TECHNICAL REPORT AUTISM SPECTRUM DISORDER RESEARCH IN MALAYSIA

Abstract

Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by deficits in social, communicative and cognitive skills. About 1 in 68 children has been identified with autism spectrum disorder (ASD) according to estimates from Centers for Disease Control and Prevention (CDC) Autism and Developmental Disabilities Monitoring (ADDM) Network. There is increased awareness amongst Malaysian parents currently. A local survey conducted in 2005 revealed that one in every 625 Malaysian children has ASD (unpublished data, Ministry of Health). National Autism Society of Malaysia (NASOM) has reported increased intake of
children with ASD in their organization. This Technical Report of Autism Spectrum Disorder Research in
Malaysia comprises of selected abstracts of published local journal and theses/dissertation. The objective of this report is to provide local evidence based information on children and adolescents aged 18 years and below
with the diagnosis of ASD. A literature search for relevant abstracts from Google Scholar search, Clearinghouse for Research on Disability website, Medline (PubMed), Psyinfo and Cinahl limited to English and Malay
language was conducted. The abstracts were divided into six main scopes (Medical, Engineering, Education, Information Technology, Psychology and Miscellaneous). The theses/dissertation abstracts were compiled by a hand search of the grey literature in the public universities around Klang Valley. All related agencies could utilize this report for policy making and programe planning on ASD. Future direction for research priorities on ASD can be established based on this report. It is hoped that this report will be an addition to the existing reference materials on local autism research and thus encourage and facilitate planning to improve and increase the local
research in Malaysia.

Full text

Institute for Public Health, Ministryof Health
Family Health Development Division, Ministry of Health
2015
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Copyright © Institute for Public Health, National Institutes of Health,
Ministry of Health, Malaysia 2015. All rights reserved
This work is copyright. Institute for Public Health welcomes request
for permission to reproduce in whole or part of its publication.
Application and inquiries should be addressed to Secretariat,
Research Committee of Institute for Public Health.
ISBN : 978-983-2387-10-7
MOH/S/IKU/40.15 (HB)
Title:
TECHNICAL REPORT AUTISM SPECTRUM DISORDER
RESEARCH IN MALAYSIA
Suggested citation:
Jasvindar Kaur, Julia Patrick Engkasan, Ranjini S. Sivanesom,
Norharlina Bahar, Hasnah Toran, Malisa Mat Noor and Khairun Nisa
Kamarudin. Technical Report Autism Spectrum Disorder Research in
Malaysia.
Any enquiries or comments on this report should be directed to:
Dr Jasvindar Kaur
Institute for Public Health
National Institutes of Health
Ministry of Health
Jalan Bangsar
50590 Kuala Lumpur
Malaysia
Email : jasvindar@moh.gov.my
Tel : +603-22979400
Fax : +603-22823114
Published by Institute for Public Health, Ministry of Health, Malaysia
in collaboration with Family Health Development Division, Ministry
of Health, Malaysia
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Autism Spectrum Disorder (ASD) is a disorder of neural
development characterized by impaired social interaction, verbal and
non-verbal communication and restricted and repetitive behavior.
The awareness of autism in Malaysia has increased in the last few years based
on the number of cases reported and parents coming to seek help. There is
increased awareness amongst Malaysian parents currently. Hence this calls
for a comprehensive approach in the management for children with ASD.
This report is a compilation of research findings on ASD among Malaysian
children aged 18 years and below. Experts from various fraternities could use
this report to design new programmes and evaluate the strengths and
weaknesses of existing resources.
This report has also identified gaps in ASD research among Malaysian
children. There is no evidence based data on the prevalence and
sociodemography of ASD in Malaysian children. It is hoped that research
priorities on ASD can be identified and focused research conducted to
address the problem on ASD in Malaysia.
I would like to congratulate the Institute for Public Health and members of
The Technical Team for this report. Special thanks to all individuals and related
agencies who have contributed towards this report publication.
Dr. Shahnaz Murad
Deputy Director-General of Health
(Research and Technical Support)
Ministry of Health Malaysia
Preface By Deputy Director
General Of Health
(Research And Technical Support)
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iv Technical Report Autism Spectrum Disorder Research In Malaysia
We wish to thank the Director-General of Health and Deputy
Director General of Health (Research and Technical
Support) for their support in the publication of this technical report.
Our sincere gratitute and appreciation to the Director, Institute for
Public Health for his guidance and support. The project team was
headed by Dr. Jasvindar Kaur (Senior Public Health Physician), Institute
for Public Health. Special appreciation and thanks to all our Technical
Team members: Dr Julia Patrick Engkasan, Dr Ranjini S.
Sivanesom, Dr Norharlina Bahar, Dr Hasnah Toran, Miss Malisa
Mat Noor and Miss Khairun Nisa Kamarudin for their time, effort
and commitment spent on this report. We also wished to extent our
gratitude to all those who have contributed their expertise either
directly or indirectly in ensuring the success of this publication.
ACKNOWLEDGEMENT
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Technical Report Autism Spectrum Disorder Research In Malaysia v
EXECUTIVE SUMMARY
Autism spectrum disorder (ASD) is a neurodevelopmental disorder
defined by deficits in social, communicative and cognitive skills.
About 1 in 68 children has been identified with autism spectrum
disorder (ASD) according to estimates from Centers for Disease Control and
Prevention (CDC) Autism and Developmental Disabilities Monitoring
(ADDM) Network. There is increased awareness amongst Malaysian parents
currently. A local survey conducted in 2005 revealed that one in every 625
Malaysian children has ASD (unpublished data, Ministry of Health). National
Autism Society of Malaysia (NASOM) has reported increased intake of
children with ASD in their organization.
This Technical Report of Autism Spectrum Disorder Research in
Malaysia comprises of selected abstracts of published local journal and
theses/dissertation. The objective of this report is to provide local evidence
based information on children and adolescents aged 18 years and below
with the diagnosis of ASD. A literature search for relevant abstracts from
Google Scholar search, Clearinghouse for Research on Disability website,
Medline (PubMed), Psyinfo and Cinahl limited to English and Malay
language was conducted. The abstracts were divided into six main scopes
(Medical, Engineering, Education, Information Technology, Psychology and
Miscellaneous). The theses/dissertation abstracts were compiled by a hand
search of the grey literature in the public universities around Kalng Valley.
All related agencies could utilize this report for policy making and programe
planning on ASD. Future direction for research priorities on ASD can be
established based on this report. It is hoped that this report will be an
addition to the existing reference materials on local autism research and
thus encourage and facilitate planning to improve and increase the local
research in Malaysia.
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vi Technical Report Autism Spectrum Disorder Research In Malaysia
Advisor
Dr. Hj Tahir bin Aris
Director of Institute for Public Health.
Members
Dr. Jasvindar Kaur (Team Leader)
Public Health Consultant (Researcher), Institute for Public Health
Assoc. Prof. Dr. Julia Patrick Engkasan
Rehabilitation Specialist, University Malaya Medical Center (UMMC)
Dr. Ranjini S. Sivanesom
Consultant Developmental Paediatrican, Paediatric Institute, Hospital Kuala Lumpur
Dr. Norharlina Bahar
Child & Adolescent Psychiatrist, Hospital Selayang
Assoc. Prof. Dr. Hasnah Toran
Director of PERMATA Kurnia
Miss Malisa Mat Noor
Research Officer, Institute for Public Health
Miss Khairun Nisa Kamarudin
Research Officer, Institute for Public Health
MEMBERS OF THE TECHNICAL TEAM
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Technical Report Autism Spectrum Disorder Research In Malaysia vii
TECHNICAL REPORT i
PREFACE BY DEPUTY DIRECTOR – GENERAL OF HEALTH iii
ACKNOWLEDGEMENT iv
EXECUTIVE SUMMARY v
MEMBERS OF THE TECHNICAL TEAM vi
TABLE OF CONTENTS vii
TABLE OF FIGURES xii
1.1 INTRODUCTION 1
1.2 METHODOLOGY 1
1.2.1 Criteria for considering studies for this review 1
1.2.1.1. Type of study 1
1.2.1.2. Participants 1
1.2.1.3. Interventions 1
1.2.2 Search strategy 1
1.2.2.1. Electronic search 1
1.2.2.2. Hand Search grey literature 2
1.2.3 Selection of studies/ screening 2
1.2.4 Data extraction 2
1.3 RESULTS 2
1.3.1 Publication year 2
1.3.2 Disciplines of research 3
1.3.3 Study design 4
1.3.4 Target population 5
1.3.5 Abstracts 5
1.3.6 Theses/ Dissertations 5
Table Of Contents
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Technical Report Autism Spectrum Disorder Research In Malaysia
viii
1.4 FINDINGS OF STUDIES 6
1.4.1 Education 6
1.4.1.1 Educational intervention 6
1.4.1.2 Early Intervention Program 7
1.4.1.3 Teacher’s Knowledge 7
1.4.1.4 Children Development 7
1.4.1.5 Special Education Program 8
1.4.2 Engineering 8
1.4.2.1 Utilizing EEG as Diagnostic Tool 8
1.4.2.2 Robot-based Intervention 9
1.4.3 Information Technology 10
1.4.3.1 Assessing the Effectiveness of ICT Software 10
1.4.3.2 Software development 11
1.4.3.3 Use of ICT Tools 12
1.4.4 Medical 12
1.4.4.1 Clinical care and therapy 12
1.4.4.2 Prevalence and risk factors 12
1.4.4.3 Interventions 13
1.4.5 Psychology 13
1.4.5.1 Psychological wellbeing of parents 13
1.4.5.2 Perceived Support, Coping Strategies and Quality 14
of Life (QoL) of Parents of Children with ASD
1.4.5.3 Public awareness 15
1.4.5.4 Parents’ recognition of early symptoms of ASD 15
1.4.6 Miscellaneous 15
1.4.7 Theses/ Dissertations 15
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Technical Report Autism Spectrum Disorder Research In Malaysia ix
1.5 DISCUSSION 16
1.5.1 Education 16
1.5.1.1 Educational Intervention 16
1.5.1.2 Early Intervention Program 16
1.5.1.3 Special Education Program 17
1.5.2 Engineering 17
1.5.2.1 Utilizing Electroencephalogram (EEG) as diagnostic tool 17
1.5.2.2 Robot based intervention 17
1.5.3 Information Technology 18
1.5.4 Medical 18
1.5.5 Psychology 19
1.5.5.1 Psychological wellbeing of parents 19
1.5.5.2 Perceived Support, Coping Strategies and Quality of Life 20
(QoL) of Parents of Children with ASD
1.5.5.3 Public awareness 20
1.5.5.4 Parents’ recognition of early symptoms 20
1.5.6 Miscellaneous 20
1.5.7 Theses 20
1.6 CONCLUSION 21
1.6.1 Public Health Implications 21
APPENDIX 1 23
ABSTRACTS 23
1.1 Education 24
1.1.1 Educational Intervention 24
1.1.2 Early Intervention Program 25
1.1.3 Teachers Knowledge 27
1.1.4 Children Development 29
1.1.5 Special Education Program 30
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Technical Report Autism Spectrum Disorder Research In Malaysia
x
1.2 Engineering 31
1.2.1 Utilizing Electroencephalogram (EEG) as Diagnostic Tool 31
1.2.2 Robot-based Intervention 34
1.3 Information Technology (IT) 37
1.3.1 Assessing the Effectiveness of ICT Software 37
1.3.2 Software Development 38
1.3.3 Use of ICT tools 41
1.4 Medical 42
1.4.1 Clinical Care & Therapy 42
1.4.2 Prevalence and Risk Factors 44
1.4.3 Interventions 46
1.5 Psychology 50
1.5.1 Psychological Wellbeing of Parents 50
1.5.2 Perceived support, coping strategies & quality of life of parents 52
with children with ASD
1.5.3 Public Awareness 53
1.5.4 Parents Recognition of Early Symptoms of ASD 54
1.6 Miscellaneous 54
1.7 Thesis/ Dessertation 54
1.7.1 Education 54
1.7.2 Allied Health 57
1.7.3 Information Technology (IT) 59
APPENDIX 2 61
DATA EXTRACTION TABLE 61
3.1 Education 62
3.1.1 Educational Intervention 62
3.1.2 Early Intervention Program 64
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Technical Report Autism Spectrum Disorder Research In Malaysia xi
3.1.3 Teacher’s Knowledge 67
3.1.4 Children Development 69
3.1.5 Special Education Program 71
3.2 Engineering 73
3.2.1 Utilizing Electroencephalography (EEG) as a diagnosis tool 73
3.2.2 Robot-based Intervention 79
3.3 Information Technology (IT) 84
3.3.1 Assessing the Effectiveness of ICT Software 84
3.3.2 Software Development 86
3.3.3 Use of ICT Tools 91
3.4 Medical 93
3.4.1 Clinical Care & Therapy 93
3.4.2 Prevalence and Risk Factors 96
3.4.3 Intervention 99
3.5 Psychology 104
3.5.1 Psychological wellbeing of parents 104
3.5.2 Perceived support, coping strategies & quality of life of 107
parents with children with ASD
3.5.3 Public awareness 109
3.5.4 Parents' recognition of symptoms of ASD 110
3.6 Miscellaneous 111
REFERENCES 113
INDEX 125
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Technical Report Autism Spectrum Disorder Research In Malaysia
xii
Table Of Figures
Figure 1 Percentage of papers by range of years 3
Figure 2 Percentage of papers by disciplines of research 3
Figure 3 Number of published papers by individual disciplines of research 4
Figure 4 Percentage of papers published by study design 4
Figure 5 Percentage of papers by target population 5
Figure 6 Percentage of theses by disciplines of research 6
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Technical Report Autism Spectrum Disorder Research In Malaysia 1
1.1 INTRODUCTION
Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by deficits in
social, communicative and cognitive skills52. Globally the awareness of autism has increased
in recent years. One in every 625 Malaysian children has ASD (unpublished data MOH 2005).
In Malaysia, the awareness of autism has increased in the last few years as evidenced by the
number of cases reported and parents seeking medical attention. However, there is no
compilation of local research on ASD. This would make it difficult to objectively assess the
situation and to develop support systems and services for children with ASD and their
families. We sought to understand the current state of research on ASD in Malaysia and
identify gaps in scientific knowledge.
1.2 METHODOLOGY
This report is based on a scoping review methodological framewok by Arksey and O’Malley
(2005)12.
1.2.1 Criteria for considering studies for this report
1.2.1.1. Type of study
This report comprises a broad range of study design including cross
sectional, cohort, case study, case control and qualitative study.
1.2.1.2. Participants
Children and adolescents aged 18 years and below with the diagnosis of
Autism Spectrum Disorder (ASD). Most studies did not state the type and
severity of the ASD.
1.2.1.3. Interventions
All types of interventions to improve psychological, medical, educational
and social wellbeing of children with ASD were included.
1.2.2 Search strategy
Our search strategy for the report included: 1) Searching electronic medical and
social science databases and 2) Hand search of grey literature
1.2.2.1. Electronic search
Structured method was used to search, screen and select relevant studies.
The electronic search terms were (Autis* OR Pervasive developmental
disorder OR Asperger's OR Rett'sOR Autistic spectrum disorder OR
Childhood developmental disorder OR Childhood disintegrative disorder
OR Pervasive Developmental Disorder non otherwise specified) AND
(Malaysia OR Asia). The following databases were searched: Medline
(PubMed), Psyinfo, Cinahl, Cochrane review database and Health
Technology Assessment. The search was limited to the English and Malay
language.
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Technical Report Autism Spectrum Disorder Research In Malaysia
2
1.2.2.2. Hand Search grey literature
Academic institutions and related agencies were contacted for research
pertaining to ASD. Once permission granted, we hand-searched the
libraries (UPM, UKM, UM, Social Welfare Department) for thesis and
dissertation related to ASD.
1.2.3 Selection of studies/ screening
Titles and abstracts were screened for eligibility according to the following inclusion
and exclusion criteria. For the first level of screening, at least two reviewers
screened titles of the citations retrieved from the electronic databases and removed
all unrelated citations. The second level of screening involved reviewing the
remaining abstracts and selecting the appropriate articles. Full text articles of the
selected abstracts were further reviewed. When there was a conflict among the 2
reviewers at any level of the screening, a third reviewer would evaluate the article.
Final decision was based on group consensus.
The selected full articles were classified into Education, Engineering, Information
Technology (IT), Medical, Psychology and Miscellaneous. These articles were
distributed accordingly to the various experts of the review team.
1.2.4 Data extraction
Five reviewers participated independently in the data extraction. Data was
compiled into a data charting form using an Excel database.
Details of study: Author, year, title, journal, study designs, aim of study,
inclusion/exclusion criteria.
Participants’ characteristics: age, gender, type of autism (if available)
Intervention: If available
Outcome or result: If available
1.3 RESULTS
1.3.1 Publication year
Our search did not yield any studies prior to year 2000. However there was an
increasing trend of publications since then. Majority of publications (86.0%) were
from the year 2010 to 2014 (Figure 1).
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Technical Report Autism Spectrum Disorder Research In Malaysia 3
0
2010-2014
2005-2009
Publication Year
Percentage (%)
2000-2004
86.08
12.66
1.27
10080604020
Figure 1 Percentage of papers by range of years
0
Medical
Disciplines of Research
Percentage (%)
Miscellaneous
Psychology
IT
Engineering
Education
252015105
1.27
12.66
18.99
18.99
24.05
24.05
Figure 2 Percentage of papers by disciplines of research
1.3.2 Disciplines of research
There were 79 publications retrieved whereby the medical and education papers
ranked the top (48.1%, Figure 2).
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Technical Report Autism Spectrum Disorder Research In Malaysia
4
Development of ICT software appeared to be a subject of interest amongst Information Technology
researchers. Medical researchers focus was largely on intervention for children with ASD. Papers on
psychology stressed on wellbeing and coping strategies for both parents and carers. Interestingly, the
education researchers covered a varied spectrum of papers on educational intervention including Early
Intervention Program (EIP) and teachers’ knowledge. Similarly, the papers on engineering were focused
equally on robot based intervention and utilizing electroencephalogram (EEG) as diagnostic tool.
0
Medical
Disciplines of Research
Number of Published Papers
Miscellaneous
Psychology
IT
Engineering
Education
108642 20
Intervention
Educatioan Intervention
Utilizing EEG as Diagnostic Tool
Software Development Use of ICTTo ols Effectiveness of Software
Robot-base Intervention
EIP Teacher’s Knowledge SEP
Children
Development
Clinical Care &
Therapy
Prevalence & Risk
Factors
18161412
11 4 4
54433
87
1032
4411
Psychology
Wellbeing of parents
Perceived Support,
Coping Strategies & Qol
Public
Awareness
Parent’s Recognition of Early Symptoms
1
Figure 3 Number of published papers by individual disciplines of research
0
Cross Sectional
Study Design
Percentage (%)
Action Research
Descriptive
Intervention
Cohort
Quasi Experiment
Mixed Method
Review
Case Study
Qualitative
Case Control
252015105 3530
30.38
25.32
11.39
11.39
6.33
5.06
3.8
2.53
1.27
1.27
1.27
Figure 4 Percentage of papers published by study design
1.3.3 Study design
Thirty percent (24 papers) were cross sectional studies. Case study accounted for
25% (20 papers) while both case control and qualitative studies were about 11%
(9 papers each) respectively (Figure 4).
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Technical Report Autism Spectrum Disorder Research In Malaysia 5
0
Children
Target Population
Percentage (%)
Not Determined
Teachers
Parents/ Caregivers
Mixed Population
604050302010
5.06
10.13
13.92
17.72
53.16
Figure 5 Percentage of papers by target population
1.3.4 Target population
Majority of the papers were conducted on children (53%, 42 papers).
Approximately 18% (14 papers) were on mixed population which comprised of
multiple target groups, e.g. parents/ caregivers and children, teachers and children
(Figure 5)
1.3.5. Abstracts
Abstracts (Appendix 1.1 – 1.6) and data extraction tables (Appendix 2).
1.3.6 Theses/ Dissertations
Hand search of grey literature was carried out at the public universities in Klang
Valley. Thirteen theses abstracts were obtained. There were six theses on education,
five on allied health and two on IT respectively (Figure 6).
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Technical Report Autism Spectrum Disorder Research In Malaysia
6
0
Education
Allied Health
Disciplines of Research
Percentage (%)
IT
46.15
38.46
15.38
5040302010
Figure 6 Percentage of theses by disciplines of research
Executive summaries of the theses are in Appendix 1.7
1.4 FINDINGS OF STUDIES
1.4.1 Education
1.4.1.1 Educational intervention
There were three papers on teaching English as a Second Language (ESL).
All the three studies used qualitative method as their design. One study
was conducted among ten children with ASD (Abd Rahim & Harun
2006)2, while the other two studies were conducted among teachers
(Yahya et al. 2013a, Yahya et al. 2013b)141,142. The number of subjects in
all the studies were small, ranging from four to ten subjects.
It is found that children with ASD were able to collaborate with peers
and use the Imaginative Learning in learning ESL (Abd Rahim & Harun
2006)2. The two studies on sight vocabulary found that teachers used
variety of practices and accommodations in teaching ESL.
Some of the practices found to promote sight vocabulary acquisition
were prompting with first language, adjusting vocabulary level, providing
opportunities to use words, showing expectation, giving extra attention,
inviting participation and acknowledging students’ effort (Yahya et al.
2013a, Yahya et al. 2013b).141,142
A case study by Low & Lee (2011)71 described an intervention based on
speech language and communication skills of a 4 year old girl with severe
autism. This intervention required a prior understanding of her behavioral
patterns and learning styles so as to develop the deficient skills and use
of compensatory strategies to facilitate communication. Hence, speech
and communication skills will enable sustainable inclusive education for
these children.
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Technical Report Autism Spectrum Disorder Research In Malaysia 7
1.4.1.2 Early Intervention Program
There were two studies which discussed the parent’s perspective on early
intervention and identification for children with ASD. One study focussed
on parents’ view on strategies to change the societal perception on ASD
and challenges and strategies to improve school performance. The
qualitative and mixed method study involved adults who were parents to
children with ASD. Study conducted by (Liew & Mohd Ali 2008)68
involved 50 parents of children with autism aged 2-8 years old and had
received early intervention program for at least 6 months whereas (Badzis
& Zaini 2014)13investigated the perception of one mother with an ASD
child on needs of early identification and intervention.
An example of an early intervention program (EIP) is the individual
education plan (IEP).One study investigated the achievement rate of IEP
among children attending UKM Autism Learning Laboratory. The
achievement rate of learning objectives ranged from 40.0% to 85.71%.
1.4.1.3 Teacher’s Knowledge
There were four studies looking into teachers’ training, knowledge,
perception and practices. The number of subjects for all four papers
varied from 3 to 147. Majority of the participants in these studies were
female teachers. Only one study mentioned the age range of 20-60 year
old (Hasnah et al. 2010)43. Two studies (Hasnah et al. 2010, Omar et al.
2013)43,86 were conducted among the special education teachers and
another two studies (Nornadia et al. 2013, Saad et al 2013)83,105included
mainstream teachers. All three studies differed in their designs. Two
studies used cross sectional (Hasnah et al. 2010, Saad et al. 2013)43,105
while the other two studies used case study (Nornadia et al. 2013)81 and
qualitative study design (Omar et al. 2010)86 respectively.
Saad et al. (2013)105 found that teachers had a moderate level of
knowledge in special education needs. In investigating knowledge and
confidence of teachers, the study found formal teachers’ training was
not effective with regards to understanding and teaching children with
ASD. Quality of training in service was only moderate but it was better
than formal training. This resulted in teachers having low confidence in
teaching children with ASD (Hasnah et al. 2010)43. The usual teaching
approach used was to reach out and attract attention of the students to
help them focus. The study on teachers’ perceptions (Nornadia et al.
2013)83 showed that the teachers were not prepared to teach children
with ASD in their class.
1.4.1.4 Children Development
Lim et al. (2012)69 reported that children attending special needs
education (integration programme) had different types of pencil grip
during writing skills. In a pilot study involving 36 special needs children,
the author observed that children with specific learning disabilities
performed the best in the various types of pencil grip accounting to 8.4%
for dynamic pencil grasp, 51.6% for static tripod grasp and 1.8% for the
other types of pencil grasp.
The qualitative study (Vijayen 2002)137, described the development of
social skills of the 3 male students with moderate autism. Education in
the school focused on academics and not sufficiently on social skills.
Teachers should be trained to teach social skills to children with ASD.
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Technical Report Autism Spectrum Disorder Research In Malaysia
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The cross sectional study (Sulaiman et al. 2011)128 examined the cognitive
ability of children with learning disabilities (LD) who were involved in the
community based education program. These included 59 children with
ASD. They were able to identify components of a computer and to
recognize and pronounce alphabets and words. However, they had
problems in reading and writing.
1.4.1.5 Special Education Program
One study (Loh & Syed Yahya 2013)70 looked into transitional needs of
children with special needs from secondary school to employment and
found that it included collaborative support system, job coaching, self-
advocacy skills training, career guidance and transition assessment,
vocational training, trained transition personnel and transition services.
The process of transition should be a collaborative process between the
government and non-governmental sector.
Kamaliah & Wan Aminah (2010)58 did a study on the implementation of
inclusive program for children with ASD in special education, which
supported the need of good planning and monitoring. Hussin et al.
(2012)47 discussed collaboration of government and non-governmental
organizations in integrating children with ASD into mainstream classes.
The paper identified key features towards successful inclusion were smart
collaboration, co-teaching, peer-learning, after-school coaching and
experiential learning.
1.4.2 Engineering
1.4.2.1 Utilizing EEG as Diagnostic Tool
Eight relevant studies related to the use of Electroencephalogram (EEG)
with Autism Spectrum Disorder (ASD) were obtained. These studies
involved six children with autism from National Autistic Society of
Malaysia (NASOM), 7-9 year olds (seven studies) and six typical subjects.
The other study had 3-12 year olds (six normal children, three children
with autism spectrum disorder and eight Down Syndrome children).
Electroencephalogram (EEG) is used to distinguish children with ASD
from typically developing children during motor imitation. Children with
ASD demonstrate very high intensity brain activation during motor
imitation. The author concluded that EEG signals in children with ASD
were helpful in the diagnostic process (Razali & Abdul Wahab 2011)97.
Razali & Abdul Wahab’s (2011)97 research involved EEG signals which
were processed using specific feature extraction method and further
classified into motor learning imitation and dynamic movement. Subjects
were asked to watch video stimuli that showed three different emotions
which were happy, calm and sad while the final video was on a person
clenching their hands (switching left and right hands) within one minute
time. EEG signal analysis revealed that this method could differentiate
between autism and control group up to 86.62 percent accuracy. Razali
& Abdul Wahab (2011)97 reported that EEG activation signals were far
less during a motor movement in children with ASD compared to typically
developing children.
Shams & Abdul Wahab (2013)115 concluded that motor cortex activation
of children with ASD differed from typically developing children. Shams
& Abdul Wahab (2013)115 concluded that the EEG signal during motor
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Technical Report Autism Spectrum Disorder Research In Malaysia 9
tasks will be useful for early detection of autism. Shams & Abdul Wahab
(2011)115 revealed that for children with ASD, an approach using the
principle component analysis method to extract features from EEG
improved the detection of autism in subjects during a motor task than in
open eyes activities. Hence the author concluded that the changes in the
EEG signal during a motor task was useful for early detection of autism
in the clinics.
Qidwai & Shams (2013)95 concluded that EEG signals in children with
ASD differ from typically developing children during eyes-open and eyes-
closed and that EEG was helpful to establish diagnosis of ASD.
Sudirman & Safri (2010)127 looked into EEG signal recording captured
from normal and special needs children based on their visual response
using Visual Evoked Potential (VEP) method. This is based on the alpha
rhythm value. Typically developing children have an alpha value at the
frequency of 8-12 Hz which is greater than children with autism, while
children with autism have an alpha value greater than Down Syndrome
children when they were exposed to visual stimuli. Sudirman & Safri
2010)127 concluded that EEG can be utilized to record brain signal in order
to monitor the level of children's visual response after undergoing eye
treatment.
Othman & Abdul Wahab (2010)90studied the EEG signal spectrum of
typically developing and children with ASD while watching emotionally
related facial expressions. The emotional faces are displayed to the
children for the affective states of calm, happy and sad. Result analysis
revealed that the emotional dynamics of ASD children demonstrated a
reversed valence compared to the typically developing children. Hence
the author concluded that it was possible to detect differences in the
emotional dynamics of children with autism compared to typically
developing children.
1.4.2.2 Robot-based Intervention
Eight relevant studies related to robot based intervention programmes in
the management of ASD were obtained. These studies involved twelve
children with ASD from National Autistic Society of Malaysia (NASOM),
five other children diagnosed with ASD and a single subject study.
Ismail et al. (2012)53 studied the interaction between humanoid robot
NAO and ASD children. This was recorded for both Robot-based
Intervention Program (RBIP) interaction and normal classroom interaction.
The authors concluded that the eye contact of the ASD child was often
seen in RBIP interaction compared to normal classroom interaction. Ismail
et al. (2012)54 observed and evaluated the initial response of stereotyped
behaviour in Human-Robot interaction between Humanoid Robot NAO
and children with ASD during Robot-based Intervention Program (RBIP)
and normal class session. The author found that ASD children with higher
full scale intelligent quotient (FSIQ) responded with less stereotypic
behaviour in the presence of RBIP compared to the normal human-
human interaction in normal classroom session. Ismail et al. (2012)53
determined the initial response of eye contact time between humanoid
robot NAO and ASD children in Robot-based Intervention Program (RBIP)
interaction and normal classroom interaction. There were 5 modules in
the RBIP interaction. The study showed that more eye contact was being
made during the RBIP interaction compared to the classroom interaction.
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The author concluded that aid from humanoid robot NAO will be
beneficial for improving eye contact during learning in classroom setting.
Shamsuddin et al. (2012)117 explored the response of two children with
ASD to a Humanoid Robot NAO that had been programmed to display
5 different emotions using its body poses and gestures. Initial exposure
to NAO robot had potential to teach children with ASD about head and
body posture that were associated with certain emotions. The authors
concluded that positive utilisation of robots will be helpful in the
rehabilitation of children with autism.
Shamsuddin et al. (2012)118 used Humanoid robot for intervention. The
interaction began with the simplest module of NAO in static mode for
45-seconds, then doing head-turn, eyes blinking, talking, moving its
arms, playing nursery rhymes combined with eyes blinking and ended
with NAO playing the ‘ABC’ song combined with arm movement. Four
out of the 5 children exhibited a decrease in autistic behavior
(communication subscale) during the single session of child-robot
interaction. These promising results indicated that the basic modules of
interaction together with the appealing appearance of the NAO robot
were able to attract the children’s attention, and hence kept each child
engaged with the robot during interaction. ASD children with FSIQ of
moderately impaired (40-54) were receptive to robot-based intervention.
