by Dr B. J. C. Perera

MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paediatrics), MRCP(UK), FRCP(Edin), FRCP(Lond), FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)

Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.

An independent freelance medical correspondent.

When a family first receives a diagnosis of Autism Spectrum Disorder (ASD) in a child, the immediate reaction is often a mixture of confusion, sorrow, anguish, overwhelming uncertainty and the terrible feeling of total helplessness. In Sri Lanka, where cultural perceptions and societal expectations around child development run ever so deep, parents of autistic children frequently ask themselves: “What did we do wrong?” or “Whose fault is it?” or “What will become of our child’s future?” etc.

The short answer to those sentiments is: you did nothing wrong. Autism is not an illness to be cured; nor is it the result of poor parenting. It is due to a developmental disturbance in the unique neurological wiring of the affected child’s brain. While clinical interventions, speech therapy, and occupational therapy play essential roles, the most profound transformations should occur where the child spends the vast majority of their time: at home, surrounded by close family and loved ones.

To support a child on the spectrum of ASD effectively, families must understand that autism is not a one-size-fits-all condition. As the very name suggests, it manifests along a broad continuum, from mild (Level 1) to severe (Level 3). Navigating this path requires specifically tailored strategies for home care, an understanding of local resources, inspiration from proven global approaches, and a clear awareness of some practices that can do more harm than good.

Understanding the Spectrum of ASD and Tailoring Home Care

Every child with autism has a distinct profile of strengths, sensory sensitivities, and developmental challenges. Matching your home environment to your child’s specific position on the spectrum is crucial for their growth and further development.

The Three Severity Levels

These levels measure how much daily help a person needs. They look at two main areas: social communication and restricted or repetitive behaviour.

* Level 1 (Requiring support): It is the mildest level. Affected children have trouble starting social interactions or organising tasks without help. They have fluent speech but struggle with distinction and gradation. They need subtle social cues in everyday life.

* Level 2 (Requiring substantial support):

It is a moderate level. The affected patients show clear social communication issues and strict routines that interfere with daily life even with help. Their speech is phrase-limited; they have significantly high sensory overload and often require visual schedules.

* Level 3 (Requiring quite extensive support):

This is the most severe form of the disorder. Those affected have severe communication impairments with minimal coherent speech and extreme resistance to change, needing constant and intensive help. They show marked behaviour problems, severe distress and meltdowns.

The Mild Stage (High-Functioning / Level 1)

Children on the mild end of the spectrum often speak fluently and could even excel academically or in specific interest areas. However, they may struggle significantly with subtle social cues, emotional regulation, and adapting to unexpected changes.

* Home Strategy to Follow: The family members need to focus on explicit social coaching and emotional literacy. Use “social stories”, like short, illustrated narrative scripts to explain everyday scenarios like taking turns during family games, handling losing, or starting a conversation with a cousin.

* Behavioural Pattern:

They may talk incessantly about a narrow passion such as train timetables or marine life while failing to notice when a listener has lost interest. Rather than hushing them, family members can set structured “sharing windows” (e.g., “We will talk about trains for 10 minutes, and then we will talk about dinner”). Genuinely responding to them and paying intense attention to what they say is of paramount importance.

The Moderate Stage (Level 2)

Children at this stage exhibit more pronounced communication delays, repetitive behaviour, such as hand-flapping or pacing, and have noticeable difficulties in shifting focus from one task to another.

* Home Strategy to Follow: Implement visual schedules. Children with moderate autism tend to process visual information far better than spoken words. Use picture cards affixed to a board to show the daily routine: Brush Teeth, Eat Breakfast, School, Play Time, Bath, Bed.

* Behavioural Pattern:

They may experience distress during routine shifts, such as leaving the house for a family visit. Providing a 10-minute and 5-minute visual timer countdown before a transition helps to ease anxiety dramatically. They need to be kept informed about what is going to happen.

The Severe Stage (Level 3)

Children on the severe end of the spectrum are often non-verbal or use very limited functional words. They frequently experience intense sensory sensitivities and may engage in self-injurious behaviour, such as head-banging, biting or severe meltdowns when overwhelmed.

