‘I don’t want to go to school!’

Understanding whether it’s just a tantrum or a clue at something more serious needs your attention

Image Credit: WikiCommons
Gulf News

David Snape is a 26 year-old from England who works at a postal office. He also runs a successful blog with more than 2,000 followers and hosts a radio show on Mixcloud.

Half a world way is another 26-year old, in India – her name is Sarah but her life is not that of a functioning adult. She had to be taken out of school at 16 as no mainstream schools would accept someone who knew ‘absolutely nothing’. She prefers the safe and comfortable routine at home without which she gets upset. She is also extremely uncomfortable in social situations.

“These disorders and disabilities are very common in the UAE, with a probability of one in 300-400 children having ASD. However, the lack of awareness...is what makes the child and...the family suffer.””
-Dr Binu George | King’s College Hospital Clinics
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Both of these youngsters have one thing in common – Autism Spectrum Disorder or ASD, which covers a wide range of disabilities and symptoms associated with abnormality in brain development.

The difference in how their lives turned out as adults is the difference between awareness and ignorance. In one case, the symptoms were identified, diagnosed and managed while in the other, the child was pushed to her limits, her caregivers and teachers not recognising her disabilities or her specific abilities.

Studies show that on an average, 1 to 2 per cent of children across the globe are diagnosed with ASD. ASD is a spectrum of conditions that are associated with pervasive development disorders – which can also include learning disabilities, language and motor disorders and co-ordination disorders. Other problems include attention-deficit hyperactivity disorder (ADHD) and obsessive compulsive behaviours (OCDs) which are not exclusive to neuro-developmental issues.

Gulf News spoke to Dr. Binu George, Consultant Paediatrician (Neurodevelopment and Neuro-disability) at King’s College Hospital Clinics, Abu Dhabi and he said: “These disorders and disabilities are very common in the UAE, with a probability of one in 300-400 children having ASD. However, the lack of awareness and readiness to consult an expert is what makes the child and, in consequence, the family suffer.”

ASD may show all, some or one of these disabilities in children, which can be correctly diagnosed in children aged 9 or younger in most cases. It is easy to identify children with moderate to extreme forms of ASD, at as early as 18 months to 2-years old.

When speaking to Gulf News, Dr. Binu said, “They [the symptoms] can be as simple as uncharacteristic speech delay or lack of normal responsiveness. Extreme reactions against breaking routines, repetitive activity and inability to make eye contact are some other common symptoms.”

However, milder forms of ASD can manifest itself in small yet significant ways after 4 years of age and at any time before the child turns 11 or 12-years old. This is where it becomes essential for parents and teachers to be aware of what to look for in the behaviour of the child.

Talking about the subject, Dr. P.M.M. Sayeed, a specialist in Paediatrics at Aster Clinic said, “What ‘expected behaviour’ is to parents is what makes or breaks the identification of symptoms. If parents refuse to accept that their child is behaving differently, as observed by a teacher for example, the child suffers.”

Most doctors reiterate that parents can be biased as observers of their own children and that teachers are best-placed to identify learning disabilities and behavioural issues. Teaching at least 20 students per class, they can easily spot repetitive patterns in one child’s behaviour.

According to Dr. Binu, when teachers try to diagnose the child and directly confront the parents, it leads to misunderstanding. “Teachers should ideally refer the child to the school counselor, who has psychological experience with children and can observe the child to call [if required] a discussion meeting with the parents for further diagnostic action.” he added.

Dr. Mohammad S. Tahir, a child, adolescent and adult psychiatrist at Medcare Hospital, told Gulf News: “If a child is continuously showing bad results in class, teachers can arrange one-on-one sessions for a period of time to check progress or problems, if any. This will help pinpoint issues that parents may not be able to.”

Dyspraxia, a developmental co-ordination disorder, is another common disorder found in children in the UAE. With Dyspraxia Awareness Week in October, health practitioners around the world hope to raise awareness about this condition to help with early diagnosis and to get patients integrated care.

“Earlier the diagnosis, better are the results. As adults it is harder to rewire the mind to accept and manage these conditions”, said Dr. Mahendra Ramdas a specialist neurologist at Aster Clinic.

