Implications de l'application de l'« altération cliniquement significative » à l'évaluation de l'autisme : commentaire sur six problèmes rencontrés dans la pratique clinique

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

Cette publication est incluse dans le projet « Contributions académiques de personnes autistes sur l’autisme ». un auteur·ice de cette publication est identifié·e comme autiste dans le projet.

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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: 23/04/2021 Ajout dans AutiHub: 17/09/2026 Type: Article Langue de l’article: Anglais
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Auteurs

Auteur·ices des publications
2
Auteur·ices de la publication identifié·es comme autistes
1 / 2 (50,0 %)
  1. Rachel Jellett
  2. Joshua Muggleton *

Résumé

L'ajout d'une « altération cliniquement significative » (American Psychiatric Association, Diagnostic and statistical manual of mental disorders, Author, 2013) aux critères diagnostiques de l'autisme dans le DSM-5 vise à établir un seuil pour cette condition. Toutefois, la place accrue du paradigme de la neurodiversité et du modèle social du handicap va à l'encontre de l'idée selon laquelle les caractéristiques de l'autisme sont fondamentalement altérantes. Par conséquent, les critères diagnostiques de l'autisme deviennent de moins en moins alignés sur les conceptions contemporaines de « trouble » et de « handicap ». Dans ce commentaire, nous présentons six problèmes cliniques qui découlent de ce désalignement lors de l'évaluation diagnostique de l'autisme, ainsi que la tension que cela crée dans la prise de décisions diagnostiques. Nous concluons en examinant les façons dont le critère d'« altération cliniquement significative » pourrait être modifié, et les implications que cela aurait pour la pratique clinique et le concept d'autisme.

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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Références citées
94
Avec un DOI
83
Sans DOI, à partir du texte brut de la bibliographie
8
6 / 94 (6,4 %) références citées comprennent au moins une personne identifiée comme autiste.
Références avec données à compléter
10 / 94 (10,6 %)
Références avec noms d’auteurices détectés
89 / 94 (94,7 %)
Sans nom d’auteurice détecté
5
Sans titre structuré
9
Sans identifiant stable
8
Références avec noms bruts d’auteurices restant à vérifier
4
Références avec problème de récupération des métadonnées externes
0
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Noms d’auteurices détectés dans la bibliographie citée
343
À partir du DOI ou de métadonnées externes
343
À partir du texte brut validé de la bibliographie
0
Noms bruts déjà validés
0
Noms bruts restant à vérifier
4
155 / 343 (45,2 %) noms sont associés à un·e auteurice déjà présent·e dans AutiHub. 188 / 343 (54,8 %) noms ne sont pas encore associés.
Noms associés à une personne identifiée comme autiste
7 / 343 (2,0 %)
Calculé sur l’ensemble des noms d’auteurices détectés dans la bibliographie citée. Parmi les noms associés à un·e auteurice déjà présent·e dans AutiHub : 7 / 155 (4,5 %). Personnes distinctes identifiées comme autistes : 5 / 280 (1,8 %).
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