* Home Strategy to Follow: Prioritise safety, basic communication, and sensory regulation. Set up a dedicated “calm-down corner” in the house, stocked with soft pillows, weighted blankets, and sensory toys. Communication should rely on Picture Exchange Communication Systems (PECS) or basic hand sign gestures for fundamental needs like “water”, “food”, or “toilet”.

* Behavioural Pattern:

Sensory meltdowns in these children are not temper tantrums. They are involuntary neurological overloads caused by bright lights, loud noises, or internal distress. During a meltdown, lower the room lights, reduce noise, ensure physical safety, and family members need to sit quietly nearby without overwhelming the child with verbal demands and specific instructions to follow.

Lessons from the West: The “Son-Rise” Connection

In Western cinema and literature, stories like “Son-Rise: The Miracle Continues”, which documents how Raun Kaufman’s parents helped him overcome severe autism, offer valuable insights for Sri Lankan homes. While some historical claims in early literature about “total cures” should be viewed through a modern scientific lens, the core philosophy of the Son-Rise Programme remains profoundly effective: “Join the child in his or her world before you ask them to join yours.”

In traditional settings, adults often try to stop a child’s repetitive behaviour, such as spinning wheels or rocking. The Son-Rise approach flips this paradigm upside down, so to speak:

* Joining: If your child is sitting on the floor spinning a saucer, sit beside the child and gently spin a saucer, too. This non-judgmental validation builds an unexpected bridge of trust. The child realises, “You are not trying to change me; you are interested in what I am doing.“

* Capitalising on Eye Contact:

The moment the child turns to look at you in surprise, use that brief window of shared attention to offer a warm smile, a soft word of encouragement, or a gentle toy exchange.

* Parental Attitude:

The most crucial element from these Western frameworks is changing the emotional tone of the home from one of anxiety, desperation and pity to one of unconditional acceptance, love, and hopeful facilitation.

Mobilising the Extended Sri Lankan Family

One of Sri Lanka’s greatest cultural strengths is the extended family support system, consisting of grandparents, aunts, uncles, and domestic helpers living under one roof or nearby. When mobilised correctly, this network provides an extraordinary support system.

* Educating Grandparents: Older generations may view autism through traditional lenses, misinterpreting it as bad karma, spiritual affliction, or spoiled behaviour. Parents must gently educate elders using simple medical concepts. It is necessary to explain that the child’s brain is like a radio tuned to a different frequency. It is not broken; it just hears and sees the world differently.

Assigning Role-Based Support:

* Grandparents can offer calm, unhurried companionship, reading structured storybooks or tending a home garden alongside the child.

* Aunts and Uncles

can assist with transportation to clinical appointments or provide respite care, giving the primary parents a necessary break to prevent “caregiver burnout”.

* Siblings

should be taught how to act as play-partners rather than secondary parents. Encouraging games, such as building blocks, painting or water play that do not rely heavily on complex verbal rules, is a very useful and productive strategy to adopt.

Utilising Local Facilities and Community Services in Sri Lanka

While specialised services were once concentrated solely in major medical hubs, Sri Lanka has made noticeable strides in multidisciplinary care for developmental conditions such as ASD. Families should actively tap into both state and non-governmental resources.

* State Healthcare Infrastructure: Most of our tertiary care hospitals offer specialised Autism Assessment Clinics, speech and language therapy, as well as occupational therapy units. District General Hospitals across the island increasingly feature Developmental Clinics supported by the Sri Lanka Association for Child Development (SLACD).

* Primary Health Network:

Public Health Midwives (PHMs) and local Medical Officers of Health (MOHs) are often the first line of early detection. Parents who notice some lack of eye contact, speech delay, or absence of social smiling by 12 to 18 months of age in their child should request an evaluation through their local MOH Clinic.

* Non-Governmental and Foundation Support:

Organisations such as the MJF Charitable Foundation (Rainbow Centre) provide holistic therapy, inclusive education, and vocational training facilities. Regional charities, such as ECSAT in the Southern Province, offer community-based outreach, one-to-one educational support, and even home visitation programmes for families unable to travel daily.

