Autistic Savants

Stephen Wiltshire drawing Singapore

by Kenneth Lyen

INTRODUCTION

The most amazing paradoxes associated with autism is the savant syndrome.

A savant is an outlier with an incredible ability to perform tasks far beyond what most of us can achieve. And this takes place despite having a mental disability such as autism, or other neurological deficits. Examples of extraordinary accomplishments include having a prodigious memory, brilliant mathematical calculations, phenomenal music, art or language abilities. Most savants are only able to display an outstanding skill in one major domain, but there are some exceptions (1).

There may be some restrictions in the savant’s abilities. For example, some of the them are excessively focused on one skillset only, while others may be prone to repetitive compulsive behaviours, and yet others may have a problem finding functional applications for their abilities (2).

The prevalence of savant syndrome is about 1 in one million, and the ratio of males to females is around 6 to 1. Up to 50% of savants are said to be autistic. Looking at it from another angle, the number of savants observed in autistic people ranges from 1 in 10 to 1 in 200.

It is very easy to point at famous historical figures designating them to be autistic savants. These might include Michelangelo, Isaac Newton, Charles Darwin, Albert Einstein and countless others. However, the burden of proof is diabolical. How can you diagnose autism centuries after the departure of these celebrities? You are definitely unable to verify their diagnosis of autism on the Diagnostic and Statistical Manual 5^th Edition (DSM-V). But even if they were alive today, you will still have difficulty diagnosing them!

It should be pointed out that many savants are not autistic, but have some other disabilities. For example there is Nobuyuki Sujii who was born blind, but won several international piano competitions (3). John Nash, featured in the movie “A Beautiful Mind”, suffered from schizophrenia, and won the Nobel Prize for his mathematical game theory (4). Vincent Van Gogh is said to have suffered bipolar disorder, and produced some really remarkable paintings (5).

SAVANT SKILLS

There are some contemporary autistic savants that we can explore and get a more accurate diagnosis of autism. In the film Rainman, Dustin Hoffman plays the role of an autistic savant showing his phenomenal memory and his amazing powers of calculation such that he keeps on winning at Las Vegas’ blackjack. His character is based on real life autistic savants, including Kim Peek (6).

Below are listed are some savant skills displayed by prominent autistic individuals:

a) Calculations

Daniel Tammet’s genius is his ability to figure out complex mathematical calculations quicker than a calculator. He can recall pi (π ) to 22,514 decimal places. When Tammet is multiplying large numbers with each other, he arrives at the answer almost instantaneously and effortlessly. After an epileptic fit, he suffered from synaesthesia,  and started to see numbers as shapes, colours and textures, and he sees the number two as a motion, and the number five as a clap of thunder. He said: “When I multiply numbers together, I see two shapes. The image starts to change and evolve, and a third shape emerges. That’s the answer. It’s mental imagery. It’s like maths without having to think.” (7)

b) Prodigious Memory

Kim Peek, featured in the movie “Rainman” has an elephantine memory. He was born with a large head, damaged cerebellum and agenesis of the corpus callosum. His motor development was delayed, and he did not walk until he was 4 years old, and he could not button up his shirts. However he could speed-read both pages of a book simultaneously, and remember the contents of at least 12,000 books that he has read (6).

c) Calendar Savant

In addition to having a prodigious memory, Kim Peek also possesses the ability to know the day of the week when given a date. This ability is probably the most common skill of autistic savants. They do so effortlessly (6,8).

d) Music

There appears to be quite a number of autistic music savants, some of them may even have another disability, such as blindness. Music savants have the ability of picking music, like learning to play the piano, at an extraordinary rate. The may have a brilliant memory and can play a piece of music when they have only heard it once. There is one other interesting observation, and that is many autistic music savants possess absolute or perfect pitch. Derek Paravicini is a blind autistic savant who has given many public concerts, and featured on several television programs (9).

e) Art

Artistic savants can often draw from memory extremely accurately. Stephen Wiltshire is an artistic savant who was diagnosed to have autism at the age of 3. He draws many cities, including Singapore, after flying over just once (10).

f) Hyperlexia

Hyperlexia are autistic people who read voraciously and they can remember everything they have read. Rainman’s Kim Peek also has this ability (6).

AUTISTIC COMORBIDITIES

Autism is often associated with several other conditions, such as those listed below:

Attention Deficit Hyperactivity Disorder

Some 30% of autistic individuals also display attention deficit hyperactivity disorder. Famous entertainers like Woody Allen and Johnny Depp have self-diagnosed themselves as mildly autistic plus attention deficit hyperactivity disorder. The hyperactive brain tends to skip around, thus more likely to encounter novel ideas. Autistic individuals are often obsessionally focused on a narrow range of interests. The correct balance of these two traits may enhance creativity.

Bipolar Disorder

A number of autistic people are also known to roller coaster from mania to depression, also known as bipolar disorder. These mood swings can engender creative thoughts during the manic phase. Famous people thought to have bipolar disorder, but probably not on the autism spectrum, include Edgar Allan Poe, Sylvia Plath, Robert Schumann, Vincent Van Gogh, Tim Burton and Francis Ford Coppola.

Obsessive-Compulsive Disorder

Autistic people may have obsessional repetitive behaviours. It is sometimes difficult to differentiate Obsessive-Compulsive Disorder (OCD), the psychiatric condition characterized by obsessive thoughts and compulsive behavior, from autism. Famous persons who have displayed obsessive-compulsive tendencies include inventor Nicola Tesla, film and airline magnate Howard Hughes, and entertainer Marc Summers.

Epilepsy

Many autistic persons are also epileptic. Some brilliant people have a history of epilepsy, and because it is a brain condition, it is relevant when discussing brain functioning and creativity. There are at least two theoretical possibilities why epilepsy may have a beneficial effect on one’s thinking. Firstly the electric discharges that occur during an epileptic fit may cause flashes of new ideas. Secondly, recurrent epilepsy or the transient hypoxia it can engender might fortuitously cause minor damage to those areas of the brain that inhibit thinking, and this disinhibition of thought processes may enhance creative thinking. Famous people who suffered from epilepsy include: Julius Caesar, Alexander the Great, Napoleon Bonaparte, Pyotr Tchaikovsky, Charles Dickens, George Handel and Hector Berlioz.

Schizophrenia

Autism and schizophrenia have a long and tangled history. In fact autism used to be called childhood schizophrenia, and indeed there are some overlapping symptoms. Schizophrenia is a severe psychiatric disorder characterized by hallucinations, delusions, blunted emotions, disordered thinking, detachment from reality and withdrawal into the self.  It affects males and females equally. There is a strong genetic component. While the etiology is still not fully established, the current favorite biochemical theory revolves around disordered dopamine metabolism affecting certain areas of the brain. The most prominent example of a genius affected by schizophrenia is John Nash. Interestingly, Nash is quoted by biographer Sylvia Nasar as saying that he often refused to take medication for schizophrenia because it blunted his creative thinking (11). This sentiment is reflected by a number of artists and scientists suffering from other psychological conditions, such as bipolar disorder. The medical profession is therefore faced with a dilemma of deciding whether or not to treat mild mental afflictions knowing that medical treatment may smother creativity.

HOW DOES AUTISM CREATE GENIUSES?

Compensatory Adaptation

Just as the blind have a heightened sense of hearing and touch, and the deaf have increased sharpness of vision, certain types of mental disability may cause compensatory adaptation. The best candidate for this is dyslexia. If a dyslexic has difficulty with language, then he compensates by increasing his powers of visual perception.

Neural Connections

Recent advances in the neurophysiology of the autistic brain have shown that long-distant nervous connections are reduced, while short-distance local connections are increased. This local concentration of nerve networks is hypothesized to correlate with the obsessional focus of thoughts, and because the connections are close to one another, the speed of thinking is accelerated.

Direct Effects of Mood Swings

As mentioned above, autism may be comorbidly associated with bipolar disorder. Mild mania could have some benefits. It is associated with quicker thinking, greater verbal fluency, play on words, increased self-confidence, and greater optimism. Severe mania, on the other hand, can be counterproductive and may result in loss of concentration and wild behaviors. Mild depression can act as a sort of editor to prune the excesses of mania. But severe depression can dampen all activities and thinking. Once again, having an optimal balance of autism and manic-depression might lead to exceptional abilities.

Knight’s Move Thinking

Certain mental disorders like attention deficit hyperactivity disorder, bipolar disorder, and schizophrenia are characterized by sudden jumps in one’s thinking. These leaps from one idea to another can be quite unexpected and illogical, and are referred to as the chess “Knight’s Move” thinking. This way of thinking is important in creative thinking because it enables a person to make innovative leaps without being anchored by preconceived ideas or imprisoned by one’s sense of logic.

Famous People in History that may have Autism

Although unproven, it is always very tempting to try to diagnose autism in famous outstanding individuals. Here is a list of some of the more famous “savants”.

• Hans Christian Andersen – Children’s Author
• Lewis Carroll – Author of “Alice in Wonderland”
• Henry Cavendish – Scientist
• Charles Darwin – Naturalist, Geologist, and Biologist
• Emily Dickinson – Poet
• Paul Dirac – Physicist
• Albert Einstein – Scientist & Mathematician
• Bobby Fischer – Chess Grandmaster
• Bill Gates – Co-founder of the Microsoft Corporation
• Temple Grandin – Animal Scientist
• Steve Jobs – Former CEO of Apple
• James Joyce – Author of “Ulysses”
• Barbara McClintock – Scientist and Cytogeneticist
• Michelangelo – Sculptor, Painter, Architect, Poet
• Wolfgang Amadeus Mozart – Classical Composer
• Sir Isaac Newton – Mathematician, Astronomer, & Physicist
• Satoshi Tajiri – Creator of Nintendo’s Pokémon
• Nikola Tesla – Inventor
• Ludwig Wittgenstein – Philosopher
• William Butler Yeats – Poet

History’s 30 Most Famous People with Autism

FINAL THOUGHTS

Unanswered Questions

Several questions immediately pop up when probing autistic savants. First are we too restrictive in only looking out for a few talents, such as memory, mathematics, calendar calculations, music and art. What about other skills. What about cooking, gardening, architecture and fashion design? Recently entrepreneur Elon Musk claims that he has mild autism or Asperger Syndrome (12,13). Should he be considered a savant? What about cartoonists? Satoshi Tajiri, the creator of Pokemon, was diagnosed to have childhood autism (14). How wide should we expand our outstretched arms to embrace these other domains of achievements?

If you carried the conventional picture of an autistic person in your mind, perhaps someone with speech impairment, often isolated and not mixing with others, and obsessed by flapping or rocking motions, someone who usually requires special education, you would be surprised if you discovered that person has hidden talents. Not just a mild talent. But incredibly prodigiously ultra-talented. A person who is able to multiply large numbers faster than you can enter them into a calculator, or someone who on hearing a piece of music once can play it back flawlessly, or someone who can draw a major city with the number of windows of a multi-story building drawn absolutely correctly. You would be stupefied, your mouth wide open. And that’s the paradox of the autistic savant.

Yes, we know there is a link between genius and autism. But it is a complex one. It appears to be the result of a fortuitous convergence of a number of factors, including a minimum level of intelligence, the ability to join ideas from different domains, the skill in generating novel ideas, to be able to think independently and flexibly, to focus one’s mind, to apply self-discipline, perseverance, to establish the right social and cultural environment. All these factors need to converge to create a savant.

This raises that tantalizing question whether we can create that perfect physical, emotional and educational environment to produce a genius. By studying the mechanisms, both biochemical and educational, that link mental disorders and genius, one may gain insight into factors that can engender creativity and kindle future potential geniuses (15,16). 

In his book “Islands of Genius”, Daniel Treffert describes savants that sometimes appear unexpectedly after a head injury or a stroke. He asks the provocative question “Are all of us potential savants?” If we can wake up our dormant brains, perhaps all of us can become geniuses (17).

To sum up, here is a modified quote: “You don’t have to be mad to be a genius… but it helps.”

REFERENCES

1 Savant Syndrome. Wikipedia.

https://en.wikipedia.org/wiki/Savant_syndrome

2 Treffert DA. The savant syndrome: an extraordinary condition

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677584/

3 Nobuyuki Sujii: Wikipedia.

https://en.wikipedia.org/wiki/Nobuyuki_Tsujii

4 John Nash: How was schizophrenia portrayed in A Beautiful Mind?

https://www.banyanmentalhealth.com/2021/03/30/how-schizophrenia-was-portrayed-in-a-beautiful-mind/
 
5 Vincent Van Gogh: Nolens WA et al. New vision on the mental problems of Vincent Van Gogh.
https://journalbipolardisorders.springeropen.com/articles/10.1186/s40345-020-00196-z

6 Kim Peek: Wikipedia

https://en.wikipedia.org/wiki/Kim_Peek

7 Daniel Tammet: A genius explains.

https://www.theguardian.com/theguardian/2005/feb/12/weekend7.weekend2

8 Olson IR et al. A calendar savant.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917639/

9 Derek Paravicini. Wikipedia.

https://en.wikipedia.org/wiki/Derek_Paravicini

10 Stephen Wiltshire. Wikipedia.

https://en.wikipedia.org/wiki/Stephen_Wiltshire

11 Nasar S. A beautiful mind: the life of mathematical genius and Nobel laureate John Nash. Touchstone Books 2001.

12 Elon Musk reveals he has Asperger’s on Saturday Night Live.

https://www.bbc.com/news/world-us-canada-57045770

13 Elon Musk isn’t the first ‘SNL’ host with Asperger’s.

Elon Musk Isn’t the First ‘SNL’ Host With Asperger’s

14 Satoshi Tajiri: Famous people on the spectrum.

https://pubmed.ncbi.nlm.nih.gov/18646626/

16 Lyons V, Fitzgerald M. Critical evaluation of the concept of autistic creativity.

https://www.intechopen.com/books/recent-advances-in-autism-spectrum-disorders-volume-i/critical-evaluation-of-the-concept-of-autistic-creativity

17 Treffert DA. Islands of Genius. Jessica Kingsley Publishers 2011.

18 Rimland B & Fine D. Special talents of autistic savants. in The Exceptional Brain, New York, Guilford Press 1988.

19 Eysenck JJ.  Genius : The Natural History of Creativity. Cambridge Univ Press 1995

20 Howwe MJA. Genius Explained. Cambridge Univ Press 2001.

21 Fitzgerald M: Autism and Creativity. Routledge 2004.

22 Fitzgerald M: The Genesis Of Artistic Creativity: Asperger’s Syndrome and the Arts. Jessica Kingsley Publishers 2005.

Causes of Autism

by Kenneth Lyen

INTRODUCTION

Autism is a common but complex neurodevelopmental disorder characterized by early-onset difficulties in social communication and unusually restrictive repetitive behaviours and interests. It manifests as a wide spectrum, ranging from a mild hesitancy in communicating with others, to someone who barely talks to anyone else. It encompasses the person who physically displays obsessionally recurring movements, to the savant with exceptionally gifted mathematics or artistic talents.

Trying to discover the causes of autism is like finding one’s way through a dense forest with only the guide of a global positioning system, which sets the general direction you want to travel, but does not help you overcome the obstacles that can block your progress.

Because autism is a complex disorder, there are potentially many causes (1). We can stratify the causes into several layers. The basic layer will be the underlying genetic and environmental causes which will interact with each other. The genes will express themselves in many ways, including biochemically and neurodevelopmentally. The next layer to explore is the brain: how does the structure, neurocircuitry, and function of the brain modulate behaviour. Environmental influences are still pervasive, and can alter a child’s behaviour before or after birth. The factors potentially affecting foetal or child development are numerous, and may include food, infections, toxins, etc.

Diagnosis of Autism (2)

An important question that needs to be answered: “Is autism one condition, or is it several overlapping conditions?”  Is it a single diagnosis or is it a composite of several diagnoses. The clinical presentation of autism is variable with a diversity of expressions, and therefore the diagnosis can be challenged or refuted. Without a definitive diagnosis, how do we prove which cause is the right one? Could we have misdiagnosed autism in some cases?

Ideally autism is a single diagnosis which can be securely verified. Conventionally, the diagnosis of a disease is based on a reliable set of symptoms and signs, supported by clear investigation results. This is the problem with autism. As there is a spectrum of clinical symptoms, signs and investigation results, the diagnosis is often somewhat inconclusive. Thus, at the moment, we do not have a definitive clinical diagnosis for most individuals suspected of being on the autism spectrum.

If we can link relevant and replicable investigations to the clinical manifestations, we can formulate a hypothesis of cause and effect. Unfortunately, at the moment we have neither unarguable clinical findings nor clearcut investigatory findings.

Autism has a myriad of causes. This makes it difficult to pin down which aetiology is the dominant one. To date, there are no indisputable scientific experiments, no incontrovertible imaging or genetic findings that can pinpoint the main causes. For example, genetic probes which are the most promising research findings, have led to the discovery of hundreds of possible genes linked to autism. It is confusing. But complexity itself does not negate that one is on the right tract. It just makes it harder to prove the aetiology or aetiologies.

Associated Conditions (3)

Another confounding factor is that some autistic persons may have other associated conditions. Some 30% will have intellectual disability, and between 10-15% will have epilepsy. Other associated conditions include attention deficit hyperactivity disorder, epilepsy, large heads, obsessional compulsive behaviour, and gastrointestinal symptoms, etc. Each of these symptoms can be due to a separate diagnosis in its own right.  Clinically, it is important to decide whether or not these comorbidities should be viewed as part of the autistic diagnostic spectrum, or should they be disassociated into different categories? This will be explored later.

Epidemiology (4)

The prevalence of autism is between 0.6-2% of the population. Over the past few decades, the prevalence has been increasing.

This increased prevalence could be due to heightened public awareness, or the relaxation of the diagnostic criteria by the American Psychiatric Association in their Diagnostic and Statistical Manual 5^th edition (DSM-V). These two explanations have been questioned. If indeed there is a real increase in its prevalence, we need to explain why.

Another finding that also needs to be explained is the predominance of males diagnosed with autism. It is estimated that autism is between 3 to 4 times more common in males compared to females. Is this an artefact due to the underdiagnosis of autism in females? Or is it a real observation? If indeed there is a male predominance, can we explain it by attributing it to the influence of male hormones in antenatal brain development, or are there any other theories?

GENETIC CAUSES

Basic Chemistry

Currently, many significant advances in the causes of autism are found in genetic research. Autism can arise either from established inheritability from a parent, or it can be to the fresh de novo alteration of the genes before, during, or after birth.

The fundamental building blocks of genes are known as nucleotides and consist of nucleic acids. Chemically the nucleic acid is deoxyribonucleic acid or DNA. The DNA is encoded using four bases:  adenine (A), cytosine (C), guanine (G), and thymine (T).

