What is Autism Spectrum Disorder (ASD)?

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by a range of impairments and variations in the development of social communication, cognition, and emotions. Individuals with ASD also display restricted and repetitive patterns of behaviors, interests, and sensory processing difficulties. During early development, children with ASD may experience delays in cognitive, language, and motor skills. These symptoms, along with challenges in various developmental areas, can significantly impact social interaction, learning, emotional well-being, and behavior. The effects of ASD often persist into adulthood, presenting ongoing challenges in areas such as forming social relationships and overall life satisfaction. While no official data on the prevalence of ASD in Hong Kong is available, it is estimated that approximately 1 in every 621 children may receive a diagnosis of ASD*.

*Wong, V.C.N., & Hui, SL.H. (2008). Epidemiological study of autism spectrum disorder in China. Journal of Child Neurology, 23(1), 67-72

Symptoms of ASD

❖ Social Communication Symptoms

• Avoiding or lacking eye contact
• Delayed or limited response to name
• No directing facial expressions toward others
• Showing little interest in interacting with peers
• No pointing to indicate needs or to share interests
• Not sharing interests by showing objects they like
• Lack of interest in playing simple interactive games
• Engaging in one-way communication (e.g., question and answer)
• Limited use of gestures in daily communication, e.g., nodding/shaking  head, waving goodbye

❖ Restricted or Repetitive Behaviours or Interests

• Upset by minor changes in routines
• Excessive repetition of certain gestures
• Lining up toys or other objects repeatedly and excessively
• Repeating words or phrases without communication intent
• Intense focus on specific parts of toys (e.g., wheels of toy cars)
• Unusual reactions to sensory stimuli (e.g., visual, sound, smell)
• Engaging in self-stimulatory behaviors like spinning or hand-flapping  

The Etiology of ASD

The exact cause of ASD remains largely unknown. However, several factors may contribute to an increased risk of developing ASD:

❖ Heredity: Studies have shown that children with ASD have a higher likelihood of having siblings with the disorder compared to the general population, suggesting a genetic component.

❖ Chromosome Abnormalities: Approximately 10% of individuals with ASD also have other genetic disorders, such as Fragile X syndrome and Down syndrome.

❖ Advanced Paternal Age: Research indicates that older paternal age is associated with a higher risk of ASD in children. For every ten-year increase in fathers' age, the likelihood of their children having ASD increases by 18%. Mothers' age also plays a role, with a 21% increased likelihood for every ten-year increase.

❖Pregnancy and Birth Complications: Certain factors during pregnancy and birth, such as prematurity, low birth weight, and multiple pregnancies, have been linked to an increased risk of ASD.

Who should consider taking an ASD assessment?

It is important to consider undergoing an ASD assessment for children who exhibit certain behaviors and developmental patterns. ASD symptoms can manifest as early as 1.5 to 2 years of age. During this period, children with ASD may show limited eye contact with adults and demonstrate little or no interest in sharing their interests, such as showing toys or pointing to objects. Language development delays are also commonly observed. Additionally, restrictive patterns of behavior and intense interests tend to emerge gradually but may diminish as children grow older. However, their difficulties in social communication become more noticeable as they face more complex social situations in older age.

Research has consistently highlighted the benefits of early identification and interventions for autism. Such interventions have been shown to have significant positive effects on managing symptoms and promoting long-term skill development. Interactions with others play a crucial role in children's learning, and enhancing their social and communication abilities can greatly support the development of other essential skills.

How to assess children with ASD?

The assessment of children with ASD involves a comprehensive approach that considers their age, developmental level, and the potential overlap of symptoms with other developmental disorders. Our psychologist needs to determine whether specific behaviors exhibited by a child are abnormal compared to typically developing children of the same age or language level. This requires objective tests, careful behavioral observation, and the exclusion of other possible contributing factors. The assessment process includes a clinical interview with parents or caregivers to gather information about the child's history and behaviors. A developmental history is also obtained to assess milestones, language development, social interactions, and atypical behaviors at different stages. The psychologist directly observes the child's behavior in various settings to identify ASD-related behaviors and their impact on functioning. Standardized assessments are used to evaluate specific areas such as social communication, language skills, cognition, and adaptive behaviors. Autism-specific screening tools may also be employed to assess the presence and severity of ASD symptoms.

