2021 CIM-11 ➽ “6A02 AUTISM SPECTRUM DISORDER” ICD-11 (& Aug. 2016 online beta draft for public comments) • WHO ICD-11, MMS et al.: “International Classification of Diseases for Mortality and Morbidity Statistics OMS CIM-11, SMM et al. : « Classification Internationale des ‹ Maladies › (‹ désaises ›) pour les Statistiques de Mortalité et de Morbidité »|68|134|

WHO·OMS WHO.int ICD · 11 International Classification of Diseases for Mortality and Morbidity Statistics · 10 International Statistical Classification of Diseases and Related Health Problems · WHO.int/standards/classifications/classification-of-diseases
 
• JUILLET 2021 article de 2016 en cours de révision · en conservant l’historique à propos de ICD-11 maintenance et al.onlinebeta2016forpubliccomments
• Cf. mises à jour · additions : i‖2021-07-21.b · ii‖2021-07-21.d · iii‖2021-07-23.e · iv‖2021-07-24.f · v‖2021-07-24.h · vii‖2021-07-29.j · viii‖2021-07-29.k · ix‖2021-07-29.l · vi‖2021-07-29.m · 🡰
· Document du mardi 20 juillet 2021
 · Article revu le 4 août 2021

κ
Il est indubitable que lorsque lon trouble lautisme, on obtient un trouble de lautisme.Ceux qui refusent la syntaxe sont invités à aller voir ailleurs s’ils y sont.Si vous n’avez rien à faire, prière de ne pas le faire ici.
κ

Tableau des petits logosICD-10 Cliquer (sur la flèche ou sur l’image ou ici) pour agrandir · Le présent article comporte dans tous ses paragraphes des icones dans le texte, permettant de s’y retrouver dans les différentes versions de l’ICD/CIM et ses pages de documentation. Sans ces icones la consultation du présent article est beaucoup plus difficile. Il semble que sur un grand nombre de téléphones mobiles, ces icones ne s’affichent pas (ne sont pas « chargées »). Pourtant une vérification sur un vieil appareil en réseau 4G (Paris) en divers lieux de vérification, ne présente jamais aucun défaut de chargement des images-logos-icones. Cliquer sur l’image ci-dessus pour avoir une idée par la capture d’écran du « tableau » ci-dessous récapitulant les icones utilisées dans l’article.

‖ (ICD-10·CIM-10) ICD-10obsolete ‖ (ICD-11·CIM-11) ICD-11 maintenance et al.development2007 ‖ (DSM-5) DSM-52013·cdciaac ‖ ICD-11 maintenance et al.onlinebeta2016forpubliccomments ‖ ICD-11 maintenance et al.advancepreview2018 ‖ ICD-11adopted2019current2021 ‖ EUicd11euguide ‖ WHO·OMSwhoicdpage ‖ ICD-11icdhomepage ‖ ICD-11referenceguide ‖ ICD-11releases ‖ ICD-11 maintenance et al.ongoingmaintenance ‖ ICD-11 maintenance et al.whoficfoundation ‖ ICD-11 maintenance et al.userguide ‖ Syndrome de Peyosyndromedepeyo ‖ ICD-11 maintenance et al.aspergersyndrome ‖ κ

Autisme/« trouble (du spectre) de » l’autisme, description ou définition

• En aucun cas on ne peut parler de « définition » de l’autisme, hormis quand il s’agit du mot seulement (e.g. « substantif masculin », historique du mot, sémantique). La notion de « définition » ne peut en aucun cas porter sur la biologie, que l’on peut observer et dénommer mais par nature même, jamais définir. — Plus largement, on ne peut parler de « définition » que s’agissant des « unités de mesure » : strictement rien d’autre ne peut faire l’objet de « définition » en science : pour toutes autres notions que les unités de mesure, on parle de « description ». Parler de « définition » pour autre chose que les unités de mesure (le mètre, le litre, le degré centigrade ou le Kelvin, etc.), c’est tomber directement dans la mystification, et s’agissant d’autisme, encore plus directement dans la malfaisance.

[2016] κ


Sur la portée de teneur sémantique descriptive de ICD-11adopted2019current2021 l’ICD-11·CIM-11 en 2021 et auparavant, et portée de date officielle d’entrée en vigueur au 1er janvier 2022

  • ICD-11adopted2019 [Aussi en français] World Health Assembly Update · 25 May 2019 · News release Geneva · International Statistical Classification of Diseases and Related Health Problems (ICD-11) · Member states agreed today to adopt the eleventh revision of the ICD-11 International Statistical Classification of Diseases and Related Health Problems (ICD-11), to come into effect on 1 January 2022. (…) · WHO.int/news/item/25-05-2019-world-health-assembly-update

[2021-07-20] κ

Aucune date de « vigueur » n’étant tolérable s’agissant de l’état des connaissances médicales disponibles, compatible avec l’état des connaissances scientifiques à tout moment, le tout selon en l’occurrence les capacités des rédacteurs de l’ICD·CIM, la date officielle d’entrée en vigueur de l’ICD-11·CIM-11 concerne exclusivement le but statistique par la « codification » des items, e.g. « 6A02 ». Ainsi que le délai pour mise à jour des moyens de recueil et transmission de la codification nouvelle de la situation diagnostique des patients. Voir les extraits ci-dessous : le Reference Guide indique même que la situation fréquente ou la plus fréquente parmi les pays membres de la WHO·OMS WHO·OMS est celle dans laquelle ce ne sont pas les auteurs des diagnostics, les médecins, qui effectuent la codification, mais des personnels spécialisés dans le codage des diagnostics. Et en effet et respectivement, par essence même de la médecine, il est inconcevable dans le principe que les capacités diagnostiques de médecins puissent être limitées par l’état sémantique descriptif des items d’une classification.

