ICD-11 or DSM-5 for ASD?

As you have engaged very fully in discussion about Asperger in this thread, and I was not the first to bring Asperger into the discussion, this is pretty rich.

The concept of a spectrum is more useful than the implementation of some relatively arbitrarily defined diagnostic 'boxes', in which to stick people, and out of which they are unlikely to move.

The concept of a spectrum encourages the assessment of each autistic person as an individual, and the subsequent provision of individually tailored support.

The 'box concept' encourages the partition of autistic people into separate cohorts and the provision of generic support for the people in each cohort. This, I believe to be divisive of the autistic community and fundamentally prejudicial to individualised support, which I think is self-evidently superior to its generic alternative.

In regard to 'the teacher', it was not obvious to me from the way you worded your post. It is really the recipient of a piece of information that decides if it is unambiguous or not, not the originator. A little like politicians, who wrongly say, "I am clear ...". This is nonsensical, only other people can decide if they are being clear or not. What they mean to say is, "I am clear in my own mind ...", or, "I wish to be clear ...".

Matters relating to any dubious activities of Hans Asperger, or his political views and association, are completely off topic for this discussion. Please refer to the OP. It's a question whether Britain should adopt ICD-11 as the primary reference for psychiatric and mental health conditions (including ASD) or should Britain stick with DSM-5?

It's almost an “is the Pope a Catholic?” type question. Of course it is a real teacher.

A - The man colluded in the murder of some of his patients, passive collusion, but collusion nonetheless. He fully deserves any ad hominem attack he gets, from any quarter.

B - My intellect is fully functional. I have no personal animus against Hans Asperger, how could I? I never met the man.

C - Just answer a simple question.

I do wonder whether it's really possible to have an intelligent discussion about this subject with somebody who launches an ad hominen attack on Hans Asperger. It certainly comes across to me that you have serious grudges and grievances towards the man to the point that emotion has overridden intellect.

If you sit down and have a good think about it, then you should be able to answer your own question whether it is a hypothetical teacher or a real teacher.

Is this a hypothetical teacher, created for argument's sake?

A primary school teacher thinks that lumping all the different types of ASD under a single banner is a mistake. The spectrum is so huge that a person with no noticeable speech and language delay and average or above average academically in the main subjects cannot be compared with someone who is almost completely non-verbal or someone who is very behind academically and spends half the day sitting underneath a table growling like a wolf and the other half throwing objects around the classroom. The teacher has seen them all and thinks that there are reasonably clear subcategories for ASD and this helps to understand why it is so different for people. Each of the three aforementioned people require very different types of support services in a school setting.

Another term that the teacher really hates is BAME because it lumps together a diverse and disparate collection of people into something that is treated as if it were a single homogeneous group.

The difference is in using a hard or soft 'g'. The hard 'g' sound is the original German pronunciation. I identify as autistic, and I have outperformed the majority of neurotypicals academically. However, I do not wish to abandon or disown my fellow autistics who have less ability than me. I think the concept of Asperger's Syndrome is deeply unhelpful, as it creates an 'us and them' situation.

Martin said:

In addition, it sounds like 'ass-burger' or 'aarse-burger

I take objection to this I have always pronounced it as-sperg-ers. As far as I can tell ass-burgers is an American import pronunciation.

Martin said:

Bizarre response. You obviously have a lot of emotional investment in the concept of 'Asperger's Syndrome'.

Is that so difficult to understand? The average man in the street thinks autistic = rain man. It's worth reminding them that some of us equal or even out perform them in important areas of life. I'm not sure if keeping the term Asperger's is the way to do that but I'd think it'd be obvious why you might want to continue to emphasise that.

Martin said:

In the manner of Asperger, people use his eponymous syndrome to draw a distinction between themselves as autistic 'Übermensch', who are 'intelligent and functional', from the 'Untermensch' of non-verbal, and/or intellectually and/or cognitively challenged autistics, whose functionality in society appears to be less. I think the present use of 'Asperger's Syndrome' is open to this sort of unpleasant usage and it is for this reason, and not in order to re-write history, or invalidate any research, that I think that its contemporary usage should be abandoned.

It isn't anything to do with 'Übermensch' vs 'Untermensch'. It's just that the needs and requirements of people with AS and the people with traditional or Kanner autism are considerably different when it comes to the provision of support and services. A bit like the needs and requirements of blind people and people who use wheelchairs are different. Any primary school teacher will tell you this.