ASD Treatments

Behavioral-Focused Training

ASD treatments aim to improve the functioning and participation of children with ASD in their communities, although there are no known cures for the disorder. Several interventions have shown effectiveness in enhancing skills and adaptive behaviors: 

❖Applied Behaviour Analysis (ABA) - ABA therapists analyze the antecedents and consequences of problematic behaviors and develop strategies to change them. The objective is to replace inappropriate behaviors with new adaptive skills. ABA breaks down skills into small steps and uses rewards to reinforce desired actions. This intensive therapy typically requires 20-40 hours per week to gradually develop skills.  

❖ Environmental Support - This approach is implemented in real-life settings like school and home. Therapists use visual strategies and peer participation to break down skills into manageable steps. Approaches such as TEACCH and SCERTS modify the environment to enhance social communication and learning skills.  

❖Relationship-Based Treatments - This approach focuses on coaching parents in using daily activities to promote flexible thinking, social communication, emotional regulation, and awareness of social changes. Examples of this approach include Relationship Development Intervention (RDI) and DIR/Floortime. As parents play a crucial role, they can help their children apply these skills to different aspects of life if they have ample time and follow the treatment strategies.  

❖Executive Functioning Training - Group or individual training can provide guided participation and environmental prompts which help the development of executive functioning skills such as problem-solving, cognitive flexibility, and planning/organization abilities.

Brain-Focused Training

❖ EEG-based neurofeedback therapy - Brain waves are monitored, regulated, and conditioned to the desired frequency, enhancing different brain functions.

Psychiatric Medication

Psychiatric medications are not curative for ASD, but they may be used to target specific symptoms, such as aggression, obsessive-compulsive disorders, or ADHD

ASD Assessment at Neuroscientist

Service Target

❖ Children and adolescents aged 1.5 to 16

Content of Service

❖ Clinical Interview: The psychologist will engage in detailed discussions with parents to gather information about the child's social, emotional, behavioral, and learning functions

❖ Developmental and Intelligence Assessments: We conduct intelligence tests to assess cognitive abilities and rule out the possibility of intellectual disability contributing to the child's attention and behavioral problems. Additionally, developmental assessments help evaluate the child's language skills, motor development, and other relevant areas.

❖ Behavioral Observation: The psychologist observes the child's social communication and interaction with their parents and the examiner. This allows for the identification of potential symptoms associated with ASD. We also review the parents' approaches to handling the child's behavior and communication, providing guidance and suggestions for effective parenting strategies.

❖Other Tests: Children over the age of six undergo executive functioning tests to assess cognitive flexibility, working memory, planning, and organization abilities. In cases where there are concerns about co-occurring conditions like ADHD or other developmental disabilities, additional tests may be conducted to assess for comorbidities.

Referral & Follow-Up

❖ Our psychologist will prepare a comprehensive report (English) that integrates the findings and explains the assessment results during a report meeting.

❖ Based on the assessment results, if it is determined that the child exhibits significant features of ASD, appropriate interventions and treatment recommendations tailored to the child's individual needs will be provided.

❖ For children over the age of six who exhibit significant features of ASD and may benefit from medication treatment, we will make a referral to the Child and Adolescent Mental Health Centre of the Hospital Authority. Children under the age of six will be referred to preschool rehabilitation services provided by the Social Welfare Department. These services include options such as Special Child Care Centre (SCCC), Integrated Programme in Kindergarten-cum-Child Care Centre (IP), Early Education and Training Centre (EETC), or On-site Preschool Rehabilitation Services (OPRS). Children over six years old can submit the assessment report to their school for school-based support.