Il est (donc) ignare, obscurantiste, illettré, d’arriération mentale, d’imaginer que la teneur sémantique descriptive des items de l’ICD·CIM puisse faire l’objet d’une quelconque date d’entrée en vigueur, y compris celle d’adoption et ses modalités par l’assemblée générale de la WHO·OMS : ceci ne peut concerner que la codification des diagnostics. La teneur sémantique descriptive des items n’a en rien pour « décideur » la WHO·OMS ni d’ailleurs aucun « décideur » imaginable. La WHO·OMS ne fait que reconnaître l’état des connaissances, qu’elle n’a elle-même ni produites ni établies, mais dont elle a seulement établi une formulation de la teneur, dans une perspective statistique. Celle-ci se manifeste par codification attribuée aux items répertoriés de diagnostic, pour qu’à la suite cette codification soit attribuée à des diagnostics individuels, qui quant à eux ne peuvent par essence de la médecine être en rien contraints par un état des connaissances tel que formulé dans un but statistique. Ceci, lorsque cela se produit, ne peut être attribué qu’à de la « technocratie administrative » détruisant la notion même de médecine. — Science is the belief in the ignorance of experts. – Richard P. Feynman.

Ainsi, rigoureusement aucune « date de valeur », et encore moins de « vigueur », de la teneur sémantique descriptive d’items diagnostiques dans l’ICD·CIM, ne peut être reconnue, seul l’état individuel de mise à jour de leurs connaissances par les intéressés ayant à tout moment la moindre valeur possible. Ceci est signifié en redondances extrêmes par le Reference Guide, sans le dire expressément puisqu’il s’agirait alors d’une insulte à l’intelligence, aux capacités, du « public concerné » par l’ICD·CIM. Cependant ici… on n’hésite pas à le mentionner… ; y comprenne qui pourra… en ignore qui l’ose.

[2021-07-21] κ

  • ICD-11referenceguide ICD-11 Reference Guide
    1. — Part 1 - An Introduction to ICD-11
    • 1.1. — Purpose and multiple uses of ICD
      The International Classification of Diseases and Related Health Problems (ICD) is a tool for recording, reporting and grouping conditions and factors that influence health. It contains categories for diseases, health related conditions, and external causes of illness or death. The purpose of the ICD is to allow the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times. (…)
      The ICD is primarily designed for the classification of diseases and injuries. However, not every problem or reason for coming into contact with health services can be categorized in this way. Consequently, the ICD includes a wide variety of signs, symptoms, abnormal findings, complaints and social factors that represent the content from health-related records (see section on morbidity). The ICD can therefore be used to classify data recorded under headings such as ‘Diagnosis’, ‘Reason for admission’, ‘Conditions treated’ and ‘Reason for consultation’, which appear on a wide variety of health records from which statistics are derived, for treatment, prevention, or patient safety.
      11-04-2019 » · ICD.who.int/icd11refguide/en/index.html#1.1.0Part1purposeandmultipleusesofICD
      • N.b. The passage in bold is the only such one in the original text. Italics are added here.
    • « 1.4 Main Uses of the ICD : Morbidity
      Morbidity data are used for statistical reporting mostly at national or local levels. While some of this statistical reporting is conducted within an academic research context, it is commonly conducted in applied settings to inform health system and public health agency decision- making. (…)
      • 1.4.1 What is coded : Conditions of patient
        The health care practitioner responsible for the patient’s treatment is also responsible for documenting the patient’s health conditions. This information should be organised systematically by using standard recording methods. A properly completed record is essential for good patient management. It is also an essential prerequisite to the creation of a valid coded record of patient diagnoses, derived through a coding process from written information describing a patient’s medical condition. When a sound written record of patient conditions is available, successful coding of this information in ICD and associated classifications produces a valuable source of epidemiological and other statistical data on morbidity and other health care problems. The person transforming the information on the stated condition to codes (the ‘coder’) may be the health care practitioner or a clinical coder (who is not responsible for the patient’s treatment). In the latter situation, which is quite common among member countries, the coder depends on the adequacy of clinical documentation of patient conditions by health care practitioners in the medical record. The primary importance of clinical documentation by health care practitioners as the starting point for coded health data cannot be overstated, and needs to be underlined as being a matter of key importance within countries and internationally – with implications for health information and clinical documentation teaching within health care practitioner training programs.
        11/04/2019 » · ICD.who.int/icd11refguide/en/index.html#1.4Mainusesmorbidity
      • N.b. Italics are added here.

[2021-07-20] κ


Expulsion totale du « déficit intellectuel » de la notion de « ‹ Trouble › (du spectre) de » l’autisme (et a fortiori, de la notion d’autisme) · ICD-11 maintenance et al.development2007 + DSM-52013 + ICD-11 maintenance et al.onlinebeta2016forpubliccomments + ICD-11adopted2019current2021 + ICD-11 maintenance et al.ongoingmaintenance (& ICD-11 maintenance et al.whoficfoundation)

Conformément aux données acquises depuis des décennies de la recherche portant sur l’autisme, le cas des « désordres/troubles intellectuels, désordres/troubles du développement intellectuel » (« déficit intellectuel ») ne concerne plus que ceux qui croient de façon fantasmagorique que l’autisme en comporte. Ce sont ceux qui croient comme des croyants que l’autisme comporte des désordres/troubles intellectuels… qui souffrent eux-mêmes de désordres/troubles intellectuels ; ceci est réglé, ainsi :

