Rethinking Autism Support: A Conversation with Dr. Selvam Karuppiah

In this episode, we sit down with Professor Dr. Selvam Karuppiah, Founder and CEO of Freesoul UNI BHD, Malaysia. Dr. Selvam shares his unique insights on autism advocacy, building inclusive support systems, and how structured programs can empower neurodivergent individuals to live fulfilling, independent lives. 

Transcript

SPEAKER_01 0:00

Hello Professor, I'm Neveta, Assistant Professor in Department of Psychology at Hindustan University Chennai. Can you briefly introduce about yourself, sir?

SPEAKER_00 0:09

Well, thank you for inviting me to this program. And I'd like to say I owe a lot to India and Chennai particularly, because I started my career, my medical school training in Chennai. And I finished my training, went back to Malaysia, and literally worked across the globe. And I worked in many areas of medicine, including gynecology, general medicine, and particularly neurosciences and psychiatry. And lately I have switched to integrative health care, which means we have two parts in medicine now. One is the conventional medicine treating the patients like normal doctors do. But what integrative medicine is now trying to do is take all components of health, like even Ayurveda, traditional medicine, and try and improve the outcomes for the patient. So that is integrative health, and this is the new science that is being developed.

SPEAKER_01 1:16

What differences are happening in the brain of a child?

SPEAKER_00 1:19

Okay, basically, you want to know about autism. The interest in autism has more or less spiraled five, six times more than the last few years. We find a higher incidence of autism. Whether this is due to our awareness or actual physical rise in the incidence is still unclear. You see, 15 or 10 or 20 years ago, autism was there and we didn't know much about autism. So the incidence and statistics may have changed over the time because our knowledge about autism has changed now. So that's one of the factors. Number two, the world has gone through a lot of pollution in many forms. Pollution is just a single word, but pollution in many forms. Pollution in the genetics, pollution in the environment, pollution in the human body. There are so many types of pollution. Now, any one of those could have contributed to the sharp rise of autism. Autism, in my view, is a very complex disorder. There are concepts like it's only in the brain, but I don't think it's only in the brain, although the brain is a primary component in autism, the entire neural system is involved in autism. What you would find in autism, one of the first symptoms is the motoneurons are not as active as the other neurons. So you find a weaker motoneuron system. You find in in a lot of autistic children they have a disability in movement. And over time, through exercise, through training, they get better. The other side of autism, you will find the cognitive processing to be difficult, disorganized. It's a complex structure. And no two autistic children are the same. And it's very difficult to define exactly where the issues are. Because, like I said, the human body is a very complex system. And if you go into the neuronal structure, the central nervous system, it's even far more complex. And all of this sit in a system which is autoregulative, which means if you change something somewhere, there is a possibility that the body will self-regulate back to its original state. So then what you have is a much more serious outcome or a lesser form of symptom presentation. And we don't know if we can call this cure. And in my mind, I don't think that is a cure, but I would rather prefer to use the word adaptation. And I think adaptation is the right word because even for us people who we who think we think we are normal, right? I don't know how you would like to look at the question. I don't think anybody is normal. I think we are all mad. Only the madness is different in each one of us. Some of us may need treatment, others may not. That's a difference. But the adaptation process in a human being is what keeps us within that normal bracket. For example, if you don't like the sun, then you adapt by moving towards the shade. So that makes you normal. But if you keep walking in the hot sun, then you're going to get sunburnt, you're going to get rashes, you're going to develop the symptoms from something that you don't like. So I think adaptation of the body is more the right word than using the word cure.

SPEAKER_01 5:08

And what are some early signs and totals that parents and preschool teachers should watch out for?

