Autism Spectrum Disorder (ASD): A World of Their Own

Nature of the Illness

Typically evident within the first three years of life, and mostly in males, ASD refers to a group of developmental disorders with a wide range or 'spectrum' of symptoms resulting in varying degrees of disability. Hong Kong already has 25,000 registered autistic children, and a further 10,000-plus are expected to be diagnosed in 2017-2018, up from 7,200 in 2015-2016. One report in the US late last year, tracking autism rates globally, even put Hong Kong at the top of the world, with 372 in every 10,000 children in the city diagnosed with autism.

For a clearer picture of the graveness of the situation, consider the signs that children with ASD show:

  • Often isolate themselves
  • Do not express emotion, or interest in a variety of things
  • Have deficits in language and non-verbal communication skills
  • Throw tantrums or have outbursts when their routines are disturbed
  • Lack of startled response to sudden loud noises, or diminished response to pain
  • Appearing 'lost', as if in their own world
  • Many children with autism also have below-normal intelligence (IQ below 70).

A key criterion for determining whether a child might need assessment is to check his communication abilities against developmental milestones appropriate for his age:

  • By 12 months, he should be babbling, and using gestures such as pointing and waving
  • By 16 months, uttering single words
  • By 24 months, spontaneously using phrases of two words or more

Behaviours incongruent with the child's age warrant professional screening. In general, evaluation by a healthcare expert is recommended when a child is 18-months-old, and again at 24-36 months, to check for signs of autism.

Depending on the severity of their symptoms, an autistic individual may be classified as either 'low-' or 'high-' functioning; thus the former type may require lifelong institutional care, while the latter might grow up with minimal incident, succeed in finding work, marry and start their own family like average people. Interestingly, some sufferers turn out to be savants; that is, they appear 'gifted' at doing one particular thing. Such remarkable 'gifted' cases are rare, though, and often these persons remain impaired in other areas of their life.

Early diagnosis is therefore essential, as prompt treatment can make a big difference and help a child with autism reach their full potential.

Treatment of the Illness

Following clinical diagnosis of ASD by proper specialists such as a psychologist, psychiatrist or paediatrician, an intensive, multipronged management programme addressing the core deficits of the disorder is usually advised. This includes:

  • Early developmental intervention - training routines focusing on the ability to pay attention to other people, use of verbal communication, play, and social interaction
  • Behavioural management - Applied Behavioural Analysis or ABA is a popular approach based on the principles of learning theory; it is employed to reinforce desirable behaviour, and is most effective when started early and applied consistently
  • Pharmacological management - medications, particularly atypical antipsychotics such as Aripiprazole (Abilify), are most effective in assisting developmental, educational and behavioural therapies.

It is important to note there is no proven cure for ASD; medication is only for managing common associated symptoms such as anxiety, depression and epilepsy. And the wide range of issues facing children 'on the spectrum' means there is no single best countermeasure for ASD. The burden of treatment thus falls to parents and caregivers, who should be trained to consistently implement the recommended behavioural strategy in all of the child's environments. Being equipped with the right knowledge and attitude duly enables family members to be effective co-participants in realising the best possible outcome for their loved one.

Given the complicated nature of ASD, the various specialist treatments that must be undertaken simultaneously, and the often-long duration involved, a sufferer's family have to be prepared for a sizeable commitment not just practically but also emotionally and financially. For instance, a therapist's services may cost around HK$1,300 per session. And in more severe cases, daily follow-up with the therapist may be required. This, on top of the initial cost of consulting a psychiatrist, which can be HK$5,500 for a 90-minute test for children. For adults, the first evaluation, lasting 60 minutes, generally costs HK$1,800, and follow-up appointments HK$1,000 each time.

Reference

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