Annual research review: re-thinking the classification of autism spectrum disorders

Lord, Catherine; Jones, Rebecca M.

doi:10.1111/j.1469-7610.2012.02547.x

Cited by 290Autism Spectrum Disorder ResearchChild Nutrition and Feeding IssuesGenetics and Neurodevelopmental Disorders

Annual research review: re-thinking the classification of autism spectrum disorders

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Lord, Catherine, Jones, Rebecca M.·2012·Journal of Child Psychology and Psychiatry

DOI 10.1111/j.1469-7610.2012.02547.xPMC PMC3446247

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Abstract

Background: The nosology of autism spectrum disorders (ASD) is at a critical point in history as the field seeks to better define dimensions of social‐communication deficits and restricted/repetitive behaviors on an individual level for both clinical and neurobiological purposes. These different dimensions also suggest an increasing need for quantitative measures that accurately map their differences, independent of developmental factors such as age, language level and IQ. Method: Psychometric measures, clinical observation as well as genetic, neurobiological and physiological research from toddlers, children and adults with ASD are reviewed. Results: The question of how to conceptualize ASDs along dimensions versus categories is discussed within the nosology of autism and the proposed changes to the DSM‐5 and ICD‐11. Differences across development are incorporated into the new classification frameworks. Conclusions: It is crucial to balance the needs of clinical practice in ASD diagnostic systems, with neurobiologically based theories that address the associations between social‐communication and restricted/repetitive dimensions in individuals. Clarifying terminology, improving description of the core features of ASD and other dimensions that interact with them and providing more valid and reliable ways to quantify them, both for research and clinical purposes, will move forward both practice and science.

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Individuals with ASD with low nonverbal IQs, compared to those with greater cognitive abilities, show greater social-communication difficulties.
“More specifically, individuals with ASD with low nonverbal IQs, compared to those with greater cognitive abilities, show increased repetitive behaviors (Gabriels et al. 2005) and greater social–communication difficulties (Lord and Jones 2012).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Lord and Jones 2012
In “Other dimensions relevant to ASDs” (page not provided), the review says that individuals with greater general learning difficulties also have more specific social-communication difficulties. That supports the comparison by cognitive ability, but the passage does not establish it specifically for low nonverbal IQ. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Language ability has been linked to outcomes, such that individuals with minimal verbal abilities often show more severe ASD symptoms and greater intellectual impairment.
“Language ability has also been linked to outcomes, such that individuals with minimal verbal abilities often show more severe ASD symptoms (Lord and Jones 2012) and greater intellectual impairment (Luyster et al. 2008).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Lord and Jones 2012
In “Where should the dimension of language skill fit into classification of ASD?” (page unavailable), the review says language level affects ASD symptoms and that diagnostic features vary markedly with expressive language. It does not establish the more specific claim that minimally verbal individuals often have more severe ASD symptoms. The intellectual-impairment clause is attributed to Luyster et al., not to this source. (LLM, conf=0.82)
Experimental — accuracy not yet measured
The major rationale behind DSM-5 changes is to improve reliability.
“The major rationale behind these changes is to improve reliability [3].”
From Subgrouping the Autism Spectrum: Reflections on DSM-5 (2013) · cites this paper as [3]
The 'Psychometric issues in developing classification measures' section calls reliability a continued goal for diagnostic classifications. It does not identify improving reliability as the major rationale for the DSM-5 changes; the 'Limitations of new diagnostic systems' section instead describes increasing equity across existing ASD subcategories as an overall goal of the new criteria. Page numbers are unavailable in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Many argue that categorical and dimensional approaches are fluid, such that dimensions can become categories by defining thresholds, and categories can become dimensions by combining constructs to allow for common core features with accompanying variation.
“Many argue that categorical and dimensional approaches are fluid, such that dimensions can become categories by defining thresholds, and categories can become dimensions by combining constructs to allow for common core features with accompanying variation, as is seen in the transition from DSM-IV to DSM-5 (see Fig. 1; Pickles and Angold 2003; Lord and Jones 2012).”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Lord and Jones 2012
The relationship between IQ and symptom severity is unsurprising given that individuals with lower cognitive abilities likely possess fewer strategies to compensate for ASD-specific deficits.
“While the relationship between IQ and symptom severity is unsurprising given individuals with lower cognitive abilities likely possess fewer strategies to compensate for ASD-specific deficits (Lord and Jones 2012), it is important to consider these associations when disentangling the effects of ASD and IQ on phenotypic profiles.”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Lord and Jones 2012

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Self-citation
EDITORIAL Autism assessment tools in the transition from DSM-IV to DSM-5
Zuddas, A. (2013)

Authors: Lord, C., & Jones, R. M.
Affiliations: Weill Cornell Medicine (US)
ORCID: Lord, Catherine
Jones, Rebecca M.
Venue: Journal of Child Psychology and Psychiatry
Publisher: Wiley
Published: 2012-04-04
Volume: 53
Issue: 5
Pages: 490-509
ISSN: 0021-9630 (ISSN-L)
1469-7610
DOI: 10.1111/j.1469-7610.2012.02547.x
PMC: PMC3446247
OpenAlex: W2109246429
Cited by: 290
References: 182
Citations by year: 2026: 6 · 2025: 12 · 2024: 9 · 2023: 10 · 2022: 12 · 2021: 18 · 2020: 18 · 2019: 20 · 2018: 18 · 2017: 22 · 2016: 30 · 2015: 24 · 2014: 34 · 2013: 39 · 2012: 17
FWCI: 2.89
Type: journal article
Language: en
Open access: green
europepmc.org
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Journal of Child Psychology and Psychiatry (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5rc1mh089721-02)
U.S. Public Health Service (UA3-MC-1055)
National Institute of Mental Health (MH 081873, RC1 MH-089721, R01MH078165, MH 081757, MH 089721, R01MH081757, R01MH081873, MH078165)
Topics: Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetics and Neurodevelopmental Disorders
Keywords: autism spectrum disorder, disease classification, DSM-5, ICD-11, social communication deficits, restricted and repetitive behaviors, quantitative indicators, developmental differences, diagnostic criteria
MeSH terms: Adult, Child, Child Development Disorders, Pervasive, Child Psychiatry, Child, Preschool, Humans, Psychometrics, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders

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