Autism spectrum disorders: An historical synthesis and a multidimensional assessment toward a tailored therapeutic program

• An historical synthesis of autism spectrum disorders highlights the limits of the categorical approach.
• This is evident for borderline cases to which many different diagnostic categories can be applied.
• A multidimensional assessment enables the elaboration of a tailored therapeutic strategy.

Autism is a large group of disorders. From the first description in 1943 until know, attempts to propose nosological boundaries, through successive redefinitions of diagnostic criteria, have not succeeded in constraining the extensiveness nor in explaining the heterogeneity of autism. The failure of the categorical approach is revealed by several indices, including excessive comorbidity, the frequent use of Not Otherwise Specified categories and diagnostic uncertainty in borderline cases.Several proposals have been formulated to categorize subgroups of children with complex severe developmental disorders but less severe trajectories than typical autism. The diversity and overlap in their clinical expression emphasize the importance of using a multidimensional assessment inscribed in a developmental perspective. In this way, clinicians could encompass the issues of the categorical approach, address the child holistically and then achieve a functional diagnosis enabling the elaboration of a tailored therapeutic proposal.