Early Symptomatic Syndromes Eliciting Neurodevelopmental Clinical Examinations

Copyright © 2013 Christopher Gillberg et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This special issue is devoted to the concept of ESSENCE (Early Symptomatic Syndromes Eliciting Neurodevelopmen-tal Clinical Examinations). It is an acronym that one of us coined some years ago [1] with a view to highlighting the clinical reality of children (and their parents) presenting in first, second, or third tier clinical settings with, usually complex , impairing developmental symptoms already in early childhood. The children are reported to have problems in the fields of (a) general development, (b) communication and language, (c) social interrelatedness, (d) motor coordination, (e) attention/ " listening, " (f) activity, (g) behavior, (h) mood, and/or (i) sleep. Children with major difficulties in one or more (usually several) of these fields will be seen by health vis-in the vast majority of cases they will be seen only by one of these specialists, when, in fact, they would have needed the input of two or more (occasionally even all) of the " experts " referred to. Categorical diagnosis is an integral part of everyday clinical and research practice. We are so insistent on the distinction between disorder and not disorder (normalcy) that clinics and clinicians become more and more specialized and cater to the needs of children with " Autism Spectrum Disorder/ASD only, " " Attention-Deficit/Hyperactivity Disorder/ADHD only, " " Language Disorder only, " " Reactive Attachment Disorder/RAD only, " or " Tourette syndrome only. " This has led to a situation in which the typical clinical diffuseness of disorder has come to be underestimated. At the same time, there is growing acceptance that coexistence of disorders and sharing of symptoms across disorders (so-called comorbidity, a misnomer if ever there was one, seeing as we are usually not dealing with completely separate coexisting disorders) are the rule rather than the exception (e.g., [2]). This was pointed out more than a quarter of a century ago [3], but, in clinical practice, this insight has not led to new approaches when trying to address the needs of children and families with " complex needs. " Instead, diversification has boomed. There are legislational, scientific, and clinical attempts to separate out children with certain disorders/diagnosis; for example, ASD from those who do not meet criteria …