![]() ![]() Thus, a more precise, quantitative description and more objective measurement of symptoms are suggested that define the clinical ASD phenotype. This could limit our understanding of etiology and biological pathways of ASD and bears the risk that precision medicine, i.e., a targeted approach for individual treatment strategies based on precise diagnostic markers, is more far from becoming reality. For research, the hypothesis is that the specificity of ASD will be reduced and this will additional increase the already high heterogeneity with the effect that replication of studies will be hampered. This bears a large danger of false positive diagnoses, of further increased prevalence rates, limitations of access to ASD-specific services and of increasing the non-specificity of treatments. It contains many vague and subjective concepts that lead to non-falsifiable diagnoses. ![]() It moves away from an observable, behavioral, and neurodevelopmental disorder to a disorder of inner experience that can hardly be measured objectively. The clinical utility is questionable as this conceptualization can hardly be differentiated from other mental disorders and autism-like traits. By guiding the user through the ICD-11 text, it is argued that, in contrast to DSM-5, ICD-11 allows a high variety in symptom combinations, which results in an operationalization of ASD that is in favor of an extreme diverse picture, yet possibly at the expense of precision, including unforeseeable effects on clinical practice, care, and research. Problems of organization and planning hamper independence.This perspective article compares and contrasts the conceptualization of Autism Spectrum Disorder (ASD) in ICD-11 and DSM-5. Inflexibility of behaviour causes significant interference with functioning in one or more contexts. For example, a person who is able to speak in full sentences and engages in communication but whose to-and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful. May appear to have decreased interest in social interactions. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others. Without supports in place, deficits in social communication cause noticeable impairments. Distress and/or difficulty changing focus or action. Inflexibility of behaviour, difficulty coping with change, or other restricted/repetitive behaviours appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication. Marked deficits in verbal and nonverbal social communication skills social impairments apparent even with supports in place limited initiation of social interactions and reduced or abnormal responses to social overtures from others. Great distress/difficulty changing focus or action. Inflexibility of behaviour, extreme difficulty coping with change, or other restricted/repetitive behaviours, markedly interfere with functioning in all spheres. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches. Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. Requiring very substantial support (Level 3) Restricted, Repetitive Behaviours (Criterion B) ![]()
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