* Community Integration:

Encourage participation in inclusive community settings. Local religious centres, such as temples, churches, and mosques, as well as community parks, can serve as gentle environments for social exposure during off-peak, quiet hours.

What NOT to Do: Some Counterproductive Measures

In their eagerness to help, well-meaning family members can inadvertently hinder progress or cause emotional regression. Families must consciously avoid several common pitfalls:

* Forced and Prolonged Eye Contact – For an autistic child, forcing direct eye contact can trigger physical anxiety akin to a threat response. It is much better to look at a shared object or toy together. Eye contact will improve naturally and progressively as trust grows. Improved eye contact is a definitive sign of progress.

* Punishing “Stimming”

(short for self-stimulatory behaviour) is the repetition of physical movements, sounds, words, or object manipulations used to self-regulate emotions and process sensory input. Flapping, rocking or humming are vital self-regulatory mechanisms for processing stress or joy for affected children. It is necessary to allow safe stimming freely and to gently intervene only if the behaviour has the potential to cause physical self-harm.

* Excessive Screen Time –

Handing a child a smartphone or TV screen to keep them quiet suppresses human-to-human social neural networks. It is far better to replace passive screen consumption with tactile sensory performance such as playing with sand, playdough, or pouring water.

* Hiding the child –

Keeping the child isolated out of fear of social stigma (“What will the neighbours say?“) robs them of essential social learning opportunities. It is necessary to introduce the child to community environments gradually during calm, low-density hours.

* Inconsistent discipline

– Allowing a behaviour one day (perhaps due to tiredness) and scolding for it the next day creates severe confusion for a child with ASD who generally tends to thrive on predictability. Ideally, it is desirable to maintain firm, calm, and uniform boundaries across all household members.

Light at the End of the Tunnel: Hope Begins at Home

Although many parents are devastated by the diagnosis, ASD is not the end of the world. Autism presents a unique developmental journey, but it is not a complete dead end. When a home environment shifts from a focus of intense frustration to one of structured acceptance, remarkable progress is most likely to unfold. The intense efforts put into such an endeavour will provide tangibly positive results. That platitude has been shown repeatedly and proven to be quite true, over and over, again and again, in very many scientific studies.

By blending modern behavioural strategies, leveraging some of the Western philosophies of unconditional joining, drawing strength from Sri Lanka’s extended family networks, and utilising available local clinical services, affected families can transform their homes into safe anchorages. In doing so, they give every affected child, regardless of where they sit on the Autism Spectrum, the opportunity to bloom into their fullest potential. It can be a fruitful and deeply satisfying journey of achievement. The secret to success is not to be miserably dejected, but to be hopeful and optimistic. Easier said than done sometimes, but it is the only axiom that will show clearly perceptible and improved results.

by Col. (R) Nalin Herath

There is a question that the international community must periodically ask itself: What happens to a State after its regime has been ousted?

The question is particularly relevant when examining Iraq and Libya. Saddam Hussein and Muammar Gaddafi were authoritarian rulers. Their governments were associated with political repression, human-rights violations and the suppression of political opposition. None of this should be ignored or excused. But recognising the failures of authoritarian rule does not prevent us from asking another, equally important strategic question:

Did the removal of these regimes adequately prepare for what came next?

The experience of Iraq and Libya suggests that removing a ruler is considerably easier than replacing the political, administrative and security architecture around that ruler.

Danger of confusing regime change with State reconstruction

A state is more than its leader. It consists of institutions, security forces, civil servants, courts, political structures, infrastructure, economic systems and, perhaps most importantly, an accepted monopoly over the legitimate use of force. When an authoritarian system has concentrated enormous power around one individual, removing that individual can expose weaknesses that were previously hidden. The strategic mistake is to assume that once the dictator has gone, a democratic and stable state will naturally emerge. History does not support such an assumption. The aftermath of Iraq demonstrates this particularly clearly. Following the 2003 invasion, the Coalition Provisional Authority issued Order No. 2, formally dissolving the Iraqi Ministry of Defence and the Iraqi Army, among other security institutions. A US congressional report later documented the enormous consequences of this decision, including the disappearance of hundreds of thousands of military personnel from the institutional framework of the state. Whatever the intentions behind the decision, the strategic consequence was that an established security structure had to be rebuilt while the country was simultaneously experiencing political upheaval and growing violence. That is a dangerous combination.