When the disorders are not diagnosed and children or young adults are left to handle them on their own, the risk of mental health issues becomes extremely high. Anger, anxiety, depression, inability to perform daily tasks and inability to be socially active are common in such cases.

Conditions like ASD do not mean that these children lack intelligence and therefore, treating them as such can hurt their self-esteem. According to Centers for Disease Control and Prevention (CDC), almost half (44 per cent) of children with ASD have average to above average intellectual ability.

All parents need to do is to be open to diagnosis. This open-mindedness can help the child lead a normal and productive life. Snape, who was diagnosed with autism as a child, had a supportive growth environment which included his parents, teachers and specialist doctors.

When speaking to Gulf News, he said, “[To people with autism] autism is something you will have all your life but that isn’t going to stop you from making the most of your life and doing something brilliant in your time on earth.“


Common symptoms to look out for in children

  • Communication disability and/or extreme social awkwardness
  • Rudeness due to lack of understanding of social cues
  • Inability to make eye contact 
  • Repetitive or obsessive compulsive behaviour and/or arranging things in continuous lines (getting extremely upset if the arrangement is disturbed) 
  • Picky eating (with a strong tendency to get very upset and refusing to eat if food item is changed)
  • Lack of responsiveness (sensory)
  • Too sensitive to light, sound, noise and other sensory stimuli
  • Wanting to be alone or seeking out places to be alone 
  • Hurting other children or adults without any provocation (repeated instances)
  • Lack of focus/extreme activity
  • Extremely averse to going to school despite showing signs of high intelligence.
  • Difficulty in handling cutlery and pens or pencils even after repeated help
  • Clumsiness and prone to falling frequently with no visible or significant trigger (after the age of 5) 
  • Regular appearance of bruises as a result of bumping into things at school or at home 
  • Inability to understand jokes or social cues appropriate to age
  • Inability to read and write relative to age and level in school
  • Any other repetitive behaviour uncharacteristic to age or normal behavioural pattern


Here are seven common signs of ADHD

1 Self-focused behaviour
A common sign of ADHD is an inability to recognise other people’s needs and desires. A child with ADHD may interrupt other people when they’re talking. They may have trouble waiting their turn for classroom activities or when playing games with other children.
2 Emotional turmoil
A child with ADHD may have difficulty keeping emotions in check. They may have outbursts of anger at inappropriate times. Younger children may have temper tantrums.
3 Fidgetiness
Children with ADHD often can’t sit still. They may try to get up and run around, fidget, or squirm in their chair when forced to sit.
4 Unfinished tasks
A child with ADHD may show interest in lots of different things, but they may have problems finishing them. For example, they may start projects, chores, or homework, but move on to the next thing that catches their interest before finishing. 
5 Lack of focus
A child with ADHD may have trouble paying attention, even when someone is speaking directly to them. They’ll say they heard you, but they won’t be able to repeat back to you what you just said. 
6 Mistakes
Children with ADHD have difficulty following instructions that require planning or executing a plan. This can then lead to careless mistakes, but it doesn’t indicate laziness or a lack of intelligence.
7 Daydreams
Children with ADHD aren’t always rambunctious and loud. Another sign of ADHD is being quieter and less involved than other kids. A child with ADHD may stare into space, daydream, and ignore what’s going on around them

Common neuro-developmental and behavioural disorders

Autism Spectrum Disorder (ASD)
Covers a wide range of disabilities and symptoms associated with abnormality in brain development. Having a child with autism increases the probability of having another autistic child by 5 per cent.
Attention Deficit Hyperactivity Disorder (ADHD)
Inability to focus and pay attention, difficulty to control emotions and excessive activity. ADHD can lead to other mental health problems if not managed appropriately.
Dyspraxia or developmental co-ordination disorder
Affects co-ordination skills for tasks requiring balance, kicking and throwing a ball and fine motor skills (writing or using small objects carefully) in children and adults - National health Service, UK 
Dyslexia or reading disorder
Causes difficulty in reading and impair fluent reading and comprehension. Despite being intelligent, children may be unable to read or decode reading as easily.
Affects language and communication learning
Difficulty in writing including issues in handwriting, spelling and organisation skills