Quantitative Nature of Social Vulnerability and Autism: An Important Paradigm Shift in the DSM-5 for Autism Spectrum Disorder

Abstract

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.

Risk Factors for Depression in Children and Adolescents with High Functioning Autism Spectrum Disorders

“…Estimates on prevalence of comorbid depression vary widely among studies. In the next few years we will be able to assess the empirical effects of the new conceptual framework for ASD resulting from the DSM-5 criteria [ 38 ] in the general context of the epidemiology of depression in ASD.…”

“…The involvement of genetic factors is evident from the results of a twin study, while many gene variants that seem to affect brain development and synaptic functions have been reported in association with ASD [ 38 , 83 ].…”

The Origin of Population Diversity: Stochastic Interactions between a Modifier Variant and the Individual Genetic Background

“…In spite of the stochastic manner of the stochastic epistasis, the repeated purge of the same non-fittest extremes may be another process of evolutionary trends in which the phenotypic mean value can be passively changed [67]. In a liability-probability model, the non-fittest extreme tail possesses extremely low fecundity and the fecundity is continuously and sharply recovered at the majority of the bell-shaped population [73]. Both the active directional trend by de novo epistatic modifiers and the passive directional trend by repeated purge of the non-fittest tail may affect the position of the distribution in the nonlinear relation to fecundity probability, especially through a population bottleneck or reproductive isolation of a smaller population.…”

The New DSM-5 Impairment Criterion: A Challenge to Early Autism Spectrum Disorder Diagnosis?

“…Consistent with its general conceptualization of mental disorders, DSM-5 has introduced an additional explicit impairment criterion for ASD: Criterion D. ''Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning'' (p. 50), to ensure that only clinically relevant phenotypes are diagnosed (Ijichi et al 2013). In DSM-IV/-TR (APA 2000), only Asperger's Disorder comprised such a criterion, although many clinicians might have implicitly assumed that the same applied for Autistic Disorder and Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS).…”