AUTISM SPECTRUM DISORDER 299.

00 (DSM-5)

Specify if: Associated with a known medical or genetic condition or environmental factor; Associated
with another neurodevelopmental, mental, or behavioral disorder
Specify current severity for Criterion A and Criterion B: Requiring very substantial support, Requiring
substantial support, Requiring support
Specify if: With or without accompanying intellectual impairment, With or without accompanying
language impairment, With catatonia (use additional code 293.89 [F06.1])

A. Persistent deficits in social communication and social interaction across multiple contexts, as
manifested by the following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and
failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to
failure to initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example,
from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body
language or deficits in understanding and use of gestures; to a total lack of facial expressions and
nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from
difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play
or in making friends; to absence of interest in peers.

Specify current severity:

Severity is based on social communication impairments and restricted, repetitive patterns of
behavior

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the
following, currently or by history (examples are illustrative, not exhaustive; see text):
1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor
stereotypies, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal
behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns,
greeting rituals, need to take same route or eat same food every day).
3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g., strong attachment to
or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper- or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment
(e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures,
excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity:

Severity is based on social communication impairments and restricted, repetitive patterns of
behavior

C. Symptoms must be present in the early developmental period (but may not become fully manifest
until social demands exceed limited capacities, or may be masked by learned strategies in later life).
D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of
current functioning.
E. These disturbances are not better explained by intellectual disability (intellectual developmental
disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently
co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social
communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder,
or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism
spectrum disorder. Individuals who have marked deficits in social communication, but whose
symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social
(pragmatic) communication disorder.

Specify if:
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor
(Coding note: Use additional code to identify the associated medical or genetic condition.)
Associated with another neurodevelopmental, mental, or behavioral disorder
(Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or
behavioral disorder[s].)
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119–120,
for definition)
(Coding note: Use additional code 293.89 [F06.1]
catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)
6A02 Autism spectrum disorder (ICD-11)
Autism spectrum disorder is characterized by persistent deficits in the ability to initiate and to sustain
reciprocal social interaction and social communication, and by a range of restricted, repetitive, and
inflexible patterns of behaviour and interests. The onset of the disorder occurs during the
developmental period, typically in early childhood, but symptoms may not become fully manifest until
later, when social demands exceed limited capacities. Deficits are sufficiently severe to cause
impairment in personal, family, social, educational, occupational or other important areas of
functioning and are usually a pervasive feature of the individual’s functioning observable in all settings,
although they may vary according to social, educational, or other context. Individuals along the
spectrum exhibit a full range of
intellectual functioning and language abilities.

Inclusions: Autistic disorder

Pervasive developmental delay
Exclusions: Developmental language disorder (6A01.2)
Schizophrenia or other primary psychotic disorders (BlockL1-6A2)

6A02.0 Autism spectrum disorder without disorder of intellectual development and

with mild or no impairment of functional language
All definitional requirements for autism spectrum disorder are met, intellectual functioning and
adaptive behaviour are found to be at least within the average range (approximately greater than the
2.3rd percentile), and there is only mild or no impairment in the individual's capacity to use functional
language (spoken or signed) for instrumental purposes, such as to express personal needs and desires.

6A02.1 Autism spectrum disorder with disorder of intellectual development and with
mild or no impairment of functional language
All definitional requirements for both autism spectrum disorder and disorder of intellectual
development are met and there is only mild or no impairment in the individual's capacity to use
functional language (spoken or signed) for instrumental purposes, such as to express personal needs and
desires. 8 ICD-11 MMS - 2018

6A02.2 Autism spectrum disorder without disorder of intellectual development and

with impaired functional language
All definitional requirements for autism spectrum disorder are met, intellectual functioning and
adaptive behaviour are found to be at least within the average range (approximately greater than the
2.3rd percentile), and there is marked impairment in functional language (spoken or signed) relative to
the individual’s age, with the individual not able to use more than single words or simple phrases for
instrumental purposes, such as to express personal needs and desires.

6A02.3 Autism spectrum disorder with disorder of intellectual development and with
impaired functional language
All definitional requirements for both autism spectrum disorder and disorder of intellectual
development are met and there is marked impairment in functional language (spoken or signed) relative
to the individual’s age, with the individual not able to use more than single words or simple phrases for
instrumental purposes, such as to express personal needs and desires.

6A02.4 Autism spectrum disorder without disorder of intellectual development and

with absence of functional language
All definitional requirements for autism spectrum disorder are met, intellectual functioning and
adaptive behaviour are found to be at least within the average range (approximately greater than the
2.3rd percentile), and there is complete, or almost complete, absence of ability relative to the
individual’s age to use functional language (spoken or signed) for instrumental purposes, such as to
express personal needs and desires.

