ICD-10 vs DSM-V

[Dusty gold]

Not none...I meant bone up on info!

 

[Dusty gold]

Flippin spell check! She is Adhd but meant ADD! SILENTLY SCREAMING!!!!

 

[Dusty gold]

Last time I try this...the school says she on the spectrum but won't have school's assessment till 11/14...

 

[Crossbreed]

Both Home - Autism Society and US Autism & Asperger Association continue to recognize Asperger's Syndrome, post-DSM4.

 

[Crossbreed]

@Dusty gold , there is an EDIT link at the bottom of each of your posts while they are still new.

 

[katjac]

Here is the simple answer to your question. ICD-10 is what is used for billing, period. The DSM5 is what is used for diagnosis, and there is an ICD-10 code listed for each DSM5 code. In other words, the ICD-10 is not a separate or different process of diagnosis with different criteria. It is a numerical code that insurance companies are now requesting for processing insurance claims rather than DSM codes. I am a psychologist, so this is why I know about this.

 

[psychgirl95]

Preference could be a factor in your diagnosis coming from the ICD, although I have to wonder if insurance is the main reason. Either way, it doesn't really matter (unless you're a student); you got your diagnosis and that's a huge accomplishment! Honestly, I don't even really know what I was diagnosed from (and I suppose it doesn't really matter). My psychologist (who disagrees with the DSM-5 only using ASD) diagnosed me within 20 minutes or so of our hour session, and he just said something like, "I'm pretty sure that you qualify for the diagnosis of Asperger's instead of Autistic Disorder." In the letter he wrote for my school's disability support services, I think both ASD and Asperger's were mentioned. (My school, like many others, requires that diagnoses be from the DSM-5.)

Now, as for the DSM-5 controversy, I'm a psychology and neuroscience double major (intending to become a psychiatrist that specializes in treating and researching ASD), so it's probably not surprising that I see the DSM-5 a whole lot differently than most people on the spectrum do. (Apparently, my interest in reading the DSM for fun was an aspect of me being diagnosed.) I don't know much about psychology students (presumably in the UK?) being told to ignore the ICD-10, but I would not be surprised if the reason for doing so is because it's been known for quite some time now that the ICD-11 will just use ASD. However, I do I know from reading the research articles that the DSM-5 committee based their changes on that the diagnosis was actually changed for multiple reasons, most of which were to help people with autism, not hurt them.

Believe it or not, but the DSM-IV-TR was completely flawed (as was the DSM-IV); one clinician could diagnose you with PDD-NOS, the other Asperger's, and another Autistic Disorder. In other words, there was no consensus about which diagnosis a person had; part of this actually had to do with the fact that Asperger's never was really defined well and was instead just seen as "high functioning autism." This wouldn't matter if each diagnosis was considered equal (as in the diagnosis of ASD), but since they weren't it did matter because the diagnosis that a child received determined what educational and therapeutic services they received (or were eligible for). Some clinicians openly admitted to diagnosing a kid who met the criteria for Asperger's (or PDD-NOS) with AD instead, just so they could receive the services necessary to help them succeed. If the criteria for the subtypes isn't going to be followed, what's the point in having them?

Not surprisingly, since the ranking of the disorders was usually seen as AD being the most severe and PDD-NOS the least severe (although I've also seen some people consider it more severe than Asperger's), a kid with a diagnosis of AD could get services that a kid with Asperger's couldn't. This makes no sense as the two diagnoses were differentiated based on one symptom (normal or delayed speech, which is kind of abstract anyway). A diagnosis of ASD became less meaningful because of all of the aforementioned issues; that's what lead people to not believe in the validity of the diagnosis. Consequently, the idea of a spectrum diagnosis was implemented so that everyone who receives the diagnosis is eligible for the same services and so that autism diagnoses can actually be valid (e.g., convey a person's approximate place on the spectrum). The specifiers are used for this purpose (and I know people disagree with the idea of the specifiers too).

