On the 18 June 2018, the World Health Organization (WHO) released its new International Classification of Diseases (ICD-11). The ICD catalogues different pathologies and conditions in order to provide a common language to inform and control their development, as well as comparing and sharing data following standard criteria between hospitals, regions and countries in different time periods. To do this, the diagnostic terms are converted into around 55 000 unique alphanumeric codes.
The ICD-11 is the result of ten years of work and replaces the previous classification, published 28 years ago, with the intention of offering an updated view of the different health and disease conditions. There has been unprecedented involvement of health care workers in the elaboration of this 11th edition of the ICD. They have joined collaborative meetings and submitted proposals. The ICD team in WHO headquarters received over 10 000 proposals for revisions. ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by Member States, and will come into effect on 1 January 2022.
What has changed in the ICD’s classification of autism?
The ICD-11 updates the diagnostic criteria for autism, and is now more in line the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) published in 2013 by the American Psychiatric Association. This is to say that it includes Asperger’s Syndrome, Childhood Disintegrative Disorder and certain other generalised developmental disorders, within the category of ‘Autism’.
With regards to the described characteristics of autism, the ICD-11 also includes the same two categories as the DSM-5: difficulties in interaction and social communication on the one hand, and restricted interests and repetitive behaviours on the other. It thus removes a third characteristic listed in the previous edition of the ICD, related to language problems. Both classifications also point to the importance of examining unusual sensory sensitivities, which is common among people on the autism spectrum.
However, the ICD-11 and the DSM-5 do vary in a number of ways. For example, the ICD-11’s classification provides detailed guidelines for distinguishing between autism with and without an intellectual disability. The DSM-5, for its part, only states that autism and intellectual disability can occur simultaneously. The ICD-11 also includes the loss of previously acquired competences as a characteristic to be taken into account when making a diagnosis.
With regard to autism during childhood, ICD-11 places less emphasis on the type of play that children partake in, since this may vary depending on the country or culture. Instead, it focuses more on whether children follow or impose strict rules when they play, a behaviour that can be perceived in any culture and is a common characteristic among autistic people.