An autism spectrum disorder (ASD) diagnosis is a huge consideration for a parent to process; add to this the myriad of information and treatment options out there, and it’s hard not to feel incredibly overwhelmed.
Following a diagnosis, parents should take some time to digest the news and explore the pathways ahead. But then it’s time to get cracking on a treatment plan, because early intervention is recommended.
According to Dr David Fischer, Behaviour Consultant at The Autism Partnership, “The best time to get services is when a child is young; if you wait, the door can close on some early intervention results.” Early intervention before the age of three can mean children with ASD have a better chance of learning important skills, like talking, walking and interacting with others.
So what does a good treatment plan look like?
Unique pathways
Each child with ASD is different, each parent is different and each case is unique – which means each treatment path will be unique, too. Treatment plans are also dynamic: they need to be adjusted and updated as the child learns new skills and hits new phases in their behavioural, developmental and social growth.
It’s important to acknowledge how demanding ASD treatments can be – not just for the child, but for the whole family. Treatment plans are usually intensive undertakings that involve a high degree of parental involvement. With 25-plus hours of treatments per week not uncommon, these plans can require significant adjustment to family routines and may require support and buy-in from the extended family, presenting a considerable challenge for many parents. Getting support is a topic that we’ll discuss in our third article in the series, in next month’s issue of Playtimes.
So, what treatment options are available to help children with ASD and their families in Hong Kong?
There are many treatment options available – and for those with a new diagnosis, therapies can read like a list of random capitalised letters! It’s overwhelming and takes a lot of time to absorb. Although there are too many treatments to include them all here, we touch on some of the main options below.
Behavioural training and management
Behavioural training and management uses positive reinforcement, self-help and social skills training to improve behaviour and communication. The most commonly used behavioural training and management programme is Applied Behavioural Analysis (ABA). ABA is an umbrella term that includes many individual treatments such as Discrete Trial Training (DTT) Early Intensive Behavioural Intervention (EIBI), Pivotal Response Treatment (PRT), Video-based Intervention (VBI) and others. Another behavioural approach is Treatment and Education of Autistic and Communication Related Handicapped Children (TEACCH) – a highly individualized and structured teaching programme.
ABA is commonly held to be the go-to treatment for children with ASD. While it’s not for everyone, it’s widely accepted by the healthcare industry and is implemented in some schools. ABA comes in many incarnations, but in short it encourages positive behaviours and skills acquisition through position affirmations. It’s an intensive, immersive therapy that covers developmental, social and behavioural challenges.
The Autism Partnership is a global provider of ABA and an authority on ASD. Its Hong Kong campus is in Quarry Bay. Dr David Fischer leads a team of therapists and professional clinicians while overseeing cases here and throughout Asia. He believes for ASD, “the treatment that is most effective is ABA. That should be the core of any treatment package any child should receive.” The Autism Partnership offers ABA in group sessions, individual programmes and in-home sessions. They also sometimes work with selected schools and with parents who are looking to execute their own ABA programme at home.
Some centres offering ABA therapy in Hong Kong include (among others): The Autism Partnership; Autism Recovery Network; Child Development Centre; Sprout in Motion; and Bridge Academy.
Speech and language therapy
Speech and language therapy (SLT) comes in different forms and addresses an array of problems presented by children with ASD. Children will be evaluated and a special individual therapy will be created to help them with their challenges. Speech therapy can help children master spoken language or create simple signs to communicate with parents and caregivers. Speech therapists might specialise in children with ASD or work with a wider field of patients.
Here in Hong Kong, parents have options when seeking speech therapy assistance. Places like the Child Development Team at Central Health Partners offer experienced speech therapists who treat a wide variety of children. Other places, such as the Rainbow Project and Child Development Centre, specifically cater to children with special needs. Government and charitable centres also offer speech therapy for families who qualify for assisted services.
Occupational therapy
Occupational therapy (OT) can help children with their sensory processing. Often, children with ASD experience sensory overload and this can impact their behaviour, causing them to either withdraw or ‘act out’ to deal with overwhelming feelings.
Occupational therapy sessions work to help children master daily life tasks like getting dressed, and fine motor skills like drawing and handwriting. This is another type of therapy where professionals work closely with Mum, Dad or caregiver to create a treatment plan that extends into the home. Working with an occupational therapist, parents will be able to identify strategies and activities that will work towards decreasing anxiety and increasing their child’s ability to learn and focus.
Again, centres such as the Rainbow Project and Child Development Centre can help facilitate occupational therapy for ASD kids. Another option for parents on a budget, or those on the government waiting list for early intervention services, is Watchdog.
Treating associated symptoms
Many children with ASD also suffer from associated symptoms that may be common to children with ASD but not specific to the disorder. These can include sleep problems, food intolerances and tummy problems, and will be treated by other professionals.
While there is no medication to cure ASD or its core symptoms, in some cases medications are an option to help manage symptoms associated with or common to ASD. Medications may be able to help with sleep disturbances, energy levels, depression, seizures and more. A paediatrician or psychologist can help parents explore medication options and the consideration that while drugs may work for some children, others may experience side effects that outweigh the benefits.
