**2. General management of ASD from the clinical perspective**

The general management of ASD from the clinical perspective encompasses both interventions in the family/environment as well as interventions addressed to the patient. Ideally, after diagnosis confirmation, the best initial approach could be done by an interdisciplinary team including professionals coming from medicine, psychology and social sciences.

According with DSM-IV-TR, and in agreement with previous epidemiological data, our group found that the most prevalent ASD is the PDD-NOS, followed by Autistic Disorder, and then by Asperger Disorder. Accordingly, the Rett Disorder and the Childhood Disintegrative

The increasing levels of prevalence in ASD probably is due to several reasons, such as the changes in diagnostic criteria, the high level of awareness, the underestimation of former data, the massive information exchange regarding ASD, the public strategies, etc. The first descrip‐ tion of autism was made by Hans Asperger, in 1938. In 1943, when Leo Kanner described a sample with 11 children, autism was a rare condition affecting not more than 4 in 10.000

However, childhood autism is much more frequent and is identified in at least one in each 100 children nowadays. For instance, a recent paper describes prevalence of 2.6% of ASD in

Autism and ASD certainly have different kinds of approaches. These neurobehavioral syndromes can be addressed, for example, both from the clinical and from the experimental field. To our knowledge, at least in the academic environment, the best approach could be the translational type because it made us able to rapidly build a bridge between the experimental

Obviously, the earlier results usually came from the experimental research for several reasons. In general, the time spent in each one experiment can be shorter compared to clinical research; the environmental variables can be in part controlled, etc. By the other side, clinical research can be more time consuming and potentially more complicated to be performed. There is no doubt that both approaches are not mutually exclusive. Actually they are complementary. Strictly speaking from the clinical perspective in autism, we can divide the clinical approach into two basic and complementary issues. The first one is the general management, including the confirmation of the correct diagnosis, the determination of the intensity of the compromise, and the evaluation of intensity level of eventual core behavioral symptoms. The last one encompasses several treatment options, which includes psychopharmacotherapy and differ‐

As the first cases of autism were described in the early 40's, now we have adults with ASD. That is the reason to keep in mind how ASD symptoms usually change during lifetime. As time pass, different symptoms change differently and it is crucial to clinicians to know these differences. In this context, the present chapter aimed to review (i) the general management of ASD from the clinical perspective; (ii) the lifetime changes in ASD symptoms; and (iii) the evidence-based

The general management of ASD from the clinical perspective encompasses both interventions in the family/environment as well as interventions addressed to the patient. Ideally, after

**2. General management of ASD from the clinical perspective**

Disorder for sure are less frequently seen in the clinical practice (Longo et al. 2009).

children aging from seven to twelve years of age (Kim et al. 2011).

and the clinical field (Gottfried and Riesgo 2011).

ent types of non-medical treatments.

treatment options.

children (Kanner 1943).

634 Recent Advances in Autism Spectrum Disorders - Volume I

Obviously, before initiating any kind of intervention, several steps must be done as follows. First of all, the final diagnosis must be confirmed by a careful anamnesis as well doublechecked using the DSM-IV criteria as well as a reliable clinical instrument such as Autism Diagnosis Interview-Revised (ADI-R) (Becker et al. 2012). The ADI-R is frequently used as a gold standard instrument for publication purposes, but it is problematic in the clinical practice for several reasons, such as it can miss same ASD cases as well as it need at least two hours to be completed. Then, the intensity of the ASD could be defined both from the clinical perspec‐ tive and by one instrument such as CARS (Pereira, Riesgo, and Wagner 2008). Another critical issue is to delimitate if there is any associated mental disability and its degree of intensity. As clinicians, we know the prognostic importance of an unaffected intelligence in ASD patients.

The second step includes the definition of the parent's doubts, fears, and degree of awareness. Usually, after diagnosis confirmation, parents became stressed. Not infrequently they go to internet in order to search every kind of available information regarding autism. Because some information coming from internet can be inaccurate, at this point, it is very important to clarify which are the evidence-based types of therapies to date.

The third step could be the delimitation of environmental variables that needs to be addressed, starting from the home and family. Neighborhood and school needs to be evaluated both in terms of potential stressors and also because they can facilitates choosing a given type of therapy on an individual basis.

The next step is done by the identification of the target behaviors needing treatment. After core symptoms definition in each case, the different professional specialties that need to be involved are selected. In general, the team includes a physician specialized in ASD patients as well as one speech therapist and others professionals arising from health care and/or education with experience in children with ASD.
