Jellett Rachel, Muggleton Joshua
Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia.
Clinical Psychologist for NHS Fife, Lynebank Hospital, Halbeath Road, Dunfermline, Fife, KY11 4UW, Scotland.
J Autism Dev Disord. 2022 Mar;52(3):1412-1421. doi: 10.1007/s10803-021-04988-9. Epub 2021 Apr 23.
The addition of 'clinically significant impairment' (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, Author, 2013) to the diagnostic criteria for autism in DSM-5 attempts to establish a threshold for the condition. However, the increased prominence of the neurodiversity paradigm and social model of disability runs counter to the idea that characteristics of autism are fundamentally impairing. Consequently, diagnostic criteria for autism are becoming misaligned with the contemporary views of 'disorder' and 'disability'. In this commentary, we outline six clinical issues that arise from this misalignment during diagnostic assessment for autism, and the tension this creates in making diagnostic decisions. We conclude by considering ways the 'clinically significant impairment' criterion could be changed, and the implications this would have on clinical practice, and the concept of autism.
在《精神疾病诊断与统计手册》第五版（DSM - 5）中，将“临床上显著的损害”（美国精神病学协会，《精神疾病诊断与统计手册》，作者，2013年）纳入自闭症诊断标准，试图为该病症设定一个阈值。然而，神经多样性范式和残疾社会模型日益凸显，这与自闭症特征从根本上具有损害性的观点背道而驰。因此，自闭症的诊断标准正与当代对“障碍”和“残疾”的看法脱节。在这篇评论中，我们概述了自闭症诊断评估过程中因这种脱节而产生的六个临床问题，以及这在做出诊断决策时所造成的紧张局面。我们通过思考“临床上显著的损害”标准可以如何改变，以及这将对临床实践和自闭症概念产生的影响来得出结论。