Each human cell has 46 chromosomes. Each chromosome consists on average 660 million DNA base pairs, totaling 3 billion DNA base pairs per cell. Three base pairs code for one amino acid. When amino acids join up, they form polypeptides, which in turn becomes larger and become proteins. Genes can be of different sizes, ranging from a few hundred DNA bases to more than 2 million bases.

While we think of genes as responsible for the manufacture of proteins, we forget that most of our genes do not code for proteins. In humans only 20,000 genes code for proteins, and these are known as exomes or exons. They only comprise 1% of our genes. The other 99% are called introns, and because we still do not know what exactly they do, they are sometimes referred to as “dark matter”, not to be confused with the dark matter of our universe!

Why Are Genes Are Linked to Autism? (5)

It originates from the famous studies of identical and non-identical twins (6). When one twin has autism, then an identical twin has a 60% to 90% chance of developing it. In contrast, a nonidentical or fraternal twin of the same sex share the autistic diagnosis around 30% of the time, compared to boy-girl twin pairs that only share the diagnosis about 20% of the time. The concordance rate for different-aged siblings is about 10%, while the general population risk ranges from 0.5% to 1.8% depending on which country is surveyed.

The fact that the identical twin concordance rate is not 100% suggests that there must be other factors involved, most probably environmental.

Hunt for Variants or Mutations

Humans match each other quite closely, with 99.9% of the order of their base pair DNAs identical with one another. The non-identical 0.1% are known as variants and are either nonfunctional, or they may contribute to disease risk, or they may even protect one from diseases. Gene variants can arise from mutations. Nowadays the terms variants and mutations are used interchangeably.

Are variants or mutations inheritable? Yes and no. Some variants can cause inheritable diseases, like those associated with autism. Fortunately, they are relatively rare. Below are some of the inheritable causes of autism.

Inheritable Causes of Autism

How might genes give clues to understand the cause of autism? One way is to study inherited conditions that are associated with autism, like the ones below:

1. Fragile X Syndrome (7)

Inheritable forms of autism are relatively rare. For example, there is an abnormality of the X-chromosome, known as the Fragile-X Syndrome. This is a sex-linked (X-linked) dominant condition and 50% of the affected children will develop autism. Fragile X Syndrome is associated with the gene known as FMR1, and it causes multiple repeats of the base pairs. This results in hyperactivity of the glutamate receptor (mGluR5) in the brain.

Researchers developed a mutant mouse that lacked the FMR1 gene and reproduced the hyperactive glutamate receptor. When they reduced the glutamate receptor activity, it resulted in increased dendritic neuronal density and hippocampal protein synthesis. Another group increased Gamma-AminoButyric Acid (GABA) by giving an agonist, baclofen, it increased synaptic protein synthesis and increased neuronal density in the spinal cord.

2. Tuberous Sclerosis (8)

Tuberous sclerosis is an autosomal dominant disorder affecting one of two chromosomes. One has a variant called TSC1 which is located on chromosome 9q34.3 and the other is known as TSC2, which is found on chromosome 16p13.3. It causes a problem in the rapamycin MTOR signaling pathway in the hippocampus. A group of researchers looked at mice with deficits in one or two TSC1 genes in the cerebellum and the mice showed decreased neuronal activity, abnormal social interactions, and repetitive behaviours. Treating these mice with rapamycin improved neuronal activity and behavioural deficits.

Another group of scientists developed mutant mice missing one copy of TSC2 resulting in cognitive deficits, and they could treat adult mice with rapamycin which improved synaptic plasticity and behavioural deficits.

3. Rett Syndrome (9)

Another condition also involving the X-chromosome is Rett Syndrome. The gene affected is known as MECP2, and only girls are affected. A unique feature of this syndrome is the obsessional hand-washing motions. They have an awkward gait, and the condition worsens progressively. The mutations of the MECP2 gene results in abnormal neurons.

A mutant mouse lacking the MECP2 gene was developed, and these mice displayed some symptoms resembling Rett Syndrome. When they reactivated the MECP2 gene back to normal in adult mice, these mice regained some normal functioning including normalizing neuronal signaling in the hippocampus, which is found in autism.

4. Phelan-McDermid Syndrome (10)

Deletion of part of chromosome 22 in the region of 22q13.3 which is known as the Shank3 gene causes a disease known as Phelan-McDermid Syndrome. This is inherited as an autosomal dominant, and is associated with autism.

5. Chromosome 16

Chromosome 16 is interesting because not only is it associated with tuberous sclerosis (see above), but other parts of this chromosome, such as the regions 16p11.2 and 16p12.1 are associated with autism, delayed development and recurrent seizures.

The syndromes listed in Table 1 are frequently associated with autism, and they are inherited in an autosomal or sex-linked dominant manner. But they are relatively rare. By understanding the pathophysiology of these genetic disorders linked to autism, we can gain deeper understanding into the causes and potential treatment of autism.

The majority of persons with autism do not have any family history. They arise discontinuously, and therefore they are most likely due to new impromptu mutations, also known as de novo variants.

De Novo Variants (11)

De novo variations of the genes are usually thought to arise spontaneously and quite passively. Most do not cause any problems. But sometimes they can result in serious diseases, including autism. Spontaneous mutations may occur in either the sperm or the ovum before fertilization, or after fertilization. They are not inherited from earlier generations as they arise unexpectedly, but they will affect the offspring.

Genome-Wide Linkage Studies

To link genetic causes to autism, one of the methods is to do a genome-wide linkage study. This is achieved by trying to identify chromosome regions or loci that are inherited by affected individuals more frequently than expected by chance. But the scope was widened to search for all DNA variations in all families, whether several members are involved, or if only one member has autism.

Copy Number Variations (CNV) (12-14)

Early studies aimed to identify multiple copies of new variants. These copies range from 50 to thousands of DNA sequences. Most of these base pairs are duplicated, but some are deleted. Detection of these CNVs was originally done by inserting a fluorescent probe by in situ hybridization (FISH) that detects by binding to the genomes.

To discover which genetic mutation is responsible for autism, researchers compared the DNA of an autistic child with their parents and unaffected normal siblings. Early findings showed 65 genes that had strong correlation with autism, and an additional 170 genes with weaker association with autism. The interesting results show that many of these genes affect nerve transmission in the brain, and others affect the chromatin or DNA wrapped in a protein called histones. Chromatins are important because they modulate the function of DNA replication, and therefore they can be controlled by other proteins. This phenomenon is known as epigenetics.

One can line up these CNV mutations along one of the chromosomes. Take for example, chromosome 7q11.23. There are 5 mutations that cluster along this chromosome. This has created a lot of excitement because it has long been known that this particular chromosomal disorder has a missing section or deletion, found in a condition called William Syndrome. This condition is characterized by heart failure, a typical facial appearance, intellectual disability, and incredibly by an extremely sociable personality. This is the opposite of autism where there are duplications of the genes in this neighbourhood. It appears that deletion of part of the 7q11.23 chromosome results in hyper-sociability, while duplication of this area leads to reduced sociability found in autism.

So, historically, CNV analysis of genes was the first step that helped identify variants associated with autism. But it was quite soon after that another more precise technique became available.

Using new microarray technology, one could detect single gene errors, referred to as Single Nucleotide Polymorphisms (SNPs) Some of these SNPs are found in families with autism, and so one would then look for a particular area of the chromosomal region that they might be clustered.

Most autistic persons do not have other family members who are affected. Therefore to look for variants, scientists began to compare the genes of autistic persons with their non-affected parents and sibling. Realising that there are thousands if not millions of potential mutations, scientists began narrowing their attention at genes that only code for proteins, known as exomes. The exomes comprise just 1% of all our genes. Hence by limiting the search, it accelerated the identification of mutations that lead to errors in protein manufacture. In other words, the mistakes made by wrong coding can potentially result in making the wrong proteins, which can have many repercussions in altering structure and function.

Single Nucleotide Variant (SNV), Single Nucleotide Polymorphisms (SNP), Insertion/Deletion (Indel), and Copy Number Variations (CNV) (15)

Technology went a step further. One can now look at each individual base pair or genome. Several types of misreading errors were discovered. They include:

1 Misplacing a single base pair known as a Single Nucleotide Variant (SNV). The Single Nucleotide Variant (SNV) has the largest impact, but it is the rarest of the variants, occurring in once out of 3 million replications, and one base pair is affected. If more than 1% of the population has SNVs, we rename them Single Nucleotide Polymorphisms (SNPs) (15).

2 There may be either an accidental insertion of an extra base pair, or a deletion of the nucleotide, collectively referred to as “Indel” The Indel variant is second most common, occurring once every 250,000 replications, and can affect less than 1,000 base pairs.

3 The copying of a rather large stretch of the chromosome, known as Copy Number Variation (CNV). The commonest variant involving only one nucleotide is the Copy Number Variation (CNV), occurring once every 2,000 replications, and this can involve well over 1,000 base pairs.

Linkage Studies (16)

The first set of results were from studies of families with autism, and noting which chromosomes had more Single Nucleotide Polymorphisms (SNPs). The results are interesting, because nearly every chromosome of these families has clusters of SNPs. However, by looking at subsets of these families, including those where the autistic individual were more severely speech delayed or were males, they noted greater clustering of these SNPs. This made one more curious to try to delineate which genes have such effects on autistic people.

Whole Exome Sequencing (WES) (17)

Thanks to the human genome project, an international scientific research project that identified and mapped out all the base pairs or genes that make up human DNA. The project was started in 1990, and completed in 2003. The technology allowed one to sequence extraordinarily large numbers of Single Nucleotide Polymorphisms (SNPs).

Concentrating on those nucleotides that are tied to amino acid and hence protein synthesis, one could look at de novo variants of these SNPs. These nucleotides are known as exomes (also known as “exons”).

The search for the entire protein-manufacturing exomes is known as Whole Exome Sequencing (WES). This procedure has revolutionized the study of genes in autism. Using this new technology, scientists can look at all 21,000 genes comprising 180,000 exome nucleotides, which constitute about 0.6% of the 30 million base pairs of the entire human genome.

Although several hundreds of gene variations are found in autistic subjects, when they looked at the function of these genes, they were able to group them into their functions. One group of variants were involved in the neurons, influencing the neuronal cell adhesion molecules, and thereby affecting the function of nerves, while another group affected a ubiquitin pathway, which helps in the synthesis of new proteins, and the destruction of defective proteins.

With current whole exome sequencing, we can explore all the exome genes at the same time, which not only widens the search, but simultaneously cuts down the time taken for research.

Other Genetic Challenges

There are still several challenging problems that waiting for clarification:

Firstly, there are hundreds of genes associated with autism, some of them affecting nerve cell development and function, others affecting gene expression, a phenomenon known as epigenetics. Looking at the wide spectrum of autism, it seems quite likely that these different genes interact with one another and converge in producing the clinical picture of autism.

Secondly, the genes are expressed at different times of development. Some of them are active in early embryonic life, others later, and some after birth.

Thirdly, genes can affect different organs differently, and each organ can in turn interact with one another, perhaps altering their functions.

Overall, between 10-20% of people with autism have a de novo genetic mutation.

NEUROLOGICAL CAUSES

Brain Pathophysiology (18)

Exploring the genetics is only the first step in our attempts to understand the causes of autism. The next step is to understand the neuroanatomy and the neurophysiology, of the autistic brain and how it differs from the non-autistic brain. Fortunately, recently there have been major advances in mapping out the form and function of the brain and the nerve connections.

The brain has billions of nerve cells or neurons. However, in autism, these neurons are not communicating with each other appropriately. Researchers are trying to pinpoint which parts of the brain are affected, and what are the mechanisms of the problems found in autism.

Functional Magnetic Resonance Imaging (fMRI) (19,20)

One major advance in understanding the function of the brain is the development of functional magnetic resonance imaging (fMRI). This detects increased oxygen that is supplied to active brain nerve cells.

There have been many studies using fMRI to see how the brains of autistic individuals differ from neurotypical brains. For example. Autistic persons are said to be less sociable compared to non-autistic people.

The areas of the brain believed to be linked to sociable behaviour include the superior temporal gyrus and the amygdala. The test subject is asked to view a photo of a human’s eyes and then chose which of two adjectives better describes the person’s mental state. The non-autistic person shows activity in orbitofrontal cortex, superior temporal sulcus (STS), and amygdala in normal subjects. In contrast, autistic subjects were found to have no amygdala activation and abnormal STS activation. The reduced activity in these brain areas are thought to be due to reduced neuronal connectivity.

Diffusion Tensor Imaging MRI (21)

Diffusion tensor imaging is a form of magnetic resonance imaging (MRI) that detects the flow of water along the white matter of the brain. In so doing it shows the white matter connections in the brain.

Children with autism have increased connections of the shorter nerve fibres close to one another, and decreased connections with distant parts of the brain.

Magnetic Resonance Spectroscopy (22)

Another new development in magnetic resonance imaging is modifying conventional magnetic resonance imaging (MRI) to see a specific set of brain chemicals. For example one can now measure Gamma-AminoBenzoic Acid (GABA) which is an inhibitory transmitter, as well as glutamate, which is an excitatory transmitter. Autistic children had a higher glutamate concentration, and a lower GABA concentrations in their occipital cortex, suggesting that there is imbalance with increased excitation and decreased inhibition.

It is postulated that the ability to excite and inhibit brain function can be used to filter sensory information. Failure to dampen down excitatory stimuli can, for example enhance loud sounds or visual stimulation, which many autistic individuals do not tolerate well.

Knowing the neurotransmitters involved, adults with autism have undergone a trial where they were treated with riluzole, which blocks the pre-synaptic release of glutamate and facilitates GABA activity, and preliminary data are encouraging.

Electroencephalography (EEG) (23-26)

Epilepsy occurs in 1-2% of the general population but in 20-40% of those with autism. An abnormal EEG occurs in about 2-4% of the general population but in 50-80% of those with autism. These statistics suggest that the autistic brain may harbour some underlying disorder.

The use of simple resting state EEG has inconsistent results. But when combined with eye-tracking manoeuvres, the results correlate significantly with autistic subjects.

CONCLUSIONS

Finding the causes of such a complex condition as autism is highly challenging. Advances in genetics have uncovered hundreds of genes linked to autism. The precise mechanisms by which the genes lead to autism are still being explored. The other major areas of research are in the area of brain imaging, using functional MRI, diffusion tensor MRI, and magnetic resonance spectroscopy (MRS). They have also unraveled geographic areas and the function of these brain regions in relation to autism. These investigations have also been used to determine the efficacy of the treatment of autism.

FUTURE CHALLENGES

Hopes for the future include the following:

a) Prevention

Prevention is better than cure. If we can discover the causes of childhood developmental conditions, we may be able to prevent more of these states. Already the incidence of Down Syndrome and cerebral palsy has fallen. I hope that autism will follow suit. Whole genome sequencing during pregnancy or at birth may lead to earlier identification of autism before or shortly after birth can potentially lead to some form of intervention or therapy to correct biochemical deficiencies. Advances in gene therapy or genome editing (CRISPR) can one day correct mutations for many genes.

b) Inclusive Education

Different, not disabled. I do not believe in segregating children with differences into separate schools or institutions. Children have different abilities and interests, but we should not partition them into isolated schools. They can still join in other activities such as sports, art, music, dance, etc. We need to develop a mindset that we are all part of a family.

Better understanding of the neurophysiology of autism can help us better understand human neurodiversity, how each individual have their own unique brain connectivity and function.

c) New Technologies

Creating new technologies to help the disabled should be given more funding. Enhancing communication, facilitating the integration of special children into society, them to travel, shop, etc with ease can be developed further.

d) Stem Cells

Stem cells may one day be developed to produce different types of cells, either to replace neurons affected by autism, or to do research into which drugs or toxins can influence these stem cell neurons.

e) Dark Matter

We are currently looking at the protein-related exome genes which comprises only 1% of all our genes. We have barely started looking at the “dark matter” non-protein related intron genes. Like the Dark Matter in the universe, we have a long way to go, but we may be surprised by what this research might lead to.

f) Infant Brain Imaging Study (IBIS)

Ongoing studies using conventional magnetic resonance imaging scans (MRI Scan) coupled with electroencephalography (EEG) and eye tracking (ET) tests, applied to children between 6 months and 2 years old. These children are followed up with repeated MRI scans and psychological tests to detect early autism. The objective is to see if there are any early structural changes in the brain of children that can predict autism, which hopefully can lead to earlier intervention.

REFERENCES

1 Causes of autism. Wikipedia: https://en.wikipedia.org/wiki/Causes_of_autism

2 Diagnosis of autism. Wikipedia: https://en.wikipedia.org/wiki/Autism

3 Furfaro H. Conditions that accompany autism, explained. https://www.spectrumnews.org/news/conditions-accompany-autism-explained/

4 Epidemiology of autism. Wikipedia: https://en.wikipedia.org/wiki/Epidemiology_of_autism

5 Genetics of autism spectrum disorders. eMedicine:

https://emedicine.medscape.com/article/2024885-overview#showall

6 Marina Sarris. Twins study finds large genetic influence in autism.

https://iancommunity.org/autism-twins-study

7 Fragile-X and autism. https://fragilex.org/understanding-fragile-x/fragile-x-syndrome/autism/

9 Deweerdt S. Rett Syndrome’s link to autism, explained.

https://ojrd.biomedcentral.com/articles/10.1186/s13023-015-0323-9

11 De novo mutations in autism spectrum disorder

https://www.frontiersin.org/articles/10.3389/fgene.2018.00406/full

12 Zeliadt M. Autism genetics, explained.

https://www.frontiersin.org/articles/10.3389/fncel.2019.00057/full

15 Weiss LA. Autism genetics

https://www.medscape.com/viewarticle/713222_3

16 Holt R et al. Linkage and candidate gene studies in autism spectrum disorders

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2987412/

17 Yu TW et al. Using whole exome sequencing to identify the causes of autism

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694430/

18 Brasic JR. Pathophysiology of autism spectrum disorder

https://emedicine.medscape.com/article/912781-overview#a3

19 Gabrielsen TP et al. Functional MRI (fMRI) connectivity in children with autism

https://molecularautism.biomedcentral.com/articles/10.1186/s13229-018-0248-y

20 Way KW. Resting state (fMRI) abnormalities in autism spectrum disorders

https://www.nature.com/articles/s41598-019-40427-7

21 Solso S. Diffusion tensor imaging MRI in autism spectrum disorder toddlers

https://www.sciencedirect.com/science/article/pii/S0006322315005697

22 Ford TC, Crewther DP. Magnetic resonance spectroscopy (MRS) in autism spectrum disorder

https://www.frontiersin.org/articles/10.3389/fnmol.2016.00014/full

23  Bosl WJ et al. EEG analytics for early detection of autism spectrum disorder

https://www.nature.com/articles/s41598-018-24318-x

24 EEG in Children with Autism

https://www.corticacare.com/care-notes/why-and-when-are-eegs-recommended-for-children-with-autism

25 Zhang S, et al. Children ASD Evaluation Through Joint Analysis of EEG and Eye-Tracking Recordings With Graph Convolution Network

https://media.proquest.com/media/hms/PFT/1/azDMJ?_s=eVqI7gF2oCNAy1sS6k6UdXR8eTA%3D

26 Vettori S, et al. Combined frequency-tagging EEG and eye tracking reveal reduced social bias in boys with autism spectrum disorder
https://lirias.kuleuven.be/2911569?limo=0

Pharmacotherapy of Autism

by Kenneth Lyen

INTRODUCTION

Currently, no medicines have been proven to significantly improve the core symptoms of autism, namely the communication socialising difficulties, and the restrictive repetitive movements. Medicines can help with some of the associated manifestations  of autism, which include attention deficit hyperactivity disorder, obsessional compulsive behaviour, epilepsy, aggressive and self-injurious behaviour, anxiety, and abdominal symptoms.

