ICD-11 or DSM-5 for ASD?

ICD-11 will officially come into effect on 1 January 2022 and supersede ICD-10.

Should Britain adopt ICD-11 as the primary reference for psychiatric and mental health conditions (including ASD) or should Britain stick with DSM-5? Please explain why.

The US previously used DSM-IV for ASD, so the changeover to DSM-5 was the changeover to a newer edition of the same manual. Britain previously used ICD-10 for ASD, so the changeover to DSM-5 was the changeover to a completely different manual.

The Americans don't generally use ICD for psychiatric and mental health conditions, so the impact of ICD-11 on ASD in the US is expected to be minimal. They will stick with DSM-5 until either DSM-6 is released or DSM is abolished.

There are significant differences between ICD-11 and DSM-5 for ASD. In ICD 11, the types of ASD are categorised whereas in DSM-5 they are a one-dimensional spectrum.

In ICD-11 we have the following categories of ASD:

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

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

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

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

6A02.4 Autism spectrum disorder without disorder of intellectual development and with absence of functional language

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

6A02.Y Other specified autism spectrum disorder

6A02.Z Autism spectrum disorder, unspecified

For 6A02.0, 6A02.2, 6A02.4 intellectual functioning and adaptive behaviour are found to be at least within the average range - approximately greater than the 2.3rd percentile.

Asperger Syndrome still technically exists in ICD-11 as 6A02.0.

Parents

Peter over 4 years ago

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.

Reply

Peter over 4 years ago

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.

Children

Arran over 4 years ago in reply to Peter

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.