4/2/2024 0 Comments Dsm 5 asd dx![]() Subsequent to the publication of DSM-IV, the accrual of large data sets collected using standardized measures, and advances in computing that have made multivariate statistical techniques increasingly accessible, have allowed for the DSM-IV model of autistic symptoms to be tested empirically. This decision to merge the social and communication domains of the autism triad is well founded, and is a genuine example of diagnostic criteria being modified for strong scientific reasons. The architects of DSM-5 have chosen to do away with the venerable autistic triad, and to replace it with a dyad, comprising 'social-communication' and RRSB symptom dimensions. In DSM-IV these symptom clusters were called 'impairments in social interaction', 'impairments in communication' and 'restricted, repetitive and stereotyped behavior' (RRSB). The pioneering work of Wing, Gould and Rutter resulted in a longstanding and widely accepted notion about ASD: that it manifests as a triad of related but distinct impairments. In this editorial, I seek to describe and evaluate four key changes to diagnostic criteria, and to offer some thoughts on their likely implications. In the move from the fourth to the fifth edition of the DSM there has been a profound shift in the conceptualization of ASD that will have ramifications for research and clinical practice. With the publication of DSM-5 in May this year, the international consensus about how ASD manifests, and how it can be identified, has been rewritten. Like all hypotheses, diagnostic criteria need to be tested against data and modified accordingly. As such, diagnostic criteria for ASD are a sort of working hypothesis, that a particular cluster of symptoms signifies the presence of the disorder. These educated guesses, written down in the DSM and the International Classification of Disease, are called diagnostic criteria. The best solution to the problem posed by the lack of a biomarker for ASD is to make educated guesses about how it manifests. In fact, it is almost universal to the study and treatment of psychopathology. Nevertheless, in order to understand and help people with ASD, clinicians, researchers, educationalists and other stakeholders need to be able to identify the disorder. We do not know what ASD actually is and we cannot observe or assess it directly. This presents a practical and theoretical problem. To date, this work has not yielded a consensus autism is an enigma that has thus far stubbornly resisted description, let alone explanation. An extensive research endeavor is underway to identify the ASD 'disease entity' or biomarker: the underlying abnormalities of brain development, structure and function that constitute the disorder itself. What is autism spectrum disorder (ASD)? The most candid answer to this question is: 'we do not know - yet'.
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