There is definitely anecdotal evidence that wherever DSM-5 ASD is adopted then people with an Asperger or an ASD Level 1 diagnosis are being pushed to the back of the queue and treated as lower priority when it comes to support and services on the basis that they are too able, with most of the resources channelled towards people on the more severe end of the spectrum.

Martin said:

In addition, it sounds like 'ass-burger' or 'aarse-burger and in any English-speaking country this ridiculous connotation is sufficient reason, in my view, for it to be dropped.

Very questionable and debatable.

There have been concerns raised over the perception of Asperger vs autism by employers, and whether a label of autism will harm employment prospects compared with Asperger.

Eugenics in liberal democracies did not, except in theoretical discussions - as far as I am aware, seriously advocate the mass murder of disabled people.

In reply to your last question, unlike Asperger, I am not a Nazi. I condemn book-burning and censorship. I have no problem at all with Asperger having existed, and having published studies. Equally, I have no problem with other people having used his name in their studies, in the past. What I am advocating, is that people in the present-day should stop using and identifying with an outdated nomenclature.

In the manner of Asperger, people use his eponymous syndrome to draw a distinction between themselves as autistic 'Übermensch', who are 'intelligent and functional', from the 'Untermensch' of non-verbal, and/or intellectually and/or cognitively challenged autistics, whose functionality in society appears to be less. I think the present use of 'Asperger's Syndrome' is open to this sort of unpleasant usage and it is for this reason, and not in order to re-write history, or invalidate any research, that I think that its contemporary usage should be abandoned.

In addition, it sounds like 'ass-burger' or 'aarse-burger and in any English-speaking country this ridiculous connotation is sufficient reason, in my view, for it to be dropped.

Martin said:

Hans Asperger deserves to be attacked. He extolled 'high functioning' autistics as useful to the Third Reich for their possible technical skills, while consigning those autistics in his care who showed less obvious usefulness, to the tender care of Nazi eugenics (i.e. to be murdered). If this is not execrable in a human being, and even more so in a clinician, I do not know what is

Eugenics was practiced in both the US and Britain before and after WW2 by clinicians, so it would by hypocrisy to attack Hans Asperger on this point.

Martin said:

Relegating Asperger and his syndrome to history does not invalidate those of his findings that remain useful, no more than it does the same to the work of any subsequent clinicians or researchers. It merely means that the term 'Aspergers Syndrome' is replaced with 'autism'.

In a similar way that you cannot have Christianity without Jesus, you cannot have Asperger Syndrome – no matter what it is called – without Hans Asperger. To call it autism for the simple reason that Hans Asperger does not deserve to be honoured is nothing short of brushing the dirt under the carpet, and is unacceptable behaviour from a scientific perspective. If ASD is to incorporate the findings of Hans Asperger then it has to cite and reference his research.

Are you trying to imply that books written about Asperger Syndrome should all be burnt?

Bizarre response. You obviously have a lot of emotional investment in the concept of 'Asperger's Syndrome'. Hans Asperger deserves to be attacked. He extolled 'high functioning' autistics as useful to the Third Reich for their possible technical skills, while consigning those autistics in his care who showed less obvious usefulness, to the tender care of Nazi eugenics (i.e. to be murdered). If this is not execrable in a human being, and even more so in a clinician, I do not know what is

Relegating Asperger and his syndrome to history does not invalidate those of his findings that remain useful, no more than it does the same to the work of any subsequent clinicians or researchers. It merely means that the term 'Aspergers Syndrome' is replaced with 'autism'.

Martin said:

Aperger and his syndrome need to be consigned to the dustbin of history, if only because Asperger was a marginally less depraved Nazi than Josef Mengele. 

This is an ad hominen attack on Hans Asperger.

It's unacceptable (and highly unscientific) to discredit or attempt to obliterate the research findings in a field of medicine because of an individuals dubious activities and lifestyle, or their political views and association.

Obliterating the research findings of Hans Asperger will also systematically obliterate the subsequent work on the subject by Lorna Wing, Uta Frith, Tony Attwood, and even Luke Jackson, amongst others.

You make a valid point.

There is a big question whether the world really needs two diagnostics manuals for psychiatric and mental health conditions, or whether it would be better to have one manual. However, the question could be looked at the other way in that there could be multiple diagnostics manuals, each written for a particular nation or community. This has been discussed at my local AS support group.

