![]() Diagnosis of autism from Kanner to DSM-IV We begin with a short review of the history of diagnostic approaches, the rational for the DSM-5 model, and a discussion of its uses and limitations. This paper reviews recent developments in the diagnosis of autism in Diagnostic and Statistical Manual, fifth edition (DSM-5). Other differences include issues of comorbidity, impairment requirements, and implications for service eligibility. Probably the major difference between ICD-10 and DSM-IV is the provision in ICD-10 of separate guidelines for research and clinical work while DSM-IV provides one set of guidelines for both purposes. Various interests must be balanced in designing official systems for example, reliability and ease of use, differentiation of categories, and consideration of developmental issues. Since the alignment of diagnostic criteria of DSM-IV and ICD-10, there has been an explosion of research – with well over 2,000 peer-reviewed scientific papers published last year, an increase from fewer than 2,000 peer-reviewed papers published in the decade before DSM-IV/ICD-10, highlighting the utility of such an alignment. 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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