Autism is a complex neurobehavioral condition that involves impairments in communication skills, social interaction, and sensory processing . Due to the range of symptoms, this disorder is now called ASD (Autism Spectrum Disorder). ASD is a developmental disability that can cause an individual to establish repetitive behavioural patterns with other people. According to a report from the WHO, it is estimated that 1 in 160 children have ASD across the globe. In Hong Kong, the Autism Children Foundation estimates that there are 25,000 registered autistic children in the city, with boys outnumbering girls.
What is Autism Spectrum Disorder (ASD)?
ASD is a developmental disorder that affects the communication and behaviour of a person. It has both genetic and environmental underpinnings. It includes conditions called autism, Asperger’s syndrome and pervasive developmental disorder. Keep in mind that ASD is not a mental illness. Autism spectrum disorder affects your child’s quality of social interaction, verbal as well as nonverbal communication, play behaviour and interests.
Signs and Symptoms of Autism Spectrum Disorder (ASD)
- Slow speech development
- Monotonous or repetitive speech
- Unusual speech, including exaggerated prosody, loud and high/low pitch
- Little nonverbal pragmatic skills in communication
Behaviour and Interest
- Continuous demand to do certain things and resistance to change
- Repetitive body movements
- Restricted and narrow pattern of interests
- Weak imaginative play
- No or poor initiative to interact with others
- Weakly integrated eye contact
- Difficult to build relationships with friends and age peers
- Difficult to understand others’ feelings and thoughts
Some common symptoms that children with ASD might show are:
- Avoid eye contact
- Do not respond to their name by 1 year of age
- Repeat words and actions
- Prefer to be alone or play alone
- Find it difficult to express emotions and needs
- Give inappropriate or flat facial expressions
- Avoid physical contact
- Flap their hands and rock their body
- Unusual reactions to the way things look, smell, and taste
- Picky diet and constipation
- Use reverse pronouns (e.g., use “You” instead of “I”)
- Do not get jokes, teasing, and sarcasm
Approximately 70% of children with Autism Spectrum Disorder have some form of delayed development.
Causes of Autism Spectrum Disorder (ASD)
There is no single known cause that can explain ASD. However, some experts have put forward genetics and environmental factors.
- Genetics: For some children, genetic changes (mutations) may increase the risk of autism spectrum disorder. Still other genes may affect brain development or the way that brain cells communicate, or they may determine the severity of symptoms. Some genetic mutations seem to be inherited, while others occur de novo.
- Environmental factors: perinatal Complications or medication intake during pregnancy, heavy metal poisoning and air pollution might be a trigger of ASD. Poor attachment and bonding with caregiver also contributes to impairment in the development of social skills.
What Do Other Disorders Come Under Autism Spectrum Disorder (ASD)?
Autism is a syndrome that falls under ASD. Disorders that can be classified under this umbrella term include:
- Autistic Disorder: It refers to issues with communication and social interaction in children aged 2 to 3 years old.
- Pervasive Development Disorder: Commonly called PDD, is also known as atypical autism. This category refers to a group of disorders identified by delays in the development of communication and social skills.
- Asperger’s Syndrome: Children under this category don’t have delay in language development, but they lack quality in communication and socialization. They have motor incoordination and may have gifts in some areas.
Usually, the signs of ASD show up when a child is around 2 to 3 years old. But, according to professionals, it starts much earlier, when the child’s brain begins to develop.
Diagnosis and Screening of ASD
Since there is no medical test available to diagnose ASD, diagnosis is a challenge. To make a diagnosis, the doctor looks at the behaviour and development of the child. Sometimes, this disorder can be detected in a child at 18 months or younger. However, many children with ASD don’t receive medical care on time and this delay means that they may not get the help they require.
ASD diagnosis is divided into two steps:
1) Developmental Screening: This is a short test, performed by a doctor on a child to evaluate his/her basic learning skills. During the test, the medical expert may ask some questions to parents or talk to the child to analyze how he/she speaks, behaves, moves, and learns. A delay in any of these areas could be a sign of Autism Spectrum Disorder. parents checklist such as M-CHAT can be used to improve the diagnostic yield.
All children must be screened for developmental disabilities, delays, and ASD during regular well-child doctor visits from the age of 9 to 24 months. If the doctor finds any of the ASD signs, it means the child needs a comprehensive diagnostic evaluation.
2) Comprehensive Diagnostic Evaluation: Comprehensive diagnostic evaluation involves analyzing the child’s behaviour and development using standard assessment tools, and an interview with parents. It may also include vision and hearing screening, neurological testing, genetic testing, and other medical related tests.
If a primary care doctor finds some delays in the child’s activities, he might refer the child to a specialist for further investigation. Specialists who can perform additional assessments include Child Neurologists, Child Psychiatrists, and Developmental Pediatricians.
How to treat ASD?
