Cochlear Implants on Small Kids: Is This Our Best Option?

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. The next few months we’ll be focusing on parents of deaf and hard of hearing kids. Previous articles include: diagnosis, choosing a language to communicate in (part I and part II), keeping devices on kids, sports and activities.

If you’ve recently found out your child qualifies for a cochlear implant, you’ve probably got a lot on your mind. Parents like you have to make tough decisions for their little ones. The stakes and costs can be high, so we spoke with a doctor and a parent to highlight different aspects of the decision process. Dr Lynne Lim HY from the Lynne Lim Ear Nose Throat & Hearing Centre in Singapore gave us key points from a medical standpoint, and Damien Wee shared his family’s experience with his 4-year-old daughter.

How Do Cochlear Implants Work?

The simplest way to describe cochlear implants (CI) is as a replacement part for a non-functioning ear. In terms of sound processing, there are two parts to a cochlear implant, one external and one internal. The external processor picks up sounds and transforms them into electronic signals which are transmitted to the internal electronic device connected to the cochlear nerve. Thus sound is transmitted to the brain, bypassing many ear pathologies. For a diagram and more, check out this video and article at KidsHealth.

When is the Best Time to Undergo the Operation?

Technically the operation can be done as soon as your child is able to withstand general anaesthesia. “The youngest patient I operated was 6 months old, and the oldest 83 years old,” says Dr Lynne. She sometimes admits waiting until children weigh at least 10 kilogrammes, for medical reasons. But the main time constraint is actually linked to language acquisition.

As mentioned in previous articles, a child’s brain soaks up language from 0-3 years. If children aren’t exposed to an accessible language during that time, they will find picking up any language difficult. The so-called “accessible language” doesn’t have to be speech, it can be signed. But that requires the family and extended social network being fluent enough in sign language for the child to develop diversified and structured language patterns. For a glimpse into what this could mean, read Phoebe Tay’s perspective here (as well as additional links).

Many families can’t commit to signing and want their child access to the hearing world as soon as possible. This was the case for Damien’s family. “We are not familiar with sign language so our initial focus was for our daughter to gain access to sound and be able to communicate using speech,” he says. “As she was born profoundly deaf, she would never have access to sound without the implants,” he explained. In their case, the operation was carried out when their little one was 10 months old.

My Child Isn’t Profoundly Deaf: Is this my Only Option?

This is often the trickiest case, as the operation will usually destroy any residual hearing your child may have (for exceptions, read here). If their residual hearing is good enough, methods might be better suited to developing language. This could entail using hearing aids rather than cochlear implants. To see more, you can revert to these previous articles (part I and part II).

The main difficulty is asserting what your child can really hear. In the words of Dr Lynne, “hearing beeps in a soundproof room with good headphones is much easier than listening in real life situations with competing demands for attention, background noise and poor environmental acoustics. So hearing tests can also underestimate the difficulty a patient has with hearing in the real world.”

Another concern is your child’s ability to communicate what they hear, especially when only a few months old. In Damien’s daughter’s case, they had additional hearing evaluation tests (the Auditory Brainstem Response tests) conducted at two different hospitals. “Doctors put probes into her ear,” he recalls, “and adjusted the volume and frequency of the sounds to evaluate the level of sounds her nerves registered. Both tests showed that the level of sound registered was not enough for her to develop speech with regular hearing aids, hence cochlear implants were the best chance for her to be able to hear.”

Photo credit: gfpeck on Flickr

Last but not least, some types of hearing loss can evolve over time. So it might turn out that your child’s form of hearing loss was mild enough for hearing aids in the beginning but not anymore. Staying watchful during those critical years of language acquisition will ensure you’re able to react fast and adapt.

Are there any Long Term Negatives I Should Know About?

Like all invasive operations, there are risks associated with implanting the devices. Some are related to how the body accepts the implants, to others are linked to the fact that the inner ear is affected over the following days. And parents are sometimes advised to have their child vaccinated against meningitis before the operation, as people with cochlear implants have higher risks of contracting the illness in their lifetime. “Once we had made up our minds, we didn’t think about it too much,” admits Damien. “We concentrated on researching and choosing which cochlear implants would be best.”

Another long-term negative that could affect people with CIs is potentially being unable to benefit from future drugs that might “cure” certain forms of deafness. At this stage, it’s difficult to do more than speculate, but you can read more here.

What’s the Future of CIs?

Dr Lynne says “technology is so advanced, CIs can only get better.” This means smaller, thinner implants and processors, fewer wires, better technology for filtering noise,  and longer battery lifespans. In many cases, accessories for activities like swimming. , are already available. Current innovations are even very high tech and somewhat savvy, like the ability to pick up phone calls. Future CIs may not even need an external component or might be able to deliver medication directly into the ear.

Remember these from a recent post? ListenLid also helps keep CIs dry!

Sometimes parents can be tempted to wait for newer innovations instead of opting for cochlear implants. “It’s difficult to find information on the development of these newer innovations, aside from CIs. Even within the CI industry, the three main producers of Cochlear Implants are competitors, so they aren’t always keen to publicize their development plans and results.” Damien was quite pragmatic: “ We do not know when these newer innovations will be commercially available and how reliable they will be. Cochlear implants have proved to work for many people. We needed to make a decision fast so as not to lose the important first few years of language acquisition for our child.”

What Comes Right After the Operation?

We’ve all seen videos of “wow moments” when a child hears for the first time as their implants are turned on. Each kid’s reaction is different, from wonder to fear at this new sense. We compiled a playlist to give you a glimpse.

It’s important to stress that the implants alone are not enough to fully understand sounds. Following the operation, a lot of hard work goes into training the brain to recognise different types of sound.  “Parents should be aware that all kids have different outcomes,” underlines Dr Lynne, citing other physical factors (like cognitive delay and autonomy of the cochlear nerve), medical history (early or late diagnosis) and psychological aspects, particularly motivation.

Every patient Dr Lynne works with has had their own “wow” moment. There are many highs and lows after the operation, but she’s impressed by the hard work and courage her patients display. Some, like the baby she performed her first simultaneous bilateral cochlear implant on, grow up to become top students in their schools. Meanwhile, Damien remembers how four months after the implants were turned on, his daughter was finally doing really well on the Ling Six Sound test: “I was so moved to see her developing her hearing capabilities.”