Shamsuddin et al. (2012)118 looked into a single case subject who had a
non-verbal IQ score of 104 (average), verbal IQ score of 110 (high
average), FSIQ of 107 (average) and diagnosed as ASD. He complied with
all the exclusion criteria including no hearing and vision deficit, no
abnormal eye movement, obtained his parent/guardian’s consent, was
able to speak and follow simple commands in English and did not possess
self-injury of aggressive behavior. The overall comparison between
observations during child-robot interaction and normal class setting in
this particular case study supported the author's hypothesis that the
humanoid robot NAO served as a significant platform to support and
initiate interaction in children with ASD.
Yussof et al. (2012)146 recorded using video camera the initial response of
all children with ASD who participated in the RBIP (module 1 to 5). This
initial response of children with ASD interacting with Humanoid Robot
NAO in RBIP was compared with normal interaction in their classroom
or in their social life. Interaction with Humanoid Robot NAO generated
more concentration level amongst children with ASD. Shamsuddin et al.
(2013)117 programmed the robot in accordance to the purpose of the
intervention. Video recording of the regular learning environment
(without robot) and during child-robot interaction was done followed by
assessment of the videos and comparison of the behavior scores. The
authors claimed that the statistical data showed that the robot had
significantly reduced the autistic traits of the children with ASD for the
subscale stereotypic behavior and communication.
1.4.3 Information Technology
1.4.3.1 Assessing the Effectiveness of ICT Software
Two studies evaluated the Effectiveness of ICT Software that had been
developed for children with ASD. The first study was a preliminary
investigation of the Interactive Multimedia Learning Awareness (IMLA)
in enhancing awareness of autistic characteristics among parents and the
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society in Malaysia. It was reported that there was a lack of awareness of
autistic characteristics among parents and Malaysian society that needs
to be addressed (Dolah et al. 2011)33.
The second study conducted on 20 children with ASD aged 9 to 14 years
suffering from mild autism observed the interface that the children with
ASD selected for the same 3-D sonic game within 3-D environment. The
authors concluded that this can result in creating a suitable design of
Haptic Interface Technique for Children with ASD to enable them to
interact and communicate effectively with their families, friends and
community (Mustafa et al. 2013)79.
1.4.3.2 Software development
There were 9 studies on software development for children with ASD in
Malaysia. There were 5 reviews, 2 cross sectional and qualitative studies
each and 1 case study. Three studies were conducted solely on the
children with ASD, whereby the first pilot study reported the use of a
specially designed computer game called “Find Me” to improve the social
skills of children with ASD. Playing the game regularly improved their
performance (Riaza & Sarah 2013)101. Another study demonstrated that
children with high functioning autism successfully utilised an educational
software or computer aided-learning as a practical tool for learning
academic skills in a classroom (Abdul Manap et al. 2014)6. The third study
assessed the use of a personal visual system (DVST Client) to enable
children with ASD and fine motor problems to carry out an individual
training program (Hitam et al. 2011)46.
There were 2 studies seen to be beneficial in teaching Quran to the
children with ASD. In 1 study, interviews were conducted with five
doctors and eleven therapists to identify the basic problems of children
with ASD and then developing computer based interventions as
educational tools, including learning Quran (Shams Aliee et al. 2013a)113.
The second study reported the preparation of an interactive course ware
prototype using visual supports to teach the basic Quran recitation to the
children with ASD and to make them focus attention on learning (Shams
Aliee et al. 2013b)112.
Another study aimed to identify autism behavioural symptoms through
the development of Interactive Multimedia Learning Autism (IMLA). The
system design of IMLA was based on autistic behavioural symptoms
which were the main learning objects in enhancing learner’s knowledge
and awareness towards these issues (Dolah et al. 2011)32.
Two studies described the development of Block-Based learning software
for children with ASD. (Ismail et al. 2009, Ismail et al. 2012)51,52. One
study described Block-Based Software Development method and
approach that enabled the end-users (such as parents and teachers) to
build application software to suit the different needs of an autistic child.
The other study described the design and implementation of blocks
software development to enable end users to build personalised
courseware for children with ASD.
Finally, one study reported the development of an educational software
"I like learning" to teach Malay language to children with ASD. This
software used the “ADDIE methodology” to attract childrens’ attention
in learning the Malay Language (Sidek et al. 2014)122.
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1.4.3.3 Use of ICT Tools
Three studies assessed the utilisation of ICT tools among children with
ASD.
Tablet acceptance among children with high functioning autism was
evaluated among 20 caregivers at NASOM. The high functioning autism
children did not seem to have difficulties swiping the touchscreen.
Children with ASD who had sensory issues used the stylus pen for
browsing the tablet. Hence tablets have the potential of becoming new
assistive technology devices for children with ASD (Syarifah Diyanah &
Salam 2013)129.
The possibility of children with high functioning ASD, 8 to 15 years of age
to surf the web independently with minimal guidance in three different
autistic centres in Malaysia was studied. It was concluded that all the
children observed existing search engines were not user friendly and it
was difficult for a child with ASD to utilize it with minimal guidance.
However, development of suitable communication techniques within the
browsers would help the children to surf the web independently (Ravana
et al. 2014)96.
Another study observed 24 children with ASD, aged 5-10 years, response
to a multi-media presentation where visuals were accompanied with
music. The children were divided into 4 groups, based on their level of
functioning and global development. All the children with ASD
responded positively to the computerized multi-media program. This
indicated role of computer especially as a multi-media aid in
understanding the thinking pattern of children with ASD as a means to
modify their behavior (See & Tang 2009)111.
1.4.4 Medical
1.4.4.1 Clinical care and therapy
There were five papers available pertaining to clinical care (Tan & Yadav
2008, Tan & Yadav 2008 )130,131 and service provision (Singh & Gray 2011,
Leong et al. 2011, Leong et al. 2013)123,6 6,65 of which 2 studied
development assessment, one described gross motor skills, two explored
the provision of sensory integration therapy, and one explored speech
language practices. Clinical assessment studies were performed on
children with various types of disabilities aged from 1 month to 12 years,
whilst gross motor skills study was specific to autistic school children aged
7 to 17 years old. Both the development assessment studies used Denver
Developmental Assessment Test (DDST) II chart and Schedule of Growing
Scale (SGS) II were used as outcome measures. Texas Revision of Fait’s
Basic Motor Skills Test: Basic Movement Performance Profile was used to
assess gross motor skills. Both studies pertaining to sensory integration
(SI) and speech language therapy (SLT) explored the patterns of such
services from the viewpoint of the service providers.
1.4.4.2 Prevalence and risk factors
There was no study that specifically investigated incidence of autism in
Malaysia, however there were 3 cross sectional studies and one cohort
study that provided some data on its prevalence. Two studies reported
the percentage of children with autism specifically among children with
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learning disabilities (Aina Mariana & Wong 2011, Toh et al. 2011)9,134
while the other 2 studies reported the percentage among children with
various types of disabilities (Tan & Yadav 2008, Tan & Yadav 2008)130,131.
The studies were done in various locations in Malaysia; Negeri Sembilan,
Sarawak, Kelantan, Perak, Johor and Selangor. Two studies (Aina Mariana
& Wong 2011, Toh et al. 2011)9,134 were done in hospital setting whilst
one was in health care clinics (Tan & Yadav 2008)130,131. Prevalence of
autism in these studies ranged from 5.4 to 9.5%. There was no data
available on sociodemography or further description of characteristics of
autism.
There was only one study that examined perinatal, antenatal and
maternal risks factors associated with autism (Abdullah et al. 2012)6. This
retrospective study was conducted in 2 government hospitals (Hospital
Pulau Pinang and Hospital Bukit Mertajam) in Penang. The population
was autistic children aged 2 and 10 years old who were born in HPP or
HBM. This study identified 7 risk factors including multiple pregnancy,
psychiatric disorder, birth asphyxia, parity between 2 and 3, maternal
smoking, maternal age, and race.
1.4.4.3 Interventions
There were 10 publications on interventions performed on children with
ASD. The majority of the studies (9 studies) were done in school
environment. The subjects in the study included both sexes with high
functioning groups in 2 studies; low functioning group in 1 study and
the rest were either not specified or mixed. The most frequent
intervention was music therapy (4 studies). Other interventions included
animation, digital picture, brain training, portrait drawing therapy,
interactive stroller and physical training (one study each). Although all
interventions showed positive results in their targeted outcomes,
significant values were not available due to small number of subjects.
Most publications have multiple outcomes in a single study but the
commonest outcome measured was social behaviour (5 studies). Other
common outcomes include motor skills (3 studies) and communication
skills (3 studies). Three studies measured reading skill, cognitive skill and
independence as one of their measure outcomes respectively.
1.4.5 Psychology
There were several topics of focus on studies of parents of children with ASD. The
main aspects were psychological wellbeing of parents, their perceived support,
coping strategies and quality of life.
1.4.5.1 Psychological wellbeing of parents
Four relevant studies looked into parental wellbeing of children with ASD.
Three of the studies’ subjects were parents with age range between 30
to 60 years old. One study (Vetrayan et al. 2013)136 was conducted on
parents with children of moderate to severe ASD. One study (Nikmat et
al. 2008)81 excluded parents of children with ASD who had history of
psychological or mental health disorder.
Three studies (Nikmat et al. 2008, Shobana & Saravanan 2014, Vetrayan
et al. 2013)81,121,136 were conducted in an urban city, among parents who
attended either therapy sessions or psychoeducation sessions in hospitals,
clinics or special schools. All the three studies were cross-sectional studies
with sample sizes ranging from 30 to 100 participants.
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Majority of the papers reported strong evidence that parents of children
with ASD faced a high level of stress. A paper (Nikmat et al. 2008)81
investigated 52 parents with children of ASD and found that they,
particularly mothers, have significant level of stress and significant clinical
disturbance in psychological wellbeing. There was no significant
correlation between severity of autistic symptoms and parental stress,
psychological wellbeing and support system received by parents.
In comparing the risks and presence of depression among mothers of
children with developmental disabilities in four countries (Brazil,
Columbia, Thailand, Malaysia), a high percentage (23%) of Malaysian
mothers had significant depressive symptoms. Morbid depression is more
common among mothers of children with disabilities in Latin America
than in Southeast Asia. However, it was difficult to generalize the result
due to methodological issues (Osada et al. 2012)88.
One study found parents who had children with ASD exhibited levels of
hopelessness which correlated inversely with parental level of education
(Vetrayan et al. 2013)136. Another study found that mothers of children
with ASD exhibited higher scores on somatic symptoms, anxiety and
social dysfunction when compared with their counterparts with Down
syndrome and intellectual disability. A study reported negative parental
attitude as significant predictor of psychological problems (Shobana &
Saravanan 2014)121.
1.4.5.2 Perceived Support, Coping Strategies and Quality of Life (QoL) of
Parents of Children with ASD
There were four cross-sectional studies looking at the support, coping
strategies and quality of life for parents of children with ASD.The
participants’ age ranged from 22 to 48 years old. Two of the studies
(Poh & Siew 2012, Hasnah et al. 2013)94,44 indicated that majority of their
subjects were female while the other two studies (Ting & Chuah 2010,
Clark et al. 2012)133,27 did not mention the gender of the participants.
Three studies (Hasnah et al. 2013, Ting & Chuah 2010, Clark et al.
2012)44,133,27 were conducted in urban cities. Another study (Poh & Siew
2012)94 was done in three non-governmental organizations but the
author did not disclose the exact sites. The sample size for each study
ranged from 12 to 52 participants.
A study looking on the availability and type of support perceived by 20
parents of children with disabilities revealed that comprehensive
information and support for them was lacking in Malaysia. Most parental
support came from informal sources e.g. family, friends and other
parents.
One study (Ting & Chuah 2010)133 reported parents coping strategies
used to handle their children’s behaviour. These were parents who send
their children to the Resource and Educational Centre, Sarawak Autistic
Association, Kuching. The study revealed that the parents managed their
distress and anxiety mainly through religious means and family support.
The study points to a need for more government-supported services for
children with ASD and their parents.
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1.4.5.3 Public awareness
There was one study looking into parent/ caregivers-child relationship in
relation to public awareness and discrimination. The qualitative study was
conducted among four parents and two teachers of children with ASD.
The study concluded that there was a lack of awareness and
understanding of children with ASD among the general public in
Malaysia (Jin & Chin 2012)57.
1.4.5.4 Parents’ recognition of early symptoms of ASD
There were two cross-sectional studies looking into this area (Ting &
Chuah 2010, Yeo & Lu 2014)133,144. The participants were 12 parents and
79 mothers respectively. Both studies found speech delay or loss of
speech ability as the first symptoms that alerted them to the possibility
of autism. Parents also notice stereotypic behaviour, difficulties in
socializing with peers, lack of eye contact, sleep problems, hyperactivity
and hypersensitivity to specific sounds (Ting & Chuah 2010)133.
1.4.6 Miscellaneous
This study was aimed at obtaining the views and consensus of experts on the
impact of video on the learning of students with autism in Malaysia. The use of
video by experts, identifying behavior of students with autism in their use of video
and determining the limitations of video and ways to overcome them by using the
Fuzzi Delphi technique (Saiman et al. 2013)106.
1.4.7 Theses/ Dissertations
There were 13 theses retrieved for this report. Summary for this grey literature was
obtained from the abstracts, as full theses were not available. Twelve studies
involved children (7 out of 12 studies on children involved only autistic children
while another 5 studies involved children with learning disability children), whilst
one described computer system development. Three of the 12 studies were
observation studies describing the children integrative skills, the association
between sensory processing disorder (SPD) and tantrum characteristics, and their
non-literal understanding.
The other 8 studies examined the effects of various interventions to improve
learning and behaviour. The interventions to improve learning included using
multimedia technology (3 studies), puppet (1 study), cooperative teaching method
(1 study), economy token (1 study), discrete trial teaching (1 study), and arithmetic
teaching aid. One study investigated the effect of sandplay in reducing problematic
behavior. The interventions showed positive outcome in some children in all
interventions except for sandplay where there was no positive changes in
behaviors. Finally one study described the development of NASOM Parent’s
Support System where a diagnosis module was developed to help parents to
diagnose the probability of child having autism.
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1.5 DISCUSSION
1.5.1 Education
1.5.1.1 Educational Intervention
One study noted that teachers in schools should be trained to teach social
skills to children with moderate autism (Yahya S. et al. 2013)135. A meta-
analysis of 55 studies by Bellini (2007)17 noted that social skill
interventions have been minimally effective for children with ASD.
However, strategies were recommended to increase the effectiveness of
teaching social skills to children with ASD. These included increasing the
duration of social skill interventions, training in the child’s familiar
environment and matching the intervention strategy with the type of skill
deficit.
Low & Lee (2011)71 stated that the behavioral patterns and learning styles
of children with severe autism should be assessed to ensure development
of an effective speech, language and communication intervention. Paul
(2008)92 noted that children with ASD require intensive, early intervention
on communication with trained peers in natural settings to enhance this
intervention on communication.
Children with ASD who participated in a community based education
program had difficulty in reading and writing, although they could
identify computer parts and articulate words (Sulaiman et al. 2011)128.
Different teaching approaches resulted in different reading skills in
children with ASD. A pilot study by Flores et al. (2013)36 demonstrated
the implementation of direct instruction (DI) as an effective reading
comprehension intervention for students with ASD. However, the author
recomended that evaluation should be done on a larger group of
students with a more robust methodology.
1.5.1.2 Early Intervention Program
Corsello (2005)28 reported that experts working with children with autism
agreed that early intervention is critical as it leads to better outcome.
Recommendations for Early Intervention Program (EIP) should include
parent involvement, intensity, a predictable environment, incorporating
the child's interests, actively engaging the child and focusing on
individualized developmental goals.
Fuentes et al. (2009)37 reported that handwriting skills were observed to
be poor in individuals with autism. A case-control study of handwriting
samples from children with and without ASD was performed. Samples
were scored on an individual letter basis in 5 categories: legibility, form,
alignment, size and spacing. Children with ASD show overall worse
performance on a handwriting task than do age-and intelligence-
matched controls. More specifically, children with ASD show worse
quality of forming letters but do not show differences in their ability to
correctly size, align and space their letters. Within the ASD group, motor
skills were significantly predictive of handwriting performance whereas
age, gender, IQ and visuospatial abilities were not. The authors suggested
that training letter formation in combination with general training of fine
motor control may be the best direction for improving handwriting
performance in children with ASD.
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1.5.1.3 Special Education Program
The best educational environment for students with ASD was to be
assessed individually and not to be connected with a single classroom
model (Renty 2004)100. However, benefit of inclusive program for children
with ASD was abundant. It included more learning, increased self-
esteem, increased expectations of the learning potential of the students,
behavioural modelling on normally developing peers, more accepting
attitudes from peers and less isolation and stigma for disabled students
and their families (Banerji 1995; Mesibov 1996; Peetsma 2001)14,74,93.
According to the results, implementation of inclusive program for
children with ASD required intensive planning, monitoring and
collaboration with other agencies. Many teachers who had received
training to teach students may not have the required knowledge to teach
in an inclusive environment (Kilanowski 2010, Hayes 2013)60,45. Only a
minority of mainstream teachers believe that students with ASD should
be integrated. The issues of the inclusive classroom for children with ASD
have been debated for decades (Hayes 2013, Harrower 1999)45,40.
Proper planning on preparation of teachers (Hayes 2013)45 and
educational adaptation are needed (Panerai 2002)91 especially in areas
of alternative communication, educational environment, parental
involvement and finally, autism-specific knowledge and training.
This report revealed that there are multilevel needs to be fulfilled in order
to ensure successful transition of children with ASD from secondary
school to employment. Some of the needs identified were vocational
training, post-secondary education, adult support services, community
participation, independent living and outcome of employment
(Westbrook et al. 2013)140.
1.5.2 Engineering
1.5.2.1 Utilizing Electroencephalogram (EEG) as diagnostic tool
Electroencephalogram (EEG) has been recommended as a diagnostic tool
for children with ASD in some local research. Our search did not reveal
any international article to confirm this. However, Kim (2006)61 concluded
that Video-EEG evaluation done for children with autism who present
with seizure-like events reveal epileptiform EEG abnormalities in the
majority. EEG is not a standard tool used for diagnosing children with
ASD.
1.5.2.2 Robot based intervention
Local studies looked into humanoid robots interaction with ASD children
and concluded that social interaction and stereotypic behaviour
improved. Children paired with the robot mediator demonstrated
increased shared attention (visual contact, physical proximity) and
imitated facial expressions (smile) more than the children paired with the
human mediator. However forms of shared conventions such as imitation
of body movements and of familiar actions are higher with two children
paired with a human mediator (Duquette et al. 2008)35. Dautenhahn
(2000)30 looked into the design issues that are relevant in a robot as a
therapeutic teaching device for children with ASD which the local
humanoid-robot studies lack. Local studies compared interaction with
humanoid-robot with ASD and typically developing children whilst Werry
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& Dautenhahn (1999)139 compared and found that human robot
interaction for some children with ASD was longer than an interaction
with a non robotic toy. Robins et al. (2005)102 concluded that it is not
clear whether any of the social and communicative skills that the children
exhibit during interaction with the robot have any lasting effect and
whether these skills could be generalized and applied in children's day to
day life outside the trial scenario. There is no clear evidence that
intervention using robot improves social interaction both in local and
international studies for children with ASD.
1.5.3 Information Technology
Our report noted that computer aided tools have been used to develop social,
communication and academic skills of children with autism spectrum disorders.
Globally, in proportion to the increase in number of cases, there has been a similar
trend. Information and Communication Technologies (ICTs) create safe
environments and reduce the frustrations associated with repeated mistakes in
real world (Ingersoll 2013)50.
Lahiri et al. (2013)63 demonstrated the development of effective social
communication skills among the participants with ASD. However during testing of
a technology-assisted intervention, the researchers evaluated that these may not
be suitable for individuals with low functioning ASD.
A systematic review on use of computer aided tools for children with autism
spectrum disorders (Bartolome & Zapirain 2014)15 concluded that it strengthened
communication skills with visual aids but did not provide evidence that children
learn to communicate with such tools. Furthermore, computer aided tools may
need to be adapted for children with different levels of severity to gain maximum
benefit. Further research should be conducted to assess if the skills gained
improved the overall quality of life of these children.
Our researchers have developed a suitable design of Haptic Interface Technique for
children with ASD to improve their communication skills. However, it was noted
that the current prototypes developed had to be tested on the patients and further
clinical evaluation should be done to ensure the safety of haptics. Design control
and bio-feedback systems that correspond to the patient’s and therapist’s needs
should be designed (Vaucelle et al. 2009)135.
Tablet acceptance among high functioning children with ASD was noted by our
researchers. Likewise, it was noted that tablet applications promoted positive
behaviors in children with ASD whereby they enjoyed social activities, developed
appropriate social skills and expressed themselves. It was recomended to use
tablets to strenghten social activities of children with ASD (Hourcade et al. 2012)48.
Our report noted that children with high functioning ASD found the existing search
engines were not user friendly and it was difficult for them to utilize it with minimal
guidance (Ravana 2014)96.
1.5.4 Medical
In our report, it was obvious that epidemiology data on autism was lacking. The
prevalence of ASD obtained in this report was extracted from studies, where the
primary objectives were not to examine disease prevalence. The prevalence of
autism was calculated among children who attended selected health facilities and
hence this was not the true reflection of the actual prevalence. The best method
to determine prevalence would be a population based survey (Brugha et al 2011)22
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and not hospital-based study. Although this study managed to obtain the
prevalence of autism, it is not possible to compare our prevalence with
international data ie. 1 in 68; 12.7/10000 (CDC US 2014)24 due to methodological
differences. Other epidemiology components that have not been researched on
locally include the socio-demographic data of those affected by ASD and their
parents, the characteristics of ASD and the associated medical conditions. As many
as 25-30% of individuals with ASD have associated medical conditions such as
epilepsy and sensory impairment (Levy et al. 2010)67. Epidemiological information
in ASD is crucial in establishing the magnitude of this problem which will assist
policymakers to make decisions on resource allocation and healthcare programs.
(Baxter 2014)16.
There has been a growing interest to study effects of various interventions to
improve behavior and learning in children with ASD. This is evident from the
increasing number of publications in the last five years. Intervention studies in this
report have generally focused on non-pharmacological interventions which were
implemented on the children, mostly by their teachers. Internationally, intervention
studies have moved towards implementation by parents and peers network as well
as parental support. (Rogers et al. 2014, Kamps et al. 2014, Stuttard et al.
2014)103,59,126. Thus there is a need for the local researchers to expand the target
group of their interventional studies. Though all the intervention studies in this
report showed positive results, the studies were done with small samples and there
were no randomized controlled trials conducted. Thus the positive results obtained
from the local studies have limited value in actual implementation.
1.5.5 Psychology
1.5.5.1 Psychological wellbeing of parents
Our report found that caring for children with ASD caused extra stress,
difficulties and psychological distress. Several studies have reported this
(Browne & Bramston 1998, Warfield et al. 1999)21 ,138 and found that
parents with children with ASD reported higher stress and more
adjustment problems compared to parents with Downs syndrome (Ryde-
Brandt 1990, Dumas et al. 1991, Sanders & Morgan 1997)104,34,107 and
mothers of children with intellectual disability without ASD (Olson &
Hwang 2001)85. This report nothed that hopelessness and education level
were inversely correlated, which is consistent with other studies (Breslau
et al. 1982)19.
ASD is a disorder that involves behavioural disturbance and limitation in
social skills and responsiveness. These factors have been found to
contribute to parental stress and difficulties (Cameron et al. 1991,
Hodapp et al. 1997)23,47. In addition, restrictions in parents’ personal life
also contributed to the higher risk of depression in parents of children
with ASD. Hence it is important to provide sufficient support for these
parents.
It was found that mothers were more vulnerable to have significant
stress. This is consistent with other studies (Olson & Hwang 2001, Breslau
1982) 85,19. It is postulated that mothers are often more involved in
looking after the child (Bristol et al. 1988, Moes 1992)20,76 giving up their
jobs and not able to pursue their own interests (Breslau 1982)19. It may
also be that fathers demonstrate their distress in other ways.
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1.5.5.2 Perceived Support, Coping Strategies and Quality of Life (QoL) of
Parents of Children with ASD
It was found that parental support from government is lacking and most
parents cope by receiving support from families and friends. This is in
accordance to studies in other countries too (Sivberg 2002)125. There is a
need for more government-supported services for children with ASD and
their parents.
Little is known about QoL in parents of children with ASD. High level of
motivation among them contributed to better QoL. Many papers found
such parents exhibited a lower QoL as compared to parents of healthy
children and those with intellectual disability and cerebral palsy
respectively (Mugno et al. 2007, Allik et al. 2006)78,10. The lower parental
QoL could be due to environmental factors, genetic factors or
combinations of both (Mugno et al. 2007)78. Further research is needed
to examine the genetic and environmental influences on parental QoL.
1.5.5.3 Public awareness
In Malaysia, general public awareness on ASD is lacking. This is consistent
with findings in other developing nations (Arif et al. 2013, Shaukat et al.
2014, Shetty & Raiz 2014)11,119,120.
1.5.5.4 Parents’ recognition of early symptoms
Parents noted speech delay or loss of speech ability as the earliest
symptom alerting them on the possibility of ASD. This is similarly reported
in other studies (Young 2003, Goin-Kochel 2005)145,38.
1.5.6 Miscellaneous
Usage of video is effective on students with autism besides shaping the behavior
desired (Saiman K. et al. 2013)106. Similarly, a review by Delano (2007)31 concluded
that video modeling interventions were effective in teaching a variety of skills to
children with ASD.
1.5.7. Theses
A significant number of theses were accessed for this report, many as a result of
postgraduate research. These theses hold valuable information but due to lack of
publications, the information is inaccessible to others. Researchers should make
an effort to publish their theses in scientific journals to improve existent evidence
based scientific knowledge.
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1.6 CONCLUSION
ASD research in Malaysia shows a rising trend since the year 2000. The study design of
majority of the studies were cross sectional, case control and qualitative. There was a
noticeable published literature gap on studies on children with ASD. General public
awareness on ASD is lacking.
The papers were categorized as Education, Engineering, Information Technology, Medical,
Psychology and Miscellaneous.
Papers on prevalence and sociodemography data were lacking. Special need education
program is deficient and the educators require strengthening of training in this field. Early
Intervention Program (EIP) was beneficial for children with ASD. Several interventions
inclusive of robot, music and movement therapy were described to improve their behavior.
Computer aided tools have been used to develop social communication and academic skills
of children with ASD. However, educational and ICT software need further evaluation and
have to be specifically designed to cater the needs of children with varying levels of severity.
Tablet and multimedia presentations were positively received by children with ASD.
EEG has been suggested to assist in the diagnosis of ASD although this is not a standard
practice. There is no clear evidence that intervention using robot improves social interaction
both in local and international studies for children with ASD.
The earliest symptoms recognized by parents of children with ASD are speech delay or
regression of speech. Understandably, parents of children with ASD are noted to have a
lower quality of life. Most parents received support from families and friends. However,
support from both governmental and non-governmental organizations needs to be
strengthened.
Our report ascertained gaps in ASD research in Malaysia. Future research priorities in ASD
could be identified and focussed towards epidemiological, intervention, education and
family/ carer based studies. High quality studies are required as evidence for policy makers
to improve standard of care in management strategy and service provision for children with
ASD.
1.6.1 Public Health Implications
Identifying the main areas of need:
• Public awareness & early diagnosis
• Training at all levels (educators, carers, professionals)
• Easy access to service provision (EIP & Special Need Education)
• Continued support from childhood to adulthood
• Parental support
• Conduct prioritized research
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Appendix 1
ABSTRACTS
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1.1 Education
1.1.1 Educational Intervention
1.1.1.1 Teaching of Speech, Language and Communication Skills for
Young Children with Severe Autism Spectrum Disorders:
What Do Educators Need to Know?
Low H.M. & Lee L.W.
New Horizons in Education 59(3), 2011: 16-27
Abstract: Background: Globally, there is an increased prevalence of preschool and school-age children
diagnosed with Autism Spectrum Disorders. Current reports show that about one in every 110 children
fall within this category of disorders. Consequently, the successful inclusion of these children in both
regular and special education classes is becoming a critical issue to address. Aims and methods: In this
paper, attention is placed on the children’speech, language and communication skills which are the
primary deficits associated with this category of disorders. Approaching it from the perspective of
speech and language therapy, this paper will offer insights and suggestions to educators in regular
schools and special education programs on how to teach speech, language and communication skills
to young children with severe Autism Spectrum Disorders. A case study is illustrated to provide the
objective exemplar of how a child with severe ASD could learn and improve once being given the
appropriate, evident-based and individualized teaching management and intervention. Conclusion:
The teaching of speech, language and communication skills to children with severe ASD requires a
prior understanding of their behavioral patterns and learning styles. The teaching could be targeted
to help them to develop the deficient skills and to use compensatory strategies to facilitate
communication. A better understanding of how to teach children with severe ASD in schools will lead
to a better teaching and learning experience to both the teachers and the children, with important
implications on promoting sustainable inclusive education for these children.
1.1.1.2 Facilitating ESL Students with Autism Learn Sight Vocabulary:
Teachers’ Practices and Voices
Yahya S., Md Yunus M. & Hasnah T.
International Journal of Sciences: Basic and Applied Research 11(1), 2013: 90-98
Abstract: Teachers’ support is critical to the learning of special needs students. Without teachers’
assistance and understanding, it may be difficult for such students to develop learning. The paper
reports the findings of a study that looked into English language teachers’ practices in facilitating
primary school ESL students with autism learn sight vocabulary. Observational field notes, interviews,
and document analysis indicate that the teachers used a variety of ways to help the students learn.
The findings indicate humanistic language teaching practices. The practices seem to be important in
promoting sight vocabulary development among the students. The findings have important
implications for teacher educators, in service and pre service teachers involved in teaching ESL students
with autism in inclusive and special education settings.
1.1.1.3 Instructional Practices in Enhancing Sight Vocabulary Acquisition
of ESL Students with Autism
Yahya S., Md Yunus M. & Hasnah T.
Procedia Social and Behavioral Sciences 93, 2013: 266-270
Abstract: Teaching sight vocabulary to students with autism is a challenge as these students have
different needs from their nondisabled peers. This study explored teachers’ instructional practices in
teaching sight vocabulary to ESL students with autism in the natural classroom setting. Data collection
included field notes on classroom observation and interviews of teachers. The findings of this study
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suggested that teachers provided support through bridging second language instructions with the
students’L1 (Malay) to ease learning. Findings also indicated that teachers adjusted their level of
vocabulary during instruction to promote sight vocabulary acquisition. Further, results suggested that
giving the students frequent opportunities for using words as their nondisabled peers promotes sight
vocabulary acquisition.