Iraq: Removing the structure before building the replacement

Saddam Hussein’s government was unquestionably authoritarian. It also reflected a complicated sectarian and political structure in which members of the Sunni minority occupied disproportionate positions of power despite being a demographic minority. But the question for strategic planners should not simply be whether Saddam deserved to remain in power. The question should have been:

What institutional structure would replace the system once he was removed?

An army can be politically controlled without being politically representative. A bureaucracy can serve an authoritarian government while still providing essential state functions. A security institution can be reformed without necessarily being destroyed. The distinction between reforming institutions and eliminating institutions is therefore critical. The post-2003 experience demonstrated the consequences of institutional disruption. Security vacuums contributed to insurgency and instability, while the process of rebuilding Iraq’s security forces took place amid an increasingly deteriorating security environment. The lesson is not that authoritarian institutions should never be reformed. The lesson is that state capacity should not be casually destroyed without a credible replacement.

Libya: prosperity, authoritarianism and institutional fragility

Libya presents an even more complicated case. Gaddafi’s government was authoritarian and deeply personalised. Political freedom was severely restricted, and the security apparatus was deliberately structured around regime survival. Yet Libya, under Gaddafi, also used substantial oil revenues to fund education, healthcare, infrastructure and social services. World Bank data from around the end of the Gaddafi era show life expectancy reaching approximately 75 years by 2011, skilled attendance at birth at 100 percent and measles immunisation at 98 percent. This does not prove that Gaddafi’s system was politically legitimate. It demonstrates something different: economic and social outcomes can coexist with authoritarian political structures.

The Great Man-Made River illustrates the scale of Libya’s investment ambitions. The World Bank described the project as one of the world’s largest engineering schemes, involving thousands of kilometres of planned pipelines to transport water from deep desert aquifers toward the populated coastal belt. The original project was estimated at approximately US$ 25 billion over several phases. Again, this should not become nostalgia for dictatorship. It should become a lesson in state capacity.

What happened after Gaddafi?

The post-2011 experience is perhaps the clearest illustration of the vacuum problem. Libya did not simply move from dictatorship to a consolidated democratic state. Instead, competing armed groups, political factions and institutions emerged. A UN economic and social affairs analysis concluded that the fall of the Gaddafi regime exposed weak state institutions and that the post-Gaddafi period was characterised by the proliferation of armed militias and institutional fragmentation.

The World Bank has similarly described how the security vacuum allowed armed groups to expand, while attempts to integrate them into the formal security apparatus produced a hybrid system in which state institutions and powerful armed groups operated alongside one another. This is the heart of the lesson. The consequences of regime change were also evident in Libya. The 2012 Benghazi attack, later portrayed in 13 Hours: The Secret Soldiers of Benghazi, illustrated the security vacuum that emerged after Gaddafi’s fall. The collapse of central authority allowed militias and competing armed groups to fill the space left by weakened state institutions. The lesson is clear: removing a regime may achieve military victory, but without a credible plan to rebuild the state, victory can quickly become a security vacuum.

When the state withdraws, something else occupies the space. If the replacement is not a legitimate national institution, the vacuum can be filled by militias, tribes, ideological movements, criminal networks or competing political authorities. The vacuum does not remain empty.

Terrorism question

There is another uncomfortable issue. Authoritarian regimes frequently suppress political and armed movements through coercive security systems. When those systems disappear abruptly, previously contained organisations can find new operating space. This does not mean that dictatorship is an appropriate method of counterterrorism. It means that counterterrorism cannot be separated from State capacity. The international community therefore needs to distinguish between defeating a particular terrorist organisation and maintaining the institutional conditions that prevent multiple armed actors from competing for power. The destruction of one regime does not automatically eliminate the forces that created insecurity. Sometimes it creates an environment in which those forces multiply.

