Editorial: Secondary vs. Idiopathic Autism

Secondary vs. Idiopathic AutismThis Research Topic consists of four articles, contributed by 30 authors, each focusing on various aspects of secondary autism spectrum disorder (ASD).The articles in this Research Topic discuss some of the controversies and progress made in how to assess a child with secondary ASD.They discuss the utility of using genetic and metabolic tests, as well as combinations of the same.They also grapple with the relationship of intellectual disability (ID) and other symptoms in patients with secondary ASD.The diagnostic boundaries of the behavioral phenotype that define ASD are fairly broad due to the large variability that is observed in symptom types, onset, and severity.This variability serves as an index of etiological heterogeneity for a group of complex conditions where multiple genetic/ environmental hits provide an additive burden to symptom expression.Within this spectrum of disorders our Research Topic examines a subpopulation of patients where the ASD phenotype occurs and a specific cause can be identified (1).These cases are often referred to as "secondary" ASD as a way of distinguishing them from "idiopathic" ASD.While there is some variation of the estimates, about 85% of individuals with ASD are termed as having idiopathic ASD with about 15% diagnosed with secondary ASD (2).Cases of secondary ASD display significant etiological diversity and, sometimes, more severe behavioral problems than individuals having idiopathic ASD (3, 4).Well documented causes of secondary ASD include conditions such as tuberous sclerosis, down syndrome, Fragile X syndrome (FXS), and some congenital infections (e.g., cytomegalovirus) (5-7).Differentiating between idiopathic and secondary ASD is essential when drawing conclusions regarding pharmacological and behavioral treatments among published studies (8).Clinical study design benefits from the selection of homogeneous populations, those without prognostically distinct subgroups, as it makes it easier to assess treatment efficacy (vide infra, (9)].Indeed, a thorough understanding of the different clinical presentations, natural history and even life expectancies of persons with ASD should go beyond the influence of traditional variables and use relevant classifiers of biomedical and sociocultural differences that may have an impact on the health and wellbeing of the studied subject population.Genomic scanning is beginning to elucidate the underlying genetic architecture that confers ASD susceptibility.Chromosomal and penetrant gene abnormalities are common, contributing to about 5%-15% of ASD cases in some estimates (10).By way of contrast, de novo chromosomal copy number variants, important contributors to lower IQ, and diminished motor skills (11), are seen in

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