[2016] κ

ICD-11·CIM-11 · ICD-11 maintenance et al.onlinebeta2016forpubliccomments ICD-11adopted2019current2021 ICD-11 maintenance et al.ongoingmaintenance (& ICD-11 maintenance et al.whoficfoundation)
  • ICD-11 maintenance et al.onlinebeta2016forpubliccomments ICD-11 · « 6A02 Autism spectrum disorder »
    (dead 2016 link Apps.WHO.INT/classifications/icd11/browse/l-m/en#/http://id.who.int/icd/entity/437815624)
    • D’“Intellectual disability/deficit”, il n’est pas question comme composante du « ‹ trouble › (du spectre) de l’autisme » (… et dès lors encore moins comme composante de l’autisme…)  :
    • ICD-11 maintenance et al.onlinebeta2016forpubliccomments “Individuals along the spectrum exhibit a full range of intellectual functioning and language abilities.”
    • ICD-11 maintenance et al.onlinebeta2016forpubliccomments “The co-occurring Disorder of intellectual development should be classified separately, using the appropriate category to designate severity (i.e., mild, moderate, severe, profound, provisional).”  : le désordre mal traduit « trouble », du « développement intellectuel », quant à lui devant être coté séparément, ne fait pas partie non plus de la notion de « désordre (“trouble”) de l’autisme ». Il en est de même s’agissant de « impairment of functional language », qui est ou n’est pas présent.
      • ICD-11 maintenance et al.ongoingmaintenance (& ICD-11 maintenance et al.whoficfoundation) :
        “Qualifiers for characterizing features within the Autism Spectrum :
        These qualifiers enable the identification of co-occurring limitations in intellectual and functional language abilities, which are important factors in the appropriate individualization of support, selection of interventions, and treatment planning for individuals with Autism Spectrum Disorder. A qualifier is also provided for loss of previously acquired skills, which is a feature of the developmental history of a small proportion of individuals with Autism Spectrum Disorder.
        (i.) Co-occurring Disorder of Intellectual Development
        Individuals with Autism Spectrum Disorder may exhibit limitations in intellectual abilities. If present, a separate diagnosis of Disorder of Intellectual Development should be assigned, using the appropriate category to designate severity (i.e., Mild, Moderate, Severe, Profound, Provisional). Because social deficits are a core feature of Autism Spectrum Disorder, the assessment of adaptive behaviour as a part of the diagnosis of a co-occurring Disorder of Intellectual Development should place greater emphasis on the intellectual, conceptual, and practical domains of adaptive functioning than on social skills.
        (i.i.) If no co-occurring diagnosis of Disorder of Intellectual Development is present, the following qualifier for the Autism Spectrum Disorder diagnosis should be applied :
        · without Disorder of Intellectual Development
        (i.ii.) If there is a co-occurring diagnosis of Disorder of Intellectual Development, the following qualifier for the Autism Spectrum Disorder diagnosis should be applied, in addition to the appropriate diagnostic code for the co-occurring Disorder of Intellectual Development :
        · with Disorder of Intellectual Development
        (ii.) Degree of Functional Language Impairment
        The degree of impairment in functional language (spoken or signed) should be designated with a second qualifier. Functional language refers to the capacity of the individual to use language for instrumental purposes (e.g., to express personal needs and desires). This qualifier is intended to reflect primarily the verbal and non-verbal expressive language deficits present in some individuals with Autism Spectrum Disorder and not the pragmatic language deficits that are a core feature of Autism Spectrum Disorder.
        The following qualifier should be applied to indicate the extent of functional language impairment (spoken or signed) relative to the individual’s age :
        · with mild or no impairment of functional language
        · with impaired functional language (i.e., not able to use more than single words or simple phrases)
        · with complete, or almost complete, absence of functional language” “(…)”.

[2016 complété 2021-07-23] κ

Ainsi, la ICD-11 maintenance et al.onlinebeta2016forpubliccomments CIM-11 acte l’expulsion du diagnostic de « Trouble (du spectre) de » l’autisme (et a fortiori expulsion de la qualification « autiste, autisme »), de toutes les délétions et variantes génétiques, et autres, impliquant (i.e. systématiquement) un « déficit intellectuel ».
  • Ceux qui continuent à vouloir incruster les implications de « déficit intellectuel » dans l’autisme-le trouble de l’autisme sont donc des escrocs et par Ceux qui disent « AUTISME égale TSA » auront des comptes à rendre. — Il s'agit de HAINE ENVERS LES AUTISTEShaineenverslesautistes.

[2016] κ

Compléments

[2021-07-20] κ


Il en ressort respectivement κ :


Notion-item ICD-11·CIM-11 de « Trouble (du spectre) de » l’Autismeet non : « Autisme » (ni : « ICD-10obsolete Childhood Autism · Autisme infantile ») · ICD-11 maintenance et al.dev20072019 ICD-11 maintenance et al.onlinebeta2016forpubliccomments ICD-11adopted2019current2021 ICD-11 maintenance et al.ongoingmaintenance (& ICD-11 maintenance et al.whoficfoundation)

Avec l’adoption de la CIM-11 (prévue mai 2018, effectuée avril 2019 : Update : “ICD-11 maintenance et al.dev2019 ICD-11 has been adopted ICD-11adopted2019 by the Seventy-second WHO·OMSwhoicdpage World Health Assembly in May 2019 and comes into effect [statistics] on 1 January 2022”), « l’autisme » ne relève plus de diagnostic médical ni de prise en charge médicale : seul le « ‹ Trouble › de l’autisme » (Autism Spectrum Disorder) peut faire l’objet de diagnostic médical, comme il était déjà ainsi dans le cadre du DSM-5, celui-ci DSM-52013 s’étant coordonné avec les travaux de la CIM-11 débutés en 2007, « Classification Internationale des Maladies et des problèmes de santé connexes » sous égide OMS, Organisation Mondiale de la Santé, celle-ci étant sous égide ONU.

[2016 complété 2021-07-20] κ

Synonyms

  • ICD-11 maintenance et al.whoficfoundation WHOFIC·Foundation Last Update : Jul 09, 2021 (FIC, Family of International Classifications)
    • ICD-11 maintenance et al.whoficfoundationWHOFIC·Foundation · Autism spectrum disorder
      Synonyms
      Autistic disorder
      autistic
      autistic disorder of childhood onset
      infantile autism
      childhood autism [ICD-10obsolete]
      Kanner syndrome
      Pervasive developmental delay NOS [not otherwise specified]”
      ICD.who.int/dev11/f/en#/http://id.who.int/icd/entity/437815624
      N.b. Le terme « autism » employé seul, ni non plus le terme « autist » employé seul ou non (le terme « autist » en langue anglaise pré-existant au terme « autist-ic », celui-ci ayant pour sémantique : « qui se réfère à autist »), ne figurent parmi les synonymes de « autism spectrum disorder », selon les auteurs mêmes de l’ICD-11 établissant une liste exhaustive de « synonymes » au sens de l’ICD-11 et à celui de la WHOFIC·Foundation à mise à jour permanente, 2021. · I.e. la notion « autism » (terme employé seul) et la notion « autist » (terme employé seul ou non) sont éjectées du champ médical « clinique » au sens de l’ICD-11 et à celui de la WHOFIC·Foundation à mise à jour permanente, 2007·2021·…. [2021-07-21] κ

[2021-07-20] κ

Illustration : Un cas particulier · Le Syndrome de Peyo Syndrome de Peyosyndromedepeyo

OUI au langage imagé. Docteur Schtroumpf : schtroumpferie ou trouble du spectre de la schtroumpferie ?Schtroumpfez-vous français ?Pour ceux qui ont besoin de belles images pour comprendre… Peyo illustrait déjà la CIM-11 : OUI AU LANGAGE IMAGÉ. Docteur Schtroumpf : schtroumpferie ou trouble du spectre de la schtroumpferie ?
Autisme ou trouble de l’autisme, là est la question…
[ 2021-07-24 ] κ et au cas de difficultés : test rapide.

