Actualmente la terminología de TEA, aunque no existe como término clasificatorio dentro de los manuales DSM-IV o CIE-10, hace referencia a los Trastornos Generalizados del Desarrollo (TGD), llegando el primero a utilizarse más ampliamente por la flexibilidad dimensional que el concepto TEA ofrece.
El concepto de TEA puede entenderse como un abanico gradual de síntomas, un “continuo” donde en un extremo está el desarrollo totalmente normal y en otro aquellos trastornos generalizados del desarrollo más graves.
Este término representa un avance más pragmático que teórico, e implica una valoración pormenorizada de todas las capacidades y déficits de los niños, con lo que ayuda a definir sus necesidades de apoyo y operativiza el plan de tratamiento individualizado.
Además el uso del término “generalizado” puede resultar confuso o ambiguo, pues implicaría una afectación en todos los aspectos del desarrollo, lo cual no es correcto, ya que algunas personas con autismo tienen un desarrollo ordinario en algunas áreas y afectado en otras.
El grupo elaborador recomienda fundamentalmente el uso de la clasificación CIE-10 (OMS) y/o DSM-IV-TR (American Pschiatric Association) para estos trastorno. A continuación se presenta una tabla (Tabla 4) de comparación de estas clasificaciones diagnósticas:
- COMPARACION DE CLASIFICACIONES DIAGNOSTICAS CIE-10 Y DSM-IV-TRR
Siguiendo la clasificación diagnóstica del DSM-IV-TR se identifican cinco tipos de trastornos en los TGD:
- Trastorno autista, autismo infantil o Síndrome de Kanner123. Manifestaciones en mayor o menor grado de las tres áreas principales descritas anteriormente.
- Trastorno de Asperger o Síndrome de Asperger. Incapacidad para establecer relaciones sociales adecuadas a su edad de desarrollo, junto con una rigidez mental y comportamental. Se diferencia del trastorno autista porque presenta un desarrollo lingüístico aparentemente normal y sin existencia de discapacidad intelectual.
- Trastorno de Rett o Síndrome de Rett. Se diferencia en que sólo se da en niñas e implica una rápida regresión motora y de la conducta antes de los 4 años (con estereotipias características como la de “lavarse las manos”). Aparece en baja frecuencia con respecto a los anteriores. Este trastorno está asociado a una discapacidad intelectual grave. Está causado por mutaciones en el gen MECP2124.
- Trastorno desintegrativo infantil o Síndrome de Heller. Es un trastorno muy poco frecuente en el que después de un desarrollo inicial normal se desencadena, tras los 2 años y antes de los 10 años, una pérdida de las habilidades adquiridas anteriormente. Lo más característico es que desaparezcan las habilidades adquiridas en casi todas las áreas. Suele ir asociado a discapacidad intelectual grave y a un incremento de alteraciones en el EEG y trastornos convulsivos. Se sospecha por tanto que es resultado de una lesión del sistema nervioso central no identificada.
- Trastorno generalizado del desarrollo no especificado. Agrupa todos los casos en los que no coinciden claramente con los cuadros anteriores, o bien se presentan de forma incompleta o inapropiada los síntomas de autismo en cuanto a edad de inicio o existencia de sintomatología subliminal.
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