Strategic mistake: winning the war but losing the peace

Military intervention can have a clearly defined operational objective. State reconstruction does not. A military campaign may successfully remove a government in weeks or months. Building legitimate institutions can take decades.This creates a fundamental strategic asymmetry. The shorter the planning horizon for intervention, the greater the danger of a long-term vacuum. The international community therefore needs to think beyond the first question: How do we remove the regime?

It must ask: Who governs the country the next morning? Who controls the borders? Who controls the security forces? Who pays government employees? Who maintains electricity, water and hospitals? Who protects critical infrastructure? Who administers justice? Who prevents armed groups from becoming alternative governments? Who provides political legitimacy? And perhaps most importantly: Who possesses the authority to enforce the decisions of the new state? If there are no convincing answers, regime change is only the beginning of the problem.

The lesson should not be that the United States or its allies should never intervene. Nor should it be that Saddam Hussein or Muammar Gaddafi should be rehabilitated as models of governance. The lesson is more practical. Regime change must never be confused with state-building.

Before dismantling an established political order, external powers need a credible understanding of the institutions that will replace it. Security-sector reform should normally distinguish between individuals who must be removed and institutions that must be preserved. A national army may need reform. A ministry may need restructuring. A security service may need accountability and civilian oversight. But destroying institutional capacity without having an operational replacement can create consequences far beyond the original objective.

Wider geopolitical lesson

The consequences of Iraq and Libya did not remain within their borders. State fragmentation affects neighbouring countries, migration, organised crime, arms trafficking, terrorism, energy markets and regional power competition. In today’s interconnected world, a failed transition in one country can become a security problem for an entire region. That is why intervention planning should include not only military objectives but also political, economic, humanitarian and security-sector objectives. The most important planning document may therefore not be the operational plan for removing the regime. It may be the plan for Day One after the regime has disappeared.

History should not be written as a simple choice between dictatorship and democracy. The real strategic challenge is more complicated. Saddam Hussein and Muammar Gaddafi were dictators. Their governments committed serious abuses, and their populations had legitimate grievances. But the failures of authoritarian rule do not automatically justify the destruction of state institutions without a credible plan for rebuilding them. The experience of Iraq and Libya demonstrates a fundamental principle of international security: A political vacuum is not neutral space. Someone will fill it. If legitimate national institutions cannot fill that space, armed groups, sectarian interests, extremist organisations or foreign-backed factions may do so. The ultimate lesson for the United States, its allies and the wider international community is therefore straightforward:

Removing a regime may win the immediate battle. Building a legitimate, functioning and secure state determines whether the intervention succeeds in the long term. The world should learn to ask not only “How do we remove the dictator?”. It must also ask:

“What happens to the country when he is gone?”

That may be the most important strategic question of all.

(The writer is the Secretary General of the Ceylon Chamber of Shipping, former Director General of the Institute of National Security Studies (INSS), and former Spokesman of the Ministry of Defence. He is also a Non-Resident Fellow at the London Dialogue. His areas of expertise include international relations, geopolitics, maritime affairs, national security, economic policy, and strategic governance. He is a consultant at JITT Group and a member of World Pace Board.).

Tales of Mystery and Suspense – 23

By Prof. Rajiva Wijesinha

As I have noted with regard to the adventures of John Rebus, I am indebted to Dinali Fernando and her husband Steve for whole hosts of thrillers. The latter strongly recommended Kate Atkinson when I borrowed four books. I wondered about this, for I had not been too impressed with her debut novel, Behind the Scenes at the Museum, which was amongst the entries I had to judge for the Eurasian section of the Commonwealth Writing Prize. Two decades later, I had forgotten what it had been about.

But I am glad Steve persuaded me to read her. Kate Atkinson is distinctively British, and Death at the Sign of the Rook is set in a country house and the surrounding village, and seems a modern descendant of the laidback Agatha Christies I so much enjoy.

