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Relatively independent of the existing diagnostic systems, for the last 30 years or so, hope for understanding autism has lain in genetic and neurobiological approaches that might identify or lead to clear etiologies. Nevertheless, the urge to consider psychiatric and psychological disorders as “diseases” remains extremely powerful ( Hyman, 2010), perhaps assuming that conceptualizing psychiatric disorders as diseases means that there will be simple etiologies and pathophysiologies that can be used to treat, cure and/or prevent them. Because a high proportion of health concerns in many countries are associated with chronic conditions and complex interactions among genetic and environmental factors, rather than infectious diseases, there is increased insistence that other branches of modern medicine do the same. However, conceptualizations of psychiatric and psychological disorders moved beyond this model many years ago ( Susser, Brown, & Matte, 1999). Concepts of disease have been an underpinning of modern medicine since the late 1880s, with the expectation that disease can be prevented or if contracted, treated and cured ( Stewart & Devlin, 2006 Sykes, 2001). Issues in classification: diseases or disorders?Įxisting diagnostic frameworks for ASD (American Psychiatric Organization, 1992 2000) occur within classification systems for diseases, defined as an abnormal condition or risk for which there is a known etiology or pathophysiology ( Hyman, 2010 Kraemer, 2008). Finally, we come back to questions of classification, description and measurement in terms of clinical needs and links to neurobiological research. Third, specific changes proposed in DSM-5 and ICD-11are outlined. Second are sections that discuss the core dimensions that underlie a category of autism spectrum disorders. This includes differences between concepts of disease and disorder, as well as diagnosis, and the role of dimensions as a useful construct for clinical purposes and for neuroscience. First, challenges to existing (DSM-IV ICD-10) ASD classifications are discussed starting with general issues in the diagnosis of psychiatric and psychological disorders. The review is organized in four sections.
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Full descriptions of these new systems from their respective entities will be available when they are published. The focus of this review is on issues related to diagnostic classifications in ASD, including a selective discussion of how these issues may be addressed in the proposed new classification frameworks. Now is a time to consider some of the challenges we face in the nosology of ASD. As we move into new editions of the major frameworks for diagnosing autism, the Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association (2012) and the International Classification of Diseases (ICD-11) of the World Health Organization (2012 see also Rutter, 2011), proposals for classifications of autism and related disorders (referred to interchangeably as autism, autism spectrum disorders or ASD) are well underway but not finalized.