Diagnosis of Autism
EDITOR - The clinical review of the diagnosis of autism by Baird et
al. provides an excellent summary of the salient issues in this complex
area (1). They rightly highlight the need for a multi-agency process of
assessment and supportive intervention to be made available to all
children presenting with concerning symptoms, in accordance with the
recommendations of recent national reviews (2, 3). One important
additional reason for such provision, which their review does not
emphasise, is that well-coordinated, multi-agency ASD assessment teams
have a better chance of accurately not giving a diagnosis of ASD.
For example, our multi-agency ASD assessment service has seen 57
patients in the last two years. We request baseline speech and language
therapy and (where applicable) educational psychology assessments
regarding the likelihood of ASD, for all cases prior to their being seen
by our team, so as to ensure best use of clinical resources. Despite this
approach, only 26 patients (46%) deemed to be likely cases of ASD actually
received a positive diagnosis. This is not due to over-zealous
interpretation of ICD-10 ASD diagnostic criteriae (which are increasingly
recognised as being in urgent need of review) as we tend, if anything, to
err in favour of diagnosis, even if ICD-10 (or DSM-IV) criteriae, are not
It is essential that relevant agencies receive adequate funding for
the implementation of the National Autism Plan for Children (3). This is
not just to benefit those children and their families who are struggling
with the often-devastating impact of this disorder, but also, the (we
suspect) depressingly high number of children who will be wrongly, or
inaccurately, diagnosed, if ASD assessment services do not improve.
I McClure, consultant child and adolescent psychiatrist
H Mamdani, consultant community paediatrician
R McCaughey, senior speech and language therapist
ASD Assessment Team,
Acorn Centre, Vale of Leven Hospital, Alexandria, G83 0UA
Competing interests: None declared.
1. Baird G, Cass H, Slonims V. Diagnosis of Autism. BMJ 2003; 327:488
2. Hanlon P, et al. Public Health Institute of Scotland. Autistic Spectrum
Disorders Needs Assessment Report. Glasgow: PHIS December 2001.
3. Le Couteur A, Baird G, National Initiative for Autism: Screening and
Assessment (NIASA). National autism plan for children. London: National
Autistic Society, 2003.
Competing interests: No competing interests