1.1.1.4 First We Imagine, Then, We Collaborate: An Insight with Autistic
Children
Abd Rahim N. & Harun N.I.
Gading Business and Management Journal 10(2), 2006: 57-67
Abstract: This research focuses on the autistic children learning a second language. It investigates the
nature, number and balance of interactions of ten children and further investigates the content of
discussion and reactions which occurred while they were using the learning approach. The subjects
consist of 10 children (7 to 15 years old) with autistism from five schools in Selangor and Negeri
Sembilan, Malaysia. The ‘Imaginative Learning Approach’ is introduced to enhance learning the
English language and, in turn, encourage subjects in collaborating with their peers. It is found that
autistic learners are able to collaborate with peers in the ‘Imaginative Learning Approach’.
1.1.1.5 Teaching Approach for Autism Students: A Case in Malaysia
Omar H., Hussin Z. & Siraj S.
Procedia Social and Behavioral Sciences 106, 2013: 2552-2561
Abstract: Children with Autism are isolated in their own nature, not because they are visually or
hearing impaired but because of the difficulty of understanding what is happening around them.
Pupils’ background of Autism disorders as expressed in term of delayed language development,
communication, social interaction and behavior have created problems for teachers when
implementing the teaching and learning process in the classroom. This paper presents the findings of
a case study conducted in Malaysia to identify teaching approaches applied by the teachers during
the process of teaching pupils with Autism. This study was carried out by interviews with two teachers
who teach Autism student in Special Education classes and a teacher who teaches Autism students
in an Inclusive classroom. All respondents were selected based on criteria of already having more than
five years teaching experience and a history of outstanding teacher awards over their service. Verbatim
interview data are further supported by the observation data and document analysis. This study has
demonstrated impressive results in which teachers are always trying to reach out and attract the
attention of students with autism to focus on the classroom teaching by using the elements of love
and profound concern. The study also found that patience was apparent in the teachers and exhibited
at a high level on a continuous basis during teaching sessions; this was seen to alter some Autism
students’ negative behavior to a more positive behavior.
1.1.2 Early Intervention Program
1.1.2.1 Early Identification and Intervention of Autism Spectrum Disorder
among Young Children
Badzis M. & Zaini M.F.
IIUM Journal of Educational Studies 2(2), 2014: 67-89
Abstract: The present study focused on the paramount importance of early identification and
intervention of Autism Spectrum Disorder (ASD) among young children. The focus of the study is on
children with autism and their typical characters which are identified by adults. The study investigates
the occurrence of Autistic Spectrum Disorder (ASD) among young children from the parents’
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perspective. This descriptive and analytical study aimed at finding 1) parents’ perception of the need
of early identification and intervention of children with autism, 2) parents’ own perception of the
challenges and strategies to help students with autism increase their school performance and 3)
parents’ view on strategies to help change the societal perception on ASD. There were three research
questions to investigate the parents’ perception in the current study; 1) the issue pertaining to the
need of early identification of children with autism, 2) the questions related to useful of identification
to parents, school teachers and society, 3) the questions on the challenges and strategies parents had
to help ASD children receive optimal care by adults. It was found that parents identified their children
behavior as ASD, regardless its degree of severity. The behaviors such as 1) emotionally unstable with
bad tempered, 2) easy to be frustrated, 3) having ritual behavior, 4) quick walking habit, 5) problem
with understanding, 6) reserved personality and lonely were identified with the help of the teachers
in school. Strategies to help children with autism are also discussed in this paper.
1.1.2.2 The Practice of Early Intervention Programming Autistic Children
from the Parents’ Perspective
Liew P.Y. & Mohd Ali M.
Jurnal Pendidikan 33, 2008: 19-33
Abstract: The purpose of this study is to explore parents’ perspective on the usage of the types of
intervention, service delivery and family involvement in the early intervention program received by
autistic children. Data were obtained through questionnaires and interview. Questionnaires were
distributed to 50 parents of autistic child aged 2 to 8 years old from 5 different autistic or learning
disabilities centres three out of these parents were randomly chosen to be the interview subjects.
Data was descriptively analyzed using percentages while the qualititative data were trancribed
verbatimly. The results showed that speech therapy is the kind of intervention that most autistic
children received. There were changes in the development of the autistic child as a result of
intervention. The results also showed that there is a lack of consistency in service delivery between the
services delivered by centers and service practitioners. The results too indicated that in most of the
cases only mothers were involved in the early intervention programme. This study has implication on
the service planners and parental involvement in the intervention programs.
1.1.2.3 An Exploratory Study on the Special Education and Early
Intervention Programme for Autistic Children
Sani B., Wan Chik M.N. & Badzis M.
The International Conference on Early Childhood and Special Education (ICECSE) 2011: ‘Nurturing
Every Child’s Potential for a Better Future’, Penang, Malaysia, 10-12 June 2011: 1-9
Abstract: The objective of this paper is to explore the special education and the intervention
programme for autistic children run by two Non-Governmental Organizations and identify how their
programmes help autistic children improve learning disability. The methodology of this study is
qualitative using a single case study. The research will be an exploratory study with a field study on
two different organizations which are currently active in helping children with learning disabilities.
Semi-structured interviews and informal conversations are used to obtain the data. Findings showed
that both centres used a naturalistic curriculum model where activities carried out are mostly dealing
with real life activities, while topics and skills are focused on sensory skills and children are taught to
use their senses and attention span. Teaching methods used are a mixture of several latest teaching
techniques currently being applied worldwide for autistic children. In the early intervention
programme, the teaching and learning techniques are based on the individual child_s ability. Both
centres admitted that some parents play a supportive role while others play non-supportive roles.
More knowledge of the learning process and learning development of autistic children as well as the
teaching and early intervention strategies is needed to provide better understanding and guidance for
teachers and parents or caregivers to deal with the needs of these children.
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1.1.2.4 Monitoring Progress using the Individual Education Plan for
Students with Autism
Hasnah T., Mohd Hanafi M.Y., Fadliana C. & Mohd Mokhtar T.
Procedia Social and Behavioral Sciences 7(C), 2010: 701-706
Abstract: The Individual Education Plan (IEP) is a written document specifically developed for students
with disabilities. It contains learning objectives for the student, including facilities and resources
needed to achieve these objectives. This study investigated the IEP process carried out in an autism
learning laboratory established in a local university in Malaysia. Specifically, this study investigates the
objectives set for the students and their achievement of these objectives. IEPs were developed IEPs for
10 students with autism who are studying in this laboratory. Results showed that students’
achievement ranged from 40% to 100% of their IEP objectives.
1.1.3 Teachers Knowledge
1.1.3.1 Towards Holistic Inclusion in Malaysia: Knowledge of Special
Educational Needs among In-Service Distant Learning Students
Saad S., Ibrahim H. & Nayan N.
Proceedings of International Conference on Special Education 2013/CAPEU,
Syiah Kuala University, Banda Aceh, Indonesia, 4-6 September 2013: 673-683
Abstract: The findings of previous researches showed that mainstream teachers' have a negative
attitude towards students with special educational needs (SEN) in Malaysia due to the lack of
information and awareness. The purpose of this study was to determine the knowledge level of SEN
among experienced mainstream teachers in Malaysia. A survey was distributed among 147 teachers
undergoing distance learning Bachelor of Education (BEd) degree in a public university. Teaching
experience and familiarity with SEN persons did not affect the knowledge level of the three groups
of participants. The results of the study revealed that teachers had a moderate level of knowledge on
SEN. The implication of these findings for inclusion and for future research in Malaysia is also provided.
This study also made recommendations on how to improve the knowledge level of SEN inservice
teachers in Malaysia, and the need to assess the knowledge on SEN among parents, paraprofessionals,
educational administrators and other stake holders in order to achieve holistic inclusion for pupils
with SEN.
1.1.3.2 Teachers’ Perceptions of Including Children with Autism in a
Preschool
Nornadia M.R., Hasnah T., Sazlina K., Norshidah M.S. & Mohd Hanafi M.Y.
Asian Social Science 9(12), 2013: 261-267
Abstract: Inclusive education supports the vision of the United Nations (UN) in upholding the
fundamental rights of children with special needs towards education. In Malaysia, the Persons with
Disabilities Act 2008 recognized the rights of children and persons with disabilities in regards to
education. However, the implementation of inclusive education for children with autism in Malaysia
has been problematic, especially in preschool. Therefore, this study investigated teachers' perceptions
of including children with autism in a mainstream preschool. The objectives of this study were: 1) to
determine the attitudes of teachers towards inclusive education 2) to identify the knowledge and
skills of pre-school teachers regarding inclusive education 3) to identify the barriers and challenges in
implementing inclusive education in pre-school 4) to investigate the reasons behind the non-
acceptance of preschool teachers on having children with autism in their classes. Data were collected
using a structured interview. Three pre-school teachers in Selangor agreed to participate in this study.
The interviews were transcribed text verbatim and information was analyzed by identifying relevant
themes. The findings showed that the teachers were not prepared to teach children with autism in
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their class because they did not know the characteristics of children with autism and did not
understand the importance of inclusive education. In conclusion, the practice of inclusive education
in pre-school is yet to be implemented successfully due to some constraints experienced by teachers
and lack of support in the environment.
1.1.3.3 Observational Study on Teachers’ Approach in Teaching Children
with Autism to Read
Mislan N., Tian A., Sharifuddin R.S., Guan J. & Lee M.F.
Journal of Education and Practice 3(12), 2012: 156-164
Abstract: Children with autism are characterized with unique cognitive and social emotional
development which makes the process of teaching them to read to be difficult and complicated. In
attending to the special needs and characteristics of children with autism, special education teachers
should have necessary knowledge and techniques in teaching children with autism to read and taking
their characteristics into consideration during the reading lesson. This research aims to examine the
approaches used by teachers in teaching children with autism to read. A total of two special education
teachers were willing to participate in the case study. A non-participant observation was carried out
with the two respective teachers in different time frame in a selected autism centre. The findings
were presented in different phases of the reading process which were carried out. There are no single
theories which was used in teaching students to read in each phase. It involves the combination of
various theories to help students to understand the content of the reading material. Based on the
findings, the teachers used several theories in teaching reading to children with autism. These theories
include reading theories (traditional, cognitive and metacognitive view of reading) and Vygotsky’s
Sociocultural theory.
1.1.3.4 Tahap Latihan, Pengetahuan dan Keyakinan Guru-guru
Pendidikan Khas tentang Autisme (Special Educators’ Level of
Training, Knowledge and Confidence of Autism)
Hasnah T., Mohd. Hanafi M.Y., Mohd. Mokhtar T. & Salleh N.
Jurnal Pendidikan Malaysia
Autism is a developmental disorder that negatively impacts the ability for communication and
interaction. Current statistics have reported an increase in its prevalence. Therefore, the need for well
trained teachers to teach children with autism has also increased. This study was implemented to
investigate the level of training, knowledge, and confidence of special education teachers on autism.
Formal teacher training courses was found to be rather ineffective in training special education
teachers to understand and teach children with autism. It has also been found that inservice training
is slightly better in quality. This caused them to have low confidence in their ability to teach children
with autism. However, they showed interest to undergo advanced courses to enhance their
competence in educating children with autism. Therefore, formal special education teacher training
needs to be improved through an additional component on autism. Special education teachers also
need to be provided with access to inservice training in autism because the field of autism education
has progressed and various strategies that have been proven effective scientifically are now available.
Further studies are needed to identify weaknesses in both types of teacher training and methods to
improve the quality of both in terms on education for children with autism.
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1.1.4 Children Development
1.1.4.1 Kemahiran Asas Sosial Kanak-Kanak Autisme di Persekitaran
Sekolah
Vijayen G.
Maktab Perguruan Keningau. Sabah
Abstract: Kajian kes ini bertujuan untuk menjawab tiga persoalan kajian iaitu a) apakah kemahiran
asas sosial yang telah oleh kanak-kanak autisme. b) apakah kemahiran-kemahiran asas sosial yang
belum dikuasai oleh kanak-kanak autisme, dan c) apakah faktor-faktor yang membolehkan kanak-
kanak autisme berupaya menguasai dan tidak menguasai kemahiran asas sosial mengikut pandangan
guru. Tiga kanak-kanak autisme di Sekolah Kebangsaan Bukit Padang, Kota Kinabalu, Sabah, dipilih
sebagai subjek dan tiga orang guru yang mengajar subjek-subjek ini ditemubual. Kajian ini berfokus
kepada lima kemahiran asas sosial sahaja. Kaedah pemerhatian dan temubual dengan instrument
senarai semak dan soalan terbuka digunakan. Dapatan kajian menunjukkan kelima-lima kemahiran
asas sosial dikuasai oleh subjek tetapi belum menguasai beberapa sub kemahiran. Dapatan temubual
menunjukkan faktor guru, persekitaran, rakan sebaya, dan kaedah mengajar membolehkan
penguasaan kemahiran-kemahiran asas sosial. Sebaliknya faktor kekurangan pendedahan mengenai
autisme dan kaedah mengajar yang khusus, pertukaran guru dan kekurangan pengetahuan ibu bapa
mengenai autisme menghalang penguasaan kemahiran asas sosial.
1.1.4.2 Pencil Grip among Children with Learning Disabilities to Increased
Writing Skill
Lim C.Y., Mohd Hanafi M.Y. & Mohd Mokhtar T.
Malay Language Education Journal, 2012: 65-77
Abstract: Efficient handwriting during learning is important to every student because its failure can
bring a negative effect to self-esteem and academic achievement. It is an obstacle to academic
achievement in school especially in Special Education Integration Learning Disabilities Program (PPKI).
Children Categories Of Learning Disabilities (KKBP) in Malaysia are Down Syndrome, Mild Autism,
Attention Deficit Hyperactivity Disorder (ADHD), Minimum Mentally Retarded and Specific Learning
Disabilities (example Dyslexia). This survey analysis was conducted to highlight the types of pencil grip
among KKBP, the types of levels of pencil grip for learning disabilities students at school stage and
determine the difference of pencil grip in KKBP categories. This study involves photo shooting of
pencil grip when writing by 225 respondents from seven primary schools undergoing Special
Education Integration Program in Klang district, Selangor. A pilot study was carried out on 36
respondents in a school. The findings showed that the category Specific Learning Problems recorded
the highest percentage for all three types of pencil grip level is 8.4% (19 students) for mature stage,
51.6% (116 students) for immature stage and 1.8% (4 students) for other levels. Hopefully, this
research can provide input to the educator to be more focus on how to grip a pencil when writing
and therapists working to design more effective intervention program and provide feedback to the
curriculum education planners on formulating a more effective curriculum for KKBP. Few suggestions
were also presented.
1.1.4.3 The Level of Cognitive Ability among Learning Disabilities
Children in Malacca Malaysia
Sulaiman T., Baki R. & Megat A. Rahman P.Z.
International Journal of Psychological Studies 3(1), 2011: 69-77
Abstract: The objective of the study is to examine the cognitive ability of children with learning
disabilities (LD) who were involved in the PDKNet education program. The children involved in this
study are made up of children with learning disabilities (LD). A total of 106 children from 7 Community
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Based Rehabilitation (CBR) Centre in Malacca took part in this study. The instrument used in this study
is divided into 5 main basic categories which consisted of the ability to identify computer hardwares,
alphabets, words, colours and shapes. The findings of the study indicated that more than half of the
children with learning disabilities (LD) were able to identify components of a computer such as
monitor, keyboard and mouse. More than half of the LD children were also able to recognize and
pronounce words and alphabets. However, they face difficulties in reading and writing the respected
words as well as having difficulties in providing examples for the shapes asked. Therefore, teaching
children especially children with learning disabilities should be given more attention to help them to
read and to write.
1.1.5 Special Education Program
1.1.5.1 Effective Transitional Plan from Secondary Education to
Employment for Individuals with Learning Disabilities:
A Case Study
Loh S.C. & Syed Yahya S.Z.
Journal of Education and Learning 2(1), 2013: 104-117
Abstract: One of the major goals in the education and training of individuals with special needs is to
prepare them for independence. However, in the Malaysian context, parents who have special
adolescents are in doubt as to what would be the future of their children soon after they have finished
the vocational training. This case study explores the transitional needs and subsequently to develop
an effective transitional plan from secondary education to employment for Malaysian individuals with
special needs. The sample comprises two high school special educators and four persons with learning
disabilities who are at work. The findings were triangulated among five co-ordinators of Non-
Governmental Organisation, as well as parents for the four persons with learning disabilities and their
employers. The findings reveal that transitional needs of individuals with special needs includes
collaborative support system, job coaching, self-advocacy skills training, career guidance and transition
assessment, vocational training, trained transition personnel and transition services. The transition
process would be a collaborative process between the government and non-governmental sector.
From the findings, an effective transitional plan from secondary education to employment for students
with learning disabilities was drawn. Several implications have been drawn from this study.
1.1.5.2 Pelaksanaan Program Pendidikan Inklusif Murid Autistik di
Sebuah Sekolah Rendah: Satu Kajian Kes
Kamaliah M. & Wan Amimah W.M.
Proceedings of the 4th International Conference on Teacher Education;
Join Conference UPI & UPSI, Bandung, Indonesia, 8-10 November 2010: 561-575
Abstract: Tujuan kajian ini adalah untuk mengenal pasti pelaksanaan Program Pendidikan Inklusif
murid-murid autistik di sebuah sekolah rendah di Kuala Lumpur. Kajian ini menggunakan pendekatan
kualitatif dan kuantitatif untuk mengumpul data-data. Seramai dua puluh satu orang respoden terlibat
dalam kajian ini yang terdiri daripada seorang Guru Besar yang kemudiannya digantikan oleh Guru
Penolong Kanan, Penyelaras Program Integrasi Pendidikan Khas Pembelajaran, tiga orang Guru
Pendamping dari Persatuan Autistik Kebangsaan Malaysia atau The National Autism Society Of
Malaysia (NASOM), tiga orang guru mata pelajaran, tiga orang murid autistik dan sepuluh orang
murid normal. Sekolah A merupakan sebuah sekolah yang menjalankan Program Pendidikan Inklusif
yang dinamakan “Projek Rintis Pendekatan Inklusif Bagi Murid-murid Autistik”. Seramai lapan orang
murid autistik dari (NASOM) telah berjaya dimasukkan secara sepenuh masa di kelas biasa di sekolah
tersebut. Istimewanya program ini ialah setiap kelas yang mempunyai murid autistik akan disertasi
oleh seorang guru pendamping dari (NASOM) yang akan membantu murid-murid tersebut. Semua
guru kelas dan guru mata pelajaran telah diberi kursus pendedahan berkaitan dengan murid-murid
autistik dan Program Pendidikan Inklusif oleh pegawai-pegawai dari Jabatan Pendidikan Khas,
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Kementerian Pelajaran Malaysia (KPM) dan (NASOM). Dapatan kajian mendapati guru-guru kelas dan
guru mata pelajaran menjalin kerjasama yang baik dengan guru-guru pendamping dari (NASOM)
untuk membantu aktiviti pembelajaran murid-murid autistik. Murid-murid ini mampu mengikuti
aktiviti pengajaran dan pembelajaran bersama-sama rakan sekelas yang lain dan berdikari sekiranya
guru pendamping tidak hadir. Semua murid-murid tersebut gembira belajar di sekolah ini. Mereka
boleh berkomunikasi dengan rakan-rakan sekelas dan guru-guru mata pelajaran. Guru Penolong
Kanan menyarankan Program Pendidikan Inklusif akan berkesan jika dirancang dengan rapi dari pihak
KPM dan diimplimentasikan dengan bantuan dan pemantauan berterusan.
1.1.5.3 Overcoming the Challenge of Inclusion through Smart Initiatives:
A Case Study
Hussin S., Loh S.C. & Quek A.H.
Journal of Special Needs Education 2(1), 2012: 51-62
Abstract: In Malaysia, children with special needs have the opportunity for education in special
schools as well as in integrated and inclusion programs conducted in mainstream primary and
secondary schools. Children who benefit from these integrated and inclusion programs include those
with autism alongside many other categories of special needs. Children from the integrated program
who are high functioning have the privilege to be included in mainstream classes. Many questions
remain, however, on how to best implement the inclusion programs in Malaysian schools. As such,
the challenge of inclusion remains. In this article, we describe the smart initiatives since 2005 by the
Malaysian Government and the Non-Governmental Organisations in overcoming the challenge of
including children with autism into the mainstream classes. A research visit was conducted with the
aim of gathering insight into the successful inclusion of children with autism in the mainstream classes
in one of the primary schools located in metropolitan Kuala Lumpur in the Klang Valley, Malaysia.
Children with autism in the inclusive classrooms were allowed to participate in classroom activities and
to respond to teachers' questions to enhance their experiential learning. Few key features towards
successful inclusion such as smart collaboration, co-teaching, peer learning, after-school coaching
and experiential learning were identified. This smart initiative has spearheaded few more inclusion
programs throughout Malaysia.
1.2 Engineering
1.2.1 Utilizing Electroencephalogram (EEG) as Diagnostic Tool
1.2.1.1 2D Affective Space Model (ASM) for detecting autistic children
Razali N. & Abdul Wahab A.R.
2011 IEEE 15th International Symposium on Consumer Electronics, Singapore,
14-17 June 2011: 536-541
Abstract: There are many research works have been done on autism cases using brain imaging
techniques. In this paper, the Electroencephalogram (EEG) was used to understand and analyze the
functionality of the brain to identify or detect brain disorder for autism in term of motor imitation.
Thus, the portability and affordability of the EEG equipment makes it a better choice in comparison
with other brain imaging device such as functional magnetic resonance imaging (fMRI), positron
emission tomography (PET) and megnetoencephalography (MEG). Data collection consists of both
autistic and normal children with the total of 6 children for each group. All subjects were asked to
clinch their hand by following video stimuli which presented in 1 minute time. Gaussian mixture model
was used as a method of feature extraction for analyzing the brain signals in frequency domain. Then,
the extraction data were classified using multilayer perceptron (MLP). According to the verification
result, the percentage of discriminating between both groups is up to 85% in average by using k-fold
validation.
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1.2.1.2 Affective Face Processing Analysis in Autism using
Electroencephalogram
Othman M. & Abdul Wahab A.R.
Information and Communication Technology for the Muslim World (ICT4M), 2010 International
Conference, Jakarta, Indonesia, 13-14 December 2010: E23-E27
Abstract: Past research in the area of psychology has indicated the inability of Autism Spectrum
Disorder (ASD) patients for interpreting other people’s emotion. This impairment is due to their lack
of social motivation and eye contact during communication, causing insufficient information to the
brain for interpreting emotional faces. This paper investigates human brainwaves for understanding
affective face processing of ASD children. Pattern classification results are explained based on the 2-
dimensional emotion model. The 2-dimensional model explains human emotion in terms of the
pleasant/unpleasantness (or valence) and intensity (or arousal). Analysis results revealed that emotion
of the non-autistic group is altered towards matching the affective faces currently displayed on the
computer monitor. Emotion dynamics of ASD children, however, indicated the trend for reversed
valence while watching emotionally related facial expressions.
1.2.1.3 A Source-Discrimination Approach for Detection of ASD Using
EEG Data
Qidwai U.A. & Shams W.K.
International Journal of Bioscience, Biochemistry and Bioinformatics 3(5), 2013: 492-496
Abstract: This paper presents a study which was done in an attempt to discriminate between two
motor actions; eyes-open task and eyes-closed task, for two classes; Autism Spectrums Disorders
(ASD) and Typical or Normal (TP). Both of these groups were composed of school children with ages
between 6 to 9 years. Utilizing the Time Different of Arrival (TDOA) approach applied with raw
Electroencephalography (EEG) data for feature extracted in time domain. For each action, specific
features were calculated and a Multilayer Perception (MLP) based Neural Network was used to classify
the data into the two classes. The classification process was carried out for three scenarios for each
group; first, all task for both group were combined together, second, eyes-open were classified for
both groups separately, and third, eyes–closed was classified separately. The results show accuracy over
90 % and clearly discriminate for the features.
1.2.1.4 Characterizing Autistic Disorder based on Principle Component
Analysis
Shams W.K. & Abdul Wahab A.R.
2011 IEEE Symposium on Industrial Electronics and Applications (ISIEA2011), Langkawi, Malaysia,
25-28 September 2011: 653-657
Abstract: Autism is often diagnosed during preschool or toddled age. This diagnosis often depends
on behavioral test. It is known that individuals with autism have abnormal brain signals different from
typical persons yet this difference in signals is slight that it is often difficult to distinguish from the
normal. However, Electroencephalogram (EEG) signals have a lot of information which reflect the
behavior of brain functions which therefore captures the marker for autism, help to early diagnose
and speed the treatment. This work investigates and compares classification process for autism in
open-eyed tasks and motor movement by using Principle Component Analysis (PCA) for feature
extracted in Time-frequency domain to reduce data dimension. The results show that the proposed
method gives accuracy in the range 90-100% for autism and normal children in motor task and
around 90% to detect normal in open-eyed tasks though difficult to detect autism in this task.
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1.2.1.5 Dynamic Analysis of Critical Features in EEG for Motor Imitation
among Autistic Children
Razali N. & Abdul Wahab A.R.
Recent Researches in Education: Proceedings of the 10th WSEAS International Conference on
Education and Educational Technology (EDU '11), Penang, Malaysia, 3-5 October 2011: 174-179
Abstract: Research study among children with autism had shown impairment in motor imitation in
addition to social disability. Currently, imitation becomes an important issue which can be seen as
new procedure to detect early childhood autism. Hence, this paper proposed the used of motor
imitation action by analyzing the brain waves frequency. Experimental results revealed that control and
autistic children both perform the motor imitation well but the brain activation for both group are
different. Autistic children demonstrate a very high intensity brain activation indicating they are
struggling to do the action. This illustrates some potential methods that can be extended in detecting
autism for early childhood.
1.2.1.6 Human-Robot Interaction Intervention Therapy Procedure for
Initial Response of Autism Children with Humanoid Robot
Yussof H., Ismail L.I., Shamsuddin S., Hanapiah F.A., Mohamed S., Piah H.A.,
Idris S., Hashim H. & Zahari N.I.
1st Joint International Symposium on System-Integrated Intelligence 2012: New Challenges for
Product and Production Engineering, Hannover, Germany, 27-29 June 2012: 148-150
Abstract: This paper presents the initial response of Autism children interacting with Humanoid Robot
NAO in Robot-based Intervention Program. Twelve Autism children from National Autism Society of
Malaysia (NASOM) is being selected based on their behaviour characteristics which has been identified
by certified clinical specialist, psychiatrist, occupational therapy and psychologist. Their Intelligence
Quotient based on Stanford Binet Intelligence Test has been first carried out and they have undergo
the autism diagnose based on Autism Diagnostic Observation Schedule by certified psychologist from
NASOM. The twelve of Autism Children will then participated in the Robot-based Intervention
Program (RBIP), which started from module 1 until module 5. The interaction between Autism Children
and Humanoid Robot NAO is being recorded with two Sony Video Camera and one mini camera
mounted on the chess of Humanoid Robot Nao for initial response analysis based on Gillian Autism
Rating Scale-2nd Edition. The interaction module between the children and robot has been developed
by using the graphical user interface from choreographe of Humanoid Robot Nao.
1.2.1.7 Source-Temporal-Features for Detection EEG Behavior of Autism
Spectrum Disorder
Shams W.K. & Abdul Wahab A.R.
Information and Communication Technology for the Muslim World (ICT4M),
2013 5th International Conference, Rabat, Morocco, 26-27 March 2013: 1-5
Abstract: This study introduces a new model to capture the abnormal brain activity of children with
Autism Spectrum Disorder (ASD) during eyes open and eyes closed resting conditions. EEG data was
collected from normal subjects' ages (4 to 9) years and ASD subjects match group. Time Difference
of Arrival (TDOA) approach was applied with EEG data raw for feature extracted at time domain. The
neural network, Multilayer Perception (MLP) was used to distinguish between the two groups during
the two tasks. Results show significant accuracy around 98% for both tasks and clearly discriminate
for the features in z-dimension his electronic document is a "live" template and already defines the
components of your paper [title, text, heads, etc.) in its style sheet.
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1.2.1.8 Study of Electroencephalography Signal of Autism and Down
Syndrome Children using FFT
Sudirman, Saidin S. & Safri N.M.
2010 IEEE Symposium on Industrial Electronics and Applications (ISIEA 2010),
Penang, Malaysia, 3-5 October 2010: 401-406
Abstract: Electroencephalography (EEG) signal between normal and special children is slightly
different. Different types of special children will generate different shape of EEG patterns depend on
their neurological function. This paper demonstrates the classification of EEG signal for special
children: to determine and to classify level and pattern of EEG signal for autism and Down syndrome
children. EEG signal was recorded and captured from normal and special children based on their visual
response using Visual Evoked Potential (VEP) method. The data is analyzed using Fast Fourier Transform
(FFT), so that, normal and special children can be distinguished based on alpha (_) value. As a result,
alpha value for normal children at 10 Hz is higher than autism and Down syndrome children. A friendly
user interface was built for easy storage and visualization.
1.2.2 Robot-based Intervention
1.2.2.1 A Qualitative Method to Analyze Response in Robotic
Intervention for Children with Autism
Shamsuddin S., Yussof H., Hanapiah F.A. & Mohamed S.
2013 IEEE RO-MAN: The 22nd IEEE International Symposium on Robot and Human Interactive
Communication, Gyeongju, Korea, 26-29 August 2013: 324-325
Abstract: This paper presents a method to carry out qualitative analysis when evaluating the
interaction between child and robot in autism intervention. The technique consists of 24-items of
behavioral assessment which was referenced to the Gilliam Autism Rating Scale-Second Edition (GARS-
2). GARS-2 is a screening instrument used to identify and diagnose autism. Preliminary results from
a pilot study show that this method had allowed qualitative observation to be carried out to compare
the behavior of autistic children with and without the presence of a robot. The feasibility of this
technique will be further justified through future wide-spread studies involving a larger number of
children spanning across the whole spectrum of autism.
1.2.2.2 Estimation of Concentration by Eye Contact Measurement in
Robot-based Intervention Program with Autistic Children
Ismail L.I., Shamsudin S., Yussof H., Hanapiah F.A. & Zahari N.I.
Procedia Engineering 41, 2012: 1548-1552
Abstract: Lacking of eye contact in social interaction and communication is one of the impairments
that being diagnosed with some of the children with Autism Spectrum Disorder (ASD). This paper
presents the initial response of eye contact time between humanoid robot NAO and ASD children in
Robot-based Intervention Program (RBIP) interaction and normal classroom interaction. Twelve ASD
children from National Autism Society of Malaysia (NASOM) based on inclusive criteria and certain ASD
characteristics are being selected to participate in this intervention program. The interaction between
humanoid robot NAO and ASD children is being recorded for both RBIP interaction and normal
classroom setup. The eye contact time in both interactions for each child is being observed and
recorded. The eye contact of the ASD child is often seen in RBIP interaction as compared to the normal
classroom interaction.
