ICD-11 and ASDs

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Naturally, are lots of topics about the DSM-V people are probably primarily affected by the changes of the upcoming DSM-V.

This is for those few like me whose countries officially use the coding of the ICD - ICD-11 in 3 years from now.

I am hoping this to be a topic that when there are new titbits of information, a few will remember to contribute to or remember to check for changes. If you learnt of something regarding the ICD-11 and how it will handle ASDs, please post it here to inform others who are interested in the ICD.

There's still no word out to the public about what's going to happen to F84.0 childhood autism, F84.5 Asperger Syndrome and F84.1 Atypical Autism from what I know. I'm not exactly up to date though... mostly because autism specialists that I know don't seem to know much either.

A short summary on the situation in the ICD-10:

The category that includes autism, "pervasive developmental disorders" are categorised under "disorders of psychological development". As for the rest, go here: http://apps.who.int/classifications/icd10/browse/2010/en#/F84

Make note of the the above version does not contain the research criteria. (=like the criteria commonly copied from the DSM)

If you are looking for the ICD-10 research criteria for classical autism, AS and atypical autism, I'll post them below. Or just look them up here: http://www.who.int/entity/classifications/icd/en/GRNBOOK.pdf



Now onto the sparse information about the ICD-11.

In the ICD-11 Alpha "draft":

"Autism spectrum disorders" are categorised as "neurodevelopmental disorders".

The Alpha draft lists the following independant entries as "autism spectrum disorders":
http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23F84

Autism
Disintegrative disorder
Social reciprocity disorder

These are marked as "ICD-11 definition is missing", whereas the following are marked as "unchanged from the ICD-10":

Atypical Autism
Rett Syndrome
Overactive disorder associated with mental retardation and stereotyped movements
Asperger Syndrome
Other pervasive developmental disorders
Pervasive developmental disorder, unspecified

No visible change towards a unification of ASDs as in the DSM-V so far.

Other entries now categorised in neurodevelopmental disorders can be found here:

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23690_81655b5c_debe_4590_b8ad_ea6448685723

Quite a change from previous categorisations of other disorders that might be of interest to people with common co-morbid disorders.


Next thing the WHO website says is going to happen:

what is Social reciprocity disorder ?

Taken from here: http://www.who.int/entity/classifications/icd/en/GRNBOOK.pdf

There are variations nearly identical with these spread across the internet but I'm going to stick with these because the link is from the WHO.

F84.0 Childhood autism

A. Abnormal or impaired development is evident before the age of 3 years in at least one of the following areas:

(1) receptive or expressive language as used in social communication;
(2) the development of selective social attachments or of reciprocal social interaction;
(3) functional or symbolic play.

B. Qualitative abnormalities in reciprocal social interaction, manifest in at least one of the following areas:

(1) failure adequately to use eye-to-eye gaze, facial expression, body posture and gesture to regulate social interaction;

(2) failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions;

(3) A lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people's emotions; or lack of modulation of behaviour according to social context, or a weak integration of social, emotional and communicative behaviours.

C. Qualitative abnormalities in communication, manifest in at least two of the following areas:

(1) a delay in, or total lack of development of spoken language that is not accompanied by an attempt to compensate through the use of gesture or mime as alternative modes of communication (often preceded by a lack of communicative babbling);

(2) relative failure to initiate or sustain conversational interchange (at whatever level of language skills are present) in which there is reciprocal to and from responsiveness to the communications of the other person;

(3) stereotyped and repetitive use of language or idiosyncratic use of words or phrases;

(4) abnormalities in pitch, stress, rate, rhythm and intonation of speech;

D. Restricted, repetitive, and stereotyped patterns of behaviour, interests and activities, manifest in at least two of the following areas:

(1) an encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature although not abnormal in their content or focus.

(2) apparently compulsive adherence to specific, non-functional, routines or rituals;

(3) stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting, or complex whole body movements;

(4) preoccupations with part-objects or non-functional elements of play materials (such as their odour, the feel of their surface, or the noise or vibration that they generate);

(5) distress over changes in small, non-functional, details of the environment.

E. The clinical picture is not attributable to the other varieties of pervasive developmental disorder; specific developmental disorder of receptive language (F80.2) with secondary socio-emotional problems; reactive attachment disorder (F94.1) or disinhibited attachment disorder (F94.2); mental retardation (F70-F72) with some associated emotional or behavioural disorder; schizophrenia (F20) of unusually early onset; and Rett's syndrome (F84.2).



F84.5 Asperger's syndrome

A. A lack of any clinically significant general delay in spoken or receptive language or cognitive development. Diagnosis requires that single words should have developed by two years of age or earlier and that communicative phrases be used by three years of age or earlier. Self-help skills, adaptive behaviour and curiosity about the environment during the first three years should be at a level consistent with normal intellectual development. However, motor milestones may be somewhat delayed and motor clumsiness is usual (although not a necessary diagnostic feature). Isolated special skills, often related to abnormal preoccupations, are common, but are not required for diagnosis.

B. Qualitative abnormalities in reciprocal social interaction (criteria as for autism).

C. An unusually intense circumscribed interest or restricted, repetitive, and stereotyped patterns of behaviour, interests and activities (criteria as for autism; however it would be less usual for these to include either motor mannerisms or preoccupations with part- objects or non-functional elements of play materials).

