Identification and Diagnosis of Autism Spectrum Disorders: An Update

Greg Pasco

Disclosures

Pediatr Health. 2010;4(1):107-114. 

In This Article

Future Perspective

The two main diagnostic frameworks are currently being updated, with DSM-V expected to be published in 2012[104] and ICD-11 due in 2014.[105] A comprehensive summary of the discussions amongst the experts contributing to the revised criteria for ASDs has been published online by the American Psychiatric Association.[106] It is not yet clear how the criteria will be revised, but it is likely that Asperger syndrome will be incorporated within the autism spectrum/PDD category. There may well be an increased emphasis on describing the profile of the individual, not only in relation to the three main aspects of communication, social interaction, and restricted and repetitive interests, but also in terms of intellectual ability, sensory difficulties, motor co-ordination problems and comorbidity. Overall, there will be a shift away from the current categorical approach to diagnosis, with a more dimensional framework being adopted.

A new module of the ADOS (the 'Toddler Module') has been created as a means of probing for autistic symptomatology in children under 30 months of age[49] and a toddler version of the ADI-R is also being developed,[50] although these are not yet available for use outside of the research context. Alternative diagnostic algorithms, incorporating scores from items from the restricted and stereotyped behavior domain, have been developed in order to improve the diagnostic validity of the ADOS,[51] but these are as yet unavailable for clinical use. In relation to earlier diagnosis, prospective studies investigating the early profiles of 'high-risk siblings' may provide clearer data about the early signs of autism, although symptom heterogeneity may continue to make very early diagnosis unstable. Studies are continuing into the utility of early screening questionnaires, although it is likely that universal screening of toddlers will prove to be an efficient method of identifying children at risk for ASD.

There will inevitably be further research into the prevalence of ASDs, including studies conducted in developing countries. Modifications to the formal definitions of ASDs are likely to have an impact on measures of prevalence, although the direction and degree of changes are difficult to predict until the new criteria are finalized. Studies suggesting increased prevalence will no doubt continue to fuel the controversy regarding the belief that the true incidence of autism is on the increase, although only well-conducted studies with adequate methodology will be able to address this crucial question.

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