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1.2.2.3 Initial Response in HRI- a Case Study on Evaluation of Child with
Autism Spectrum Disorders Interacting with a Humanoid Robot
NAO
Shamsuddin S., Yussof H., Ismail L.I., Mohamed S., Hanapiah F.A. & Zahari N.I.
Procedia Engineering 41, 2012: 1448-1455
Abstract: The evolution of human-robot interaction (HRI) is now expanding its wings to aid children
with Autism Spectrum Disorders (ASD) in areas of socialization, communication and playful behavior
through robot-based intervention. Herein we present our holistic, longstanding goal to contribute to
the lives of children with ASD; who suffer a lifelong developmental disability. The purpose of this
paper is to elaborate on a case study in our pilot experiment where a child with ASD is exposed to
the humanoid robot NAO in order to gauge his initial response and behavior in the presence of a
robot. NAO robot is the chosen robotic agent as it is a commercially available humanoid with simpler
in appearance compared to real humans, thus appears more approachable to children with ASD. The
pilot procedures involve the robot executing basic, simple components of interaction through a series
of 5 different modules. In this study, the principal results show that the basic HRI carried out by the
robot is able to suppress the child’s autistic behavior during the child-robot interaction. Also, more eye
contact is observed between the child and robot compared to the child with his teacher during regular
class session. Relating this to the child’s IQ which falls in the moderate category, it is suggested that
children with ASD in the same IQ group will be receptive to robot-based intervention even in the first
interaction session. Hence, it can be concluded that the humanoid robot NAO has potential to serve
as a platform to support and initiate interaction in children with ASD.
1.2.2.4 Motor Movement for Autism Spectrum Disorder (ASD) Detection
Razali N. & Abdul Wahab A.R.
Information and Communication Technology for the Muslim World (ICT4M), 2010 International
Conference, Jakarta, Indonesia, 13-14 December 2010: E90-E95
Abstract: In this paper, we are looking at the differences between autistic and normal children in
term of fine motor movement. Previous findings have shown that there are differences between
autistic children and normal children when performing a simple motor movement tasks. Imitating a
finger tapping and clinching a hand are two examples of a simple motor movement tasks. Our study
had adopted one of the video stimuli for clinching the hand from Brainmarkers. 6 selected autistic
children and 6 selected normal children were involved in this study. The data collection is using EEG
device and will be analyzed using Gaussian mixture model (GMM) and Multilayer perceptron (MLP)
as classifier to discriminate between autistic and normal children. Experimental result shows the
potential of verifying between autistic and normal children with accuracy of 92%. The potential of
using these techniques to identify autistic children can help early detection for the purpose of early
intervention. Moreover, the spectrums of the signals also present big differences between the two
groups.
1.2.2.5 Robot-based Intervention Program for Autistic Children with
Humanoid Robot NAO: Initial Response in Stereotyped Behavior
Ismail L.I., Shamsudin S., Yussof H., Hanapiah F.A. & Zahari N.I.
Procedia Engineering 41, 2012: 1441-1447
Abstract: The development and research on Human-Robot Interaction (HRI) between the humanoid
robot and autistic children is new and innovative. This paper presents the initial response of
stereotyped behavior in HRI between Humanoid Robot NAO and children with Autism Spectrum
Disorder (ASD) during the Robot-based Intervention Program (RBIP) and normal class session. The
presence of stereotyped behavior in children with ASD is being evaluated during the RBIP interaction
and normal class session interaction. Humanoid Robot NAO is being utilized for the interaction in
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RBIP. The relationship between initial response of stereotyped behavior and the intelligence level of
ASD children were analyzed during two interaction set-up, which were RBIP and normal classroom
interaction, from which these findings are discussed in this paper. Our focus of discussion in this
research is the initial response of autistic children exhibiting stereotyped behavior in RBIP and normal
classroom session.
1.2.2.6 Humanoid Robot NAO as HRI Mediator to Teach Emotions using
Game-centered Approach for Children with Autism
Shamsuddin S., Yussof H., Miskam M.A., Che Hamid M.A., Abdul Malik N.,
Hashim H., Hanapiah F.A. & Ismail L.I.
HRI 2013 Workshop on Applications for Emotional Robots, Tokyo, Japan, 3-6 March 2013
Abstract: This short report presents the latest development in our robot-based intervention program
for children with autism. Following the outcome from our first pilot study; the aim of this current
experiment is to explore the application of NAO robot to engage with a child and further teach about
emotions through a game-centered and song-based approach. The children participating in this study
has been diagnosed with mild autism. Initial exposure to the robot shows that the NAO robot; a
humanoid with moderate likelihood to actual human does have potential to teach children with autism
about head and body postures that are associated with certain feelings or emotions. Overall
observation suggests the positive utilization of robots, specifically the humanoid robot NAO in the
rehabilitation of autistic children.
1.2.2.7 Humanoid Robot NAO Interacting with Autistic Children of
Moderately Impaired Intelligence to Augment Communication
Skills
Shamsuddin S., Yussof H., Ismail L.I., Mohamed S., Hanapiah F.A. & Zahari N.I.
Procedia Engineering 41, 2012: 1533-1538
Abstract: This report presents the findings from our pilot study on the initial behavior of autistic
children of moderately impaired intelligence when exposed to simple human-robot interaction (HRI)
modules executed by a humanoid robot NAO. All 5 children have been specifically assessed using the
Autism Diagnostic Observation Schedule (ADOS) and their diagnosis is classified as autistic disorder.
We hypothesize that NAO’s human-like appearance, its capability to blink its eyes, speak and play
music; coupled with the simplicity of the HRI modules will be able to entice the children’s interest to
engage in communication. Hence, this would significantly reduce the children’s autistic characteristics
in communication behavior compared to the usual class setting. In this study, the principal result
shows that 4 out of the 5 children exhibited a decrease of autistic behavior (in communication
subscale) when the robot is executing HRI modules during the single session of child-robot interaction.
This promising outcome indicates that the NAO robot were able to attract the children’s attention,
keep each child engaged with the robot during interaction and hence give positive impact to the
children’s communication behavior. Relating this to the children’s FSIQ, it can be deducted that autistic
children with FSIQ of moderately impaired (from 40-54) are receptive to robotbased intervention. This
is again showed by the lower autistic traits observed during the HRI modules compared to in-class
setting. Overall, this research suggests that autistic children of moderately impaired intelligence show
good response to robot-based intervention. This finding is crucial to form a solid foundation and
proof on the positive utilization of the humanoid robot NAO for the children affected by autism.
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1.3 Information Technology (IT)
1.3.1 Assessing the Effectiveness of ICT Software
1.3.1.1 A Preliminary Investigation: Potential of Interactive Multimedia
Learning Awareness (IMLA) in Enhancing Awareness of Autistic
Characteristics among Parents and Society in Malaysia
Dolah J., Wan Yahaya W.A.J. & Chong T.S.
electronic Journal of Computer Science and Information Technology 3(1), 2011: 19-25
Abstract: In this article, we report the feedback from respondents in relation to the implementation
of Interactive Multimedia Learning Awareness (IMLA) in enhancing awareness of autistic characteristics
among parents and society in Malaysia. Methods of gathering information such as observation and
interviews were used in order to identify the current level of awareness towards autistic children. Nine
respondents were selected to participate in this interview ranging from two content experts from the
National Autism Society of Malaysia (NASOM), a researcher who is also an expert in autism from
Universiti Kebangsaan Malaysia (UKM), a mother with autistic children, a mother without autistic
children, two parents without autistic children and three unmarried women. The findings of this
preliminary investigation confirm that there is a lack of awareness that needs to be addressed by
Malaysian society. As a conclusion, the implementation of Interactive Multimedia Learning Awareness
(IMLA) needs to be designed and developed to facilitate and to enhance the awareness of autistic
characteristics in Malaysia.
1.3.1.2 Framework Methodology of the Autism Children - Vibratory
Haptic Interface (ACVHI)
Mustafa M., Arshad H. & Zaman H.B.
International Conference on Advanced Computer Science Applications and Technologies,
Sarawak, Malaysia, 22-24 December 2013: 201-206
Abstract: This paper provides the Framework Methodology of the Autism Children –Vibratory Haptic
Interface (AC-VHI) conducted on the mild autism children who have impairment in social interaction.
This paper has exclusively explored problems faced by Malaysian autistic children in a National Autism
Society at Kuala Lumpur, Malaysia. It also has been conducted at two locations: the classroom and
the court of the National Autism Society in Malaysia (NASOM), Kuala Lumpur, Malaysia. The paper has
sampled 20 children with mild autism, who have impairment in social interaction, based on the records
of the National Autism Society of Malaysia. The sample collection method followed the purposive
sampling approach, which is a form of non-probability sampling that allowed us to choose a case,
because it illustrates some features or processes, in which we are interested. The framework included
three main three process which are Process one, process Two and Process Three. This’s three processes
of the framework was suitable with the area of research and could to accomplish objectives of this
research in helping the autism children to interact and communicate effectively with their families,
friends and the broad community. The framework included three main three process which are Process
one, process Two and Process Three. This’s three processes of the framework was suitable with the
area of research and could to accomplish objectives of this research in helping the autism children to
interact and communicate effectively with their families, friends and the broad community.
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1.3.2 Software Development
1.3.2.1 Computer Game Approach Focusing on Social Communication
Skills for Children with Autism Spectrum Disorder: An Initial Study
Abdul Manap A., Sarah R.D., Riaza M.R. & Sardan N.A.
International Conferences on Computer Graphics, Visualization, Computer Vision, and Game
Technology (VisioGame 2013), Jakarta, Indonesia, 21 December 2013: 26-31
Abstract: Autism Spectrum Disorders (ASD) and autism are both general terms for a group of complex
disorders of brain development. ASD is characterized by difficulties with communication, social deficits,
stereotyped or repetitive behaviours and interests. One of the major reasons behind the push to use
technology and multimedia to assist interaction with children diagnosed with ASD is that they have
shown a preference for, as well as a fascination with, “visual stimuli” such as computer applications,
games, and videos. Primordial purpose of this study is to synthesize a survey regarding social problems
and situations faced by children with autism. A number of questionnaires for parents and teachers
with a semi-structured interview for five doctors and eleven therapists were conducted to identify
basic problems of children with Autism and psychological methods for each problem.
1.3.2.2 Computer Game Approach for Children with Autism Spectrum
Disorder: A Pilot Study
Riaza M.R. & Sarah R.D.
Recent Advances in Computer Science: Proceedings of the 6th WSEAS World Congress: Applied
Computing Conference (ACC '13) & Proceedings of the 12th WSEAS International Conference on
Information Security and Privacy (ISP '13), Nanjing, China, 17-19 November 2013: 174-179
Abstract: Computer games are currently a significant topic in research for children with some forms
of disability. Autism is one of the groups of serious development problems known as Autism Spectrum
Disorder (ASD). It is a lifelong disability that prevents people from understanding what they see, hear
and sense. Children with learning disability such as ASD who have serious impairments with social
interaction, communication skills and in behaviour need a high degree of personalization in using
computer games. In this paper we present a pilot study conducted on six ASD children of age ranging
from 5 to 8. This game called find me is specially designed to teach children on improvement of social
skills. Participant observation was conducted to understand their behaviour in game engagement and
get feedback on their needs and learning goals, as a basis for further research on this topic.
1.3.2.3 Courseware Development Course ‘I Like Learning” for Malay
Language Learning Among Austisme Children
Sidek S.F., Fathil N.S., Mohamed Zain N.Z. & Kamaliah M.
Malay Language Education Journal 4(1), 2014: 1-10
Abstract: Children with autism usually have difficulty learning as it is quite hard to attract their
attentions. In this research, educational software named ‘I Like Learning’ has been developed to help
children with autism learn Malay Language. The research respondents were five primary school
students in Kuala Lumpur who had been diagnosed with mild level of autism. For the monitoring
purposes, the existing monitoring form with some modification according to the research needs,
suggested by Megan Davis, Kerstin Dautenhahn, Chrystopher L. Nehaniv and Stuart D. Powell in their
research entitled The Narrative Construction of Our (Social) World: Steps towards an Interactive
Learning Environment for Children with Autism was used. The research findings were analysed using
a Qualitative content analysis based on several research questions with some modification that was
also suggested in their research. The result shows that the educational software that has been
developed using ADDIE methodology is able to attract the children’s attention in learning Malay
Language subject.
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1.3.2.4 Design and Implementation of Blocks-Based Educational
Courseware for Children with Learning Disabilities
Ismail A., Omar N. & Mohd Zin A.
Asian Journal of Information Technology 11(1), 2012: 14-21
Abstract: Customized education is now being seriously considered for children with learning disability
such as autism who have serious impairments with social, emotional and communication skills. One
of the approaches for providing this type of education is by using highly personalized educational
courseware. The aim of this study is to describe the design and implementation of blocks for
developing educational courseware for autistic children with learning disabilities. The availability of
these blocks enables end-users (such as parents or teachers) to build personalized educational
courseware within the block-based software development environment. The process of designing
and implementing programming blocks involves four main activities: blocks identification process,
blocks design, blocks implementation and evaluation. In order to prepare the autistic child to learn to
read, four blocks that are required in the pre-reading stage: apart from these three blocks, there are
three types of blocks that need to be provided so that application programs can be properly
developed. The suitability of the blocks have been shown by using simple case studies.
1.3.2.5 Developing Learning Software for Children with Learning
Disabilities through Block-based Development Approach
Ismail A., Omar N. & Mohd Zin A.
International Conference on Electrical Engineering and Informatics,
Selangor, Malaysia, 5-7 August 2009: 299-303
Abstract: Children with learning disability such as autism who have serious impairments with social,
emotional, and communication skills require a high degree of personalization in using the educational
software develop for them. The aim of this paper is to propose Block-Based Software Development
method and approach that enables the end-users (such as parents and teachers) to build application
software to suit the different need of an autistic child. This research hopefully can produce useful
tailorable learning software in order to assist educating autistic children.
1.3.2.6 Digital Visual Schedule and Training System for Centre of Autistic
Children
Hitam S., Tan K.L., Sahbudin R.K.Z., Mokhtar M., Ahmad Anas S.B. & Sali A.
Journal of Applied Sciences 11(5), 2011: 788-796
Abstract: Research indicated that there is no proven cure for autism sufferers. Usually, implementing
the appropriate treatment and education can eventually help the autism person to be integrated into
their community. However, the conventional visual schedule and training system that depending on
physical tool and toy bringing the difficulty on changing or update the picture, text and current using
tool. Therefore, Digital Visual Schedule and Training System (DVST System) is developed as a user-
friendly, interactive and flexibility system for children with autism. The inconveniency of traditional
training program that depending on physical tool or multiple application software is improved by
DVST system that provides a complete set of features and functions for the therapist and autistic
children to carry out the administration work (for therapist-Server) as well as training program (for
autistic children-Client) in a single application.
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1.3.2.7 Facilitating Autistic Children’s Split Attention in Designing
Computer Teaching Instructions
Shams Aliee Z., Jomhari N., Rezaei R. & Alias N.
Life Science Journal 10(3), 2013: 88-96
Abstract: One of the most important difficulties of autistic children in learning is not being able to
focus attention on the relevant information. Considering autistic individuals have higher visual abilities
in comparing with ordinary people, visual supports are used to enable learning. Intending to offer
visual information displays, computers are used among individuals with autism. Previous researches
indicated that autistic children could be supported effectively by providing a structured and controlled
environment using computer based intervention. Preparing instructions for the autism spectrum
requires customizing specific design issues to facilitate their split attention. Moving forward in this
paper, it is concluded that in addition to the design issues to be considered for the autistic children,
teaching instructions need to be incorporated. This paper aims to present the specified user interface
design issues incorporated with the required teaching instructions for the autistic children to facilitate
their split attention.
1.3.2.8 Impact of Video on Learning in Students with Autism in Malaysia:
Future Prospects
Saiman K., Sinnatamby S., Mustafa L.M., Alias N. & Siraj S.
Procedia Social and Behavioral Sciences 103, 2013: 459-466
Abstract: Use of video in Malaysia is seen as having a bright future because technology development
is expanding even more now. Thirty articles related to use of video on students with autism have been
investigated. Only 12 articles have been selected as appropriate for use as references for this study.
This article looks at the future prospects of impact of video on learning of students with autism in
Malaysia. The focus of this study is the use of video by experts, identifying behavior of students with
autism in their use of video and determining the limitations of video and ways to overcome them. This
study uses the Fuzzy Delphi approach to achieve consensus of experts on the focus of study. The
findings show that usage of video is extremely effective on students with autism besides shaping the
behavior desired. Although video has its limitations, these can be overcome in various ways as
suggested by the experts and researchers.
1.3.2.9 The Implementation of Interactive Multimedia Learning Autism
(IMLA). Alpha, Beta and Pilot Testing Stages
Dolah J., Wan Yahaya W.A.J. & Chong T.S.
International Journal of Scientific & Engineering Research 3(8), 2012: 1-5
Abstract: The increasing numbers of Autism have been increased lately. Even though many research
dedicated to autistic children around the world but the outcome was too limited and only made
known to the doctor and the parents. None of this outcomes could be shared and distribute to society
because the outcomes was too technical and limited. The information’s related to Autism are too
general and only focus on certain cases. The main issues arises are how this information’s could be
learn and shared amongst society? This study proposes one prototype to be implemented which is the
implementation of Interactive Multimedia Learning Autism (IMLA). The development of IMLA was
resulted from rigorous researches that have been made before such as through extensive literature
reviews and Preliminary Investigation (PI). This study will highlight the elements and process used in
the development such learning theories, theoretical framework, alpha, beta and pilot testing. The
findings from the study will lead to the implementation of IMLA and will be tested with real target
respondents. The findings show that the significance levels of knowledge, awareness and motivation
of target respondents are increased significantly.
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1.3.2.10 User Interface Design Issues for the Autistic Children
Shams Aliee Z., Jomhari N., Rezaei R. & Alias N.
Life Science Journal 10(3), 2013: 58-62
Abstract: One of the most important problems of the autistic children is split attention that avoids
them from being able to focus attention on their learning. Because of having higher visual abilities in
comparing with ordinary people, visual supports are required to be used for these individuals. With
the intention of presenting visual information displays, computers are used among children with
autism. On the other hand, many other researches proved that by providing a structured and
controlled computer based environments, autistic children could be supported effectively. Thus,
specific design issues should be customized for them to facilitate their split attention in learning.
Accordingly, This paper aims at providing an application that considers the identified design issues
based on Fakih method for the autistic children to manage their split attention.
1.3.3 Use of ICT tools
1.3.3.1 Autism and the Need for Special User Interface Design for Web
Surfacing
Ravana S.D., Gurusamy N. & Varathan K.D.
Education Practice and Innovation 1(2), 2014: 93-105
Abstract: In view of distinctive information needs and skills among users, we ought to evaluate if
existing information retrieval systems are competent to cater for these users. The present study
highlights the feasibility of search engine for children with special needs, specifically children with
Autism Spectrum Disorder (ASD). The objective of this study is to investigate the utilization of a search
engine for the purpose of learning and entertainment of children with ASD. The shortcomings of the
existing commercial search engines in terms of accommodating the needs of these children will be
discussed. Finally, based on the survey analysis from the mediators, important criteria of a search
engine user interface design for children with ASD were proposed.
1.3.3.2 Children with High Functioning Autism Acceptance in Using Tablet
Syarifah Diyanah Y. & Salam S.
The International Journal of Soft Computing and Software Engineering [JSCSE], Vol. 3, No. 3,
Special Issue: The Proceeding of International Conference on Soft Computing and Software
Engineering 2013 [SCSE’13], San Francisco, CA, U.S.A., 1-2 March 2013: 826-828
Abstract: This paper presents the preliminary study of the tablet acceptance among children with high
functioning autism. Children who were diagnosed with high functioning autism have an IQ score of
80 or above. Generally, their autism characteristics are not obvious and often they are mistakenly
underserved as having a low profile characteristic. The discussion is generally based on observation
of three sample high functioning autism children, feedback from distributed questionnaire to all of
20 caregivers at National Autism Society of Malaysia (main center at Titiwangsa, Kuala Lumpur) and
interview with autism specialist from the same organization. This preliminary study will help to see on
the tablets potential of becoming a new assistive technology device as a pacing technology for autism
children.
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1.3.3.3 Using a Multi-Media Presentation to Analyze Thinking Patterns
of Children with Autism
See C.M. & Tang K.N.
International Journal of Interdisciplinary Social Sciences 4(1), 2009: 369-384
Abstract: Temple Grandin has suggested that rigidity in both behavior and thinking is a major
characteristic of people with autism (Autism Today, 2002). “Rigid in thinking” in such children means
taking information literally, focusing on details at the expense of the total concept, and having
difficulties dealing with the multiple perspectives of abstract thinking. Other literature supports this
view that people with autism are rigid in their thinking and have no theory of mind. Teachers, parents,
or caregivers face difficulty in communicating with these children because it can be really hard to
understand what they want, especially with those children that have little or no verbal communication.
Therefore, it would be useful to understand an autistic child’s thinking so that his teachers, parents
and caregivers can intervene and re-direct the thinking in the management of his behavior. Research
has been conducted to address this issue at an autistic centre by using an audio-visual slide
presentation which is divided up into the five themes, (a) color, (b) light, (c) visual, (d) perception, (e)
cartoon, and (f) character. The audio-visual slide presentation was shown to 24 children with autism
aged between 5-10 years old. Each child attended a 45 minutes session thrice weekly over six months.
After the children had experienced the audio-visual presentation, they were asked to describe or draw
what they had seen. Their drawings or descriptions were analyzed for their thinking pattern and
conclusions have been drawn which form the basis for some behavioral therapies to direct attention
to the present and to what they see.
1.4 Medical
1.4.1 Clinical Care & Therapy
1.4.1.1 Assessing the Development of Children with Disability in Malaysia
Tan K.L. & Yadav H.
Med J Malaysia 63(3), 2008: 199-202
Abstract: This is a cross-sectional study investigating the profile of children with disability registered
with the primary health care clinics in Malaysia. The purpose of the study was to assess the
developmental stage of children with disability. Secondary data from the pilot project conducted by
the Family Health Development Division, Ministry of Health Malaysia was used in this study. The study
period was for six months from 1st August 2004 until 31st January 2005. A total of 900 disabled
children were selected in this study. Schedule of Growing Scale (SGS) II was used for analysis. Results
showed more boys than girls were affected with a ratio of 6:4. The mean total SGS score increases
as the age of the child increased. The score was highest in delayed speech cases and lowest in cerebral
palsy cases. The performance among children with delayed speech was the highest while children
with cerebral palsy were the lowest. There was a statistically significant difference between the major
ethnic groups in delayed speech and attention deficit hyperactive disorder.
1.4.1.2 Reassessment on the Development of Children with Disability in
Malaysia
Tan K.L. & Yadav H.
Med J Malaysia 63(1), 2008: 17-20
Abstract: This is a cohort study investigating the profile of children with disability registered with the
primary health care clinics in Malaysia. The purpose of the study was to determine whether
reassessment on the development of children with disability under rehabilitation should be done at
three months interval or six months interval. Secondary data from the pilot project conducted by the
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Family Health Development Division, Ministry of Health Malaysia was used in this study. The study was
carried out for seven months from 1st August 2004 until 28th February 2005. A total of 168 disabled
children followed up for six months were selected in this study. Schedule of Growing Scale (SGS) II was
the tool used for analysis. Results showed a statistically significant difference in the mean total SGS
score at six months interval but not at three months interval. The result suggests that reassessment
on children with Down Syndrome, Autism, Cerebral Palsy, mental retardation and delayed speech
under rehabilitation should be carried out every six months while children with gross developmental
delay and slow learner might need a longer interval for reassessment.
1.4.1.3 A Comparison of Malaysian and Australian Speech-Language
Pathologists’ Practices with Children with Developmental
Disabilities Who are Pre-Symbolic
Singh S.J., Lacono T. & Gray K.M.
International Journal of Speech-Language Pathology 13(5), 2011: 389-398
Abstract: The aim of this study was to explore the assessment, intervention, and family-centred
practices of Malaysian and Australian speech-language pathologists (SLPs) when working with children
with developmental disabilities who are pre-symbolic. A questionnaire was developed for the study,
which was completed by 65 SLPs from Malaysia and 157 SLPs from Australia. Data reduction
techniques were used prior to comparison of responses across questionnaire items. Results indicated
that SLPs relied mostly on informal assessments. Malaysian and Australian SLPs differed significantly
in terms of obtaining information from outside the clinic to inform assessment. When providing
intervention, SLPs focused mostly on improving children’s pre-verbal skills. A third of Australian SLPs
listed the introduction of some form of symbolic communication as an early intervention goal,
compared to only a small percentage of Malaysian SLPs. Regarding family involvement, SLPs most
often involved mothers, with fathers and siblings being involved to a lesser extent. Overall, it appeared
that practices of Malaysian SLPs had been influenced by developments in research, although there
were some areas of service delivery that continued to rely on traditional models. Factors leading to
similarities and differences in practice of SLPs from both countries as well as clinical and research
implications of the study are discussed.
1.4.1.4 Sensory Integration Therapy in Malaysia and Singapore: Sources
of Information and Reasons for Use in Early Intervention
Leong H.M., Carter M. & Stephenson J.
Education and Training in Autism and Developmental Disabilities 48(3), 2013: 421-435
Abstract: Sensory integration (SI) therapy is a popular form of intervention for children with
disabilities, particularly those with autism spectrum disorders, even though research evidence
demonstrating beneficial outcomes from the use of SI therapy is limited. A questionnaire was
distributed to early intervention education service providers in Malaysia and Singapore to explore the
reasons why they choose to use SI therapy, their sources of information and training in its use, and
the ways in which it was employed. Occupational therapists were consistently reported as a major
source of information and training in SI therapy, and their advice was a primary reason for using SI
therapy. SI therapy was provided to students based on a wide range of criteria, of which challenging
behaviors related to sensory stimuli were the most consistently reported. About half of the participants
appeared to believe that there was sufficient evidence on the efficacy of SI therapy from research, even
though they seemed to lack direct access to sources such as university courses and academic journals.
Based on these findings, it was recommended that efforts be taken to disseminate research
information to service providers in order to promote evidence-based practice.
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1.4.1.5 The Use of Sensory Integration Therapy by Intervention Service
Providers in Malaysia
Han M.L., Stephenson J. & Carter M.
International Journal of Disability, Development and Education 58(4), 2011: 341-358
Abstract: Sensory integration (SI) therapy is a controversial intervention used in intervention for
children with disabilities that is popular in the United States. Little is known about the use of SI therapy
for children with disabilities in educational centres in developing nations such as Malaysia. Supervisors
and teachers from seven educational intervention centres in city-centre areas in Malaysia were
interviewed on their use of SI therapy. Occupational therapists were found to have a major influence
on the decision to use SI therapy by the interviewees. It was also found that SI therapy was
implemented in a limited manner in these centres and that one of the primary factors that motivated
teachers to use SI therapy was the perception that students’ behaviours were associated with sensory
stimulation. Implications for evidence-based decision-making in developing countries are discussed.
1.4.2 Prevalence and Risk Factors
1.4.2.1 Auditory Stimulus for Children with High Functioning Autism:
Towards Reducing Developmental Disorders and Inattentive
Attitudes
Ong J.H.L., Dani N.A. & Johari A.Z.
Australian Journal of Basic and Applied Sciences 7(4), 2013: 676-682
Abstract: Preliminary findings in several works have described that children with high functioning
autism frequently show hypersensitivity to auditory stimulus. We seek the answer by using auditory
stimulus interventions in our time series research. Interventions were assigned alternately to weekly
30 minutes learning session each for musical auditory stimulus followed by musical songs auditory
stimulus for 8 weeks without washout period. The aim is to detect trends such as reductions in
developmental disorders and inattentive attitudes among participants. Targeted variables for
developmental disorders are responsiveness in language, social, cognitive, and emotion. Cognitive
and emotion responsiveness are included as a new variables which has not been reviewed by any of
the authors referred to. The participants are 5 boys (mean age 12.2 years) with a primary diagnosis
of HFA and students of special education programme for children with autism conducted by The
National Autism Society of Malaysia (NASOM). The result shows that musical songs auditory stimulus
is more beneficial to children with high functioning autism in reducing their developmental disorders
with the highest responsiveness both in language and cognitive variables. The same stimulus is also
regarded as the more valid intervention in measuring the participants’ attentive attitudes by showing
a 43 percent reduction with a ratio of 1 in musical auditory stimulus equal to 2 in musical song
auditory stimulus. Nevertheless, both interventions cannot reduce the autistic aloneness, a deficit in
the social skill of children with high functioning autism. A possible beneficial future study on the
effect of musical songs auditory stimulus in children with Rett syndrome is strongly suggested.
1.4.2.2 Children with Learning Disabilities in the Paediatric Clinic,
Hospital Tuanku Ja'afar Seremban: An Overview
Aina Mariana A.M. & Wong S.L.
Med J Malaysia 66(5), 2011: 487-490
Abstract: The aim of the study was to document the prevalence of learning disability among the
children attending the Paediatric Clinic in Hospital Tuanku Ja’afar Seremban. The demographic
distribution of these patients; the age of detection of the problem; the associated medical conditions
and types of intervention received by these patients were documented. Patients who were between
the ages of five to twelve years were included in the study. Learning disability was divided into three
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categories: speech and articulation problems, academic skills disorder and other categories which
included developmental delay. Children with cerebral palsy were excluded from the study. Out of
1320 patients screened, 355 were found to have learning disorders. Majority were Malays, with the
male to female ratio of 1.9:1. Most of the patients stayed in Seremban. The learning problem was
most commonly detected at the age of 4 years and below. The commonest type of learning disorder
was developmental delay, followed by academic skills disorder, speech and academic skills problems
and speech disorders. Problems that were detected early were speech problems and developmental
delay. Majority of the children had associated medical conditions. Most of the patients received some
form of intervention but 11.3% did not attend any intervention program at all. A strategy should be
formulated and implemented to help this group of children.
1.4.2.3 Clinical Diagnosis and Non-Verbal Ability of Primary-One School
Children with LD
Toh T.H., Wong S.C. & Abdullah M.R.
