Poruchy autistického spektra dle MKN-11: Přehled klinických kritérií a diagnostických nástrojů

ICD-11 classification and clinical criteria of Autism Spectrum Disorder (ASD)

The ICD-11 has introduced significant changes in the classification of Autism Spectrum Disorder (ASD), incorporating both childhood autism and Asperger's syndrome into a single category. The ICD-11's approach to ASD classification is more comprehensive and inclusive, taking into account the individual's language and intellectual abilities.

The ICD-11's clinical criteria for the diagnosis of "core" Autism Spectrum Disorder (ASD) include the following essential features:

• Persistent deficits in the ability to initiate and sustain reciprocal social interaction and social communication.
• A range of restricted, repetitive, and inflexible patterns of behavior and interests.
• These disturbances are usually associated with distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning.

The ICD-11's classification system for ASD includes several subtypes, that are categorized based on the individual's language and intellectual abilities, providing a more detailed and nuanced approach to characterizing the different presentations of ASD.

The subtypes of ASD according to the ICD-11 are as follows:

1. Autism spectrum disorder WITHOUT disorder of intellectual development and WITH MILD OR NO impairment of functional language: 6A02.0
2. Autism spectrum disorder WITHOUT disorder of intellectual development and WITH impaired functional language: 6A02.1
3. Autism spectrum disorder WITH disorder of intellectual development and WITH MILD OR NO impairment of functional language: 6A02.2
4. Autism spectrum disorder WITH disorder of intellectual development and WITH impaired functional language: 6A02.3
5. Autism spectrum disorder without disorder of intellectual development and WITH MILD OR NO impairment of functional language: 6A02.4
6. Autism spectrum disorder WITHOUT disorder of intellectual development and WITH impaired functional language: 6A02.5

These subtypes reflect the range of intellectual functioning and language abilities, from individuals with high IQ and good language to those with intellectual disability and no functional language. The ICD-11's classification system provides a more detailed and nuanced approach to characterizing the different presentations of ASD, taking into account the individual's language and intellectual abilities.

The ICD-11's approach to ASD classification is important for pediatricians and other medical specialists who diagnose and treat individuals with ASD. The new system allows for a more accurate and consistent diagnosis across different age groups and levels of severity, enabling clinicians to provide more tailored and precise diagnoses and support for individuals with ASD.

In addition to the clinical criteria, the ICD-11 recommends the use of specific assessment tools and metrics for the evaluation of ASD:

• DISCO (Diagnostic Interview for Social and Communication Disorders): A semi-structured interview designed to elicit a full range of information from parents or caregivers about a child's social and communication abilities, as well as their behavior and interests.
• ADI-R (Autism Diagnostic Interview - Revised): A comprehensive, semi-structured interview for diagnosing autism and distinguishing it from other developmental disorders. It is conducted with the parents or caregivers of the individual being evaluated.
• ADOS (Autism Diagnostic Observation Schedule): A semi-structured assessment of communication, social interaction, and play (or imaginative use of materials) for individuals suspected of having autism or other pervasive developmental disorders.

ICD-10 and ICD-11

The ICD-10 provided a classification system for Autism Spectrum Disorder (ASD) that included subtypes based on the age of onset and the presence or absence of language delay. The subtypes of ASD according to the ICD-10 were Childhood autism, Atypical autism, Other pervasive developmental disorders, and Pervasive developmental disorder, unspecified. However, the ICD-10 did not provide detailed guidelines for distinguishing between autism with and without intellectual disability, a feature that is included in the ICD-11. The ICD-10's approach to ASD classification was less comprehensive and inclusive compared to the ICD-11.

In conclusion, the ICD-11 provides clinical criteria for the diagnosis of "core" Autism Spectrum Disorder (ASD), which is characterized by impairments in social communication and restricted, repetitive patterns of behavior, interests, or activities. The ICD-11's approach to ASD classification is more comprehensive and inclusive, taking into account the individual's language and intellectual abilities. The subtypes of ASD are categorized based on the individual's language and intellectual abilities, providing a more detailed and nuanced approach to characterizing the different presentations of ASD.

ICD-11 and DSM-5

The ICD-11 and DSM-5 offer distinct approaches to the classification and diagnosis of Autism Spectrum Disorder (ASD). The ICD-11's clinical criteria for the diagnosis of "core" ASD include persistent deficits in social communication and social interaction, as well as a range of restricted, repetitive, and inflexible patterns of behavior and interests. Its classification system encompasses several subtypes, categorized based on the individual's language and intellectual abilities, providing a more detailed and nuanced approach to characterizing the different presentations of ASD. In addition to the clinical criteria, the ICD-11 recommends the use of specific assessment tools and metrics for the evaluation of ASD, such as DISCO, ADI-R, and ADOS. The ICD-11's approach is more comprehensive, inclusive, and tailored, allowing for a more accurate diagnosis and support for individuals with ASD across different age groups and levels of severity.

For more information on the ICD-11's classification of ASD, please visit the official ICD-11 website at https://icd.who.int/en.