1

Table of contents
1. Introduction of Parents of Autistic Children
1.1 Significance of topic
1.2 Challenges faced by parents with autistic children
1.3 Derivation of constraints
1.3.1.A lack of understanding and empathy by society
1.3.2. Fear of seeking help
1.3.3 Autistic childs needs takes precedence over personal well-being

3
4
4
8
8
9
10

2. Introduction of migrant workers

2.1 Issues faced (CPI)
2.2 Constraints of 1st community
2.2.1 Lack of understanding and empathy
2.2.2 Fear of seeking help
2.2.3 Their familys needs take precedence over their personal well-being
2.3 Linking of constraints between the 2 communities

11
11
13
13
13
14
14

3. Expansion of efforts for migrant workers

3.1 Nature of expansion
3.2 Current solutions for Migrant Workers
3.2.1 Current Solution #1: Migrant Workers Awareness Week
3.2.2 Current Solution #2: Dialogue in the Dark session
3.3 Main findings derived from solution

15
15
15
15
16
18

4. Current ideas of parents of autistic children

4.1 Current idea #1: Autism Spectrum Disorder (ASD) Support Forum
4.2 Current idea #2: Counselling
4.3 Current Idea #3: World Autism Awareness Day
5.1 Generated Idea #1
5.2 Generated Idea #2
5.3 Generated Idea #3

19
19
19
20
23
24
25

6. Bibliography

27

1. Introduction of Parents of Autistic Children

Figure 1.0

1.1 Significance of topic

Figures from KKH1 and NUH2 showed a 76% increase in the number of children diagnosed with
autism3 between 2010 and 2014.
The rising number of diagnosis of autism indicates that more parents are confronted by the
difficult circumstances of taking care of an autistic child. Hence, more parents are plagued with
stress pertaining to their autistic child. This is evident from a survey 4 showing that more than
80% of the parents are stretched beyond their limits (Sharpley, et al. 1997).
Another report5 also showed that 90% of parents were unable to deal effectively with their
autistic childrens behaviour (Haisley.D, 2014). Almost half of them were also found to be
worried and two-thirds were clinically depressed6. A study by IMH7 indicated that if stress is not
addressed promptly, it leads to severe health problems8 in individuals.

1 KK Womens and Childrens Hospital

2 National University Hospital
3 Autism results in a complex disorder of brain development and is characterized by a difficulty in communication and
social interaction and impairs their ability to take care of themselves

4 In a survey of 219 parents of children with autism, Sharpley, et al. (1997).

5 A report by Lauren D. Haisley, from the University of Connecticut
6 It was obtained from a report titled Parenting Stress in Parents of Young Children with Autism Spectrum Disorders:
the Role of Child Characteristics and Social Support

7 National Institute of Mental Health

8 E.g heart disease, high blood pressure, diabetes, depression, anxiety disorder, and other illnesses.
4

1.2 Challenges faced by parents with autistic children

Figure 1.1 (Parents career after their child is diagnosed with autism)

Financial aspect
A study9 showed that families with autistic children are strained financially with an average loss
of 14 percent in their family income due to jobs foregone and money spent on the treatment for
their autistic children.
In a survey10, nearly three-fifth of mothers forgoed employment because of their childs special
needs. Furthermore, as seen in figure 1, 43% of parents stopped working to take care of their
child after the diagnosis while 12% of parents switched to a part time job from a full time job.

Educational aspect of children

9 It is a study featured in Pediatrics
10 In 2013, 326 moms of kids with autism were surveyed in a study at Washington State University.
5

A survey showed that 50% of these parents would be uncomfortable with their child seated
beside a child with special needs. According to above survey11, 54% of parents of autistic
children found that preschools were unwilling to take in children with special needs (Lien
Foundation,2016) and more than half felt that the support given was inadequate. These
evidences show that the lack of inclusiveness in the present educational system results in
parents of autistic children facing difficulty in enrolling their autistic child in mainstream schools.
Lack of understanding of the community
Autistic children tend to avoid eye contact and do not know how to communicate with others.
Furthermore, they exhibit abnormal behaviours. These behaviours tend to be deemed as rude
or mischievous by people who do not understand autism. Hence, they often make hurtful and

insulting comments to their parents. This is evident from a survey12 that showed that among
special needs children and their families, autistic children and their parents received the highest
percentage of insensitive remarks.

Inherent conditions of autism

11 The Lien Foundation commissioned the Inclusive Attitudes Survey and to explore the views and attitudes of
Singaporeans towards children with special needs. Research polled over 1,000 respondents in April 2016 for the
survey, focusing its questions on the experience of inclusion in early childhood, education and daily life.

