ICD-11 or DSM-5 for ASD?

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?

Martin said:

At least DSM-5 concentrated on the type and level of support an autistic person needed.

This is debateable. The exact type and level of support will depend on the age of the person, the setting that they are in, and the nature of the society that they live in. It would probably be best if details of the type and level of support are decided on a national, or even localised, basis rather than written into a diagnostics manual.

Take into account that ICD is international so it must be neutral with regards to culture and institutions of individual nations, whereas DSM is American so is geared towards American culture and institutions.

Details of the type and level of support for children who attend American schools may not be optimal, or even relevant, for children who attend schools in other countries.

ICD-11 looks like a step backwards, a return to medicalised 'butterfly collecting'. The plethora of definitions seem like a nice box-ticking exercise for clinicians making diagnoses. At least DSM-5 concentrated on the type and level of support an autistic person needed.

I think the DSM-5 went off the rails, but large areas of science have become politicised these days.