Other Takeaways

Damien advises getting more than one medical opinion and also speaking with parents whose children have undergone cochlear implant operations. “Getting another professional evaluation helps verify the hearing test results and makes you more confident with your decision. In addition, talking with parents whose children have cochlear implants will give you a better understanding of the social, emotional aspects of the operation or other hearing options,” he says.

Remember, some of the world’s greatest athletes, like Duck-hee Lee, are born deaf.

At the end of the day, you’re going to be teaching your child to reach their full potential and be confident, so you need to be convinced you are making the best choice possible. His little one now speaks three languages she learned living in a multicultural setting, and thanks to the hard work they have all put in, she’s now thriving in a mainstream kindergarten).

For comments or questions, get in touch!

Disclaimer: these blog posts are intended as exploratory articles for parents of recently diagnosed children. They do not constitute medical advice and cannot replace a medical opinion.

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Parenting Deaf and Hard of Hearing Kids: Choosing a Language (Part II)

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. The next few months we’ll be focusing on parents of deaf and hard of hearing kids. This article follows a previous article here.  Last time we spoke about deaf kids was here: Diagnosis, Keeping Devices on Kids, Sports and Activities.

Part I focussed on the importance of early language acquisition and briefly reviewed different methods. This article will draw on the experience of three people with different perspectives, to give you more informal insight.

We were very lucky to have input from three experts and parents. Phoebe Tay is a Deaf teacher from Singapore. She speaks of her journey growing up oral in a predominantly hearing society to discovering the Deaf community, where she learned about Deaf culture and Deaf identity. Toshiko Clausen-Yan shares experience as a hearing mother to a multilingual oral son. We also spoke to Joyce Lew, a speech-language therapist and certified auditory-verbal therapist who migrated from teaching using the auditory-oral method to concentrating on auditory-verbal.

A Speech-Language and Auditory-Verbal Therapist on Oral Methods: Joyce Lew’s Experience

Joyce started her career in Singapore at a time when screening tests were rarer, and kids came into her office quite late. “They had already learned how to get by with lip-reading and mostly came from hearing families”, she recalls. Their families didn’t really have the time to learn a whole new language (like signing) to be able to stimulate them soon enough. “Parents were really just desperate to connect with their kids. They wanted activities to do that would teach their kids language, now.”

Joyce initially focussed on auditory-oral methods. “But research [at the time] suggested that if we continued teaching kids language through lip-reading, they would likely plateau in language acquisition because we read and spell based on how words sound.” So she decided to test auditory-verbal methods in her work.

At first, it was difficult for children to accept to learn relying only on their residual hearing. “It felt extremely unnatural at first,” she says “we had to think of all kinds of ideas to bring the focus away from the lips. But within a few months, there were moments of automatic listening and verbal responding while the kids were busy with their heads down in play.”

In some cases, residual hearing can be used to access language.

A few years later, as newborn screening became mainstream and more and more hard of hearing babies arrived with hearing devices, auditory-verbal became a norm. She says “some of the reasons are associated with the relative ease that babies experience in getting used to hearing devices and in learning how to listen without first learning how to lip-read.”

After a decade in her field, Joyce is convinced communication is key to developing language. And that parents tend to communicate more with their child if they are comfortable with the chosen language.

From Oral to Signing and Deaf Culture: Phoebe Tay’s Journey

 

Phoebe’s life changed when she started to use both English and Auslan

Phoebe was born deaf and diagnosed around three and half years old. At the time in Singapore, oral methods seemed to be the only option. Moreover, spoken and written English were expected to be understood by everyone. With the use of hearing aids and residual hearing, Phoebe was able to pick up English. She fared well enough in school and her language skills “started to bloom from upper primary onwards.”

 

Yet communicating wasn’t always easy. “It was okay to communicate in one to one setting”, she says “but classroom and group settings were tough.” Phoebe points out that language development is not just linked to academia, but also to social development. She felt like she couldn’t quite fit into the hearing world. Almost like language was a barrier.

Then she went to Australia, where she learned Australian Sign Language (Auslan). She suddenly discovered a language she could acquire, as well as a whole new culture. “I started to feel more confident, and signing helped me get a better sense of self-esteem.” Realising that she could use both Auslan and English changed her life.

There’s growing evidence that being part of a Deaf community and developing a Deaf identity helps build a child’s resilience. For Phoebe, this effect was palpable even as an adult. “I use aids, but they have their limitations. And they don’t make me a hearing person.” At the end of the day, “some kids will fail at oral methods no matter how hard they try because they simply can’t hear enough”. They still deserve to have a language they can succeed in naturally.

When Cochlear Implants Are Combined with Auditory-Verbal Therapy: A Mother’s Modern Tale

Toshiko’s second son was born profoundly deaf. Her family chose to give him the most mainstream life possible. This was possible according to doctors, who recommended cochlear implants at a very early age: only seven months old! Despite their natural fears regarding invasive surgery and the high cost, they chose this option.

Of course, this meant many years of intense speech therapy. “As soon as he had his cochlear implant, he got the same exposure to language as a hearing child,” she says. Sometimes it can be hard to get children that young to focus on tasks (like speech therapy) and keeping their devices in place, “but you have to keep in mind the long-term goals.”  Over time, her son has been able to learn several languages, including English, Mandarin, Japanese and Norwegian in natural settings.

Implants are getting more and more sophisticated and invisible.

For Toshiko’s son, the implants worked so well he can hear very minute sounds. “The advancement of technology has made this possible and we embrace all advancement that makes life simpler and better,” she says. In fact, he can now pick up calls directly to his implants, which he thinks is pretty neat.

She has a few words of encouragement to parents of children born deaf: surround yourself with people who are supportive and positive. “I did not allow people to cry or feel sad for him in front of him,” she remarks. “Stay positive, and keep your child feeling positive.”

As a brief conclusion

We hope these three testimonials will help you with parenting your child. Remember: each family is different. We hope yours will thrive!

Additional Links

Looking for some of our sources? We used some of these links. Send us more by commenting below!

Disclaimer: these blog posts are intended as exploratory articles for parents of recently diagnosed children. They do not constitute medical advice and cannot replace a medical opinion.

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Parenting Deaf and Hard of Hearing Kids: Choosing a Language (Part I)

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. The next few months we’ll be focusing on parents of deaf and hard of hearing kids. Last time we spoke about deaf kids was here: Diagnosis, Keeping Devices on Kids, Sports and Activities.

