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300 M. VLASSOPOULOS et al PSYCHIATRIKI 21 (4), 2010have been a result of more sophisticated diagnostictools, more experienced or specialized personnel ora much more sophisticated referral system, in theform of a more sensitized and aware school systemor community, who would be more capable of identifyingthese disorders.Although our results show that referrals fromschool (10% of the cases) or from the parents themselves(15% of the cases) did not change significantlyover time, there appeared to be an increasein non-medical referrals from one time period tothe next, which however was not statistically significantdue to the small sample. Consequently, itcould be argued that there is a tendency in the lastfew years for increased awareness of these issuesby parents, schools and other community members.Furthermore, there is an indication that parents aremore aware of children’s developmental milestones,since the children in Group B walked significantlyearlier than those in Group A, indicating that thoseparents were not appeased by this developmentalmilestone.Our second and third hypotheses were not confirmedby our data: the children in Group B werenot significantly younger at intake, nor did thesechildren have a higher level of functioning thanthose in Group A (table 3), something which wouldhave reflected a true increase in public awarenessof these issues. It is interesting to note that mostchildren from both groups are referred by theirpediatrician or other medical sources, which referchildren equally from all levels of functioning.Children who are referred by the school seem tohave a higher level of functioning and are older, butowing to the sample size, no significant differencewas found (table 4).Conversely, many of the parents came to ourService principally with the demand that their childwas “language delayed”, and not concerning thechild’s communication, behaviour or social skills. Tocompound this finding, a large number of families(40%) had already visited other services concerningtheir child’s problem and more than one familyin four (28%) discontinued their co-operation withour Service of their own accord, although this rate islower than that observed for the rest of the patientsattending our Service, which is at 45.7%. 19 It appearsthat many families are not able to accept the diagnosisof PDD easily, and at this relatively early stagein their child’s life, they are still unable to come toterms with the severity of their child’s problem. InGreece, the national medical system allows the patientto seek a second or even third medical opinionfrom various public medical services (CommunityHealth Centres, Paediatric Hospitals, etc.) or evenfrom private practitioners.In this study, family and environmental factors,which possibly contributed to the child’s disorder,were also investigated. Some researchers have suggestedthat prenatal and perinatal risk factors, aswell as adverse environmental factors, may contributenegatively to an already sensitive biochemicalmake-up, something which may partly explain therising frequency in these cases. 20,21 Furthermore,these children may have family histories of mentalillness, substance abuse and domestic violence. 22Table 4. Crosstabulation between level of functioning and referral source for children who are referrring by theschoolCount Referral Total1 2 3 4 5Level of functioning 2 1 3 3 73 1 5 2 10 184 3 5 8 165 3 1 4Total 5 16 1 5 18 451: Self-referral, 2: Paediatrician, 3: Community, 4: School, 5: Other services