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 Autism Spectrum Disorder in ICD-10

Autism is assigned to ICD-10 (International Classification of Diseases) main categories of Disorders of psychological development (F 80-89) and Pervasive developmental disorders (F 84) (Kerola & Kujanpää 2009, 26).

F84 Pervasive developmental disorders

"A group of disorders characterized by qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by a restricted, stereotyped, repetitive repertoire of interests and activities. These qualitative abnormalities are a pervasive feature of the individual's functioning in all situations.
Use additional code, if desired, to identify any associated medical condition and mental retardation." (World Health Organization ICD Version 2007.)

F84.0 Childhood autism

"A type of pervasive developmental disorder that is defined by: (a) the presence of abnormal or impaired development that is manifest before the age of three years, and (b) the characteristic type of abnormal functioning in all the three areas of psychopathology: reciprocal social interaction, communication, and restricted, stereotyped, repetitive behaviour. In addition to these specific diagnostic features, a range of other nonspecific problems are common, such as phobias, sleeping and eating disturbances, temper tantrums, and (self-directed) aggression.
Autistic disorder
Infantile:
• autism
• psychosis
Kanner's syndrome
Excludes: autistic psychopathy ( F84.5 )" (World Health Organization ICD Version 2007.)

A. Abnormal or impaired development is evident before the age of 3 years in at least one of the following areas:

3. functional or symbolic play 

(Kerola & Kujanpää 2009, 27.)

B. A total of at least six symptoms from 1, 2 and 3 must be present, with at least two from 1 and at least one from each of 2 and 3

1. Qualitative impairment in social interaction are manifest in at least two of the following areas:

a. failure adequately to use eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

b. failure to develop (in a manner appropriate to mental age, and despite ample opportunities) peer relationships that involve a mutual sharing of interests, activities and emotions

c. lack of socio-emotional reciprocity as shown by an impaired or deviant response to other people’s emotions; or lack of modulation of behavior according to social context; or a weak integration of social, emotional, and communicative behaviors

d. lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. a lack of showing, bringing, or pointing out to other people objects of interest to the individual) (Kerola & Kujanpää 2009, 27-28.)

2. Qualitative abnormalities in communication as manifest in at least one of the following areas:

a. delay in or total lack of, development of spoken language that is not accompanied by an attempt to compensate through the use of gestures or mime as an alternative mode of communication (often preceded by a lack of communicative babbling)

b. relative failure to initiate or sustain conversational interchange (at whatever level of language skill is present), in which there is reciprocal responsiveness to the communications of the other person

c. stereotyped and repetitive use of language or idiosyncratic use of words or phrases

d. lack of varied spontaneous make-believe play or (when young) social imitative play (Kerola & Kujanpää 2009, 28.)

3. Restricted, repetitive, and stereotyped patterns of behavior, interests, and activities are manifested in at least one of the following:

a. An encompassing preoccupation with one or more stereotyped and restricted patterns of interest that are abnormal in content or focus; or one or more interests that are abnormal in their intensity and circumscribed nature though not in their content or focus

b. Apparently compulsive adherence to specific, nonfunctional routines or rituals

c. Stereotyped and repetitive motor mannerisms that involve either hand or finger flapping or twisting or complex whole body movements

d. Preoccupations with part-objects of non-functional elements of play materials (such as their oder, the feel of their surface, or the noise or vibration they generate) (Kerola & Kujanpää 2009, 28.)

C. The clinical picture is not attributable to the other varieties of pervasive developmental disorders:

disinhibited attachment disorder (F94.2)

(Kerola & Kujanpää 2009, 28-29.)

F84.1 Atypical autism

"A type of pervasive developmental disorder that differs from childhood autism either in age of onset or in failing to fulfil all three sets of diagnostic criteria. This subcategory should be used when there is abnormal and impaired development that is present only after age three years, and a lack of sufficient demonstrable abnormalities in one or two of the three areas of psychopathology required for the diagnosis of autism (namely, reciprocal social interactions, communication, and restricted, stereotyped, repetitive behaviour) in spite of characteristic abnormalities in the other area(s). Atypical autism arises most often in profoundly retarded individuals and in individuals with a severe specific developmental disorder of receptive language.
Atypical childhood psychosis
Mental retardation with autistic features
Use additional code (F70-F79), if desired, to identify mental retardation." (World Health Organization ICD Version 2007.)