D. The disorder is not attributable to the other varieties of pervasive developmental disorder; schizotypal disorder (F21); simple schizophrenia (F20.6); reactive and disinhibited attachment disorder of childhood (F94.1 and .2); obsessional personality disorder (F60.5); obsessive-compulsive disorder (F42).

Thanks for the info. It was interesting and helpful. I first heard about classic Autism decades ago, and did not see myself in it or in any subsequent articles I read about it. About 10 years ago I first read about Asperger's, and immediately saw myself in it. I continued to read any Aspie articles I came across and finally started researching it online, and took one of the online tests, which confirmed what I already had figured out. After a life time of misery, and mystery, I finally found myself. Your input is a helpful list that other searchers can check out.

Thought I might share this:

Read it here

Sora, thanks for the information, that helps greatly.

This is most interesting. They don't even agree on the definition of what constitutes ASD.

Small notice: ICD-11 BETA is out.

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23F84

Based on the alpha draft it looks like they will not unify the ASDs. This will lead to some frustration in the world wide medical feild, and the difference between medical doctors and psycolgists, as because of insurance requirements, medical doctors in the US code using the ICD (although they are super behind and are only going to implement the ICD-10 next year, forget about the ICD-11).

Part of the difference between the ICD and the DSM has to do with their approach. ICD is a more clinical approach, the different ASDs have clinical differences, although the dividing line between different areas is not set as it is a spectrum, and the treatments can vary between different areas on the spectrum, so it looks like they will be kept separate. The DSM is more research approach, and thus as there are solid commonalities and research indicates that all ASDs are related and in ONE spectrum, they are giving it one diagnosis.

The fun is going to watch the trouble this difference makes at world wide conferences.

I always love reading the first line of Asperger's in the ICD-##:

On the fence much?

Massive alert for everyone who was diagnosed with F84.5 Asperger's syndrome.

http://apps.who.int/classifications/icd11/browse/f/en#/http%3a%2f%2fwho.int%2ficd%23F84.5

At this very moment, "autism spectrum disorders" are split into the subcategories of

- autism
- disintegrative disorder
- Rett syndrome
- social reciprocity disorder (Asperger syndrome)

Social reciprocity disorder now has the definition of Asperger's syndrome listed under it and is supposedly synonyms with "AS".

(edit: fixed a typo, the SRD and SCD look way too similar)

Judging just from the name, the ICD-11's SRD reminds me of the DSM V's SCD (social communication disorder) (link) which however is a differential diagnosis to ASD. As of now, it should therefore not be confused with the ICD-11's form of SRD that's basically AS without calling it such officially.

That's as far as neutral summarising goes, okay?




Pure idiocy. Oh, pardon me oh you mighty wise professionals/scientists or alternatively whoever caused that hopefully idiotic but mere accident of being unable to utilise the website.

That much for those smart German university hospital proclaiming with bold loudness about how AS and autism are all the same and will definitely be merged into a single diagnosis.

New update:

For now, the short description of autism says:

And the description of social reciprocity disorder [Asperger syndrome] says:



Even the autism spectrum disorders category in which autism and social reciprocity disorder are positioned now has a definition up (including that obvious typo):

Autism with social-only deficits. I wonder how they tell it apart from schizoid personality, though.

Am I the only one who can't find 'Pervasive developmental disorder, unspecified" (PDD-NOS) in ICD-11 Beta? Is it folded into SRD, just like AS in the proposal?

I could not find it too, but there are only a few proposals about the ICD11 found in general online.

In comparison to the Social Communication Disorder in the DSMV and the Social Reciprocity Disorder in the ICD11, the Social Communication Disorder rules out Autism Spectrum Disorder and the Social Reciprocity Disorder falls under the Autism Spectrums Disorder, do I understand it correct?
If I am correct, something doesn't make sense to me.

It is confusing because the same term is used in different ways. In the DSM-V "autism spectrum disorder" is the actual disorder, a diagnosis that people will get diagnosed with.

In the ICD-11 however, "autism spectrum disorders" is the name of a category of several disorders and the category was formerly called "pervasive developmental disorders". It's not an actual disorder or a diagnosis, it's just a name to call a group of other disorders by. The diagnoses of autism, social reciprocity disorder, Rett's syndrome and disintegrative disorder are all "ASDs" according to the ICD-11.

Well, I rarely ever heared Rett's syndrome and (childhood) disintegrative disorder called forms of autism before. Some health professionals and therapists who specialise in childhood autism, AS and atypical autism don't even know what Rett's and disintegrative disorder are.

The parent-category of DSM-V's disorder ASD and ICD-11's category of ASDs is both called "neurodevelopmental disorders", if I recall correctly.



Maybe this? http://apps.who.int/classifications/icd ... 6448685723 ...whatever that is supposed to be in concrete terms, urgh.

But to tell the truth, with this little information and all the uncertainty, it's hard to be sure about what such an obscure/unspecified ICD-10 diagnosis could possibly translate into. Sorry about that. I think that at worst, if you need an up-to-date diagnosis for something after the ICD-11 is out, you'll have to get retested in some way.

On the same note, I now wonder what my F90.8 will translate into. Nothing, I'd imagine.

Last edited by Sora on 22 Aug 2012, 6:39 pm, edited 1 time in total.