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Background Estimates of the proportion of children with autism spectrum disorder (ASD) who are minimally verbal vary from 25%to 35%. However, there is a lack of consensus in defining minimally verbal and few detailed reports of communication outcomes for these children following intervention. The aim of this study was to explore how minimally verbal children have been defined and to document the proportion of minimally verbal children in a group of children with ASD receiving a community based early intervention programme. Method A longitudinal cohort design was used to examine the proportion of children who met criteria for minimally verbal in 246 children with ASD when they entered and exited an early intervention programme. Results Overall, 26.3% of the children in this study exited the programme using 'fewer than five spontaneous and functional words' and 36.4% exited not using 'two word phrases' as indicated by direct assessment. However, our findings were mixed depending on measures and definitions used, with parent report indicating that as many as 29.4% of children were not 'naming at least three objects' consistently, and 43.3% not using 'phrases with a noun and verb' consistently at exit. More than half of the children who entered the programme with minimal speech exited the programme with a similar language profile. A small percentage of children (1.2%-4.7%) regressed in their language level over time. Conclusions Despite advances in early intervention, and access to services at a younger age, around a quarter of individuals with ASD in this study exited early intervention with significant communication needs. Our findings are considered in relation to the literature and clinical implications, and future research directions are discussed. [ABSTRACT FROM AUTHOR]

Our conceptualisation of autism spectrum disorder has changed over time, with recent classifications reflecting a heterogeneous clinical presentation now regularly encountered in routine general paediatric practice. As the prevalence of autism and associated demands for services have increased so has research into understanding the cause and trials aimed at providing best care and intervention. However, the heterogeneity of autism has meant that no single aetiology can account for all differences in presentation, and not all children benefit from broad-based interventions. Now is the time to rethink how best to understand individual differences in order to focus research efforts and take steps towards more sophisticated strategies that go beyond the behaviours we look for when making an autism diagnosis. We suggest adopting a dimensional approach to autism assessment, with the consideration of eight spectrums of abilities, ways of thinking and behaviour. This eight-spectrum approach will assist clinicians to consider each individual's strengths and needs and personalise interventions and support accordingly. Profiling individual skills across these dimensions may also provide researchers with a greater capacity to link causal pathways with specific phenotypes, which is needed to develop precision medicine for autism., (© 2018 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: General practitioners are concerned with improving the health of the community, and Divisions are an important structure through which this can be achieved. Any focus on health outcomes needs to consider what general practice and Divisions can do to reduce inequalities in health outcomes., Method: We analysed 2000-2002 strategic and business plans from 78% of Divisions in NSW and Victoria, to see how Divisions were developing capacity to address health inequalities in the community through appropriate needs assessments, allocation of resources and partnership approaches., Results: Thirty percent of Divisions discussed socioeconomic barriers to people accessing health care within their community. None used equity as a needs priority. Thirty percent specifically committed resources through programs for disadvantaged groups. Thirty-six percent used partnership approaches to improve access, although only 11% used a broad advocacy role., Discussions: Divisions see socioeconomic disadvantage as an important issue, and some are developing significant multilevel strategies to address them, although significant gaps exist in the capacity of Divisions to undertake this work.