Commentary on Autism Spectrum Disorder: Presentation and prevalence in a nationally representative Australian sample – Service implications

The Longitudinal Study of Australian Children (LSAC) is an important representative developmental project. The present report has utilized LSAC data in relation to Autism Spectrum Disorder (ASD) prevalence in two cohorts. Children recruited at kindergarten (K cohort) and at birth (B cohort), with 2-yearly waves of data. Cohort B was recruited at birth (0–1 years) in 2004–2005 and Cohort K at preschool, born in 1999–2000. It is of interest that the ASD prevalence of 2.5% for the B cohort was found to be higher than for the earlier born K Cohort of 1.5%. Children reported by parents to have been diagnosed with ASD were found to be experiencing more problems than their peers with socio-emotional behaviours, receptive vocabulary and non-verbal reasoning.

The authors point out that the Helping Children with Autism Package (HCWA) was launched by Department of Families Housing Community Services and Indigenous Affairs in 2008, providing up to US$12,000 for approved early intervention before turning 7  years. Children in the B Cohort were still under 6 years when the programme became available. While still not proven, this may have led to earlier diagnoses under the age of 6. Further follow-up of these cohorts is thus required. International studies vary in reports of percentages of children, identified by parents and teachers as having difficulties with peer relations and prosocial behaviour. The present authors query whether their own and other epidemiological studies may miss special types of communication difficulties in children with ASD. Certainly, at the more severe clinical end of the spectrum, severe communication and behaviour problems are common (Levy, 2007; Williams et al., 2008).

In terms of service provision, the apparent increase in ASD prevalence in a representative national sample underlines the need for increased training and service for this complex condition. In Australia, ASD services have been largely managed between Paediatric Developmental Services and Department of Aging, Disability and Home Care. On the other hand, there are increasing pressures on Child and Adolescent Psychiatry to provide services for the comorbid behaviour problems experienced by many ASD children. Yet at older developmental stages, an expansion of Child and Adolescent psychiatry into the mental health problems experienced by 18- to 25-year-olds is being discussed by some programmes. Given current manpower limitations, it is possible that a ‘generalist’ approach of being all things to all people could result, rather than the recognition of specialized skill sets required for early developmental, adolescent and early adult populations. For example, the pressures for adolescent crisis intervention tend to put downward pressure on pre-pubertal child services. The Australian experience differs from the United States and the United Kingdom where numbers of Child and Adolescent psychiatrists are much greater per child population levels. In Australia, early intervention and pre-pubertal psychiatric services stand to be disadvantaged by broader service pressures (Levy, 2014).

See Research by Randall et al., 50(3): 243–253.