Approaches To Diagnosis: A Brief Review
Both categorical and dimensional approaches to diagnosis have been utilized, although in actual clinical practice diagnostic approaches tend to be ideographic, ie, encompassing all the complexities of the specific individual.5 Categorical approaches have tended to dominate in official classification schemes, but are not incompatible with dimensional ones, eg, selection of an arbitrary cutoff point for hypertension or intellectual disability.
Categorical approaches have become much more sophisticated in recent yearsnotably with the advent of the research diagnostic criteria adopted with DSM-III .6,7 Categorical systems have great value for record-keeping and statistical purposes but face some intrinsic challenges, eg, the problem of setting a specific diagnostic threshold while recognizing subthreshold forms of conditions, dealing with co-occurring conditions , and addressing developmental change, as well as the enduring tension between narrow vs broader definitions. The latter reflects, in part, an intended use for research or more general clinical approaches.
Restricted And Repetitive Behaviors
ASD includes a wide variety of characteristics. Some of these include behavioral characteristics which widely range from slow development of social and learning skills to difficulties creating connections with other people. They may develop these difficulties of creating connections due to anxiety or depression, which autistic people are more likely to experience, and as a result isolate themselves.
Other behavioral characteristics include abnormal responses to sensations including sights, sounds, touch, taste and smell, and problems keeping a consistent speech rhythm. The latter problem influences an individual’s social skills, leading to potential problems in how they are understood by communication partners. Behavioral characteristics displayed by autistic people typically influence development, language, and social competence. Behavioral characteristics of autistic people can be observed as perceptual disturbances, disturbances of development rate, relating, speech and language, and motility.
The second core symptom of autism spectrum is a pattern of restricted and repetitive behaviors, activities, and interests. In order to be diagnosed with ASD under DSM-5 or DSM-5-TR, a person must have at least two of the following behaviors:
Autistic individuals can display many forms of repetitive or restricted behavior, which the Repetitive Behavior Scale-Revised categorizes as follows.
Self-injury
Objective Measurement Of Autism Symptoms
In the 1960âs and 1970âs, researchers sought to developobjective measures of the core ASD symptoms, resulting in the development of ratingscales used to aid in the identification of ASD . One of the primary measures to emerge included the Childhood AutismRating Scales , which assessed 15 autism-related symptoms based on observationand/or caregiver report. In addition, the CARS yielded an overall ASD severity scoreand a cutoff score used to determine the presence or absence of autism . Additional assessments were developed tostandardize the methods for assessing parent- and teacher-reported symptoms andclinical observation and to determine the presence of an ASD as well as the severityof ASD symptoms . Although the first instruments focused onthe assessment of children, ASD assessments have progressively focused on measuringsymptoms across the lifespan, including infancy and adulthood .Researchers have also turned their attention toward examining the distribution ofASD-related traits in the population as a whole and using ASD assessments to examine the broader autism phenotype.
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How Is Autism Classified In The Icd
Autism is labeled with the code F84.0. It is a billable code, meaning its detailed enough to constitute a medical diagnosis. It falls under the section for mental and behavioral disorders , the subsection of pervasive and specific developmental disorders , and the smaller subsection of pervasive developmental disorders .
The ICD defines a pervasive developmental disorder as severe distortions in the development of many basic psychological functions that are not normal for any stage in development. F84 itself is a non-billable code, so it cant be entered into any system as a diagnosis, but every code that falls under it can.
Clinical Development And Diagnoses
Leo Kannerearly infantile autism
Autism as it is known today can be drawn back to the late 1930s, when two separate psychiatrists – Hans Asperger of the Vienna University Hospital and Leo Kanner of the Johns Hopkins Hospital – used the word autism to describe the patients they were studying in their own clinical research. The word autism first took its modern sense in German, when Asperger adopted Bleuler’s terminology autistic psychopaths in a 1938 lecture in German about child psychology. Asperger was investigating an ASD which was later known as Asperger syndrome, although it did not become widely recognized as a separate diagnosis until 1981. In English, Kanner first used autism in its modern sense when he introduced the label early infantile autism in a 1943 report of 11 children with striking behavioral similarities. Almost all the characteristics described in Kanner’s first paper on the subject, notably “autistic aloneness” and “insistence on sameness”, are still regarded as typical of the autistic spectrum of disorders. It is not known whether Kanner derived the term independently of Asperger.
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The Table Below Shows Related Terms From The Dsm
In relation to the DSM-IV and the ICD-10, the term, Autism Spectrum Disorders or ASDs, is a collective term for autism-related disorders. People using this term may or may not include the rarer conditions/disorders listed below. Clinicians in Australia use two references that describe ASD/PDD and its subtypes. The several references are:
- The Diagnostic and Statistical Manual of Mental Disorders, fifth edition 2013 is published by the American Psychiatric Association . The text of the DSM-5 section on Autism Spectrum Disorder can be found online at . The Diagnostic and Statistical Manual of Mental Disorders, fourth edition, 1994 was published by the American Psychiatric Association . There was also a “Text Revision” to this manual, usually known as the DSM-IV-TR, published in 2000.