Over nine out of ten deaf and hard of hearing kids are born into hearing families with almost no connections to other deaf or hard of hearing people. Their parents have to quickly grasp the ins and outs of their child’s specific form of hearing loss while making decisions about how to communicate with their little one. Our aim here is to introduce you to different options, without claiming to have a blanket solution for all families.

Back to Basics: Communication vs. Language

If you’re a parent, you probably measure your child’s development against standard milestones. Communication and language skills are often a focal point: they help us understand our child and be understood by him. On a very practical level, it’s such a relief to go from guessing why he’s frustrated or ecstatic, to handing him the glass of water he’s asking for and sharing his joys.

Of course, parents of deaf and hard of hearing kids face the same practical need. But there’s also additional urgency for them. While parents of hearing kids know their child is constantly picking up language (even though they aren’t showing yet), parents of deaf and hard of hearing kids don’t know exactly what their child may or may not be picking up. “Kids are hardwired to learn a language, be it oral or visual,” says Joyce Lew, a speech-language therapist and certified auditory-verbal therapist, “but they need to be exposed to one.”

Babies only have a few years to gain solid understanding of language.

If deaf and hard of hearing kids aren’t exposed to an accessible language, they are at risk for language deprivation. In short, their brains aren’t learning what language is. They must acquire strong foundations in a first language during the critical early years. Those who don’t will have difficulty learning any language in the future, even non-oral languages because their brains haven’t yet formed the necessary connections. “While individual cases vary widely, the younger we see the kids, the more confident we are of the outcome,” says Joyce.  Thus parents have about 4 years to make sure their child is equipped to build a strong foundation in a first language, irrespective of which one they have learnt.

Different Viable Communications Methods

Here’s a brief overview of main communications methods used today.

Auditory-verbal or oral methods focus on using only residual hearing. Therefore children learn how to concentrate on the actual sounds with very little visual help. These methods typically work best for people who can hear across the speech spectrum, using hearing aids and/or cochlear implants.

Auditory-oral or cued speech methods teach children to combine listening with lipreading and visual cues. Cued speech provides additional visual elements for words that look the same on lips. For example, when speaking, hand gestures will specify the first letter of a word, like between “pat” and “bat”.

Manual communications modes include different forms of “sign language”. Many variations exist and some are not considered “languages” in their own right. The easiest way to understand is that Manual English (which includes SEE) is a literal transcription into signs, whereas other sign languages (like ASL for the US, Auslan for Australia, SGSL for Singapore etc) have their own grammar and internal logic.

Girls learning sign language.

Total communication methods allow for the use of all of the above methods in the acquisition of language. The underlying idea is to help kids pick up language with a combination of approaches, which may or may not include sign language, using cues, lipreading and maximising residual hearing.

How to Start Exploring and Choosing

Each case is different. As you explore, you’ll run into advocates of each type of method. Some will focus on making your child’s deafness as invisible as possible, others will want to open doors to Deaf culture and identity. Together they will complement the advice you’re getting from your doctors. How much residual hearing your child has and her prospects of learning sounds are important factors.

You’ll also take into account the community you live in – or want to live in. You need to know you’ll have enough support in your community to go forward with your choice. How much time and resources do you have to invest?  For example, if you are confident you can learn to sign and that your child will have a community of Deaf people to interact with, this will impact your choice.

We’ll be exploring experience from three interviewee’s in part II. Check it out here.

Additional Links

Looking for some of our sources? We used some of these links. Send us more by commenting below!

Disclaimer: these blog posts are intended as exploratory articles for parents of recently diagnosed children. They do not constitute medical advice and cannot replace a medical opinion.

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Diagnosing Sight Loss in Children and Adapting

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. We’ll be looking at what parents and specialists have to say about raising children who are blind or have sight loss. 

This month we interviewed Lea Lay Hong, Vision Teacher at the IC2 Prephouse of Singapore, who specialises in assisting those with sight deficiencies in learning how to adapt. She is also the mother of two children with visual impairments. The elder now studies in a polytechnic school and the youngest is still in a mainstream high school. Both are national para-swimmers!

Step 1 – Red Flags and Diagnosis

We asked Lay Hong what telltale signs could alert parents as early on as possible. Some symptoms seem more obvious than others: if your child is bringing things close up to their faces to look at them or shows signs of ocular discomfort (like rubbing their eyes excessively), a trip to the eye doctor could be in order.  She advises also to consider the child’s eye movements (are they jerky?) and whether the child is directing their gaze at people and objects.  Does he seem interested to look at people speaking to them? Does she startle easily when you pick him up, does she seem surprised when someone starts speaking near her?

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Homer, the celebrated, blind poet of Greece

All these signs may not specifically mean that your child is blind, but they can help initiate the right discussions with your doctor. Then, and only then, can you start testing your child’s eyesight to discover if there is a problem. It’s important to remember that “a definitive diagnosis is not possible at the first or initial visit”. In fact, Lay Hong explains that “many conditions are progressive so a diagnosis may not be possible until some years later

 

As the medical investigation continues, parents and caregivers need to move on to finding ways to help the child continue to learn. As says Lay Hong, “What is important is not so much the diagnosis per se, but knowing what your child can or cannot see, and how to ensure they are still able to learn like their peers.

Step 2 – Finding Support and Becoming Empowered

As with many conditions, most parents go through a grieving phase when they find out their child will have a different life path than expected. Moreover, “because visual impairment is a very low incident disability, chances are [the affected parents] do not know of anyone else going through the same ordeal as they are.” Thus Lay Hong stresses that parents should find support networks as soon as possible. There they will get emotional support – or counselling when needed – as well as knowledge and insight regarding their child’s education process.

“Remembering that the child learns differently, and knowing what adaptations or modifications are needed to enable the child to learn is important,” says Lay Hong.  There is no “one-stop” solution, but there will be a combination of adaptations that will give your child the tools to reach their full potential. Moreover, Lay Hong is optimistic and ambitious for kids with sight loss. She states that they don’t usually have slower learning curves than other children if concepts are presented to them in accessible ways, i.e. tactile methods.

stevie-wonder

Stevie Wonder was a child prodigy and musical genius, blind since shortly after birth.

For completely blind children, however, the learning curve might be different as “their acquisition of information is linear, moving from one to the other. It is difficult for them, especially at a very young age, to understand complex relationships between objects, ideas, etc.” In this regard, common difficulties may include using concepts like “otherness” and “permanence”. In the first case, blind children sometimes have trouble with the use of pronouns – I, you, me, them – and in the second, they may cling to objects and people, fearing that once they let go, they will disappear.

