Does your child have autism? Understand the early signs and assessment process in one go.

Many parents may notice during their children's growth that they seem "a bit slow" or particularly "shy" in terms of speech, expression, or social interaction. Are these behaviours simply due to personality differences, or could they be early signs of Autism Spectrum Disorder (ASD)? According to the World Health Organization (WHO), approximately 1 in every 100 children worldwide is diagnosed with autism, with a significantly higher diagnosis rate among boys compared to girls.

Early detection and intervention are crucial for improving a child’s communication and social skills. This article will provide a detailed breakdown of the classification, characteristics, causes, assessment, and treatment methods for autism, helping you grasp essential information to support your child’s developmental journey.

Autism Spectrum Disorder (ASD) is a congenital neurodevelopmental disorder. It primarily affects an individual’s social interaction, communication skills, and behavioural patterns, with common characteristics including narrow interests and repetitive, rigid behaviours. Due to the wide variation in symptoms and severity among individuals, akin to a spectrum, it is referred to as a "spectrum" disorder.

Under the previous diagnostic criteria, autism was mainly categorised into the following types (now, in the latest edition of the *Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition* (DSM-5), these categories have been unified under "Autism Spectrum Disorder"):

Autistic Disorder

Symptoms typically become evident before the age of 3, including delayed language development, lack of eye contact, and limited interest in peers. It can be further subdivided into:

• High-Functioning Autism: Normal or even above-average intelligence, with primary difficulties in social interaction and understanding.
• Low-Functioning Autism: Significant limitations in intellectual development, with challenges in daily communication and self-care abilities.

Asperger's Syndrome

Language development is normal or even advanced, but there are significant difficulties in social understanding, non-verbal communication, and emotional expression. Individuals often exhibit intense focus on specific interests but pay little attention to others’ reactions or emotions.

Atypical Autism (PDD-NOS)

The individual’s symptoms do not fully meet the diagnostic criteria for typical autism but still show evident difficulties in social interaction, language, or behaviour.

Childhood Disintegrative Disorder

A rarer type of disorder. Children develop normally in early childhood (around age 2), but later (typically between ages 3 and 4), they experience significant regression in previously acquired skills, such as loss of language abilities, social skills, or self-care capabilities.

Children with autism spectrum disorder exhibit varying behaviours, but commonly face challenges in the following areas:

• Difficulty in social interaction: Lack of eye contact; no response when their name is called; inability to initiate play or share with others.
• Communication barriers: Delayed language development (e.g., not speaking); repeating others’ words (echolalia); difficulty in clearly expressing their needs or feelings.
• Repetitive and stereotyped behaviours: Preference for lining up toys or objects; repeatedly performing the same actions (such as rocking or clapping); insistence on fixed routines or paths, becoming emotionally distressed with any changes.
• Atypical sensory responses: Over-sensitivity to sounds or touch (e.g., fear of noise or being touched); or an unusual craving for certain sensory stimuli (such as spinning objects or lights).
• Narrow and intense range of interests: Excessive preoccupation with specific items, such as wheels, numbers, or subway maps.
• Difficulty understanding abstract concepts or social norms: For instance, inability to comprehend metaphors, sarcasm, or jokes.

The exact causes of autism are still not fully understood, but the medical community generally believes it results from a complex interaction of genetic and environmental factors:

• Genetic factors: If a family member has autism, the risk for other siblings is correspondingly higher.
• Genetic mutations: Certain genetic abnormalities (such as Fragile X syndrome and tuberous sclerosis) have been confirmed to be associated with ASD.
• Environmental factors: Issues such as viral infections during pregnancy or oxygen deprivation during childbirth may also increase the risk of developing autism.

According to the World Health Organization and numerous authoritative studies, there is no direct link between vaccination and autism.

Some children may begin to show early signs within the first 6 months after birth, with the period between 12 to 24 months being a critical time for observation and identification. Parents are encouraged to pay close attention to the following:

6 Months Old

• Rarely smiles or shows expressions of happiness.
• Little to no eye contact.
• Shows no noticeable reaction to strangers.

9 Months Old

• Rarely makes babbling sounds (such as "cooing" or "babbling").
• Lacks interactive responses, such as smiling, making sounds, or facial expressions.
• Does not follow the direction of someone pointing with their finger (lacking joint attention).

12 Months Old

• Does not respond most of the time when their name is called.
• Rarely uses gestures (such as pointing at objects or waving goodbye).
• Has not started babbling.

16 to 24 Months Old

• Has a very limited vocabulary (no single words by 16 months; unable to form two-word phrases by 24 months).
• Repeats language or uses stereotypical phrases (e.g., reciting cartoon dialogues as a response).
• Is extremely sensitive to minor changes in daily routines, easily leading to emotional outbursts.
• Engages in repetitive movements, such as constant clapping, rocking, or spinning in circles.
• Shows an unusual obsession with specific objects or activities.

