Autism and autistic spectrum disorders in the context of new DSM-V classification, and clinical and epidemiological data

Abstract

Autism is one of disorders from the autism spectrum, besides Asperger syndrome, atypical autism and pervasive developmental disorder not otherwise specified. They are classified as mental disorders as being manifested by a wide range of cognitive, emotional and neurobehavioural abnormalities. Key categorical characteristics of the disorder are clear impairments of the development of the child?s socialisation, understanding and production of verbal and non-verbal communication and restricted and repetitive patterns of behaviour. Demarcation boundaries are not clear, neither within the very group of the disorders from the autistic spectrum, nor with respect to the autistic behavioural features in the general population. For this reason, the term spectrum points out the significance of the dimensional assessment of autistic disorders, which will most likely be the basis of the new diagnostic classification of the disorders belonging to the current group of pervasive developmental disorders in the new DSM-V classification. The understanding, as well as the prevalence of the autistic spectrum disorders has changed drastically in the last four decades. From the previous 4 per 10,000 people, today?s prevalence estimates range from 0.6 to around 1%, and the increase of prevalence cannot be explained solely by better recognition on the part of experts and parents or by wider diagnostic criteria. The general conclusion is that the autistic spectrum disorders are no longer rare conditions and that the approach aimed at acknowledging the warning that this is an urgent public health problem is completely justified.Autizam je jedan od poremecaja iz autisticnog spektra, pored Aspergerovog sindroma, atipicnog autizma i pervazivnog poremecaja koji nije drugde klasifikovan. Ovi poremecaji su svrstani medju mentalne poremecaje, jer se manifestuju kroz sirok spektar kognitivnih, emocionalnih i neurobihejvioralnih nenormalnosti. Kljucne kategorijalne odlike poremecaja su: jasno ostecenje razvoja socijalizacije deteta, razumevanja i produkovanja verbalne i neverbalne komunikacije, te ograniceni i ponavljani obrasci ponasanja. Demarkacione granice nisu jasne ni unutar same grupe poremecaja iz spektra autisticnog poremecaja, niti u odnosu na autisticne crte ponasanja u opstoj populaciji. Zbog toga termin ?spektar? ukazuje na znacaj dimenzionog sagledavanja autisticnih poremecaja, sto ce najverovatnije biti osnova i u novom dijagnostickom klasifikovanju poremecaja iz sadasnje grupe pervazivnih poremecaja razvoja u novoj klasifikaciji DSM-V (Diagnostic and Statistical Manual of Mental Disorders, peto izdanje) Americkog udruzenja psihijatara (American Psychiatric Association - APA). Razumevanje poremecaja iz autisticnog spektra, ali i prevalencija poremecaja, korenito su se menjali u poslednje cetiri decenije. Tako se predvidjanja prevalencije od cetiri obolela na 10.000 osoba danas krecu od 0,6% do oko 1%. Ovo povecanje prevalencije ne moze se objasniti iskljucivo boljim prepoznavanjem poremecaja od strane strucnjaka i roditelja, niti sirim dijagnostickim kriterijumima. Opsti je zakljucak da poremecaji iz autisticnog spektra vise nisu retka stanja i da je potpuno opravdan pristup usmeren ka prihvatanju upozorenja da je rec o hitnom problemu javnog zdravstva.