Function, not behavior, driving diagnosis and treatment of ASD in RDoC project

Abstract

The World Health Organization defines mental disorders as qualitative abnormalities in thoughts, perceptions, emotions, behaviors, and relationships with others (http://www.who.int/mediacentre/factsheets/fs396/en/). Clinically, these disorders are described and differentiated based on categorical criteria (e.g., DSM or ICD categories). As biological influences on behavior are elucidated, categorical classifications for defining mental health disorders have come under increasing criticism (Clark et al., 1995; Hyman, 2010; Insel et al., 2010; Kendell & Jablensky, 2003; van Praag, 2000). Many core symptoms of different mental disorders overlap, and there is large heterogeneity in behavioral presentations within a given disorder. Factors including state‐dependent changes, environment, and development influence behavior at any given time and thus can impact clinical assessments and, in turn, treatment decisions. There can be unclear boundaries between psychopathology and normality, disorders can co‐occur, symptoms can overlap across disorders, and presentations change over time and development. This is especially evident in child psychiatry, where developmental trajectory, sensitive periods, and dynamic interactions between brain development and environment add additional variability to the clinical presentation. Development yields a wide distribution of “normal” or typical behaviors for any given age or level of development.