Intended for healthcare professionals

Clinical Review

Diagnosis of autism

BMJ 2003; 327 doi: (Published 28 August 2003) Cite this as: BMJ 2003;327:488

Autism...a diagnosis in the eye of the beholder?

Autistic Spectrum Disorder, a term that obviously incenses the
intellect of some posters to this thread.

Perhaps if I might borrow the description Of Systemic Lupus as "a
disease of a thousand faces". It can be equally applied to Autism which
presents itself in an individual & complex manner but without the
benefit of a standardised reproducible physical test to determine
suspected diagnosis.

So where does that leave the individual crippled by a multi-hued
variety and combination of physical, behavioural, cognitive, perceptual
and social communication disabilities?

Possibly on a socially determined spectrum of Autism?

At this time it would seem that diagnosis rests on a consensus of
opinion gained by recording and categorising observable behaviour.The
diagnostic tools are crude and applied with the inevitable personal
filters of each practioner or team.As yet it is all that is available for
all it's failings hence it would not be helpful to limit it further with
the ridgidity of such terms as severe, moderate or what you will.

I hold little hope for future determination of Autisms' aetiology or
potential for development of treatment if there is lack of concensus in
how Autism might manifest itself and the possible co-existing features
which need to be acknowleged to receive any form of treatment or therapy.

A favourable outcome for each individual would require far more than
being able to model speech and communication on what is considered
socially acceptable. To accept that as the sole standard of what needs to
be addressed, physically, emotionally and cognitively is to sell all
Autistic children and adults so far short that it is beyond shameful.It
fundamentally denies the existence of underlying mechanisms which create

As parents, we want so much more than that to achieve our childrens
health and well being and as another parent has already mentioned, we want
to know why this has happened to our children.


Competing interests:  
Parent of an Autistic child

Competing interests: No competing interests

04 September 2003
M C Feliciello