- The World Health Organization publishes the International Statistical Classification of Diseases and Related Health Problems, tenth revision . The ICD-10 is available online: see
The following table shows relationships between clinical terms and their sources.
| DSM-5 |
|---|
F: Autistic Spectrum Disorder
This code is applicable to infantile autism, autism spectrum disorder, Kanners syndrome, and infantile psychosis.
Symptoms of Infantile Autism
- Doesnt maintain eye contact
- Doesnt have appropriate facial expressions
- Doesnt show empathy for others
- Doesnt respond to their parents facial expressions
- Doesnt look at objects or events a parent is looking at or pointing to
- Is unable to perceive what others might be thinking or feeling by observing their facial expressions
- Unable to make friends or uninterested in making friends
Symptoms of Infantile Autism
- Doesnt say single words when theyre sixteen months old
- Repeats people verbatim without understanding the meaning of the words
- Doesnt point at things to show their needs or share things with others
- Doesnt respond to their name being called but does respond to other sounds
- Mixes up their pronouns
- Doesnt appear to have a desire to communicate
- Doesnt start or continue a conversation
- Has a good rote memory
- Loses language or other social milestones between the ages of 15 to 24 months
- Doesnt use toys or other objects to represent people or real life in pretend play
Symptoms of Infantile Autism
Kanners Syndrome
Symptoms of Kanners Syndrome
Symptoms of Autism Spectrum Disorder
Symptoms of Autism Spectrum Disorder
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Adhd And Disruptive Behaviors
Using standardized assessments, researchers have found that one-third ormore of individuals with ASD also meet criteria for formal ADHD diagnosis, andthat the most common ADHD subtypes are the predominantly inattentive type andthe combined type . Additionally, disruptive behaviorsfrequently manifest themselves in individuals with ASD. Recent investigationshave found that up to sixty percent of adults with ASD and an intellectualdisability present with difficult-to-manage behaviors, including self-injurious,disruptive, and destructive behaviors. . In addition, a significant number of very young childrenpresent with difficult-to-manage behaviors, whereas oppositional and defiantbehaviors can occur in children and adolescents . Additionalclinically relevant subgroups are comprised of individuals who exhibit behaviorsthat pose a serious safety risk, including elopement, pica, and self-injury.
F844 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 who show major problems in hyperactivity and in attention, as well as stereotyped behaviours. They tend not to benefit from stimulant drugs and may exhibit a severe dysphoric reaction when given stimulants. In adolescence, the overactivity tends to be replaced by underactivity . 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.”
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Childhood Autism By Dsm
The American Psychiatric Association has outlined its criteria for childhood autism.
The child is not adapted to society, does not make contact with parents and others. The baby does not respond to the emotions of another person, rarely expresses any feelings. He/she is not interested in communicating with other people.
When trying to communicate he/she does not use facial expressions, gestures, different tone of voice. Speech is always monotonous.
It is difficult for an autist to make friends, he/she cannot play games, it is not interesting to play with other children.
There are stereotypes in movement, speech, or when using objects.
For example, laying out a row of toys, repeating one word many times. The child needs a regular daily routine, when there is a violation of the schedule, the baby is under severe stress.
It is difficult for such children to switch attention from one object to another. They are hard to be interested in something, but if a hobby arises, they are so addicted that interest turns into mania.
Pronounced or weak reaction to external stimuli of the senses. For example, an indifferent reaction to pain or hysteria for harsh strong sounds.
According to DSM-IV classification, the degree of severity is set for the child, it is determined whether there is mental retardation or not.
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International Classification Of Diseases Tenth Edition
The ICD-10 is the most commonly-used diagnostic manual in the UK.
It presents a number of possible autism profiles, such as childhood autism, atypical autism and Asperger syndrome. These profiles are included under the Pervasive Developmental Disorders heading, defined as “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”.
A revised edition is expected in January 2022 when it will start being used and is likely to closely align with the latest edition of the American Diagnostic and Statistical Manual .
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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.”
F843 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 Excludes: Rett’s syndrome ”
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Treatment Research And Asd Subtypes
Our desire to identify ASD subgroups stems not only from the need tounderstand etiology and cause, but also the need to develop a personalized medicineapproach to treating core and associated symptoms of ASD . Intreatment research, the need to study well-characterized and specifically chosensubgroups in order to increase statistical power and to allow testing of specifichypotheses has led to the recommendation that treatment subgroups be chosen tomaximize homogeneity in ways that best illuminate treatment efficacy . Based on these ideas, model treatmentapproaches are often developed first on a specific subgroup, and follow-up researchstudies are conducted to determine the generalizability of these treatments to newsamples or settings. Thus far, research shows that well-designed behavioral,educational, and pharmacologic interventions can result in significant improvementsin the social and behavioral functioning of individuals with ASD, although outcomesdo vary substantially.