SPEAKER_00 5:16

Okay, autism, uh as we know now, parents live in a state of denial most of the time. Parents think that they always give the excuse, this happened in your uncle, this happened in your grandfather, it's a normal thing. As you get older, you will become better, and they delay seeking medical help. This is the normal story that we see even today. And part of that could be true because autism has got a genetic loading factor. So it may be true that it runs in the family. So they normalize the scenario and they do not think it's a problem. So the illness, or I I hate to use the word disease, the illness progresses and becomes serious by the time the child is six. We are born with about trillions of neurons. And if you notice a child, you know, the child does this first movement, hand-mouth coordination. If the child keeps on doing this, the neuron gets thicker and becomes a pathway, which later helps in the coordination of the hand and mouth. So the child can later feed itself. So just like that, our entire human neuronal system gets embossed. Like if you imagine a circuit board, the circuit board becomes endorsed by the repeated movements. When that becomes part of you, how easy do you think it's going to be to change it? That's going to be difficult, yeah? So that answers the question in autism. So we now encourage parents to be more watchful, um, braver in accepting something that's not right. Now we're looking at milestones, yeah? When the baby turns over, when the baby sits up, crawls, walks. Now, all this will be quite a hallmark for early diagnosis. Now, in today's time we even have uh AI assisted programs which can detect autism. A child for an assessment would be about at least a year's one year old, you know, if you find some issues. But I don't see any disadvantage for all children to be screened, because some may develop it earlier, some may develop it later, so why not put all the children through the screening? Because the incidence of autism these days is something like 1 is to 8 or 1 is to 10, where previously it used to be 1 is to 40.

SPEAKER_01 8:47

How can parents and teachers better support an autistic child?

SPEAKER_00 8:52

Both have an immense kind of responsibility, and this is something I spoke about in the public media in Malaysia in 2011 in a teachers' conference, because teachers spend actually teachers spend more time with any child than the actual parents. So whilst the parents have the genetic responsibility, parenting these days have changed compared to 30 years, 40 years ago, where the child is surrounded by grandparents, aunties, even if the mummy is not around, there's so many cousins, so many people surround the child. But honestly, you walk into any home today, most of the time the child is sat in front of the TV or playing with a phone or playing with the play system, left alone. And what do you get? The narrative you get from parents is my child is wonderful. My child doesn't disturb anybody. You just give him one toy and the child plays with the same toy. I mean, to the parent, this is hey, wonderful, great, don't even ask me for a different toy. But what do you see in the true essence? This could be the first signs of autism. A child who continues to play with one toy, her child who prefers to be the quiet, isolated child, the child who likes routine, that means you put the child in one corner, the child will stay in that corner. If you take the child and put it in another corner, all hell breaks loose. So mommy says, No, no, no, I'll put you in your corner. Your favorite corner, right? I put you there. So this is seen as an advantage by the parent. But very rarely they realize that this is autism unfolding. But today's children are protected species. If the teacher raises his or her voice, the parents come to the school and then start off with saying, Oh my god, why was my child spoken to rudely today? My child is traumatized. And children as young as five years old can now say, I am stressed. I don't know what that child understands by the word stress, but this is what's happening in the social scene. So it's it's a bit of a difficult scenario, but the teachers are going to be the first ones, if anybody, who is going to pick up on this abnormal behavior, abnormal habits, abnormal performance, abnormal seclusion, you know. There'll be a group of kids who'd enjoy that group activity, but this one child will prefer to do something else. So these are ways teachers can pick up. So I think the role of teachers and parents is fairly important, and a good communication within parents and teachers is going to be taking this uh intervention way, way forward.

SPEAKER_01 12:28

So, Professor, we are having a massive rise in anxiety and stress among school students. So, what are the strategies that schools and families use to support such students?

