Ijichi Shinji, Ijichi Naomi, Ijichi Yukina, Hirotaki Kazumi, Sameshima Hisami, Kawaike Yoichi, Morioka Hirofumi
Health Service Center, Kagoshima University, 1-21-24 Korimoto, Kagoshima 890-8580, Japan ; Institute for Externalization of Gifts and Talents (EGT), 7421-1 Shimofukumoto-cho, Kagoshima 891-0144, Japan.
ISRN Neurol. 2013 May 8;2013:201719. doi: 10.1155/2013/201719. Print 2013.
In the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), autistic characteristics in social interaction and communication are described as qualitative impairments. However, the difference between autistics and nonautistics in the draft of the 5th edition (DSM-5 draft) is quantitative rather than qualitative. The word "qualitative" is deleted in the draft text, and it is specified that the relation between social demands and individual limited capacities is critical for symptom manifestation (criterion C). Because the proposed levels of support requirement in the draft are mere observable outcomes of social vulnerability, the boundary between level 1 and nonautistic condition is determined by the relation between social demands and individual capacities. In addition to the introduction of the single category (autism spectrum disorder (ASD)) to cover the entire case spectrum, the DSM-5 draft is clearly based on a conviction that ASD is indistinguishable from the normal behavioral range. This concise review provides an explanation for this implicit paradigm shift from qualitative to quantitative. Importantly, the conditional role of social demands for symptom manifestation in the draft can be plausibly interpreted using a unique liability-probability model.
在《精神疾病诊断与统计手册》第四版（DSM-IV）中，自闭症在社交互动和沟通方面的特征被描述为质性损害。然而，在第五版草案（DSM-5草案）中，自闭症患者与非自闭症患者之间的差异是量的而非质的。草案文本中删除了“质性”一词，并明确指出社会需求与个体有限能力之间的关系对症状表现至关重要（标准C）。由于草案中提出的支持需求水平仅仅是社会易损性的可观察结果，一级与非自闭症状态之间的界限由社会需求与个体能力之间的关系决定。除了引入单一类别（自闭症谱系障碍（ASD））以涵盖整个病例范围外，DSM-5草案显然基于一种信念，即ASD与正常行为范围无法区分。这篇简要综述为这种从质性到量性的隐性范式转变提供了解释。重要的是，草案中社会需求对症状表现的条件作用可以使用独特的易感性-概率模型进行合理的解释。