12 An inclusiveness attitudes survey conducted by Lien Foundation.

7

Autistic individuals have difficulties in understanding the beliefs, attitudes, emotions of others.13
Furthermore, they often exhibit challenging behaviour when placed in unfamiliar situations or
discomfort due to their surroundings.

1.3 Derivation of constraints

1.3.1. A lack of understanding and empathy by society

A study14 has found that the overall earnings for families with autistic children are 28% ($17,763)
less compared to families whose children do not have health limitation. Corporates unfair
treatment towards parents with autistic child and the lack of inclusiveness in education for the
child indicates a lack of empathy and understanding of the autistic child and the problems faced
by their parents.
Members of the public do not share the same experiences as parents of autistic children when
taking care of them. Hence, they are unable to understand and empathize with them. According
13 They are often unable to share a common focus. Furthermore, they have difficulty interpreting facial expressions,
vocal intonation and body language.

14 It is a study in the journal Pediatrics in 2012

8

to a survey15, 64% of the respondents expressed that they were willing to share public spaces
but unwilling to interact with children with special needs. 32% believed that developing children
are comfortable with interacting with children with special needs. In the same survey, one of the
parents is criticized for bringing their child of special needs to the library16. From the figure
above, it was also shown that 31% of parents feel judged by their parents and hence, do not
want to bring their child out to public places.

The inability to understand the plight faced by parents and their child leads to unfair treatment
towards these parents. The public shuns the child and makes insensitive remarks to parents.
This unfriendly treatment demoralizes parents and discourages them from confiding in others to
obtain appropriate advice. Hence, stress accumulates due to the inability to confide.

1.3.2. Fear of seeking help

The social stigma associated with seeking professional help has been conceptualized as one of
the most significant barriers to treatment (Sibicky & Dovidio, 1986; Stefl & Prosperi, 1985). This
may be because the public tends to provide negative descriptions of individuals who experience
mental illness (Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000). Parents who seek help are at
risk of being labelled as awkward, cold, defensive, dependent, insecure, sad, unsociable, weak
and disturbed (Sibicky & Dovidio, 1986).
Parents are generally unwilling to seek help from psychiatrists due to the fear of social stigma.
The absence of appropriate help granted to parents to reduce stress coupled with the
challenging behaviour of their autistic child leads to the worsening of mental illnesses and
escalates their stress levels.
15 The Lien Foundation commissioned the Inclusive Attitudes Survey and to explore the views and attitudes of
Singaporeans towards children with special needs. Research polled over 1,000 respondents in April 2016 for the
survey, focusing its questions on the experience of inclusion in early childhood, education and daily life.

16 Laws should make it clear that someone with ASD (autism spectrum disorder) can go anywhere they want.I was
scolded 3 times for bringing my child to the library.

1.3.3 Autistic childs needs takes precedence over personal

well-being
There are many challenges associated with taking care of autistic child and many of these
challenges arise due to the child's inability to engage in social interaction with others. A report17
states that parenting is hard enough, let alone when the demands of a child with special needs
and challenging behaviors are added into the mix. This resulted in them spending relatively
more time taking care and seeking help for their autistic child which is evident in a study18
showing mothers of those with autism spend at least 2 hours more each day for caregiving than
other mothers. This leaves them with less time and effort for their own financial,emotional and
social well being, leading to the accumulation of stress in the long run.
Parents are constantly worried that because of their social incompetency, their child is
vulnerable to bullies according to an article19. This leads them placing a huge emphasis in
ensuring that their child integrates well with the society, they are left with insufficient time to look
into their own well-being.

17 This is a report by autism speaks (is an autism advocacy organization in the United States) titled Long term
solution, what if we just cant do this anymore

18 In a 2007 study from the university Wisconsin-Madison.

19 This is an article by Washington-Post on April 2014 titled Parents of autistic children fear their children being
bullied for good reason

10

2. Introduction of migrant workers

Migrant workers: Low-wage foreign workers with work permits involved in manual labour,
including domestic workers.
Society: Individuals, non-governmental organisations and the government.

2.1 Issues faced (CPI)

In this report, we will focus on migrant workers who do not seek help. This includes those who
are unaware of the available avenues and those who do not want to do so, according to
Channel NewsAsia report20 and our preliminary research21. They are unwilling to voice their
problems due to 3 reasons which will be covered in 2.2.

20 The article is about migrant workers and efforts to improve their welfare in various areas is reported by
Channel NewsAsia.
21 A primary survey is done with 50 migrant workers.

