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Changes to Autism Diagnosis: Benefits and Challenges Ahead

The new edition of the widely used manual in psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), will be published in May 2013. In the latest issue of PLoS Biology, researchers at the Autism Research Centre comment on the changes and implications to autism, now defined using the umbrella term “Autism Spectrum Disorder” (ASD).

“Highlighting the dimensional nature of autism, and improving the organization of symptom descriptions, are excellent features of the new manual,” said Dr. Meng-Chuan Lai, lead author of the commentary. He added that this unitary diagnostic label, together with an individualized assessment of needs for support, an important new feature, will be potentially beneficial in securing required levels of support for individuals with a diagnosis of ASD.

Dr. Michael Lombardo, a co-author on the commentary, expressed the team’s reservations about the impact of such revision may have on autism research. “Autism is extremely heterogeneous and is expressed differently in different individuals. While going back to one omnibus label of ‘ASD’ is beneficial in many ways, it may not be the best prescription for how research into causal factors should proceed. Understanding the driving factors behind the massive heterogeneity in autism requires a way of thinking for future research that goes beyond just one omnibus label.”

Professor Simon Baron-Cohen, Director of the Autism Research Centre and another co-author, agreed: “To make progress in autism research, and ultimately to improve clinical practice, we need to move forward to the identification of subgroups within the autism spectrum.”

The authors argue that potential subgroups may be identified by a more extensive use of “specifiers”, such as different developmental patterns, different cognitive profiles, different genetic and environmental correlates, different co-occurring conditions, and even the differences arising from sex/gender. They suggest that all of these could aid subgrouping. They also argue that some clinical subgroups previously recognized, such as Asperger Syndrome, are still valuable categories that need further research.

Dr. Bhismadev Chakrabarti, the other author of this commentary underlined the key message: “In a world that is moving toward individualized treatment, the identification of specific subgroups is a vital step forwards.”

The authors were supported by the following funding agencies during the period of this work: the European Autism Interventions – A Multicentre Study for Developing New Medications (EU-AIMS consortium), the Medical Research Council, the Wellcome Trust, the Waterloo Foundation, the British Academy, the NIHR CLAHRC for Cambridgeshire and Peterborough NHS Foundation Trust and the Autism Research Trust.

Adapted from article by Amber Ruigrok for Department of Psychiatry News

 

Posted on 20/05/2013

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