ASD Support Basics: Developmental Assessments Part One

Dr. Fanny Lam unravels the complexities of developmental assessment.


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Dr. Fanny Wai Fan Lam is a specialist in Developmental-Behavioural Paediatrics with three decades of clinical experience in Hong Kong, Canada, and Australia. Dr. Lam serves as a developmental-behavioral pediatrician at the Hong Kong Developmental Paediatrics Centre, Matilda International Hospital, Union Hospital, and Gleneagles Hong Kong Hospital.  Dr. Lam is committed to enabling children to reach their potential through parent coaching and early identification and intervention.

At what age can children typically receive a reliable diagnosis of ASD, and what behavioral signs should parents look out for?

ASD can be reliably diagnosed at 1.5 years of age. One of the main signs that parents should look out for during infancy and toddlerhood would be pointing. For example, whether the child would ever use his/her finger to indicate interest in something or look in the direction or at the object you’re pointing at. 

Other things parents should look out for would be abnormalities in eye contact, speech development, and whether the child engages in social interactions, such as imitating others or responding to their name. 

Parents should also observe for any signs of regression, meaning that the child loses speech or other skills that he/she has learned. It is commonly seen in children on the spectrum during toddlerhood. 

What types of assessments or evaluations are commonly used for young children to determine if they are at risk for ASD?

Multiple types of tools are used to determine the risk for ASD. Some commonly used parent questionnaires are the M-CHAT and the Cambridge University Behaviour and Personality Questionnaire for Children (AQ Child). Other assessment tools such as the Autism Diagnostic Observation Schedule (ADOS) are also often used in the assessment process.

There are also emerging methods to evaluate risk for ASD. For example, the Comprehensive Autism Screening (CAS) program uses electroencephalogram (EEG) screening and genetic testing can help provide patterns of evidence that may show a child’s risk of developing ASD. Such processes can be conducted as early as six months of age, giving early intervention a new meaning.


Which conditions resemble ASD in symptoms, and what is the differentiation process during assessment?

When evaluating symptoms that resemble ASD, the following conditions or disorders should be considered:

Epilepsy (specifically absence seizure): 

An EEG screening is essential to provide medical evidence of potential epilepsy.

Developmental delays:

A series of cognitive assessments are conducted to evaluate the child's cognitive abilities. The results will then be compared to the average performance of typically developing children of the same age.

Hearing impairment:

The assessment includes a basic hearing ability evaluation.

Visual impairment:

The assessment includes a basic visual ability evaluation.

Lack of stimulation: 

The assessment includes an evaluation of the child's sensory profile to assess their sensory processing and identify any abnormalities.

Social anxiety:

In addition to interacting with the child at the center for evaluation, comparisons will be made between the child's behavior and characteristics in different settings, such as school, the assessment center, and home. Communication with relevant parties provides valuable insights. Children with social anxiety usually behave more naturally after warming up to the examiner. 

Does early ASD assessment and diagnosis affect a child's long-term prognosis?

The process of assessing and diagnosing ASD early can have a profound impact on a child's long-term prognosis and outcome. It encompasses various aspects of the child's development, taking advantage of brain plasticity, which enables better outcomes through intervention, particularly at a younger age. Early identification and intervention play a crucial role in achieving positive results.

From a neurological perspective, an early diagnosis of ASD allows timely identification of underlying seizure conditions, enabling early treatments to alleviate the condition.

Medical treatments and supplements can be provided to minimize complications that result from ASD such as mood instability, constipation, and sleep problems.

An early diagnosis also helps parents gain a deeper understanding of their child, enabling them to make necessary adjustments and acquire specific parenting skills for children with special needs. This ultimately alleviates confusion and feelings of helplessness, providing parents with the professional guidance they require.

What role does a developmental behavioral pediatrician play in creating support programs for children with ASD?

A specialist can determine the medical causes, prescribe medications for various symptoms and issues, identify comorbidities, offer parenting guidance, coordinate a multidisciplinary team, liaise with schools, and assist in planning the patient's education for individual patients.

Specialists also assist in navigating governmental resources and refer patients to other professionals, such as dentists or ophthalmologists experienced in caring for children with ASD, as developmental behavioral pediatricians typically maintain a network of ASD specialists.

Education and advocacy are important responsibilities for specialists, who may lead parent support groups, guide NGOs and charities, oversee other support groups, represent children with ASD in relevant forums like the Legislative Council of Hong Kong, and enhance public and professional awareness about the condition.


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