International Journal of Public Health Research Special Issue, 2011: 33-40
Abstract: Introduction: More school children were referred for learning difficutly (LD), especially after
the introduction of LINUS sccreening programme by Ministry of Education Malaysia. Aims: To study
the clinical diagnosis and non-verbal ability of primary-one school children with LD after paediatric
assessment, as well as associated behavioural issues and socio-economincal background. Methods:
Assessment findings by Paediatricians and Naglieri Non-Verbal Ability Test® (NNAT®) results of all
primary-one school children referred in year 2010 with LD were studied retrospectively. Results: Ninety-
three children were included (62.4% male), and 72.0% of them failed the LINUS screening
programme. The commonest diagnoses were Borderline Intellectual Disability (ID, 37.6%) and Mild
ID (19.4%). Other diagnoses included Attention Deficit Hyperactive Disorder (ADHD, 11.8%), Specific
Learning Disability (SLD, 10.8%), Autistic Spectrum Disorder (n = 5) and Severe Language Disorder (n
= 3). Mean NNAT scores were 84.5 ± 11.8 (n = 85), of which 9.4% children scored less than 70 (<2nd
percentile), while 63.7% scored between 71 and 90 (3rd-24th percentile). Twenty-three children
(27.1%) scored 90 - 110 (25th-75th percentile) and 111-119 (76th-90th percentile). More than two-
thirds of the parents never attended school, or only received education up to Form 3. Nearly 80% of
mothers were housewife and 78.7% of fathers were labour or semi-skilled workers. A significant
numbers of children with ADHD, Borderline ID, Mild ID and Severe Language Disorder/ SLD had
significant or borderline internalizing and/or externalizing behaviours. Conclusions: Majority of
primary-one school children referred for LD do not have intellectual disability. Their clinical diagnosis
and non-verbal ability were very variable. A significant number of them have poor socio-economical
background and associated behavioural problems. A more realistic education system and targeted
program should be offered.
1.4.2.4 Perinatal, Maternal and Antenatal Associated Factors for Autism:
A Case Control Study
Abdullah M.N., Wan Mohamad W.M.Z., Abdullah M.R., Yaacob M.J. & Baharuddin M.S.
2012 IEEE EMBS International Conference on Biomedical Engineering and Sciences, Langkawi,
Malaysia, 1719 December 2012: 144-148
Abstract: Autism disorders are a group of neurodevelopmental disorders which characterized into
three main domains which are social interaction impairment, communication delay and repetitive or
stereotypic behavior. Many studies had suggested that the risk factors for autism derive from three
big factors namely environmental factors, genetic predisposition and vaccine induced. The aim of this
study was to investigate the perinatal, maternal and antenatal associated factors on autistic disorder
children at Hospital Pulau Pinang and Hospital Bukit Mertajam, Pulau Pinang. A case control study
involving 312 cases and control was conducted using data retrieved from hospital records at Pulau
Pinang hospital and Bukit Mertajam hospital from 2001 to 2008. The departments involved were
Psychiatric, Obstetrics and Gynecology and Record and Management Department. All cases which met
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the inclusion and exclusion criteria were included in the study. Univariable and multivariable logistic
regression were used to explore the perinatal, maternal and antenatal associated factors associated
with autistic disorder children. There were seven associated factors contributed most to autistic
disorder determination. The factors were maternal age [Adjusted Odds Ratio (OR): 1.41; 95%
Confidence Interval (CI): (1.27, 1.57)], maternal smoking reported at first antenatal visit [Adjusted
OR: 13.61; 95% CI: (1.87, 99.35)], birth asphyxia [Adjusted OR: 0.35; 95% CI: (0.11, 1.08)],
psychiatric history [Adjusted OR: 54.94; 95% CI: (12.07, 250.04)], multiple gestation [Adjusted OR:
4.81; 95% CI: (1.86, 12.45)], parity for more than 4 [Adjusted OR: 0.11; 95% CI: (0.03, 0.47)], parity
between 0 and 1 [Adjusted OR: 0.19; 95% CI: (0.07,0.55)], Chinese race compared to the Malay
race [Adjusted OR: 10.11; 95% CI: (3.61, 28.30)] and Indian race compared to the Malay race
[Adjusted OR: 5.14; 95% CI: (1.38, 19.16)]. The results suggested that autistic disorders were
associated with perinatal, maternal and antenatal factors such as delivery, pregnancy and maternal
characteristics.
1.4.3 Interventions
1.4.3.1 Brain Training to Improve Sociability and Behavior of Autism
Spectrum Disorder (ASD) Children and Young Adults
Norsiah F. & Mohd Mahayuddin N.A.
Procedia Social and Behavioral Sciences 143, 2014: 308-314
Abstract: This article details on the use of brain training device, Neuro feedback Training (NFT) device
to improve the sociability and behaviour of ASD children and young adults. A quasi-experimental
study using pre-test and post-test within subject design was used. The research involved thirty-four
participants, purposively selected from Kuching Autistic Association (KAA). The Autism Treatment
Evaluation Checklist (ATEC) was used to measure the effectiveness of NFT on ASD children and young
adults in KAA. The observation emphasized on sociability and behavioral changes among the
participants. The findings showed an overall improvement in total ATEC score. Sociability and
behaviors are among ASD children and young adults. There is a difference between ATEC post-test
score in behavior with the age of participants.
1.4.3.2 Communication Responses of an Indian Student with Autism to
Music Education
Chiang E.F. & Ching S.L.
Procedia Social and Behavioral Sciences 65, 2012: 808-814
Abstract: The purpose of this study is to investigate the communication responses of a male subject
with autism towards music intervention. Interview and observation results revealed that the subject
had typical autistic communication impairments before the music education sessions. A single-case-
single-site qualitative action research design was used to inquire into the verbal and non-verbal
interactions, singing as well as the reading skills of the subject. Research findings through observations,
video recording and interview with the class teacher revealed that the subject had obvious
improvement in his verbal and non-verbal interactions as well as his reading and singing skills after
intervention. Finally, recommendations for conducting music interventions were given.
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1.4.3.3 Digital Pictures to Enhance Storytelling amongst Special Needs
Children
Abd Rahim N., Sujud A., Yacob Y. & Zainon Hamzah Z.A.
The International Journal of the Humanities 6(4), 2008: 1-8
Abstract: English has a difficult role to play since it is the second language for most Malaysian and
in the Malaysian Education system for the special needs as there is no special syllabus for the autistic
children. Children with autism are expected to learn the same thing with the rest of the children in
the normal school. Autistic children have difficulty to concentrate and therefore the same learning
syllabus with the normal children will make them difficult in acquiring the language in a short time.
Even though, the normal children will have the difficulty of learning the language but they have a lot
of time to learn at home or with their friends around them. In other way, the autistic children will have
to learn more than the normal children. Autism is a complex developmental disorder that appears in
the first 3 years of life, though it is sometimes diagnosed much later. It affects the brain’s normal
development of social and communication skills. Autism is a spectrum that encompasses a wide
continuum of behavior (Bailey, D. B., Jr., D. D. Hatton, et al., 2001). Core features include impaired
social interactions, impaired verbal and nonverbal communication and restricted and repetitive
patterns of behavior. This paper focuses on Asperger syndrome which is also considered as autistic
spectrum. This paper investigates Asperger children’s motivation level when using digital pictures in
creating a short story in the task based English language classroom and investigate the language use
in the short story created by asperger children when using digital camera in the task based English
language classroom. It is hoped that digital pictures able to enhance storytelling amongst the special
needs children.
1.4.3.4 Disability Learning Tool: Brushing-Teeth Using Music for Autism
Othman A. & Kamarudin F.N.
Proceedings of EDULEARN11 Conference, Barcelona, Spain, 4-6 July 2011: 354-363
Abstract: This research is an attempt of combining music with the 3D animation technique in order
to develop a disability-learning tool which can be used as one of occupational therapy for autism
children. Autism is a developmental disability of the brain, much like dyslexia, mental retardation, or
attention deficit disorder that often makes it hard to communicate with and relate to others. The
treatment that we are going to apply in our research is related to the occupational therapies which
involved music, multisensory stimulant and computer usage. Occupational therapy assists autistic
people in developing the skills for daily job such as brushing teeth. Music can stimulate brain and
help individuals with a wide range of cognitive and emotional challenges to improve their ability to
function. Music primarily can help autism children improve their observable level of functioning and
selfreported quality of life in various domains such as cognitive functioning, motor skills, emotional
and effective development, behavior and social skills. The problem that we are trying to overcome by
doing this project is the independence among autism children. At the autism centre where we did our
research, they are manually taught by parent or teachers and they have to teach the same thing every
day. For example, the teachers have to show them every day on how to brush teeth using the teeth
set and the big tooth brush. They seem cannot remember all the steps. In this research, by
collaborating these elements, we try to develop a 3D animation disability-learning tool to help in
stimulating independence in autism children. Music is included in the animation as part of the
treatment. The objectives of this projects are first to investigate and analyze the acceptance of different
types of music among autism children. Our second objective is to develop a 3D animation that show
steps in brushing teeth according to the beat of the selected music. The third objective is to analyze
the effectiveness of the application in stimulating remembrance brushing technique skills. 3D
animation is a technique that can visualize characters or movement as same as in the real life. The
current technology of 3D animation exist today is amazing. This application which is called Disability
Learning Tool: Brushing-Teeth Using Music for Autism has been tested to a group of autism children
with mild cases and has shown positive result. It can be seen that the independence in the autism
children gradually increased. However, there’s a lot more to do for further improvement and we are
going to look into each of these weaknesses in detail.
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1.4.3.5 Interactive Stroller for Increasing Focus Time and Participation in
Learning Al Quran for Autistic Children
Bilikis B. & Jomhari N.
Advanced Engineering Forum 10, 2013: 63-68
Abstract: Autistic children with hyperactive behavior are usually denied when it comes to teaching
of Al Quran or academic skills due to their inability to focus and participate in learning. They exhibit
minimal time of attention while learning as they enjoy running around and engaging in other activities
that stimulates them. This study was carried out in order to identify an environment that
accommodates learning and hyperactive behavior of autistic children. The learning of Al Quran was
taught in two different environments. The first environment was the school center where the students
sits on the floor and the second environment was in a moving stroller. A moving car was also used as
an alternative. The result of this study indicated that the level of participation in a stroller and car
increased and it was more effective for gaining the child’s participation compared to the sitting in the
class.
1.4.3.6 Leaving No Child Behind: Investigation on Gross Motor Skill
among Autistic Children
Norkamariah M., Tarveen K., Zainal Abidin Z., Asha Hasnimy M.H. & Halijah I.
International Sport Science Conference, Putrajaya, Malaysia, 19-20 December 2006
Abstract: Autism is defined as a developmental disability that affects the ability of a person to
communicate, understand language, play, and interact with others (Dunlap & Bunton-Pierce, 1999).
Children who suffer from autism usually show uneven gross and fine motor skills and lack of
cooperativeness in group play. Opportunities should be given among autistic children to interact
successfully with peers. An investigation was conducted to investigate the performance of gross motor
skill among autistic children. Seven autistic children performed 20 items of Texas Revision of Fait’s
Basic Motor Skills: Basic Movement Performance Profile (Faith, 1978). Results indicated that the autistic
children scored lower than their normal peers. The mean score of gross motor activities indicated that
autistic boys perform better than autistic girls. The autistic children showed difficulties in performing
nonlocomotors movements as compared to locomotors movements. Suitable physical activity program
should be developed to widen the opportunity and increase physical ability of autistic children to
interact and play with their peers.
1.4.3.7 Music Education for Children with Autism in Malaysia
Chiang E.F. & Mohd Jelas Z.
Procedia Social and Behavioral Sciences 9, 2010: 70-75
Abstract: The purpose of this study is to enhance our understanding of the effects of teaching group
music to 5 children with autism. An action research methodology was adopted using the action cycles
of plan-act-observe-reflect design. A cross-case analysis showed that group music teaching was
generally effective in improving verbal and non verbal communication, and the demonstration of
both positive motor skill development as well as negative motor reactions among the subjects.
Although the outcome for social behaviours was minimal, three of the subjects showed reciprocal
social spirit and outward expressive behaviour in the musical games.
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1.4.3.8 Portrait Drawings Therapy: Windows of Hope for Children with
Autism Spectrum Disorder
Yap B.C., Salleh A. & Jusoff K.
World Applied Sciences Journal 14 (Learning Innovation and Intervention for Diverse Learners),
2011: 44-51
Abstract: The paper reports a case study on the ability of a group of children with autistic spectrum
disorders (ASD) in recognising face using potrait drawing technique. Sample comprised of four ASDs
children and four non-ASDS children and eight teachers. Eight individual drawing sessions were
conducted with the children sample. Data were collected using observations, interviews and Portrait
Drawing Assessment (PDA) Instrument. Results showed that the two groups of children had different
profile. The analysis was also able to identify the drawing developmental stage of each participant.
The results imply that drawing technique has a potential to draw autistics children attention and
teacing them to recognise faces. This paper concludes that potrait drawing session has a great
potential to be an intervention for ASDs children developing communication. As the present study was
the first for children with ASD in Malaysia therefore more evidences are required to confirm the
finding.
1.4.3.9 Program Intervensi Kemahiran Membaling Bolaterhadap Pelajar
Autisme Sekolah Menengah: Satu Kajian Kes
Tan T.B. & Loh S.C.
Jurnal Pendidikan 27(1), 2007: 217-233
Abstract: The purposes of this research were to examine the effectiveness of an intervention program
on ball throwing skill and to explore autistic students' ability in throwing the ball right at the target.
Three autistic male students aged between 14 and 18 years old were chosen as subjects of the study.
They were undergoing the Special Education Integrated Program in two secondary schools in Kuala
Lumpur. The intervention program designed in this study was conducted within five weeks, with three
sessions per week, and sixty minutes per session. The training in this intervention program was
systematically planned in accordance with the principles of training. The training sessions started with
warming up, followed by drilled practice and cooling down. At the end of the drilled practice, each
subject was given five trials in skill testing. An Individualized Educational Plan (IEP) for each subject
was drawn based on the subject's achievement in previous skills. Hence, the level of activities planned
for each subject in drilled practice differed from one another. Data were recorded based on the
observations on the behavior and targeted distance of ball throwing in skill-based tests. The results
showed that the intervention program was effective in enhancing the ability of three autistic students
in ball throwing. Subjects A, B, and C each demonstrated the ability to throw the ball right at the
target with distances of 32 feet, 12 feet and 2 feet respectively.
1.4.3.10 The Use of Music and Movement Therapy to Modify Behaviour of
Children with Autism
See C.M.
Pertanika Journal of Social Science & Humanity 20(4), 2012: 1103-1116
Abstract: Children with autism are often associated with behavioural problems such as being restless
and fidgety; exhibiting tendencies to touch and hit people; being noisy (shouting or screaming);
temper tantrums, being inattentive; non-compliance; spaced out; and body stiff. These behavioural
patterns might be extreme and highly apparent or more subtle. Hence, music and movement therapy
was developed to help improve the behaviours of children with autism. There were a total of 41
children who participated in the research, and they were divided into two groups and two sessions.
Group 1 comprised of 18 children (5 girls and 13 boys). The age of the children in Group 1 ranged
from 2 to 10 years old. Meanwhile, Group 2 comprised of 23 children (2 girls and 21 boys). The age
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of the participants in Group 2 ranged from 11 to 22 years old. The music therapy was carried out
weekly and two sets of music therapy were used alternately for 10 months. The duration for each
session was an hour. A Target Behaviour Checklist was also developed for the study purpose. The
parents, music teachers and research assistant evaluated the child’s behaviour on an average of once
a month for 10 months. One-way ANOVA and T-test were used to examine whether there was a
significant change or improvement in the target behaviours among the two groups of children. The
findings demonstrated that music and movement therapy has positive effects on the behaviours of
these children, especially in helping children with autism to improve in restlessness, fidgety, temper
tantrum and inattentive behaviours.
1.4.3.11 Use of Music and Movement Therapy to help persons with Autism
See C.M.
International Journal of Child Development and Mental Health 2(2), 2014: 7-22
Abstract: Individual with autism usually appear physically normal but display motor and coordination
deficit. Therefore, they need fine motor, gross motor and motor coordination skills training. A
structured Music and Movement Therapy for individual with autism was developed and for the
purpose of this study, the focus is to review the effect of the Music and Movement Therapy on motor
and coordination skills of persons with autism. A total of 41 children and adolescents participated in
the study and were divided into two groups. Group 1 comprised of 18 children (5 girls and 13 boys).
The age of these children ranged from 2 to 10 years old. Meanwhile, Group 2 comprised of 23
adolescents (2 girls and 21 boys). The age of these adolescents ranged from 11 to 22 years old. A
session of the Music and Movement Therapy was carried out weekly and two sets of Music and
Movement Therapy module were used alternately for 10 months. Each Music and Movement Therapy
session is for 45 minutes. A Motor and Coordination Performance Checklist was developed to enable
the parents, facilitators and research assistant to evaluate the participants’ skills averagely once a
month for 10 months. T-test and descriptive analyses were conducted to examine any significant
improvement and changes of the motor and coordination skills among the two groups. In this study,
the children and adolescents with autism showed improvement in their motor and coordination skills
after participating through the Music and Movement Therapy in this study.
1.5 Psychology
1.5.1 Psychological Wellbeing of Parents
1.5.1.1 Stress and Psychological Wellbeing among Parents of Children
with Autism Spectrum Disorder
Nikmat A.W., Ahmad M., Ng L.O. & Razali S.
ASEAN Journal of Psychiatry 9(2), 2008: 65-72
Abstract: Objective: To investigate the prevalence of parental stress and psychological wellbeing
among parents with autistic children and their associations with dimensions of support system.
Methods: This is a preliminary cross sectional study which randomly selected parents with clinically
diagnosed autistic children. Those parents who attended psycho-education session on management
of autistic children at Health Psychology Unit were randomly selected to enroll in the study.
Psychological wellbeing, parental stress and dimensions of support system were assessed by using
the General Health Questionnaire (GHQ-28), the Parenting Stress Index (PSI) and the Provision Social
Relation (PSR), respectively. Results: Of 52 parents with autistic children (34 female and 18 male),
about 90.4% of parents had significant parenting stress, and 53.8% of parents showed clinical
disturbance in psychological wellbeing. Gender (t=1.67, p=0.02) and occupation (F=4.78, p=0.01)
showed statistically significant association with psychological wellbeing. No association found between
other socio-demographic factors, parental stress and psychological wellbeing with dimensions of
support system among parents with autistic children. Conclusion: Parents with autistic children have
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high prevalence of stress and psychological disturbances. Interactions of various factors need to be
acknowledged and considered in order to reduce the burden of parents with autistic children.
1.5.1.2 Level of Hopelessness among Parents with Autistic Children
Vetrayan J., Daud A. & Smily Jesu P.V.P.
Indian Journal of Health and Wellbeing 4(4), 2013: 875-878
Abstract: This study aimed to investigate the level of hopelessness among parents with autistic
children. The study also to identify whether the age of the child and the level of education affect their
level of hopelessness. The participants of this study consist of 33 parents with autistic children with
their age ranging from 31 to 60 years old (with mean age 39 years and 5 months). The children were
reported to be moderately autistic while 23 of them were severely autistic. Beck Hopelessness Scale
is used to assess the level of hopelessness of parents with autistic children. The mean value of the level
of hopelessness among parents with autistic children was 4.55 which mean that parent of autistic
children were mildly affected by feeling of hopelessness. There is a large negative correlation between
level of hopelessness among parents with autistic children (r=0.616, p=0.001, p<0.05). But there no
correlation between age of the child and level of hopelessness (r=0.078, p=0.666, p<0.05). Most of
the parents with autistic children were mildly affected by feeling of hopelessness.
1.5.1.3 Comparative Study on Attitudes and Psychological Problems of
Mothers towards Their Children with Developmental Disability
Shobana M. & Saravanan C.
East Asian Arch Psychiatry 24, 2014: 16-22
Abstract: Objective: Parents’ positive attitudes and psychological wellbeing play an important role in
the development of the children with developmental disability. This study aimed to measure the
prevalence of psychological problems among mothers of children with autism disorder, intellectual
disability, and Down syndrome. The second aim was to assess the differences in mothers’ attitudes and
psychological problems among their children with intellectual disability, autism disorder, and Down
syndrome. The third aim was to identify whether negative attitude was a predictor of psychological
problems in these mothers. Methods: In this study, 112 mothers of children having mild and moderate
levels of autism disorder, Down syndrome, and intellectual disability were assessed using the Parental
Attitude Scale and General Health Questionnaire–28. Results: Overall, mothers of children with
intellectual disability were found to have the most negative attitude towards their child. Mothers of
children with autism disorder exhibited higher scores on somatic symptoms, anxiety, and social
dysfunction when compared with their counterparts with Down syndrome and intellectual disability.
Negative attitude was a significant predictor of psychological problems. Conclusion: Parental attitudes
and psychological problems would vary among mothers of children with different types of
developmental disability.
1.5.1.4 Depression Risks in Mothers of Children with Developmental
Disabilities: A Cross-Cultural Comparison of Brazil, Colombia,
Malaysia and Thailand
Osada H., de Amorim A.C., Velosa A., Wong P.W., Lotrakul P. & Hara H.
International Journal of Social Psychiatry 59(4), 2012: 398-400
Abstract: Background: Compared with US or European countries, there are fewer mental health
services for mothers of children with developmental disabilities in Latin American and/or Southeast
Asian countries. Aims: To explore the risk of depression in mothers of children with developmental
disabilities in countries with a lack of mental health professionals, we conducted cross-cultural
comparisons for four countries: Brazil, Colombia, Malaysia and Thailand. Methods: Using the CES-D,
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we compared the participants’ depressive symptoms, by which we also estimated the prob-ability of
morbid depression. Results: In every country, participants tended to show depressive symptoms. In the
CES-D total scores and the numbers of mothers who were observed to have a high level of depressive
symptoms, there were significant differences among countries (F = 4.36, p = .006; X2 = 10.3, p =
.015). Conclusions: Considering cultural models, we could apply evidence-based intervention to
depressive mothers of chil-dren, and conduct intervention and treatment for those mothers and
evaluate ways of providing better mental health services to these individuals.
1.5.2 Perceived support, coping strategies & quality of life of parents
with children with ASD
1.5.2.1 A Survey on Quality of Life and Situational Motivation among
Parents of Children with Autism Spectrum Disorder in Malaysia
Poh C. S. & Siew H.T.
International Proceedings of Economics Development and Research 56(18), 2012: 89-94
Abstract: This study aimed to examine the relationship between quality of life (QoL) and situational
motivation (SIMS) adopted by parents of children with autism spectrum disorder (ASD). Participants
were 47 parents who had at least one son or daughter with ASD, and were recruited from 3 NGOs
in Malaysia. Approval from person in charge of the 3 NGOs and informed consent from participants
were obtained before conducting the study. Purposive sampling was used to select participants, and
questionnaire survey method was used to collect data. In the questionnaire participants needed to fill
in their demographic information and 2 scales - the WHOQOL-BREF and the SIMS. The results found
that more parents with high intrinsic motivation to participate in the program have better social
relationships than those with low intrinsic motivation, and more parents with high identified regulation
to participate in the program have better physical health than those with low identified regulation.
No such association was found in those parents who participated in the programs due to the external
regulation and motivation. This finding can provide a better understanding of how motivation relates
to QoL among parents of children with ASD. Programmers at NGOs may consider applying the
findings into their programs and policies to improve the QoL of parents of children with ASD.
1.5.2.2 An Initial Look at the Quality of Life of Malaysian Families That
Include Children with Disabilities
Clark M., Brown R. & Karrapaya R.
Journal of Intellectual Disability Research 56(1), 2012: 45-60
Abstract: Background While there is a growing body of literature in the quality of life of families that
include children with disabilities, the majority of research has been conducted in western countries.
The present study provides an initial exploration of the quality of life of Malaysian families that include
children with developmental/ intellectual disabilities. Dynamics characterising Malaysian society are
described as developments in social policy and service delivery that support persons with disabilities
and their families. Method Questionnaire data were collected using the Family Quality of Life Survey
– Short Version. Members of 52 families that included one or two children with disabilities were
interviewed. Their responses provided their perceptions within six dimensions of family quality of life
across the nine life domains assessed. Results Findings showed a consistent pattern of relatively strong
perceived ‘importance’ ratings in each of life domains as compared to mean ratings for other family
quality of life dimensions. Some dimensions of family quality of life, in particular ‘opportunities’,
‘initiative’ and ‘attainment’, demonstrated particularly strong associations with each other. Overall
means of satisfaction with and attainment of family quality of life as well as global evaluations of
quality of life and satisfaction all demonstrated significant associations, although each of these
correlations accounted for less than 50% of the common variance. Conclusions The importance rating
can be viewed as a determining factor in terms of quality of life, and it played a critical role in
supporting attainment of, and satisfaction with, family quality of life, assuming opportunities, initiative
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and stability are adequate. The need for a broader sample including families that were not receiving
services was noted. Future research questions based on the results of the current study and some of
the dynamics impacting Malaysian society are also suggested.
1.5.2.3 Support for Parents of Children with Disabilities in Malaysia
Hasnah T., Yunus V., Mohd Hanafi M.Y. & Wan Md Zain W.N.
The Social Sciences 8(2), 2013: 213-219
Abstract: Parents of children with disabilities need information and practical support in order to
reinforce their confidence and ability to cope with the stress of parenting their children. The objective
of this study is to gain an understanding on the availability and types of support perceived by parents
of children with disabilities in Malaysia. About 20 parents of children with various disabilities were
interviewed. The interviews were transcribed and analyzed for themes. Findings suggested that there
is a lack of comprehensive information and support for parents of children with disabilities in Malaysia.
Instead, support for parents come from informal sources, such as family, friends and other parents.
Formal support from government agencies, non-governmental organizations and the private sector
should be improved in order to empower parents to provide better care for their children. Suggestions
on how to improve these services include getting parents input and carrying out evaluations of current
services.
1.5.2.4 Parents’ Recognition of Autistic Behaviour and Their Coping
Strategies: A Case Study at Sarawak Autistic Association
Ting S.H. & Chuah H.K.
International Journal of Social Policy and Society 7, 2010: 52-65
Abstract: The paper reports the parents’ recognition of autistic behaviour of their children and the
coping strategies they used to handle their children’s behaviour. The case study involved 12 parents
with children registered at the Sarawak Autistic Association, Kuching. Semi-structured interviews
revealed that more parents reported differences in social interaction patterns and physical behaviours
than speech impairment when compared to children with normal development. The behavioural
indicators of autism highlighted by the parents were stereotypic behaviour, sleep problems,
hyperactivity and hypersensitivity to specific sounds. The autistic children also showed difficulty mixing
with peers, liking to be hugged and lack of eye contact. However, it was the loss of speech ability and
absence of speech development which alerted them to the possibility of autism. The study revealed
that the parents handled their distress and anxiety mainly through religious means and family support.
The findings suggest the need for support and services for autistic children in Sarawak.
1.5.3 Public Awareness
1.5.3.1 Narrative from the Care Givers of Autism Spectrum Disorder
Children in Malaysia
Jin K.K. & Chin C.G.
International Proceedings of Economics Development and Research 48(40), 2012: 193-197
Abstract: The paper adopts the lens of moral philosophy to take on a relational approach. Data was
collected using qualitative methods of observation and interviews. The narratives drawn from the
care givers of autism spectrum disorder children will be presented. The findings show a lack of
awareness and understanding of children with autism spectrum disorder among the general public
in Malaysia. The themes emerging from the narrative further support Eva Kittay’s views on aspects of
interdependent relations. Carers of autism spectrum disorder children yearn for acceptance of their
children in the general community.
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1.5.4 Parents Recognition of Early Symptoms of ASD
1.5.4.1 Factors Associated with Diagnosis of Autism Spectrum Disorder
(ASD) under the Age of 24 Months in Malaysia
Yeo K.J. & Lu Xi
Sains Humanika 2(1), 2014: 65-69
Abstract: A total of 79 mothers of children with autism spectrum disorder (ASD) who were born
within the period of 1998 to 2008 in Malaysia, were selected to answer the questionnaire in this
study. The Childhood Autism Rating Scale (CARS) was adapted for parents (CARS-P) to assess the
degree of autistic symptoms perceived by mothers. Difficulty in learning to speak was the first
symptom found by most of mothers (above 60%). The binary logical regression result found the
higher CARS-P score (severity of autistic symptom perceived by mothers) as predictor of the higher
probability on early diagnosis of ASD under the age of 24 months. Larger samples are suggested in
future study.
1.6 Miscellaneous
1.6.1 Impact of Video on Learning in Students with Autism in Malaysia:
Future Prospects
Saiman K., Sinnatamby S., Mustafa L.M, Alias N. & Siraj S.
Procedia - Social and Behavioral Sciences 103, 2013: 459 – 466
Abstract: Use of video in Malaysia is seen as having a bright future because technology development
is expanding even more now. Thirty articles related to use of video on students with autism have been
investigated. Only 12 articles have been selected as appropriate for use as references for this study.
This article looks at the future prospects of impact of video on learning of students with autism in
Malaysia. The focus of this study is the use of video by experts, identifying behavior of students with
autism in their use of video and determining the limitations of video and ways to overcome them. This
study uses the Fuzzy Delphi approach to achieve consensus of experts on the focus of study. The
findings show that usage of video is extremely effective on students with autism besides shaping the
behavior desired. Although video has its limitations, these can be overcome in various ways as
suggested by the experts and researchers.
1.7 Thesis/ Dessertation
1.7.1 Education
1.7.1.1 Development of an Arithmetic Study Aid for Autistic Children
Lee S.G.
Universiti Malaya, 2007
Abstract: The primary objective of this study is develop a Systematic Airthmetic Study Aid, SASA as
a complementary aid in the teaching of basic computational skill, especially addition, to autistic
children in normal school setting. A systematic approach was used to design SASA and it has proven
its influence in bridging the number sense of a child to addition skills. With the intended goals being
firstly identified and defined, resources materials were collected and reviewed, a sound arithmetic
teaching aid was ultimately formed. It was validated by a panel of experienced Mathematics teachers.
The pretest and posttest in each unit were used in evaluating the effectiveness of the instructional
programme. SASA consists of a pre-knowledge assessment and 4 instructional units. Units 1 and units
2 are instruction for 5-frame and Unit 3 and Unit 4 are instructional for 10-frame. For each type of
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frames, concrete and representation frames are complementing with the instructions assisting the
child to acquire number sense and addition skills. Each unit comprises a pretest and a posttest to test
the performance of the child. For all the four units, the child attained high achievements. The
systematic approach of SASA together with the attractive study frames have helped the child to master
addition skill. The child responded positively to the use of concrete and representation frames in SASA.
The mathematical ability is achieved after the instruction material being introduced to the child. The
SASA developed is thus proven to be an effective study aid.
1.7.1.2 Meningkatkan Keberkesanan Pembelajaran Simpulan Bahasa
dalam Kalangan Murid Tahun 3 Bermasalah Penglihatan Melalui
Kaedah Koperatif
Mat Adam A.N.I.
