ICD-11 Criteria for Autism Spectrum Disorder

ICD-11 Criteria for Autism Spectrum Disorder (6A02)

Autism spectrum disorder is characterised by persistent deficits in the ability to initiate and to sustain reciprocal social interaction and social communication, and by a range of restricted, repetitive, and inflexible patterns of behaviour, interests or activities that are clearly atypical or excessive for the individual’s age and sociocultural context. The onset of the disorder occurs during the developmental period, typically in early childhood, but symptoms may not become fully manifest until later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause impairment in personal, family, social, educational, occupational or other important areas of functioning and are usually a pervasive feature of the individual’s functioning observable in all settings, although they may vary according to social, educational, or other context. Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.

Inclusions:              

• Autistic disorder

Exclusions:             

• Rett syndrome (LD90.4)

6A02.0     Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language

All definitional requirements for autism spectrum disorder are met, intellectual functioning and adaptive behaviour are found to be at least within the average range (approximately greater than the 2.3rd percentile), and there is only mild or no impairment in the individual's capacity to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires.

6A02.1      Autism spectrum disorder with disorder of intellectual development and with mild or no impairment of functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is only mild or no impairment in the individual's capacity to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires.

6A02.2       Autism spectrum disorder without disorder of intellectual development and with impaired functional language

All definitional requirements for autism spectrum disorder are met, intellectual functioning and adaptive behaviour are found to be at least within the average range (approximately greater than the 2.3rd percentile), and there is marked impairment in functional language (spoken or signed) relative to the individual’s age, with the individual not able to use more than single words or simple phrases for instrumental purposes, such as to express personal needs and desires.

6A02.3      Autism spectrum disorder with disorder of intellectual development and with impaired functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is marked impairment in functional language (spoken or signed) relative to the individual’s age, with the individual not able to use more than single words or simple phrases for instrumental purposes, such as to express personal needs and desires.

6A02.5      Autism spectrum disorder with disorder of intellectual development and with absence of functional language

All definitional requirements for both autism spectrum disorder and disorder of intellectual development are met and there is complete, or almost complete, absence of ability relative to the individual’s age to use functional language (spoken or signed) for instrumental purposes, such as to express personal needs and desires

6A02.Y        Other specified autism spectrum disorder

6A02.Z         Autism spectrum disorder, unspecified

REFERENCE:

International Classification of Diseases Eleventh Revision (ICD-11). Geneva: World Health Organization; 2022. License: CC BY-ND 3.0 IGO.

https://creativecommons.org/licenses/by-nc-nd/3.0/igo/

Childhood Disintegrative Disorder: Clinical Features and Diagnostic Criteria

Waleed Ahmad

Published online by MRCPsych UK: Tuesday, 03 May 2022

Introduction

There is a loss of skills in several areas of development and deficits in social, communicative, and behavioural functioning that follow normal development in this condition. Often the condition follows a prodromic period during which children develop obscure symptoms; they become restive, irritable, anxious, and overactive. Impoverishment follows this and then loss of speech and language, accompanied by behavioural disintegration. Sometimes the loss of skills is persistently progressive (especially if there is an underlying progressive neurological condition), but more often, the decline over some months and then a slight improvement. The prognosis is usually abysmal, and it leaves most individuals with severe intellectual disability. There is uncertainty about the extent to which this condition differs from autism. Sometimes, the disorder can be because of some associated encephalopathy, but clinicians should make the diagnosis on the behavioural features. If the condition occurs because of an underlying neurological condition, clinicians should record that separately.

Diagnostic Features

1. Diagnosis requires a healthy development during the first 2 years of life, followed by a loss of skills; qualitatively, abnormal social functioning accompanies this.
2. A profound regression of language, level of play, social skills, adaptive behaviours, and bowel, or bladder control are common.
3. Patients also lose interest in the environment and develop stereotypes, mannerisms, and social, and communication deficits.
4. Unlike dementia, there is no evidence of organic disease, and the lost skills may recover. Thus, the ICD-10 has classified the syndrome as a pervasive developmental disorder, instead of dementia.1

Inclusions and Exclusions

The ICD-10 includes the following under childhood disintegrative disorder:

1. Symbiotic psychosis
2. Heller disease
3. Disintegrative psychosis
4. Dementia infantilis

However, the following are excluded:

1. Selective mutism
2. Schizophrenia
3. Rett disorder
4. Acquired epileptic aphasia

With autistic disorder, Asperger syndrome, and atypical autism, the DSM-5 and ICD-11 classifications have subsumed it under autism spectrum disorders.2-3

About the Author

Waleed Ahmad, consultant psychiatrist at the Department of Psychiatry, Mercy Teaching Hospital, Peshawar, Faculty member at the Department of Psychiatry and Behavioural Sciences, Peshawar Medical College, Peshawar, 25 000, KP, Pakistan. Email: dr.waleed@outlook.com

Copyright

Copyright © The Author(s), 2022.

Bibliography

1. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. 10th ed. World Health Organization; 1992.
2. Association AP. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association; 2013.
3. Organization WH. International Classification of Diseases, Eleventh Revision (ICD-11). World Health Organization. Updated February 11, 2022. Accessed April 25, 2022. https://icd.who.int/browse11/l-m/en