Mehreen Arshad tells Mahlia Lone how she helps children with special needs, with learning disabilities and those who have been sexually abused

What’s your background?

I have a Masters in Applied Behavior Analysis, a branch of Psychology from USA. My specialization is Developmental Disabilities, and Organizational Behavior Management. I also have research experience in working with children who have been sexually abused and children in foster homes. I worked for a number of years in the U.S. before moving to Pakistan and taking the initiative to open a non-profit, center-based program providing treatment to children with special needs.

What kind of therapies does your clinic provide?

Therapies provided at the clinic are based on evidence-based best practices in the field of Applied Behavior Analysis (ABA). In other words, only therapies, which have been proven by research to be effective in the field of ABA, are implemented. Home-based services are also available now in order to maximize the number of therapy hours provided to clients.

Are there any other services provided by your clinic?

Another thing I focus on is staff training. Since ABA is not offered as a program in Pakistan as yet at the graduate or doctoral level, new hires have to be taught everything from the very basics. I also provide training and supervision at clinic sites that are out of Pakistan. I recently visited an autism clinic in Indonesia to provide staff training. It was an eye-opening experience because it made me realize just how much there is a lack of effective treatments available in other nations worldwide. While it is important to give back to our own community in Pakistan, I think it is also impertinent that we help out people in other nations; this will make us proud Pakistanis!

Moreover, in August 2018, I am launching a training program for practitioners, students, and parents that will focus on teaching treatment strategies for children with developmental disabilities with hands-on training.  This training program will also include workshops for teenagers on topics such as child sexual abuse and domestic violence.

“Applied Behavior Analysis is not offered as a program in Pakistan as yet at the graduate or doctoral level”

What are some signs that should alert parents that their child may have special needs?

A child can now be placed at risk as early as birth even though a formal diagnosis is not provided until a few years later. Early risk factors include poor or lack of the following: Eye contact; gaze shifting in which the infant looks at the caregiver and then at an object in the environment that the caregiver is pointing at; joint attention in which the infant and the caregiver share attention on an object such as a toy. Therefore, treatment can begin as early as infancy in which infant reflexes and skills are targeted.

Children may also have motor skill deficits, such as a weak grasp. Children with a developmental delay or disability also have language delays. They may not speak a lot of words or sentences.

How do you help these children?

Firstly, I encourage parents to get their child assessed as early as possible since early intervention has the best treatment outcomes. Through behavioral assessment, skill deficits are identified, which then become the goal of treatment. Since every child is different, individualized treatment plans are then developed and implemented. The goal of treatment is to bring these children up to the functioning level of their peers so that they may become independent and integrated in the community.

Is parent involvement important in the treatment of children?

Parent involvement is an integral part of treatment. I conduct parent training with the caregivers or anyone in the child’s home who spends a significant amount of time with the child. It is important that parents are taught to implement treatment protocols with their child as well in the home as that is where the child is spending most of the time.

Which are some schools you work with?

In the past I have conducted workshops at Beaconhouse National University and Government College. I also conduct teacher training for clients upon request. It is important to ensure that the child is getting the required support at the school.

What are the different challenges in children that your clinic addresses?

Treatment is available for children with speech and/or developmental delays, Autism Spectrum Disorders, and Mental Retardation. Children with the mentioned diagnosis usually have behavior problems such as stereotypic behaviors in which the child repetitively engages in an action such as hand flapping. Treatment protocols are put in place that target these behaviors. Moreover, there are other 7 other major domains in which skill deficits occur: Language & Communication, Social Skills, Play Skills, Gross & Fine Motor, Cognitive/Academic, Self-Care, and Community Involvement. Treatment plans that are put in place address challenges that children face in all these areas.

I would also like to add that sometimes a child is developing normally but may start losing previously learned skills. This is termed regression; so, as a parent, if you notice that your child doesn’t talk so much anymore or is not interacting with you or others then you should definitely get your child assessed.

“There is a correlation between cousin marriages and the children being born with birth defects and/or a disability that has a genetic link (such as Down Syndrome)”

Do you see more developmental problems with children due to cousin marriages?

There is a correlation between cousin marriages and the children being born with birth defects and/or a disability that has a genetic link (such as Down Syndrome). The prevalence of autism is 4 times greater in boys than girls so there is definitely a genetic link although there is no known cause of autism as yet. There are also certain environmental factors (such as lack of a nourishing environment and infant-caregiver interaction) that may play a role in the child developing a problem.

Is ADHD a myth or a reality? Do you train teachers and counselors at schools on how to handle it? Should parents put their children on drugs like Ritalin or are there exercises they can do to help the kids focus on task at hand?

ADHD is not a myth; however, I do not recommend putting young children on medication as it impairs learning. Behavior problems that children, adolescents, and even adults with ADHD have can be managed with behavioral interventions. ABA-based interventions are available for teachers in schools that can help manage behavior problems associated with ADHD.

In your opinion, what issue affects the most children in Pakistan?

Well, if I’m to mention the prevalence of autism then I would say it affects 1 in 88 children in USA. Although there has been no research conducted in Pakistan on its prevalence, I would say the rate is approximately the same. It’s difficult to pinpoint what issue affects children the most here as a lot of times children also get misdiagnosed in Pakistan and families also tend to hide the fact that their child has a certain problem due to social stigma.

Just to give an example of this I’d like to mention that child sexual abuse occurs in 1 in every 5 girls and 1 in every 7 boys approximately worldwide. These high rates are present in the U.S. as well, where there is a lot of awareness and legal repercussions on this issue. A lot of issues that children or teenagers face are not even reported in Pakistan.

I would also like to add that raising awareness is not always effective unless it is followed by a plan of action. If the goal of an awareness campaign is to just add to someone’s knowledge then that can be easily achieved, but if the long-term goal is to bring about a change then running an awareness campaign is not enough.

What about school stress–how does that affect children?

A small amount of stress is sometimes good for children, especially in school where homework has to be submitted on time and children need to prepare for exams. Every child’s stress threshold is different. What children need to be taught is how to manage stress so there is equilibrium in their life between positive and negative or stressful situations. Extreme stress can cause children to either act out or to withdraw into a shell and avoid social interactions. Stress can also affect children’s health, for example, a loss of appetite may occur.

What are simple measures parents can do that improve the emotional well-being of their child?

Parents should engage in positive interactions with their child and also participate in activities that the child enjoys. The trick is to find a balance between stress and positive activities for the child. Also, parents should recognize areas of strength of their child and encourage those instead of imposing on the child to excel in an area that might not be the child’s greatest strength. The parent should also encourage positive social interactions of their child among peers. Having an open communication environment in the home is very important. In this way, if the child is facing a problem then he/she is likely to reach out to the parent for help. There are certain stress management techniques that the parent can teach their child too.

“In August 2018, I am launching a training program for practitioners, students, and parents that will focus on teaching treatment strategies for children with developmental disabilities with hands-on training”

You only deal with children 2-12. What about troubled teenagers who are challenged plus have hormones compounding their problems?

Yes, my area of focus is on children with developmental disabilities up to the age of 12. To help teenagers, there is a large amount of parent and community involvement that is required. Unfortunately, that is not available so much in Pakistan at the moment due lack of university programs that can provide variety of specializations that target a specific population. I continue to provide current clients/parents with on-going support and consultation even beyond the age of 12.

Take home message:

Denial of a problem only sets the child back. The best recommendation is to start intervention as soon as the parent sees concerns. Waiting takes away time you’ll never get back. Time is of essence for children. Pre-established behaviors are difficult to change once they have been constantly reinforced. Best time to support children is when they are small and behaviors are easier to change.

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