4/17/2024 0 Comments Asd symptoms dsm 5![]() Time trends in the conceptualization of autism Despite its apparent subjective nature, clinical expertise is currently the only guarantor of maintaining diagnostic accuracy. ![]() The diagnostic decision still relies on direct observation, reported behavior, and qualitative symptom descriptions and is thus dependent on subjective evaluations by clinicians. Although ASD emerges from a genetic and neurobiological background, defining biological markers has not been identified. To date, Autism Spectrum Disorder (ASD) is usually conceptualized as a neurodevelopmental, behaviorally defined disorder whose symptoms emerge in early development, are present in multiple contexts and persist over lifespan. Therefore, employing a more finely grained, objective, clinical symptom characterization which is more relatable to neurobehavioral concepts is of central significance. Identification of core ASD subtypes/endophenotypes and a precise description of symptoms is the necessary next step to advance diagnostic classification systems. 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. This perspective article compares and contrasts the conceptualization of Autism Spectrum Disorder (ASD) in ICD-11 and DSM-5. ![]()
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