What are the Main Targets for Therapy?

The main targets for therapy are to improve communication and social skills, to promote academic functioning, decrease negative behaviour, and ultimately to improve the quality of life of the autistic individual.

The proven ways of achieving most of these goals are through special education with trained teachers and therapists in a small class, preferably started early in the child’s life. The interventions include occupational therapy, physiotherapy, social skills training, speech and language therapy, and the use of music, art and sports to enhance all the therapies.

Is there a dichotomy between medical and non-medical therapies? Meaning, should medical therapy be relegated only to comorbid conditions associated with autism? Or should we combine special education and behavioural intervention strategies with medicines?

The answer must be, yes, one can indeed combine the different therapy modalities. Ideally all intervention strategies should be evidence-based. Therefore one needs to be careful in selecting the therapies and medicines. Trials are still ongoing comparing the different treatments of autism, and in reality many parents one cannot wait, and will embark on different therapies in the hope that some will be of benefit.

CONDITIONS ASSOCIATED WITH AUTISM

Attention Deficit Hyperactivity Disorder (ADHD)

About 30% of children on the autism spectrum have attention deficit hyperactivity disorder. This means they are easily distracted, and have difficulty focusing on a given task. Some of them cannot keep still and wander around aimlessly others have intermittent impulsivity in which they suddenly do things unexpectedly.

Examples of lack of impulse control seen in autistic children include disruptive behaviours when they interrupt you when you are in the middle of doing something, or when others are playing together they may intrude. Some may blurt out an answer even before you have finished asking the question, and others may have difficulty controlling their emotions and suddenly become angry.

Although there are several medicines available for managing ADHD, I shall focus only on two more commonly used:

a) Methylphenidate (1)

The first is methylphenidate, which is an amphetamine derivative without the addictive side effects of amphetamine. This works in about 50% of autistic individuals with ADHD, compared to those who do not have autism where the percentage of efficacy can be over 70%. We sometimes observe that one of the side effects of methylphenidate used in autistic ADHD is worsening of their social withdrawal. Their irritability is not worsened, and if they have tics, these also do not get worse.

There are two preparations commonly available, both containing methylphenidate. Ritalin is quick-release and therefore shorter-acting, lasting 4-8 hours, and Concerta which slow-releasing and lasts 10-12 hours. Ritalin can be given twice or three times a day, while Concerta is usually given only once daily. The latter is more convenient for children who may be spending an entire day at school.

b) Atomoxetine (2,3)

Atomoxetine is a selective noradrenaline reuptake inhibitor. It is effective in about 20-50% of autistic subjects with ADHD. Side effects are common, and include restlessness, depression and abdominal discomfort. It is usually given to those children who have side effects with methylphenidate.

Irritability, Aggressive Behaviour, Temper Tantrums, Self-Injuries

Many autistic children have a variety of behavioural issues. They range from irritability, aggression, temper tantrums and self-injurious behaviour. The initial management is to calm the person down, isolating them in a safe quiet room where there are no sharp or potentially dangerous furniture or instruments. If this type of therapy is ineffective or the person is at risk of harming either other people or themselves, then medical treatment may have to be considered. These include the following:

a) Risperidone (4)

Risperidone is an antipsychotic that blocks the dopamine and serotonin receptors in the brain. Both dopamine and serotonin are neurotransmitters that regulate one’s moods, especially the pleasurable sensations. It is therefore paradoxical why it is effective in irritable and aggressive behaviours because blocking happy and good feelings should worsen these behaviours.

Risperidone is given to children 5 years and older. It is effective in over 50% of cases, reducing irritability, aggressive behaviour, temper tantrums and self-injurious behaviours. It can be used for long-term. Side-effects are mainly sleepiness, increase in appetite leading to weight gain, drooling from the mouth, and rarely, it may cause involuntary movements, affect the heart, and induce suicidal thoughts. Giving the lowest dose that is effective, is advised. It may take up to 6 weeks before the full effects are seen.

The aggressive self-injurious behaviours often do not respond to risperidone. One can try some alternative medicines, including aripiprazole, clozapine, olanzapine, or ziprasidone, with careful monitoring for adverse effects.

b) Aripiprazole (5)

Aripiprazole is a tranquiliser, but its mode of action is complex. It is a partial agonist at the dopamine D2 and the serotonin 5-HT1A receptors, but it is an antagonist at serotonin 5-HT2A receptor. Exactly how does it exert its action in autism is still  unknown.

Aripiprazole is used in children aged 6 years and above. It is useful for severe tantrums, when a child might lash out at others, or when they might injure themselves. The dose should start small, and be gradually increased.

One of the side effects is known as akathisia, or restlessness, the feeling of “ants in the pants”. Other side effects are stiff jerky involuntary movements, muscle spasms, and slight weight gain.

Anxiety, Depression

Anxiety and depression are more prominent in older autistic individuals. Triggers for anxiety and depression may be being bullied at school or not getting their own way. These symptoms are often missed because many autistic people tend to be withdrawn and not very sociable in the first place. The depression can sometimes be quite profound and they may have suicidal thoughts. Warning signs of depression include increased sleepiness, becoming more on edge, more anxious, feeling sad, inattentive, and loss of appetite.

Cognitive behavioural therapy sometimes help reduce anxiety and depression. If non-medical therapies are  ineffective, it may be necessary to add an antidepressant to the management.

a) Selective Serotonin Reuptake Inhiibitors (SSRI): Fluoxetine (6)

The American Food and Drug Administration (FDA) approved the use of fluoxetine for children aged 8 years old and above, in 2017. There is some controversy concerning the use of selective serotonin reuptake inhibitors (SSRI) in autistic children.

The onset of fluoxetine is rather slow. There may be some improvement in symptoms after 1-2 weeks, but the full effect may take 4-6 weeks to reach full effect. The half-life is long, and when you stop taking, its effects will last at least 4 weeks. It is therefore advisable to slowly taper off the medicine over one month and not to stop it suddenly. Another important advice is that you should not mix two antidepressants together.

The side effects of fluoxetine increased impulsivity, insomnia. Occasionally, there are a few more serious side effects, known as the serotonin syndrome. These children experience sweatiness, muscle rigidity and a fast heart rate. Therefore, children who are treated with serotonergic agents should be evaluated at baseline before beginning treatment and then regularly evaluated for symptoms of a serotonin syndrome.

b) Benzodiazepine: Diazepam, Clonazepam

Benzodiazepines are tranquilizers that act by raising the level of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the brain. GABA weakens or slows down anxiety-inducing signals; low levels are associated with anxiety, and higher levels reduce anxiety. Benzodiazepines also have antidepressant effects, and they are also used to treat epilepsy.

They can help reduce anxiety in autistic individuals. However, it is not recommended for long-term use. The commonest side effect is drowsiness.

Epilepsy, Abnormal EEG and Repetitive Behaviour

Epilepsy occurs in around 12.5% of children from 2 to 17 years old. This compares to 1-2% of the general population that have epilepsy.

Some of children on the autism spectrum have repetitive movements such as hand flapping, clapping, running up and down, rocking two and fro, etc. It is hypothesized that the purpose of these behaviours is to enable the autistic person to cope with an unpredictable and slightly threatening environment. The repetitive movements are occasionally misdiagnosed as epilepsy or obsessive compulsive disorder (OCD). There is a distinction between diagnosis of OCD and autism; while both will exhibit repetitive behaviours, people with OCD are fully conscious of their repetitive behaviours, while autistic individuals do them without self-awareness. The treatment for OCD may not work for autism.

Valproic Acid (7-9)

Valproic acid is an anti-epileptic drug which surprisingly has shown to be effective for some children with repetitive behaviours. It is more effective in the children who also have abnormal electroencephalographic (EEG) findings. Side effects include drowsiness and hair loss.

Cognitive Enhancers

The use of cholinergic enhancing medicines to help autistic individual’s cognitive function is controversial, but some people believe that they improve memory, attention, the ability to interact with others, speak, think clearly, and perform regular daily activities.

Donepezil (10,11)

Donepezil binds reversibly to acetylcholinesterase and inhibits the hydrolysis of acetylcholine, thus increasing the availability of acetylcholine at the synapses, enhancing cholinergic transmission. Side effects include nausea, vomiting, diarrhoea, loss of appetite and frequent urination.

Social Responsiveness

Autism is characterised by poor social communication. Not surprisingly, there have been some attempts to enhance socialising.

Oxytocin (12,13)

Oxytocin is a peptide hormone produced in the base of the brain, a region known as the hypothalamus and promotes positive pro-social warn feeling. It plays a role in social bonding. There have been some studies that have shown oxytocin improves socialising in autistic people. The medicine is administered intra-nasally.

Sleep Disturbances

Autistic people may have difficulty falling asleep, and they wake up several times in the middle of the night.

Melatonin (14)

Melatonin is a hormone released by the pineal gland, released at night-time. It is associated  with the control of the sleep–wake cycle. It is quite widely used by the general public for treating insomnia and jet-lag. Studies have shown that melatonin can sometimes help autistic people who have sleep disturbances.

MEDICINES AND DIETS THAT DO NOT WORK

There are no large double-blind placebo-controlled trials for the treatments and medicines listed below. However, many parents believe that they work. Provided they do not do any harm, and are not prohibitively expensive or time-consuming, and if they do not displace therapies that are proven to work, then it is probably all right for  parents and patients to continue with the therapies below.

• Anti-Fungal and Anti-Yeast Medication
  • Anti-Yeast Medication
  • Flagyl (metronidazole)
  • Diflucan (fluconazole)
  • Nystatin
• Cannabis and Marijuana
• Chelation Therapy
• Complementary Alternative Medicine
• Transcraniosacral Magnetic Stimulation
• Essential Oils
• Fecal Microbial Transplantation
• Herbs and Homeopathic Treatments
• Hyperbaric Oxygen Therapy
• Iridology
• Magnets
• Marijuana
• Neurofeedback Therapy
• Secretin
• Special Diets
  • Gluten-free (wheat)
  • Casein-Free (dairy)
  • Gluten-Free plus Casein-Free Diet (GfCf Diet)
  • Sugar free
  • Removal of food dyes
• Vitamin and Supplement Therapy
  • Vitamin A
  • Vitamin B6
  • Vitamin B12
  • Vitamin C
  • Vitamin D
  • Magnesium
  • Dimethylglycerine (DMG)
  • Calcium
  • Omega 3 Fatty Acids

REFERENCES

1 Sturman N et al. Methylphenidate for children and adolescents with autism spectrum disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486133/

2 Ghanizadeh A. Atomoxetine for treating ADHD symptoms in autism.

https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.884.3461&rep=rep1&type=pdf

3 Eslamzadeh M. Assessment the efficacy of atomoxetine in autism spectrum disorders. https://sites.kowsarpub.com/ijpbs/articles/10596.html

4 Canitano R, Scandurra V. Risperidone in the treatment of behavioral disorders associated with autism in children and adolescents.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2536539/

5 Blankenship K et al. Aripiprazole for irritability associated with autistic disorder in children and adolescents aged 6–17 years. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043611/

6 Nadeau J et al. Treatment of comorbid anxiety and autism spectrum disorders. SSRI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3809000/

7 Viscidi EW et al. Clinical Characteristics of Children with Autism Spectrum Disorder and Co-Occurring Epilepsy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701630/

8 Smith P. Understanding the Relationship Between Autism, OCD, and Repetitive Behaviors. https://autismspectrumnews.org/understanding-the-relationship-between-autism-ocd-and-repetitive-behaviors/

9 Carrasco M et al. Pharmacologic treatment of repetitive behaviors in autism spectrum disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3340598/

10 Eack SM et al. Cognitive enhancement therapy for adult autism spectrum disorder. https://pubmed.ncbi.nlm.nih.gov/29286586/

11 Srivastava RK et al. Role of Donepezil in Autism: Its Conduciveness in Psychopharmacotherapy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3420777/

12 Bernaerts S et al. Oxytocin treatment attenuates amygdala activity in autism: a treatment-mechanism study with long-term follow-up. https://www.nature.com/articles/s41398-020-01069-w

13 Wright J. Oxytocin spray boosts social skills in children with autism. https://www.spectrumnews.org/news/oxytocin-spray-boosts-social-skills-children-autism/

14 Gagnon K, Godbout R. Melatonin and Comorbidities in Children with Autism Spectrum Disorder. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6096870/

5

The Magic Paintbrush: the Musical

The Magic Paintbrush: the Musical

Book, Lyrics and Artistic Director by Brian Seward

Music Composed by Kenneth Lyen

Music Arranger and Additional Music by Bang Wenfu

A week earlier, I tried to buy tickets online, and there were only six tickets left. However, I had something else to attend to, and so delayed buying my ticket by one hour. When I got round to buying the ticket, there was only one left, and no choice, I bought that last one. Sure enough, today’s performance was full house.

Throughout the performance, I heard shrieks of laughter, and children shouting to the cast telling them what to do, and misleading the villains by pointing them in the wrong direction. This impromptu interaction was fascinating for me to observe. Probably the best review one can get is what is overheard as one leaves the auditorium. Both adults and children were gushing: “Good, really really good!” “So funny!” “Must tell my friends to watch!” “Hilarious!” Those are some of the descriptions I overheard by the audience members, complete strangers to me.

All the elements came together in this musical. It resonated with the children. They saw the father scolding his stage daughter because she had fallen asleep instead of studying for her exams. And the children laughed. They saw the poor hungry peasant family trying to catch the chicken that had just been brought to life. And they laughed. They saw the villains Shrimp and Sotong getting lost, and undecided which direction to go. And they laughed. The laughter continued unabated right through the show.

A musical for children will only succeed if it speaks to the adults as well. Indeed the Magic Paintbrush does just that. It talks about excessive parental pressures on the kid’s academic studies, about greed for material wealth, about using one’s abilities to help others.

The Magic Paintbrush is based on an old Chinese folktale about a young boy, Ma Liang (Jodi Chan), who wants to paint, but is too poor to afford a paintbrush. He wishes for a paintbrush, and his wish is heard by The Spirit of Creation (Dwayne Tan) who sends Madam Hoang, a phoenix bird (Amanda Tee) to help. The Spirit of Creation then personally appears to deliver the paintbrush to Ma Liang, instructing him to use it wisely. This paintbrush is magic because it has the power to transform painted objects into 3-dimensional life forms.

Ma Liang’s first creation is a chicken (Ghazali Muzakir) who becomes attached to him, and follows him everywhere. Ma Liang helps the poor and hungry wherever he goes, by painting food for them to eat. However, his acts of altruism is witnessed by two hare-brained rogues, Shrimp (Darren Guo) and Sotong (Ebi Shankara). They inform the Emperor (Tan Shou Chen), who is obsessed with acquiring gold. They apprehend Ma Liang, and imprison him. Fortunately his faithful chicken finds Madam Hoang the phoenix, and with the help of a pie rat (Elizabeth Loh) residing in the prison, they rescue Ma Liang.

But their escape is thwarted by Shrimp and Sotong, who capture them all. The greedy Emperor orders Ma Liang to paint an ocean, a ship made of solid gold, and some wind to enable the ship to sail. However, Ma Liang paints wind that becomes increasingly stronger, eventually sinking the ship, together with the Emperor, Shrimp, and Sotong. Ma Liang continues to help the poor and needy.

Suddenly Ma Liang wakes up, and realizes it is all a dream. Or is it?

The actors are all triple threats, able to sing, act, and dance. They are excellent singers, capable of matching some of the best professional singers in major overseas centres. Their acting is also remarkable. You would not believe that there are only nine actors in total, most playing multiple roles. They convey the lyrics of the songs with perfect diction. My favorite three songs are “Reaching”, sung by Ma Liang:

“Reaching for a shining star
Working for a world so far
Looking for a place to call
My home at last.

Striving for a heart that’s true
Searching for the peace you knew
Hoping for a future better than your past.”

And the song “Wisely, Wisely”, sung by the Old Man:

                “The spirit of each person   
                Holds a precious jewel   
                The joy of life and of love   
                The joy of kindness from above 
                Use it wisely, my child,   
                Use it wisely.   
 

                At the heart of every person 
                Lies a precious gift.   
                The gift of joy, or of song   
                The gift of knowing right from wrong 
                Use it wisely, my child,   
                Use it wisely.”

And “Wishing for a World”, sung by the Paintbrush

             “A wish can bring you joy
                A wish can bring you grief
                It all depends on the way you wish
                And what is in your heart

                Wishes are powerful
                Wishes are strong
                Beware the selfish wish that harms
                The wish that causes wrong”

The Magic Paintbrush is an entertaining, and at the same time, a profound thought-provoking musical. The credit for this goes to Brian Seward, who is both the writer as well as the director. The music arrangement and additional music are by Bang Wenfu. The music is brilliantly directed by Sara Wee. Cathy Kee choreographed the dances, and the movements flowed very smoothly. The sets are absolutely stunning, as are the props, the puppets, and the costumes. Sound and lighting were flawless.

May I congratulate everyone involved in this project. It is certainly a landmark in Singapore’s musical theatre. Bravo!

