Profile, Controversial Issues, Gender and Co-Morbidity in Autism

**3**

**Chapter 1**

*Michael Fitzgerald*

**1. Introduction**

**2.1 Validity**

research in this area.

Introductory Chapter:

Controversial Issues in

research in psychiatry. The medical model will not suffice.

**2. Heterogeneous issues in autism**

**2.2 Screening and diagnosis in autism**

Autism - Research and Practice

The major reason why there are so many controversial issues in autism is because it is such a heterogeneous condition. There are no sub-types of autism at this time, despite almost fifty years of searching for them. This quest continues but there is doubt whether it will succeed. There are no diagnostic biomarkers in autism or indeed, in psychiatry as a whole. This in a way, is what distinguishes psychiatric diagnoses from medical diagnoses like diabetes. Of course, there are many conditions associated with autism like tuberous sclerosis, but that is quite a different matter to having a biomarker specifically for autism. There is also a great deal of heterogeneity in relation to aetiological factors. There are a large amount of genes involved of small effect, associated with autism and the number is continually increasing, but there is no specific pattern of genetic findings for autism and unlikely to be again because of heterogeneity. We need new research paradigms for

Validity is probably the biggest problem in psychological and psychiatric research on autism. Validity of diagnostic categories is probably the weakest link in

Charman and Gotham [1] state that, 'we're limited by the lack of a true test for autism spectrum disorder'. the same goes for screening instruments. One of the most widely used screening incidents, the M-CHAT [2] (modified checklist) according to Peter Hess [3], 'misses a majority of autistic children at eighteen months, and this failure was particularly in those with average IQ'. Hackethal [4] stated that the M-CHAT, 'misses the majority of children with ASD'. In terms of diagnostic instruments for autism, Charman and Gotham [1] state correctly that, 'expensive ASD-specific diagnostic instruments will not always be appropriate'. Indeed, NICE [5] recommend no specific instrument for clinical diagnosis and state that clinical diagnosis of autism should be done by a clinical expert in autism, which usually will mean a psychiatrist, psychologist or specialist paediatrician. Charman and Gotham [1] state that, 'professionals must be realistic about
