Before autism was first recognized officially by the Diagnostic and Statistical Manual, third edition (DSM-III) in 1980, it was very difficult to be sure of the comparability of samples this hindered the ability to synthesize findings across studies and hampered research. Official diagnostic systems, such as the World Health Organization’s International Classification of Diseases (ICD-10) and the American Psychiatric Associations Diagnostic and Statistical Manual, fourth edition (DSM-IV), have usually been oriented around specific categories but have increasingly also included dimensional approaches to provide better characterization. As Rutter and Schopler noted, there is not a single, simple, right way to approach this task and, for psychiatric and developmental disorders, a range of approaches have been developed. For DSM-5, the impact of these changes remains unclear.Ĭommonality in approaches to classification help us communicate more effectively about clinical problems (rapidly conveying a general sense of the kinds of difficulties exhibited) and conduct better research by insuring comparability of samples across sites and countries. Significant discontinuities in diagnostic practice raise significant problems for both research and clinical services. The impact is probably greatest among the most cognitively able cases and those with less classic autism presentations. The overall efficiency of this system falls if only one source of information is available and, particularly, if the criteria are used outside the research context. If research diagnostic instruments are available, many (but not all) cases with a DSM-IV diagnosis of autism continue to have this diagnosis. The various relevant studies are summarized. The advent of changes in DSM-5 presents some important moves forward as well as some potential challenges. Since the Fourth edition of the Diagnostic and Statistical Manual (DSM-IV) appeared in 1994 there has been an explosion in research publications. Since Kanner’s first description of autism there have been a number of changes in approaches to diagnosis with certain key continuities.
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