Step 3 – Fun, Games and Everyday Life

A recurring theme in bringing up kids with sight loss is how to ensure they are included in games and activities with their peers. Parents sometimes worry that they will be left out, or games are difficult to adapt. Yet, according to Lay Hong, certain simple good practices can go a long way to helping them interact.

They should be included in all family activities, mealtimes, outings, shopping, etc, as much as possible,” she says. Other tips can be easy to implement even outside family circles. For example “conversations directed at them should begin with their names, so they know they are being spoken to.” And when in group situations, telling them how many people are in the room (as well as their names) and encouraging them to call out to those in the room to organise activities or games, helps them become more autonomous.

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Marla Runyan, legally blind, competed and won in both para and able-bodied competitions

According to Lay Hong, any game can be adapted. Want to play football? What about using a ball with bells inside (and possibly smaller teams) so that everyone can find the ball? Cards with Braille or other tactile methods mean they can be part of fun games. Lay Hong notes that visually impaired kids are frequently left out of games because the rules aren’t explained in an accessible way, or others simply assume they cannot play.

Final Words – Always Assume the Impossible is Possible

Lay Hong encourages parents to never take no for an answer. “Do not accept when people tell you your child can’t do something because he can’t see,” she says. “Find out, if there are different ways to go around doing the same thing.” Sometimes you will have to advocate and be strong to make sure your child has access to quality learning. So read up and stay up to date.

And most importantly, remember that you know your child best, and are his or her best ally. You will be constantly explaining how your child is unique, so find simple ways of getting the right message across. For example, “instead of saying “My child has constricted field of vision due to retinitis pigmentosa”, you may simply say “my child has difficulty seeing things around him, and may need some help when moving around, especially going down the stairs, or if there are obstacles around him”.”

Additional Links

Some additional links for parents looking for more information. 

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Playing with Children on the Spectrum: Developing Faculties and Playtime

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. This month we’ll be looking at what parents and specialists have to say on raising children on the autism spectrum. Previously we wrote about the diagnosis stage here and helping parents here.

All parents know that play is fundamental in a child’s development, be they neuro-typical or facing specific challenges. But playtime is also a unique moment to interact with your child and create bonds. We spoke to Delia Yeo, a speech and language therapist, and Ladislas de Toldi, co-founder of Leka, to know more about how play can help children on the autism spectrum develop skills and bond.

Playing and Engaging with People

Games stimulate and motivate children, through fun and the desire to win. Yet both experts stress that children on the spectrum often have difficulty engaging with playmates, remembering  rules or using all the concepts necessary to win.

Therapists like Delia “look at several aspects of how the child plays to understand how he or she understands the world”. Like an alternative mapping, Delia is able to identify what types of play are easy, which ones are hard. She chooses specific types of games accordingly centred on internal feelings, external sensations, sitting, physical activity, etc.

In some cases, Delia has to teach a child to play before she can teach them skills through play. She starts with simpler games, ensuring she can interact and engage, before moving on to complex games. Most importantly, she has to look for what the child enjoys. “I choose the game depending on the child’s interest, [so] they [will] have a gleam in their eye and connect”.

Games and Technology

Traditional games like hide and seek, puzzles, swings or anything another child might play are used to help autistic children learn skills. Nowadays, thanks to technology, new games have emerged, some of which are more high-tech than anything a neuro-typical child will use.

Take Leka, for example, a small, round, ball shaped robot developed by a French start-up with specialists in several countries. The robot uses artificial intelligence and is designed to help children progress on their cognitive, motor, social and communications skills. Less intimidating than a human, the robot interacts directly with children, setting the rules and congratulating them when they succeed. They get a real sense of accomplishment when they are able to crack the game. Amongst other games, Leka plays hide and seek and Simon Says, and new games are added every week.

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Leka, the robot, happy face

“The most important thing”, says Ladislas “is figuring out what each child enjoys. It’s the only way to open the door. And if they only like Dreamworks animated movies, then so be it.” In fact, Leka are very humble in their approach. They advise parents and organisations consider all their options before investing in Leka, because at the end of the day, their objective is to make sure the robot is bringing out the best in children.

“There are so many incredible new ways of interacting with children on the spectrum now. I’m impressed by some apps on the iPad, that have non verbal children interacting with the world, and I’m stunned by how apps like Sidekicks are helping people with autism communicate with their families.” Children on the spectrum can greatly benefit from technological playthings, which unlock new opportunities to learn and communicate.

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A child plays with Leka the robot

Is All Play Work Disguised as Fun?

Delia recommends that “parents should always play without a teaching goal in mind”. The tendency to test their child might take all the fun out of playing. Just the act of spending quality time together and fostering engagement is valuable. As they play together, the child will learn some things naturally from them, in a softer, less goal oriented way.

family-harmony

Family play time, in this case with Leka the robot

“My advice is to simply follow your child’s lead. Join and imitate her at first, and as your play grows, her ideas will grow too. You’ll be “teaching” by supporting her experience in play”. As you do so, Delia suggests introducing your ideas and small challenges into games. They will encourage your child to problem solve around them, or create unity in a scattered game.

Delia recalls an autistic teen who was brought up with very little play. “He was very compliant and would carry out tasks, but seemed robotic and detached.” Recently, as she has worked around discovering what he likes and doesn’t like, and developing his ideas through play, she has seen the teen grow in confidence and become a real playmate. “He used to interact because he was supposed to, not because he wanted to. Now he’s pulling his weight in our interaction!”

Happy playtime!

Additional Links

Some additional links for parents looking for more information. Please also suggest more to us, which we can add to the list.

  • For more about Leka you can also visit here. Leka is currently looking for financial partners. Contact Ladislas at ladislas@leka.io for any inquiries,
  • An example of a sidekick app,
  • A review of Ron Suskind’s book on using Disney sidekicks at home to communicate with their son Owen,
  • Link to the film about using Disney sidekicks. 
  • Autism Speaks has a very long list of apps here

Note: all photos in this article are curtesy of Leka

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Diagnosing Hearing Loss in Children

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. This month we’ll be looking at what parents and specialists have to say on raising children who are deaf or are hard-of-hearing. The following article on hearing loss and sports can be found here.

