There is limited understanding of Autism spectrum disorder (ASD) in Vietnam. This ethnographic study aimed to explore how ASD is represented and managed in the cultural, social and economic contexts of Vietnam, and describe the experiences of families with children with ASD in Hanoi, Vietnam. This study was conducted from 2011 to 2012 in Hanoi and employed a range of methods, including participant observation, in-depth interviews with 27 parents of children with ASD and 17 key informants, and online survey. This study found that within Hanoi, Vietnam, ASD has been culturally and socially constructed as a disease , karmic demerit and family problem rather than a life-long developmental disorder that needs support from government. Children with ASD and their families experience various forms of stigma and discrimination. There are limitations in assessment and diagnosis of ASD. Parents of children with ASD have little access to services for their children, and the limited political and economic supports exacerbate their difficulties. This study highlights some of the ways in which the understandings and management of ASD vary cross culturally. It also suggests further attention is required to the provision of appropriate public education, low cost interventions and support for family advocacy groups.