This week the WHO (World Health Organisation) published the first release version of the IDC-11. It will replace the ICD-10 and is expected to be implemented in January 2022. The ICD-11 has been eagerly awaited by the learning and developmental disability community due the anticipated changes in the classification of autism spectrum disorders/conditions.
The ICD stands for the International Classification of Diseases and defines diseases, disorders, injuries and health related conditions. It is used for both research and clinical practice. The ICD has been published by the World Health Organisation since 1948 (version 6), but it originally began in 1893 when it was called the International List of Cause of Death. The ICD is used throughout Europe and across the globe providing an alternative to the American DSM-V (Diagnostic and Statistical Manual). You can read more about the ICD, including the science and statistics behind it, on the WHO website.
The latest updates include Gaming Disorder within addictive behaviours and Gender Incongruence (transgender) is no longer classified as a mental disorder. In addition, the new version of the ICD supports:
- improved usability
- updated scientific content
- ability to code all clinical detail
- eHealth ready
- full multilingual support
Learning Disabilities and Autism Spectrum Disorders are in Section 06 of the ICD 11, under Mental, Behavioural and Neurodevelopmental Disorders.
Learning Disabilities in the ICD-11
Learning disabilities fall within Disorders of Intellectual Development under code 6A00. The classifications remain the same as in previous versions: Mild ID, Moderate ID, Severe ID, and Profound ID. A Provisional ID diagnostic category exists for when the individual is too young for assessment, and also an Unspecific ID category. Additional codes can be used to specify known aetiologies.
Autism Spectrum Disorders in the ICD-11
The DSM-V initiated the removal of Asperger’s syndrome as a separate diagnosis (however it is recommended that those with an existing diagnosis keep it). The ICD-11, was expected to, and has followed suit by removing the classification of Asperger’s syndrome. The argument for this is, in part, that Asperger’s Syndrome is not associated with a language delay in childhood and there is no presence of a co-associated intellectual/learning disability. As a result, it is considered, for some individuals, that the features of autism, do not meet the criteria for a clinical diagnosis i.e. do not impact negatively upon behaviour, health, functioning or wellbeing to a threshold that requires support. In some ways this could be a positive and the beginning of recognising ASD as a difference rather than disability in itself, however there are numerous criticisms as many feel it neglects the variations of difficulties in social and adaptive functioning experienced by individuals with ASC and could render those who may be in need, ineligible for help.
The ICD-11 criteria appears to have made an attempt to take this into account and the new codes distinguish between ASC with an intellectual/learning disability and ASC without (the DSM-V only recognises it occurs), and emphasise differences in impairments in, or an absence of, functional verbal language. Difficulties in initiating and sustaining reciprocal social interaction and restricted, repetitive and inflexible patterns of behaviour and interests remain the key characteristics of ASD with classifications falling under Code 6A02 in the ICD-11.
What about Aspies??
Removing a diagnosis not only impacts on widespread understanding but also if the diagnosis has become part of the individual’s identity and reconstructed in social norms e.g. referring to one self as an ‘aspie’ and embracing autism as a positive difference rather than disability. This link has quite an interesting take and suggests that despite the diminished used in medical forums, the term Asperger’s is likely to remain – http://theconversation.com/what-happened-to-aspergers-syndrome-89836
Also in the news this week
- Read and watch a video of the Kent, Surrey and Sussex Community of Practice Conference 2018 here.
18/7/2018 – The Participatory Autism Research Collective (PARC) Conference at the London South Bank University. PARC is designed to bring autistic people, including scholars and activists, together with early career researchers and practitioners who work with autistic people. They aim to build a community network where those who wish to see more significant involvement of autistic people in autism research can share knowledge and expertise. See the schedule and book your place here.
- Guidance on use and implementation of the ICD-11 is available online with a suit of tools to help staff and clinicians prepare.
- Online short course on Global Health and Disability, available through Future Learn (free access to course and content, payment for certificate).