Le “Syndrome d’Asperger” : pas mort ICD-11 maintenance et al.aspergersyndrome

2021 Nota bene : Le « Syndrome d’Asperger » supprimé en tant qu’item-entité de l’ICD-11·CIM-11 a été réintroduit-maintenu dans la version “Maintenance” (mention de avec lien vers “Foundation entity”) et à la “WHOFIC Foundation” (“Foundation entity”). — Cette réintroduction-maintien est effectuée dans la catégorie-item ICD-11·CIM-11 “Autism Spectrum Disorder”, et non dans la catégorie “Autism” : en effet, il n’est pas mentionné à titre principal (dénomination d’item-entité) en tant que “Asperger Syndrome Disorder”. Pour l’ICD-11·CIM-11, le Syndrome d’Asperger n’est pas une “forme d’autisme”, mais dans la gamme (“spectrum”) de “désordre de l’autisme/dans l’autisme”.

ICD-11 “6A02.0 Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language” :

Compare :

with

  • ICD-11 maintenance et al.ongoingmaintenance ICD-11 “Maintenance Platform 07/2021 Update” ICD.who.int/dev11/l-m/en#/http://id.who.int/icd/entity/120443468
    6A02.0 Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language”
    (…) “All Index Terms
    · Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language
    · Autism spectrum disorder without disorder of intellectual development and without impairment of functional language
    · Asperger syndrome [title="This index entry is an entity in the foundation that is not included in this linearization. Therefore the contents have been included as index entries. Click to see the foundation entity"] Asperger disorder · Asperger”

and

Et voir : Article Livre « LES ENFANTS D’ASPERGER » d’Édith SHEFFER, une « maman » propagandiste pour son fils Éric « autiste honteux » pour détruire la notion même d’autisme (mention en couverture du livre). Livre préfacé par Josef Schovanec.

[2021-07-24] κ


Si vous ne comprenez pas, le plus simple est de lire plutôt des choses que vous comprenez

CONCLUSION : Dès lors, selon rigoureuse cohérence de termes-teneurs sémantiques descriptives icd-11·cim-11 oms, « lautisme » nest plus dans le champ de la médecine « clinique », mais seulement le « trouble (du spectre) de » lautisme (Autism « spectrum disorder » : « gamme du trouble de » l’autisme) κ

La traduction malveillante « Trouble du spectre de » l’autisme au lieu de « Gamme du trouble de » l’autisme pour : Autism « spectrum disorder »

Tout est dans l’énoncé.
Et lorsque « autistique · cnrtl · etymonline » est substitué à : « de l’autisme », il s’agit de fiel · cnrtlCeux qui disent « AUTISME égale TSA » auront des comptes à rendre. — Il s'agit de HAINE ENVERS LES AUTISTEShaineenverslesautistes.

Car c’est d’une gamme de trouble dont se compose l’item-entité 6A02 ASD : 6A02.0 · 6A02.1 · 6A02.2 · 6A02.3 · 6A02.5 · 6A02.Y · 6A02.Z

Seul l’item-entité global 6A02 « définit la description » des spécificités de l’« Autism spectrum disorder », et non les sous-items-entités :

 
 Si vous ne comprenez pas, le plus simple est de lire plutôt des choses que vous comprenez


Appendices

Texte Global ICD-11·CIM-11 « 6A02 Autism spectrum disorder » (ASD), « ‹ Trouble › (du spectre) de » l’autisme (TSA) / Gamme du trouble de l’autisme

Pour la version 2021 adoptée OMS 2019, Voir : ICD-11adopted2019current2021 ICD-11 maintenance et al.ongoingmaintenance ICD-11 maintenance et al.whoficfoundation

« 

ICD-11·CIM-11 Beta 2016 Draft « 6A02 Autism spectrum disorder » ICD-11 maintenance et al.onlinebeta2016forpubliccomments

(dead 2016 link : Apps.WHO.INT/classifications/icd11/browse/l-m/en#/http://id.who.int/icd/entity/437815624)

  • Parent : Neurodevelopmental disorders
    ICD-10 : F84.0
  • Description
    Autism spectrum disorder is characterized 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 and interests. 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
    • Pervasive developmental delay
  • Exclusions
    • Developmental language disorder (6A01.2)
    • Schizophrenia or other primary psychotic disorders (6A20-6A4Z)
  • All Index Terms
    • There are no index terms associated with this entity

»

[2016] κ


« 

ICD-11·CIM-11 Adopted 2019 Current 2021 « 6A02 Autism spectrum disorder » ICD-11adopted2019current2021

ICD.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/437815624

  • Parent : Neurodevelopmental disorders
  • Description
    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 (addedsinceonlinebeta2016forpubliccomments). 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)

»

[2021-07-29] κ

Texte Subdivisions (gamme) de : ICD-11·CIM-11 « 6A02 Autism spectrum disorder »

Pour la version 2021 adoptée OMS 2019, Voir : ICD-11adopted2019current2021 ICD-11 maintenance et al.ongoingmaintenance ICD-11 maintenance et al.whoficfoundation

« 

ICD-11·CIM-11 Beta 2016 Draft ICD-11 maintenance et al.onlinebeta2016forpubliccomments
  • 06 Mental, behavioural or neurodevelopmental disorders
    • Neurodevelopmental disorders
      • 6A00 Disorders of intellectual development
      • 6A01 Developmental speech or language disorders
      • 6A02 Autism spectrum disorder
        (dead 2016 link : Apps.WHO.INT/classifications/icd11/browse/l-m/en#/http://id.who.int/icd/entity/437815624)
        • 6A02.1 Autism spectrum disorder without disorder of intellectual development and with mild or no impairment of functional language
        • 6A02.2 Autism spectrum disorder with disorder of intellectual development and with mild or no impairment of functional language
        • 6A02.3 Autism spectrum disorder without disorder of intellectual development and with impaired functional language
        • 6A02.4 Autism spectrum disorder with disorder of intellectual development and with impaired functional language
        • 6A02.5 Autism spectrum disorder without disorder of intellectual development and with absence of functional language
        • 6A02.Y Other specified autism spectrum disorder
        • 6A02.Z Autism spectrum disorder, unspecified
      • (…)

»

[2016] κ


« 

ICD-11·CIM-11 Adopted 2019 Current 2021 ICD-11adopted2019current2021

»

[2021-07-29] κ


DSM-5 (2013) “299.00 Autism Spectrum Disorder” (ASD) DSM-52013

  • Rem. À propos de la teneur sémantique descriptive de l’item “299.00 Autism Spectrum Disorder” dans le DSM-5 rapportée à celle de l’item “6A02 Autism Spectrum Disorder” dans la CIM-11 :
    • Observations à venir.
  • Voir ci-dessous texte intégral de
    DSM-5 “299.00 Autism Spectrum Disorder”.