11

12

Fig. 1 Flowchart of events

2.2 Constraints of 1st community

2.2.1 Lack of understanding and empathy

As reported by Channel NewsAsia22, there is a lack of understanding and empathy towards
migrant workers by relevant people and organisations who provide help in the society, resulting
in them not having trust in the effectiveness of the help in catering to their needs. Migrant
workers thus are unwilling to seek help.

2.2.2 Fear of seeking help

22The article about migrant workers and efforts to improve their welfare is reported by Channel
NewsAsia.

13

Our preliminary research shows that migrant workers fear being sent home by employers after
voicing their problems as they have the need to provide for themselves and their families. The
article23 also stated that his fear of the negative consequences of reporting their employers
causes them to be unwilling to seek help to address their problems of exploitation.

2.2.3 Their familys needs take precedence over their personal wellbeing
Francis Seah24 reports that most migrant workers work in Singapore to earn income for their
families. Our primary survey25 shows that this is of utmost priority to 68% of them. They are thus
afraid of being sent home by their employers if they report the ill-treatment, hence they do not
voice their problems and choose to tolerate the mistreatment.

23 The article about migrant workers and efforts to improve their welfare is reported by Channel
NewsAsia.

24 Francis Seah is a Senior Specialist in Migrant Workers Centre

25 50 migrant workers are interviewed and 34 of them stated this.
14

2.3 Linking of constraints (findings) between the 2

communities
1

Lack of understanding and empathy by certain groups of people towards both

communities causes them to not seek help.

Their fear of the negative consequences of seeking help outweighs their need to
address their problems.

Their familys needs are more valued than their personal well-being.

3. Expansion of efforts for migrant workers

3.1 Nature of expansion
The lack of understanding and empathy of society towards migrant workers and the the fear of
the negative consequences of voicing their problems have prompted non-governmental
organisations and government to increase their efforts, as seen in Fig 1.

3.2 Current solutions for Migrant Workers

3.2.1 Current Solution #1: Migrant Workers Awareness Week 26
Description
Features and
Affordances

Feature: Members of the public get to witness the living conditions of migrant
workers first hand.
Affordance: Public will better understand and empathize with them. This
reduces the stigmatization of migrant workers from the eyes of the public and
allows them to better understand the lives of migrant workers.(F2)

Limitation

It is limited in scope as only those who are interested will attend. Hence,
people who are not interested in understanding migrant workers will remain
distant from migrant workers.
It lacks sustainability as there is a short time span of the programme and no
follow up is provided.

26 An estimated of 400 people ranging from students to members of the public attended the event and interacted
with more than 130 migrant workers.

15

Fig 2. Migrant workers dormitory. Image by TODAY.

Fig 3. Migrant workers and Yale-NUS students who participated in the Migrant Workers Awareness Week.
Image by Kimberley Pah

3.2.2 Current Solution #2: Dialogue in the Dark session

Description
Dialogue in the Dark was one of the activities organised during Migrant Workers Awareness
Week in Singapore.

16

Features and Affordances

Feature: Participants cannot see each other in plain view in

the dark.
Affordance: This allows for confidentiality and removes
visual differences which encourage the migrant workers to
share about the issues faced at work more openly. Ms Lisa
Jaffar27 stated that this is an effective platform for migrant
workers to share their experience and voice their fears as
they find it safer. Mr Menon28 has observed that after this
programme, there is less reluctance on the part of the
migrant workers to step forward and seek help.
Feature: The session is one hour long.
Affordance: There is sufficient time provided for a long
conversation and for understanding to be fostered on a
deeper level.
Feature: Anonymity is maintained throughout the session.
Affordance: This helps to assure migrant workers that their
personal safety (financial security, physical abuse) is not
compromised, making them more willing to go for the
session.
Limitations

Ad hoc29 events are not sustainable in aiding the efforts of

reducing exploitation of migrant workers for the long run.
The reach and impact of this programme is quite limited as it

27 Ms Lisa Jaffar, the associate programme coordinator of the Dialogue in the Dark
28 Mr Bernard Menon, the Executive Director of Migrant Workers' Centre
29 Ad hoc solutions refer to makeshift solutions that are not intended to be adapted for other purposes
17

is purely voluntary so migrant workers may choose not to

attend it.

4. Current ideas of parents of autistic children

4.1 Current idea #1: Autism Spectrum Disorder (ASD) Support Forum
Description
An online forum for parents of autistic children.
Features and Affordances

Feature: Platform provides information via experiences of other

parents
Affordance: More relatable for parents of autistic children and
it can be applied with ease, thus reducing the stress.