Looking At F840 Autistic Disorder
The description of F84.0 autistic disorder in the ICD is basically the same as other descriptions of autismchildren with ASD will have difficulties with social interaction, language and communication skills, and repetitive behavior that become evident in early childhood, particularly before the age of three.
An ICD code may have inclusion terms, which are other conditions the code can be used for. Often, the inclusion terms are just synonyms of the primary one. In the case of code F84.0, the inclusion terms are autism spectrum disorder, infantile autism, infantile psychosis, and Kanners syndrome.
The ICD also has Type 1 Excludes Notes, which indicate when two codes should never be diagnosed alongside each other. In this case, autism and aspergers syndrome are considered to be mutually exclusive . Aspergers syndrome is called code F84.5 instead of code F84.0. The difference, according to the ICD, is that children with aspergers dont have the language and cognitive impairments that can be found in other autism spectrum disorders.
ICD coding allows professionals to include an additional code in their diagnosis, so they can further specify the disorder or identify any associated medical condition such as an intellectual disability. In that case, the patient would be coded for F84.0 autistic disorder as well as a code between F70-F79, which represent mild, moderate, severe, and unspecified intellectual disabilities.
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What Is The Icd Code For Autism
When you have a child or children with autism, you probably spend more time with doctors and therapists than most other families. First, theres the search for a diagnosis, then there are potential treatments, not to mention the other conditionssuch as ADHD or gastrointestinal issuessometimes associated with ASD.
All this means youve almost certainly come into contact with the ICD-10-CM. What does this string of letters and numbers mean, and how does it connect to autism? In this article, well explore the ICD and how it impacts autism diagnosis.
Complications & Comorbid Conditions Rules For F840
When F84.0 is used as a secondary diagnostic code, the patient’s visit may be considered to have Complications & Comorbid Conditions or Major Complications & Comorbid Conditions .
Exclusions apply. When the primary diagnostic code is is in the exclusion list, the patient visit CC/MCC does not qualify for a CC or MCC.
CC/MCC grouping rules are adjusted each year, so check the rules for the fiscal year of the patient’s discharge date.
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Dimensional Approaches To Diagnosis
Dimensional approaches offer some considerable advantages, with instruments often having had extensive periods of development and well known psychometric properties, ie, of reliability. These are exemplified in the use of standard tests of intelligence, adaptive behavior, or communication. For disorders like autism where highly unusual behaviors or developmental features are sampled there can be special problems for developing and using dimensional assessments. However, a considerable body of work now exists on their use both for purposes of screening and diagnosis.8,9 And now some of these approaches have been used to crosswalk back to categorical ones.
In autism and related conditions dimensional approaches have taken various forms. For example, instruments designed to assess normative development, eg, of intelligence, communication, motor development, and adaptive behavior are widely used.10,11 Such instruments provide information that can be used both to monitor progress to refine interventions and may also inform issues of diagnosis. As noted, subsequent differences in psychological profiles may mark different expressions of the autism phenotype, eg, with individuals with Asperger’s disorder exhibiting rather different profiles compared with those with classical autism.12 One of these instruments, the Vineland Adaptive Behavior Scales, has also been used as a screening tool and had considerable utility in discriminating individuals with and without autism.13
F: Other Childhood Disintegrative Disorders
This code can be applicable to several conditions, including dementia, disintegrative psychosis, symbiotic psychosis, and Hellers Syndrome. It is only suitable for individuals who are 0 to 17 years of age.
Hellers Syndrome
Hellers Syndrome is a vicious and regressive form of autism. It affects about every one or two children out of one hundred thousand. This condition causes developmental delays in language, social function, and motor skills.
Symptoms of Hellers Syndrome
- Regression in social skills
- Regression in motor skills Regression in language skills Cognitive regression Regression in toilet training
F84.5: Aspergers Syndrome
The F84.5 code is applicable to aspergers syndrome only. This neurodevelopmental condition causes a person to experience extreme challenges when engaging in nonverbal communication and social activities. Individuals with this disorder often behave in a very repetitive manner.
Symptoms of Aspergers Syndrome
- An increased ability to focus on details
- The ability to work independently
- Recognizing patterns that others usually dont
- Thinking in a unique and original way
- The capacity to persevere in specific interests without being swayed by other peoples opinions
- Intensity
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F: Pervasive Developmental Disorder
This ICD-10 code can be used to specify conditions such as active but odd autism, pervasive developmental disorder of a residual state, autism spectrum disorder, and savant syndrome. Individuals with active but odd autism approach others, but they do so in a naive, peculiar, and one-sided manner. They will often want to speak about their own interests without asking the other person questions. It appears as though theyre not actually looking for a reciprocal interaction.
However, they usually have much larger vocabularies and are much better at communicating verbally than other people who have been diagnosed with autism. Although their speech is better, it may still be delayed and not completed in a normal manner. For instance, these individuals may speak in long and complex sentences that theyve memorized because they were listening to someone else.
Symptoms of Individuals with Active but Odd Autism
- Clumsiness
- The ability to construct extremely repetitive imaginary scenarios and identities