Editorial Preface

This issue of the Journal of Autism and Developmental Disorders contains 12 articles on a diversity of topics. The first paper by Ventola and colleagues addresses the critical issue of what tool to use to make a diagnosis of autism in the second year of life, the optimal time for initiating early intervention. This study compared “Agreement among four diagnostic instruments for autism spectrum disorders in toddlers”. The four instruments were the Autism Diagnostic Observation Schedule-G (ADOS-G), the Autism Diagnostic Interview-Revised (ADI-R), the Childhood Autism Rating Scale (CARS), and clinical judgment using DSM-IV criteria for autistic disorder or pervasive developmental disorder not otherwise specified applied to toddlers. The study evaluated 45 children between 16 and 30 months who had failed the Modified Checklist for Autism in Toddlers (M-CHAT). Of the 45 children, expert clinical judgment assessed 27 to have autistic disorder, 9 PDDNOS and 9 without ASD. By comparison, the ADOS diagnosed 30 with autism, 8 with PDDNOS and 7 as non-spectrum. The CARS diagnosed 32 as having autism; not autism was the only other diagnosis possible with this instrument. The ADI-R diagnosed 22 as having autism, significantly under-diagnosing toddlers because of the requirement for repetitive behavior, which had not yet emerged; 23 were classified as not having autism. Though there was high agreement between the ADOS and CARS on the diagnosis of autism, the absence of a spectrum diagnosis with the CARS makes this less desirable as a diagnostic instrument. The ADOS requires more skill and training than the CARS but the number of affected children with ASD, the cost of services, and the cost of not treating affected children demands the most effective diagnostic instrument available. The ADOS, though, will only be as effective as the innate skills and autism experience of the individual chosen to receive the training and the frequency of its use following training and of the reliability methods employed following training. Finally, it is worth emphasizing that these children got to early diagnosis because of the use of an autism-specific early screening tool- the M-CHAT. Without this, their diagnosis might well have been delayed to the usual 4–5 years of age that is common. …