Limitations

No specific official forum for autism in Singapore, thus the

network and number of cases to reference from is limited.
It does not reduce stigmatization from society as normal
individuals will not view the forums. Thus the stigma from
society persists, causing stress to linger.
It eliminates the stress from the current problem faced.
However it does not target the long-term stress from the
neglect of their well-being to take care of their child.

4.2 Current idea #2: Counselling

Description
Think Psychological Services provides one-to-one counselling to autistic children and their
family members and provides recommendations on how to handle their childs issues.
Features and Affordances

Feature: Professional counsellors have experience in

counselling parents
Affordance: Large samples of the case study of parents to
reference from to formulate solutions catered for the specific
needs of parents
Feature: Follow-up of sessions
Affordance: Allows for continuous updating of their situations
for newer solutions

Limitations

Parents may be unwilling to undergo counselling. This is

18

attributed to the negative stigma associated with counselling as

they may be deemed to be mentally unsound after potential
diagnose of emotional disorders. Research30 has shown that
depressed individuals who sought help were deemed more
emotionally unstable than those who chose not to (Ben-Porath,
2002). Thus, as parents choose not to seek help, their stress
remains.
4.3 Current Idea #3: World Autism Awareness Day
Description
A day commemorated by having iconic structures and institutions in Singapore light up in blue
colour - the official colour that represents autism. This is part of the campaign which includes
carnivals, concerts and art exhibitions to showcase the abilities of individuals with autism.
Features and Affordances

Features: Information boards about autism available.

Affordances: Increases the awareness in the general public
about autism, hence the stigmatization by society is reduced as
understanding of autism increases. Parents of autistic children
may be more willing to confide, thus reducing their stress.

Limitations

Greater awareness is insufficient in fostering empathy as there

a lack of direct interaction between society and these parents,
thus stress is unresolved.
Lack of focus on the stresses faced by parents as the main
highlight is generally individuals with autism. Thus, society has
limited understanding of the problems faced by these parents.

30 Three hundred and eighty undergraduates were presented one of four case vignettes that were identical and
surveyed on their perception of seeking help for psychological injury.

19

Fig 1. A member of the public interacting with an student from Eden School taken during the Action for Autism carnival in
conjunction with World Autism Awareness Singapore.

20

Fig2. A poster for World Autism Day that helps to increase awareness in people

21

5. Generation of Ideas
5.1 Generated Idea #1
Description
An activity whereby challenging scenarios faced by parents of autistic children will be
presented to participants. Participants who experience the scenario will add a block to their
stack, of which it signifies the stress added to them when they experience the scenario.
Features and
affordances

Feature: Participants consist of both parents of autistic children and people

from the general public.
Affordance: This allows different results to be obtained and parents of
normal children are able to learn about the challenges parents of autistic
children face.
Feature: Questions in the form of challenging scenarios parents of autistic
children face will be asked.
Affordance: This allows participants to imagine themselves in those
scenarios so as to better understand the challenges parents of autistic
children face.
Feature: Blocks will be given to parents.
Affordance: Each block represents the additional stress participants have.
Participants will be able to visualise and understand the additional stress
parents of autistic children receive while facing the challenges mentioned in
the scenarios.
Feature: Parents who experienced the scenarios mentioned will stack up a
set of blocks on the table.
Affordance: Participants are able to visualise the higher levels of stress
parents of autistic children face based on the height of the structure.
Feature: At a point when the structure is extremely high, it will fall.
Affordance: This allows participants to understand that the stress levels
parents face are extremely high such that these parents are unable to
withstand it.

Impact(s)

Parents stress can thus be reduced as there is an increase in the

understanding towards them, of which they are able to confide in more
people regarding the problems they face.

Limitations

The activity cannot be conducted on a large scale for everyone. Therefore,

non-participants are unable to understand the challenges these parents
face. Hence, this idea may not be very effective in increasing the
understanding of the general public on the challenges and high stress levels
parents of autistic children face.
Autism is a spectrum of disorders. Therefore, different autistic children may

22

exhibit different behaviours, resulting in parents having to face different

scenarios. Hence, the scenarios presented may not be relevant to all
parents of autistic children and thus, the results may not be very accurate.

