Autism Spectrum Disorders (ASD) has been conceptualized a complex neuro-developmental/behavioral disorder. In the past two decades the interest in autism has increased tremendously among the general population, parents, clinicians and the scientific community.
Epidemiological studies in the early 1990s estimated a prevalence of 1 in 1500 children with autism. In 2002, the prevalence increased to 1 in 150 (NIH). In 2006, the CDC reported that 1 in 100 children have been diagnosed within the Autism Spectrum Disorders (ASD). Now recently, a prevalence rate has been set of 1 in 90 children based on telephone interviews of parents. There has been a debate about the epidemiological findings and researchers have given several possible explanations for this trend (NIH, 2009, CDC 2010). However, whether the rate is 1 in 150 or 1 in 100 or 1 in 90, Autism Spectrum Disorders (ASD) represents a challenge to public health officials, parents and service providers. Together we all play our part in helping to ensure that the autism community has access to adequate and personalized medical, educational, occupational, and social services throughout their lives.
Since the DSM-IV was published in 1994 and revised in 2000, clinicians and researchers have been demanding for a new conceptualization of Autism Spectrum Disorders diagnosis. Currently the DSM-IV is based only on a set of behavioral descriptions.
The current Autism Spectrum Disorder classification seems to be obsolete and the lack of an appropriate classification of Autism Spectrum Disorders represents a big challenge for clinicians (psychiatrists, psychologists, educators among others), which may lead to a diagnostic confusion. Updated genetic, epigenetic, neurochemical and neuroimaging studies on autism provide convincing findings to shift the paradigm and abandon the current behavioral-centered classification to a more operational taxonomy that lends itself to individualized therapy. Siegel (2010) proposed a new kind of taxonomy for autism spectrum disorder where individuals with ASD are operationalized as “autistic learning disabilities” (ALD) or “autistic learning styles” (ALS). Therefore, the DSM can provide operational definitions that refer to “functional defects in perception, processing, storage, retrieval, or output of sensory, affective, or cognitive inputs”. By adopting the ALD/ALS approach we can expect to provide a predictive validity for treatment responses.
Currently, we have different diagnostic practices between professionals, geographical areas and countries. The Autism Diagnostic Observation Schedule (ADOS) is the most widely used and best validated assessment tool (Lord, Risi, Lambrecht, et al. 2000). The most established autism-specific diagnostic interview is the Autism Diagnostic Interview – Revised (ADI-R) (Lord, Rutter, Le Couteur, 1994).
Today, the most recommended evidence-based intervention is Applied Behavioral Analysis (ABA) with or without psychotropic medications. The DSM-V is planning to be published in 2012-13 and the ICD-11 is due in 2014, and we are all waiting in expectation to see what changes will be made to the diagnostic criteria of Autism Spectrum Disorders. My hope is that this effort will come about out of close collaboration between clinicians, researchers, and families with children with ASD and the general population.