Institut Pendidikan Guru Malaysia, Kampus Ilmu Khas, 2011
Abstract: This study was conducted to improve the effectiveness of idiomatic learning to Year 3 pupils
with visual impaired student in a school through a cooperative. A total of four pupils were selected
to participate in this study. The focus of this study was to assess whether the cooperative method is
carried out to enhance the interest of students in activities to understand the concept and purpose
of each learned idioms and improve student achievement in Malay Language. Initial survey found
that students quickly lose focus on the teaching of idiomatic expressions by the teacher through the
questions and answers and the use of teaching aids flash card. Students will only be focusing on 10
to 20 minutes when you are in class during teaching and learning process to be implemented. To
alleviate this problem, cooperative learning methods have been used. Results showed that students
can understand easily learned idiomatic meaning. Pupils also enjoyed the session more lesson and
study carried out.
1.7.1.3 Penggunaan Boneka dalam Teknik Main Peranan untuk
Meningkatkan Kemahiran Bertutur Murid-murid Bermasalah
Pembelajaran Kelas K4
Mohamed Shohor M.F.
Institut Pendidikan Guru Malaysia, Kampus Ilmu Khas, 2010
Abstract: This research was conducted to improve the speaking skill of pupils with learning disabilities
of K4 class using dolls in role playing techniques. Respondents in this study consisted of three students
with learning disabilities, with each category of down syndrome, autism, and slow learner a school
in Kuala Lumpur. Using puppets in teaching and learning process will attract students to communicate
in two ways, indirectly improve their speaking skills. Survey found that the speaking skills of students
K4 class is weak. Therefore, researchers have used the puppet in the induction step instruction set and
cover teaching and learning as the first intervention. Then, researchers use the puppets during the
teaching and learning take place as the second intervention. The results showed that the use of
puppets in role playing techniques to increase the number of references to the word and reduce errors
to mention the words by the subjects under study. Improvement in terms of efficiency and
understanding in communication is also seen after the puppets used in the step of teaching and
learning.
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1.7.1.4 Penggunaan ICT dan Kad Perkataan untuk Meningkatkan
Kemahiran Membina Ayat Tunggal dalam Bahasa Melayu untuk
Murid-murid Bermasalah Pendengaran Tahun 3
Daud M.A.
Institut Pendidikan Guru Malaysia, Kampus Ilmu Khas, 2011
Abstract: The purpose of this research is to improve the skills of hearing impaired pupils in
constructing simple sentences by using ICT and word cards. Two pupils from Year 3 were selected in
this research. The main focus is to evaluate if the use of ICT and word cards would able to improve
the skills of hearing impaired pupils in constructing the simple sentences. Earlier observation shows
that some pupils were not able to complete the task given due to their lack of understanding to
construct sentences correctly. Therefore, ICT and word cards were used to overcome this problem. The
result shows that the pupils were able to construct simple sentences when using these methods.
1.7.1.5 Use Token Economy to Reduce Behavior Problems among
Learning Disabilities Pupils from Group 5 in Visual Art
Abdul Ghaffar N.A.
Institut Pendidikan Guru Malaysia, Kampus Ilmu Khas, 2010
Abstract: This action research was undertaken to reduce the behavior problems of learning disabilities
children by using token economy. The target of this study is 7 pupils from group five around Selangor.
Token economy was chosen because the pupils tend to listen to teacher’s instructions better as it is
more rewarding. Initial observations were carried out during the teaching and learning process. The
findings do indicate that pupils have undesirable behavior problems during the teaching and learning
process. Pupils are introduced to the method of compensation called the token economy. This
technique is done by pasting a sticker each time the pupils perform desired behaviors and removing
a sticker each time pupils show undesirable behavior. The study was carried out for three month.
Results indicate that seven pupils were successfully in reducing undesirable behaviors through the
use of token economy. Records of all the observations and findings of interviews conducted show that
the undesired behaviors of students were successfully changed through the token economy method.
1.7.1.6 Using Discrete-Trial Teaching to Increase Social Skills of Autistic
Children
Malie Y.
Universiti Kebangsaan Malaysia, 2007
Abstract: The purpose of this study was to find out on the effectiveness of discrete-trial teaching
approach to facilitate increased social skills of autistic children in the aspects of eye contact, joint
attention, imitation and turn taking. A case study was conducted using multiple baseline design
strategy across participants. This case study was conducted for 16 weeks involving three autistic
children with the mean age of 8 years old. Observation was divided into 2 parts: baseline and
intervention, where each session was allocated for 10 minutes with 30 seconds interval. The
instruments used in this study were the autistic social skill rating scale to identify the social skills of
autistic children; the intervention observation form to record the frequency of the data into percentage
and the social skill lesson plans to conduct the study. Fieldwork observation form was also used to
record the data qualitatively. Data from the autistic social skill rating scale and the intervention
observation form were analyzed using descriptive statistics: frequencies, percentage and mean.
Qualitative data were described according to the prompt and reinforcement types received during
the intervention. The findings of this study indicate that discrete-trial teaching can be implemented
to increase the social skills of autistic children. All of the participants exhibit increase in their eye
contact and joint attention skills during the intervention sessions. Only two participants showed an
increase in their imitation and turn-taking skills. The findings also show that the participants received
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prompt in term of modeling. There is qualitative difference in the use of reinforcement among the
participants. This study has implication on educational practice and pedagogy in relation to the social
skills of the autistic children.
1.7.2 Allied Health
1.7.2.1 A Study of Non-Literal Understanding in Children with High
Functioning Autism
Hasherah M.I.
Universiti Kebangsaan Malaysia, 2002
Abstract: This study was carried out to investigate non-literal understanding in 2 high functioning
autistic (HFA) children aged 8 and 11 years old respectively. This group was then compared with 2
normal children matched by the same chronological age and gender. Another 6-year-old normal child
was also included in this study to match the receptive language age of the HFA group. A play-based
methodology was used to carry out the current study. The child listens to a taperecorded story into
which 10 idiomatic expressions were embedded. The child then acts out the story as it is played again,
sentence by sentence. The play is video recorded and transcribed. Actions for each idiom are
categorized and then analyzed. The results indicate that the children with HFA did, as a group,
demonstrated fewer appropriate idiomatic interpretations and more inappropriate interpretations
than of the normal group. However the higher response for inappropriate scores reflected more fuzzy
responses than the literal ones. This may indicate awareness among these children that the literal
meaning is inappropriate in the absence of adequate idiom vocabulary. It may also reflect difficulty in
retrieving known idioms from memory and/or selecting the most appropriate meaning from several
possibilities in context. Besides that, it is also worth noting that, although other language structures
develops fairly well in the HFA group, non-literal understanding of this group was at the level of a six
year old normal child. It is suggested that the characterization of children with high functioning autism
as predominantly literal needs to be revised. Rather than seeking a blanket characterization of
nonliteral understanding in an essentially heterogeneous group, it may be more useful to consider that
literalization strategy adapted for idiom comprehension in these children is a secondary manifestation
of semantic and/or pragmatic difficulties.
1.7.2.2 Effectiveness of Sand Play Intervention against the Behaviour
Regulation among Autistic Children in Center of Community
Based Rehabilitation of Selangor
Ngah Y.C.
Universiti Kebangsaan Malaysia, 2011
Abstract: This is a study of sand play interventions. The study was conducted on autism children in
the center of community based rehabilitation (CBR) Tanjong Karang, Selangor. This study aimed to
investigate whether the sand play interventions help in reducing problematic behaviors and changing
behaviors of autism children who had participated in the sand play intervention programs. The study
also investigated the effectiveness of sand play interventions in regulating the behaviors of high
function and low function autism children. To achieve these objectives and experimental and
qualitative case study has been conducted among three autism children. The first participant was
aged four years and five months, the second participant was aged six years and two months, and the
third participant was aged eight years and four months. Each session of sand play interventions
consisted of an opening ritual, the sand play period and the closing ritual. This study was conducted
at the center of the CBR and the participants’ house, respectively. Qualitative data collected included
demographic data, interviews with the mothers of participants and trainers of PDK, direct observation
during the interventions sessions conducted, and the informant. Participants’ behaviors in each session
were recorded using behavioral observation form. The behaviors of hurting themselves or others,
stereotypic behaviors, aggressive behaviors, and behaviors of damaged properties were investigated
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among the informants in this study. Data analysis did not show any positive changes in behaviors
observed among the participants after participated in the intervention program. This study showed
that the sand play intervention did not display different effects on high function participant and low
function participants. The implications of the findings, study limitations, and suggestions for future
research are discussed in this study.
1.7.2.3 Interrogative Skills: Comparison between Normal Malay Children
with Malay Autistic Children
Ab Jabar S.Z.A.
Universiti Kebangsaan Malaysia, 2003
Abstract: The purpose of the study was to determine the capabilities of Normal Malay Children (KKN)
and Autistic Children (KKA) in interrogative skills and to compare performance between the two
groups. This was a descriptive and cross-sectional study, which consists of 4 KKN and 4 KKA with the
language age of 6 years old. The language age was determined by Malaysian Developmental
Language Assessment Kit-Expressive level (MDLAK). Mental age of KKA was determined by Vineland
Adaptive Behaviour Scale (VABS). Subjects were tested with the same question list. Subjects needed
to answer the questions spontaneously. Cues were given to get the subjects to answer correctly. Based
on the results, it was noted that the ability to answer the questions spontaneously for KKN was above
65% while the KKA percentage was lower than 30%. For the rest of the questions, cues were needed
to get the subjects to answer them correctly. The most frequently-used cue was question cue for KKN.
Both groups showed a low percentage in answering incorrectly or inappropriately. Subjects tend not
to give answers for those questions even with cues. Based on the research results, cues given in verbal
way gave no benefit to KKA in order to help them in answering questions. The high percentage in
cue usage for KKA was visual cues, which included picture selection.
1.7.2.4 Sensory Processing Disorder and Tantrum Characteristics in
Children with Autism in Klang Valley
Ismail S.F.
Universiti Kebangsaan Malaysia, 2009
Abstract: Sensory processing disorder affects behavior in children with Autism. The purposes of this
study are to 1) determine the prevalence of children with Autism who exhibit temper tantrum, 2)
determine the composition of tantrum characteristics in children with Autism, 3) determine sensory
processing domains in children with Autism who exhibit temper tantrum, 4) compare sensory
processing domains in boys and girls who exhibit temper tantrum and 5) correlate between tantrum
characteristics and sensory processing domains. This longitudinal study was done at five branches of
National Autisme Society of Malaysia around Klang Valley. Data collection was done in October to
December 2008. There are two main focuses in this study which are tantrum characteristics and
sensory processing disorder in children with Autism. This study used the Tantrum Behavioral Checklist
to determine temper tantrum status and tantrum characteristics and Short Sensory Profile is to
determine the level of sensory processing disorder. The samples (n=54), are children with Autism ages
between 3 to 6 years old. The results show that there is no significant difference between two of the
sensory processing domains and tantrum characteristics. The domains of movement sensitivity and
under-responsivity or sensation seeking were found to be related to tantrum characteristics among
children with Autism.
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Technical Report Autism Spectrum Disorder Research In Malaysia 59
1.7.3 Information Technology (IT)
1.7.3.1 Interactive CD Learning for the Treatment of Autism Children
Siti Iradah I.
Universiti Teknikal Malaysia Melaka, 2008
Abstract: Interactive CD Learning for the Treatment of Autism Children is an educational courseware
used for autism children in primary schools. Since the autism disorder qualifies as learning disability,
a treatment and therapy progress especially in their educational process is necessary to assist them.
There are four modules in this educational courseware prototype that is based on Huraian Kurikulum
Pendidikan Khas Bermasalah Pembelajaran (PKBP). The topic selected is to identify and naming the
living things (human), which are further divided into sub-modules based on Science, Social and
Environments Components. By using graphics, animation, voice and sound effects, children’s interest,
attention, and learning of verbal material increased over a control group who received only a
traditional therapeutic learning approach. It is developed to assist teachers and students with autism
in primary schools to a life path a normalcy. In particular, this report explains seven main chapters
which consist of Introduction, Literature Review and Project Methodology, Analysis, Design,
Implementation, Testing and Project Conclusion. The introduction explains what the application is
and what their purposes are. While in the literature review and project methodology, it explains the
existing similar application and comparison, the methodology approach and project requirement.
Analysis is the critical part in this report which all information are captured and recorded properly. In
addition, the requirements analysis is also covered in this part. The Design is where the architecture
of educational courseware prototype will be defined. The implementation explains the production
and implementation process which encompasses the text, graphic, audio and animation production,
and the media integration. Testing was conducted among the special education primary and private
school teachers and students. It is carried out in order to retrieve their opinions on this courseware
prototype. The respondents consist of 5 special education teachers and 8 autism students from Bukit
Cina Primary School, Autism Intervention Centre (NASOM), and Joy Workshop (PKIIM) in Malacca. The
findings of this study are useful for autism community in order to assist them to learn. Finally, the
Project Conclusion explains the prototype strengths and weakness.
1.7.3.2 National Autism Society of Malaysia-Nasom Parent’s Support System:
Diagnosis Module
Kong C.H.
Universiti Teknologi Malaysia, 2010
Abstract: NASOM Parent’s Support System – Diagnosis Module is a tool that has similarity to Decision
Support System (DSS). This system is introduced to a portal of our UTM’s master student, Puan Aida
in order as a suggestion to perform medical monitoring by using this tool. This project is a combination
of 3 systems that consists “NASOM Parent’s Support System – Information System Module”, “NASOM
Parent’s Support System – Diagnosis Module” and also “NASOM Parent’s Support System –
Monitoring Module”. “NASOM Parent’s Support System Diagnosis Module” is a web based as a
purpose to help the users mainly parents to diagnose the probability of the child to be autism. This
system is developed using Evolution Prototype methodology. The software’s used in developing this
system are consists of ASP.NET which is used as the main programming language and also MSSQL as
to manage the system’s database. Besides, Microsoft Visual Studio 2008 is used in order to produce
an interactive and user friendly web based system. By developing this project, hopefully the system
can smooth the process of obtaining diagnose result for the autism children.
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Technical Report Autism Spectrum Disorder Research In Malaysia
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1.7.3.3 Penggunaan Video dalam Perisian Power Point bagi
Meningkatkan Tumpuan Belajar Murid-murid Bermasalah
Pembelajaran Kelas 3 Melur dalam Kemahiran Urus Diri Mengikat
Tali Kasut
Abu Halim
Institut Pendidikan Guru Malaysia, Kampus Ilmu Khas, 2010
Abstract: The purpose of this study is to improve the skills of self-governance among pupils of class
3 Melur with learning disabilities through the use of video in power point. The target group consists
of seven pupils with four girls and three boys in a group. They are categorized into the problem of
autism, Down syndrome, Slow Learner and multiple disabled. Researchers have used video to enhance
pupils’ skills of lace shoes and directly teach them to be independent. The results of this survey show
that the undesirable behavior occur such as unfocused on teaching and learning processes, running
out of class and sleeping in class. In an effort to obtain data, researchers have used various techniques
through video such as pause and play technique, see and do, and yes and no technique in the period
of four weeks. Data collection has been made through interviews with their teachers/ mentors,
teachers of Self Governance subject, assistants’ student management (PPM) and analysis of documents
from each pupil. The final result shows the improvement in terms of controlling the class and pupils
focus on learning. They also feel that learning is more enjoyable.
1.7.3.4 Relation between Sensory Processing Problems among Autistic
Children with Their Parent Distress Level
Ahmad M.A.
Universiti Kebangsaan Malaysia, 2011
Abstract: Most of autistic children showed features of sensory processing disorder (SPD). They
markedly show have difficulty in social skills, emotional, physical and behavior problems. The study
showed the effects of mental burden and psychological effects on the parents of children with autism.
This study aimed to investigate the relationship between SPD in children with autism on their parent
mental burden. This research was conducted from September 2010 until December 2010. This cross
sectional study involving the participation of as many as 37 parents of children with autism in 7
registered Community Rehabilitation (CBR) in Kuala Selangor. Short Sensory Profile (SSP) and Zarit
Burden Interview Revised (ZBIR) were completed to 37 parents. Results of index showed the mental
burden of parents of children with autism have higher level of mental burden with the mean rate of
42.32. Min score of ZBIR found the father to feel more depressed (43.70 + 14, 522) than the mothers
(41.81 + 17,321). However, no difference in the mental burden of the mother and the father (>0.05).
Besides, there were no significant differences between the mental burden of the parents based on
race, age, educational level and income group. There was a significant correlation relationship
between sensory processing problems of children with autism with their parents mental burden
(p<0.05). The conclusion of the study is there were no significant differences between the mental
burden of the parents based on race, age, educational level and income group and SPD encountered
in children with autism have a relationship with the mental burden of their parents. Future research
may help parents to understand their child’s problems and intervention based therapies to help in
dealing the autistic children with SPD and at the same time reduce the mental burden experienced
by parents.
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Appendix 2
DATA EXTRACTION TABLE
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Technical Report Autism Spectrum Disorder Research In Malaysia
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
3.1 Education
3.1.1 Educational Intervention
1. Yahya S., Md
Yunus M. &
Hasnah T.(2013)
Facilitating ESL
Students with
Autism Learn
Sight
Vocabulary:
Teachers’
Practices and
Voices
To report the findings of
a study that looked into
English language
teachers’ practices in
facilitating
primary school ESL
students with autism
learn sight vocabulary.
NA 4 ESL teachers NA NA NA NA The findings indicated humanistic
language teaching practices. The
practices seem to be important in
promoting sight vocabulary
development among the students.
The findings have important
implications for teacher educators,
in service and pre service teachers
involved in teaching ESL students
with autism in inclusive and special
education settings.
2. Low H.M. &
Lee L.W. (2011)
Teaching of
speech,
language and
communication
skills for young
children with
severe autism
spectrum
disorders: what
do educators
need to know?
To describe a speech,
languange and
communication
intervention process of
a child with
severe autism
The subject
has severe autism
A 4 year
old girl with
severe autism
4 Female severe Speech,
language &
communication
by a SLP
Subject showed improvements in
turn-taking, object-picture
matching, following one-step
commands but not in imitating
vocalization.
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Technical Report Autism Spectrum Disorder Research In Malaysia 63
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
3. Abd Rahim N.
& Harun N.I.
(2006)
First We Imagine,
Then, We
Collaborate: An
Insight with
Autistic Children
To find out as to whether
autistic learners are able
to collaborate with their
peers by ‘Imaginative
Learning Approach’ in
the language classroom.
NA 10 children
with autism
from 5 schools
in Selangor &
Negeri
Sembilan
7 to 15
years old
NA NA Imaginative
Learning
Approach
It is found that autistic learners are
able to collaborate with peers in the
‘Imaginative Learning Approach’.
4. Yahya S., Md
Yunus M. &
Hasnah T.
(2013)
Instructional
practices in
enhancing sight
vocabulary
acquisition of
ESL students
with autism
Explore teachers’
instructional practices
in teaching sight
vocabulary to ESL
students with autism in
the natural classroom
setting.
NA 4 teachers in 3
primary
schools in
Malaysia. 2
mainstream
teachers and 2
special
education
teachers
NA NA NA NA The findings of this study suggested
that teachers provided support
through bridging second language
instructions with the students’ L1
(Malay) to ease learning. Findings also
indicated that teachers adjusted their
level of vocabulary during instruction
to promote sight vocabulary
acquisition. Further, results suggested
that giving the students frequent
opportunities for using words as their
nondisabled peers promotes sight
vocabulary acquisition.
5. Omar H., Hussin
Z. & Siraj S.
(2013)
Teaching
approach for
autism students:
a case in
Malaysia
To identify teaching
approaches used by
teachers when
implementing the
teaching process to
pupils with autism
3teachersand 3 students
withautism. Inclusion
criteriasatleast 5 years
teachingexperiences,had
beenawarded anexcellent
tracherawards, atleasta
bachelordegree,willing to
cooperateand commit.
3 teachersand 3
studentswith
autism
NA NA NA NA Teachers always try to reach out
and attract attention of the students
to focus. High level of pateince is
apparent.
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Technical Report Autism Spectrum Disorder Research In Malaysia
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3.1.2 Early Intervention Program
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
6. Badzis M.
& Zaini M.F.
(2014)
Early
Identification
and Intervention
of Autism
Spectrum
Disorder Among
Young Children
To investigate:
(a) parents' perception of
the need of early
identification and
intervention of children
with autism (b) parents'
own perception of the
challenges and strategies
to help students with
autism increase their
school performance
(c) parents' view on
strateies to help change
the societal perception
on ASD
Current study
selected the sample
based on the
researcher’s
immediate
environment and
friendship
1 mother with
1 child with
autism
NA NA NA NA 1. There was a need of students
with autism to be involved in school
activities, however, teachers need to
identify certain activities suitable for
the child with autism. 2. The use of
early identification is to involve
parents, teachers and society to
make the children with ASD to be
independent adult later in their life.
3. Successfull helping strategies
involved role played by parents,
teachers, school counselor &
homeroom teacher.
7. Liew P.Y. &
Mohd. Ali M.
(2008)
Amalan Program
Intervensi Awal
Kanak-Kanak
Autistik Mengikut
Perspektif Ibu
Bapa
To explore parents’
perspective on the usage
of the types of
intervention, service
delivery and family
involvement in the early
intervention program
received by autistic
children
A total of 50 parents
who have autistic
children between the
ages of 2 to 8 years
old and has received
early intervention
program for at least 6
months
50 parents of
chilldren with
ASD
F & M NA NA Various
intervention
involved:
aumentative
communication,
behavioral
support, expert
consulatation,
inclusive
service, parents
training, speech
1. Program intervensi awal yang
diterima kurang teratur dan
terancang. Ibu bapa mendapatkan
maklumat dan menentukan
intervensi yang diamalkan ke atas
anak masing-masing secara
persendirian selepas mengenal
pasti bahawa anak mereka
mengalami simptom-simptom
autisme.
2. Cara pelaksanaan dan
pengamalan program adalah kurang
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Technical Report Autism Spectrum Disorder Research In Malaysia 65
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
therapy, music
therapy,
occupational
therapy, e.t.c.
selaras antara pusat latihan
atau pembekal perkhidmatan.
Perkhidmatan-perkhidmatan yang
disediakan adalah kurang jelas dari
segi penaksiran dan penilaian,
laporan kemajuan, perancangan
pengajaran
dan teknik pengajaran
3. Ibu bapa melibatkan diri dan
mengetahui peranannya dalam
pelaksanaan program intervensi
awal. Walaupun begitu, sejauh
manakah penglibatan dalam
kalangan ibu bapa dan keluarga
dalam pelaksanaan program
intervensi awal masih perlu ditinjau
dengan lebih mendalam
8. Hasnah T.,
Mohd Hanafi
M.Y., Fadliana C.,
Mohd Mokhtar T.
(2010)
Monitoring
progress using
the individual
education plan
for students with
autism
To investigate the IEP
process carried out in an
autism learning
laboratory established in
a local university in
Malaysia. Specifically,
this study investigates
the objectives set for the
students and their
achievement of these
objectives.
Students with autism
who study in the
UKM/Hulu Langat
Autism Learning
Laboratory. No
mention on exclusion
criteria.
10 3-16
years old
9 boys,
1 girl
Moderate
and severe
autism
Early
Intervention
Program (EIP)
Students’ percentage of
achievement of learning objectives
ranged from 40% to 85.71%.
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Technical Report Autism Spectrum Disorder Research In Malaysia
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
9. Sani B.,
Wan Chik M.N.
& Badzis M.
(2011)
An Exploratory
Study on the
Special
Education and
Early
Intervention
Programme for
Autistic Children
To explore the special
education and the
intervention
programme for autistic
children run by two Non-
Governmental
Organizations and
identify how their
programmes help
autistic children improve
learning disability
NA two
respondents
working in
organizations
located in
Ipoh, Perak
NA All
females
NA NA Findings showed that both centres
used a naturalistic curriculum
model where activities carried out
are mostly dealing with real life
activities, while topics and skills
are focused on sensory skills and
children are taught to use their
senses and attention span.
Teaching methods used are a
mixture of several latest teaching
techniques currently being applied
worldwide for autistic children. In
the early intervention programme,
the teaching and learning
techniques are based on the
individual child_s ability. Both
centres admitted that some
parents play a supportive role
while others play non-supportive
roles.
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Technical Report Autism Spectrum Disorder Research In Malaysia 67
3.1.3 Teacher’s Knowledge
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
10. Mislan N., Tian
A.,Sharifuddin
R.S., Guan J &
Lee M. F.
(2012)
Observational
Study on
Teachers’
Approach in
Teaching
Children with
Autism to Read
To obtain in-depth
understanding regarding
the teaching approaches
used by special
education teachers in
educating children with
autism to read
Special education
teacher
2 special
education
teachers
NA NA NA NA Total observation in the autism
centre is six. Each observation took
duration of 90 minutes.
Approaches used in teaching were
divided into 4 phases namely:
1. Introduction phase
2. Pre-reading phase
3. Guided reading phase
4. Post reading phase
11. Nornadia M.R.,
Hasnah T.,
Sazlina K.,
Norshidah M.S
& Mohd. Hanafi
M.Y. (2013)
Teachers’
Perceptions of
Including
Children with
Autism in a
Preschool
To investigate teachers'
perceptions of including
children with autism in a
mainstream preschool.
The objectives of this
study were: 1) to
determine the attitudes
of teachers towards
inclusive education 2) to
identify the knowledge
and skills of pre-school
teachers regarding
inclusive education 3) to
identify the barriers and
challenges in
implementing inclusive
education in pre-school
Maintream
preschool teachers.
Exclusion: NA
3 mainstream
preschool
teachers
NA All
females
NA NA The findings showed that the
teachers were not prepared to teach
children with autism in their class
because they did not know the
characteristics of children with
autism and did not understand the
importance of inclusive education.
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Technical Report Autism Spectrum Disorder Research In Malaysia
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
4) to investigate the
reasons behind the non-
acceptance of preschool
teachers on having
children with autism in
their classes.
12. Saad S., Ibrahim
H. & Nayan N.
(2013)
Towardsholistic
inclusion in
malaysia:
knowledge of
speciel educational
needs among in-
service distant
learningstudents.
To determine the
knowledge level of
Special Educational
Needs (SEN) among
experienced mainstream
teachers in Malaysia.
147 teachers
undergoing distance
learning Bachelor of
Education (BEd)
degree in IIUM
147 teachers
undergoing
distance
learning
Bachelor of
Education
(BEd) degree
in IIUM
NA NA NA NA Moderate level of knowledge on
autism (57.8%) among 147
teachers. Only 0.7% had high level
knowledge on autism, while 4.8%
had high level knowledge on
autism. 36.1% of the teachers had
none/ low knowledge on autism.
13. Hasnah T., Mohd
Hanafi M.Y.,
Mohd Mokhtar
T., Norani S.
(2010)
Tahap Latihan,
Pengetahuan &
Keyakinan Guru-
guru Pendidikan
Khas tentang
Autisme
To investigate the level of
training, knowledge, and
confidence of special
education teachers on
autism.
Responden
merupakan peserta
yang terlibat dalam
sebuah bengkel
tentang autisme yang
dianjurkan oleh
Fakulti Pendidikan,
Universiti
Kebangsaan Malaysia
112 guru
pendidikan
khas dari
Selangor,
Johor, Negeri
Sembilan dan
Wilayah
Persekutuan
Putrajaya
4
responden;
20-30
tahun,49
responden;
31-40
tahun,17
responden;
41 hingga
50 tahun
dan 2
responden
51-60
tahun.
9
responden
(8.04%)
ialah lelaki
dan 102
responden
(91.07%)
ialah
perempuan.
NA NA Kursus perguruan formal didapati
kurang berkesan dalam melatih
guru pendidikan khas untuk
memahami &mendidik kanak-
kanak autisme. Kualiti latihan
dalam perkhidmatan bagi
pendidikan autisme hanyalah pada
tahap sederhana, tetapi lebih baik
daripada latihan perguruan formal;
menyebabkan guru mempunyai
tahap keyakinan yang rendah
dalam mendidik
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Technical Report Autism Spectrum Disorder Research In Malaysia 69
3.1.4 Children Development
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
14. Vijayen G.
(2002)
Kemahiran Asas
Sosial Kanak-
kanak Autisme
di Persekitaran
Sekolah
To study the level of
social skills among
children with autism
and to identify the
challenges and support
towards learning social
skills.
Subjects are
receiving special
education in
government school
3 students
and 3 teachers
10,
10,
9
years old
3 male
students
moderate
autism
This study
does not
implement an
intervention
but describes
the social
skills of the
subjects
Education in the school focused on
academics and social skills were not
focused on enough. Teachers
thought that group teaching was not
effective for children with autism.
Lack of training for teachers. Lack
of awareness and teaching skills
among parents.
15. Lim C. Y., Mohd
Hanafi M. Y. &
Mohd Mokhtar T.
(2012)
Genggaman
pensel kanak-
kanak
bermasalah
pembelajaran
dalam
meningkatkan
kemahiran
menulis
1. To highlight the types
of pencil grip among
KKBP
2. To determine the
types of levels of pencil
grip for learning
disabilities students at
school stage
3. To determine the
difference of pencil grip
in KKBP categories
Integrasi
Bermasalah
Pembelajaran
(PPKIBP) di sekolah
rendah yang
disediakan oleh KPM
dalam daerah Klang,
Selangor.
Populasi kajian
di daerah
Klang
sejumlah 609
orang
(Pejabat
Pelajaran
Daerah Klang
2011) dipilih
secara rawak
daripada
senarai
sekolah
rendah
tersebut.
NA F & M Mild
Autism
NA Hasil tinjauan menunjukkan murid-
murid bermasalah pembelajaran
hanya memenuhi 8 daripada 10
jenis genggaman pensel.
jenis-jenis genggaman tidak matang
(peringkat tidak matang) terdiri
daripada genggaman jejari silang
tapak tangan, genggaman supinate
tapak tangan, genggaman dengan
lanjutan jari, genggaman ibu jari
silang, genggaman tripod statik,
genggaman empat jari, genggaman
thumb tuck, genggaman thumb
wrap dan genggaman broken type.
Jenis-jenis genggaman matang
(peringkat matang) terdiri daripada
genggaman tripod lateral dan
genggaman tripod dinamik
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Technical Report Autism Spectrum Disorder Research In Malaysia
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
(Schneck & Henderson 1990).
Manakala, jenis-jenis genggaman
pensel selain daripada jenis-jenis
genggaman matang dan jenis-jenis
genggaman tidak matang
dikategorikan sebagai peringkat
lain-lain.
16. Sulaiman T., Baki
R. & Megat A.
Rahman P.Z.
(2011)
The Level of
Cognitive Ability
among Learning
Disabilities
Children in
Malacca
Malaysia
To examine the
cognitive ability of
children with learning
disabilities (LD) who
were involved in the
PDKNet education
program.
