Mengalami kesukaran dalam aspek sentuhan.

38.mengalami kesukaran apabila disentuh orang lain, walaupun cuma dicuit sedikit

(khususnya di bahu dan kepala).

1 2 3 4 5 6

39.Menunjukkan keresahan apabila disentuh secara tiba-tiba. 1 2 3 4 5 6

40.Mengalami kesukaran dengan baju yang berkelim atau mempunyai tag. 1 2 3 4 5 6

E. Mengalami kesukaran dalam aspek deria rasa

41.Membuat pilihan makanan yang terhad (tertentu). 1 2 3 4 5 6

42.Hanya menerima makanan dengan tekstur atau warna tertentu. 1 2 3 4 5 6

43.Perlu menyentuh makanan sebelum makan. 1 2 3 4 5 6

VI. ISU_ISU KOGNITIF

A. Buta minda (Teori Akal).

44.Melihat dunia dalam hitam dan putih (Contoh: mengakui melanggar satu

peraturan walaupun mengetahui ada risiko untuk ditangkap).

1 2 3 4 5 6

45.Tidak menyedari bahawa orang lain mempunyai sudut pandangan berbeza

daripada dirinya

1 2 3 4 5 6

46.Tidak menyedari dia boleh mengatakan sesuatu yang mengguris perasaan orang

lain.

1 2 3 4 5 6

B. Kurang fleksibiliti kognitif.

47.Menghadapi kesukaran dalam kemahiran mengorganisasikan (Contoh: apa

yang perlu saya lakukan, dan bagaimana saya boleh melakukannya?).

1 2 3 4 5 6

48.Mempunyai kesukaran dengan urutan susun atur (Contoh: apakah urutan /

susunan yang digunakan untuk menyelesaikan sesuatu tugas?).

1 2 3 4 5 6

49.Mempunyai kesukaran mengikut arahan. 1 2 3 4 5 6

C. Permainan Imaginasi :

50.Cuba mengawal semua aspek aktiviti permainan; (Contoh: Sebarang cubaan pihak

lain untuk mengubah permainan itu akan ditentang dengann keras).

1 2 3 4 5 6

51.Terlibat dalam permainan yang kelihatan berimaginasi tetapi sebenarnya ditiru

daripada media (Contoh: Filem / rancangan TV / buku yang diminatinya).

1 2 3 4 5 6

52.Fokus kepada minat khusus sehingga mereka mendominasi permainan dan pilihan

aktiviti.

1 2 3 4 5 6