29 October 2016

ACTOR                                                CHARACTER

Jodi Chan                                            Toni Lee, Ma Liang

Tan Shou Chen                                  Father, Emperor

Amanda Tee                                      Mother, Madam Hoang (phoenix)

Ebi Shankara                                      Sotong

Darren Guo                                        Shrimp

Dwayne Tan                                       Paintbrush, Old Man

Elizabeth Loh                                     Peony Blossom, Pie Rat

Ghazali Muzakir                                Lotus Flower, Chicken

Daphne Ong                                       Villager, Puppeteer

CREATIVE TEAM

Book, Lyrics, Director                    Brian Seward

Composer                                          Kenneth Lyen

Music Arranger, Additional Music  Bang Wenfu

Music Director                                 Sara Wee

Choreographer                                Cathy Kee

Sets and Props                                 Wai Yin Kwok

Puppets                                              Lisa Kelly

Lighting Designer                           Gabriel Chan

Flower Costumes                            Nakupelle

Costume Realization                     Joanne Ng Mui Huang

PRODUCTION TEAM

Production Manager                     Hatta Sulaiman

Stage Manager                                Alycia Finley

Asst Stage Managers                     Nadia Noordin, Nureen Raidah, Delia Oh Kheng Yee

Crew (intern)                                    Nur Atikah

Sound Engineer/Operator           Sharizal Hamid

Lighting Ops                                     Justina Khoo

[Performed at the Drama Centre Singapore from 27 October to 12 November 2016]

The Girl With The Red Balloon: the musical

A Raffles Hall Musical Production

Book by Aidan Woodford, Music by Liew Nam Yang and Ding Jian Han

Directed by Yong Hwee Jun, Tay Yu Rong, and Pang Wei Han

Producers: Poh Yu Tong, Yan Yilong, and Gavin Prasetyo Raharjo

I have been invited by Hall Master Prof Ho Chee Kong, to help out with Raffles Hall’s annual musicals since its inception in 2011 with the production of Happealy Ever After. Every year I have seen these productions evolve into ever complex  products. This year is no exception.

Ostensibly The Girl With the Red Balloon is a love triangle set in an old public housing estate due for demolition. What makes this musical so compelling is the in-depth development of the main characters. Kudos goes to bookwriter Aidan Woodford. Each character has a complex psychological make-up with a compelling back story. As an aside, if Aidan keeps up with this profound multi-layered writing, he will be a major creative force in Singapore’s literary scene.

The male protagonist, Josh is brilliantly played by Jasper Lee. Josh defies convention by chosing to become an artist, but even his art is unconventional, as he is a graffiti artist who paints on the walls of public areas.  Although Josh has garnered considerable acclaim, he remains unknown because he is hiding behind the pseudonym, GD.  We feel sorry for him because we sense that his attempts to prevent the redevelopment of the old block of flats, and to salvage the broken relationship with his childhood girlfriend, are doomed to failure. His subtle and convincing character development is key to the success of this musical.

Josh’s childhood girlfriend, Indigo, is sensitively played by Chan Shiyin. She has gone to New York for an extended internship, and has come back to Singapore only for a short visit. Josh’s initial delight in seeing Indigo is quickly dashed when she introduces Howard, her fiancé, whose arrogant and condescending personality is played to a tee by Chua Song Yu.

The other cast members support the protagonists very well. The hot-tempered gangster-like Archie is played by Clement Tan. The buffoonish Don is played by Caleb Ho, who brings on the most laughs in this production.  Indigo’s childhood friend Carrie, is a rather sweet innocent girl who likes to hang out with her female friends, and Rachel Wong carries (apologies for the unfunny pun) the role very well. The third member of the female is Beth, humorously played by Wong Yushan. Adding even more hilarity to the show is the Kopi auntie, who Vanessa Ng Zi Yan portrays with much aplomb, complete with proletariat Singlish. Jerome Wong plays Indigo’s father so convincingly that you can believe that he is indeed her real father.

Music is an important, if not the most important, component of a musical. It was most enjoyable listening to the varied moods and rhythms composed by Liew Nam Yang and Ding Jian Han. One must not forget the music arrangers who enhance the emotional effects of the music, and they were created by Hew Kai Ling and Jesline Tang Chia Ling. The choral directors Lim Hoe King, Sebastian Tan, and Raphael Quek made the cast sing harmoniously.

 Dance formed a significant element of The Girl with the Red Balloon. The choreographers Png Rou Jing, Tan Shi Bei, Tristan Teo, and Ng Yiling, must be congratulated for their varied dance movements.

Often forgotten are the directors Yong Hwee Jun, Tay Yu Rong, and Pang Wei Han. They really extracted every ounce of profundity, subtlety, and character development from the main cast. Hidden, and yet absolutely essential to a successful production, are the producers: Poh Yu Tong, Yan Yilong, and Gavin Prasetyo Raharjo. Overseeing the entire production with delicate mastery is Prof Ho Han Kiat.

In a large production like this, it is inevitable that many names will be omitted, inadvertently. All must be congratulated.

In short, The Girl With the Red Balloon is another important landmark in the history of Raffles Hall Musical Productions. It is funny, yet serious. It is frivolous, yet profound. It is entertaining, yet philosophical. And oh yes, the music is wonderful.

Congratulations!

Reviewed by Kenneth Lyen

23 Oct 2016

Viva Lah! Singapura: the musical

Viva Lah! Singapura: the musical

Raffles Hall Musical reviewed by Kenneth Lyen

It is said that when the stars align, the world will hold still. Tonight the world of musical theatre at the National University of Singapore held still. Bursting onto the University Cultural Centre stage was a coven of hungry new talent, fixated upon bewitching their audience with a devastatingly enchanting new musical.

Produced by Raffles Hall, Viva Lah! Singapura revolves around Happy Laksa House, which is being acquired by a multimillionaire property developer. After the death of his father who founded this eatery, Ah Hock became the owner and sole chef. His daughter, Rachel, is unable to see eye-to-eye with him, in part because he objects to her ambitions to embrace music as her career. While singing at a bar, Rachel is noticed by Darren, who is attracted to her. He recognizes her as Ah Hock’s daughter because he has seen them at Happy Laksa House which he frequents. Darren is disillusioned with his current office job and secretly wants to become a laksa chef. Comic relief is provided by the two stall helpers, Aunty Nancy and Ah Jie. A slightly more menacing figure is Mr Lam, the right-hand man of property developer David. The twist at the end is discovering who David really is, and what finally happens to Happy Laksa House.

There are many outstanding features of this musical. The characters are very strongly delineated: their wants, their dreams, their frustrations. The conflict is also sharply etched. This includes the abrasions between father and offspring arising from the latter’s ambitions of entering non-traditional professions, namely singing and becoming a laksa chef. The plot is linear but has enough twists and turns to make it unpredictable. Humor is liberally sprinkled throughout. There is the clever wordplay on the Chinese word for oyster, “hum”; e.g. “you warm the cockles of my heart”. There is a dig at Singapore’s propensity to use acronyms in the song “Home is No ABC”. There are also gentle pokes at the difficulties of doing business in Singapore, and the compulsory military service for boys. Whenever the social network service Twitter is spoken of, you hear the sounds of tweeting birds. Highly exaggerated embellishment of the word “hashtag” adds to the jocularity.

A musical would not be a musical if does not reverberate in songs. Viva Lah! Singapura does not disappoint. The melodies are catchy so that one leaves the theatre humming (pun intended) the tunes. Especially catchy are these songs: “Happy Laksa House”, “Why? Why? Why? Why?”, “To Be Me”, “Stars”. Credit goes to the dynamic duo, bookwriter Sebastian Ang and composer Jonathan Shin. Both took part in writing the lyrics.

Casting is near perfect, with everyone a triple threat, being able to act, sing, and dance. It is difficult to single any one performer because they are all good. Quite remarkable for a student production. But if forced to, one must mention Bryan Wong who plays the lead character Darren, Chin Ying Xin who plays Ah Hock’s musician daughter, Boh Ze Jun who plays Ah Hock so well that one can accept him as being middle-aged, Yong Hwee Jun who plays the flamboyant getai singer Aunty Nancy, Raphael Quek Hao Chong who plays a perfect schoolboy nerd, and Sebastian Tan Jun Pin who plays Mr Lam, the property developer’s erratic henchman, Priscilla Chan Xin Yu who has such an authentic mainland China accent, and Lim Hoe King, the cold-hearted property developer. All good!

You can write the best musical ever, but it can easily be ruined by poor stage directing. Fortunately the triumvirate directors, Tan Yilong, Sebastian Ang, and Tan Choong Hou, brought out every nuance, every joke, and extracted every drop of tears from the audience. Particularly memorable was the bar scene where the awkward advances and subtext dialogue struck an embarrassing chord in the audience.

Kudos also to the music directors, Joshua Koh and Kayla Koh, as well as the dance choreographers: Ng Shi Ming Tammy, Shalom Lau Li Yin, and Chua Zhi En. The sets were cleverly designed by Gavin; sets heads were Ang Li Qing, Georgina Lim, and Yan Xu. They are all essential to the success of the musical.

To make all this possible are another triumvirate, namely, the producers: Tan Li Lian, Tan Wei Chun, and Koh Hui Wen Michelle. They have to coordinate the entire production and manage cast and crew, totaling 190 students. Quite a feat!

The Master of Raffles Hall, Professor Ho Chee Kong, and the Advisor to the musical production, Professor Ho Han Kiat, must also be congratulated for their incredible support.

A good musical is one with a good story and good music. A great musical is one that makes you laugh until it hurts, and one that makes you cry because it has touched your soul. Viva Lah! Singapura is a great musical.

Congratulations!

Reviewed by Kenneth Lyen
17 Oct 2015

CAST
Darren: Bryan Wong Mun Kit
Rachel: Chin Ying Xin
Ah Hock: Boh Ze Jun
Aunty Nancy: Yong Hwee Jun
David: Lim Hoe King
Robert: Raphael Quek Hao Chong
Ah Jie: Priscilla Chan Xin Yu
Mr Lam: Sebastian Tan Jun Pin

CREATIVE TEAM
Producers: Tan Li Lian, Tan Wei Chun, Koh Hui Wen Michelle
Directors: Tan Yilong, Sebastian Ang, Tan Choong Hou
Book and Lyrics: Sebastian Ang
Music and Lyrics: Jonathan Shin
Music Directors: Joshua Koh, Kayla Koh
Music Arrangers: Cho Koi Hong Jermain, Eveline Patricia Kutawijaya, Hew Kai Ling
Vocal Coaches: Ng Kai Jun, Sherman Yuen
Choral Directors: Shuy Wan Xin, Koh Yeh Jie Wilson, Tay Yu Rong
Choral Arranger: Samantha Wee
Dance Choreographers: Ng Shi Ming Tammy, Shalom Lau Li Yin, Chua Zhi En
Sets Designer: Gavin
Sets Heads: Ang Li Qing, Georgina Lim, Yan Xu
Lights Designer: Prakash Prashanth
Costumes Designers: Fung Wing Sang, Rachel Lim Jia En, Wan Kai Mi
Stage Managers: Nyeow Low Chen, Lionel Lim Jun Jie, Cynthia Tantono, Karluis Quek
Hon General Secretary & Treasurer: Sun Wee Wair, Kan Pei Ru
Graphic Designers: Lee Jia Sheng, Raja Aravindh Raj

Singapore Musical Theatre

Singapore Musical Theatre
by Kenneth Lyen
In Singapore Soundscape edited by Jun Zubillaga-Pow and Ho Chee Kong

Ever since Singapore became independent, the government has been trying to forge a unique Singapore identity. Two decades of exceptional economic growth lifted Singapore from a Third World into a First World country, and the basic necessities of employment, housing, health and education were largely met. Singaporeans had more time for leisure and were now clamouring for the higher things in life. Art and entertainment were no longer trivial subsidiary components; they had become essential elements of the good life. Musical theatre quickly assumed that role. It told stories that the public could identify with, embellished with a youthful and earnest corp of singers, actors and dancers.

In the 1970s, Singapore was regarded as a ‘cultural desert’. Committees on music, literature, drama, art and dance were established by the government in 1977 to accelerate cultural development. In 1989, the government published the Report of the Advisory Council on Culture and the Arts. The then Deputy Prime Minister Ong Teng Cheong wrote, ‘Countries all over the world are recognising the positive impact of the arts on the economy.’ In order to attract overseas talent to live and work in Singapore, the country needed to transform itself into a gracious society and become an artistically vibrant city. The arts would play a major role in this endeavour. While the motivation for promoting the arts was initially economic, nevertheless the government did commit to the establishment of the National Arts Council and the investment of $600 million in the development of the Esplanade, a complex of theatres, a concert hall and a performing arts library. Furthermore, it liberalised its attitudes towards censorship.

Prior to 1988, the only musicals seen in Singapore were Western imports from Broadway and the West End. Their influence was pervasive but the companies that performed these shows did little in terms of technology transfer. There was no tradition of Singapore librettist, lyricists, composers, producers, directors, choreographers, designers and engineers. There were no experienced mentors to guide the novice creative and performing teams. The Singapore musical had to start from scratch.

Because Singapore sits at a crossroads between the East and the West, its theatre and musical influences are mainly from Britain and the United States on the one hand and, to a smaller extent, from China and Japan on the other. To an even lesser extent, there are also influences derived from Southeast Asia and India. Interestingly, English-language musicals have continued to dominate the landscape. It could be argued that after nearly 140 years of British rule, when the only musicals performed in Singapore were Gilbert and Sullivan, Noel Coward and other West End musicals, one should not be surprised that Singapore would begin by imitating British musicals.

As the urge to create became overwhelming, two theatre companies created the first Singapore musicals in 1988. Act 3 assembled a team and produced Makanplace, while TheatreWorks originated Beauty World. Despite the lack of experience and no track record, both theatre companies created stories and characters that Singaporeans could identify with, accompanied by appealing and danceable songs. These pioneer Singapore musicals were exuberant and competent and were instant successes, performing to sell-out crowds.

Subsequently, many more locally-written musicals were created, but the attendance at these productions has been inconsistent at best. Most Singapore musicals were unable to sustain a run longer than a couple of weeks. By contrast, imported shows from the United States and Britain, like Phantom of the Opera, Chicago and Les Misérables, not only had relatively longer runs but were also brought back for multiple runs.

What are the reasons for the short runs of Singapore musicals? In the main, support for locally-written musicals is not as strong compared to foreign imports. A large percentage of the population speaks Chinese as a first language. The segment that speaks English well and attends English-language theatre remains relatively small. In addition, musicals with a short run often do not break even. Without adequate profits, production companies have to rely heavily on corporate sponsorships and government subsidies. Unfortunately, government help is accompanied by restrictions in terms of what is deemed acceptable for public performance. For example, funding support has been reduced when a production company produces shows that glorify alternative lifestyles or are too risqué. Because of the fragile nature of obtaining regular funding, and the uncertainty of commercial success, production companies are reluctant to take risks and often cut costs to minimise potential losses. As a result, production values suffer.

Otherwise, a few successful Singapore musicals like Beauty World (1988) and Chang and Eng (1997) have travelled overseas in Asia. While Beauty World toured the Japanese cities of Fukuoka, Hiroshima, Osaka and Tokyo, Chang and Eng was performed in Bangkok, Beijing and Hong Kong. To date, however, no Singapore musical has made it to Broadway or the West End. Neither have Singapore musicals achieved international quality. Why is this?

Foremost, Singapore is a relatively young, independent nation and its musical theatre is even younger. Entering so late onto the international scene can be a disadvantage. On the one hand, writers and composers write for their audience. In general, the average Singapore audience prefers low-brow humour and melodic songs, and tends to avoid intellectual or deeply emotional themes. Knowing this, the creative teams write accordingly. Thus, two decades have not been long enough for Singapore writers and composers to discover their own voice.

On the other hand, Singapore writers and composers are not bound by West End or Broadway traditions. One might have expected them to look at the musical from a fresh perspective and to be more experimental in their efforts. However, they tend to be rather conservative. There may be many Asian stories to tell, and indeed the Singapore musical does well in telling these stories, but the stories chosen tend to be rather bland and without intellectual or emotional depth.

International versus Local

Art and entertainment in the globalised world of today is heavily influenced by the West. When the inexperienced writer or composer faces an audience brought up on a diet of Western musicals, it is doubly difficult to find that unique Singaporean voice. This includes telling stories, creating characters, describing the physical and emotional landscape, and expressing the values, history and personal experiences of Singapore and its peoples. Furthermore, most homegrown musicals generally do not have a sufficiently rigorous developmental process of polishing and refining, so the final product fails to achieve an international calibre.

Singapore audiences like to identify with their characters and, if the story is set locally, it is then expected that they will speak Singlish, a colloquial form of English. It incorporates words from Malay, Hokkien and other Southeast Asian languages. Singlish often raises laughs among Singaporeans, and its use in theatre is mildly subversive: the Singapore government frowns on and actively discourages Singlish in schools and public broadcasting. Also, non-Singaporeans may have difficulty understanding Singlish, and too much of it might reduce a show’s exportability.

Therefore the writer is caught in a dilemma – should one write for an international audience with the hope that these shows can travel overseas? Or should one write something that reflects the authentic local culture? Theatre companies, aware of the relatively small size of the Singapore theatre-going audience, try to produce shows for an international audience, hoping to export these shows overseas. The need to write for an international audience inevitably influences their style of writing. Because of this dilemma, English-language musical theatre will continue to face difficulties finding its own voice in Singapore because of the nation’s varied uses of English.

There is also a shortage of good scriptwriters in Singapore. The scriptwriter is responsible for the story as well as the spoken dialogue. It is important for the success of a musical that the writer tells a compelling story and develops interesting characters. As a result, some songwriters, like Dick Lee, have frequently collaborated with non-Singaporeans in their musicals. Dick Lee teamed up with British and American writers Steven Dexter and Tony Petito and lyricist Anthony Drewe for the musical A Twist of Fate, and British writer Stephen Clark for the musicals Sing to the Dawn and Forbidden City. Some have argued that to develop a truly Singapore musical, there needs to be less reliance on non-Singaporean writers.

The music component of Singapore musicals seems to have become stuck in the period between 1950 and 1970. Beauty World has a Latino slant, Nagraland leans towards Indonesian ethnic music and Chang and Eng features a lyrical Broadway style with Asian elements. The music of many English-language musicals sounds like church music: not gospel music, but rather contemporary Christian music. The music is melodic and the harmony tries to be slightly unpredictable so as to give it a modern feel. The structure follows the traditional verse-chorus plus bridge convention.

Chinese-language musicals, on the other hand, are influenced by the xinyao style, a genre of songs unique to Singapore. Xinyao songs have a unique style with a clear melodic line, sung by one or more singers usually accompanied by a guitar. Liang Wern Fook is a proponent of this xinyao style, and his two musicals, December Rains (1996/2010) and If There’re Seasons (2009) are of this genre. However, not all Chinese-language musicals employ the xinyao style. For example, Liao Zhai Rocks! (2010) employs mostly rock music. What is conspicuously missing among Singapore musicals is a lyric-centred style of songwriting exemplified by the works of Stephen Sondheim and Jason Robert Brown.

Chinese-Language Musicals

In its early years, all Singapore musicals were written in English; it is only from the mid-1990s that Chinese-language musicals gradually made their appearance. Despite being performed in Chinese, the structure and style of Chinese-language musicals reflect Broadway and West End musicals. One of these musicals is Mr. Beng (1999/2000), which was produced by Drama Box and staged at the World Trade Centre Auditorium. The librettist was Otto Fong and the music composed by Iskandar Ismail; the musical was directed by Kok Heng Leun. The story follows the rise and fall of Chow Kok Beng, a young contractor who strives to discard his image of being ‘beng’ (a man perceived to be loutish and uncouth) after falling in love with Peach, a wealthy English-educated brat. He falls prey to Peach’s coaxing to alter his lifestyle and to discard his ‘beng’ friends for the finer things of life, such as dining in French restaurants and speaking proper English. However, he is unaware that Peach is only putting on an act of loving him so as to crush him both financially and emotionally. The dialogue and lyrics are in English, Mandarin and Hokkien, and could be confusing for those who do not understand all three.

