Every trip to the Institute of Mental Health (IMH) is a heartbreaking affair for Mr Muhammad Ridzuan Raman, 40, and his wife.
They have been screamed at and bitten by their son Akid while he is strapped to the hospital bed.
It has been close to a month since the 10-year-old boy was admitted there. The couple is still trying to come to terms with his sudden behavioural change.
Akid is autistic, his parents revealed. Diagnosed five years ago, he only started showing signs of aggression early this year, they added.
The boy's father Mr Ridzuan, a driver, said: "I really miss him so much - his smile, the way he hugs me, kisses me."
Speaking to The New Paper on Monday from his three-room flat in Clementi, the father of four showed this reporter videos of Akid before he became violent.
One of the videos showed the boy walking around in school, giggling while playing with his toy.
Another, which Mr Ridzuan uploaded to his Facebook page early this month, showed Akid strapped to the hospital bed, spitting at his father after being fed water.
The clip has since gone viral, with more than 1,900 shares.
Voice choking, Mr Ridzuan said: "When I see his old videos, it reminds me of the old Akid. He loves singing. He was very obedient, very quiet. He's in his own world and always plays alone."
The stark contrast in Akid's behaviour started showing last month.
One day, he came home from his school for autistic children with an injured finger.
Teachers also called to say he threw tantrums in school.
Mr Ridzuan suspected his son had injured himself.
Two days later, he tried to run away from home.
His first attempt was through the window of the family's flat on the third storey.
"At about 8.30am, my wife came out of the toilet and found half of Akid's body outside the window. Luckily she was in time to pull Akid in," Mr Ridzuan said.
Akid then tried to escape via the door. With no keys, the boy broke part of the door grille and got out.
Pointing to a cling-wrapped part of his front door grille, Mr Ridzuan said: "You see that plastic over there? He broke that (part of the gate). Can you imagine, how someone can have enough strength (to break the metal)?"
Mr Ridzuan's wife dashed out of the flat upon realising Akid had run away.
They ended up in the police station, where Akid was taken to the National University Hospital in an ambulance. He was later transferred to the IMH, where he is now warded.
Akid has to be strapped to the hospital bed whenever he turns violent to prevent him from harming himself and others, said Mr Ridzuan.
So far, the boy has deliberately pulled out two of his own teeth, said Mr Ridzuan.
Showing this reporter scars from bite marks, the father of four said: "The moment he cannot get what he wants, he will bite. He will punch."
Upon Akid's admission to IMH, Mr Ridzuan said he cried for two weeks.
The sadness stems from guilt and self-reproach.
"Doctors said that one of the (possible reasons why) Akid has autism is due to genetic reasons," said Mr Ridzuan, who has Tourette's Syndrome and autism.
Looking at his wife, Mr Ridzuan said he is grateful for her emotional support, adding that she is stronger emotionally than he is.
Mr Ridzuan's wife, a 38-year-old housewife who declined to be named, gave a resigned smile.
"People tell me I will cry (while caring for an autistic child) but no, leh. I miss (Akid) a lot, but I must be strong," she said.
It helps that their three other children - two sons aged 11 and eight, and a daughter aged nine - do not give her much trouble, she said.
"They miss their abang (Malay for brother). (My husband and I) get to see him every day, but the kids don't," Mr Ridzuan's wife added.
The family live on Mr Ridzuan's monthly income of $1,200. His occasional singing gigs supplement the household income.
Some friends, like Mr Mohamad Azahary, have taken it upon themselves to help raise funds for the family's medical expenses.
The couple plans to meet social workers from IMH to discuss how to handle the hospital bills.
Said Mr Ridzuan: "Some friends ask me how I manage with my monthly pay. But I tell them, it's not how much you earn, but how much you save."
Ex-colleague helps with crowdfunding
His heart went out to the distressed 10-year-old boy when he watched the video.
Especially since he knew the boy's father, Mr Muhammad Ridzuan.
So Mr Mohamad Azahary helped him by setting up a crowdfunding page on Give.Asia last Saturday.
The 34-year-old owner of a decal business told The New Paper: "We are not close friends, just ex-colleagues.
"But looking at the videos (of his son), I felt bad for him. He looked very pitiful.
"And he needs money for medical expenses, so why not?"
The gesture was a pleasant surprise for Mr Ridzuan, sole breadwinner for his family of six.
The driver, who earns $1,200 a month, said: "Mr Azahary asked me how we managed but I was 'paiseh' (Hokkien for embarrassed) to tell him.
"Eventually I confided in him."
So far, the electricity and water supply to his home has never been cut off, said Mr Ridzuan when asked about his financial situation.
But he conceded that he recently started fretting over medical expenses for Akid and himself.
Mr Ridzuan is on medication for Tourette's Syndrome, a condition characterised by involuntary tics.
He intends to meet a social worker from the Institute of Mental Health to work out the finances, he added.
When does an autistic child turn violent?
When autistic children turn aggressive, it could be them trying to express fear, frustration or anxiety.
This is because many of them are language-impaired, said psychiatrist Daniel Fung, president of the Singapore Association for Mental Health.
He added: "Children with autism may be intellectually disabled, so they may have difficulty expressing themselves.
"When they are sick or upset, they may use aggression to express how they feel as they do not have the appropriate language...
"This is inappropriate and needs to be managed, otherwise such behaviours can become ingrained."
According to the Institute of Mental Health (IMH) website, autism spectrum disorder is a range of developmental disorders characterised by difficulties in socialisation and communication, and restricted or repetitive pattern of behaviours and interest.
No two individuals with autism are the same.
Behavioural changes are common in autistic children as they take to actions to show they are stressed.
Those with aggressive behaviour after being admitted into a hospital may be restrained, with strapping to the bed done as a last resort, said Dr Lim Boon Leng, a psychiatrist in private practice.
Dr Lim, who was trained at IMH, said: "Sometimes, there is no choice. It is more to protect a patient from injuring himself or getting into trouble by injuring others."
Some are strapped down to give medication to decrease the aggression, he said.
"Usually, those who are strapped down are reviewed frequently (to assess whether they still have to be restrained)," Dr Lim said.
While there is no cure for autism, early intervention can make a difference.
For instance, speech therapies can improve abilities if symptoms are diagnosed early.
"We may not diagnose someone because the symptoms are not clear, but if we identify the symptoms early, there can be a remedy," he said.
Dr Fung said specialised support is available at special schools and the Autism Resource Centre.
Clinical services are also available at the National University Hospital, KK Women's and Children's Hospital and the IMH, he said.
This article was first published on February 25, 2016.
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