With all that being said, without a doubt, there are some serious flaws in how ASD is diagnosed and seen by clinicians (including how they respond to an older individual asking to be assessed for it), but most of them have to do with the fact that ASD is already an abstract diagnosis; it's not like we have biomarkers or can take fMRI scans and diagnose ASD from that (although that's what my research lab is kinda focusing on being able to do). Having 3 autism diagnoses that essentially couldn't tell a clinician anything about their patient/client only made things worse. On that note, in regards to getting a diagnosis under the DSM-5 being harder, because of what I just mentioned, that's actually not necessarily true in all cases. From what I've seen (and I admit this isn't an area that I actively pursue), there are some studies about it, although I believe most only focused on children, and not adolescents or adults, and the findings have actually been mixed. (Some have found that the majority of children still would receive a diagnosis.) In the realm of ASD research, there's very few articles about it. Most of them seem to have been published right after the DSM-5 was published too, so it doesn't seem like it's actively being pursued much anymore.

For the most part, I don't think the diagnosis being changed affects older clinicians who've seen many individuals with Asperger's; this may be only my experience, but I've seen younger clinicians (whom generally work with children) being uninformed of how higher functioning individuals can present (so it's understandable to be concerned for children, although not necessarily for older individuals attempting to get a diagnosis). For example, my first ASD assessment was conducted by a recently graduated psychologist. Since her research mentor throughout her PhD is now my mentor, I figured she'd be knowledgeable about Asperger's, but she literally knew nothing about it. The reasons she said I didn't meet criteria for the diagnosis of ASD were so ridiculous that I can't even remember most of what she said. It was stuff like, "People with autism don't have anxiety because they're not aware that they're socially awkward."

Sorry for the essay; you can probably tell that this is a topic I'm pretty passionate about.

 

[AspieWatchmaker]

Preference could be a factor in your diagnosis coming from the ICD, although I have to wonder if insurance is the main reason. Either way, it doesn't really matter (unless you're a student); you got your diagnosis and that's a huge accomplishment! Honestly, I don't even really know what I was diagnosed from (and I suppose it doesn't really matter). My psychologist (who disagrees with the DSM-5 only using ASD) diagnosed me within 20 minutes or so of our hour session, and he just said something like, "I'm pretty sure that you qualify for the diagnosis of Asperger's instead of Autistic Disorder." In the letter he wrote for my school's disability support services, I think both ASD and Asperger's were mentioned. (My school, like many others, requires that diagnoses be from the DSM-5.)

Now, as for the DSM-5 controversy, I'm a psychology and neuroscience double major (intending to become a psychiatrist that specializes in treating and researching ASD), so it's probably not surprising that I see the DSM-5 a whole lot differently than most people on the spectrum do. (Apparently, my interest in reading the DSM for fun was an aspect of me being diagnosed.) I don't know much about psychology students (presumably in the UK?) being told to ignore the ICD-10, but I would not be surprised if the reason for doing so is because it's been known for quite some time now that the ICD-11 will just use ASD. However, I do I know from reading the research articles that the DSM-5 committee based their changes on that the diagnosis was actually changed for multiple reasons, most of which were to help people with autism, not hurt them.

Believe it or not, but the DSM-IV-TR was completely flawed (as was the DSM-IV); one clinician could diagnose you with PDD-NOS, the other Asperger's, and another Autistic Disorder. In other words, there was no consensus about which diagnosis a person had; part of this actually had to do with the fact that Asperger's never was really defined well and was instead just seen as "high functioning autism." This wouldn't matter if each diagnosis was considered equal (as in the diagnosis of ASD), but since they weren't it did matter because the diagnosis that a child received determined what educational and therapeutic services they received (or were eligible for). Some clinicians openly admitted to diagnosing a kid who met the criteria for Asperger's (or PDD-NOS) with AD instead, just so they could receive the services necessary to help them succeed. If the criteria for the subtypes isn't going to be followed, what's the point in having them?

Not surprisingly, since the ranking of the disorders was usually seen as AD being the most severe and PDD-NOS the least severe (although I've also seen some people consider it more severe than Asperger's), a kid with a diagnosis of AD could get services that a kid with Asperger's couldn't. This makes no sense as the two diagnoses were differentiated based on one symptom (normal or delayed speech, which is kind of abstract anyway). A diagnosis of ASD became less meaningful because of all of the aforementioned issues; that's what lead people to not believe in the validity of the diagnosis. Consequently, the idea of a spectrum diagnosis was implemented so that everyone who receives the diagnosis is eligible for the same services and so that autism diagnoses can actually be valid (e.g., convey a person's approximate place on the spectrum). The specifiers are used for this purpose (and I know people disagree with the idea of the specifiers too).

