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Journal of Autism and Developmental Disorders

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23-04-2021 | Commentary

Implications of Applying “Clinically Significant Impairment” to Autism Assessment: Commentary on Six Problems Encountered in Clinical Practice

Auteurs: Rachel Jellett, Joshua Muggleton

Gepubliceerd in: Journal of Autism and Developmental Disorders | Uitgave 3/2022

Abstract

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.

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There are mixed opinions on identity-first/person-first language use (Bury et al., 2020), though identity first is increasingly being advocated for (Kenny et al., 2016). Throughout this manuscript we use both and hope to respect broad preferences across the autism community.

We assume here that difficulties are internal: a descriptor which marks how well a person can do a particular task. Impairment we define something created when the effects of difficulties reach a point where they interfere with a person’s functioning.

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Titel: Implications of Applying “Clinically Significant Impairment” to Autism Assessment: Commentary on Six Problems Encountered in Clinical Practice
Auteurs: Rachel Jellett
Joshua Muggleton
Publicatiedatum: 23-04-2021
Uitgeverij: Springer US
Gepubliceerd in: Journal of Autism and Developmental Disorders / Uitgave 3/2022
Print ISSN: 0162-3257
Elektronisch ISSN: 1573-3432
DOI: https://doi.org/10.1007/s10803-021-04988-9

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