Issues for DSM 6 – an Alternative Model for Neurodevelopmental Disorders to enhance nosological validity and clinical utility

The categorical diagnostic approach in the DSM-5 for Neurodevelopmental Disorders often reveals significant limitations, as high rates of comorbidity are common across conditions such as ADHD, autism spectrum disorder, and developmental coordination disorder. This co-occurrence aligns with a neuroconstructive dimensional perspective of neurodevelopment, which emphasizes the interconnectedness of cognitive, motor, and social impairments evolving throughout development. This perspective challenges modular and categorical views of neurodevelopmental phenotypic manifestations. Envisioning the DSM-6, a proposed dimensional Alternative Model for Neurodevelopmental Disorders (AMND) could integrate functioning severity and pathological traits, drawing inspiration from DSM-5 innovations, such as the Autism Spectrum Disorder severity levels. Such a model could facilitate nuanced profiling of individual strengths, needs, and developmental risks, accommodating both categorical and dimensional diagnostic approaches. This framework could also improve early identification of vulnerabilities to severe mental illnesses and clarify the developmental antecedents of adult-onset psychiatric conditions, offering pragmatic insights for clinical interventions and prognosis.