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Autisme (description) : Notion scientifique de variante cérébrale, inférée à partir de cas similaires présentant dès la petite enfance un ensemble similaire de difficultés de sociabilité et d’éducation dans le cadre social majoritaire. Ces difficultés sont le cas échéant diagnostiquées en médecine sous la dénomination « trouble (du spectre) de l’autisme (trouble de l’autisme étant une gamme) » lorsqu’elles ont une ampleur gênant le développement de l’enfant ou les activités de l’adulte. [2016] κ

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DSM-5 (2013) “299.00 Autism Spectrum Disorder” (ASD) DSM-52013
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Source : A4.org.au/dsm5-asd

Following is the full description of Autism Spectrum Disorder (ASD) from the Diagnostic and Statistical Manual of Mental Disorder, 5th edition (DSM-5) DOI.org/10.1176/appi.books.9780890425596.

DSM-5

DSM-5 · 299.00 Autism Spectrum Disorder ([ICD-10:] F84.0) [ICD-11: 6A02] · DSM-52013 Diagnostic Criteria

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by all of the following, currently or by history (examples are illustrative, not exhaustive ; see text) :

  • 1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation ; to reduced sharing of interests, emotions, or affect ; to failure to initiate or respond to social interactions.
  • 2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication ; to abnormalities in eye contact and body language or deficits in understanding and use of gestures ; to a total lack of facial expressions and nonverbal communication.
  • 3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts ; to difficulties in sharing imaginative play or in making friends ; to absence of interest in peers.

Specify current severity : Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive ; see text) :

  • 1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
  • 2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food every day).
  • 3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
  • 4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity : Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur ; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note : Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if :

  • With or without accompanying intellectual impairment ;
  • With or without accompanying language impairment ;
  • Associated with a known medical or genetic condition or environmental factor
    (Coding note : Use additional code to identify the associated medical or genetic condition.)
  • Associated with another neurodevelopmental, mental, or behavioral disorder
    (Coding note : Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)
  • With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition)
    (Coding note : Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)

Recording Procedures

For autism spectrum disorder that is associated with a known medical or genetic condition or environmental factor, or with another neurodevelopmental, mental, or behavioral disorder, record autism spectrum disorder associated with (name of condition, disorder, or factor) (e.g., autism spectrum disorder associated with Rett syndrome). Severity should be recorded as level of support needed for each of the two psychopathological domains in Table 2 (e.g., « requiring very substantial support for deficits in social communication and requiring substantial support for restricted, repetitive behaviors »). Specification of « with accompanying intellectual impairment » or « without accompanying intellectual impairment » should be recorded next. Language impairment specification should be recorded thereafter. If there is accompanying language impairment, the current level of verbal functioning should be recorded (e.g., « with accompanying language impairment no intelligible speech » or « with accompanying language impairment-phrase speech »). If catatonia is present, record separately « catatonia associated with autism spectrum disorder. »

Specifiers

The severity specifiers (see Table 2) may be used to describe succinctly the current symptomatology (which might fall below level 1), with the recognition that severity may vary by context and fluctuate over time. Severity of social communication difficulties and restricted, repetitive behaviors should be separately rated. The descriptive severity categories should not be used to determine eligibility for and provision of services ; these can only be developed at an individual level and through discussion of personal priorities and targets. Regarding the specifier « with or without accompanying intellectual impairment, » understanding the (often uneven) intellectual profile of a child or adult with autism spectrum disorder is necessary for interpreting diagnostic features. Separate estimates of verbal and nonverbal skills are necessary (e.g., using untimed nonverbal tests to assess potential strengths in individuals with limited language).
 

TABLE 2 Severity levels for autism spectrum disorder
Severity level Social communication Restricted, repetitive behaviors
Level 3 « Requiring very substantial support » Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches. Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/ difficulty changing focus or action.
Level 2 « Requiring substantial support » Marked deficits in verbal and nonverbal social communication skills ; social impairments apparent even with supports in place ; limited initiation of social interactions ; and reduced or abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited to narrow special interests, and who has markedly odd nonverbal communication. Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in a variety of contexts. Distress and/ or difficulty changing focus or action.
Level 1 « Requiring support » Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful responses to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to-andfro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful. Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

 
To use the specifier "with or without accompanying language impairment," the current level of verbal functioning should be assessed and described. Examples of the specific descriptions for "with accompanying language impairment" might include no intelligible speech (nonverbal), single words only, or phrase speech. Language level in individuals "without accompanying language impairment" might be further described by speaks in full sentences or has fluent speech. Since receptive language may lag behind expressive language development in autism spectrum disorder, receptive and expressive language skills should be considered separately.

The specifier "associated with a known medical or genetic condition or environmental factor" should be used when the individual has a known genetic disorder (e.g., Rett syndrome, Fragile X syndrome, Down syndrome), a medical disorder (e.g. epilepsy), or a history of environmental exposure (e.g., valproate, fetal alcohol syndrome, very low birth weight).

Additional neurodevelopmental, mental or behavioral conditions should also be noted (e.g., attentiondeficit/hyperactivity disorder ; developmental coordination disorder ; disruptive behavior, impulse-control, or conduct disorders ; anxiety, depressive, or bipolar disorders ; tics or Tourette’s disorder ; self-injury ; feeding, elimination, or sleep disorders).

