Classification of behaviorally defined disorders: biology versus the DSM.
DSM labels are behavior-only; adding biology could give quicker, cleaner diagnoses and better treatment matches.
01Research in Context
What this study did
Rapin (2014) wrote a position paper, not an experiment.
She argues that the DSM-5 lists behaviors to define autism, ADHD, and other disorders.
She says we should add biology—genes, brain circuits, and lab tests—to make faster, sharper diagnoses.
What they found
The paper finds the DSM too slow and too vague.
It claims the NIMH RDoC matrix can glue behavior to biology and speed up new treatments.
How this fits with other research
Iversen et al. (2021) backs her up. Their meta-analysis shows executive-function scores line up with repetitive behaviors in autism. This gives one clear biology-behavior link Isabelle wants.
Erickson et al. (2016) also fits. Brain scans reveal local wiring differences in autistic kids that match symptom severity. This is the kind of biomarker Isabelle asks for.
Marshall et al. (2023) seems to clash. Their survey shows many BCBAs still pick treatments from old DSM labels, not biology. The gap is real, but it doesn’t refute Isabelle—it shows the field just hasn’t caught up.
Why it matters
You still write goals from DSM labels. Isabelle urges you to watch for bio-behavior data that could refine those labels. Start noting executive-function or sensory profiles alongside your standard assessments. These extra slices could explain why similar-looking kids need very different teaching plans.
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02At a glance
03Original abstract
Three levels of investigation underlie all biologically based attempts at classification of behaviorally defined developmental and psychiatric disorders: Level A, pseudo-categorical classification of mostly dimensional descriptions of behaviors and their disorders included in the 2013 American Psychiatric Association's Fifth Edition of the Diagnostic and Statistical Manual (DSM-5); Level C, mostly categorical classification of genetic and environmental causes (etiologies) of Level A disorders; and Level B, the pathophysiologic--both categorical and dimensional--biologic mechanisms underlying Level A "diagnoses" which comprise hierarchically interacting molecular, cellular, and neural networks and major brain pathways orchestrated by Level C etiologies. Besides modest numbers of effective psychotropic medications and their derivatives, major advances in treatment have addressed the behavioral symptoms of Level A-defined developmental and psychiatric disorders. The National Institute of Mental Health proposes support for a new biologically based Research Domain Criteria (RDoC) classification; its goal is to apply to behaviorally defined Level A developmental and psychiatric disorders the biologically based Level C and Level B research strategies that have greatly accelerated treatment and prevention of medical disorders. It plans to supplement effective educational and behavioral symptom-based interventions with faster, more potent and specific biologic therapies and, hopefully, to discover how effective behavioral interventions alter brain function. This commentary raises the question of whether a hybrid nosology that maps biology onto behavior is attainable. At a minimum, such a nosologic effort requires greater in-depth and better informed dialog between investigators of behavior and biology than occurs typically, and more realistic communication of the implications of research results to the public.
Journal of autism and developmental disorders, 2014 · doi:10.1007/s10803-014-2127-5