Diagnosis of autism
http://www.100md.com
《英国医生杂志》
EDITOR—The use by Baird et al in their clinical review of the diagnosis "autism" and "autistic spectrum disorders" confuses me.1 The authors list five outcomes in box 8 that indicate the success of therapeutic and teaching interventions and may help us to comprehend what is the cardinal feature of autism: normal use of verbal language, some use of verbal language for a range of purposes, some functional use of language, ability to use an alternative system of communication, the child's idiosyncratic communication is better understood.
In each of these five successful outcomes for autism is one constant thread—the abnormal use of language for communication. I suggest that autism is none other than this—as opposed to the delayed development of speech. If that is so, then we do not need a spectrum any more than we need an asthmatic spectrum or a diabetic spectrum.
The diagnosing clinician must decide either that the child has autism or he or she does not have autism. If there is uncertainty, then this can be expressed reasonably. Responsible clinicians can justifiably give some idea of the severity of the autism by saying that it is severe or it is moderate or it is mild.
I believe that the use of autistic spectrum (as opposed to a straightforward diagnosis of autism) is undisciplined thinking. Either children have abnormal use of language for communication or they do not. Don't leave them on the autistic spectrum when you cannot come to a clear and definite diagnosis of autism.
P V Finn Cosgrove, consultant all-age psychiatrist
Bristol Priority Clinic, Bath BA2 5YD bristolpriorityclinic@btopenworld.com
Competing interests: PVFC is a specialist in the diagnosis and treatment of attention deficit hyperactivity disorder in children, adolescents, and adults
References
Baird G, Cass H, Slonims V. Diagnosis of autism. BMJ 2003;327: 488. (30 August.)
In each of these five successful outcomes for autism is one constant thread—the abnormal use of language for communication. I suggest that autism is none other than this—as opposed to the delayed development of speech. If that is so, then we do not need a spectrum any more than we need an asthmatic spectrum or a diabetic spectrum.
The diagnosing clinician must decide either that the child has autism or he or she does not have autism. If there is uncertainty, then this can be expressed reasonably. Responsible clinicians can justifiably give some idea of the severity of the autism by saying that it is severe or it is moderate or it is mild.
I believe that the use of autistic spectrum (as opposed to a straightforward diagnosis of autism) is undisciplined thinking. Either children have abnormal use of language for communication or they do not. Don't leave them on the autistic spectrum when you cannot come to a clear and definite diagnosis of autism.
P V Finn Cosgrove, consultant all-age psychiatrist
Bristol Priority Clinic, Bath BA2 5YD bristolpriorityclinic@btopenworld.com
Competing interests: PVFC is a specialist in the diagnosis and treatment of attention deficit hyperactivity disorder in children, adolescents, and adults
References
Baird G, Cass H, Slonims V. Diagnosis of autism. BMJ 2003;327: 488. (30 August.)