Furthermore, the applicability of items and concepts taken out of context and without formal training in the assessment processes from which the items are derived may create some significant issues. This approach, while both cost efficient and research focused, comes at the potential price of some loss of “ecological validity.” In other words, in real-world settings, clinicians do not have the time to take weeks of training on a panoply of research instruments. The use of such instruments for research is well known, and often, as in autism, these have been explicitly “keyed” to categorical diagnostic criteria. A second shift in the DSM-5 has been the focus on the use of relevant dimensional and other assessment instruments. Historically, DSM has been used for both research and clinical purposes this differs from the current ICD-10 approach, which has separate manuals for research and clinical work. This decision, understandable particularly from the point of view of more specific and research-based criteria sets, also poses some practical challenges for DSM-5. One is the elimination of “subthreshold” categories, such as pervasive developmental disorder not otherwise specified (PDD-NOS), throughout the manual. Before discussing the specific changes, it is important to note 2 overarching conceptual shifts in DSM-5.
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