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Brief Report: DSM-5 “Levels of Support:” A Comment on Discrepant Conceptualizations of Severity in ASD


Proposed DSM-5 revisions to the diagnosis of autism spectrum disorder (ASD) include a “severity” marker based on degree of impairment. Although qualitative differences between support levels are described, quantitative methods or practice recommendations for differentiating between levels remain undetermined. This leaves the field vulnerable to potential discrepancies between severity categorizations that may have inadvertent service implications. We examined overlap between mild, moderate, and severe impairment classifications based on autism symptoms, cognitive skills, and adaptive functioning in 726 participants (15 months—17 years) with ASD. Participants with mild, moderate, and severe autism symptoms demonstrated varying levels of adaptive and cognitive impairment. These discrepancies highlight the need for a clearly elucidated method of classifying level of support in ASD diagnosis.

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This study was supported by a Grant from the Vanderbilt Kennedy Center and the Marino Autism Research Institute. This includes core support from NCRR/NIH (UL1 RR024975-01), NICHD (P30HD15052), and NIMH (T32-MH18921). We gratefully acknowledge the contribution of the parents and children who took part in this study and the support of the clinical research staff of the Vanderbilt Kennedy Center Treatment and Research Institute for Autism Spectrum Disorders.

Conflict of interest

Katherine O. Gotham receives royalties for the Autism Diagnostic Observation Schedule, 2nd edition; all royalties from clinics and projects in which she is involved are donated to charity.

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Correspondence to Amy S. Weitlauf.

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Weitlauf, A.S., Gotham, K.O., Vehorn, A.C. et al. Brief Report: DSM-5 “Levels of Support:” A Comment on Discrepant Conceptualizations of Severity in ASD. J Autism Dev Disord 44, 471–476 (2014).

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