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

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Jellett, R. & Muggleton, J. (2021). Implications of Applying “Clinically Significant Impairment” to Autism Assessment: Commentary on Six Problems Encountered in Clinical Practice. Journal of Autism and Developmental Disorders, 52(3), 1412-1421. https://doi.org/10.1007/s10803-021-04988-9

Publication date: 23 Apr 2021 Added to AutiHub: 17 Sep 2026 Type: Article Article language: English
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Authors

Publication authors
2
Publication authors identified as autistic
1 / 2 (50.0%)
  1. Rachel Jellett
  2. Joshua Muggleton *

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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Cited references
94
With a DOI
83
Without a DOI, from raw bibliography text
8
6 / 94 (6.4%) cited references include at least one author identified as autistic.
References with data to complete
10 / 94 (10.6%)
References with detected author names
89 / 94 (94.7%)
Without detected author names
5
Without a structured title
9
Without a stable identifier
8
References with raw author names still to review
4
References with external metadata lookup issues
0
These indicators apply to cited references displayed on this page, after technical duplicates have been merged. A reference without a DOI can still support author statistics when a title and author names are available.
Author names detected in the cited bibliography
343
From DOI or external metadata
343
From validated raw bibliography text
0
Raw names already validated
0
Raw names still to review
4
155 / 343 (45.2%) names are linked to an author already present in AutiHub. 188 / 343 (54.8%) names are not yet linked.
Names linked to a person identified as autistic
7 / 343 (2.0%)
Calculated across all author names detected in the cited bibliography. Among names linked to an author already present in AutiHub: 7 / 155 (4.5%). Distinct people identified as autistic: 5 / 280 (1.8%).
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