With all that being said, without a doubt, there are some serious flaws in how ASD is diagnosed and seen by clinicians (including how they respond to an older individual asking to be assessed for it), but most of them have to do with the fact that ASD is already an abstract diagnosis; it's not like we have biomarkers or can take fMRI scans and diagnose ASD from that (although that's what my research lab is kinda focusing on being able to do). Having 3 autism diagnoses that essentially couldn't tell a clinician anything about their patient/client only made things worse. On that note, in regards to getting a diagnosis under the DSM-5 being harder, because of what I just mentioned, that's actually not necessarily true in all cases. From what I've seen (and I admit this isn't an area that I actively pursue), there are some studies about it, although I believe most only focused on children, and not adolescents or adults, and the findings have actually been mixed. (Some have found that the majority of children still would receive a diagnosis.) In the realm of ASD research, there's very few articles about it. Most of them seem to have been published right after the DSM-5 was published too, so it doesn't seem like it's actively being pursued much anymore.

For the most part, I don't think the diagnosis being changed affects older clinicians who've seen many individuals with Asperger's; this may be only my experience, but I've seen younger clinicians (whom generally work with children) being uninformed of how higher functioning individuals can present (so it's understandable to be concerned for children, although not necessarily for older individuals attempting to get a diagnosis). For example, my first ASD assessment was conducted by a recently graduated psychologist. Since her research mentor throughout her PhD is now my mentor, I figured she'd be knowledgeable about Asperger's, but she literally knew nothing about it. The reasons she said I didn't meet criteria for the diagnosis of ASD were so ridiculous that I can't even remember most of what she said. It was stuff like, "People with autism don't have anxiety because they're not aware that they're socially awkward."

Sorry for the essay; you can probably tell that this is a topic I'm pretty passionate about.

I deffinately agree that cleaning up the criteria and unifying the diagnosis on a spectrum to reflect the spectral nature of the condition going forward is for the best. This is part of my confusion of not having been placed within that criteria. As they say though, the devil is in the details and it would be concerning to me if it is harder to be diagnosed and get the support you need in the new system.

Thank you for sharing so much information on a topic which you are passionate about.

 

[AspieWatchmaker]

Here is the simple answer to your question. ICD-10 is what is used for billing, period. The DSM5 is what is used for diagnosis, and there is an ICD-10 code listed for each DSM5 code. In other words, the ICD-10 is not a separate or different process of diagnosis with different criteria. It is a numerical code that insurance companies are now requesting for processing insurance claims rather than DSM codes. I am a psychologist, so this is why I know about this.

Hmm.. seems I had a fundimental misunderstanding here. So the ICD codifies the names of conditions for statistical, recordkeeping, and insurance/billing without stating the criteria for the conditions themselves? And there is weirdness at the moment with regards to our topic because the version of the ICD currently used in the US does not correspond exactly to the current DSM?

This is both a more simple and a more complicated subject than I imagined.

 

[Nitro]

I'm not sure how many of you actually read any of the DSMs,but I did read all of IV,some of III and skimmed over 5.
I never bothered to look at the ICD writings because they didn't apply to what I wanted to know about the USA,but I'll assume they are pretty much the same event printed on different paper with slight differences in the language.


While I totally agree that the DSM-5 was written as a fiscal responsibility guide for government and insurance purposes,I think it's also myopic in believing that cutting clients out of a one size fits all diagnosis was the answer just the same.

If you try to cookie cutter label psych issues,you will be overrun by the crossovers present in all of psychology,not just autism spectrum disorders. As they attempt to better understand all of sciences,changes will always be necessary as more discoveries are made or older theories are tossed aside.

To me,the varied levels of ASD impairment show an approach to better addressing the issues at hand and addressing actual symptoms instead of hiding some under a smaller Asperger's umbrella and kicking them to the curb.

Labeling is an attempt to make order of it all,but most important to keep in mind is that the entire craft is highly subjective where it is influenced by what school of psychology they were trained under or what their practice follows.
That part of my statement was verified by a professional that I manipulated to open up to me instead of the other way around.
Some clinical people will avoid giving out the autism labels due to what problems that could hand them later in life as they enter the employment arena.

If you follow what I am saying here,you will better understand that there are vast variances in how autism spectrum disorders manifest themselves across the entire spectrum,the key word here being spectrum,not a pin pointed focus on a small area that some of y'all still want to cling to.

In the end,you or they can call your condition anything you or they want,but it still won't change who or what you are inside.

 

[Voxsh]

That's incorrect information, Aspergers is an important part of ICD10, it no longer exists under DSM 5 and is likely to disappear from ICD11 which is releas3in May next year.

