![]() ![]() There have been concerns that the DSM-5 criteria may be more stringent than DSM-IV, such that some individuals who qualified for PDD will not meet the new ASD criteria. The DSM-5 field trial in North America has shown that ASD diagnosis has reasonable test-retest reliability, with an intraclass Kappa (a statistical measure of reliability) of 0.69 (95% CI 0.58–0.79). The major rationale behind these changes is to improve reliability. Finally, DSM-5 proposes a more inclusive age-of-onset criterion, recognizing that although symptoms should present in early childhood, they may not fully manifest until social demands exceed the capacity of the individual to cope with them. ![]() This means an individual can have ASD with or without a language disorder. DSM-5 characterizes ASD in two behavioral domains (difficulties in social communication and social interaction, and unusually restricted, repetitive behaviors and interests) and is accompanied by a severity scale to capture the “spectrum" nature of ASD.Īlso new in DSM-5, language development/level is treated as separate from ASD. New in DSM-5 is the explicit recognition of the “spectrum" nature of autism, subsuming and replacing the DSM-IV Pervasive Developmental Disorder (PDD) categorical subgroups of “autistic disorder," “Asperger's disorder," “pervasive developmental disorder not otherwise specified," and “childhood disintegrative disorder" into a single umbrella term “Autism Spectrum Disorder" (ASD). Here we reflect on what the revision may mean for research, and for understanding the nature of autism. Although this manual is primarily designed for creating a common language for clinical practice, it is also often used in research settings to define the conditions to be studied. While acknowledging concerns about issues such as diagnostic inflation and financial conflicts of interest, DSM-5 is now “set in stone" and will be published in May 2013. The two international psychiatric classification systems (the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases ) remain useful for making clinical diagnoses, but each time these classification systems are revised, the new definitions inevitably subtly change the nature of how the conditions are construed. The biology of autism cannot yet be used diagnostically, and so-like most psychiatric conditions-autism is defined by behavior. Quantitative Checklist for Autism in Toddlers SRS, ![]() US National Institute of Mental Health PDD, International Classification of Diseases NIMH, The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Ĭompeting interests: The authors have declared that no competing interests exist.Īutism Spectrum Screening Questionnaire BAP,ĭiagnostic and Statistical Manual of Mental Disorders ICD, Simon Baron-Cohen is supported by the Wellcome Trust ( ) and the Medical Research Council, UK. ![]() Bhismadev Chakrabarti is supported by the Medical Research Council, UK ( ). Lombardo is supported by the British Academy ( ) and Jesus College, Cambridge ( ). This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.įunding: Meng-Chuan Lai is supported by the Waterloo Foundation ( ), Wolfson College, Cambridge ( ), and the European Autism Interventions – A Multicentre Study for Developing New Medications (EU-AIMS, the research of EU-AIMS receives support from the Innovative Medicines Initiative Joint Undertaking under grant agreement n° 115300, resources of which are composed of financial contribution from the European Union's Seventh Framework Programme (FP7/2007–2013), from the EFPIA companies in kind contribution and from Autism Speaks). PLoS Biol 11(4):Īcademic Editor: Eric Nestler, Mount Sinai School of Medicine, United States of AmericaĬopyright: © 2013 Lai et al. Citation: Lai M-C, Lombardo MV, Chakrabarti B, Baron-Cohen S (2013) Subgrouping the Autism “Spectrum": Reflections on DSM-5. ![]()
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