F84.2 Rett's syndrome

"A condition, so far found only in girls, in which apparently normal early development is followed by partial or complete loss of speech and of skills in locomotion and use of hands, together with deceleration in head growth, usually with an onset between seven and 24 months of age. Loss of purposive hand movements, hand-wringing stereotypies, and hyperventilation are characteristic. Social and play development are arrested but social interest tends to be maintained. Trunk ataxia and apraxia start to develop by age four years and choreoathetoid movements frequently follow. Severe mental retardation almost invariably results." (World Health Organization ICD Version 2007.)

F84.3 Other childhood disintegrative disorder

"A type of pervasive developmental disorder that is defined by a period of entirely normal development before the onset of the disorder, followed by a definite loss of previously acquired skills in several areas of development over the course of a few months. Typically, this is accompanied by a general loss of interest in the environment, by stereotyped, repetitive motor mannerisms, and by autistic-like abnormalities in social interaction and communication. In some cases the disorder can be shown to be due to some associated encephalopathy but the diagnosis should be made on the behavioural features.
Dementia infantilis
Disintegrative psychosis
Heller's syndrome
Symbiotic psychosis
Use additional code, if desired, to identify any associated neurological condition.
Excludes: Rett's syndrome ( F84.2 )" (World Health Organization ICD Version 2007.)

F84.4 Overactive disorder associated with mental retardation and stereotyped movements

"An ill-defined disorder of uncertain nosological validity. The category is designed to include a group of children with severe mental retardation (IQ below 35) who show major problems in hyperactivity and in attention, as well as stereotyped behaviours. They tend not to benefit from stimulant drugs (unlike those with an IQ in the normal range) and may exhibit a severe dysphoric reaction (sometimes with psychomotor retardation) when given stimulants. In adolescence, the overactivity tends to be replaced by underactivity (a pattern that is not usual in hyperkinetic children with normal intelligence). This syndrome is also often associated with a variety of developmental delays, either specific or global. The extent to which the behavioural pattern is a function of low IQ or of organic brain damage is not known." (World Health Organization ICD Version 2007.)

F84.5 Asperger's syndrome

"A disorder of uncertain nosological validity, characterized by the same type of qualitative abnormalities of reciprocal social interaction that typify autism, together with a restricted, stereotyped, repetitive repertoire of interests and activities. It differs from autism primarily in the fact that there is no general delay or retardation in language or in cognitive development. This disorder is often associated with marked clumsiness. There is a strong tendency for the abnormalities to persist into adolescence and adult life. Psychotic episodes occasionally occur in early adult life.
Autistic psychopathy
Schizoid disorder of childhood" (World Health Organization ICD Version 2007.)

A. There is no clinically significant general delay in spoken or receptive language or cognitive development.

Diagnosis requires that single words should have developed by 2 years of age or earlier and that communicative phrases be used by 3 years of age or earlier. Self-help skills, adaptive behaviour and curiosity about the environment during the first 3 years should be at a level consistent with normal intellectual development. However, motor milestones may be somewhat delayed and motor clumsiness is usual (although not a necessary diagnostic feature). Isolated special skills, often related to abnormal preoccupations, are common, but are not required for diagnosis. (Kerola & Kujanpää 2009, 29.)

B. There are qualitative abnormalities in reciprocal social interaction

(criteria as for autism) (Kerola & Kujanpää 2009, 29.)

C. The individual exhibits an unusual intense, circumscribed interest of restricted, repetitive and stereotyped patterns of behavior interests and activities

(criteria as for autism; however, it would be less usual for these to include either motor mannerisms or preoccupations with part-objects or non-functional elements of play materials). (Kerola & Kujanpää 2009, 29.)

D. The disorder is not attributable to other varieties of pervasive developmental disorder:

Skitsofrenia simplex (F20.6)

Schizotypal disorder (F21)

Obsessive-compulsive disorder (F42)

Anakastic personality disorder (F60.5)

Other pervasive developmental disorder (F84.0 - F84.4)

Reactive attachment disorder of childhood (F94.1)

Disinhibited attachment disorder of childhood (F94.2) (Kerola & Kujanpää 2009, 29.)