ASD treatment should start immediately after its diagnosis. Early treatment is essential as proper care can lower the difficulties faced by people with ASD and help them learn new skills.
There are different types of treatments and therapies to improve speech and behaviour. The treatment or therapy that a child can benefit from depends on his/her condition and needs. Each therapy focuses on reducing ASD symptoms in the child and improving his/her learning and development skills.
Behavioural & Communication Treatments and Therapies
- Applied Behaviour Analysis (ABA): ABA therapy is used in schools and healthcare clinics to help children with ASD in learning positive behaviour. This treatment is used to boost a range of skills including:
- Pivot Response Training: PRT helps in developing the motivation to communicate and learn.
- Discrete Trial Training: DTT uses positive reinforcement and simple lessons.
- Verbal Behaviour Intervention: VBI deals with language skills.
- Early Intensive Behavioural Intervention: EIBI is perfect for children under the age of 5.
2. Treatment and Education of Autistic and Related Communication-handicapped Children (TEACCH): This structured approach uses step by step visual cues like pictures to help the child in learning common skills, such as getting dressed.
3. Development, Individual Differences, Relationship-Based Approach (DIR): This treatment allows parents to get down on the floor with their child while playing, that’s why it is also known as Floortime treatment. The goal of this approach is to support the intellectual and emotional growth of the child by helping him/her learn communication and emotional skills.
4. The Picture Exchange Communication System (PECS): Like TEACCH, it is also a visual-based approach, but it includes symbols instead of using picture cards. Through this treatment, children with ASD learn to communicate and ask questions using different symbols.
5. Sensory Integration Therapy: This therapy is for children who get upset by things such as certain sounds, bright lights, etc. It can help ASD children deal with sensory information.
6. Occupational Therapy: This treatment can help the child with ASD in learning regular life-skills such as bathing, feeding, dressing, and more. This is a great approach that helps patients to live their lives independently. Therapists may also provide sensory integration training that target at sensory-processing difficulties tailor-made for individual child.
7. Psychological and Education Therapy: People with ASD may be referred to medical specialists who are specialized in delivering behavioural, psychological, skill-building, and educational interventions. These healthcare programs are typically intensive and highly structured and may include close family members. These programs may help an individual with ASD in:
- Learning life-skills important to live independently
- Building upon strengths
- Reducing challenging behaviour
- Learning social and communication skills
How to cure ASD?
Currently, there is no medication to cure ASD, but mental health experts may use medication to treat symptoms of ASD, such as repetitive behaviour, hyperactivity, aggression, anxiety, depression, insomnia, trouble focusing, etc. Medication for ASD can be effective when combined with the right therapy. Medications may include:
- Antidepressants and anxiety medications: the most commonly prescribed medications for children are selective serotonin reuptake inhibitors (SSRIs), such as sertraline (Zoloft) or fluoxetine (Prozac). Some of these medications have been studied and approved for use with children, although not specifically for autism. This group of medications may help with mood, anxiety, or obsessive thoughts and compulsive behavior. As with most mental health medications, side effects should be closely monitored.
- Atypical antipsychotics: commonly prescribed medications are Risperdal or Abilify, are the only group of medications specifically approved for children with autism. This is because studies show them to benefit autism-related irritability. However, atypical antipsychotics may also improve anxiety, impulsivity, or mood.
Support Services and Strategies for ASD in Hong Kong
Preschool children diagnosed with ASD who are eligible for government-funded services can be referred to the Social Welfare Department for placement in Early Education Training Centre. For school-aged children, the education system of Hong Kong has started several schemes to support children with ASD. Generally, children with Autism Spectrum Disorder having average intelligence can attend mainstream schools. Children with both ASD and ID (Intellectual Disability) are placed in schools, specifically established for children with ID. These schools offer the following services and strategies in accordance with the needs of the child.
Role of Mainstream Schools in Hong Kong for Students with ASD
Basic strategies deployed by schools to support students with ASD include:
- Visual Strategies
- Structured Learning Environment
- Speech and Communication Training
- Peer Support
- Emotional and Social Training
- Social Narrative Stories
- Good Behaviour Reward Scheme
Schools also arrange educational psychologists and speech therapists to deliver services in consultation, assessment and professional support.
Role of Special Schools in Hong Kong for Students with ASD
Under the “Resource Teaching Programme for Autistic Children in Special Schools”, children with ASD in government-funded special schools are offered support in addition to normal classroom teaching and this depending on their learning performances, needs, and nature of the teaching process. With more intensive individual guidance, each student can be evaluated based on their specific conditions and personal needs.
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Article reviewed by Pediatrician Dr. Wai Fan Fanny LAM on June 13, 2019. Dr. Wai Fan Fanny LAM, MRCP(UK), HKCPaed, HKAM(Paed), Specialist in Developmental-Behavioural Paediatrics, Honorary Assistant Clinical Professor, University of Hong Kong, Tutor, The Association for Research in Infant and Child Development, UK.