Diagnostic Features

The essential features of autism spectrum disorder are persistent impairment in reciprocal social communication and social interaction (Criterion A), and restricted, repetitive patterns of behavior, interests, or activities (Criterion B). These symptoms are present from early childhood and limit or impair everyday functioning (Criteria C and D). The stage at which functional impairment becomes obvious will vary according to characteristics of the individual and his or her environment. Core diagnostic features are evident in the developmental period, but intervention, compensation, and current supports may mask difficulties in at least some contexts. Manifestations of the disorder also vary greatly depending on the severity of the autistic condition, developmental level, and chronological age ; hence, the term spectrum. Autism spectrum disorder encompasses disorders previously referred to as early infantile autism, childhood autism, Kanner’s autism, high-functioning autism, atypical autism, pervasive developmental disorder not otherwise specified, childhood disintegrative disorder, and Asperger’s disorder.

The impairments in communication and social interaction specified in Criterion A are pervasive and sustained. Diagnoses are most valid and reliable when based on multiple sources of information, including clinician’s observations, caregiver history, and, when possible, self-report. Verbal and nonverbal deficits in social communication have varying manifestations, depending on the individual’s age, intellectual level, and language ability, as well as other factors such as treatment history and current support. Many individuals have language deficits, ranging from complete lack of speech through language delays, poor comprehension of speech, echoed speech, or stilted and overly literal language. Even when formal language skills (e.g., vocabulary, grammar) are intact, the use of language for reciprocal social communication is impaired in autism spectrum disorder.

Deficits in social-emotional reciprocity (i.e., the ability to engage with others and share thoughts and feelings) are clearly evident in young children with the disorder, who may show little or no initiation of social interaction and no sharing of emotions, along with reduced or absent imitation of others’ behavior. What language exists is often one-sided, lacking in social reciprocity, and used to request or label rather than to comment, share feelings, or converse. In adults without intellectual disabilities or language delays, deficits in social-emotional reciprocity may be most apparent in difficulties processing and responding to complex social cues (e.g., when and how to join a conversation, what not to say). Adults who have developed compensation strategies for some social challenges still struggle in novel or unsupported situations and suffer from the effort and anxiety of consciously calculating what is socially intuitive for most individuals.

Deficits in nonverbal communicative behaviors used for social interaction are manifested by absent, reduced, or atypical use of eye contact (relative to cultural norms), gestures, facial expressions, body orientation, or speech intonation. An early feature of autism spectrum disorder is impaired joint attention as manifested by a lack of pointing, showing, or bringing objects to share interest with others, or failure to follow someone’s pointing or eye gaze. Individuals may learn a few functional gestures, but their repertoire is smaller than that of others, and they often fail to use expressive gestures spontaneously in communication. Among adults with fluent language, the difficulty in coordinating nonverbal communication with speech may give the impression of odd, wooden, or exaggerated “body language” during interactions. Impairment may be relatively subtle within individual modes (e.g., someone may have relatively good eye contact when speaking) but noticeable in poor integration of eye contact, gesture, body posture, prosody, and facial expression for social communication.

Deficits in developing, maintaining, and understanding relationships should be judged against norms for age, gender, and culture. There may be absent, reduced, or atypical social interest, manifested by rejection of others, passivity, or inappropriate approaches that seem aggressive or disruptive. These difficulties are particularly evident in young children, in whom there is often a lack of shared social play and imagination (e.g., age-appropriate flexible pretend play) and, later, insistence on playing by very fixed rules. Older individuals may struggle to understand what behavior is considered appropriate in one situation but not another (e.g., casual behavior during a job interview), or the different ways that language may be used to communicate (e.g., irony, white lies). There may be an apparent preference for solitary activities or for interacting with much younger or older people. Frequently, there is a desire to establish friendships without a complete or realistic idea of what friendship entails (e.g., one-sided friendships or friendships based solely on shared special interests). Relationships with siblings, co-workers, and caregivers are also important to consider (in terms of reciprocity).

Autism spectrum disorder is also defined by restricted, repetitive patterns of behavior, interests, or activities (as specified in Criterion B), which show a range of manifestations according to age and ability, intervention, and current supports. Stereotyped or repetitive behaviors include simple motor stereotypies (e.g., hand flapping, finger flicking), repetitive use of objects (e.g., spinning coins, lining up toys), and repetitive speech (e.g., echolalia, the delayed or immediate parroting of heard words ; use of “you” when referring to self ; stereotyped use of words, phrases, or prosodic patterns). Excessive adherence to routines and restricted patterns of behavior may be manifest in resistance to change (e.g., distress at apparently small changes, such as in packaging of a favorite food ; insistence on adherence to rules ; rigidity of thinking) or ritualized patterns of verbal or nonverbal behavior (e.g., repetitive questioning, pacing a perimeter). Highly restricted, fixated interests in autism spectrum disorder tend to be abnormal in intensity or focus (e.g., a toddler strongly attached to a pan ; a child preoccupied with vacuum cleaners ; an adult spending hours writing out timetables). Some fascinations and routines may relate to apparent hyper- or hyporeactivity to sensory input, manifested through extreme responses to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects, and sometimes apparent indifference to pain, heat, or cold. Extreme reaction to or rituals involving taste, smelt texture, or appearance of food or excessive food restrictions are common and may be a presenting feature of autism spectrum disorder.

Many adults with autism spectrum disorder without intellectual or language disabilities learn to suppress repetitive behavior in public. Special interests may be a source of pleasure and motivation and provide avenues for education and employment later in life. Diagnostic criteria may be met when restricted, repetitive patterns of behavior, interests or activities were clearly present during childhood or at some time in the past, even if symptoms are no longer present.

Criterion D requires that the features must cause clinically significant impairment in social, occupational, or other important areas of current functioning. Criterion E specifies that the social communication deficits, although sometimes accompanied by intellectual disability (intellectual developmental disorder), are not in line with the individual’s developmental level ; impairments exceed difficulties expected on the basis of developmental level. Standardized behavioral diagnostic instruments with good psychometric properties, including caregiver interviews, questionnaires and clinician observation measures, are available and can improve reliability of diagnosis over time and across clinicians.