Studies show that over nine out of ten deaf and hard of hearing children are born to hearing parents. This makes identifying hearing loss and adapting very difficult for families. We spoke to two mothers of deaf children who are happy to share some advice.

The Silent Handicap

Hearing loss is invisible. Many children can go years without ever being diagnosed. Bianca Birdsey, medical doctor and mother to deaf twins, recalls being politely hushed when she expressed her concerns. When she noticed oddities in her children, “people would say “it’s their normal!“”  she recalls. “They would think I was paranoid because I worked in paediatrics.” Bianca even asked a day care teacher if they noticed anything unusual about the twins, “and at the end of the day, she said “there’s nothing wrong with them”!

It took a dramatic scene in a public setting, with one twin crying for her mother, who was standing a few feet behind her, for Bianca and her husband to confirm their intuition: the girls just couldn’t hear. Stories like these are apparently quite frequent in South Africa. Bianca says many children there aren’t diagnosed until as late as five or even later.

Of course, diagnosis can differ greatly from one country to another. Tara Teo, founder of Irisada, gave birth to her daughter in Norway, where children are automatically screened. However, after the first check the nurses told them to come back two weeks later, as there might simply be “water in the ears.” The next test was also inconclusive, mainly because her daughter was too agitated to get good readings. It took an additional two months to finally get consistent readings of one ear and discover Heidi was profoundly deaf.

The Language Barrier

Why is an early diagnosis so important? The first two reasons are linked to how the human brain develops at that early age. Firstly, the early months and years of a child’s life are those where the brain learns how to structure language.  If they are diagnosed too late, they may have missed this critical phase and be left with learning difficulties.

Why? Because deaf children can only access language via visual aides until they are taught sign language or have hearing devices (if their family chooses to). Most families don’t sign at home unless there is already a deaf family member. This means that until a child is diagnosed, they often have absolutely no means of communicating and structuring thought with others.

The second very important factor, is that a child’s brains learns early on how to differentiate frequencies, especially to pick out human voices from other sounds. Tara’s daughter was given hearing aids and cochlear implants at a young age, but she needed lots of additional speech therapy to learn what to listen to in a sound. She’s also working hard to reproduce speech sounds, as she wasn’t exposed to them as early on in the belly as other babies.

Follow Your Child’s Lead

Both parents stress the amount of pressure they were under. “You’re making all these decisions for them” says Bianca, and some people have very set opinions on what is best for deaf children. Some of these decisions can be expensive in many countries, which can make it even harder. There can also be an impression that once your child has aids or implants, things will just miraculously get easier. In fact, the operation or “switch-on” is often just the beginning.

The mothers both laughed when they recalled their children’s reactions as the implants were turned on: pure horror! Bianca even jokes that there’s no point spending hours thinking up the first sentence you’ll speak to your child, as they won’t have a clue what the sounds mean! Imagine coming from a world of silence into a world of continuous noise. A great deal of energy goes into adapting to hearing.

Mothers with a Mission

Bianca’s advice is to “trust yourself”. Don’t let yourself get caught up in the politics around deafness, just follow your child’s lead. “There’s no right or wrong choice”, she says “as long as your child is progressing”. In Bianca’s case, meeting and socialising with deaf adults broke the spiral of grief. In part because she came to terms with a realigned vision for her twins’ future, and also because she was able to master sign language faster. Learning to sign, as a family, allowed them to bond like they never had before.

Tara, meanwhile, was frustrated with how difficult it was to get adapted headbands for her daughter as Heidi’s ears were simply too small to keep the devices in place. She spent hours online, searching for something that would keep the implants in place. She realised there was a gap in the market, and how useful it would be to be able to provide a small solution that could have a potentially huge impact. She felt how wonderful it would be if parents free up time they were spending sussing out where to find special products, to spend with their children instead. With this conviction and simple goal in mind, she founded Irisada, the very platform you’re reading on now.

Additional Links

Some additional links for parents looking for more information. Please also suggest more to us, which we can add to the list.

  • Facts about hearing loss
  • Bianca’s blog, on her experience of bringing up three kids with hearing loss
  • A preliminary list of famous deaf people, to get you started with imagining your child’s future
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Diagnosing ASD and Unlocking Each Child’s Potential

This series is designed to help parents manage specific aspects of bringing up a child with a different learning path. This month we’ll be looking at what parents and specialists have to say on raising children on the autism spectrum.

A recurring question around the autism spectrum is: what signs appear first? In other words, how can parents know their child is on the spectrum and when should they consult specialists?

When and how can parents know something is unusual?

According to Doctor Jean-François Havreng, a development specialist based in France, some parents express concerns for their child from six months old. Often, they find the parent-child bonding process unusual, for example eye contact is rare or inexistent, the child’s body is hyper or hypotonic when held, or the child might seem deaf. Children any age can show signs of autistic behaviour, though Doctor Havreng is careful to point out that in the early stages, cues and hints are not definitive proof. And though in some cases these signs do indicate the child is on the autism spectrum, they might have an entirely different condition, or even just display oddities now and later develop along a mainstream learning curve.

love-in-the-family-2

Love in the Family, by Kenny Tan

Doctor Havreng’s team runs an open clinic, located outside the hospital and in the center of the city, where parents can easily bring their children to meet professionals without stigma or fear. Trained specialists take the time to get to know each child, consider whether they present developmental delays and suggest tests. All the while, parents and their children are kept in a child friendly environment, with suitable toys and attractions.

There’s no way to understand a child’s developmental specificities in a few minutes. With this in mind, his centre takes a slow, measured approach to diagnosis, ensuring parents don’t feel overwhelmed. During each phase, the child interacts with several specialists, though the atmosphere is voluntarily not too medical (for example, no intimidating white lab coats), and more often than not, multiple evaluation techniques are applied to confirm and explain a diagnosis.

Diagnosing Unique Children
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Daring Cats and Mouse, by Kenny Tan

Each case of autism is unique. Understanding how a child on the spectrum can develop is complex, which is why Doctor Havreng recommends finding doctors with “extensive experience of developmental delays, including but not restricted to autism.”

The diagnosis gives parents a single word to explain and describe their child’s development. But for Doctor Havreng’s team, the diagnosis is just the beginning of a more important and fulfilling task: finding how children can thrive,  acquire skills and live a fuller life.

