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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 behavioral 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, among which boys outnumber girls.
ASD is a developmental disorder that affects the communication and behavior 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 non-verbal communication, play behavior and interests.
Verbal Communication
Behavior and Interest
Social Interaction
Some common symptoms that children with ASD might show are:
Approximately 70% of children with Autism Spectrum Disorder have some form of delayed development.
There is no single known cause that can explain ASD. However, some experts have put forward genetics and environmental factors.
Autism is a syndrome that falls under ASD. Disorders that can be classified under this umbrella term include:
Usually, signs of ASD show up when a child is around 2–3 years old. But according to professionals, it starts much earlier when the child’s brain begins to develop.
Since there is no medical test available to diagnose ASD, diagnosis is a challenge. To make a diagnosis, the doctor looks at the behavior 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 parents some questions 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 9–24 months. If the doctor finds any of the ASD signs, the child would need a comprehensive diagnostic evaluation.
2) Comprehensive Diagnostic Evaluation: Comprehensive diagnostic evaluation involves analyzing the child’s behavior 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.
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 behavior. 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.
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 is 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 live independently. Therapists may also provide sensory integration training that targets 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 behavioral, 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:
Currently, there is no medication to cure ASD, but mental health experts may use medication to treat symptoms of ASD, such as repetitive behavior, hyperactivity, aggression, anxiety, depression, insomnia, trouble focusing, etc. Medication for ASD can be effective when combined with the right therapy. Medications may include:
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.
Basic strategies deployed by schools to support students with ASD include:
Schools also arrange educational psychologists and speech therapists to deliver services in consultation, assessment and professional support.
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, which depends 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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Core symptoms of ASD include: slow speech development, repetitive behaviors, difficulties in social communication and interaction.
While no medication can be used to cure ASD at the present, medications are effective in treating symptoms of ASD such as repetitive behavior, hyperactivity, anxiety, depression, insomnia, etc.
A range of therapies can improve speech and behavior in ASD children, these include: Applied Behavior Analysis (ABA), Treatment and Education of Autistic and Related Communication-handicapped Children (TEACCH), Development, Individual Differences, Relationship-Based Approach (DIR), The Picture Exchange Communication System (PECS), Sensory Integration Therapy, Occupational Therapy and Psychological and Education Therapy.
For eligible preschoolers with ASD, they can be referred for placement in Early Education Training Centre. Most school-aged children attend mainstream schools, except for students also with intellectual disability, who are placed in special schools to receive enhanced educational support.
ASD cannot be diagnosed by medical tests and presently its diagnosis relies on doctor’s evaluation of a child’s behavior and development. ASD diagnosis is divided into 2 parts: Developmental Screening and Comprehensive Diagnostic Evaluation.
Article reviewed by Pediatrician Dr. Wai Fan Fanny LAM. 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.
This article was independently written by Healthy Matters. It is informative only and not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be relied upon for specific medical advice.
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