Associated Features Supporting Diagnosis

Many individuals with autism spectrum disorder also have intellectual impairment and/ or language impairment (e.g., slow to talk, language comprehension behind production). Even those with average or high intelligence have an uneven profile of abilities. The gap between intellectual and adaptive functional skills is often large. Motor deficits are often present, including odd gait, clumsiness, and other abnormal motor signs (e.g., walking on tiptoes). Self-injury (e.g., head banging, biting the wrist) may occur, and disruptive/challenging behaviors are more common in children and adolescents with autism spectrum disorder than other disorders, including intellectual disability. Adolescents and adults with autism spectrum disorder are prone to anxiety and depression. Some individuals develop catatonic-like motor behavior (slowing and “freezing” mid-action), but these are typically not of the magnitude of a catatonic episode. However, it is possible for individuals with autism spectrum disorder to experience a marked deterioration in motor symptoms and display a full catatonic episode with symptoms such as mutism, posturing, grimacing and waxy flexibility. The risk period for comorbid catatonia appears to be greatest in the adolescent years.

Prevalence

In recent years, reported frequencies for autism spectrum disorder across U.S. and non-U.S. countries have approached 1% of the population, with similar estimates in child and adult samples. It remains unclear whether higher rates reflect an expansion of the diagnostic criteria of DSM-IV to include subthreshold cases, increased awareness, differences in study methodology, or a true increase in the frequency of autism spectrum disorder.

Development and Course

The age and pattern of onset also should be noted for autism spectrum disorder. Symptoms are typically recognized during the second year of life (12-24 months of age) but may be seen earlier than 12 months if developmental delays are severe, or noted later than 24 months if symptoms are more subtle. The pattern of onset description might include information about early developmental delays or any losses of social or language skills. In cases where skills have been lost, parents or caregivers may give a history of a gradual or relatively rapid deterioration in social behaviors or language skills. Typically, this would occur between 12 and 24 months of age and is distinguished from the rare instances of developmental regression occurring after at least 2 years of normal development (previously described as childhood disintegrative disorder). The behavioral features of autism spectrum disorder first become evident in early childhood, with some cases presenting a lack of interest in social interaction in the first year of life. Some children with autism spectrum disorder experience developmental plateaus or regression, with a gradual or relatively rapid deterioration in social behaviors or use of language, often during the first 2 years of life. Such losses are rare in other disorders and may be a useful “red flag” for autism spectrum disorder. Much more unusual and warranting more extensive medical investigation are losses of skills beyond social communication (e.g., loss of self-care, toileting, motor skills) or those occurring after the second birthday (see also Rett syndrome in the section "Differential Diagnosis" for this disorder). The essential features of autism spectrum disorder are persistent impairment in reciprocal social communication and social interaction, and restricted, repetitive patterns of behavior, interests, or activities.

First symptoms of autism spectrum disorder frequently involve delayed language development, often accompanied by lack of social interest or unusual social interactions (e.g., pulling individuals by the hand without any attempt to look at them), odd play patterns (e.g., carrying toys around but never playing with them), and unusual communication patterns (e.g., knowing the alphabet but not responding to own name). Deafness may be suspected but is typically ruled out. During the second year, odd and repetitive behaviors and the absence of typical play become more apparent. Since many typically developing young children have strong preferences and enjoy repetition (e.g., eating the same foods, watching the same video multiple times), distinguishing restricted and repetitive behaviors that are diagnostic of autism spectrum disorder can be difficult in preschoolers. The clinical distinction is based on the type, frequency, and intensity of the behavior (e.g., a child who daily lines up objects for hours and is very distressed if any item is moved).

Autism spectrum disorder is not a degenerative disorder, and it is typical for learning and compensation to continue throughout life. Symptoms are often most marked in early childhood and early school years, with developmental gains typical in later childhood in at least some areas (e.g., increased interest in social interaction). A small proportion of individuals deteriorate behaviorally during adolescence, whereas most others improve. Only a minority of individuals with autism spectrum disorder live and work independently in adulthood ; those who do tend to have superior language and intellectual abilities and are able to find a niche that matches their special interests and skills. In general, individuals with lower levels of impairment may be better able to function independently. However, even these individuals may remain socially naive and vulnerable, have difficulties organizing practical demands without aid, and are prone to anxiety and depression. Many adults report using compensation strategies and coping mechanisms to mask their difficulties in public but suffer from the stress and effort of maintaining a socially acceptable facade. Scarcely anything is known about old age in autism spectrum disorder.

Some individuals come for first diagnosis in adulthood, perhaps prompted by the diagnosis of autism in a child in the family or a breakdown of relations at work or home. Obtaining detailed developmental history in such cases may be difficult, and it is important to consider self-reported difficulties. Where clinical observation suggests criteria are currently met, autism spectrum disorder may be diagnosed, provided there is no evidence of good social and communication skills in childhood. For example, the report (by parents or another relative) that the individual had ordinary and sustained reciprocal friendships and good nonverbal communication skills throughout childhood would rule out a diagnosis of autism spectrum disorder ; however, the absence of developmental information in itself should not do so.

Manifestations of the social and communication impairments and restricted/repetitive behaviors that define autism spectrum disorder are clear in the developmental period. In later life, intervention or compensation, as well as current supports, may mask these difficulties in at least some contexts. However, symptoms remain sufficient to cause current impairment in social, occupational, or other important areas of functioning.

Risk and Prognostic Factors

The best established prognostic factors for individual outcome within autism spectrum disorder are presence or absence of associated intellectual disability and language impairment (e.g., functional language by age 5 years is a good prognostic sign) and additional mental health problems. Epilepsy, as a comorbid diagnosis, is associated with greater intellectual disability and lower verbal ability.

Environmental. A variety of nonspecific risk factors, such as advanced parental age, birth weight, or fetal exposure to valproate, may contribute to risk of autism spectrum disorder.

Genetic And Physiological. Heritability estimates for autism spectrum disorder have ranged from 37% to higher than 90%, based on twin concordance rates. Currently, as many as 15% of cases of autism spectrum disorder appear to be associated with a known genetic mutation, with different de novo copy number variants or de novo mutations in specific genes associated with the disorder in different families. However, even when an autism spectrum disorder is associated with a known genetic mutation, it does not appear to be fully penetrant. Risk for the remainder of cases appears to be polygenic, with perhaps hundreds of genetic loci making relatively small contributions.

