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.
The ICD-11 is issued by the WHO. That's reason enough for me not to want to adopt it in the UK. The WHO has lost all credibility due to its complicity with allowing China to cover up both the Coronavirus lab leak and the secret Biological weapons research conducted at the Wuhan facility by the Chinese government.
I have many issues with the WHO, but as I have previously stated: ICD is the keeper of the codes for DSM. ICD can survive without DSM but DSM can't survive without ICD until a version of DSM-6 is released that is completely freestanding and divorced from ICD.
It was at pains to explain this to an Evangelical Christian nutter (who was probably a member of Sid Cordle's fanclub) with a grievance against the WHO, but was totally unaware of the connection between DSM and ICD when they defended the use of DSM for psychiatric and mental health conditions.
WHO paid my salary for a year. They were so bureaucratic, greedy for meaningless updates and inflexible that we never considered applying for funds from them again.
Martin said:I read that there is a great deal of belief in medical circles that the DSM is of greater scope, more detailed and 'more accurate', than ICD. If this is so, and I cannot judge this as I am not a clinician, then the retention of DSM for mental health diagnosis would seem to be preferable.
There is much truth to what you say.about DSM being more detailed than ICD. However, one cannot deny that it is a publication designed first and foremost for the US with its culture and social expectations, along with the peculiarities of the privatised American healthcare system.
One reason why in the US ICD is used for medicine and DSM is used for psychiatric and mental health conditions is the fragmented system of healthcare where providers of medical services and mental health services operate in parallel, compared to Britain with its NHS and the way many services are accessed through a GP.
Peter mentioned the possibility of writing better diagnostic manuals for British people. It's certainly a possibility that should be looked into. Whether the NAS would be interested in such a project is a different matter. Do they do any R&D?
The example of my experiences - I worked for a university, I was merely WHO funded - was proffered as an example of the dysfunctionality of the organisation. An organisation that is dysfunctional in one regard may be so in others. It is a logical extrapolation.
I read that there is a great deal of belief in medical circles that the DSM is of greater scope, more detailed and 'more accurate', than ICD. If this is so, and I cannot judge this as I am not a clinician, then the retention of DSM for mental health diagnosis would seem to be preferable.