Clinical Review

Diagnosis of autism

BMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7413.488 (Published 28 August 2003) Cite this as: BMJ 2003;327:488
  1. Gillian Baird, consultant developmental paediatrician (gillian.baird@gstt.sthames.nhs.uk)1,
  2. Hilary Cass, consultant in paediatric disability2,
  3. Vicky Slonims, principal specialist speech and language therapist1
  1. 1Newcomen Centre, Guy's and St Thomas' NHS Trust, London SE1 9RT
  2. 2Great Ormond Street Children's Hospital, London
  1. Correspondence to: G Baird

    *

    Parents want autism to be diagnosed as early as possible, and early intervention may improve long term outcomes. The authors of this review discuss the identification and assessment process for children with autism and autistic spectrum disorder

    Introduction

    Autistic spectrum disorders have been the subject of increasing attention over the past few years–from the media, from clinicians, and from the general public. Stories of savants who excel in such skills as calendar calculations and detailed drawings have long been a fascination to public and clinician alike, exemplified in Dustin Hoffman's portrayal of a young man with autism in the film Rainman. Most recently, public anxiety about autism has been raised as a result of reports linking the measles, mumps, and rubella (MMR) vaccine with autism and inflammatory bowel disorder and a rise in the prevalence of autism.1 2 This has resulted in a serious fall in immunisation rates,3 despite the epidemiological evidence of a lack of association,4 and strong reassurance from the Department of Health and the Royal College of Paediatrics and Child Health about the safety of the MMR vaccine. Parents of children with autism continue to express the view that the medical profession does not take their concerns about possible causes of autism seriously. “Miracle cures” for autism–for example, with secretin–have received wide publicity through television and raised enormous hopes before being placed in their proper context by double blind trials that have not confirmed a curative effect. We consulted recent reviews, specialist journals, and recent Medline papers on the diagnosis of autism.

    What is autism?

    Autism is a behaviourally defined disorder, characterised by qualitative impairments in social communication, social interaction, and social imagination, with a restricted range of interests and often stereotyped repetitive behaviours and mannerisms. Sensory hyposensitivities or hypersensitivities to the environment are common features. …

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