There are, however, many differences in that we have a policeman who can go rogue, like Rebus, with again a female sidekick who has a mind of her own, again like Rebus. But Jackson Brodie has retired and set up as a private investigator, while Reggie, a young lady, is still in the police.

There is a lesbian couple living in the converted dairy of the manor house, as has occurred in Agatha Christie too, in A Murder is Announced. But they are peripheral to the story, unlike Ben, the brother of one of them who left the army after losing a leg in Afghanistan. When he turns up at the Manor House to shelter from a snowstorm, along with its chatelaine, Lady Milton, he is asked to answer the door as various characters turn up, including Jackson and Reggie, who then starts fantasising about him.

The others who turn up are two couples, one from America, who have paid for a murder weekend at the hotel. The family is impoverished, and has sold lots of pictures to survive, but most recently a Turner had been stolen, almost certainly by Lady Milton’s housekeeper Sophie, who vanished one night along with the picture. Reggie had been involved in that investigation, but there had been no trace of either picture or young lady.

Jackson Brodie suspects a connection between that theft and the one he has been called in to investigate, which has not been reported to the police. The picture hung opposite the bed of an old woman whose carer vanished after she died, along with it. Her children, adopted twins, have asked Jackson to investigate and also try to trace the carer, though he suspects something strange in that they did not go to the police.

Kate Atkinson

Brodie, in studying the stolen art, is also struck by the disappearance of a Rembrandt from a house in Scotland, along with a member of the cleaning staff. He thinks the three women might be the same one.

But Brodie’s assumption that the three women who vanished when valuable pictures did were identical would not have helped except that Beatrice, as she was also called, kept turning up, including to the funeral home where the old lady’s body was kept. And then that picture turned up, in the village church, and was found by the local vicar, Simon Cate, whose life story is also a prominent feature of the novel. He was an aspiring actor but then smitten by faith, and became a priest, but in time he lost his faith. His wife left him after the death of their son, and he is now in this backwater, where he feels he is of no use to anyone. But he has a great feel for living beings, and his most successful service has been one in which he blessed pets. And he was deeply concerned about the bees that Ben looks after for his sister and her wife.

He too staggers into the manor house in the midst of the storm, in which everyone concerned loses their way comprehensively. But amongst those Ben lets in is a man in a tracksuit with cuts and bruises, who then vanishes after he has been led to a bedroom, when Ben went in search of brandy. We soon work out that it is the escaped murderer about whom Reggie has been alerted.

Simon also turns up, through the back door, carrying the picture and also a gun, for he has found the dead body of one of his parishioners when he went to her house in search of his mobile phone. She had been shot and he had picked up the gun he found there. But he could not tell the police, for though he called he had lost his voice, and for the last few days had communicated only through writing.

This chaotic mix of characters at the manor house is further complicated by the group of players putting on the murder mystery play though some members have either cried off or died before reaching the venue. So, there is much doubling up and confusion over who is an actor and who is not.

The grand now largely empty rooms of the manor house, and its various odd passages and multiple doors, make it a splendid set for the lunacy that runs on and on. Reggie finds herself in a pantry Atkinsonwith a dead body, though this turns out to be the nanny who fell down the stairs and was put there by Lady Milton’s younger son. And there is high drama on the roof when the murderer nearly kills Ben, but he is saved by Reggie, and when he tries to kill Brody with an axe, he is shot by Beatrice, who has been the maid who served at the dinner before the murder mystery play, and explains to Brody how she has managed all her thefts.

And then in the melee, she vanishes on a motorbike, along with the daughter of the old lady’s adopted daughter, the only person who seemed to grieve at the funeral, and to whom the old lady had left her house in a codicil to her will, which her children have not known about. She leaves the picture to the carer, but it is brought to Simon Cate as he lies in hospital, recovering from a heart attack which adds confusion to the play.

Wonderfully convoluted, but all very clear, despite the headlong pace of the book and its shifts from one scene to another, from one character to another (or rather combinations of them) and from one-time span to another. A writer and a detective well worth looking out for. e more books by her on Dinali’s shelves.