The Diagnostic and Statistical Manual (DSM-5) defines ASD by deficits in two core domains – social interaction and communication, and repetitive, restrictive behaviors – with onset during early development. This unification constitutes the first transition that needs to be considered from the scientific view point. The current categorization adds advantages, such as the availability of specifiers and the characterization of severity levels. But also, creates scientific shadows, such as classifying those without repetitive, restrictive behaviors as Social (Pragmatic) Communication Disorder; a distinction that may be adequate for homogeneity of research samples, but perhaps inadequate in fostering appropriate services for those cases in the community.

Although it has not been rule out that, in some parts of the world, there may be a real increase of new cases – due to parental age, for example, it is evident that cases of ASD are now much more frequently identified and diagnosed than before. Thus, for being an almost rare disorder, the 2015 Written Declaration on Autism by the European Parliament calls on the EU and its Member States to adopt a European Strategy for autism, including research and multinational prevalence studies, accurate detection and diagnosis, evidence-based treatment and support for all ages, and exchange of best practices. In consequence, research projects have been initiated and we expect to benefit by new data soon.

In some countries, citizens with ASD are showing now a different profile of what it used to be. This forecast the need for an adequate, if required, adaptation and transition of the services provided to this population. For example, in certain areas of Europe more and more people with ASD without intellectual disability are being currently diagnosed (cases previously described as Asperger Disorder). Or, in some countries the effort for early screening and growing social awareness are leading to very young children (in fact, babies) being diagnosed, and thus offering the chance for an informed early intervention.

Changes in classification systems, prevalence in the community, age of diagnosis, degree of associated or not intellectual disability, presence of comorbidities, individual evolution of symptomatology across development, as well as the quite diverse degree of local understanding and available services, generate marked differences in what is done in each country. Transition, across life for this population, and for all of us as service providers, remains an essential aspect to enforce.

Joaquin Fuentes, MD
ESCAP Autism Field Advisor
Chief of Child and Adolescent Psychiatry, Policlinica Gipuzkoa
Research Consultant (Pro bono), Gautena Autism Program
Donostia / San Sebastián, Spain