Another Chinese-language musical is Lao Jiu (2005), which was produced by The Theatre Practice and staged at the Drama Centre. Based on a 1990 play by Kuo Pao Kun, it was adapted into a musical by librettists Zhang Xian and Wu Xi, with dialogue in Mandarin and Hokkien. The lyrics were written by Yang Qian, Wu Xi and Xiao Han, with music composed by Jonathan Price and puppetry by Tan Beng Tian and Rene Ong. The show was directed by Kuo Jian Hong and choreographed by Kuo Jing Hong. The title refers to the ninth and last child, the only son, born to the Chng family. They have a family friend, a traditional Chinese puppeteer, who predicts before birth that the boy will be talented and intelligent. Indeed, the predictions come true and the boy excels in his studies. He is invited to sit fora scholarship exam that could open the doors to a promising academic career. However, he dreams of becoming a traditional puppeteer, a dying art form. In the middle of the exams, he suffers a crisis of confidence and decides to follow his artistic dreams rather than the more prosaic career option strongly advocated by his parents and other family members. Despite a strong storyline, the music does not have much emotional resonance.

Directed by Goh Boon Teck, December Rains was first staged in 1996 and again in 2010. The xinyao music was written by Liang Wern Fook and Jimmy Ye. The story is about rich girl Li Qing who falls in love with her schoolmate Ying Xiong, an idealistic left-wing revolutionary typical of 1950s Singapore. The girl’s parents object to their friendship and lock her at home so as to prevent the two from communicating with each other. Ying Xiong’s idealism drives him to go to China to support the Communist cause and he asks Li Qing to join him. However, she wants Ying Xiong to remain in Singapore and sends him a letter via a mutual friend, Ming Li, who has a crush on Li Qing. Ming Li fails to deliver the letter and Ying Xiong sails to China. Thirty years later, Li Qing’s daughter, Meng Yu, falls in love with Yang Guang, an actor from China, but Li Qing disapproves of this union. History is about to repeat itself until Ming Li intervenes and persuades Li Qing to give Yang Guang a chance. When Yang Guang’s adoptive parent’s fly in to Singapore, Li Qing takes the opportunity to meet them. Yang Guang’s adoptive father turns out to be Ying Xiong! Ming Li finally decides to reveal that he was the one who failed to deliver Li Qing’s letter to Ying Xiong, but just before he manages to confess, he dies from a heart attack. The xinyao music is pleasant and melodic, but too many ballads prevent the musical from reflecting the emotional highs and lows of the drama. The development of Li Qing and Ying Xiong’s love is perhaps too rushed and one does not feel for them.

In 2011, Goh Boon Teck, the director of Toy Factory Productions, adapted Royston Tan’s 2007 film 881 as a musical. Staged at the Esplanade, the musical tells the story of two friends, Min Min and Yan Yan, who dream of singing in the Seventh Month Ghost Festival stage (getai). They seek the help of an ex-getai singer, Ling, who helps them rehearse and gives them their stage name, ‘Papaya Sisters’ (which sounds like ‘881’ in Mandarin). Three deities (Fu, Lu and Shou) narrate the story, help the Papaya Sisters, and provide slapstick comic relief. Competing for the same getai stage are the irritating Durian Sisters from Romania. The Papaya Sisters’ prospects end abruptly when Min Min collapses from an undiagnosed brain tumour and eventually dies. 881 is a jukebox musical featuring old Hokkien songs that used to be very popular in their day.

Dance is the weakest element of Singapore musicals. In general, the choreography is unadventurous and the dancers are not well synchronised. The lack of good dancers may be due to the decline in popularity of jazz ballet, modern and abstract dance. Most young dancers in Singapore are learning hip-hop, which does not have the range of expression or subtlety of interpretation seen in jazz ballet, for example. As a result, many Singapore musicals have little or no dancing.

In an effort to forge a more systematic developmental process, an association called Musical Theatre Society (later renamed Musical Theatre Live!) Was set up in 2004. This organisation discovers new creative talent and helps find collaborators for writers and composers. It nurtures talent by inviting experienced playwrights, composers and directors to critique and mentor the creative teams. Readings of the embryonic musical are conducted in front of small groups, and when ready for public display a staged reading is performed in front of an invited audience that includes producers from established theatre companies who are invited to take up the work for commercial staging. To date, this organisation has incubated over 30 new musicals, including Georgette by Ng Yi-Sheng and Clement Yang, about the life of Singapore artist Georgette Chen. This musical was staged in Singapore and the Philippines in 2007. There have been several experimental short musicals, like 10 Days of Mourning by Carolyn Camoens, who is active in the Singapore Indian arts scene. This musical featured traditional Indian music composed by Nawaz Mirajkar in 2006. Another experimental musical from 2006 was The Swami, the Cow and the Spaceman by Musa Fazal, with music by Sean Wong.

One advantage Singapore has over the West End and Broadway is that the cost of a production remains relatively low. A reasonably good production can be mounted for around $750,000. This contrasts with the multiple millions of dollars that must often be spent in the West. Also, the theatres in Singapore are relatively new and are equipped with state-of-the-art acoustics and stage facilities. However, assembling the right team of producers, directors, choreographers, performers, musicians, lighting and sound designers and stage managers remains a perennial problem. It must be remembered that the Singapore musical started in 1988 virtually from scratch and over the past two decades production companies have gradually built up their expertise. This is a continuing evolution and remarkable progress has already been made.

The term ‘triple threat’ refers to performers capable of singing, dancing and acting. Local performers who possess this ‘triple threat’ are rare, so the same faces tend to crop up in many musicals. Since 2004, there has been only one school – LASALLE College of the Arts – that offers a degree course in musical theatre. Even though only a very small handful of Singaporeans manage to pass the audition to enter this school, the musical theatre course will probably play an important role in supplying well-trained performers in the long run.

Musical theatre in Singapore is fresh and energetic. It is influenced by both the West and the East, and in time, will find its own unique voice. But the future of the Singapore musical depends on the creation of many more new works, on audience development, on increased corporate and government support, and further liberalisation in the attitudes of the funding bodies.

Selected Musicals

Makanplace (1988) takes pride of place in being the first Singapore musical to be staged. The book on which the musical is based was written by R. Chandran. The librettist was Jasmin Samat Simon, who also composed the music with Saedah Samat. It was produced by Act 3, directed by R. Chandran and choreographed by Richard Tan. Set in a hawker centre, it revolves around the lives of those who work there, those who come and go, and how their lives intertwine. It highlights the value of friendship and of chasing dreams. The music is jaunty with pleasant melodies. Altogether the show contains 10 songs, including two reprises. Notable songs include ‘Makanplace’ and ‘Where Do We Go from Here?’ The musical was first staged at Victoria Theatre and a few years later restaged at The Drama Centre. A made-for-television version was aired by Singapore Broadcasting Corporation in the early 1990s.

Beauty World (1988) was first staged at the World Trade Centre Auditorium. The script was written by Michael Chiang, with music and lyrics by Dick Lee. It was produced by TheatreWorks, directed by Ong Keng Sen and choreographed by Najip Ali. Set in Singapore in 1965, the story follows Ivy Chan Poh Choo, an illegitimate child abandoned by her family in smalltown Batu Pahat, Johor. The only clue to her heritage is a broken jade pendant with the words ‘Beauty World’ inscribed on its back. She comes to Singapore in search of her father, meets up with her dotty pen friend, who informs her that Beauty World is a sleazy nightclub in Singapore. She meets Lulu the main cabaret dancer, Mummy the mother figure, Ah Hock a gangster and bartender, and eventually Boss Quek, the owner of the club. One of the patrons of the club, Towkay Tan, lures Ivy to a room upstairs and attempts to rape her. Luckily, she is rescued by Ah Hock, who is attracted to her. Eventually, Ivy learns who her parents are and there is a happy ending. The dialogue uses Singlish quite liberally, which raises laughs with the local audience. Dick Lee’s music is pleasant with a style out of the 1950s. The most memorable tunes are ‘Beauty World Cha Cha Cha’, ‘Single in Singapore’ and ‘Ivy’. The musical had a second run in 1992, and went on tour in the Japanese cities of Fukuoka, Hiroshima, Osaka and Tokyo in September 1992. In 1998, it was reproduced as a television musical production for the fourth President’s Star Charity.

Fried Rice Paradise was originally produced in 1991, but was completely rewritten by Dick Lee to celebrate the 50th anniversary of the People’s Association in 2010. Set in the 1970s, the story centres on Bee Lean, who is trying to save her father’s coffee shop from being bought over by Rickson Goh, the owner of a disco joint. She is also trying to save their entire row of shophouses from being repossessed. Bee Lean’s idea is to transform her father’s coffee shop and attract more customers by selling her mother’s famous fried rice recipe. The most memorable song is ‘Fried Rice Paradise’. Unfortunately, it takes almost half the musical just to set up the plot and the insertion of community songs is a bit forced.

Big Bang! (1995) was staged at the Kallang Theatre. The script was written by Stephen Yan, the lyrics by Desmond Moey, and the music by Kenneth Lyen and Desmond Moey. Additional music was written by Adrian Oh. It was directed by Bob Turoff. The story is based on the life of Cambridge cosmologist, Stephen Hawking, and covers the history of astronomy from the ancient Chinese, through Galileo, Isaac Newton, Albert Einstein and Fred Hoyle. Memorable songs include ‘Big Bang!’, ‘I like Your Mind’ and ‘Stars’. The music was also used during the opening of Fusionopolis in 2008, with Prime Minister Lee Hsien Loong in attendance.

Sing to the Dawn (1996) was produced by the Singapore Repertory Theatre and staged at the Kallang Theatre. The script was written by Ho Minfong and Stephen Clark, with lyrics by Stephen Clark and music by Dick Lee. It was directed by Steven Dexter and choreographed by Gani Abdul Karim. Based on Ho Mingfong’s novel of the same name, Sing to the Dawn is the story of Dawan, a Thai peasant girl who wins a scholarship to study in the city, but has to overcome parental and societal objections to achieve her goal. Despite such a simple storyline, the book explores the deep emotional conflicts both within and outside the family. The music captures the ethnic character of Thailand and covers a wide range of moods. Three songs stand out: ‘My Child’, ‘The City’ and ‘It Just Flies’. The musical is unrelated to the 2008 animation with the same title and story.

Chang and Eng (1997) was written by Ming Wong with music and lyrics by Ken Low. It was directed by Ekachai Uekrongtham and choreographed by Mohd. Noor Saman. The story is based on the life of a pair of Siamese twins, Chang and Eng. They are taken from Thailand and brought to America to be part of a freak show. They meet a pair of American twins with whom they fall in love, marry and produce a total of 21 children. Ken Low wrote a varied score ranging from the comic ‘The Grand Midwife of the West’ to touching ballads like ‘From Now On’ and ‘Mai Phen Rai’. The show was a commercial success and toured China, Hong Kong and Thailand.

Temptations (2000) was produced by the Rainbow Theatre. The script was written by Kenneth Lyen, with lyrics by Desmond Moey and music composed by Kenneth Lyen, Desmond Moey and Iskandar Ismail. The show was directed by Jonathan Lim. The story is about food critic Shawn who takes his fellow reporter and date, Leila, to a high-class restaurant called ‘Temptations’. But because of their improper dress, the snobbish restaurant owner, Cat, treats them condescendingly. As a result, Shawn writes a poisonous article about the restaurant in his newspaper column. Cat subsequently turns up at Shawn’s newspaper office to protest, but Shawn refuses to retract his article. Not long after Cat and her restaurant’s cook go for drinks at a nearby café where they bump into Shawn and Leila again, and all four are forced to share a table. It slowly becomes apparent that behind the duelling words of Shawn and Cat is a subtext that they are actually enjoying each other’s company. The unlikely pair gradually fall in love and a series of events draw them closer. There is a subplot concerning a cross-dressing cook and Leila. Four other actors make up a Greek chorus and act as intermediaries to the audience. The highlights of the musical are the songs that drive the plot forwards, including ‘No Slippers, No Shorts’, ‘Getting Burnt’ and ‘Manya’s Story’.

Forbidden City (2002) was first commissioned to mark the opening of Esplanade – Theatres on the Bay. The script was written by Stephen Clark and Dick Lee, with lyrics by Stephen Clark and music by Dick Lee. The musical draws from Sterling Seagrave’s controversial biography of Empress Dowager Cixi. It narrates her struggle for survival behind the closed doors of the Forbidden City, maintaining her power in the face of calumny from her own subjects as well as the English press. The story is told from the point of view of American painter Kate Carl and an unscrupulous British journalist George Morrison. There is comic relief provided by the Record Keepers. The music is pleasant and enhances the drama. Forbidden City was restaged in 2003 and 2006.

Phua Chu Kang (2005) was staged at the Kallang Indoor Stadium. The script is unaccredited; the lyrics were written by Edmund Ooi, Catherine Casey, Vivienne Lin and Adeline Tan, and the music composed by Edmund Ooi and Peter Casey. The show was directed by Edmund Ooi and choreographed by Bill Calhoun. The story finds contractor Phua Chu Kang on the brink of turning 40. He drops copious hints to his relatives and workers, but they all pretend not to know while secretly planning a surprise birthday party. In the meantime, Phua Chu Kang’s arch nemesis, Frankie Foo, is angry that Chu Kang had stolen his childhood sweetheart Rosie and vows vengeance. He plants one of his relatives, a Chu Kang lookalike who claims to be Chu Kang’s brother Chu Kok. Chu Kang is hoodwinked by this imposter, who takes him to see a Feng Shui master. The latter informs Chu Kang that he will die on his 40th birthday. Depressed, Chu Kang signs away his house and all his belongings to his brother. Chu Kang’s family is angry and upset that everything has been given away to this fraudulent brother. Just as the villainous Frankie Foo is about to claim Phua Chu Kang’s home and evict the entire family, he has a heart attack. Phua Chu Kang resuscitates Frankie, who then tears up the contract, but secretly vows to destroy his savior in the future. The story is predictable and the set-up takes too long. The music is largely functional and some of the songs do not advance the plot or enhance characterisation.

Georgette (2007) was produced by Musical Theatre Ltd and staged at the Esplanade Recital Studio. The script and lyrics were written by Ng Yi-Sheng and the music by Clement Yang. The musical focuses on the life of Singapore artist Georgette Chen during her younger, formative years. The first half sets the tone by focusing on the relationship between Georgette and Eugene, an ethnic Chinese from Trinidad who is twice her age and eventually becomes the foreign minister of China. Georgette is fiercely independent while Eugene is reserved. Nevertheless, they marry against the wishes of Georgette’s wealthy parents. The story follows the pair as they travel from China to Paris to Trinidad and are ultimately caught by the sweep of history. They are imprisoned by the Japanese in Shanghai during the Second World War and they encounter communist forces. The music reflects the different countries and periods very well. It is one of the more innovative Singapore musicals. The show was also staged in the Philippines. Memorable songs include ‘Woman on the Wall’, ‘Don’t Cross Your Chopsticks’, ‘Raise the Flag’ and ‘A Bowl of Fruits’.

H is for Hantu (2009) was produced by Stages and originally staged at the Alliance Française Auditorium. The script and lyrics were written by Jonathan Lim and the music was composed by Bang Wensum. Puppets were designed, created and manipulated by Frankie Yeo. The show was directed by Jonathan Lim. Sazali is a schoolboy who can see hantu (Malay for ghosts). He is living in Singapore’s last remaining kampong, where a community of spirits lives nearby. When Angie Seah,a woman from the Housing Development Board, comes to evict the residents so that the kampong can be redeveloped, Sazali decides to fight the bureaucrats. However, it turns out that Angie is a victim herself, possessed by an unspeaking ghost who drives her to scramble through the jungle at night, searching for something. Sazali investigates and finds out that Angie used to live in that kampong as a child and her best friend, Swee Choo, a mute girl, died soon after her departure for city life. It comes to light that Angie is not a villain and actually fought hard to be put in charge of the kampong’s relocation so that she could ensure the residents were treated properly. Since one cannot defeat the government once it has made up its mind, it would be more pragmatic to get the best deal possible for the residents. When Angie offers them attractive new apartments, they are happy to move and ultimately keep their community together using a Facebook group. Angie eventually meets the ghost of Swee Choo face-to-face and presents her with the token of their friendship she has been searching for. The best thing about the show might be the puppets, which are spectacular. The music supports the mock spooky feel of the musical.

References

Atkey, Mel. A Million Miles from Broadway: Musical Theatre beyond New York and London. Toronto: Friendlysong Books, 2012.

Hales, Aaron. ‘The State on Stage: A Socio-Political Critique of Singaporean Musical Theatre.’ Ph.D. Dissertation, School of Music and School of Social and Cultural Studies, University of Western Australia, 2009.

Lee, Dick. The Adventures of the Mad Chinaman. Singapore: Marshall Cavendish, 2011.
Report of the Advisory Council on Culture and the Arts. Singapore, 1989.

Tan, Kenneth Paul. Renaissance Singapore: Economy, Culture, and Politics. Singapore: National University of Singapore Press, 2007.

Yeoh, Lizhen Geraldine. ‘The Singapore Musical: Perspectives, Paradigms, Practices.’ Honours Thesis, Department of Theatre Studies, National University of Singapore, 2011.

Singapura the musical

Singapura: the musical
Reviewed by Kenneth Lyen

Maybe if I saw this show a few decades later, when memories of historical events have largely faded, where regional accents have merged into a nondescript form of global English, where style and pizazz are more important than character and plot development, I would rate Singapura a great show, aspiring to be Singapore’s Les Misérables. Don’t get me wrong, I enjoyed tonight’s performance immensely, but I will expound how I think it can be improved, below.

Singapura: the musical focuses on one family and how they are affected by the sweep of Singapore’s history from the 1955 Hock Lee bus riots, through Indonesian confrontation, the racial riots, and ending with Singapore expulsion from Malaysia in 1965.

The main strengths of this musical are the songs, the cast, the back projection and the moveable sets.

The majority of the cast are from the Philippines. The Filipino accent was largely subdued and I was not bothered by it. Juliene Mendoza played the role of the father, and his strong voice and acting abilities carried the role brilliantly. Maybelle Ti played his wife, mother to Lee May, who was played by Marian Santiago. Lee May’s British boyfriend, Flynn, was played by David Bianco. The highlight of the musical is the powerful love duet “Be With Me” between Lee May and Flynn. Raymund Concepcion played the Man in White, ostensibly Lee Kwan Yew. He is a commanding figure with a sonorous voice to match. Comic relief is provided by Noel Rayos playing the Indian, and Onyl Torres playing the Malay character.

