參考資料來自衞生署兒童體能智力測驗服務，詳情覽 : https://www.dhcas.gov.hk/tc/autism_spectrum_disorder.html

Characteristics of Autism Spectrum Disorders

Autism Spectrum Disorder (ASD) is a developmental disorder caused by abnormal development of brain function, which mainly affects communication and connection with people. Therefore, people with autism spectrum disorder will encounter many obstacles in daily interpersonal relationships and social communication, and will also have paranoid behavior patterns. Behavioral manifestations of each person with autism spectrum disorder are different. The following are common symptoms of ASD.

(1) Deficits in social interaction:

Social interaction difficulties may vary from being aloof, passive to over-passionate, or odd mannered behaviours. Some of the very young children with ASD may only approach adults for addressing physical or biological needs, such as getting food or toys. For these, they may use others as mechanical aids to get what they need. Some may show aversion to physical contact and stiffen when held. They may show limited social relatedness and attachment with parents or close care-takers, and prefer to play alone and with little or no spontaneous sharing of interest, enjoyment and achievements. Older children may fail to initiate appropriate social signaling to others (e.g. socially directed smiles, eye to eye gaze), and lack response to others’ signals in social situations. For those who have developed useful verbal language, communication is still often used for instrumental rather than social purposes. Apart from aloofness, some may attempt to socially relate as instructed by adults but with low social volition, while others with higher social intention may appear odd, over-passionate and self-centered.

(2) Deficits in non-verbal communication:

Children with ASD are weak in the use of non-verbal communication. Very young children with ASD may have difficulty indicating needs through pointing and eye-gazing. Limited facial expression and poor eye contact may render them to be seemingly rude, uninterested or inattentive in social interactions. Some may speak with high-pitched voices, strange prosody or with robot-like monotone. Older children may have difficulty in understanding social cues from body language and tone of voice. The overall integration of verbal and non-verbal communication is weak.

(3) Deficits in relationship and friendship building:

Children with ASD lack adequate social skills to develop friendships with others. Many children with ASD have speech and language difficulties, such as weak fund of vocabularies, pronominal reversals, which affect their ability to converse effectively with peers and in friendship building. Even for those with intact language and who are eager to make friends, the weakness in empathy to understand others’ thoughts and feelings creates a range of challenges. These include difficulties in processing complex social cues and understanding implicit social rules, regulating behaviour to match specific social context, following rules of the communication context, and understanding non-literal languages including jokes, idioms and metaphors. Friendships are often one-sided or based solely on shared special interests. Inappropriate attempts at social interchange are often interpreted as aggressive or disruptive behaviour as they may be socially immature, mechanical, awkward or overly passionate.

(4) Stereotyped or repetitive motor movement or use of objects/ speech:

Restricted and ritualized patterns of verbal or nonverbal behaviours are common during early and middle childhood. During early childhood, common examples of non-verbal restricted and ritualized patterns of behaviour include lining of objects and repetitive opening and closing doors. Stereotyped body movements (stereotypies) such as flapping of hands, running back and forth, head banging, rocking of body, self-spinning, finger movements and grimacing may be present when these children become excited, distressed or agitated, and diminished through structured environments. Some children may repeatedly watch the same movie or read the same story book. Stereotyped verbal language may be rote and repetitive, lacking in functional communicative intent. The unusual speech pattern may include stereotyped words or phrases which are out of the context, immediate or delayed echolalia, repetitive questioning, and greeting rituals, and for some older children pedantic speech with vocabularies or phrase that are unusual for age or social group may be seen.

(5) Insistence on sameness:

Children with ASD often show insistence on sameness or excessive adherence to routines. Insistence on taking the same route, maintaining same arrangement for objects, eating a narrow range of food items, adopting rigid thinking patterns are some common examples. Many respond to small changes in the environment with disproportionate distress, including change in routine, transition from one activity to another, and moving to new home/classes with changes of people and environment.

(6) Fixated interest:

Fixated or narrow interests are very common in children with ASD. Some demonstrate strong memory of information and data and fascination with numbers, bus routes, calendar and natural sciences. In early infancy and early childhood, commonly there is absent or minimal exploratory play or symbolic/fantasy play. Instead, the play is monotonous and repetitive, and lacking variation, such as spinning and lining activities. For older children, including those with high functioning, there may be limited imitation, creativity and imagination. They may have unusual preoccupation with parts of objects, or perseverative interests with particular topics, all leading to negative impact on their daily and social functioning.

(7) Sensory issues:

Some children with ASD have sensory processing problems of hyper- or hypo-reactivity to sensory input or unusual interest in sensory aspects of the environment. Some show apparent indifference to pain, heat or cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement (e.g. spinning objects). They may present sensory seeking or avoidance behaviours to usual auditory, tactile, or vestibular stimulation, manifested as repetitive and compulsive behaviours.

What are the causes of autism spectrum disorder?

Though the exact cause is still not fully delineated, ASD is now widely accepted to be a neurodevelopmental disorder that is highly heritable and resulting from multiple genetic and non-genetic causes. Heritability is demonstrated by the higher recurrence rate of siblings of children with ASD. About 10% of children with autism are also identified as having Down’s syndrome, fragile X syndrome, tuberous sclerosis or other genetic and chromosomal disorder. 

What conditions may co-occur with autism spectrum disorder?

Intellectual disability and language problems are commonly found among children with ASD. Other common comorbidities include attention deficit/hyperactivity disorder, tics disorders, developmental coordination disorder, dyslexia, anxiety and depression. Other associated medical conditions include epilepsy, eating problems and sleeping problems.

Attitudes and skills in getting along with them

• Accept and respect people with autism.
• People with autism often use body movements to reflect emotions, so you should pay attention to their body language carefully and patiently when dealing with them. 
• It is recommended to speak slowly and choose simple and specific words, when communicate with patients with autism. You should ask the patient to look at you and use body language such as holding hands or touching the head to show affection. 
• Encouragement and disapproval should be clear. Good behavior should be appreciated and rewarded, while bad behavior should be corrected immediately.