SPEAKER_00 12:39

Wow, another very powerful question. Um I can only relate to uh certain experiences about growing up, yeah. And I've I've thought in about five or six universities. So when I start telling them, they'll say, Oh, prof, don't go back to your times, times are different now. I think when I was 12 years old, I could chop a tree down. We have become regressive in challenging life's natural requirements. We played all day in the sun, we played all day in the rain, because when we got back home, we got smacked, uh, we got into all kinds of trouble. But two days later we are back doing it. We were resilient. But a 12-year-old can't do that today. When I was 12 years old, I could take a bus and go to the next town, unsupervised, unaccompanied. In fact, I think I was nine years old when I took a bus from my hometown to school. But would you? I don't know how many of you parents out there would say you would have the confidence of putting your nine-year-old in a public bus and say, go and get down there. So, where is the problem, the growth process? Where children may look big, may look confident, may have eight A's, nine A's, twenty A's, whatever, but are socially not adept. Where is the confidence? Children become anxious. That's why I said a five-year-old can say, I'm stressed, I'm anxious. Mommy, I'm anxious. Why? How does a five-year-old know about anxiety to start with? Today, a college student thrown into the deep and like, okay, first time you're moving out from home and you're going into the hostel, they can't adapt. The social structure is different. And I had a doctor who called me up and said, I have this problem, my son is suicidal, da-da-da. And so I took a bit of history. So, what happens? What was his bringing up? No, he's a perfect, fantastic student, da-da-da. And I I send his father with this lunch box every day. And this is a medical college student, and the mom cooks and tells the father, take this for your son for lunch. What's happened to the world? I mean, he must be what? Um 18, 19? Why can't he go to the cafeteria, buy his own lunch? I think it'll be cheaper than cooking at home at five o'clock in the morning, and then the father travels, I think about 100 kilometers with a tiffin carrier, waits till the son finishes his lunch, and then drives back a hundred kilometers. Now, what do you think are the possibilities of this young trainee doctor going through stress? So he wasn't coping with work stress. And it became an issue. So the question that you asked me, why are young people getting stress? I think the finger points back to the parent. Uh the adaptation process has become malfunctioned. The social inadaptability is on the decline. So any challenge, any small challenge becomes a huge challenge, becomes a challenge, they become very anxious, then of course they go through the normal process of emotions that you know about. Then the anger is taken out on themselves. I'm not blaming anybody here, I'm not blaming the parents because that's the way life is. That's the way we have all evolved in our social sense. So I think as a community, we bear responsibility for some of the problems we see amongst youngsters now.

SPEAKER_01 16:58

If a teacher notices a student suddenly acting out or withdrawing or struggling, what is the best first step that they could take?

SPEAKER_00 17:07

There are different ways of handling it. If the child is five years old and is acting out, the best way as in in terms of psychology is what? You do not reward that action. If you reward, then you're going to reinforce. If you reinforce, it's going to repeat. If it repeats, it becomes part of them. So that's for a five-year-old. But if you're talking about a 15-year-old, what are the possibilities? Is there something that is bothering the child? Is there something that's affecting the child? Is there something that's chemically wrong in the system? Because a 15-year-old these days could have an unstable mind caused by so many things. It could be alcohol, it could be drugs, it could be friendships, it could be relationships, it could be bullying. There's a whole plethora of things.

SPEAKER_01 18:07

How can we change a school system so that we protect kids' mental health so before they reach a breaking point?

SPEAKER_00 18:14

I don't think it's the system that needs changing. I think it's again it's about adaptation, it's about how we are changing and learning or teaching our brain to learn. Now, the funny thing with uh today's system is if I give them a simulation, a scenario, they cannot connect the dots. So if I give them a scenario saying that, okay, you see a patient 40 years old walking in with these symptoms, what would be your first thought? They struggle. My grandfather's time, they all wrote on the sand. Yeah. Why do you think they wrote on sand?

SPEAKER_01 18:55

The sensory stimulation.

SPEAKER_00 18:57

Because I we know two 2000 years ago uh people were writing on leaves, yeah. But why did my grandfather have to write on sand? They realized that when you had this somatic sensation, it gets embedded in your memory in the sketch form as you continue to write in the sand. It's a sensation that gets embedded, like what I said earlier about trimming of the neuron, and that stays there. And if you're asked to write later, you automatically remember the script. So going back to how the brain is trained is was very, very helpful. But today, again, nobody does that. I would say in a few years' time, none of our graduates will be able to write something with a pen and paper. So in years to come, I don't think we will write anything because we now have voice modulation. You talk to your phone or computer, it types the text and gives you the document. So whether to say this is progressive or regressive, I let you guys decide whether we are moving in the right direction.