The subjects were
enrolled in
Community Based
Rehabilitation
Centers
106 children
with learning
disabilities (59
with autism)
NA 43
males,
63
females
NA This study
does not
implement an
intervention
but describes
the cognitive
skills of the
subjects
The findings of the study indicated
that more than half of the children
with learning disabilities (LD) were
able to identify components of a
computer such as monitor,
keyboard and mouse. More than
half of the LD children were also
able to recognize and pronounce
words and alphabets. However,
they face difficulties in reading and
writing the respected words as
well as having difficulties in
providing examples for the shapes
asked.
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Technical Report Autism Spectrum Disorder Research In Malaysia 71
3.1.5 Special Education Program
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
17. Loh S.C. &
Syed Yahya S.Z.
(2013)
Effective
Transitional Plan
from Secondary
Education to
Employment for
Individuals with
Learning
Disabilities: A
Case Study
To develop an effective
transitional plan from
secondary education to
employment for these
individuals.
People with
disabilities who are
working,
theiremployer,
parents, special
eduators, NGO
18 (5 NGO,
4 disable
employee,
4 parents,
2 special
educators,
3 employers).
1/4 mild ASD
NA 3 males,
1 female
mild
ASD
NA The lack of vocational training for
students with special needs has
resulted in poor employment
outcomes. Many students are
unable to have a successful
transition from secondary education
to employment because they are not
equipped with the necessary
vocational skills. There is a lack of
centers which provide vocational
training for students with learning
difficulties. This shortage has
resulted in many individuals with
learning difficulties to become
unemployed and homebound.
18. Hussin S.,
Loh S. C. &
Quek A. H.
(2012)
Overcoming the
challenge of
inclusion
through smart
initiatives: a case
study
To gather insight on the
successful inclusion of
children with autism
into the mainstream
classes in one of the
primary schools located
at the metropolitan of
Kuala Lumpur, at Klang
Valley
NA 7 Special
Education
teachers and
1 NASOM
teacher
NA NA HFA NA This article does not measure the
improvements of the students.
Instead it describes the challenges
that the children faced and the
process of having them in the
inclusive program. This article also
identified 5 elements that
contibuted towards successful
inclusion; smart collaboration, co
teaching, peer learning, after school
coaching and experiential learning.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
19. Kamaliah M. &
Wan Amimah
W.M. (2010)
Pelaksanaan
Program
Pendidikan
Inklusif Murid
Autistik di
Sebuah Sekolah
Rendah: Satu
Kajian Kes
To describe the
implementation of an
inclusive program for
children with autism in a
primary school in KL.
Children who were
receiving services in
NASOM. It is
assumed that these
children had been
diagnosed there.
Asst
Headmaster,
Sp Ed
coordinator, 3
shadow aides
from NASOM,
3 teachers,
3students
with autism
and 10 neuro
typical
students
primary
school
age
Not
described
NA Inclusive
program
Having shadow aides helped the
children with autism
tremendously. All teachers agreed
that the children improved in
terms of academic,
communication and behaviour.
Due to the training provided by
NASOM and the Special Ed Dept,
teachers and the shadow aides
were able to collaborate smoothly.
Low number of students in the
classroom was one of the factors
why the program was successful.
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Technical Report Autism Spectrum Disorder Research In Malaysia 73
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
3.2 Engineering
3.2.1 Utilizing Electroencephalography (EEG) as a diagnosis tool
1. Razali N. &
Wahab A.
(2011)
2D affective
space model
(ASM) for
detecting
autistic children
Electroencephalogram
(EEG) was used to
understand and analyze
the functionality of the
brain to identify or
detect brain disorder for
autism in term of motor
imitation.
NA Both autistic
and control
children with 6
children each
group. The
autistic
children were
selected by
National Autism
Society of
Malaysia
(NASOM) while
the control
subjects are
mix of staff’s
and relative’s
children. All
subjects went
through the IQ
test using
Stanford binet
IV which was
done by the
psychologists
from NASOM.
Around
7 to 9
years old.
NA NA Subjects were
asked to watch
video stimuli
that were
approved by a
psychiatrist.
Video stimuli
showed three
different
emotions
which are
happy, calm
and sad while
the last video
stimuli are
video of person
that clinching
their hand
(switched left
and right
hands) within
one minute
time (figure 4
& 5).
There are significant differences
between the control subject and the
autistic children.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
2. Othman M. &
Wahab A.
(2010)
Affective face
processing
analysis in
autism using
electroencephal
ogram
To investigate human
brainwaves for
understanding affective
face processing of ASD
children.
NA The subjects
of our
experiments
are 6 children
diagnosed
with ASD and
12 age-
matched
typically
developing
children.
7-9
years
NA NA No intervention.
The electrodes
are placed on
the children’s
scalp and data
are collected
using BIMEC
EEG machine.
For baseline
recording,
subjects are
instructed to
open their eyes
for one minute
and close their
eyes for another
minute.
Afterwards, the
emotional faces
are displayed to
the children for
the affective
states of calm,
happy and sad.
The recorded
brainwaves are
then saved for
off-line
processing.The
stimuli consist
Results from our experiments
showed that it is possible to detect
differences in the emotion
dynamics of autistic children
compared to non-autistic group.
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Technical Report Autism Spectrum Disorder Research In Malaysia 75
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
of happy, sad
and calm human
faces which are
as movie clips
with the duration
of 1 minute for
each affective
state. Two sets
of movie clips
were prepared
for each
emotion.
3. Qudwai U.A. &
Shams W.K.
(2013)
A Source-
Discrimination
Approach for
Detection of
ASD Using EEG
Data.
1. To investigate the new
features 2. To investigate
how ASD and normal
groups of children can be
distiguished during rest
conditions as well as
other motor tasks.
1. Six typical
children from age 6
to 9 years from a
local primary school
and six children with
autism from NASOM
2. ASD diagnosis
made by psychiatrist
using the DSM IV
criteria.
Six typical
children from
age 6 to 9
years from a
local primary
school and
six children
with autism
from NASOM.
6 to 9
years of
age
NA NA Utilizing the
TDOA approach
applied with raw
EEG data for
feature extracted
in time domain.
Data classified in
2 classes.
EEG signals in children with ASD
is helpful in the diagnostic
process. The resuts reveal high
discrimination between eyes- open
and eyes- closed for both groups.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
4. Shams W.K. &
Rahman A.W.A.
(2011)
Characterizing
autistic disorder
based on
Principle
Component
Analysis
To identify autistic child
during motor and open-
eyes tasks by applying
Principle Components
Analysis (PCA) to Short
Time Fourier Transform
(STFT) of
Electroencephalogram
(EEG) signals.
NA Six autistic
children from
the National
Autistic
Society of
Malaysia
(NASOM),
and six
typical
subjects from
preschool
7 - 9
years
NA NA No Intervention.
The subjects
were subjected
to two task for
experimentation.
The first task
contained motor
movement
where subject sit
in 75 cm away
frommonitor
screenand
asked tofollow
the right and left
hand movement
movie while the
other taskis
done by asking
the subject tosit
in rest condition
with open eyes
looking onblack
screen.
This result of work shows that it is
more practical to detect autism by
depending on motor activities than
in open eyes activities. This result
suggests that in motor task, the
motor cortex region of autistic
subjects is active in different ways
from normal subjects. Therefore,
this can be useful in clinic by
paying attention to the changes in
EEG signal during motor task for
early detection of autism.
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Technical Report Autism Spectrum Disorder Research In Malaysia 77
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
5. Najwani R. &
Abdul Wahab
(2011)
Dynamic
analysis of
critical features
in EEG for
motor imitation
among Autistic
children
To examine features of
EEG for motor imitation
in autistic children
12 children
(6 control children,
6 autistic children)
12 NA NA NA No
intervention.
Using EEG to
measure brain
signals
Compared to normal children:
Problem occurred during the
communication in their brain
while doing required action.
Autism children have some
difficulty in open and close hand
action.
6. Yussof H.,
Ismail L. I.,
Shamsuddin S.,
Hanapiah F. A. ,
Mohamed S.,
Piah H. A.,
Idris S., Hashim
H. & Zahari
N. I. (2012)
Human-Robot
Interaction
Intervention
Therapy
Procedure for
Initial Response
of Autism
Children with
Humanoid
Robot
To assess initial
response of autism
children interacting
wiith Humanoid Robot
NAO in RBIP
NA 12 autism
children from
NASOM
NA NA NA All children
participated in
the RBIP
(module 1 to
5) and the
interaction is
recorded using
video camera
for initial
response
analysis based
on GARS 2
Interaction with Humanoid Robot
NAO generate more concentration
level amongst children with
autism.
7. Shams W.K. &
Wahab A. (2013)
Source-
temporal-
features for
detection EEG
behavior of
autism
spectrum
disorder
Introduce a new model
to capture the abnormal
brain activity of children
with Autism Spectrum
Disorder (ASD) during
eyes open and eyes
closed resting
conditions.
Six typical subjects
from preschool and
six autistic subjects
in the same age
from the National
Autistic Society of
Malaysia(NASOM)
7-9
years old
NA NA ASD No
intervention.
This study features new model to
analyze EEG data to characterize
behavior of autistic and normal
subjects in time domain.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
8. Saidin S. & Safri
N.M. (2010)
Study of
Electroencephal
ography signal
of autism and
Down syndrome
children using
FFT
To determine and
classify EEG patern for
autism and Down
Syndrome children
NA 6 normal, 2
autism and 8
Down
Syndrome
children
3- 12
years
Male
and
female
Not
available
EEG signal
recorded.
External
artifact
reduced.MATL
AB software
version 7.0
used to
determine
alpha value.
Normal children have alpha value
greater than autism children.
While autism children have alpha
value greater than Down
Syndrome children
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Technical Report Autism Spectrum Disorder Research In Malaysia 79
3.2.2 Robot-based Intervention
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
9. Shamsuddin S.,
Yussof H.,
Hanapiah F.A. &
Mohamed S.
(2013)
A Qualitative
method to
analyze response
in robotic
intervention for
children with
autism
To observe the initial
response of 12 children
diagnosed with autism
when they were
exposed to a facilitated
interaction with a
humanoid robot.
All children
diagnosed using the
Autism Diagnostic
Observation
Schedule (ADOS)
12 children
with autism
from NASOM
NA NA NA Program the
robotin
accordance to the
purpose of the
intervention.
Video recording
of the regular
learning
environment
(without robot)
and during child-
robot interaction.
Assessment of
the videos and
comparison of the
behavior scores is
done.
Statistical data showed that for
the subscale stereotypic
behavior and communication,
the robot had significantly
reduced the autistic traits of the
chidlren with autism. In the
social interaction subscale, the
scores of autistic behavior
during robotic interaction was
only a fraction lower than their
actual traiits without the robot.
10. Ismail L.I.,
Shamsudin S.,
Yussof H.,
Hanapiah F.A. &
Zahari N.I.
(2012)
Estimation of
Concentration by
Eye Contact
Measurement in
Robotbased
Intervention
Program with
Autistic Children
To estimate initial
response of eye contact
time between humanoid
robot NAO and ASD
children in RBIP and
normal classroom
interaction.
NA 12 ASD
children from
NASOM
NA NA NA The eye contact
time for interaction
between humanoid
robot NAO and
ASD children is
recorded for both
RBIP interaction
and normal
classroom setup.
The eye contact of the ASD child
is often seen in RBIP
interaction.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
11. Shamsuddin S.,
Yussof H., Ismail
L.I., Mohamed
S., Hanapiah F.A.
& Zahari N.I.
(2012)
Initial Response
in HRI- a Case
Study on
Evaluation of
Child with
Autism
Spectrum
Disorders
Interacting with
a Humanoid
Robot NAO
To elaborate on a case
study in our pilot
experiment where a
child with ASD is
exposed to the
humanoid robot NAO in
order to gauge his initial
response and behavior
in the presence of a
robot.
K has a non-verbal
IQ score of 104
(average), verbal IQ
score of 110 (high
average), full-scale
IQ of 107 (average)
and he is diagnosed
as Autism Spectrum.
He also complies
with all the exclusion
criteria including no
hearing and vision
deficit, no abnormal
eye movement,
obtained his
parent/guardian’s
consent, able to
speak and follow
simple commands in
English and does not
possess self-injury
of aggressive
behavio.
single
subject
study.
10
years
old
NA Although not
mentioned in the
DSM-IV-TR
(Diagnostic and
Statistical
Manual of
Mental
Disorders:
Fourth Edition-
Text Revision),
K can be
classified as
having high-
functioning
autism as his IQ
falls in the
average to
above-average
range.
Intervention is
Humanoid
robot
The overall comparison
between observations during
child-robot interaction and
normal class setting in this
particular case study supports
our hypothesis that the
humanoid robot NAO serves
as a significant platform to
support and initiate
interaction in children with
ASD.
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Technical Report Autism Spectrum Disorder Research In Malaysia 81
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
12. Razali N. &
Rahman A.W.A.
(2010)
Motor
movement for
autism
spectrum
disorder (ASD)
detection
Looking at the
differences between
autistic and normal
children in term of fine
motor movement.
All of the selected
autistic children
have undergone
formal intervention
with professional
therapists and
currently studying in
mainstream schools.
Average IQ level
The data
collection of
our studies
consisted of 6
autistic
children and
another 6
normal
children
which already
been matched
according the
age and IQ
test.
7 to 9
years old
NA NA No intervention.
The video stimuli
of fine motor
movement will be
displayed to the
children and it
required them to
imitate the tasks.
Before recording
the real signal of
the experiments,
the subject was
given some time
to watch and
follow the
movement as in
the video stimuli.
The real recording
will start with a
minute of eyes
closed followed by
a minute of eyes
open and followed
by another minute
of the fine motor
movement.
The activation signals for the
autistic children are far less
than the normal children. The
spectrum indicates the theta,
alpha and beta waves and the
red colour showed the most
activated signals during the
tasks. The activation signal of
autistic children during the
imitation tasks is not
continuous. Signals of normal
subject are more consistent
and continue till the end of the
tasks.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
13. Ismail L.I.,
Shamsudin S.,
Yussof H.,
Hanapiah F.A. &
Zahari N.I.
(2012)
Robot-based
Intervention
Program for
Autistic Children
with Humanoid
Robot NAO:
Initial Response
in Stereotyped
Behavior.
The initial response of
stereotyped behaviour
in Human- Robot
Interaction between
Humanoid Robot NAO
and children with ASD
during RBIP and normal
class session.
NA NA NA NA NA The initial
response of
stereotyped
behaviour is
observed and
evaluated in
the behaviour
score sheet for
RBIP and
classroom
interaction.
ASD children with higher FSIQ
responds with less stereotyed
behaviour in the presence of RBIP
compared to the normal human-
human interaction in normal
classroom session.
14. Shamsuddin S.,
Yussof H.,
Miskam M.A.,
Che Hamid
M.A., Abdul
Malik N.,
Hashim H.,
Hanapiah F.A. &
Ismail L.I.
(2013)
Humanoid
Robot NAO as
HRI Mediator to
Teach Emotions
using Game-
centered
Approach for
Children with
Autism.
To explore the response
of two autistic children
to a humanoid robot
NAO that has been
programmed to display
5 different emotions
using its body poses
and gestures.
Understand, speak
and follow simple
command in
English, no
nystagmus or self-
injury, no deficit in
hearing and vision.
2 children
with mild
autism
7 and 9
years
respectively
Male Mild Initial
exposure to
NAO robot
does have
potential to
teach children
with autism
about head
and body
posture that
are associated
with certain
emotion.
Positive utilisation of robots in the
rehabilitation of children with
autism.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
15. Shamsuddin S.,
Yussof H., Ismail
L.I., Mohamed
S., Hanapiah F.A.
& Zahari N.I.
(2012)
Humanoid
Robot NAO
Interacting with
Autistic Children
of Moderately
Impaired
Intelligence to
Augment
Communication
Skills
To observe autistic
children of moderately
impaired intelligence in
terms of
communication
behaviour when they
are exposed to simple
human-robot interaction
(HRI) modules executed
by a humanoid robot
NAO.
NA 5 autistic
children
Mean age
of 8.6
years.
Range
6-13
4 boys
and
1 girl
NA Intervention is
Humanoid robot.
The interaction
begins with the
simplest module
of NAO in static
mode for 45-
seconds, then
doing head-turn,
eyes blinking,
talking, moving
its arms, playing
nursery rhymes
combined with
eyes blinking and
finally ends with
NAO playing the
‘ABC’ song
combined with
arm movement.
4 out of the 5 children exhibited
a decrease in autistic behavior
(communication subscale) when
the robot is executing HRI
modules during the single
session of child-robot
interaction. These promising
results indicate that the basic
modules of interaction together
with the appealing appearance
of the NAO robot were able to
attract the children’s attention,
and hence keep each child
engaged with the robot during
interaction. This ‘engagement’
had resulted with a reduction in
autistic behavior of these
children compared to their
typical environment in
class.From the graph, it can be
deducted that autistic children
with FSIQ of moderately
impaired (from 40-54) are
receptive to robot-based
intervention.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
3.3 Information Technology (IT)
3.3.1 Assessing the Effectiveness of ICT Software
1. Dolah J., Wan
Yahaya W.A.J. &
Toh S. C.(2011)
A Preliminary
Investigation:
Potential of
Interactive
Multimedia
Learning
Awareness
(IMLA) in
Enhancing
Awareness of
Autistic
Characteristics
among Parents
and Society in
Malaysia.
To outline the process
in the development of
Interactive Multimedia
Learning Autism
(IMLA). The objective is
to determine which
learning theories,
theoretical framework
and instructional
system design that
works and To analyze
the process of alpha,
beta testing and pilot
testing.
NA 9 respondents
ranging from
two content
experts from the
National Autism
Society of
Malaysia
(NASOM), a
researcher
who is also an
expert in autism
from Universiti
Kebangsaan
Malaysia (UKM),
a mother with
autistic children,
a mother
without autistic
children, two
parents without
autistic children
and three
unmarried
women autistic
children.
NA M & F NA Implementatio
n of online
Interactive
Multimedia
Learning
Autism
(IMLA). and
the autistic
behavioural
symptoms
characters will
be the main
learning
objects in
enhancing
learner’s
know-ledge
and awareness
towards these
issues.
Lack of awareness that needs to be
addressed by Malaysian society.
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Technical Report Autism Spectrum Disorder Research In Malaysia 85
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type
of autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
2. Mustafa M.,
Arshad H.&
Zaman H.B.
(2013)
Framework
Methodology of
the Autism
Children --
Vibratory Haptic
Interface (AC-
VHI)
Provides the Framework
Methodology of the
Autism Children –
Vibratory Haptic
Interface (AC-VHI)
conducted on the mild
autism children who
have impairment in
social interaction.
Mild autism
in National Autism
Society of Malaysia
(NASOM) having
impairments in
social interactions.
20 autistic
children
suffering
from mild
autism
in National
Autism
Society of
Malaysia
(NASOM) and
having
impairments
in social
interactions.
Aged
btw
9 to 14
years
old
NA Mild
autism having
impairments in
social
interactions.
A generalized
sequence of
the steps
involved in the
process of
developing the
virtual 3D
environment
(3D screen,
glasses, and
vibratory
haptic
interface) with
3-D sonic
game.
To create suitable designing
of Haptic Interface Technique
for Autistic Children.
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3.3.2 Software Development
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
3. Abdul Manap
A., Sarah R. D.,
Riaza M. R. &
Sardan N.A.
(2014)
Computer Game
Approach
Focusing on
Social
Communication
Skills for
Children with
Autism
Spectrum
Disorder: An
Initial Study
To synthesize a survey
regarding social
problems and situations
faced by children with
autism.
Carried out on
parents
NA NA NA NA The identified design
issues aims at
preparing teaching
instructions for the
autistic children in
learning to make
them focus
attention, and avoid
splitting attention
using computer
based
intervention in
teaching Quran. The
future enhancement
of this paper is to
evaluate the
effectiveness of the
designed system on
the autistic
children’s split
attention, and
improve the lacks of
user interface design
specification for
them.
Findings suggest that
computer-based
technologies might be useful
educational aides for
students with ASD.
Computer games provide a
safe, secure, and less
anxious environment for
autistic users. The users can
play and practice and learn
by their mistakes at their
own place.
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Technical Report Autism Spectrum Disorder Research In Malaysia 87
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
4. Riaza M.R. &
Sarah R.D.
(2013)
Computer Game
Approach for
Children with
Autism
Spectrum
Disorder: A Pilot
Study
Reports a pilot study
using a specially
designed game called
Find Me.
six ASD children of
age ranging from 5
to 8.
six ASD
children
Age
ranging
from
5 to 8.
5 boys
and
1 girl
NA Understand
their behavior
in game
engagement
and try to
understand
their needs
and
preferences in
learning.
Computer
game called
find
me is specially
designed to
teach children
on
improvement
of social skills.
Children responded to the game
slower than usual on the first
session, but their performance
improved as they played the game
regularly
5. Sidek S.F., Fathil
N.S.,
Mohamed Zain
N.Z., Kamaliah
M. (2014)
Pembangunan
Perisian Kursus
‘Saya Suka
Belajar’ Untuk
Pembelajaran
Bahasa Melayu
Bagi Kanak-
kanak Autisme
Reports the
development of
educational software
named ‘I Like Learning’
to help children with
autism learn Malay
Language.
Respondents were
five primary school
students in Kuala
Lumpur who had
been diagnosed with
mild level of autism
5 primary
school
students
NA NA Mild NA The result shows that the
educational software that has been
developed using ADDIE
methodology is able to attract the
children’s attention in learning
Malay Language subject.
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Technical Report Autism Spectrum Disorder Research In Malaysia
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
6. Ismail A.,
Omar N. & Mohd
Zin A. (2012)
Design and
implementation
of blocks-based
educational
courseware for
children with
learning
disabilities
To design and
implement blocks for
development od
educational software for
autistic children.
NA Autistic
children
NA NA NA Block based
softare
development
for pre
reading.
Enables end users to build
personalised courseware within
the block based educational
software environment.
7. Ismail A.,
Omar N. & Zin
A.M. (2009)
Developing
learning
software for
children with
learning
disabilities
through Block-
Based
development
approach.
To propose Block-Based
Software Development
method and approach
that enables the end-
users (such as parents
and teachers) to build
application software to
suit the different need of
an autistic child.
NA NA NA NA The block-
based
approach that
derived from
the
component-
based and
end-user
approach and
how the
application
software can
be developed
by the end-
users by using
this block-
based
approach.
Block-Based Software
Development that offers tailorable
design architectures that enables
the parents or teachers to
customize application software to
suit different needs of an authistic
child.
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Technical Report Autism Spectrum Disorder Research In Malaysia 89
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
8. Hitam S., Tan
K.L., Sahbudin
R.K.Z., Mokhtar
M., Ahmad Anas
S.B. & Sali A.
(2011)
Digital Visual
Schedule and
Training System
for Centre of
Autistic Children
Reports the Usage of
DVST System to enable
therapists and autistic
children to carry out
administrative work and
training program in a
single application.
NA NA NA NA NA 5 phases are
involved in the
project
development
process. DVST
Client is
system
enabled the
childern to use
a personal
visual system
to carry out
their individual
training
program.
Improve the student learning
process and autistic children with
fine learning problems to carry out
their learning more easily.
9. Shams Aliee Z.,
Jomhari N.,
Rezaei R. &
Alias N. (2013)
Facilitating
Autistic
Children’s Split
Attention in
Designing
Computer
Teaching
Instructions
Presents the specified
user interface design
issues incorporated
with the required
teaching instructions for
the autistic children to
facilitate their split
attention.
NA NA NA NA NA NA in addition to the design issues to
be considered for the autistic
children, teaching instructions
need to be incorporated
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Technical Report Autism Spectrum Disorder Research In Malaysia
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
10. Dolah J., Wan
Yahaya W.A.J. &
Toh S. C. (2012)
The
Implementation
of Interactive
Multimedia
Learning Autism
(IMLA). Alpha,
Beta and Pilot
Testing Stages
To outline the process
in the development of
Interactive Multimedia
Learning Autism
(IMLA). The objective is
to determine which
learning theories,
theoretical framework
and instructional
system design that
works and To analyze
the process of alpha,
beta testing and pilot
testing.
Total sample
was 20
undergraduate
students
NA NA NA NA Implementation of
online Interactive
Multimedia
Learning Autism
(IMLA). and the
autistic
behavioural
symptoms
characters will be
the main learning
objects in
enhancing learner’s
knowledge and
awareness towards
these issues.
In general the overall results showed
that there are signi-ficance
relationship between Knowledge and
Awareness in all stages of two
presentation modes. In term of
interaction be-tween modes there
are significance relations exists. This
result showed that Modality mode
proved to have strong effects on the
target respondents in term of
minimizing the extraneous effects in
identifying Autism behavioral
symptoms.
11. Shams Aliee Z.,
Jomhari N.,
Rezaei R. & Alias
N. (2013)
User Interface
Design Issues
for the Autistic
Children
Reports on how to
prepare the interactive
courseware prototype to
teach the basic Quran
recitation to the autistic
children, and how to
make autistic
individuals focus
attention on learning.
ASD children,
teachers,
doctors, and
therapist who
associate with
ASD patients.
NA NA NA NA NA re for parents and teachers of the
participants help us to set the main
aim of this research among
problems with the highest priority
and to recognize the components
that should be concerned in a game
based on the psychological
methods. Fig 3 therapists selected
communication problems as the
most crucial problem among
children with autism followed by
social skills problems and behavioral
problems respectively.
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Technical Report Autism Spectrum Disorder Research In Malaysia 91
3.3.3 Use of ICT Tools
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
12. Ravana S.D.,
Gurusamy N. &
Varathan K.D.
(2014)
Autism and the
Need for Special
User Interface
Design for Web
Surfacing
To investigate the
utilization of a search
engine for the purpose
of learning and
entertainment of
children with ASD.
NA NA NA NA NA NA This study concludes that the
existing search engines were
not user friendly and it is
difficult for a child with ASD
to utilize it with minimal
guidance.
13. Syarifah
Diyanah Y. &
Salam S.
(2013)
Children with
High Functioning
Autism
Acceptance in
Using Tablet.
The preliminary study of
the tablet acceptance
among children with
high functioning
autism.
high functioning
autism children and
20 caregivers at
NASOM.
three
sample high
functioning
autism
children, and
feedback from
distributed
questionnaire
to all of 20
caregivers at
NASOM.
NA NA High
functioning
autism.
Observation
of three sample high
functioning autism
children, feedback
from distributed
questionnaire to all of
20 caregivers at
NASOM.
The high functioning autism
children seem has no
difficulties swiping the
touchscreen. In casefor
autism children with sensory
issues, they can always try
using the stylus pen for
browsing the tablet.
14. See C.M. &
Tang K. N.
(2009)
Using a Multi-
Media
Presentation to
Analyze Thinking
Patterns of
Children with
Autism
To observe autistic
children response to a
multi-media
presentation
Children withthe
following criteria
were divided into
four groups: (1) very
low functioning
group, with global
development of
about 1-2 years old;
24 children
with autism
Aged btw
5-10 years
old
NA NA This study used a multi-
media presentation.
Visuals in the
presentations were
accompanied
with music selected
not to be overly
stimulating,
Generally, all the children
with autism responded
positively to the
computerized multi-media
program.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
(2) low functioning
group, with global
development of
about 3-4 years old;
(3) moderate
functioning group,
with global
development of
about 5-6 years old;
and (4) high
functioning group
with global
development level
equal to the
chronological age.
and were organized
into five collections
with the following
theme: (a) color, (b)
light, (c) visual
perception, (d)
cartoon, and (e)
character. A 45
minutes session was
provided three times a
week per child for six
months. For each
session, the teacher
selected one or two
collections and played
them to the child while
observing the child’s
behavior. A video
recording was made of
the session for later
analysis of behavior
and response. At the
end of the
presentation, the child
was asked to draw,
write, act out, or talked
about what he saw and
understood.
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Technical Report Autism Spectrum Disorder Research In Malaysia 93
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
3.4 Medical
3.4.1 Clinical Care & Therapy
1. Tan K.L. &
Yadav H. (2008)
Assessing the
Development of
Children with
Disability in
Malaysia
1. To describe the
characteristics of
children with disability
attending primary health
care clinics.
2. To score the
developmental
assessment among
children
with disability using an
appropriate assessment
tool.
3. To determine any
significant difference in
the developmental
assessment score
among children with
disability in the three
major ethnic groups.
The inclusion criteria in
this study include all of
the cases from the pilot
study. The exclusion
criteria include cases from
East Malaysia, cases that
are not Malaysian and
cases at age at
assessment of more than
144 months (12 years
old). This study included
cases from four states
involving 36 primary
health care clinics. The
four states include
Kelantan with six clinics
involving six nurses,
Perak with eight clinics
involving eight nurses,
Johor with eight clinics
involving eight nurses and
Selangor with fourteen
clinics involving fourteen
nurses.
A total of 900
children with
disability
attending
rehabilitation
provided by the
primary health
care clinic were
included in the
study. 5.6%
autism (50),
The mean
age 57.5
months
for all
participants
NA NA No
intervention
There was a statistically
significant difference
between the major ethnic
groups in delayed speech
and attention deficit
hyperactive disorder.
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
2. Tan K.L. &
Yadav H. (2008)
Reassessment
on the
Development of
Children with
Disability in
Malaysia.
To determine any
significant difference on
the development of
children with disability
reassessed at three
months and at six
months according to
ethnic group and types
of disabilities.
A total of 168 children
with disability were
assessed at three different
time intervals (baseline,
three months and six
months).
16/168 autism 1-120
months
NA NA No
intervention
Significant differences in
the mean total scores at
three months interval for
mental retardation while
statistically significant
differences at six months
interval were noted for
Down syndrome, Autism,
Cerebral palsy, mental
retardation and delayed
speech.
3. Leong H. M.,
Carter M. &
Stephenson J.
(2013)
Sensory
Integration
Therapy in
Malaysia and
Singapore:
Sources of
Information and
Reasons for
Use in Early
Intervention
To investigate: (a) What
were the sources of in-
formation about SI
therapy used by
intervention service
providers; (b) Why was
SI therapy chosen by
intervention service
provid- ers; and (c) How
did intervention service
pro- viders determine
who should receive SI
therapy.
Provides
SI therapy
32 Malaysian
provider that
provides SI
therpay
NA SI
therapy
NA 85.6% of their clients are
ASD. Staffing and teaching
qualifications. Sources of
information and training
and dura- tion of using SI
therapy. Reasons for using
SI therapy. Criteria for
using SI therapy.
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Technical Report Autism Spectrum Disorder Research In Malaysia 95
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
4. Leong H.M.,
Stephenson J. &
Carter M.
(2011)
The Use of
Sensory
Integration
Therapy by
Intervention
Service
Providers in
Malaysia.