Ed Gatchalian composed, arranged, and directed the music. For me, music is an essential component of a musical, and in this regard, the music can be highly commended. It is strident during the turbulent scenes, it is romantic during the courting scenes, sad when the mother dies, and triumphant at the finale. The songs are catchy and well arranged.

Driscoll Otto’s back projection demonstrates how photos and illustrations can greatly enhance the scenes and replace expensive sets. It is a definite wow factor.

David Permana conducted the orchestra and accompanied the singers faultlessly.

What could have been improved? The first half felt too long. The musical started off by placing too much emphasis on the history of Singapore rather than developing the individual characters. To some extent this was obviated in the second half. I did not like any of the university law lecturer’s scenes, and would have preferred to have all these scenes deleted. The over-emphasis on the role of the British after they had granted independence to Singapore overshadowed other historical elements. The lack of a satisfactory conclusion between Lee May and her British lover Flynn left me a bit confused. The father’s fears of the perils of Singapore are understandable, but his wish to emigrate to a utopian Malacca portrayed him as bit of a coward. To overcome this negative portrayal, I think his character arc needs more careful development: instead of running away from his problems, time needs to be taken to show how he confronts them. I would have liked to have seen the character playing Lee Kwan Yew to pay a visit to the kopitiam, take a drink, and have a brief conversation with the father. Finally, being a musical set in Singapore, I think more sprinkling of local languages and Singlish would enhance its authenticity.

So ultimately, we come back to the subject matter of the musical. If it is about Singapore, then it falls short. Hence the low score given below. Sorry.

However, I did enjoy the musical. And I would like to congratulate the creative team, the cast, the orchestra, and everyone involved in this musical for their magnificent effort!

2 June 2015

1.5 out of 5 stars

LKY the musical

LKY: the musical

Reviewed by Kenneth Lyen

 

This hagiographic biography of the first prime minister of Singapore is entertaining and well-performed. It also paints a panoramic history of Singapore from the 1940s until its independence in 1965. The sets are good, the use of back projections of historical photographs is effective, and the orchestration excellent.

However, as a musical, I left the Marina Bay Sands theatre with a sense of disappointment. This is not to say that it was bad. Indeed, there’s a lot to like about this musical.

The acting and singing are superb. Adrian Pang is a believable young LKY. He captures the tenderness of his love for his wife, his quick-thinking to escape from the Japanese, his charisma as leader of his political party to fight the British and later the communists. Sharon Au is the only female in the entire cast, but she pulls off her role as the wife of LKY, able to stand up to him as his equal. She is the weakest performer in this musical, but I did not mind it too much. Benjamin Chow is a talented actor-singer and there is a faint resemblance to the real Lim Chin Siong who he portrays. But his British accent mars him of believability as this left-wing extremist who is accused of having a secret agenda to take over political control of Singapore. Radhi Khalid acts the role of poker-playing Tunku Abdul Rahman, whose initial opposition to Singapore’s desire to merge with Malaya to form Malaysia makes him another antagonist. But having met and spoken to the late Tunku Abdul Rahman, I think that Radhi’s portrayal is really too off the mark. The rest of the supporting cast are good.

The lyrics are generally well-written. But overall, the songs are unmemorable. Dick Lee has written far better material in the past. The opening song of the second act is incongruous to the rest of the musical.

The three-tier sets are well-designed and used effectively. The direction and the technical aspects of the production are excellent.

The problem with the musical is that it tries to cover too much in the time allocated. It spans the period from Lee Kuan Yew’s schooldays when he came second in the final exams to Kwa Geok Choo, his future wife, to the separation of Singapore from Malaysia. I felt that Lee Kuan Yew is portrayed too superficially. There is little depiction of any inner struggles, and the love story between LKY and Geok Choo is painted too perfunctorily. The villain, Lim Chin Siong, is inadequately characterized, because we do not know what really drives him: is it ideology or ambition or both?

It is possible to write a historical musical where the ending is known beforehand, and yet maintain a degree of suspense throughout the musical. Sadly this is lacking in LKY the musical. Lee’s triumphs are rendered too predictable and the musical lacked emotional depth.

As a musical hoping to succeed in the West End or Broadway for an international audience, I doubt that, in its current form, it can realize this ambition.

But as a musical directed for a Singapore audience, it succeeds.

Congratulations!

24 July 2015

2/5 Stars

Nanyang the musical

Nanyang: the musical

Reviewed by Kenneth Lyen

You should watch Nanyang the musical, loosely based on the lives of artists Liu Kang and Georgette Chen.

Watch it to learn how not to write a musical. Nearly everything that you should not do is done here.

Character Development

To write a good musical you need to develop the main characters. Nanyang the musical has three pairs: male art student Chen Kang who falls in love with female artist Miss Li Ting; art student Mr Ren Hao who falls in love with fellow student Miss Yue Ping; and male art instructor Zhang Wen who is married to Balinese dancer Nini. Unfortunately, the bookwriter seems unable to handle this large number of protagonists, and would have done better to have cut the number down. There is no antagonist, so there is little tension generated between these main characters.

Plot

The plot is confusing. Chen Kang has just enrolled in the Xinhua Art Academy in Shanghai during the second world war just before the Japanese occupation of China. There seems to be some demonstration outside the academy. He is immediately attracted to fellow artist, Miss Li Ting. When she accidentally drops her purse at the end of the lesson, Chen Kang finds it, and upon returning it to Li Ting, quickly becomes infatuated by her. He spends the rest of the musical trying to chase after her. Then quite abruptly all these protagonists suddenly decide to go to Paris which is under Nazi occupation. Art instructor Zhang Wen successfully auctions one of his paintings, which apparently is controversial. But as we never see the painting, we cannot gauge how controversial it really is. In Paris, Ren Hao and Yue Ping announce their plans to marry, and to have their honeymoon in Bali, where Zhang Wen and Chen Kang have already decided to travel. In the meantime, Li Ting announces that she is going to America. In Bali, we discover that Zhang Wen is already married to Balinese dancer Nini and they have a young son. Then Zhang Wen receives a letter from Li Ting announcing that she is gone to Singapore. So they all travel to Singapore to meet Li Ting. Unfortunately on arrival, the Japanese who have occupied Singapore learn that the painter of the controversial painting, Zhang Wen is in that group, and want to arrest him. Initially Chen Kang claims that he is Zhang Wen, but realizing that the Japanese intend to shoot the painter, Zhang Wen gives himself up. (Spoiler alert). He is shot dead.

It is not made clear why the artists went to Nazi-occupied Paris, why the auctioned painting was so controversial as to warrant execution, and why it fell to the Japanese in Singapore to carry out the execution. In short, the plot is a mess.

Show, Don’t Tell

There are large tracts where back story is narrated. For example, Zhang Wen spends a considerable amount of time relating his past history which ideally should have been acted out. The opening scene asserts that the visual arts are an important component of life, and can act as a catalyst for revolution. But we do not see any of the art pieces, so we are unconvinced by this claim.

Imbalance

The Bali segment seems irrelevant. Far too much time is spent dancing. As there is no dancing in the other scenes, the forced injection of dance here, which does not advance the plot, makes the entire scene somewhat extraneous.

Songs

A musical must justify its use of songs. It can develop character, set the mood, advance the plot, create conflict, and intensify love scenes. Unfortunately the songs seem to be inserted erratically. This is not to say that the songs are bad individually. In fact, music is one of the saving graces of the musical.

Verdict

Nanyang the musical sadly fails in many areas. The characters are poorly developed, the plot is confusing, there is little emotional pull, and the abrupt ending is most unsatisfying. It is one of the worst commercial musicals staged in Singapore. This is a pity as it is the opening show for the Singapore International Festival of Arts 2015.

Nanyang pales in comparison with Ng Yi-Sheng’s musical Georgette, which covers the same artists.

http://www.kenlyen.com/gpage62.html

1/5 stars
6 August 2015
Director and Writer: Alex Tok
Lyricist: Xiaohan
Composer: Eric Ng
Music Director: Goh Kheng Long
Choreographer: Andy Benjamin Cai
Set Designer: Izmir Ickbal
Costume Designer: Yvette Ng

——————————————–

Review of Nanyang the Musical by Mohamad Shaifulbahri on 1st Sept 2015:

It was most unfortunate that my Singapore International Festival of Arts (SIFA) 2015 experience started with Nanyang the Musical. The work felt like an incomplete one and the writing was not particularly strong. Sure, we can debate about what a festival commission should look but the work just felt like it was not ready for the festival stage. Some of the directorial decisions made were also questionable like the odd decision to have many moments of silence during transitions (making one wonder if this was really a musical) and the Bali parts but other elements of the production made the watching more bearable though I must say that the choice to play with the projections on luggage was inspiring. The musical had a good cast that delivered and the score was fantastic and this made the show a little bit more bearable.

How to Create Talented Individuals?

How Does One Create Highly Talented Individuals?

 

The 2008 Beijing Olympics has been awe-inspiring. Incredible world records have been broken. Brilliant sportsmen like Michael Phelps from the USA, and Usain Bolt from Jamaica have held us spellbound.

 

Even Singapore grabbed a little bit of the limelight when it won a silver medal in table tennis. Never mind many of our table tennis players were born and bred in China.

 

I have been listening to a considerable amount of discussion asking why Singapore isn’t doing so well not only in sports, but in other fields such as the arts, film, and science.

 

One of the excuses given as to why Singapore has not produced its own international talent is that Singapore has too small a population. The theory is that geniuses are produced in a sort of mathematical ratio of one per x million population.

 

This cannot be true. Take Jamaica, for example. It only has a population of 2.8 million, and yet it has recently won 11 Olympic medals, compared to Singapore’s one medal. Even Ireland, New Zealand, and Croatia, with a population slightly smaller than Singapore have won more medals.

 

And it is not confined to just Olympic medals, but right across the board, including Nobel prizes and outstanding artists and filmmakers, and scientists. Singapore lags behind in all these fields.

 

 

Country	Jamaica	Ireland	New Zealand	Croatia	Singapore
Population	2.8 million	4.2 million	4.2 million	4.5 million	4.6 million
GDP per capita	$7,700	$43,100	$26,400	$15,500	$49,700
Olympic Medals (2008)	11 (6 gold, 3 silver, 2 bronze)	2 (bronze)	9 (3 gold, 1 silver, 5 bronze)	5 (2 silver, 3 bronze)	1 (silver)
Nobel Prizes	1 (Derek Walcott educated in Jamaica)	8	3	3	0
Internationally Famous Musicians	Sean Paul, Bob Marley	Sinead O’Connor, James Galway	Natasha Bedingfield, Kiri Te Kanawa	Riva, Stephen Kovacevich, Ivo Pogorelic	Melvyn Tan
Famous Scientists	Cicely Williams	Lord Kelvin, Frederick Donnan	Ernest Rutherford, Maurice Wilkins	Vladimir Prelog, Lavoslav Ruzicka	SS Ratnam

 

 

I think the problem lies in Singapore’s educational system. But first, allow me to say what I think is good about our educational system. It is universal, affordable, and the standard of mathematics and science teaching is of the highest quality.

 

Where it falls short is in the area of sports, arts, and creative thinking. My friend (CKJ) has a son who was very creative, making toys, modifying instruments and coming up with new and improved versions. However, when he entered primary school at the age of 6 years, suddenly his creativity vanished. His father said: “it was simply a question of ‘this is the answer, this is what it is, just memorize it.’”

 

Indeed school children are crammed with an inordinate amount of facts resulting in information overload. So much time is devoted to memorizing that there is scarcely enough time left for anything else. One example of this is that children are made to remember every single part of a microscope including the names of the little screws and other minor components. They are tested on these relatively unimportant facts, instead of being allowed to explore the microscope, the microscopic universe, and then be guided to think through and work out the principles of optics.

 

If a science experiment goes askew, the typical Singapore student would just copy the “correct” results obtained by a neighbour. Unfortunately this means that the student would miss out on an important learning opportunity, namely to work out what went wrong, and how the error could have been rectified. The solution to what goes wrong in an experiment is obviously not found in a textbook, and requires hard thinking.

 

Encouraging students to think for themselves, to devise their own experiments, to work out solutions to problems, and to troubleshoot faults, is distinctly lacking in most Singapore schools.

 

There are other areas of parochial thinking. For example, it is often assumed that creative thinking takes place almost exclusively in the humanities and not in the sciences. Thus science teachers do not place much emphasis on practical observations, do not challenge current theories, and do not prod students to produce original ideas and works.

 

Another example of blinkered vision is the overemphasis on the commercial value of everything. For example, scientific research in Singapore is only undertaken if it has to potential to make money. Pure research is frowned upon, because it is perceived that it takes too long to achieve commercial success. This restriction of research trickles down to all thought processes, and everyone edits out any ideas that do not obviously lead to profits.

 

A third problem is that every project must be measured by key performance indicators (KPI). This includes the performance of teachers, which is measured by how well their students do in exams. Research projects are also subjected to such evaluation. This means that certain results are anticipated, and it distorts the focus and direction of research, which, if it is meant to make profoundly original discoveries, will be thwarted.

 

Turning to sports, there are several reasons why Singapore has not produced its own indigenous sportsmen. Most of our international-standard representatives are born outside Singapore, and are granted citizenship in the hope that they will represent Singapore. A lack of facilities is not one of the reasons. Indeed Singapore is ranked seventh highest in the world with respect to GDP per capita. We have excellent sports facilities that my Jamaican sports friends would envy. So what is the problem?

 

I believe it is in the mindset. Sports is not valued as a profession worth pursuing. Most parents would discourage their children from devoting too much time to sports, as they fear this would erode into time for academic studies. Only recently has a sports school been started, but it is too early to evaluate how successful this will become.

 

Sports teachers are sometimes over-restrictive in their selection of students. If a child wants to participate in a particular sport, he would only be allowed to take part if he were already highly proficient in that sport. Beginners are rejected.

 

By and large, the same comments also apply to the arts. Parents tend to discourage their children from becoming too involved in the arts, and many teachers prefer to accept only those students who are already proven to be adept in that art. The emphasis is almost entirely on performance, and little value is placed on the creation of original art.

 

So where do we go from here? Singapore needs to re-evaluate its educational system, to place more importance on independent and original thinking. In this, it needs to sharpen the use of the tools of thought, which includes a higher level of language abilities, artistic, music and bodily-kinaesthetic expression.

 

An individual should receive a well-rounded, balanced education. Creativity can be cultivated, but it requires a fertile environment that is friendly, encouraging, and allows freedom of thought.

 

 

Like the gymnast leaping and somersaulting on a narrow wooden beam, an educational system needs to achieve a similar delicate balance. It is a balance between freedom and discipline, between active self-exploration and passive rote learning, between creative thinking and repetitive drills (divergent versus convergent thinking), between the learner chosing what to learn versus the educator dictating what needs to be learnt.

 

To achieve this balance is difficult. Any changes in the educational system or method of teaching, will only bear fruits decades later. Therefore, one should not base long-term educational decisions on short-term exam results. It is well recognized that many of our best inventors, entrepreneurs, businessmen, scientists, artists did poorly in exams.

 

To plan for the future, one encounters a further complication. The fulcrum of what constitutes a balanced education shifts from time to time, making it difficult for educators and administrators to know where precisely to position it in anticipation of future developments. A good example of this is the rise of information technology and computer education in the past few decades.

 

 

There is one more factor to consider. To rise to the absolute top of the heap, one needs to be highly motivated and stubbornly persistent. Listen to the swimmers, athletes, pianists, who all say that they have to train for hours everyday, often giving up other activities and a social life. You might ask: “How can this be regarded as a balanced life?” You would be absolutely right. You cannot have your cake and eat it. At least not initially.

 

Before I return to the question of balance, there is yet another element to consider. I have been fortunate to have been taught by top scientists, including Nobel prizewinners, and have met a few highly successful entrepreneurs. Almost without exception, they are outstanding original thinkers.  They have a keen sense of humor, and they have an unconventional way of thinking. They dare to think differently.

 

My friend (CKJ) tells me the story of a team of Formula 1 racing car engineers. When designing increasingly powerful engines that make their cars go faster no longer helps one win a race, because all the other cars are equally powerful, this team of F1 engineers met and brainstormed. Instead of concentrating on acceleration, the team’s designers realized that if they turned their attention to deceleration, they could increase the overall speed especially when turning corners. They therefore focused on brake development. If their car could brake just that little bit later at every corner of the track, it would be able to spend that fraction of a second longer at top speed than the other cars.  If they added all the corners of a race track on each lap, they could go around it maybe 2 or 3 tenths of a second faster than the other cars of equal engine power, straight-line speed and cornering speed. In F1 terms, where there are over 70 laps, this is a lot.  The point here is that it was a bit of really creative thinking by engineers, and indeed their car went on to win.

 

Talent alone is not sufficient. From the above, it is patently obvious that while innate talent is important, it is not a sufficient condition for winning the Olympics or a Nobel Prize. You need training to develop that talent, you need persistence, and you need to think creatively. Some people add luck to the equation.

 

Where can education help? I believe that the key to success in education is to remain flexible, to embrace new developments, not to lose sight of balancing the mind and body, and never abandoning the fundamental precepts of cultivating independent thinking, encouraging hard work and persistence, fostering a spirit of creative thinking, a lively sense of curiosity, and a mind that is continuously questioning.

 

That is the challenge!

 

Kenneth Lyen

25 August 2008

Confucius and Multiple Intelligences

Did Confucius think about multiple intelligences over 2 thousand years before Howard Gardner?

 

Confucius (551-479 BC) taught that the perfect gentleman had to excel in the following “arts”: mathematics, poetry, music, calligraphy, archery, charioteering, and rituals.

 

Howard Gardner (1943- present) suggested that each individual had multiple intelligences, and that these included mathematics, verbal-linguistic, music, visual-spatial, bodily kinesthetics, intrapersonal and interpersonal.

 

Is it possible that Confucius’ notion of a well-rounded person possessing many talents, might be the precursor of Howard Gardner’s multiple intelligences? If so, his ideas were conceived  over 2 thousand years ago. Think about it.

 

Howard Gardner (1943- )	Confucius (551-479 BC)
Mathematics	Mathematics
Music	Music
Verbal-Linguistic	Poetry
Visual-Spatial	Calligraphy
Bodily Kinesthetics	Archery, Charioteering
Interpersonal	–
Intrapersonal	–
–	Rituals

 

Normal Child Development

 

Historical

As academic disciplines go, the study of child development is relatively young. At beginning of the 20th century, the field of developmental psychology was still in its infancy, and psychologists were preoccupied with debates whether the developmental process was largely inherited, or molded by the child’s environment.