The Americans generally ignore ICD for psychiatric and mental health conditions, but the fact is that it is the keeper of the codes for DSM. ICD can survive without DSM but DSM can't really survive (in anything close to its current form) without ICD. It could be argued that DSM is, to an extent, a localised version of ICD for the US.

In my opinion, fully embracing DSM in Britain (or any other country apart from the US) could be viewed as being lazy more than anything else because it's designed for the American population. ICD descriptions may be terse in comparison to those in DSM, but they have to be in order to be neutral with regards to the culture and institutions of individual nations. However, the 'bare bones' nature of ICD provides an opportunity to use it as a basis for compiling multiple localised diagnostics manuals for different nations and communities.

My local AS support group is open to the suggestion of creating a British diagnostics manual for ASD based around ICD-11 (that is more descriptive than ICD-11 is and complete with details of the type and level of support required for individuals) and its officials are more than happy to contribute to such a project.

Since we're on a roll splitting away from international harmonisation at the moment we could do our own thing, reject both, and pay someone competent to write a better diagnostic manual for the uk.

The US and UK are, by global standards, very similar. Medical services are far more affected by available infrastructure and funding, than by culture or ethnicity. I would imagine that the provision of autism diagnosis and support in Mozambique are far more constrained by poverty and lack of infrastructure than by the people being Sub-Saharan Africans, speaking Portuguese, Roman Catholic or animist by religion or being Makonde or any other ethnic group.

I notice that you have not engaged with my observation that the existence of "6A02.Z Autism spectrum disorder, unspecified", negates the raison d'etre for all the other sub-divisions. What is the point of all the 'mix-and-match' varieties when an overall 'spectrum' diagnosis will inevitably  lead to individual assessment of need and level and type of support afterwards anyway? The fairly recent emergence of the concept of autistic and neurodivergent communities seems a beneficial development to me,  ICD-11 looks like a useful basis for a 'divide et impera' move by any non-autistics keen on marginalising self-identification and collective expression by autistics. Aperger and his syndrome need to be consigned to the dustbin of history, if only because Asperger was a marginally less depraved Nazi than Josef Mengele. 

This is untrue about me.

The question was about ICD-11 vs DSM-5, not ICD-10.

Martin said:

But Britain is not Bhutan. There is a lot of convergence between US and UK societies, that alone suggests that diagnostic criteria should be equally similar.

Unfortunately it doesn't quite work out as simple as this. There are differences between British and American culture and demographics.

American social sciences primarily look at society composed of white Americans and black Americans. Other ethnic groups are very peripheral, and so are people who follow non-Christian religions. In fact, there aren't even any official ethnic groups in the US for south Asians!

Britain has been much more diverse than the US (until comparatively recently) in terms of ethnicities and religions, and this is (to a varying degree) reflected in British social sciences.

Therefore the terser ICD that is more neutral with regards to culture and institutions of individual nations than the DSM offers more flexibility and leeway to enable the type and level of support to be tailored to meet the needs of individuals in harmony with their culture. The DSM is first and foremost written for people who are culturally American.

I would be surprised if the NAS realised this as they are very much a white British middle class institution.

community.autism.org.uk/.../asd-in-people-from-foreign-backgrounds

Arran doesn't understand that basic principal. Arran basically wants a separate diagnosis for individuals like himself that are able to cope relatively well because he believes that the term autism spectrum disorder label gives him a disadvantage when out in society & chooses to mis interpret the International Classification of Diseases 10 as a way to argue their view point. 

Arran also seems to come from a background of extreme luck, caring, understanding & possible wealth/privilege that made reasonable adjustments for him without him being truly  aware of them. Arran has also not came across a real world barrier yet that most people on the spectrum come across that impleads their ability to function like mental illness or problematic life events or even an employment barriers.

Arran also believes that everyone with Asperger diagnosis have the same theory of mind which just isn't true or factual. Arran actively denies that their are people with autism that are in a weird middle ground of being between Asperger or classical autism with average or above intelligence, Arran also doesn't understand the effects of how Autism may manifest differently with comorbid disorder like ADHD, International Classification of Diseases 10 also states that autism and ADHD cannot be comorbid when research has shown that nearly 40 % of all adult diagnosed with Autism also have ADHD.         

But Britain is not Bhutan. There is a lot of convergence between US and UK societies, that alone suggests that diagnostic criteria should be equally similar. The final clause, "6A02.Z Autism spectrum disorder, unspecified", is a 'catch all', which, from a logical viewpoint, could be seen to  invalidate the need for the rest of them. Why subdivide at all, if a general category could cover all?