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Autism spectrum disorder (ASD)


Autism spectrum disorder (ASD) is a lifelong developmental disability that can cause many symptoms such as deficits in communication, social interactions, emotional awareness and sensory issues. It is not a disease and it can’t be cured. Instead, a person with autism is neurodivergent, which means that their brain works differently than the neurotypical brain.

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.


The symptoms of autism may vary widely from person to person and the symptoms in adults can present differently from those in children, and many adults have learned to live with their symptoms over the years.

Social communication / interaction behaviours may include:

  • Making little or too much eye contact

  • Having facial expressions and gestures that do not match what is being said

  • Heightened emotions

  • High effective empathy

  • Having trouble understanding another person’s point of view

Restrictive / repetitive behaviours may include:

  • Repeating certain behaviours or having unusual behaviours like echolalia (repeating words or phrases)

  • Being more or less sensitive than other people to sensory input, such as light, noise, clothing, or temperature

Screening and diagnosis

1. Medical diagnosis

Medical diagnoses are made by a psychologist, developmental paediatrician, or other specialised physician based on an assessment of symptoms and diagnostic tests. These are most frequently made according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) of the American Psychiatric Association. There are no medical tests, such as blood work or brain scans for diagnosing autism - instead, a medical diagnosis must be made based on observations of the individual’s communication, social interactions, activities and interests.

2. Educational Determination

This must be made by a multidisciplinary evaluation team of various school professionals and can qualify an individual for support within school settings, but not for therapies and support outside of school. A medical diagnosis of autism does not guarantee an educational determination.

3. Screening

Stage 1: Developmental Screening

This is a short test performed by a doctor on a child to evaluate their basic learning skills. It is mandatory to screen all children aged 9-24 months for developmental disabilities, delays and ASD during regular doctor visits. If the doctor finds any of the ASD signs, the child would need a comprehensive diagnostic evaluation.

Stage 2: Comprehensive diagnostic evaluation

This involves analysing the child’s behaviour and development using standard assessment tools, and interviews with parents. If a primary care doctor finds some delays in the child’s activities, they might refer the child to a specialist for further investigation.

Sex ratio of autism

Studies that have followed children since birth show that the natural ratio of males to females with autism is close to 3:1. Males who outwardly display mild symptoms of autism are diagnosed an average of 2 years earlier than women who display similar symptoms.

This may be because:

  • The tests used to diagnose autism are based on studies done on white autistic boys, which likely leads to lower and misdiagnosis in women

  • Female special interests are generally more socially accepted than male special interests

  • Case studies show that women are more skilled at masking: from birth, girls are thrust into a more socially rigorous environment that increases the pressure to mask the challenges an autistic person faces daily

Masking behaviours

Autistic people may mask their symptoms simply because of a natural human desire to fit in with others and achieve social and professional success. Masking is fundamental to the late and misdiagnoses of patients

Examples of masking behaviours are:

  • Forcing eye contact

  • Mimicking others’ behaviours, expressions and gestures

  • Memorising scripts for small talks and common conversations

When Neurotypical people are having a conversation with somebody, they do the following at once:

1. Have the correct posture

2. Keep the right distance away from them

3. Use the right facial expressions

4. Modulate the tone

5. Make the right amount of eye contact

6. Predict what the other person is going to say and do next

This may lead to secondary mental health challenges, such as depression and anxiety

Study — The relationship between irritability and autism symptoms in children with ASD in COVID-19 home confinement period

The study, which was conducted by the Department of Child and Adolescent Psychiatry in November 2021, received approval from the Local Ethics Committee of Selcuk University.

Researchers investigated the impact of COVID-19 home confinement on autism spectrum disorder (ASD) symptoms and irritability in children and adolescents with ASD. The study participants included 46 drug-naive children aged 4-17 years diagnosed with ASD. Parents of the participants completed the Autism Behaviour Checklist (AuBC) and Affective Reactivity Index (ARI) scales for both normal conditions and COVID-19 home confinement. All subscale scores for AuBC and ARI scores significantly increased during the COVID-19 home confinement period (P < .05). The participants’ irritability and ASD symptoms were significantly worse during the COVID-19 outbreak and home confinement period compared to normal conditions.

However, there were some limitations to the study:

1. The causal relationship between ASD symptoms and related factors could not be confirmed

2. The relationship between worsening behavioural symptoms in children with ASD and their medication status was not directly tested.

3. Data was obtained via online videos

What do the findings mean?

The findings have brought attention to the importance of focusing on extremely vulnerable populations during disease outbreaks and of the necessity of developing new strategies to avoid such adverse outcomes in similar situations.

For children with ASD, access to environments in which they are able to communicate with their peers, as well as to inpatient psychiatric services, appropriate special education, and supportive services, is essential, and although online mental health services have been provided during this period, these may be inadequate for patients with ASD who require multidisciplinary intensive therapies.


Researcher: Liz


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