Psychologists such as the American John B Watson, believed that environment was the main factor and that any child could be fashioned into almost anything. This echoes the Jesuit motto: “Give me a child until he is seven and I will give you the man”. Sigmund Freud’s disciples also supported the “environmentalists” and claimed that most deviant child behavior was caused by mismanagement on the part of the parents.

Another American psychologist, Arnold Gesell, conducted child development studies in 1924 using motion pictures. In 1930, he introduced the use of the one-way observation room using a one-way mirror that enabled the investigator to watch secretly. He observed that the order and age of child development is determined more by nature than by nurture.

 

This view was supported by the Swiss psychologist Jean Piaget.  He studied how children learn, by detailed observations on his own three children. He became intrigued with his observation that children of a similar age often gave the same wrong answers to questions. This implied that there were persistent differences in the thinking and reasoning skills at various ages, which were not merely due to increased intelligence. Over the next few decades, he developed the concept that a child’s thought processes developed along particular patterns, independent of environmental influences.

 

Noam Chomsky observed that children had an innate knowledge of basic grammar common to all languages. This is interpreted that certain fundamental aspects of language development being due to nature rather than nurture. Obviously the environment will determine whether a person will speak one language or another.

 

Thus nature provides the basic framework for child development, upon which nurture will shape  subsequent growth.

 

In the field of personality development, Arnold Gesell proposed that as a child grows older, he assumes a new identity, a new personality. Therefore at each age, a child is not merely older and cleverer, but actually becomes a completely different person.

 

In 1965, the American psychologist and educator, Edward Zigler, introduced the Head Start program, which was an intervention program designed to give children from poor families a head start on their education. It has been beneficial and has given a boost to disadvantaged children as well as their parents.

 

Normal Child Development

 

Child development is the story of how a baby transforms from a helpless infant into a mature, independent, talented, intelligent, and loving adult. It includes following a child’s physical and intellectual progress, personality and social development.

The order of developmental events through which a child journeys is incredibly constant, with few deviations. Baby has to learn to sit before he can stand or walk. However, the rate at which development proceeds can vary quite substantially. Saying “ma” or “da” can commence as early as six months or as late as eighteen months.

The most prominent exception in the order of development, which is accepted as normal, is the absence of crawling. About 25 percent of children never crawl, and go straight from sitting to standing and walking, bypassing the crawling stage. Other children move themselves sitting on their buttocks, a form of propulsion known as “bottom shuffling”. Such children are delayed in their walking, which may not emerge until about two years of age. Development before and after this period of bottom shuffling is entirely normal. Perhaps the most variable component of childhood development is that of speech. While most children can say single words by 10-12 months, this can occasionally be as late as two years. A stimulating environment helps promote earlier development.

One Month Old

The one-month-old behaves very much like a newborn baby. He may be able to start smiling and to track movements by following with his eyes. The neck muscles are still weak and, if tilted forwards backwards, the head will just flop down. Although he cannot locate the source of a sound by turning his head, he can be startled by a sudden loud noise like a door bang.

 

Three Months Old

 

The three-month-old baby is starting to gain more muscle control, and can hold the head upright a bit longer, but this is still a shade unsteady. The smile is now a definite social smile in response to a familiar face or to express real happiness. Some children may start to roll half way from the back to the front. Some may start swiping at an object placed in front of them. If you give him a rattle, the first thing he does is to put it in his mouth as a form of oral exploration. He can make a lot more noise by babbling.

 

Six Months Old

 

The six-month-old is full of energy. If, when lying on his back, he sees you offer to pull him up to sit, he will anticipate you and tilt his head forward. The back will straighten and his knees will be bent, with the legs lifted up in the air. He can reach out to grab a toy, and transfer it from the left hand to the right. He may even be able to sit with his hands propped out in front like a tripod.

 

When he sees someone familiar he will squeal or laugh. He knows that he can make you smile by beaming a smile over to you. Babbling is much more frequent, and he might start blowing bubbles from the mouth. The first tooth may be starting to erupt, but this is a variable event, and some children do not have their first tooth until after their first birthday. From about six months old, children may develop stranger anxiety, so if they see a strange face, they might start crying.

 

Nine Months Old

 

The nine-month-old baby can sit without using his hands to support himself, and he can pull himself up to stand. Most nine-month-old children can crawl, but about a quarter of all babies bypass the crawling stage, and go straight from sitting to standing and walking. The baby can now pick up tiny objects between finger and thumb, clap hands and wave bye-bye. He might be able to say “ma” or “ba”, or just continue babbling. He should be able to turn his head to locate a sound source. You will probably be able to play games such as “peek-a-boo” with your nine-month-old.

 

One Year Old

 

The one-year-old can stand and walk around holding onto your hand or onto some furniture. He can say single words other than “ma” and “ba”, and understand simple commands like “give!” He might begin to show preference in using the right or the left hand. When given an object such as a rattle, he will examine it in different ways, like shaking it, hitting with it, throwing it, or mouthing it. He enjoys looking at the pictures in a book, and will point correctly to the familiar object that you name. But he is unable to turn the pages singly, grasping several pages at once. If a small object is hidden with a piece of cloth or paper, he will realize that it still exists, and will remove the cloth or paper to uncover it. This is known as object permanence. By 13-15 months of age, he can walk unaided.

 

Eighteen Months Old

 

The 18-month-old can walk very securely, and might even run around or stoop to pick up a toy. He can say several single words, such as “bird”, “dog”, “grandma”, and “brother”. When given some wooden cubes, he can build a tower with at least three of them. If given the opportunity, he can learn to drink from a cup, and attempt to eat using a small plastic spoon. When given a large nontoxic crayon, he can scribble with it. He can point to his nose and other body parts, and can roll a ball back to you. He can brush or comb hair, and hold a phone to his ears. Emotionally, he is still a little sensitive, and if you say “no” to him in too harsh a tone, he might cry.

 

My 18-month-old is still not walking yet. Should I worry?

 

Most children start to walk around 13-15 months. But there are some who start walking relatively late. Their parents may also have walked late. If walking is the only developmental delay, and the rest of the child is normal, then there is nothing to worry. Some children who get around by shuffling on their bottoms tend to walk around 20-24 months of age. However, if your child is not walking at 18 months, it is best to consult your doctor. Conditions that are associated with late walking include muscle and joint problems, or problems with the nervous system.

 

Two Years Old

 

The two-year-old can run around and climb up and down stairs holding onto the rail. He can build a tower of six blocks, scribble with pencil and paper, pour from a bottle, and point to the nose when asked. He can drink from a cup, and can sometimes indicate his toilet needs. He can join words together into a short phrase, like “no more”, “all gone”, “mama eat”, “go there”. Some become a little negative, and say “no” to whatever you want them to do. This may be a method of attention seeking. Although he can interact with adult caregivers, when placed with another child, he will probably play by himself with relatively little interaction. This is known as parallel play.

 

Three Years Old

 

The three-year-old can run so fast that you may have difficulty catching him. He can stand on one leg, jump, and ride a tricycle. He can build a tower of nine blocks, and turn the pages of a storybook singly. He can speak in short sentences comprising five words or more. He enjoys bombarding you with questions like “why?” and he can enter into a conversation with you. He can identify colors, and can answer correctly when asked “What is your name?”, “How old are you?”, and “Are you a boy or a girl?” When given a pencil, he can draw a straight line, circle, and a cross. Make-believe play, such as pretending to be a parent, can become quite imaginative. There will be much more interaction with other children, and this is the age when he might profit from a playgroup. He can feed himself, but is quite sloppy. He may be dry by day, and can indicate when he wants to go to the toilet. When upset, however, the three-year-old is prone to temper tantrums.

 

Four Years Old

 

The four-year-old can hop, leap, climb all over the place, and can start to use chopsticks. He can tell you a simple story, like The Three Little Pigs. He can draw a square, a triangle, and a picture of a person made up of only three to five body parts, albeit the limbs shown as stick figures. He can recognize numbers, alphabets, and knows opposites (small-big, hot-cold). He can sit reasonably still at the dinner table and feed himself. Many would have started attending either a nursery school or a kindergarten. He can put on and remove his socks and shoes. His play can be quite imaginative, and he can pretend to be a doctor looking after a doll patient. He can be quite susceptible to television advertisements, and join with current childhood fads. This age is probably the most dangerous time for your child because he is able to do many things, and yet has no perception of danger, such as when jumping from a height or dashing across the road. He can speak quite fluently, maintain a coherent conversation, read a few simple words, and count to ten.

 

Five Years Old

 

The five-year-old can somersault and jump down from two steps. Most are dry throughout the day and night, although a small but significant percentage still bed wet. He can hold a long discussion with you. He can read words such as “chicken” and “flower”, or even short sentences. He can write the letters of the alphabet and simple words, including his own name. He should be able to do easy additions and subtractions. The five-year-old is able to express concern over his younger sibling, and can show the little one the pictures in a storybook. However, he may not be able to distinguish fact from fantasy, and may tell untruths as if they were true. For example, he might say “I went to teacher’s house today”. His sense of time may also be inaccurate, so when he says “Yesterday I went to the toyshop”, it may mean that a few months ago, he was at the toyshop.

 

Developmental Delay

 

If a child fails to attain certain developmental milestones at the expected age, then that child may be developmentally delayed. For example, the normal child might start walking as early as nine months, and the median age for walking for most populations is around thirteen months. But if a child is unable to walk by eighteen months, one would consider him developmentally delayed. No two individuals develop at the same rate, so therefore a sound knowledge of normal childhood development and its variations is essential in the assessment of developmental delay.

 

Diagnosis of Developmental Delay

 

A child is considered developmentally delayed if he is behind in any one of the major areas of development:

 

A. Motor Development

– Head lags behind when pulled to sit by four months

– Not reaching for objects by five months

– Not rolling over by seven months

– Not sitting tripod by seven months

– Not sitting unsupported by ten months

– Not walking unaided by 18 months

 

B. Hearing and Language Development

– Failure to respond to noise

– Not babbling by six months

– Not saying single words by 18-20 months

– Not speaking in two or three-word phrases by three years

 

C. Personal and Social Development

– Not smiling by eight weeks

– Not waving goodbye or clapping hands by 15 months

 

 

Conclusions

 

Understanding normal childhood development helps you provide appropriate care for your child, and appreciating the variability of this development can allay some of your anxieties.

 

Developmental delay may be a variation of normal development, especially if the delay runs in an otherwise normal family. On the other hand, it may signal potential problems. A delay in motor skills could be due to cerebral palsy or a muscular dystrophy. A delay in intellectual development may indicate an intellectual disability. A delay in speech development may be due to hearing deficit, specific language disorders, or an autistic spectrum disorder.

 

If you notice any developmental delays, do consult your doctor or health care provider.

 

(By Kenneth Lyen)

 

 

 

Hello Kitty

Childhood Fads

Children’s fads are nothing new. Over the years we have seen them come and go. There was He-man, Cabbage Patch Dolls, Teenage Ninja Turtles, Care Bears, Teletubbies, Transformers, Tamagotchi, Pokemon and the incredible Hello Kitty!

For people like myself who do not find any of these creatures particularly appealing, the obsession displayed by their fans seems completely bewildering. What would entice large numbers of people to queue up overnight just to buy a Hello Kitty doll? What generates the incredible demand for these dolls such that the black market price for them is inflated several fold? Why did some of those who queued up for these dolls lose their tempers and come to blows over such a trivial matter? And as for those who got hurt when they pushed so hard that the glass door shattered, we ask why?

As a parent and as a paediatrician, I look at behavioural problems from a developmental point of view. Namely, what did we do wrong as parents? Why did we fail to vaccinate our children (some of them already grown up) with values and judgements so that they would not succumb to peer pressure, or to advertising’s ugly influences? How did we as parents, fail to inculcate independent thinking in our children?

Alexander Pope once wrote: “Tis Education forms the common mind; just as the twig is bent, the tree’s inclined”.” I fully agree with him. It is through education, in its widest sense of the word, that we can shape our children, so that they will develop into upright citizens. But recent events suggest that we have not been as effective parents-cum-educators as we thought we were. Let me stick my neck out, and make a sweeping generalisation. Let me preface this by saying that I don’t have any research data to back up my impressions.

I believe that parents these days seem more intent on getting their children to do well at school, to pass exams, with a view to securing better paid jobs and a more comfortable lifestyle. Children nowadays seem to be taught more and more facts, and less and less about values; they are taught more about the techniques of passing exams, and less about moral judgements; they are taught more about winning, and less about coping with failure; more about following instructions, and less about independent thinking. Now, before I get a flood of criticisms, let me immediately apologise if the above generalisation provokes a negative reaction from parents, educators, and others who feel that I have got it all wrong.

But have I really got it wrong? I think that the events rising from the Hello Kitty madness has already vindicated my beliefs. Let me give you some further observations. I have seen people queuing up behind a sign placed by the fast food chain that the Hello Kitty dolls are sold out at this point. My colleagues have noticed that their several of their office staff have arrived late to work because they had queued up for a doll. Many rubbish bins outside the fast food chain were full of discarded food uneaten, because once the person queuing obtained the doll, the food became redundant.

Some parents feel that they are displaying love to their children when they shower them with presents. They indulge their children’s every craving. This is exacerbated by the highly successful advertising on television. The child becomes obsessed with the desire to own the object advertised. Their peers exert further pressure. Parents think that they are doing their child a great favour by giving in to their demands. Sometimes the child becomes insufferable and goes into a temper tantrum. To stop these tantrums, the parent might give in, even though the parent may initially object to buying the toy. As a paediatrician, often asked to advise parents on how to deal with childhood tantrums, I always tell the parents never to give in to their child’s tantrums. Children are often smarter than we realise. They know how to manipulate their parents. They are fast learners. If they go into a temper tantrum, and the parents give into their demands, they will learn that this technique works. In future they will always go into a temper tantrum to get what they want. If, on the other hand, the parents consistently deny the tantrum child’s demands, that child soon learns the futility of launching into a tantrum. Over the course of time, the tantrums will extinguish.

Thus, if we as parents are obsessed with acquiring material wealth, or we ourselves queue up for our condominiums, or cars, our country clubs, then unwittingly we transmit these values to our children. If we would rather spend our money on expensive holidays rather than helping destitute families, we are also making a value statement. Hence to some extent, the misbehaviour of those obsessed with buying the latest fads can be traced to our own misplaced sense of values, our own obsessions, our own misbehaviour.

What can we do? As doctors, I believe we have a responsibility to society. Like it or not, society scrutinises our every act, our every word, our every deed. We are already seen to be a role model for society, and we should therefore be seen to fulfil this role responsibly. Furthermore, we are also educators. We are constantly educating our patients and the parents of our patients. We have that opportunity to allow others to “catch” our own views and values.

Education needs balance. Currently it is imbalanced towards competition rather than cooperation, towards wining at all costs rather than coping with failure, towards acquiring facts rather than values. The least we can do is to discuss the problems, to air our views, to listen to the views of the public. Maybe by engaging in dialogue we can find new solutions to achieving a balanced education. That is the direction we should be heading towards.

(In 2000 a well-known fast food restaurant gave out Hello Kitty dolls for each meal purchased, and sparked off a nation-wide craze.)

Almost Normal

My spelling is awful and I make many misrakes. When I read, the meaning does not sink in, and I have to reread several times to find out what’s it about. In fact I prefer listening to audio books than reading the printed word.

Am I normal?

Apparently not. My psychologist friend tells me that I have a hidden dyslexia. It will explain why I did so badly at school, why I was a D student, why I nearly failed all my exams.

Hence I am delighted that the British Dyslexia Association, in conjunction with the University of Westminster is spending £478,000 in a quest to uncover latent dyslexia, dyspraxia, and dyscalculia … people who struggle with reading and writing, who have problems in motor skills, or have difficulty handling numbers.

But I am worried by this study. You see, the boundary between normal and abnormal is blurred. When is dyslexia just poorly taught reading and spelling? When is dyspraxia just clumsiness? And dyscalculia just a disinterest with mathematics?

Come to think of it, is anybody normal? Are we all borderline sufferers of one psychological disorder or another? Or as John Ratey put it, do we have “shadow syndromes”?

In the 1960s there was a movement led by Thomas Szasz that claimed there was no such thing as psychiatrically abnormal people. It was society that was abnormal. Nowadays the pendulum has swung to the opposite extreme. Psychiatrists, psychologists, doctors, educationalists, busybodies, are very keen to dish out labels on everyone. There are even new labels to be distributed liberally, like “borderline personality disorder.”

If I were a hypochondriac, I would claim to suffer from a touch of everything. I would love to add a few more maladies to my inventory of complaints. I could add borderline attention deficit because I could never concentrate on anything for very long. Plus borderline autistic because I am a shy quiet type, and do not like crowds or parties. Then I would add borderline manic-depressive disorder as I have mood swings. And maybe a touch of obsessive-compusive disorder, and possibly a borderline personality disorder to boot.

Joking aside, there will undoubtedly be some genuine cases of learning disorder that will be detected by the University of Westminster’s study. However, I fear they will open Pandora’s Box, because dyslexia, dyspraxia and dyscalculia are ubiquitous. The cutoff between normal and abnormal is arbitrary. And treatment is largely unsatisfactory.

I guess you have to start somewhere, and I can only wish them the best of luck.

Sometimes I wonder how my life would have changed if they detected my dyslexia earlier. Maybe I wouldn’t have become a writer. What a dumb idea for a dyslexic to choose to be a writer!

Gilles de la Tourette

Today I was introduced to a family whose 10-year-old son has little jerky movements consisting of sudden and involuntary shrugging of the shoulders, splaying of the arms, twiching of the face, fluttering of the eyelids, and if seated, kicking of his legs. On top of that, perhaps even more startling, is that he can unexpectedly blurt out an obscenity. For a well-educated genteel upper middle class family who would never use four-letter swear words even under extreme duress, this tendency to vulgarities is most bizarre and bewildering to them.

What the little boy has is a condition called the Tourette Syndrome. It was first described in 1884 by a French physician, Gilles de la Tourette (1857-1904). He wrote about nine patients who were affected with the symptoms that were later to bear his name. One of these was the Marquise de Dampierre, an aristocratic lady who developed compulsive tics from the age of seven years, and they persisted until her death at the age of 80 years. She became a recluse and according to another doctor, she “ticked and blasphemed” all her life.

This condition affects 2% of the population, and among famous patients afflicted with this disease was Amadeus Wolfgang Mozart. Perhaps Mozart had outbursts of profanities, or coprolalia, which may have inadvertently upset poor Salieri, who is alleged to have murdered Mozart.

By the way, “coprolalia” is derived from the Greek words “kopros” (dung) and “lalein” (to babble).

The condition is inherited as an autosomal dominant, which means that it can be passed on by either parent. But to date, the gene has not been identified, nor the biochemical aberration which gives rise to the condition. Medical treatment is available but drugs only suppress the symptoms, and when the medication is stopped, the manifestations may recur.