Culture-Related Diagnostic Issues

Cultural differences will exist in norms for social interaction, nonverbal communication, and relationships, but individuals with autism spectrum disorder are markedly impaired against the norms for their cultural context. Cultural and socioeconomic factors may affect age at recognition or diagnosis ; for example, in the United States, late or underdiagnosis of autism spectrum disorder among African American children may occur.

Gender-Related Diagnostic Issues

Autism spectrum disorder is diagnosed four times more often in males than in females. In clinic samples, females tend to be more likely to show accompanying intellectual disability, suggesting that girls without accompanying intellectual impairments or language delays may go unrecognized, perhaps because of subtler manifestation of social and communication difficulties.

Functional Consequences of Autism Spectrum Disorder

In young children with autism spectrum disorder, lack of social and communication abilities may hamper learning, especially learning through social interaction or in settings with peers. In the home, insistence on routines and aversion to change, as well as sensory sensitivities, may interfere with eating and sleeping and make routine care (e.g., haircuts, dental work) extremely difficult. Adaptive skills are typically below measured IQ. Extreme difficulties in planning, organization, and coping with change negatively impact academic achievement, even for students with above-average intelligence. During adulthood, these individuals may have difficulties establishing independence because of continued rigidity and difficulty with novelty. Many individuals with autism spectrum disorder, even without intellectual disability, have poor adult psychosocial functioning as indexed by measures such as independent living and gainful employment. Functional consequences in old age are unknown, but social isolation and communication problems (e.g., reduced help-seeking) are likely to have consequences for health in older adulthood. DIAGNOSTIC CRITERIA 10

Differential Diagnosis

Rett Syndrome. Disruption of social interaction may be observed during the regressive phase of Rett syndrome (typically between 1-4 years of age) ; thus, a substantial proportion of affected young girls may have a presentation that meets diagnostic criteria for autism spectrum disorder. However, after this period, most individuals with Rett syndrome improve their social communication skills, and autistic features are no longer a major area of concern. Consequently, autism spectrum disorder should be considered only when all diagnostic criteria are met.

Selective Mutism. In selective mutism, early development is not typically disturbed. The affected child usually exhibits appropriate communication skills in certain contexts and settings. Even in settings where the child is mute, social reciprocity is not impaired, nor are restricted or repetitive patterns of behavior present.

Language Disorders And Social (Pragmatic) Communication Disorder. In some forms of language disorder, there may be problems of communication and some secondary social difficulties. However, specific language disorder is not usually associated with abnormal nonverbal communication, nor with the presence of restricted, repetitive patterns of behavior, interests, or activities.

When an individual shows impairment in social communication and social interactions but does not show restricted and repetitive behavior or interests, criteria for social (pragmatic) communication disorder, instead of autism spectrum disorder, may be met. The diagnosis of autism spectrum disorder supersedes that of social (pragmatic) communication disorder whenever the criteria for autism spectrum disorder are met, and care should be taken to enquire carefully regarding past or current restricted/ repetitive behavior.

Intellectual Disability (Intellectual Developmental Disorder) Without Autism Spectrum Disorder. Intellectual disability without autism spectrum disorder may be difficult to differentiate from autism spectrum disorder in very young children. Individuals with intellectual disability who have not developed language or symbolic skills also present a challenge for differential diagnosis, since repetitive behavior often occurs in such individuals as well. A diagnosis of autism spectrum disorder in an individual with intellectual disability is appropriate when social communication and interaction are significantly impaired relative to the developmental level of the individual’s nonverbal skills (e.g., fine motor skills, nonverbal problem solving). In contrast, intellectual disability is the appropriate diagnosis when there is no apparent discrepancy between the level of socialcommunicative skills and other intellectual skills.

Stereotypic Movement Disorder. Motor stereotypies are among the diagnostic characteristics of autism spectrum disorder, so an additional diagnosis of stereotypic movement disorder is not given when such repetitive behaviors are better explained by the presence of autism spectrum disorder. However, when stereotypies cause self-injury and become a focus of treatment, both diagnoses may be appropriate.

Attention-Deficit/Hyperactivity Disorder. Abnormalities of attention (overly focused or easily distracted) are common in individuals with autism spectrum disorder, as is hyperactivity. A diagnosis of attention-deficit / hyperactivity disorder (ADHD) should be considered when attentional difficulties or hyperactivity exceeds that typically seen in individuals of comparable mental age.

Schizophrenia. Schizophrenia with childhood onset usually develops after a period of normal, or near normal, development. A prodromal state has been described in which social impairment and atypical interests and beliefs occur, which could be confused with the social deficits seen in autism spectrum disorder. Hallucinations and delusions, which are defining features of schizophrenia, are not features of autism spectrum disorder. However, clinicians must take into account the potential for individuals with autism spectrum disorder to be concrete in their interpretation of questions regarding the key features of schizophrenia (e.g., “Do you hear voices when no one is there ?” “Yes [on the radio]”). 11

Comorbidity

Autism spectrum disorder is frequently associated with intellectual impairment and structural language disorder (i.e., an inability to comprehend and construct sentences with grammar), which should be noted under the relevant specifiers when applicable. Many individuals with autism spectrum disorder have psychiatric symptoms that do not form part of the diagnostic criteria for the disorder (about 70% of individuals with autism spectrum disorder may have one comorbid mental disorder, and 40% may have two or more mental disorders). When criteria for both ADHD and autism spectrum disorder are met, both diagnoses should be given. This same principle applies to concurrent diagnoses of autism spectrum disorder and developmental coordination disorder, anxiety disorders, depressive disorders, and other comorbid diagnoses. Among individuals who are nonverbal or have language deficits, observable signs such as changes in sleep or eating and increases in challenging behavior should trigger an evaluation for anxiety or depression. Specific learning difficulties (literacy and numeracy) are common, as is developmental coordination disorder. Medical conditions commonly associated with autism spectrum disorder should be noted under the “associated with a known medical/genetic or environmental/acquired condition” specifier. Such medical conditions include epilepsy, sleep problems, and constipation. Avoidant-restrictive food intake disorder is a fairly frequent presenting feature of autism spectrum disorder, and extreme and narrow food preferences may persist.

from https://www.autismnj.org/document.doc?id=20

see also https://www.cdc.gov/ncbddd/autism/hcp-dsm.html


What is above all needed is to let the meaning choose the wordfor the word’s content —, and not the other way around. The worst thing you can do with words is to surrender to them.” George Orwell

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