Upcoming changes to autism spectrum disorder: evaluating DSM-5

摘要

What is autism spectrum disorder (ASD) ? The most candid answer to this question is: 'we do not know - yet'. 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. To date, this work has not yielded a consensus; autism is an enigma that has thus far stubbornly resisted description, let alone explanation. This presents a practical and theoretical problem. We do not know what ASD actually is and we cannot observe or assess it directly. Nevertheless, in order to understand and help people with ASD, clinicians, researchers, educationalists and other stakeholders need to be able to identify the disorder. This bind is not unique to ASD. In fact, it is almost universal to the study and treatment of psychopathology. The best solution to the problem posed by the lack of a biomarker for ASD is to make educated guesses about how it manifests. These educated guesses, written down in the DSM and the International Classification of Disease, are called diagnostic criteria. As such, diagnostic criteria for ASD are a sort of working hypothesis, that a particular cluster of symptoms signifies the presence of the disorder. Like all hypotheses, diagnostic criteria need to be tested against data and modified accordingly.