When I asked the parents where the boy may have picked up his scatology, they immediately blamed the school. Apparently it is the norm for schoolboys to use four-letter swear words that would shock any grandmother. Definitely they would not have picked it up from Singapore television which is squeaky clean. How then, I asked, is it possible to make a diagnosis of Tourette Syndrome, if the only manifestation was the coprolalia?

The disease remains as baffling and mystifying as it did 120 years ago when Dr Tourette published his findings.

Heels on Wheels

I was nearly knocked over by a little kid today. It was during my lunch break. I had just eaten at a nearby hawker centre. Duck noodles accompanied by a bowl of soup. Chopstick licking good. Burp.

Sauntering back to my office, punctuated by casual window shopping, I suddenly saw hurtling towards me, a high speed lump of child. He couldn’t stop in time, and my reflexes were dulled by post-prandial hypoglycaemia. “Hey, watch it” he shouted at me, as if it was my fault that I trespassed into his flight path. I was too stunned to react appropriately, and my instinct, trained by my conservative middle class parents, was to be perpetually polite. “Are you all right?” I asked the boy. Without even a word of apology, he sped off quick as The Flash.

I realised that the problem arose because he was wearing shoes with wheels embedded into the heels (heelies). These shoes are now ubiquitous, and has largely replaced both the squeaky sports shoes, and heels that light up when you put your weight on them. This is a new fad. Children think it is cool to race across shopping centres and any pedestrian walkways wearing these heels on wheels.

“Freedom is a wheel in your sole”, screams a poster advertising these shoes. “Freedom obligates responsibilities”, I thought to myself.

My friend who owns a shop, said that when he was shown a pair of these shoes, before the fad caught on, he dismissed it. “It would never catch on” he told the distributor. Now he lives to regret his decision. Trying to comfort him, I told him the true story of Timex Watch, who was offered the distributorship of shiny colourful plastic watches, before they became fashionable. They turned their noses at these cheap-looking “toy” watches, and lived to regret turning down one of the most profitable distributorship of Swatch watches.

Curiously enough, I would have expected the rate of fractured arms and head injuries to have shot up with the sale of these heelies. But this does not seem to have happened. I guess the reflexes of young children are lightning fast and they usually avert disaster in the nick of time.

Like all fads, I’ll give it a year or two, tops. And these heelies will end up in the eternal resting place of all yesteryear’s fads. Yep, I know, at bottom, I’m a heel! Hehe!

Lost for Words

Can a concept exist without the words to describe it?

Would we have thought about gravity if Isaac Newton didn’t help identify it? Or how about the concept of “space-time” before Einstein defined it?

Without words, could we have been able to conceive of the following abstract ideas: “soul”, “reason”, “energy”, “subconscious”, “conscience”, “remorse”, “quark”, “pi”, “square root”, “calculus”, “absurd”, “meaning”, “endurance”, etc?

Does language shape our views and influence our thoughts? This question was first posed by Benjamin Lee Whorf in the 1930s. The Whorfian Hypothesis, as it is sometimes referred to, claims that the particular language a person speaks, independent of the culture in which he resides, affects the way that he thinks, by determining the framework for his perceptions and thoughts. Whorf and his teacher Sapir argued further that a person’s world view is largely determined by the vocabulary and syntax available in his language.

The extreme version of this hypothesis is that all thought is constrained by language. If the word does not exist, then that thought cannot be thought. Of course this is patently untrue. For example, we all experience difficulties in expressing ourselves. We know what we are thinking of, but we are stumped to find the word to express it. Hence we do not need words to think.

At the opposite extreme, to say that language has absolutely no influence on thought, is also false. For example, if a language organized colour names differently, it has been shown that a person’s discrimination of similar shades of colors can be influenced.

To explore this question further, Peter Gordon of Columbia University studied the Pirahn Indians. This tribe of hunter gatherers living on the banks of the Maici River in Brazil do not possess a vocabulary for numbers other than two words, “one” which stands for “one or two”, and the other meaning “many”. Members of this tribe are intelligent, but they have difficulty counting beyond 8 objects. Peter Gordon wrote: “They do not have the word for “number”, pronouns do not encode number (e.g. “he” and “they” are the same word), and most of the standard quantifiers like “more”, “several”, “all”, “each” do not exist.” Peter Gordon concluded that without having numbers, the Pirahn Indians were handicapped in their ability to conceive of mathematical calculations. This tribe could survive without this concept because their commerce was a form of barter, in which there was no exchange of money. Numbers did not exist as there was no need for them.

Numbers, symbols and words, act as convenient labels for concepts. They help clarify one’s thinking. For example, the 19th century physician Langdon Down discovered a subset of intellectually disabled who were later labelled as Down Syndrome individuals. This enabled better delineation of this group and allowed for further studies, such as their the genetic origins.

Words are like building blocks or stepping stones that allow us to advance concepts one step at a time. Armed with the concept of gravity, Isaac Newton took the next step and formulated the inverse square theory of gravity. Similarly, with Einstein’s concept of mass and energy, he could formulate the equation linking the two, which led to further discoveries.

One additional point of interest. Not only do the Pirahn Indians not count, but they also do not draw. Gordon wrote. “Producing simple straight lines was accomplished only with great effort and concentration, accompanied by heavy sighs and groans.”

This leads us to the next issue, namely the written representation of words. Benjamin Lee Whorf was acutely aware of the role culture and society played on the development of concepts. Take two cultures, Western and Far Eastern. In the west, words are represented by an alphabet script, whereas in the Far East, words are represented mostly by pictograms. Does the representation of words in alphabet form versus pictograms lead to qualitatively different modes of thinking? Can it explain the differences between, say, Far Eastern philosophy from Western philosophy?

Trying to display abstract ideas in pictograph form is particularly challenging, because it is very tough converting pictures into abstract concepts. The Chinese do it quite cleverly. For example the word for endurance shows a knife directly above the heart, and the word for peace is a woman under the roof of a house.

Whether this pictographic representation of concepts can subconsciously lead to a different way of thinking and a different world view remains largely unexplored. Cross-cultural studies are therefore of immense interest, not only in understanding differences in thought processes, but also in unravelling other mysteries, such as dyslexia.

Signs of Success

I am a slow learner.

I was one of the judges for a concert where the disabled co-wrote songs with the able. For the closing theme song, we were taught how to sign the lyrics. All my fellow judges learnt the sign language very quickly. But I just could not remember the action sequences, frequently getting it wrong. It was quite embarrassing.

On another occasion, I was part of the committee that made the decision to introduce the Makaton sign language, a simple system, for learning-disabled children. As committee members, we were taught some of these easy signs, and I discovered that I was actually the more learning disabled, because of my inability to learn this simplified sign language.

It is therefore with astonishment that I read about a group of Nicaraguan hearing-impaired children who created from scratch, a brand-new sign language.

It all began after the 1979 Sandinista revolution, when the new Nicaraguan Government started a nationwide program to educate deaf children. Hundreds of students were enrolled in two Managua schools. Before then, deaf Nicaraguans stayed at home and interacted with family members using a personal system of communication. They could only communicate basic needs like “eat,” “drink,” and so on.

Unfortunately the new teachers were inexperienced. They were advised by the Soviet advisors to teach the children finger spelling, which meant manually stroking with the index finger the outline of each individual alphabet onto the children’s open palms. But having no knowledge of either the alphabet or the words they were meant to spell, the children could not make head or tail what it all meant, and the effort was totally futile. The teachers even tried other methods, including lip-reading, but once again all their attempts to communicate ended in abject failure.

Then, to the teachers’ amazement, the children started communicating with each other through a unique system of hand gestures. A new sign language was being born right in front of their very eyes.

There are three major findings in the evolution of this extraordinary sign language. First, the originators of the language were children, and the signs were gradually improved upon as they entered their 20s. Secondly, a few years later, when a new generation of younger deaf children were learning this sign language, they modulated the cruder signs of their elders, enriching them so that they became more nuanced and streamlined. Their improvements were soon adopted by everyone in the community. All this was done without any assistance from their teachers or parents, who were mere spectators to this creation. The third observation is that the new sign language had rules of grammar that were similar not only to all the other sign languages in the world, but also to spoken languages.

Steven Pinker, author of “The Language Instinct,” says that what happened in Nicaraguan children is proof that language acquisition is hardwired inside the human brain. The development of this unique sign language by young children supports Noam Chomsky’s postulate that children have an innate ability to produce language, and that they are equipped with the rules of a universal grammar.

It should not surprise one that sign language can arise so relatively easily. Anthropologists claim that before the development of spoken language, early man was already communicating nonverbally. The earliest mention of sign language is by Xenophon in 431 BC. The philosopher Condillac proposed in the mid 18th century that language originated as gestures. It was the Abbé de l’Épée who observed that deaf people roaming the streets of Paris were communicating with one another using an animated system of hand gestures. The abbé established a school for the deaf in 1755, and used his deaf students’ natural signs to further their education. This French system of sign language was later to become the foundation of the American Sign Language.

It seems that sign language is closer to the origin of language than speech. Sign language appears to have arisen spontaneously and independently in different parts of the world. For example, Chinese sign language is very different from American, or Danish, or Nicaraguan sign language.

Inventing a brand-new sign language is not easy. Try it yourself. Create a new system of sign language. Pose yourself the following questions. How would you communicate the passage of time? How would you use signs to differentiate between something you have done just a few seconds ago, versus something you did last week? How would you differentiate between an act done by a male or a female, between a young person or an old person, or between people of different races, or between one solitary person versus a large group of people? How would you sign that you have just watched the film “The Eternal Sunshine of the Spotless Mind”? Then tell us what the film is all about. It is like playing the game Charades, except it quickly becomes infinitely more difficult.

Whoever invented sign language must be a true genius!

Asperger Syndrome

Definition

Asperger syndrome is defined as a condition resembling autism in which there are speech and language abnormalities, problems with nonverbal communication, severe impairment in social interaction, a fixation on a narrow field of interest, rigidity in following unchangeable routines and motor clumsiness.

Historical

In 1944, Hans Asperger described a distinctive pattern of behavior that resembled autism and is now referred to as Asperger syndrome. A year earlier, Kanner had published his observations on autism. Unlike Asperger syndrome in which the intelligence is normal or high, Kanner’s autistic subjects were quite severely intellectually disabled.

Epidemiology

In Sweden, the prevalence of Asperger syndrome is around two per 1,000 school children, and boys outnumber girls by quite a large margin. Asperger syndrome is more common and less severe than Kanner autism.

Inheritance

A number of families have a mix of members with Asperger syndrome and Kanner autism. This suggests that there is an overlap in these two conditions, and it may eventually turn out that they actually represent different degrees of severity of the same condition.

Clinical Features

Persons with Asperger syndrome may have a history of school difficulties. They display abnormalities in speech, nonverbal communication, social interaction skills, and motor coordination. They may engage in repetitive activities and are resistant to changes in routine. Other family members may have similar disturbances. Asperger syndrome is more commonly associated with normal or high intelligence.

Speech

The development of speech may be delayed. The words expressed may be sing-song in intonation, or they may be flat, with inappropriately exaggerated inflections. There may be pronoun substitution, so that “you” is used instead of “I”. The Asperger subject may invent new words (neologisms) or use long and obscure words instead of simpler ones. Speech content can be pedantic and repetitive. Simple humor may be appreciated, but complex jokes may elude them.

Nonverbal Communication

There may be a paucity of facial expressions. Eccentric gestures, like holding the arms in the air and other odd posturings are sometimes manifest. They may frequently misread the body language, intentions or facial expressions of other people. Eye contact is said to be poor, but in Asians, this can be difficult to assess, because it is not the usual practice to look someone in the eye when communicating with that person.

Social Interactions

They have difficulties in initiating and sustaining relationships with others. Social rejection may result from a failure to grasp the rules of etiquette or social conduct, including rules which govern speech, hand gestures, body posture, choice of clothing and proximity to others. They may have a preference for machines or fantasies rather than human interactions. Even hygiene can be at the same time obsessionally clean and filthy. The Asperger subject may shower several times a day, but never brush the teeth. There may be extreme lack of common sense.

Resistance to Change

Once they develop a daily pattern, they resist any change in their routines. In a similar vein, they may form intense attachments to certain belongings, and may become very unhappy when away from home.

Motor Coordination

Their movements are awkward and clumsy, their posture appears peculiar, and they may have a tremor which can affect their writing and drawing.

Skills and Interests

Persons with Asperger syndrome may have an exaggerated interest or skill in one or two areas of expertise, and they may absorb every detail in these subjects. This is similar to those individuals with Kanner autism who sometimes display quite brilliant talent in a certain skill (autistic savants).

School Experiences

Children with Asperger syndrome tend to behave quite oddly and, because of their poor social defenses, may be bullied at school. They tend to do badly in their studies because they may prefer to pursue their own interests rather than complete their homework.

Differential Diagnosis

There is controversy over whether Asperger syndrome is part of the autism continuum or a separate entity. Asperger syndrome individuals tend to have higher intelligence than those with Kanner autism, but there is some overlap.

Currently there are no valid tests that can reliably differentiate Asperger syndrome from infantile autism. The observation that people with Kanner autism may transform into Asperger syndrome after intensive treatment further supports the notion that Asperger syndrome is part of the autism spectrum.

The unusual behavior, anxieties and fixed habits of those suffering from Asperger syndrome superficially resemble a number of psychiatric conditions, such as schizophrenia, the manic phase of manic-depression, generalized anxiety disorder, and obsessive-compulsive disorder.

Therapy

There is no specific medical treatment for Asperger syndrome. Therapy is largely educational and behavior modification.

– Teach the Asperger syndrome individual how to interpret facial expressions and physical gestures.

– Teach him how to analyze social situations.

– Encourage him to do some voluntary work.

– Find out what motivates that particular individual with Asperger syndrome, e.g., he may be willing to work for money to buy more computer equipment, and use it as positive reinforcement.

– Be sensitive to the person’s emotions, e.g., do not laugh at a joke that was not intended.

– If the person with Asperger syndrome uses “faultless logic leading to nonsensical conclusions”, then he needs to be aware of the absurdity of his conclusions.

– Some individuals can even gain insight into their own condition by reading about Asperger syndrome.

– It may be helpful to introduce people with this condition to each other.

Drug Treatment

Individuals with Kanner autism sometimes respond to high doses of vitamin B6 or pyridoxine. As this is a relatively safe drug with preventable side effects, it can be given an empirical trial. If a person with Asperger syndrome has a coexisting problem, such as an anxiety disorder, then treatment for this should be given. If there are fits, anticonvulsants should be administered.

It is important to emphasize that the medical treatment of Asperger syndrome is only a small part of the total therapy. Adequate comprehensive treatment requires education, analysis of the environment with appropriate behavioral adjustments and psychotherapy if indicated. In addition, there should be meticulous evaluation and treatment of other concomitant medical problems. Thus, a team approach to treatment is essential. Medication cannot be used as a substitute for these other components of therapy.

Prognosis

The outcome of Asperger syndrome is very unpredictable, and may range from poor to excellent.

Case Studies

John is a 14-year-old in a special school. He had a normal delivery at birth but did not talk until he was six years old. Now, he is able to express himself in short sentences and has a reading age of a nine-year-old boy. However, his understanding of what he reads is below that. He has no friends. When he is not engaged in any activity, he sings to himself, bites himself and puts his fingers in his mouth and nose. John was diagnosed as having autism with developmental delay.

Ahmad is a 13-year-old boy who comes from a low income family. Despite not having any tuition and coming from a family background that does not speak English at home, Ahmad did well academically and was in the top academic stream. As a child he had delayed speech. Over the years, his speech improved, and he liked to talk, but had difficulty communicating his thoughts. He has a high-pitched voice with a flat tone. Up till today, he has no friends because he is unable to relate to others. He has a strong interest in television programs and knows a lot about them. In fact, he has learned a lot of “communication skills” like reflective listening, summarizing, and interpreting body language, from watching TV interviews. He has a very strong logical memory. He is diagnosed with Asperger syndrome.

Both John and Ahmad lie within the spectrum of autism.

Learning Styles

People with autism spectrum disorder learn in a different way from others. They tend to learn much better when information is presented to them in a visual way. While the phrase “a picture is worth a thousand words” applies to the average person, “a picture is worth ten thousand words” applies to most people with autism spectrum disorder. They also tend to have a strong memory for details, but have difficulties piecing the bits of information together to form a whole. In other words, they see the trees but not the wood. Gary Mesibov illustrates the way they see the world like a laser pointer, while non-autistic people see the world like a regular torchlight. A laser pointer is a highly-focused beam of light and causes an intense concentration in energy on one aspect of the environment. Organizing, sequencing, and time concepts are generally areas of difficulty for people with autism spectrum disorder and Asperger syndrome.

Savant

About 10 per cent of people with autism spectrum disorder have talent or are “gifted” in some specific area. Some are gifted in writing poetry, while others are talented in music, drawing, designing, computers, and calculating the day when given a date. The movies Rain Man and Mercury Rising are examples of individuals with autism spectrum disorder who have special talents.

What is the Most Effective Intervention Program?

The most common and effective form of intervention for individuals with Asperger syndrome is structured teaching, communication training, applied behavioral analysis, and social skills training. The best intervention programs come from having a deep understanding of how they see the world. These intervention programs can then be crafted to help them to see the world meaningfully. Individuals with Asperger syndrome need help in understanding the social environment and learn best when information is communicated to them in a visual way.

To meet their learning needs, TEACCH , a division of the University of North Carolina, USA, developed a structure teaching approach that focuses on the use of visual information to prepare the individual with autism spectrum disorder to learn. There are three main components to this approach: physical structure, visual schedule, and work system.

There is no one clear approach or program that works for all people with autism spectrum disorder. An effective intervention program should have the following components:

– Clear assessment of needs.

– Development of learning goals in his immediate environment with a long term aim of creating independence.

– A variety of learning opportunities for the child. This should include direct teaching, group teaching (for older children), independent practice, incidental teaching, generalization to other people and situations, and repeated practices.

– All teaching activities should be meaningful.

What are the Long-Term Goals of Intervention?

In terms of priority for goal setting, personal skills are the most important and form the foundation for skills building. Both parents and professionals place independence as the long-term goal for individuals with autism spectrum disorder. This is followed by intellectual skills and interpersonal skills.

Conclusions

We believe Asperger syndrome to be part of the autism spectrum disorder. The diagnosis is often missed by parents and teachers because children with this condition have normal to high intelligence. Nevertheless they have difficulties socializing, and may have some learning difficulties. Using visual cues to assist in their learning, giving them social skills training, can be most helpful to them.

This article by Vera Bernard-Opitz, Kenneth Lyen, Lam Chee Meng, first appeared in Rainbow Dreams (2002).