Preface

The changing face of psychiatry and clinical psychology is mostly illustrated by the hugely increasing prevalence of autism spectrum disorder (ASD) as we increase our understanding and broaden the concept from Leo Kanner's (1943) very narrow concept. The prevalence of ASD was 4/10,000 and is now 1/59, according to the Center for Disease Control in Atlanta, Georgia. Older concepts of autism, that is narrow concepts, have been shown to be completely outdated and unfortunately their use deprives children of ASD diagnosis, with serious consequences for the child, family, and school. A more restricted concept of autism is still contained in instruments, for example, the Autism Diagnostic Interview—Revised and the Autism Diagnostic Observation Scale (ADOS). Parents are still being reduced to tears when they are given a so-called diagnosis of "ADI-negative," and when parents, schools, etc., see clearly that the child has autism. The National Institute for Clinical Excellence Guidelines (2012) specifically point out that there is no precise instrument for the diagnosis of autism and that it is a clinical diagnosis by an expert in autism that is best. According to Baird et al. (2006), about 25/10,000 meet criteria for autism diagnosis based on ADI-ADOS, while the rate of current diagnosis, that is ADS, gives a rate of about 116/10,000. This means that ADI-ADOS is missing over three-quarters of patients who would now be described as having ASD. The rate of expansion of research on ASD is now so rapid that books like this are necessary to bring recent advances together in one place.

This book focuses on the controversies of the diagnosis of ASD with an examination of the putative link between autism, stercobilin, and gastrointestinal disorders. It also focuses on an exploration of scalp acupuncture as a possible treatment. There is also critical examination of autism in the classroom and an investigation into a very unusual phenomenon observed in Uganda called "nodding syndrome."

> **Michael Fitzgerald** Professor, Department of Psychiatry, Trinity College, Ireland

**1**

**Chapter 1**

Introductory Chapter: Autism

the Twenty-First Century

tional therapy and certain medications, if necessary.

sis, depending on which criteria were used:

2.One hundred forty-four (47%) met ICD-10 criteria.

3.Twenty-four (8%) met Kanner's five criteria.

nobody met criteria for Asperger's syndrome.

*Michael Francis Fitzgerald*

**1. Introduction**

**2. Diagnosis**

III-R criteria.

Spectrum Disorder - Advances at

the End of the Second Decade of

Now, as we move into the third decade of the twenty-first century, it is time to examine some of the current research in autism, for example, microbiome and other research, which is described in this book. Therapies for children with autism continue to be challenging, with no one therapy has been shown to be superior to all other forms of therapy. Indeed, the treatment situation echoes what Lewis Carroll wrote, "*all have won, and all must have prizes*." By that is meant the equivalence of outcome for various therapies for autism. Parents should not engage with therapies promising a cure for autism, however, attractive these promises may be. Nevertheless, a great deal can be achieved with current therapies, including mind reading skills therapy, behaviour therapy, speech and language therapy, occupa-

Diagnosis is still a problem with some diagnosticians still holding on to outdated concepts like Kanner's autism. Kanner's autism is very real but an extremely rare form of autism, and only a small minority of children meet the criteria for Kanner's autism. Fitzgerald et al. [1] showed that there were different prevalences of diagno-

1.There were 309 with a possible autism diagnosis, of which 285 (85%) met DSM

4.Two-hundred twenty (71%) met Kanner and Eisenberg's two criteria, and

This remains a problem, and it remains to be seen what the final diagnostic criteria for autism spectrum disorder will be. Currently, we use DSM 5 [2]. According to Baird et al. [3], about 25 per 10,000 met criteria for autism diagnosis based on