Focussing on Potential

Vincent Tan’s son Kenny was diagnosed aged 18 months. When he was finally given a name to put on his child’s uniqueness he felt both relieved and overwhelmed. He knew raising his child would indeed be challenging, but now he had clues about what that would entail.

His advice is to start with whatever issues feel the most pressing, asking other parents what they have tried. Some start by trying to make their child table ready for school – when appropriate -, others work on getting their child to stop specific behaviour patterns that create awkward or dangerous situations in the home. The quest for solutions is part of an overall discovery process to identify what makes your child tick.

wings-elephant-2

Wings Elephant, by Kenny Tan

Vincent admits the process has been difficult. There are many ups and downs and there is often no way of comparing or monitoring a child’s progress. In fact, comparisons with the development curves of other children, especially neuro-typical, can be demotivating and disappointing, as though their limited achievements reflect poorly on all the parenting put into their development.

From Childhood to Adulthood

Kenny is now 23, and has learnt many skills. He can ride a bike – in a safe environment without cars for example -, he can swim, and he has become an accomplished painter, selling his artwork in Singapore via the Everyday Revolution. He can read quite well, and enjoys reading classic literature works by Charles Dicken, George Orwell and Harper Lee. Writing independently, on the other hand, is still a challenge and needs a lot more work. In his father’s words “the most important trait is his willingness and his perseverance to try whatever the caregivers can have the patience to teach him”.

When Vincent reflects on the early years of his son’s education, he advises other parents to surround themselves with support groups, and get to know those who have similar problems. “Learn from their experience and experiments, together you will be more resourceful,” he says, with optimism.

Additional Links

Some additional links for parents looking for more information. Please also suggest more to us, which we can add to the list.

  • A short video to help explain how the world feels for people on the spectrum, by Amazing Things Happen
  • An (old) Letter to the new autism parent, by Eileen Shaklee (Autism with a Side of Fries)
  • 15 truths about parenting special kids, by Lisa Smith (Quirks and Chaos)
  • New words for parents of a child on the spectrum, also by Lisa Smith (Quirks and Chaos)

Note: all the artwork in this article is curtesy of Kenny Tan.

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HOW TO CHOOSE THE RIGHT PUZZLES FOR YOUR HOME THERAPY NEEDS (PART 1)

Abstract: This article is generally talking about the types of puzzles and how to use them for therapy (both speech and occupational) at home for kids with special needs. However, we firmly believe some of the techniques are also beneficial for teaching kids without special needs too. Note: tips here are based on compilation of the cited reference sources and also on our own personal experience of conducting therapy for our own children but they are not a replacement for medical or clinical advice. We combined both speech and occupational therapy tips as we believe both are essential for all types of children with or without special needs so  it would be good to have the other area of concepts at the back of our minds when we are conducting one type of therapy.

Random puzzles

Puzzles

Puzzles and boardgames are frequently used by speech and occupational therapists to teach language and skills to kids with ASD or other developmental delays. As caregivers, we understand that it is not always efficient or economical to bring your child to the therapists since it involves adapting of schedule, travelling time, preparation of meals for the child before, during and after therapy (gotta keep the kiddo in absolute good mood to benefit from the session isn’t it?),  what about time away from your other kids (if you have them) and sometimes, the child is simply not in the mood.

So home therapy is highly encouraged as a supplement to your usual therapy sessions as it reinforces concepts. For those who are somehow unable to access therapy (though we highly recommend getting professional help) it will be an alternative and with enough practice, parents can actually acquire the competence.

Moreover, it is a fun way to bond with the child. See it as a chance to play with your child, albeit withjust a bit more structure.

WHY ARE THEY GOOD?

These articles from Child Development Institute  by Pam Myers and learning4kids have highlighted the different skills and concepts that children can pick up. Here we summarise the important points from the article and provide more information.

  • Hand-eye coordination: When moving, flipping and turning pieces, they can learn about the connection between hands and eyes. This enables the brain to envision how the puzzle needs to look or which piece is required. It facilitates the brain, eyes and hands to work together.
  • Fine motor skills: Small, specialized movements to hold and manipulate pieces. Acquiring motor skills through using pincer movement.
  • Gross motor skills: Stacking and moving larger pieces
  • Problem-solving: Discerning if the pieces either fit or not. Children figure out by looking at the different pieces and can test them out. They learn to solve problems logically.
  • Matching: For some puzzles, kids will have to identify which two puzzles look the same and match them
  • Shape recognition: Learning to recognize and sort shapes is part of an important development in children. Puzzle pieces need to be identified and sorted.
  • Memory: Child needs to remember which exact piece, which piece has a particular size, shape, colour, pattern, that didn’t fit now and places it aside, then picking it back up later when needed again.
  • Setting small goals: Child usually willover time develop a strategy of how to work on the puzzle more efficiently. He or she will then need to set small goals like finding all the corners before achieving the larger goal of completing the puzzle.
  • Socializing and teamwork: Working on puzzles with an adult or friend will help a child learn social skills.
  • Self esteem: When kids complete a puzzle, they feel a sense of achievement and pride. This builds up their confidence and self-esteem
  • Language and speech: As you talk about the different pieces to the child, they learn about the different names of the shapes, colours, images they see. They also pick up different prepositions, verbs, sentence formations, etc

 

WHAT PUZZLES TO CHOOSE?

So here are some of the variations to puzzles. We don’t want to clear out the entire toy store so let’s figure together what some of our preferences are. Well, as expected, mixing things up a little is the best.

  1. Material: wooden, foam, plastic, cardboard, magnetic
  2. Type (According to this article on HubPages by Rose Mary an OT): connecting, non connecting, interconnecting, others
  3. Complexity: number of pieces,
  4. Theme: animals, automotives, food, alphabets and numbers, colours, shapes, cartoons, etc

Wooden ones are typically more expensive, especially if you buy high quality ones. For toy lovers, I would invest in better quality ones as they last longer and have better finishes. Simply for the purpose of therapy, buying cheaper imitations work just as well, but do take note to sand off badly finished pieces as we do not want our kids to get scratched or splinters in their fingers (we have enough to deal with).

Foam ones, like plastic, are easy to bring around. Some kids might like their squishy texture, others not. Plastic ones are the most value for money. Magnetic ones are the most fuss-free as they do not fall all over the place and are easy to store (second favourite after wooden ones).

Cardboards are typically jigsaw puzzles which are just so fulfilling when we manage to complete them. And oh so good for developing patience and focus in our little ones. They can also be matching flashcards.

