Published on 12, July, 2020
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.
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.
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.
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?
As you have engaged very fully in discussion about Asperger in this thread, and I was not the first to bring Asperger into the discussion, this is pretty rich.
The concept of a spectrum is more useful than the implementation of some relatively arbitrarily defined diagnostic 'boxes', in which to stick people, and out of which they are unlikely to move.
The concept of a spectrum encourages the assessment of each autistic person as an individual, and the subsequent provision of individually tailored support.
The 'box concept' encourages the partition of autistic people into separate cohorts and the provision of generic support for the people in each cohort. This, I believe to be divisive of the autistic community and fundamentally prejudicial to individualised support, which I think is self-evidently superior to its generic alternative.
In regard to 'the teacher', it was not obvious to me from the way you worded your post. It is really the recipient of a piece of information that decides if it is unambiguous or not, not the originator. A little like politicians, who wrongly say, "I am clear ...". This is nonsensical, only other people can decide if they are being clear or not. What they mean to say is, "I am clear in my own mind ...", or, "I wish to be clear ...".