Other Common Behaviours

• Developmental regression: Previously acquired language or social skills suddenly disappear, typically between 1 to 2 years of age.
• Difficulty in emotional regulation: Easily agitated, prone to tantrums, and struggles to self-soothe.

If parents observe multiple of the above behaviours in their child, they should consult a paediatrician or visit a maternal and child health centre for an initial assessment as soon as possible. The American Academy of Pediatrics recommends that all children undergo routine autism screening at 18 and 24 months of age. Early intervention can significantly improve a child’s language development, social skills, and ability to adapt to daily life.

Professional Diagnosis

Autism is not a physiological condition and cannot be diagnosed through blood tests or brain scans. Professional assessments are typically referred by paediatricians to the Child Assessment Centres (CAC) under the Department of Health, where a multidisciplinary team comprising clinical psychologists or child psychiatrists conducts the evaluation. The assessment process includes behavioural observation, standardised assessment tools, and in-depth interviews with parents and teachers to comprehensively determine if the child meets the diagnostic criteria for ASD.

Screening Tools for Parents

Parents can use the following internationally recognised screening questionnaires for preliminary understanding, but it must be noted that screening tools are not diagnostic tools. A high score only indicates a higher risk, and professional assessment should be sought for confirmation.

• Quantitative Checklist for Autism in Toddlers (Q-CHAT) (Applicable for toddlers aged 18-24 months)

A questionnaire completed by parents, consisting of 25 questions covering areas such as social interaction, communication, repetitive behaviours, and sensory responses, used for preliminary identification of autism risk in toddlers.[Click here to learn more or take the Q-CHAT test]

• Autism Spectrum Quotient (AQ-10) Children’s Version (Applicable for children aged 4-11 years)

A brief screening questionnaire designed for children aged 4 to 11, consisting of 10 questions, completed by parents based on the child’s daily behaviour, to quickly assess whether the child exhibits traits associated with autism.[Click here to learn more or take the AQ-10 test]

Although autism cannot be "cured," continuous and appropriate early intervention can significantly enhance a child's communication, social, and adaptive life skills. Treatment plans are often personalised and developed by a multidisciplinary team (including speech therapists, occupational therapists, physiotherapists, etc.). Common effective methods include:

• Applied Behaviour Analysis (ABA)
  Recognised internationally as one of the most effective intervention models. Through systematic approaches such as positive reinforcement, it helps build positive behaviours (like attention and communication skills) while reducing problematic behaviours.
• Speech Therapy
  Assists children in understanding and using language (including spoken words, vocabulary, and tone) as well as non-verbal communication skills (such as eye contact and gestures) to improve their expressive abilities.
• Social Skills Training
  Through group activities, role-playing, and social stories, children are taught to understand social norms, and learn skills such as taking turns, sharing, cooperating, and building friendships.
• Sensory Integration Therapy
  Designed by occupational therapists with engaging activities, it helps children improve their ability to process sensory information (such as auditory, tactile, and vestibular senses), thereby enhancing focus, emotional regulation, and participation in daily activities.
• Medication
  While medication cannot treat the core symptoms of autism, it can effectively manage associated emotional or behavioural issues, such as severe anxiety, attention deficits, aggression, or self-injurious behaviour. It must be prescribed and monitored by a psychiatrist.

In Hong Kong, most standard medical insurance plans (especially hospitalisation insurance) offer very limited coverage for long-term training and treatments related to autism, such as behavioural therapy and speech therapy. The majority of these expenses must be borne by parents out of pocket. During underwriting, insurance companies may also decline coverage, increase premiums, or impose specific exclusions due to an autism diagnosis.

A small number of high-end medical insurance plans provide reimbursement for outpatient treatments related to psychiatry (including speech therapy, psychotherapy, etc.), but the premiums are relatively expensive. Additionally, these plans often come with waiting periods and annual compensation limits. Parents are advised to consult professional insurance advisors before purchasing a plan and to carefully compare the coverage scope, waiting periods, exclusions, and annual compensation limits of different plans to assess whether they meet their children's long-term needs.

If you need assistance in selecting a suitable plan, feel free to consult 10Life licensed insurance advisors for impartial and professional advice.

Further Reading:
 10Life Research: Insurance Companies Denying Coverage for Children with Autism and ADHD May Involve Discrimination – Urgent Need for Stronger Regulations (with Latest 2025 Insurer Responses)
Denial of Coverage for Children with Autism and ADHD Not Isolated Cases – 10Life Receives Complaint Cases
[Autism] Three Key Characteristics to Identify Autism in Children – Are Limited Speech and Lack of Social Interaction Signs of Autism?
[ADHD] How to Distinguish Between Naughty Behaviour and ADHD in Children? A Comprehensive Guide to ADHD Characteristics, Causes, Assessment, and Treatment

Last Updated: 27 October 2025

This English version of this article has been generated by machine translation powered by AI. It is provided solely for reference purposes. In the event of any discrepancy or inconsistency between this translation and the original Chinese version, the Chinese version shall prevail.