To explore the use of SI
therapy in intervention
centres in Malaysia and
staff perceptions of the
therapy; What were the
sources of information
about SI therapy? Why
was SI therapy chosen
as an intervention
strategy? How did
intervention centres
implement SI therapy?
What effects did
teachers and
administrators report?
A total of 10 teachers,
including seven senior
teachers and three regular
teachers, from the seven
education centres
participated in the
interviews.
10 teachers NA NA NA NA Sources of Information
about Sensory
Integration Therapy.
Reasons for Selecting
Sensory Integration
Therapy. Implementation
of Sensory Integration
Therapy. Effects of
Sensory Integration
Therapy.
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3.4.2 Prevalence and Risk Factors
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
6. Ong J.H..L, Dani
N.A. & Johari
A.Z. (2013)
Auditory
Stimulus for
Children With
High Functioning
Autism: Towards
Reducing
Developmental
Disorders and
Inattentive
Attitudes.
To determine whether
developmental
disorders and
inattentive attitudes of
children with high
functioning autism can
be reduced by the use
of auditory stimulus.
IQ (FSIQ) above 70
and have sufficient
language to
complete the task.
They displayed
adequate attention to
music and motor or
vocal imitation
abilities and no
mental retardation.
5 children
with ASD
Mean age
12.2 years
Boys HFA Interventions are
assigned
alternately to
weekly 30 minutes
learning session
each for musical
auditory stimulus
followed by
musical songs
auditory stimulus
for 8 weeks
without washout
period.two different
types of auditory
stimulus, namely
musical auditory
stimulus and
musical songs
auditory stimulus.
The target variables were
language, social, cognitive,
emotion responsiveness and
inattentive attitudes. The
highest frequency is language
responsiveness (19 counts or
40%). The second highest
frequency is cognitive
responsiveness (11 counts or
23%). Emotion responsiveness
is higher than social
responsiveness by 1%, i.e 9
counts or 19% whereas social
responsiveness is listed at the
bottom with 8 counts or 19%.
HFA Inattentive attitude was
found to decrease during the
musical songs auditory
stimulus learning sessions.
7. Aina Mariana
A.M. & Wong
S.L. (2011)
Children with
Learning
Disabilities in the
Paediatric Clinic,
hospital Tunku
Ja'afar
Seremban: An
Overview
To determine the
prevalence of children
with learning disabilities
in the Paediatric Clinic,
Tuanku Ja’afar
Seremban Hospital.
2. To document the
demographic data of
Patients who were
born in 1996 to
2003 (ages between
5 to 12 years in
2008) attending the
Paediatric Clinic
were included in this
study
355 /1320
patients
(26.9%) had
LD
NA 65.6% of
males to
34.4% of
females
NA NA From these patients, 355
(26.9%) were found to have
learning disabilities. the most
common was syndromes
(27.6%), mainly Down
syndrome. The next most
common medical problem was
Attention Deficit Hyperactive
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Technical Report Autism Spectrum Disorder Research In Malaysia 97
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
patients with
learning disability.
3. To determine the age
of detection for the
learning problem.
4. To determine
associated medical
problems of the
children with learning
disability.
5. To determine the
types of intervention
received by the patients.
Disorder (ADHD) (12.8%)
followed by epilepsy (11.3%).
Other common causes
included autism (7.2% - 6)
8. Toh T. H., Wong
S. C., Abdullah
M.R. (2011)
Clinical
Diagnosis and
Non-Verbal
Ability of
Primary-One
School Children
with LD.
To study the clinical
diagnoses and non-
verbal ability of
primary-one school
children referred with
LD after the paediatric
assessment, as well as
associated behavioural
issues and socio-
economincal
background.
All primary-one
school children
referred by the
schools to Lau King
Howe Memorial
Children Clinic for
the year 2010.
Ninety-three of
them (37.8%)
were primary-
one school
children
referred for LD.
Mean
age:
7.09±0.36
NA NA NA By ethnic group, there was no
significant difference between
the ethnicity and sex (p =
0.97).Majority of them had
Borderline ID (n = 35, 37.6%),
followed by Mild ID (n = 18,
19.4%), ADHD (n = 11, 11.8%)
and Specific Language
Disorder (include Dyslexia, n =
10, 10.8%). ASD 5 (5.4%)
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
9. Abdullah M.N.,
Mohamad
W.M.Z.W.,
Abdullah M.R.,
Yaacob M.J. &
Baharuddin
M.S.
(2012)
Perinatal,
maternal and
antenatal
associated
factors for
autism: A case
control study
To explore the Perinatal,
antenatal and maternal
associated factors for
autism.
Autistic cdren aged
2 and 10 years old.
Born at HPP or
HBM. Exclusion
criteria - incomplete
data more than 30%
in hospital record.
156 NA NA NA NA 7 risk factors identified:
multiple pregnancy,
psychiatric disorder, birth
asphyxia, parity between 2
and 3, maternal smoking,
maternal age, race. Chinese
X10 compared to Malay whilst
India X5.
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Technical Report Autism Spectrum Disorder Research In Malaysia 99
3.4.3 Intervention
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
10. Norsiah F. &
Mohd
Mahayuddin
N.A. (2014)
Brain Training to
Improve
Sociability and
Behavior of
Autism
Spectrum
Disorder (ASD)
Children and
Young Adults
This article details on the use of
brain training device, Neuro
feedback Training (NFT) device to
improve the sociability and
behaviour of ASD children and
young adults.
NA 34 participants
diagnosed as
having symptoms
of autism by
medical doctor and
psychologists were
purposely selected
from Kuching
Autistic
Association.
3-20
years
NA NA Neuro
feedback
Training (NFT)
The findings showed an overall
improvement in total ATEC
score. Sociability and behaviors
are among ASD children and
young adults. There is a
difference between ATEC post-
test score in behavior with the
age of participants.
11. Chiang E. F. &
Ching S. L.
(2012)
Communication
Responses of an
Indian Student
with Autism to
Music Education
To investigate the communication
responses of a male subject with
autism towards music
intervention.
NA 1 boy with autism 6Male NA 15 Musical
intervention
The subject had obvious
improvement in his verbal and
non verbal interaction as well
as his reading and singing
skills after intervention.
12. Abd Rahim N.,
Sujud A., Yacob
Y. & Zainon
Hamzah Z. A.
(2008)
Digital pictures
to enhance
Storytelling
amongst special
needs children
To investigate Asperger children’s
motivation level when using
digital pictures in creating a short
story in the task based English
language classroom and in-
vestigate the language use in the
short story created by asperger
children when using digital
camera in the task based English
language classroom
NA 4 children with
asperger's
syndrome
NA 7-15
years
old
Aspergers'
syndrome
NA Overall, the nature, number and
balance of interac tions do help
to reveal certain aspects of the
motivation levels
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No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
13. Othman A. &
Kamarudin F.N.
(2011)
Disability
Learning Tool:
Brushing-Teeth
Using Music For
Autism.
1. To investigate and analyze the
acceptance of different types of
music among autism children. 2.
To develop a 3D animation that
show steps in brushing teeth
according to the beat of the
selected music. 3. To analyze the
effectiveness of the application in
simulating remembrance
brushing technique skills.
2 cycles of
testing. The first
group was the
autism students
with ranging
ages from 5 to
12 years old.
There were 8
students
altogether. the
other group was
the teachers(3)
who work at the
autism centre/
school.
8 students and
3 teachers
Students
5-12 years
old
NA NA Computer
application for
brushing
teeth.
The system shows a positive
result in increasing the
independence among autism
children.
14. Bilikis B. &
Jomhari N.
(2013)
Interactive
Stroller for
increasing
Focus Time
and
Participation in
Learning Al
Quran for
Autistic
Children.
To identify an environment that
accommodates learning and
hyperactive behavior of autistic
children.
NA Participant
used for this
study was
Afiz. He is and
has been
diagnosed
since the age
of 3 years.
11
years
old
M Low
functioning
class
NA Result of this study indicated
that the level of participation
in a stroller and car increased
and it was more effective for
gaining the child’s
participation compared to the
sitting in the class.
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Technical Report Autism Spectrum Disorder Research In Malaysia 101
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
15. Norkamariah
M., Tarveen K.,
Zainal Abidin Z.,
Asha Hasnimy
M.H. & Halijah
I. (2006)
Leaving no
children behind':
Investigation on
gross motor skill
among autistic
children
To investigate the
performance of gross
motor skills among
children with autism.
The children
have medical
records with
their diagnosis
seven 12 NA NA NONE Results indicated that the
autistic children scored lower
than their normal peers. The
mean score of gross motor
activities indicated that autistic
boys perform better than
autistic girls. The autistic
children showed difficulties in
performing non- locomotors
movements as compared to
locomotors movements.
16. Chiang E. F. &
Mohd Jelas Z.
(2010)
Music education
for children with
autism in
Malaysia
To enhance our
understanding of the
effects of teaching
group music to 5
children with autism
Their
attendance rate
and three
similar skill
levels.
5 children
with autism
NA NA NA Group music
education
Group music teaching was
generally effective in improving
verbal and non verbal
communication, and the
demonstration of both positive
motor skill development as well
as negative motor reactions
among the subjects.
17. Yap B. C., Salleh
A. & Jusoff K.
(2011)
Portrait Drawings
Therapy:
Windows of
Hope for Children
with Autism
Spectrum
Disorder
Reports the ability of a
group of children with
autistic spectrum
disorders (ASD) in
recognising face using
potrait drawing
technique.
NA Eight students.
Participants with ASD
and non-ASD with
unknown developmental
problems were chosen
from special education
class while students with
learning difficulties
aged
between
9-12
2 girls
and
6 boys
NA NA Portrait drawing can be used to
establish communication
among non-ASD children. The
results imply that drawing
technique has a potential to
draw autistics children
attention and teacing them to
recognise faces.
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Technical Report Autism Spectrum Disorder Research In Malaysia
102
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
are selected from the
typical classes that have
the lowest results in the
school.
18. Tan T.B. & Loh
S.C. (2006)
Program
Intervensi
Kemahiran
Membaling Bola
Terhadap Pelajar
Autisme Sekolah
Menengah: Satu
Kajian Kes
To examine the
effectiveness of an
intervention program on
ball throwing skill and
to explore autistic
students' ability in
throwing the ball right
at the target.
3 males 14-18 3 males All are
enrolled
in the
Special
Education
Integrated
Program
in two
secondary
schools in
K.Lumpur.
Intervention
program
on ball
throwing
skill
The results showed that the
intervention program was
effective in enhancing the ability
of three autistic students in ball
throwing. Subjects A, B, and C
each demonstrated the
ability to throw the ball right at
the target with distances of 32
feet, 12 feet and 2 feet
respectively.
19. See C.M.
(2012)
The use of music
and movement
therapy to
modify
behaviour of
children with
autism.
To study the impact of
music and movement
therapy on the
behaviour fo children
with autism.
The subjects
were enrolled
in a center for
childrenwith
autism.
41 2-22
year old
34 males,
7 females
NA Music and
movement
therapy
The research findings indicated
that most of the children (75.0%)
in Group 1 and more than half of
the children (61.9%) in Group 2
were less restless after they had
undergone the music and
movement therapy. Meanwhile,
half of the children (50.0%) in
Group 1 and 61.9% of those in
Group 2 were less fidgety after
they had undergone music and
movement therapy.
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Technical Report Autism Spectrum Disorder Research In Malaysia 103
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
20. See C. M.
(2014)
Use of Music
and Movement
Therapy to help
persons with
Autism
To examine the use of
Music and Movement
Therapy in training and
improving motor and
coordination skills
amongst children with
autism.
NA 41 ranging
from 2 to
22
7 girls
and
34 boys
NA Music therapy.
The
participants
were observed
and evaluated
over a 10-
month period
using a Motor
and
Coordination
Performance
Checklist that
was developed
specifically for
this study. The
motor and
coordination
performance of
the children
and
adolescents
were evaluated
by the parents,
facilitators and
research
assistant once
a month, at
every last
session of the
months.
The overall results from this
study confirmed the effectiveness
of Music and Movement Therapy
in developing and training the
gross motor, fine motor and
coordination skills of persons
with autism.
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Technical Report Autism Spectrum Disorder Research In Malaysia
104
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if
available)
Aim of study
Inclusion/
exclusion
criteria
3.5 Psychology
3.5.1 Psychological wellbeing of parents
1. Nikmat A.W.,
Ahmad M., Ng L.
O. & Razali S.
(2008)
Stress and
psychological
wellbeing
among parents
of children with
autism
spectrum
disorder.
To investigate the
prevalence of parental
stress and
psychological wellbeing
among parents with
autistic children and
their associations with
dimensions of support
system.
Those parents aged
be- tween 30 and 60
years old, who had
children with autism
spectrum disorders
aged between 2 and
12 years old were
enrolled in this
study. Exclusion
criteria included
parents with any
history of
psychological
disorders such as
depression or
anxiety disorders
and having any
general medical
conditions that
might affect the
study.
52 24
subjects
(46.2%)
falls within
21 to 30
years old
and 28
subjects
(53.8%)
falls within
31 to 40
years old.
34
(65.4%)
subjects
were
female
and 18
(34.6%)
were
male.
Autistic
Spectrum
Disorders by
experience
child
psychologists
in Health
Psychology
Unit, Universiti
Kebangsaan
Malaysia
(UKM)
Not relevant More than half of the parents
perceived that their child has
average to high severity of
autistic symptoms. Aa
significant difference between
gender and psychological
wellbeing of the parents with
autistic children. Moreover
there was a significant
difference between occupation
and psychological wellbeing of
the parents with autistic
children. No significant
difference between the levels of
parental stress and
occupation.There was no
significant correlation between
severity of autistic symptoms
perceived by the parents and
parental stress, psychological
wellbeing, and dimensions of
support system received by
parents with autistic children.
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Technical Report Autism Spectrum Disorder Research In Malaysia 105
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if
available)
Aim of study
Inclusion/
exclusion
criteria
2. Vetrayan J.,
Daud A. & Smily
Jesu P. V. P.
(2013)
Level of
hopelessness
among parents
with autistic
children
To identify level of
hopelesness among
paretns with autistic
children
Parents with autistic
chldren
33 parents with
autistic
children; aged
31-60 (mean
39 5 months)
10
moderate
& 23
severe
Minimal level of
hopelessnes.
3. Shobana M. &
Saravanan C.
(2014)
Comparative
Study on
Attitudes and
Psychological
Problems of
Mothers
towards Their
Children with
Developmental
Disability
To measure the
prevalence of
psychological problems
among mothers of
children with autism
disorder, intellectual
disability, and Down
syndrome. The second
aim was to assess the
differences in mothers’
attitudes and
psychological problems
among their children
with intellectual
disability, autism
disorder, and Down
syndrome. The third
aim was to identify
whether negative
attitude was a predictor
of psychological
problems in these
mothers.
112 mothers of children
having mild and
moderate levels of
autism disorder, Down
syndrome, and
intellectual disability
were assessed using the
Parental Attitude Scale
and General Health
Questionnaire–28.
autism disorder (AD),
Down syndrome (DS),
and intellectual disability
(ID). 7excluded because
did not meet criterion
and 5 were unwilling to
participate due to lack of
time. Thus, 100 mothers
of children with AD
(n = 34), DS (n = 32),
and ID (n = 34) were
included in this study.
Mothers who
NA 14 (41%) without
psychological problem.
Mothers of children with
AD exhibited higher
negative attitude (mean ±
standard deviation score,
40.41 ± 7.79) compared
with their counterparts
with DS (35.53 ± 6.53; p =
0.02). attitudes of mothers
of children with AD and ID
no significant problem.
negative attitude
significant predictor of
psychological problem.
Parents who harbour
negative attitudes towards
their children experience.
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Technical Report Autism Spectrum Disorder Research In Malaysia
106
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if
available)
Aim of study
Inclusion/
exclusion
criteria
were unwilling to
participate and those
with children having
severe disabilities
were excluded.
Children with severe
and profound ID were
excluded from this
study as they might
exhibit behavioural
and organic
problems.
4. Osada H., de
Amorim A.C.,
Velosa A., Wong
P. W., Lotrakul P.
& Hara H. (2012)
Depression
risks in mothers
of children with
developmental
disabilities: A
cross-cultural
comparison of
Brazil,
Colombia,
Malaysia and
Thailand.
To examine the risks
and actual presence of
depression in these
countries (Brazil,
Columbia, Thailand,
Malaysia) among
mothers of children
with developmental
disabilities, and to
describe their
depressive features.
The participants
were mothers of
children with
developmental
disabilities.Ttheir
children received
professional care,
but the mothers
themselves had
never consulted with
a mental health
professional.
30/161
from Malaysia
mean
42.6
Mothers ASD
(37.5% of
children)
Not relevant.
They used the
Center for
Epidemiologic
Studies
Depression
Scale (CES-D;
Radloff, 1977,
1991)
The numbers of mothers who
were observed to have a high
level of depressive symp-
toms, there were significant
differences among
countries.Morbid depression is
more common among mothers
of children with disabilities in
Latin America than in
Southeast Asia. Due to small
sample size, except for
Colombia, it seems to be
difficult to generalize our
results for mothers of children
with developmental disabilities.
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Technical Report Autism Spectrum Disorder Research In Malaysia 107
3.5.2 Perceived support, coping strategies & quality of life of parents with children with ASD
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
5. Poh C. S. &
Siew H. T.
(2012)
A Survey on
Quality of Life
and Situational
Motivation
among Parents
of Children with
Autism
Spectrum
Disorder in
Malaysia
To find the association
between different types
of motivation and QoL
of parents of children
with ASD.
Inclusion:
parents
having a
child with
ASD.
47 parents who
had at least a child
with ASD
74% were
age 36 or
above
77% were
female.
NA NA The results found that more parents
with high intrinsic motivation to
participate in the program have better
social relationships than those with low
intrinsic motivation, and more parents
with high identified regulation to
participate in the program have better
physical health than those with low
identified regulation. No such
association was found in those parents
who participated in the programs due
to the external regulation and
motivation.
6. Clark M., Brown
R. & Karrapaya
R. (2012)
An initial look at
the quality of life
of Malaysian
families that
include children
with disabilities
Reports initial
exploration of the
quality of life of
Malaysian families that
include children with
developmental/intellectu
al disabilities.
NA Members of 52
families that
included one or
two children with
disabilities
NA NA NA Questionnaire
data were
collected using
the Family
Quality of Life
Survey – Short
Version.
Findings showed a consistent pattern
of relatively strong perceived
‘importance’ ratings in each of life
domains as compared to mean ratings
for other family quality of life
dimensions. Some dimensions of
family quality of life, in particular
‘opportunities’, ‘initiative’ and
‘attainment’, demonstrated
particularly strong associations with
each other. Overall means of
satisfaction with and attainment of
family quality of life as well as global
evaluations of quality of life and
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Technical Report Autism Spectrum Disorder Research In Malaysia
108
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
satisfaction all demonstrated
significant associations, although each
of these correlations accounted for less
than 50% of the common variance.
7. Hasnah T.,
Yunus v., Mohd
Hanafi M.Y. &
Wan Md Zain
W.N. (2013)
Support for
Parents of
Children with
Disabilities in
Malaysia
To understand the
availability and type of
support perceived by
parents of children with
disabilities in Malaysia
NA 20 parents of
children with
disabilities
5 males,
15 females
22 - 56
years old
NA NA Lack of comprehensive information
and support for parents of disabilities
in Malaysia. Supports for parents come
from informal sources eg family,
friends and other parents.
8. Ting S.H. &
Chuah H.K.
(2010)
Parents'
Recognition of
Autistic Behavior
and Their Coping
Strategies: A
Case Study at
Sarawak Autistic
Association.
Reports the parents’
recognition of autistic
behaviour of their
children and the coping
strategies they used to
handle their children’s
behaviour.
Parents
who
sending
their child
to the
Resource
and
Educational
Centre,
Sarawak
Autistic
Associatio,
Kuching
12 parents with
children registered
at the Sarawak
Autistic
Association,
Kuching.
Parents:
aged
29 to 48
NA NA NA The behavioural indicators of autism
highlighted by the parents were
stereotypic behaviour, sleep problems,
hyperactivity and hypersensitivity to
specific sounds. The autistic children
also showed difficulty mixing with
peers, liking to be hugged and lack of
eye contact. However, it was the loss of
speech ability and absence of speech
development which alerted them to the
possibility of autism. The study
revealed that the parents handled their
distress and anxiety mainly through
religious means and family support.
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Technical Report Autism Spectrum Disorder Research In Malaysia 109
3.5.3 Public awareness
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
9. Jin K. K. & Chin
C. G. (2012)
Narrative from
the Care Givers
of Autism
Spectrum
Disorder
Children in
Malaysia.
To hear the voice of the
caregivers.
7 autistic
children
Groups; Asperger’s
Syndrome group
and a control
group consisting of
normal.
NA NA NA Written
records about
the behaviour
of the autistic
children over 4
months and
interview the
caregivers.
Lack of awareness and
understanding of children with
autism among the gen eral
public in Malaysia.
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Technical Report Autism Spectrum Disorder Research In Malaysia
110
3.5.4 Parents' recognition of symptoms of ASD
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
10. Yeo K. J. & Lu
Xi (2014)
Factors
Associated with
Diagnosis of
Autism
Spectrum
Disorder (ASD)
under the Age of
24 Months in
Malaysia
Diagnosis signs
& symptoms.
1. To identify the first symptom
found by mothers of children
with ASD 2.To identify home
and child related factors
associated with early diagnosis
of ASD under the age of 24
months.
Mothers of
children
with autism
spectrum
disorder
(ASD) who
were born
within the
period of
1998 to
2008 in
Malaysia.
79 mothers 20-41
years
NA autism
spectrum
disorder
(ASD)
No
inetrvention
Speaking problem is found to
be the first symptom of autism
by 60% of the mothers with
children diagnosed with ASD
under the age of 24 months,
followed by playing alone
(45%), communication with
parents (40%), odd behavior
(35%), and self injury (5%).
diagnosed with ASD after the
age of 24 months, the highest
report on first ASD symptom is
still difficulty in learning to
speak (69.49%), followed by
odd behavior (37.29%), playing
alone (32.20%),
communication with parents
(30.51%), and others (8.47%).
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Technical Report Autism Spectrum Disorder Research In Malaysia 111
3.6 Miscellaneous
No Author(s) Title
Study Design
Population of
study
(n)
Participant's characteristic
Intervention Outcome
Age Gender
Type of
autism
(if avail
able)
Aim of study
Inclusion/
exclusion
criteria
1. Saiman K.,
Sinnatamby S.,
Mustafa L.M.,
Alias N. & Siraj
S. (2013)
Impact of Video
on Learning in
Students with
Autism in
Malaysia: Future
Prospects.
To obtain the views and
consensus of experts on the
impact of video on the learning of
students with autism in
Malaysia.
NA Interviews
involving 6
experts from
Federal Territory,
Penang, Malacca
and Selangor
aimed at
developing the
themes for the
study. From the
themes derived, a
set of
questionnaires was
produced. The
questionnaire was
then distributed to
20 experts
including the 6
experts interviewed
earlier to identify
the themes.
NA NA NA The use of
video by
experts,
identifying
behavior of
students with
autism in their
use of video
and
determining
the limitations
of video and
ways to
overcome
them by using
the Fuzzi
Delphi
technique.
Choosing videos suitable for
the capability level of students
with autism.
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112 Technical Report Autism Spectrum Disorder Research In Malaysia
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INDEX
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126
Ab Jabar S.Z.A. 66
Abd Rahim 6
Abd Rahim N., 25, 47
Abdul Ghaffar N.A. 56
Abdul Malik N. 36
Abdul Manap. 11
Abdul Manap A. 38
Abdul Wahab 8, 9
Abdul Wahab A.R. 31, 32, 33, 35
Abdullah 13
Abdullah M.N. 45
Abdullah M.R. 45
Abu Halim 60
Ahmad Anas S.B. 39
Ahmad M. 50
Ahmad M.A. 60
Aina Mariana 13
Aina Mariana A.M. 44
Alias N. 40, 54
Allik 20
Arif 20
Arksey 1
Arshad H. 37
Asha Hasnimy M.H. 48
Badzis 7
Badzis M. 25, 26
Baharuddin M.S. 45
Baki R. 29
Banerji 17
Bartolome 18
Baxter 19
Bellini 16
Bilikis B. 48
Bramston 19
Breslau 19
Bristol 19
Brown R. 52
Browne 19
Brugha 18
Cameron 19
Carter M. 43, 44
Che Hamid M.A. 36
Chiang E.F. 46, 48
Chin 15
Chin C.G. 53
Ching S.L. 46
Chong T.S. 37, 40
Chuah 14, 15
Chuah H.K. 53
Clark 14
Clark M. 52
Corsello 16
Dani N.A. 44
Daud A. 51
Daud M.A. 56
Dautenhahn 17
de Amorim A.C. 51
Delano 20
Dolah 11
Dolah J. 37, 40
Dumas 19
Duquette 17
Fadliana C. 27
Fathil N.S. 38
Flores 16
Fuentes 16
Goin-Kochel 20
Gray 12
Gray K.M. 43
Guan J. 28
Gurusamy N. 41
Halijah I. 58
Han M.L. 44
Hanapiah F.A. 33, 34, 35, 36
Hara H. 51
Harrower 17
Harun 6
Harun N.I. 25
Hasherah M.I. 57
Hashim H. 33, 36
Hasnah 7, 14
Hasnah T. 24, 27, 28, 52
Hayes 17
Hitam 11
Hitam S. 39
Hodapp 19
Hourcade 18
Hussin 8
Hussin S. 31
Hussin Z. 25
Hwang 19
Ibrahim H. 27
Idris S. 33
Ingersoll 18
Ismail 9, 11
Ismail A. 39
Ismail L.I. 33, 34, 35, 36
Ismail S.F. 58
Jin 14
Jin K.K. 53
Johari A.Z. 44
Jomhari N. 40, 41, 48
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Jusoff K. 49
Kamaliah 8
Kamaliah M. 30, 38
Kamarudin F.N. 47
Kamps 19
Karrapaya R. 52
Kilanowski 17
Kong C.H. 59
Lacono T. 43
Lahiri 18
Lee 6, 16
Lee L.W. 24
Lee M.F. 28
Lee S.G. 54
Leong 12
Leong H.M. 43
Levy 19
Liew 7
Liew P.Y. 26
Lim 7
Lim C.Y. 29
Loh 8
Loh S.C. 30, 31, 49
Lotrakul P. 51
Low 7, 15
Low H.M. 24
Lu 15
Lu Xi 53
Malie Y. 56
Mat Adam A.N.I. 55
Md Yunus M. 24
Megat A. Rahman P.Z. 29
Mesibov 16
Miskam M.A. 36
Mislan N. 28
Moes 19
Mohamed S. 33, 34, 35, 36, 38
Mohamed Shohor M.F. 55
Mohamed Zain N.Z. 37
Mohd Ali 7
Mohd Ali M. 26
Mohd Hanafi M.Y. 27, 28, 29, 53
Mohd Jelas Z. 48
Mohd Mahayuddin N.A. 46
Mohd Mokhtar T. 27, 28
Mohd Zin A. 39
Mokhtar M. 39
Morgan 19
Mugno 20
Mustafa 11
Mustafa L.M. 40
Mustafa M. 37
Nayan N. 27
Ng L.O. 50
Ngah Y.C. 57
Nikmat 13
Nikmat A.W. 50
Norkamariah M. 48
Nornadia 7
Nornadia M.R. 27
Norshidah M.S. 27
Norsiah F. 46
O’Malley 1
Olson 19
Omar 7
Omar H. 25
Omar N. 39
Ong J.H.L. 44
Osada 14
Osada H. 51
Othman 9
Othman A. 47
Othman M. 32
Panerai 17
Paul 16
Peetsma 17
Piah H.A. 33
Poh 14, 52
Qidwai 9
Qidwai U.A. 32
Quek A.H. 31
Raiz 20
Ravana 12, 18
Ravana S.D. 41
Razali 8
Razali N. 31, 33, 35
Razali S. 50
Renty 17
Rezaei R. 40, 41
Riaza 11
Riaza M.R. 38
Robins 18
Rogers 19
Ryde-Brandt 19
Saad 7
Saad S. 27
Safri 9
Safri N.M. 34
Sahbudin R.K.Z. 39
Saidin S. 34
Saiman 15
Saiman K. 40
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Salam 12
Salam S. 41
Sali A. 39
Salleh A. 49
Sanders 19
Sani B. 26
Sarah 11
Sarah R.D. 38, 40, 41
Saravanan 13, 14
Saravanan C. 51
Sardan N.A. 38
Sazlina K. 27
See C.M. 42, 49, 50
Shams 8
Shams Aliee 11
Shams Aliee Z. 40, 41
Shams W.K. 32, 33, 35
Shamsuddin 10
Shamsuddin S. 33, 34, 35, 36
Shamsudin S. 34, 35
Sharifuddin R.S. 28
Shaukat 20
Shetty 20
Shobana 13, 14
Shobana M. 51
Sidek 11
Sidek S.F. 38
Siew 14
Singh 12
Singh S.J. 43
Sinnatamby S. 40
Siraj S. 25, 54
Siti Iradah I. 59
Sivberg 20
Smily Jesu P.V.P. 51
Stephenson J. 43, 44
Stuttard 19
Sudirman 9, 34
Sujud A. 47
Sulaiman 8, 16
Sulaiman T. 29
Syarifah Diyanah 12
Syarifah Diyanah Y. 41
Syed Yahya 8
Syed Yahya S.Z. 30
Tan 12
Tan K.L. 39, 42
Tan S.H. 58
Tan T.B. 49
Tang K.N. 42
Tarveen K. 48
Tian A. 28
Ting 14, 15
Ting S.H. 53
Toh 13
Toh T.H. 45
Varathan K.D. 41
Vaucelle 18
Velosa A. 51
Vetrayan 13, 14
Vetrayan J. 51
Vijayen 7
Vijayen G. 29
Wan Amimah W.M. 30
Wan Aminah 8
Wan Chik M.N. 26
Wan Md Zain W.N. 53
Wan Mohamad W.M.Z. 45
Wan Yahaya W.A.J. 37, 40
Warfield 19
Werry 17
Westbrook 17
Wong 13
Wong P.W. 51
Wong S.C. 45
Wong S.L. 44
Yaacob M.J. 45
Yacob Y. 47
Yadav 12
Yadav H. 42
Yadav, H. 42
Yahya 8, 16
Yahya S. 24, 30
Yap B.C. 49
Yeo 15
Yeo K.J. 54
Young 20
Yunus V. 53
Yussof 10
Yussof H. 33, 34, 35, 36
Zahari N.I. 33, 34, 35, 36
Zainal Abidin Z. 48
Zaini 7
Zaini M.F. 25
Zainon Hamzah Z.A. 47
Zaman H.B. 37
Zapirain 18
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