Concern for children as autism is redefined

PUBLISHED : Monday, 20 February, 2012, 12:00am
UPDATED : Monday, 20 February, 2012, 12:00am


Half of Hong Kong's children currently diagnosed as autistic may be denied treatment following a major change to the clinical definition, concern groups warned.

Their fears come as the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), one of the most authoritative guides in diagnosing mental illnesses, is at the final stage of revising its definition of autism.

The new definition is expected to be published next year.

Local psychiatrists rely on both the manual and World Health Organisation when providing treatment. Public doctors under the Hospital Authority also take international standards into account in their diagnosis and treatment.

Concern groups think some autistic patients could fall outside the spectrum and no longer be given treatment in public hospitals.

'If they were no longer labelled as autistic, it's likely they would be misunderstood,' said Vitti Poon Wai-kei, a clinical psychiatrist with the Practice, Research and Training Centre on Autism.

Poon said the new definition would probably narrow the spectrum and it was likely some children would not get the help they need.

She said parents might also become less aware of their children's problems if they were stripped of their labels. Currently, a psychologist would provide parenting guidance to help in the management of the children, she said.

Hong Kong does not have an official estimate of the population of autistic patients. Based on overseas figures, it is projected at between 70,000 and 200,000, according to both lawmaker Peter Cheung Kwok-che and Francis Yu Sau-ying of Autism Hong Kong.

The spectrum approach specifies a range of severity rather than stating the condition to give 'more accurate diagnoses that can lead to more focused treatment', according to the American association.

But analysis by US researcher Dr Fred Volkmar at the Yale School of Medicine warns that many higher-functioning patients would be excluded by the new definition. Those affected are patients with Asperger's syndrome or 'persuasive development disorder, not otherwise specified' (PDD-NOS), which are at the milder end of the autism spectrum.

About three-quarters of patients diagnosed with Asperger's and 85 per cent of those with PDD-NOS would fall out of the autism spectrum, based on the new definition.

The concern groups said children in real need would not receive treatment. Some would be misunderstood as 'merely naughty', they said.

'The new definition may result in different recommendation, different school placement, and misclassified situation,' said Dr Jeremy Greenberg, director of the Children's Institute of Hong Kong, a school set up in 2003 for children with special needs.

'The child could end up getting the wrong tool for the job. That can be very detrimental, because that's going to add a significant burden to the child, to the family, and to the classroom.'

Private psychiatrist Dr Kathy Chan Po-man said the new definition would impact more on academic studies than on clinical treatment, which is tailor-made for each patient.

She said she believed the new standard would provide a more accurate classification of patients' conditions.


The number of autistic patients receiving psychiatric services in the public system in Hong Kong, according to the Hospital Authority