6A02.5 Autism spectrum disorder with disorder of intellectual development and with
absence of functional language
All definitional requirements for both autism spectrum disorder and disorder of intellectual
development are met and there is complete, or almost complete, absence of ability relative to the
individual’s age to use functional language (spoken or signed) for instrumental purposes, such as to
express personal needs and desires

6A02.Y Other specified autism spectrum disorder

6A02.Z Autism spectrum disorder, unspecified

Pervasive Developmental Disorder F84

F84.0 Childhood autism
A pervasive developmental disorder defined by the presence of abnormal and/or impaired development
that is manifest before the age of 3 years, and by the characteristic type of abnormal functioning in all
three areas of social interaction, communication, and restricted, repetitive behaviour. The disorder
occurs in boys three
to four times more often than in girls.
Diagnostic guidelines
Usually there is no prior period of unequivocally normal development but, if there is, abnormalities
become apparent before the age of 3 years. There are always qualitative impairments in reciprocal
social interaction. These take the form of an inadequate appreciation of socio-emotional cues, as shown
by a lack of responses to other people's emotions and/or a lack of modulation of behaviour according to
social context; poor use of social signals and a weak
integration of social, emotional, and communicative behaviours; and, especially, a lack of socio-
emotional reciprocity. Similarly, qualitative impairments in communications are universal. These take
the form of a lack of social usage of whatever language skills are present; impairment in make-believe
and social imitative play; poor synchrony and lack of reciprocity in conversational interchange; poor
flexibility in language expression and a relative lack of creativity and fantasy in thought processes; lack
of emotional response to other people's verbal and nonverbal overtures; impaired use of variations in
cadence or emphasis to reflect communicative modulation; and a similar lack of accompanying gesture
to provide emphasis or aid meaning in spoken communication. The condition is also characterized by
restricted, repetitive, and stereotyped patterns of behaviour, interests, and activities. These take the form
of a tendency to impose rigidity and routine on a wide range of aspects of day-to day functioning; this
usually applies to novel activities as well as to familiar habits and play patterns. In early childhood
particularly, there may be specific attachment to unusual, typically non-soft objects. The children may
insist on the performance of particular routines in rituals of a nonfunctional character; there may be
stereotyped preoccupations with interests such as dates, routes or timetables; often there are motor
stereotypies; a specific interest in nonfunctional elements of objects (such as their smell or feel) is
common; and there may be a resistance to changes in routine or in details of the personal environment
(such as the movement of ornaments or furniture in the family home). In addition to these specific
diagnostic features, it is frequent for children with autism to show a range of other nonspecific
problems such as fear/phobias, sleeping and eating disturbances, temper tantrums, and aggression. Self-
injury (e.g. by wrist-biting) is fairly common, especially when there is associated severe mental
retardation. Most individuals with autism lack spontaneity, initiative, and creativity in the organization
of their leisure time and have difficulty applying conceptualizations in decision-making in work (even
when the tasks themselves are well within their capacity). The specific manifestation of deficits
characteristic of autism change as the children grow older, but the deficits continue into and through
adult life with a broadly similar pattern of problems in socialization, communication, and interest
patterns. Developmental abnormalities must have been present in the first 3 years for the diagnosis to
be made, but the syndrome can be diagnosed in all age groups. All levels of IQ can occur in association
with autism, but there is significant mental retardation in some three-quarters of cases.
Includes:
 autistic disorder
 infantile autism
 infantile psychosis
 Kanner's syndrome

Differential diagnosis. Apart from the other varieties of pervasive developmental disorder it is
important to consider: specific developmental disorder of receptive language (F80.2) with secondary
socio-emotional problems; reactive attachment disorder (F94.1) or disinhibited attachment disorder
(F94.2); mental retardation (F70-F79) with some associated emotional/behavioural disorder;
schizophrenia (F20. - ) of unusually early onset; and Rett's syndrome (F84.2).
Excludes: autistic psychopathy (F84.5)

F84.1 Atypical autism

A pervasive developmental disorder that differs from autism in terms either of age of onset or of failure
to fulfil all three sets of diagnostic criteria. Thus, abnormal and/or impaired development becomes
manifest for the first time only after age 3 years; and/or there are insufficient demonstrable
abnormalities in one or two of the three areas of psychopathology required for the diagnosis of autism
(namely, reciprocal social interactions, communication, and restrictive, stereotyped, repetitive
behaviour) in spite of characteristic abnormalities in the other area(s). Atypical autism arises most often
in profoundly retarded individuals whose very low level of functioning provides little scope for
exhibition of the specific deviant behaviours required for the diagnosis of autism; it also occurs in
individuals with a severe specific developmental disorder of receptive language. Atypical autism thus
constitutes a meaningfully separate condition from autism.

Includes: atypical childhood psychosis mental retardation with autistic features