Mazes (which might or might not require a separate writeup, let’s see) are another type of puzzle that are super fun and great for training fine motor skills and problem solving.

For those who find regular jigsaw puzzles dull, they can add a punch by buying those with 3D effect.

If you found this post useful, kindly like us here, or sign up for our newsletter here.

 

Thank you.

 

Team Irisada.

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Financial assistance schemes for disability in Singapore

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Having a disability, or caring for a loved one with a disability can be challenging. Physical, mental and emotional challenges aside, having a disability or caring for a loved one with an impairment can be a real financial strain.

Thankfully, in the last decade or so, as Singapore takes significant steps toward creating a more inclusive society where persons with disabilities (PWDs) can truly become empowered and recognised, more funding has been funnelled into helping children with special needs and persons with disabilities.

If you are searching for avenues of financial assistance for PWDs, look no further as we have compiled a list of grants and subsidies you could apply for. The list has been broken down into several categories, namely:

  • Support for Early Education, Study/ Training Bursaries and Grants
  • Transport Cost Subsidies, Assistive Technology
  • Support for the Elderly
  • Saving Schemes
  • Activity Centres and Disability Homes

This list is in no way exhaustive, so if anyone reading this would like to share more information regarding grants, subsidies, or whatever financial assistance schemes that has not been covered here, please let us know in the comments section below so we could update the list to make it as comprehensive as possible.

Support for Early Education by SG Enable

Development Support Programme

The Development Support Programme (DSP) helps kids with mild developmental needs to improve and overcome their language, literacy and social skills when they are in preschool (before six) to prepare them for primary education. On top of the monthly base subsidy of $300 that all Singaporean children are entitled to, parents will also receive further subsidies based on their income per capita.

*Children who are enrolled in an Early Intervention Programme for Infants and Children (EIPIC) are not eligible for DSP.<Link here>

Early Intervention Programme for Infants & Children (EIPIC)

The Early Intervention Programme for Infants & Children (EIPIC) provides social, educational and therapy services for children below the age of 6 who are diagnosed with moderate to severe disabilities. Through this programme, the kids will be able to participate freely in activities that will help with their development growth potential and also help minimise the development of their secondary disabilities. The fees at these EIPIC centres are means-tested, so families will be entitled to subsidies according to their income per capita.

*Applicants will undergo an initial screening before admittance to the programme.

<Link here>

Integrated Childcare Programme (ICCP)

The Integrated Childcare Programme (ICCP) caters to children with mild to moderate disabilities, aged between 2 and 6 years old, by providing them with a conducive environment to learn alongside their peers in an inclusive programme offered in existing childcare centres. The programme aims to better prepare children for integration into primary education. Working mothers will be eligible for subsidies of up to $300, and non-working mothers, up to $150.

<Link here>

Study/ Training Bursaries and Grants

Caregivers Training Grant (CTG)

The Caregivers Training Grant (CTG) is a $200 annual subsidy that helps defray the cost of training caregivers who need to acquire to better care for and cope with the physical and socio-emotional needs of the person with disability whom they are caring for. The caregiver must be a person in charge of the care recipient, who in turn has to be at least 65 years of age or has a disability as assessed by a doctor.

*This grant also falls under Support of the Elderly.

<Link here>

Microsoft Unlimited Potential Professional Certification Training Grant

The Microsoft Unlimited Potential Professional Certification Training Grant enables PWDs with a PCI< $700 or less, based on means-testing, to undergo Microsoft professional training for employment opportunities in IT-related work. The grant funds 50% of the total course fee and other fees relating to the course or up to $3,000 per year, whichever is lower. Applicant is allowed one grant per every two years.

<Link here><Link here>

SPD Bursary Award

The SPD Bursary Award is offered to students with physical or sensory disability, i.e. hearing or visual impairment, from low-income families with a PCI of less than $950, studying in mainstream schools. The quantum of the grant ranges from $300 per year for primary level to $6,000 per year for university level.

Educational Level Quantum of Subsidy
University $6,000 per year
Polytechnic $2500 per year
ITE $850 per year
Pre‐U/Junior College $500 per year
Secondary $400 per year
Primary $300 per year

<Link here>

Wan Boo Sow Charity Fund

The Wan Boo Sow Charity Fund aims to provide financial assistance to needy students studying in polytechnics, PWDs, and homebound elderly. Financial assistance is provided for PWDs for their expenses on education, medical needs, therapy, transport, and purchase of assistive equipment. The percentage of subsidy is tiered based on monthly per capita household income (not more than PCI =$1300) and capped at a maximum of $5,000 per annum.

*This grant also falls under Support for the Elderly

<Link here> 

Transport Costs Subsidies

Taxi Subsidy Scheme

The Taxi Subsidy Scheme aims to defray transportation costs of PWDs by providing taxi subsidies for those of whom are only able to travel by taxi for school and work. Subsidy rates are means-tested, allowing significant subsidies based on monthly household income.

Per Capita Monthly

Household Income

Subsidy Rate
Singapore Citizen Permanent Resident
$0 to $700 50% 25%
$701 to $1,100 40% 20%
$1,101 to $1,600 30% 15%
$1,601 to $1,800 20% 10%
$1,801 to $2,600 0% 0%
$2,601 and above 0% 0%

<Link here>

VWO Transport Subsidy for Persons with Disabilities

The VWO Transport Subsidy for Persons with Disabilities provides subsidised transport options for PWDs for those of whom who regularly use dedicated transport services provided by VWOs to attend their school and care service. Like the Taxi Subsidy Scheme, the VWO Transport Subsidy is provided based on PCI.

Per Capita Monthly Household Income Subsidy Rate

 (Singapore Citizen)

Subsidy Rate

(Permanent Resident)

$0 to $700 80% 55%
$701 to $1,100 75% 55%
$1,101 to $1,600 60% 40%
$1,601 to $1,800 50% 30%
$1,801 to $2,600 30% 0%
$2,601 and above 0% 0%

<Link here>

 

 

Assistive Technology Grants

SG Enable’s Assistive Technology Fund (ATF)/ Special Assistance Fund (SAF)

The Assistive Technology Fund (ATF) provides subsidies for PWDs to acquire, replace, upgrade or repair assistive technology devices that aid in daily living. Successful applicants qualify for a means-tested subsidy of up to 90% of the cost of the required equipment, subject to a lifetime cap of $40,000.

