Autism epidemiology in Hong Kong children and youths aged 6–17: Implications on autism screening and sex differences in the community

Abstract

Epidemiological studies on autism lack representation from Asia. We estimated the prevalence of autism among children and youths in Hong Kong using a two-stage approach. In addition, we evaluated the psychometric properties of the screening instrument and explored sex differences within an epidemiological context. A random school-based sample of 5,865 children and youths were screened with the Autism Spectrum Quotient-10 (AQ-10). Then, a subsample of 317 participants underwent the Autism Diagnostic Interview-Revised assessment. Prevalence was estimated by applying positive and negative predictive values (PPV/NPV) of AQ-10 derived from the subsample to the entire cohort. None of the screened negative participants had autism, resulting in an NPV of 100%. Discrepant PPVs were noted for males (20.4%) and females (5.20%). The estimated prevalence was 2.57% using sex-specific PPVs. Explorative analysis on AQ-10 Positive participants without the diagnosis (i.e. ‘false positives’) showed significantly elevated autistic symptoms. The prevalence of autism in Hong Kong is comparable to the recent estimates in Western countries, which poses a significant public health challenge. Despite the high false-positive rates, AQ-10 remains valuable for excluding autism and identifying those with autistic symptoms. Furthermore, community-based studies are crucial to address sex differences in autism expression.

Lay abstract

Although studies have found that autism is becoming more common, little is known whether this is true in Asian countries. This study looked into how many children and teenagers in Hong Kong might have autism. We first screened 5,865 school-aged children and youths with the Autism Spectrum Quotient-10 (AQ-10). Then, we conducted in-depth interviews with 317 of them to assess for autism. We found that around 2.57% of children and youths aged 6–17 years in Hong Kong might have autism. This number is similar to that of the Western countries. Furthermore, we also discovered that boys who were screened positive on the AQ-10 were more likely to have autism than girls. This could be because autism is more common in boys, and the AQ-10 might be better at spotting autism in boys than in girls. In the future, studies will need to find an optimal way of detecting autism in the community, considering how autism may present differently in boys and girls.