Autism Plus Versus Autism Pure

The reported prevalence of autism is going up and up. We propose that some—even much—of the increase in the rate of autism spectrum disorder (ASD) is driven by “Autism Plus”. Autism Plus refers to autism with comorbidities (including intellectual developmental disorder, language disorder, and attention-deficit/hyperactivity disorder), and this is what is now being diagnosed by clinicians as ASD. In clinical practice, a diagnosis of ASD much more often entails that the child will receive support at school and in the community, which is not the case for other diagnoses. In the past the comorbidities were given diagnostic priority and the “autistic features” might, or might not be mentioned as the “plus bit” in the diagnostic summary. It is high time that the comorbidities, sometimes even more important than the autism, came back on the diagnostic agenda. Autism is but one of the Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examination (ESSENCE), not the one and only.