Some parents experience success with dietary issues by changing their child’s diet or by using natural or alternative therapies. While some may see success with alternative therapies, Dr Minna Chau, Centre Director at Sprout in Motion, reminds parents, “Get your house in order with the proven therapies first – ABA, occupational therapy and speech therapy – whatever you choose. Then consider trying some additional therapies if you want, and be systematic in your approach. Do not do everything at the same time or you won’t know what’s working. If your child is on a gluten-free diet and going to cranial therapy, you’ll never know what’s effective. Parents should be aware and informed about alternative treatments.”
Balanced lifestyles
Dr Isabelle Hénault, a psychologist specialising in ASD and Asperger’s Syndrome, says that it is important to remember that friendships and regular social play are to be encouraged for kids with ASD. She advises forgetting about age and to match your child with another who shares their special interest. For instance, if you have a child who loves My Little Pony and she meets a friend who also likes My Little Pony, put aside any age difference – does it matter if one child is aged 10 and the other four? Allow them to connect simply as two children who love the toy.
Dr Hénault also recommends children with ASD get active, particularly those who suffer from anger and anxiety. She cites an Australian study that shows how physical activity is used effectively as an anxiety management tool. Formal team sports may be a challenge for some children with ASD as complex rules and sporting social interaction with team mates can induce anxiety, but an inclusive approach can bring benefits and there are also many other ways they can get active, which helps reduce stress levels.
Solo sports can be a hit, and activities such as playing the drums, simply wrestling with Dad or jumping on a trampoline can release enough energy to make an impact. Another great suggestion put forward by Dr Hénault is what she dubs ‘creative destruction’, which is providing an opportunity for children to be destructive in a controlled environment – anything from ripping paper to punching cardboard boxes. Again, this allows for a release of pent-up energy.
Parent-led training
Treatment plans often actively engage parents and other family and household members – including helpers and grandparents. It’s important to get your family on the same page when it comes to treatments. At-home treatment plans are also a great option for those working on a budget – ASD treatments are very expensive and may not be covered on health insurance plans. Therapists may also insist parents are highly involved and attend parent training sessions as a matter of course. One place that operates this way is Autism Partnership.
At a recent talk to parents of ASD children in Hong Kong, Dr Isabelle Hénault, a psychologist specialising in ASD and Asperger’s Syndrome, shared some at-home aids to help ASD kids and their family members navigate their day. Each child’s ‘tool box’ contains a variety of tools for dealing with emotions and daily challenges that will be different. One such tool is the CAT-kit, which provides a structure to organise a child’s emotional experience. The CAT-kit provides a daily diary of sorts, which captures a child’s emotional state and helps those around him or her understand how they’re feeling. It has a big fold-out timeline of the day and lots of stickers representing emotions that the children stick on that day chart. Kids stick emotions on the chart as the day progresses, or if something happens to make them happy or sad or angry etc. The kit can also be used to teach ASD kids how others may be feeling and the appropriate responses. LDA also offers some emotional cards and aids to help children learning to read emotions.
Mum as ‘mission control’
Treatment plans are created by specialists, specifically for each child. But one piece of the treatment plan that is common for all children is a parent (often mum) serving the role of ‘mission control’ and at-home therapist. This is an important role that many parents take on full time after an ASD diagnosis. A coordination role is of utmost importance since parents of a child with ASD may find themselves having to juggle multiple therapies and therapists – as well as a paediatrician, a GP, the school, a domestic helper and all the transport required to get from A to B to C. Mission control also needs to be in charge of appointment monitoring, record-keeping and the dispensing of medications, where it’s important a single person monitors all medicines a child is taking to ensure proper administration and observation of side effects.
Now, if this sounds like someone you know, take a moment to understand the additional complexities she is facing. Take her for a cup of coffee (or a glass of wine), tell her what a great job she’s doing and let her share her day with you.
If you are interested in meeting and engaging with parents of children with special educational needs, Special Needs Network Hong Kong (SNNHK) offers support and information, as well as informal meetings and talks. To contact or join SNNHK,
please email [email protected].
Read Part 1 Autism: The Facts
Read Part 3 Autism and the Family
Useful contacts:
Try these useful contacts for further information about autism treatments in Hong Kong.
- Autism Partnership
(www.autismpartnership.com.hk) - Autism Recovery Network
(http://autismrecovery.hk) - Bridge Academy
(http://bridge.edu.hk/index.html) - Child Development Centre
(www.cdchk.org) - Child Development Team at Central Health Partners (www.centralhealth.com.hk)
- Heep Hong Society
(www.heephong.org/webprod/eng) - Hong Kong Government Child Assessment Services
(www.dhcas.gov.hk/eindex.html) - New Page Learning & Developmental Consultants (www.newpage.hk/eng)
- Rainbow Project
(https://rainbowprojecthk.wordpress.com) - Springboard
(www.springboardhk.org) - Sprout in Motion
(www.sprout.hk) - Watchdog
(www.watchdog.org.hk)
