Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation

Abstract

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by deficits in social communication and the presence of restricted interests and repetitive behaviors (1). In 2013, the Diagnostic and Statistical Manual of Mental Disorders-5 th edition (DSM-5) was published, updating the diagnostic criteria for ASD from the previous 4 th edition (DSM-IV) (Table 1) (1,2).In DSM-5, the concept of a "spectrum" ASD diagnosis was created, combining the DSM-IV's separate pervasive developmental disorder (PDD) diagnoses: autistic disorder, Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified (PDD-NOS), into one. Rett syndrome is no longer included under ASD in DSM-5 as it is considered a discrete neurological disorder. A separate social (pragmatic) communication disorder (SPCD) was established for those with disabilities in social communication, but lacking repetitive, restricted behaviors. Additionally, severity level descriptors were added to help categorize the level of support needed by an individual with ASD.This new definition is intended to be more accurate and works toward diagnosing ASD at an earlier age (3). However, studies estimating the potential impact of moving from the DSM-IV to the DSM-5 have predicted a decrease in ASD prevalence (4,5) and there has been concern that children with a previous PDD-NOS diagnosis would not meet criteria for ASD diagnosis (5-7). There are varying reports estimating the extent of and effects of this change. One study found that with parental report of ASD symptoms alone, the DSM-5 criteria identified 91% of children with clinical DSM-IV PDD diagnoses (8). However, a systematic review suggests only 50% to 75% of

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