Autism epidemiology in Hong Kong children and youths aged 6-17: Implications on autism screening and sex differences in the community.
In Hong Kong schools the AQ-10 never misses autism but over-flags boys, so lower the girl cut-off and keep monitoring borderline scores.
01Research in Context
What this study did
The team gave the 10-item Autism Quotient (AQ-10) to school children aged 6-17 across Hong Kong.
They also checked a smaller group with full clinical tests to see how often the short screen was right.
What they found
About 1 in 40 kids screened positive, giving a Hong Kong prevalence of 2.57%.
The AQ-10 never missed a child who truly had autism (100% negative predictive value).
It did flag boys four times more often than girls, so the positive value differs by sex.
How this fits with other research
Zeidan et al. (2022) put the world median at 1%; Hong Kong sits a little higher, so local awareness may be catching up.
Kwok et al. (2024) looked at youth with first-episode psychosis in the same city and found autism in 28%.
The numbers seem to clash, but Ty studied a hospital group already in crisis while Wh et al. sampled everyday schools—different pools, same town.
Hodge et al. (2025) showed girls get assessed six months later because their signs are milder; this matches the AQ-10’s boy bias and warns us to lower the cut-off for females.
Why it matters
You can trust a low AQ-10 score to rule out autism, saving referral time.
When a girl scores just below the usual boy threshold, keep watching and consider a full evaluation.
Adjust your screeners by sex and you will catch the girls who would otherwise slip through to secondary school without support.
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02At a glance
03Original 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 abstractAlthough 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.
Autism : the international journal of research and practice, 2025 · doi:10.1177/13623613251360269