 

[Crossbreed]

That's incorrect information,...

Which post are you referring to?

 

[WereBear]

Pertinent to me, diagnosed as an adult, is that my insurance company would not pay for the diagnosis, will not pay for anything that actually helps (weighted blanket, massage therapy, supplements) and will only pay for psychiatric drugs, which do not work on me.

My severe illness from over-coping is not recognized. I have to drive myself into the ground, develop a physical illness, and that they will treat.

 

[Judge]

While I totally agree that the DSM-5 was written as a fiscal responsibility guide for government and insurance purposes,I think it's also myopic in believing that cutting clients out of a one size fits all diagnosis was the answer just the same.

Good point. Whether or not diagnostic protocols become globally uniform, it won't change the problem of some of those diagnosing their patients in such a manner.

Such as those who cavalierly dismiss the possibility of being on the spectrum based only on things like having the ability to look people in the eye. Something I inherently have, yet learned to condition myself to tolerate it. Indeed, "one size does not fit all" when it comes to what should be a very individualized diagnostic process from the start.

I just wish that any of the diagnostic processes devoted more time to the consideration of those of us who managed to escape proper diagnosis over so many years and learned to effectively mask our own autism. Something which doesn't at all negate a neurological condition we were born with, and will die with.

 

[WereBear]

The worst part is how Asperger’s is also a gift, especially in the modern age. Since hanging with you all, and contemplating my life in light of this knowledge, I honestly see society as far more of a “handicap” than my brain.

 

[the_tortoise]

So the ICD codifies the names of conditions for statistical, recordkeeping, and insurance/billing without stating the criteria for the conditions themselves?

No, the ICD is also a diagnostic manual with written criteria. (Not just a diagnostic manual for mental/neurological disorders, either -- "ICD" stands for "International Classification of Diseases"...it is a diagnostic manual for everything.)

The DSM has its own codes, and some places/organizations still use them -- on my diagnostic report from about 6-7 years ago (in Canada), only DSM-IV codes were used.

Anyone who would like to read the ICD criteria can find it here (in section F84): ICD Green Book

the two diagnoses [Asperger's and Autistic Disorder] were differentiated based on one symptom (normal or delayed speech, which is kind of abstract anyway)

In practice, yes.....In terms of the actual diagnostic critera, it was more complicated than that. (Although I agree with you on the statement the above quote comes from and I think merging the diagnoses was the right thing to do -- there was way more similarity than difference and the differences that existed weren't proven to be meaningful in terms of any possible neurophysiological/etiological differences, in terms of the overall picture of symptoms and functioning, or in terms of outcomes or support needs or what a person's life was like.....not to mention, as you said, how it's pointless -- and counterproductive for both research and clinical/scientific understanding -- to have distinct diagnostic criteria if nobody follows them. Still, the diagnostic distinctions were more complicated than just "speech delay vs. no speech delay".....)

For one thing, a person could be diagnosed with Autistic Disorder if they had normal speech (at least as normal as those with Asperger's). To be diagnosed with Autistic Disorder, a person needed to meet only one of the "communication criteria" in section A(2), which were as follows:

" 2. Qualitative impairments in communication as manifested by at least one of the following:

a. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).​

b. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.​

c. stereotyped and repetitive use of language or idiosyncratic language.​

d. lack of varied, spontaneous, make-believe play or social imitative play appropriate to developmental level. "​

Criterion 2(d) (bolded one) has basically nothing to do with speech or language.

And criteria 2(b) and 2(c) are symptoms of language delay/disorder rather than a speech delay.... (I know that most people don't separate speech and language but they are different things; Speech is the act of making word-sounds; Language is any system/code of symbols and meanings used to communicate.)

Another difference beyond the possible speech delay distinction is in the number of symptom criteria that had to be met for diagnosis; For Autistic Disorder it was a total of 6, for Asperger's it was a total of 3. If you count only the symptom criteria that are identical between them (don't count the section of "communcation criteria" I copied above) then for Autistic Disorder you'd need at least 5 symptoms to be diagnosed, versus 3 for Asperger's.

Interestingly, one of the DSM-IV criteria for Asperger's was this:

" F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. "

This meant that if a person met criteria for Autistic Disorder and Asperger's at the same time, they were supposed to be diagnosed with Autistic Disorder. (This rule was ignored a lot, as part of what psychgirl95 has already talked about where clinicians basically made up their own rules for various reasons.)

