Update on Diagnostic Classification in Autism
Update on Diagnostic Classification in Autism
Purpose of review In the lead up to and following the recent publication of the DSM-5, the diagnostic construct of autism has received intense scrutiny.
Recent findings This article briefly reviews the history of the diagnosis of autism, the changes that have occurred in the diagnosis over time, and the rationale for change. The most significant changes being introduced with the DSM-5 are highlighted, as well as some of the concerns that will be a focus of attention with respect to the potential impacts going forward.
Summary The categorical divisions that characterized the pervasive developmental disorders are now collapsed into a single entity, autism spectrum disorder. The final DSM-5 criteria have yet to be formally compared prospectively against prior criteria, but early indications suggest that the boundaries around the pervasive developmental disorders have not been substantially altered.
Dennis Cantwell, MD, was an icon in child and adolescent psychiatry who served on the original DSM-III task force. Among the widely quoted statements he often made regarding the development and application of psychiatric diagnoses was his observation that 'kids don't read the DSM'. The statement is a wonderful distillation of the experience of clinician scientists who have endeavored, as Mercier suggested over a century ago, to 'draw up an elaborate scheme of classes, orders, and genera' into which mental disorders might be classified (p. 284). 'Cases will always occur partaking pretty equally of the nature of two adjoining groups, and other cases will occur which exhibit at one time the features of one group, and at another time those of another'.
Against the seeming backdrop of difficulty, defining disorders in psychiatry in general and improving the approach for autism in particular has long been recognized as an important path, and should include not only understanding underlying disease processes, but diagnostic prognosis and effective treatment. The field continues to make progress in this regard, and the past year has been of particular significance with respect to diagnostic classification in autism.
Abstract and Introduction
Abstract
Purpose of review In the lead up to and following the recent publication of the DSM-5, the diagnostic construct of autism has received intense scrutiny.
Recent findings This article briefly reviews the history of the diagnosis of autism, the changes that have occurred in the diagnosis over time, and the rationale for change. The most significant changes being introduced with the DSM-5 are highlighted, as well as some of the concerns that will be a focus of attention with respect to the potential impacts going forward.
Summary The categorical divisions that characterized the pervasive developmental disorders are now collapsed into a single entity, autism spectrum disorder. The final DSM-5 criteria have yet to be formally compared prospectively against prior criteria, but early indications suggest that the boundaries around the pervasive developmental disorders have not been substantially altered.
Introduction
Dennis Cantwell, MD, was an icon in child and adolescent psychiatry who served on the original DSM-III task force. Among the widely quoted statements he often made regarding the development and application of psychiatric diagnoses was his observation that 'kids don't read the DSM'. The statement is a wonderful distillation of the experience of clinician scientists who have endeavored, as Mercier suggested over a century ago, to 'draw up an elaborate scheme of classes, orders, and genera' into which mental disorders might be classified (p. 284). 'Cases will always occur partaking pretty equally of the nature of two adjoining groups, and other cases will occur which exhibit at one time the features of one group, and at another time those of another'.
Against the seeming backdrop of difficulty, defining disorders in psychiatry in general and improving the approach for autism in particular has long been recognized as an important path, and should include not only understanding underlying disease processes, but diagnostic prognosis and effective treatment. The field continues to make progress in this regard, and the past year has been of particular significance with respect to diagnostic classification in autism.