5.2 Generated Idea #2

Description
A social experiment is carried out in a public place. A child will act as an autistic child while
his/her parent will ask a random passersby to help to take care of the child for a period of
time. Through this experiment, participants will be able to experience the challenges parents
of autistic children face when taking care of such a special need child. This increases the
understand of participants towards parents of autistic children.
Features and
affordances

Feature: Parent deliberately leave the autistic child alone, asking for a
passerby to help to take care of their child.
Affordance: This allows participants to experience taking care of an autistic
child.
Feature: The child acts as an autistic child by kicking up a big fuss and acts
in a manner that is deemed to be shameful by others.
Affordance: Participants will be able to experience first-hand, the shame
that parents of autistic children face when bringing their child out.
Feature: The child acts in a way that is incomprehensible by the participant.
Affordance: Participant is able to experience the challenge parents of
autistic children face in terms of understanding an autistic childs behaviour
and catering to their needs.
Feature: Passersby stare at autistic children and the person taking care of
him.
Affordance: This allows participant to experience the judgement towards
parents of autistic children.
Feature: When the person asks from help from a passer-by, he does not
respond.
Affordance: This allows participants to experience the helplessness parents
feel whereby nobody is able to help them. Furthermore, they feel helpless as
they want to help the child but yet are unable to.

Impact

Participants will be able to experience first hand, the challenges parents of

autistic children. Hence, they are better able to relate to them. With better
understanding among the public, parents are able to confide in more people
when sharing their problems.

Limitations

The experiment cannot be conducted on a large scale for everyone.

Therefore, the people who do not experience first hand, the challenges

23

parents of autistic children face, will not be able to understand them.

5.3 Generated Idea #3

Objective: The virtual reality headset help to increase the social interaction skills and
allow children to behave normally. As they behave more like a normal child, time and
space is created for the parents to take a short break. Stress of the parent is reduced
Description

A virtual reality headset is used to simulate real life situations where they can interact
with people in the form of a game. This allows autistic children to learn and practice
essential social skills through indicators found in the game.
Features
and
affordances

Feature 1: The virtual reality game simulates different common places that the
child might go to and the people they might encounter. In the game, the child
will be able to move freely and talk to these people. They get to involve in
situation such as face-to-face interaction with friends, teachers and parents or
even attending a formal event. This simulation prompts the child to behave
according to the situation.
Affordance: This is to simulate real life situation without the child being
discriminated and without the parents feeling uncomfortable for bringing their
child out.

Feature 2: The image displayed in the headset will be transmitted to the

handphone/laptop of the parents and the parents are able to choose the
situation they would like their child to be in and they are the controller in
charge of triggering responses of the virtual character.
Affordance: Parents have direct control over the game and this can allow
parents to monitor and track the childs progress over time

Feature 3: If the child has not been interacting with anyone in the game for
some time (e.g 15mins) the system will react by prompting the children to talk
and engage in social interactions.
Affordance: This helps to progressively improve the childs socialising skill as
it is a form of behavioural therapy, teaching autistic children the right way to
socialise with the people around them.
Feature 4: When the child displays an inappropriate public behaviour, parents
will intervene by manipulating the responses of the person to show that they
are unhappy with the behaviour of the child. While the virtual character is
communicating with the virtual character, the character will communicate

24

through facial expression, body language and verbal conversation. Whenever

the child come across key expressions they will be required to give an answer
to the expressions and its implied feeling. Regardless of the answer of the
child, short explanation will be displayed in textboxes.
Affordance: The child will be able to learn what are the proper behaviours
he/she should display in public and apply it to his daily life.
Feature 5: A virtual character acting as a friend of the autistic children and will
accompany the children throughout the game. This friend serve as a teacher
that will aid children in recognising and interpreting the expression in the game
using audio.
Affordance: This to give autistic child a chance to foster close relationship. A
study31 shows that as soon as the child become familiarise and has
established a relationship with the robot, the child start interacting with the
investigator and shown improvement in verbal communication competence.
Feature 6: When the children did something commendable, overcome certain
challenges or show appropriate behaviour, the parent controlling the game will
trigger the virtual character to give praise, words of encouragement and
display signs of appreciation32. Use audio and written to explicitly state that
those actions are meant to commend them.
Affordance: This make the autistic child feel that he can play a part to the
society. Furthermore, it makes them feel heartwarming that the society is
helpful and friendly. This can help to increase their self esteem, boost
confidence and increase the chance of them communicating in reality.

Limitations

The simulation of specific areas may not be fully realistic as each child has
different common places they visit. Hence, the implementation of one sample
may require time as it is overly specialised. This means that it is not as viable
on a larger scale.
The effectiveness of the game is constrained by current state of technology.
[Insert SI after obtaining insight from IT expert]

Word count: 3223

31 It is a study made by Robins et al. (2005). The study aimed to explore whether a longitudinal expose
to humanoid robot has an impact on autistic children social interaction skills and communicative
competence.
32 Smiling, gentle pat on the back

25

26

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