Anyone who would like to read the DSM-IV criteria for Asperger's and/or Autistic Disorder published in 2000 can read them here:

299.00 Autistic Disorder
299.80 Autistic Disorder

(There is additional explanation in the actual book that provides more detailed examples and guides interpretation of the criteria, but I have only once seen part of it published on the web and I doubt my ability find the page again -- pretty sure the DSM can be found, or ordered via inter-library loan, at most public libraries, though.)

 

[Dusty gold]

No, the ICD is also a diagnostic manual with written criteria. (Not just a diagnostic manual for mental/neurological disorders, either -- "ICD" stands for "International Classification of Diseases"...it is a diagnostic manual for everything.)

The DSM has its own codes, and some places/organizations still use them -- on my diagnostic report from about 6-7 years ago (in Canada), only DSM-IV codes were used.

Anyone who would like to read the ICD criteria can find it here (in section F84): ICD Green Book


In practice, yes.....In terms of the actual diagnostic critera, it was more complicated than that. (Although I agree with you on the statement the above quote comes from and I think merging the diagnoses was the right thing to do -- there was way more similarity than difference and the differences that existed weren't proven to be meaningful in terms of any possible neurophysiological/etiological differences, in terms of the overall picture of symptoms and functioning, or in terms of outcomes or support needs or what a person's life was like.....not to mention, as you said, how it's pointless -- and counterproductive for both research and clinical/scientific understanding -- to have distinct diagnostic criteria if nobody follows them. Still, the diagnostic distinctions were more complicated than just "speech delay vs. no speech delay".....)

For one thing, a person could be diagnosed with Autistic Disorder if they had normal speech (at least as normal as those with Asperger's). To be diagnosed with Autistic Disorder, a person needed to meet only one of the "communication criteria" in section A(2), which were as follows:

" 2. Qualitative impairments in communication as manifested by at least one of the following:

a. delay in, or total lack of, the development of spoken language (not accompanied by an attempt to compensate through alternative modes of communication such as gesture or mime).​

b. in individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others.​

c. stereotyped and repetitive use of language or idiosyncratic language.​

d. lack of varied, spontaneous, make-believe play or social imitative play appropriate to developmental level. "​

Criterion 2(d) (bolded one) has basically nothing to do with speech or language.

And criteria 2(b) and 2(c) are symptoms of language delay/disorder rather than a speech delay.... (I know that most people don't separate speech and language but they are different things; Speech is the act of making word-sounds; Language is any system/code of symbols and meanings used to communicate.)

Another difference beyond the possible speech delay distinction is in the number of symptom criteria that had to be met for diagnosis; For Autistic Disorder it was a total of 6, for Asperger's it was a total of 3. If you count only the symptom criteria that are identical between them (don't count the section of "communcation criteria" I copied above) then for Autistic Disorder you'd need at least 5 symptoms to be diagnosed, versus 3 for Asperger's.

Interestingly, one of the DSM-IV criteria for Asperger's was this:

" F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia. "

This meant that if a person met criteria for Autistic Disorder and Asperger's at the same time, they were supposed to be diagnosed with Autistic Disorder. (This rule was ignored a lot, as part of what psychgirl95 has already talked about where clinicians basically made up their own rules for various reasons.)

Anyone who would like to read the DSM-IV criteria for Asperger's and/or Autistic Disorder published in 2000 can read them here:

299.00 Autistic Disorder
299.80 Autistic Disorder

(There is additional explanation in the actual book that provides more detailed examples and guides interpretation of the criteria, but I have only once seen part of it published on the web and I doubt my ability find the page again -- pretty sure the DSM can be found, or ordered via inter-library loan, at most public libraries, though.)

 

[Dusty gold]

The tortise..thanks for the info! I always wondered about that because I feel she is autistic with asperberg tendencies...was very informative..tomorrow I meet with all school officials...and psychologist is going to have full testing results by the end of this week...its been a long road!

 

[the_tortoise]

The tortise..thanks for the info! I always wondered about that because I feel she is autistic with asperberg tendencies...was very informative..tomorrow I meet with all school officials...and psychologist is going to have full testing results by the end of this week...its been a long road!

You're welcome. If you want to read the current DSM-5 criteria for Autism Spectrum Disorder, here is a link.

I hope everything goes well with your grand-daughter's evaluation and whatever comes after