SPEAKER_01 20:18

In your opinion, what will be the future education for these students?

SPEAKER_00 20:22

Go back in time and look at how teaching was done those days. Um, I'm sure you all would have seen or heard during my time when we go to school, we used to take what we call a counterframe to do maths. Where we had beats that we push, uh, two plus three, yeah. So visually we are activated, we count, we call out the numbers, we say add, and then we say the figures. Yeah? So we know we learned maths by audio, visual, but also by touching, feeling, and actually experiential kind of learning. Psychologists all talk about experiential learning, right? Then came calculators. What did we do? Two buttons, and then you get the answer. If you ask somebody who learned maths those days, like your great-grandfather or grandfather, you give them a num few numbers, and you give them a mathematical problem, take away this or subtract this or divide this, they will do what we call mental mathematics. But try it with your 12-year-old, and I don't know if you'll get the same answers. Coming back to the question is how does learning and teaching go hand in hand? This is one of the things. And about AI AI, I would say, is the now the highest developed form of teaching, training, uh, including doctors using a lot. Of AI in screening, diagnostics, and so forth, so many things. The thing is, it is great to have AI as an assistant so that mistakes become lesser. For example, I'm doing something and I have a standard outcome that the AI knows, and if I steer away from it, the AI tells me, look out, there may be an error. That's great. But if I let the AI do the thinking for me, then I'm going to lose my functionality of interpretation, diagnosis, everything will go. Again, going back to my medical students, like I said, they know everything, but they cannot be spontaneous in connecting the dots and coming out with an outcome. Because it's less effortless, I mean more easy just to type in the AI and out comes the answer. Possible diagnosis. So what's going to happen to my medical students? It's not that they are not clever, they are losing a skill. I think human evolution we have seen, when we don't use something, we are going to lose that faculty. We are going to lose that interpretive skills. So I would say use AI as a safety guide, as your backup plan, whatever, but do not do not use that as the mainstream. But it's becoming a mainstream with a lot of students, especially out there, they get their whole whole thesis written up on AI and they go for Starbucks coffee. And by the time they come back, their assignment is ready for submission. But that's I think in the long run is not going to help because you're not going to register to retrieve it when you need it. Voicing out suicide is also an attention-seeking behavior. So there are many components. And they use this as a currency sometimes. They use this as a threat. The Jenzi themselves do not gain anything, and it puts a lot of anxiety because parents know from their time what suicide means. And teachers who are much older know what suicide means. Then she hasn't got the true picture of suicide. And I would say a lot of completed suicides are actually accidental completed suicides. And this is very worrying. I remember one particular incident where the husband had a routine. Rain or shine. And she had set the scene where she had the rope on the fan, the stool, she was standing on the stool, and she was going to attempt suicide at 5.30 because she knows the husband will drive in. Unfortunately, that day the husband didn't drive in at 5.30. A lot of suicides, completed suicides, are not really suicides, but I would say accidental suicides. I think we need to educate teenagers how to deal with stress and take suicide out of the equation. I don't say we will totally get rid of suicide as an entity, but we What are the measures to drag out students from suicidal thoughts? It's anger driven inwards. This is how we look at it. When they cannot express the anger to the outside, then they deflect the anger onto themselves. So having said that, what was their real intention? They wanted to show you how angry they are, but did they really want to die? So I think this is something that we have to wake up to and we have to do more to prevent these unnecessary deaths that comes out of emotions, out of ego, out of anger. I think we have a lot of work to do along these lines.

SPEAKER_01 27:08

Thank you for sharing an insight, Sue.

SPEAKER_00 27:10

Thank you again for having me here at Hindustan University. It was a great pleasure meeting all of you, especially from the psychology team. Hope to see you all again soon. Bye bye.