<Link here>

For adults who are unemployed, application is made to Special Assistance Fund SAF. The per capita net monthly household income is ≤$1,300.

* Any other fund administered by NCSS, SG Enable, or Agency for Integrated Care (AIC) for the same purpose would disqualify an applicant from the SAF.

<Link here>

 

SPD’s Assistive Technology Loan Library

The Assistive Technology Loan Library (AT Loan Library) has a wide range of AT devices available for loan or for the purpose of trial use, training and temporary accommodation. Loans are extended to people with disabilities as well as professionals working with people with disabilities. Deposit and nominal renting fees apply.

<Link here>

 

Support for the Elderly

HDB’s Enhancement for Active Seniors (EASE)

The Enhancement for Active Seniors (EASE) programme, part of the Home Improvement Programme (HIP), was rolled out separately and offered to all towns in March 2013. Catered to the elderly, especially those who require assistance for one or more of the Activities of Daily Living (ADL) with  improvement items such as slip-resistant treated tiles, or grab bars, to make flats more elder-friendly and improve mobility and comfort for elderly residents. The programme is greatly subsidised, and depending on the type of flat you live in (as per table below), can cover up to 95% of the total cost.

Per Capita Monthly

Household Income

Subsidy Rate
Singapore Citizen Permanent Resident
$0 to $700 90% 65%
$701 to $1,100 65% 50%
$1,101 to $1,800 40% 30%
$ $1,801 and above 0% 0%

Figures are estimates and subject to change

<link here>

Singapore Silver Pages is a one-stop resource on Community Care information to help you make informed care choices by making it easier to find the information you need. SSP is the first portal to integrate social care, healthcare, mental health and caregiving resources under one roof for seniors, caregivers and care decision makers. The following are some schemes listed in SSP’s portal.

Pioneer Generation Disability Assistance Scheme (PioneerDAS)

The Pioneer Generation Disability Assistance Scheme (PioneerDAS) is part of the Pioneer Generation Package, which honours the contributions of Singapore’s pioneers towards  the development of the country. Under this scheme, pioneers with disabilities can receive $100 a month, which they can use for expenses.  The care recipient must be a pioneer living in Singapore and require permanent help in at least three ADL.

<link here>

Seniors’ Mobility and Enabling Fund (SMF)

The Seniors’ Mobility and Enabling Fund (SMF) provides holistic support for seniors on low income by extending three different subsidies to Singaporean seniors with different needs.

  • The SMF subsidy for Assistive Devices provides financial assistance to those requiring mobility and assistive devices for daily independent living. To qualify for the subsidy, the elderly has to be a Singaporean citizen aged 60 or older, assessed by a medical professional, and making claims for the device in its category for the first time.
  • The SMF subsidy for Transport aids seniors’ transportation cost for attending any day services at the Ministry of Health-funded Eldercare Centres, Dialysis Centres or Day Hospices. The elderly must be assessed to require a wheelchair, any form of special transport, walking aides, or assistance when travelling, and must not be already getting subsidies for the same transport service.
  • The SMF subsidy for Home Healthcare Items alleviates the costs of healthcare items by providing subsidies for products such as milk supplements, adult diapers, and wound dressing. The elderly must be receiving healthcare services at home or at the Singapore Programme for Integrated Care for the Elderly (SPICE) Centre, and must be assessed to determine the type of healthcare items required.

<link here>

 

Caregivers Training Grant (CTG)

The Caregivers Training Grant (CTG) is a $200 annual subsidy that helps defray the cost of training caregivers who need to acquire capabilities  to better care for and cope with the physical and socio-emotional needs of the person with disability whom they are caring for. The caregiver must be a person in charge of the care recipient, who in turn has to be at least 65 years of age or has a disability as assessed by a doctor.

*This grant also falls under Study/Training Bursaries and Grants.

<link here>

Wan Boo Sow Charity Fund

The Wan Boo Sow Charity Fund aims to provide financial assistance to needy students studying in polytechnics, PWDs, and homebound elderly. Financial assistance is provided for homebound frail seniors who require help with expenses ranging from personal care to meals, and even escort services. The percentage of subsidy is tiered based on monthly per capita household income (not more than PCI =$1300) and capped at maximum of $5,000 per annum.

*This grant also falls under Study/ Training Bursaries and Grants.

<Link here>

 

Savings Schemes

Special Needs Savings Scheme

The Special Needs Savings Scheme is a way for parents to set aside funds from their CPF savings by nominating their child with special needs to be entitled to their savings so the child can receive a regular stream of fixed payouts upon their demise.

<link here>

Activity Centres and Disability Homes

Residential Care Services At Children Disability Homes

The Residential Care Services At Children Disability Homes are for children under 16, diagnosed with congenital disabilities, and without caretakers. Not only do these homes provide the children with the option of staying for short or long periods of time, they also enable the children to undergo therapy and training, as well as participate in recreational activities that will help to maximise their abilities. There are four different centres providing different services, so it is important to choose one that best suits the child’s needs. The fees at these disability homes are means-tested, entitling families to subsidies according to their income per capita.

<link here>

Metta Day Activity Centre for the Intellectually Disabled

The Metta Day Activity Centre for the Intellectually Disabled caters to beneficiaries aged between 18 and 55 who are diagnosed with intellectual impairment such as Down’s Syndrome, Autism and developmental delay. Programmes at the activity centre are individually designed to help each person achieve maximum gains in his/ her abilities. Like Residential Care Services at Children Disability Homes, the Metta Day Activity Centre for the Intellectually Disabled is also means-tested for fees, providing families with substantial subsidies.

<link here>

 


We hope this list of financial assistance and/or related schemes PWDs can apply for would be useful. Once again, we recognise that the list is not exhaustive and there might have been updates since our research. We have made deliberate attempts to look for schemes spanning a wide categorical spectrum so as to hopefully provide you with help in the area you are looking for.

Stay up to date  with the Singapore disabilities community

There is a large community of people with disabilities here in Singapore, and they are not always visible to the rest of the population. So if you would like to be to be a part of a community that openly celebrates the beautiful gift and unlimited potential of persons with disabilities and stay up to date with the community, sign up for the newsletter in the link below. Together, we can connect entire communities of people to a world of colours.

Sign up for the Irisada newsletter here.

*This article is written for Irisada in hopes of providing information on financial solutions for PWDs who might need financial assistance.

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