What became of Asperger syndrome and childhood autism?

The former classification (ICD-10)

The 2016 guideline described the ICD-10 subtypes as follows: childhood autism required that all three areas (social interaction, communication, stereotyped and repetitive behaviour) were affected and that a developmental or language abnormality existed before the third year of life. For Asperger syndrome, differences in social interaction and in stereotyped behaviour including particular interests had to be present, with unremarkable language and cognitive development. Atypical autism was diagnosed if only one or two of the three criteria were met or the features only became detectable after the third year of life. There were also “other” and “unspecified” pervasive developmental disorders. ^{[4, Ch. A.2.2]}

What changed with the DSM-5

According to the guideline, the DSM-5 (USA 2013, German translation 2015) introduced, among other changes: all autism disorders in one category, the criteria in two symptom areas (social interaction and communication together; stereotyped and repetitive behaviour), a classification by clinical severity levels, a description across the lifespan with a possible later onset of features, and the possibility of diagnosing further mental disorders in addition. ^{[4, Ch. A.2.2]} The guideline expected at the time that diagnosis at the margins of the spectrum might become more restrictive, and referred to a meta-analysis according to which prevalence in individual studies would fall under the DSM-5 (by 7.3 to 68.4 %). ^{[4, Ch. A.2.2]} How this actually played out in practice, the editorial team has not evaluated. The current criteria at a glance: Diagnostic criteria for autism: DSM-5 and ICD-11 explained.

What applies in Germany today

For coding diagnoses in outpatient and inpatient care, according to the BfArM ICD-10-GM continues to apply in Germany until ICD-11 is introduced in the relevant area of application; the introduction will take several more years. ^[1] That is why findings can still carry labels such as “childhood autism”, “atypical autism” or “Asperger syndrome”. Note: this is a conclusion by the editorial team from the BfArM’s information.

What this can mean for you

• An older finding does not become “wrong”. Earlier labels are part of the classification of the time. What shows in everyday life and which support is helpful does not depend on the label. Note: this is an assessment by the editorial team.
• You may keep using the earlier label if it feels right for you. Many people do; on the question of terms: Language and terms: autistic, autism spectrum disorder, neurodivergence.
• For applications and proof, it can help to ask the responsible body how an older finding is treated. More on advice: Finding independent advice: what the EUTB does. Note: this is not legal information.
• If your finding is unclear, a new assessment can make sense: Assessment in adulthood, Diagnosis in children: who, where, how?.

What else you should know

• The term “spectrum” expresses that autism looks very different: The autism spectrum: why autism looks so different.
• How assessment works: How an autism assessment works.

Sources and literature

1. Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM): Informationsseite „ICD-11“ (Einführung in Deutschland). https://www.bfarm.de/DE/Kodiersysteme/Klassifikationen/ICD/ICD-11/_node.html – Authority website (in German)
2. DGKJP. Aktuelle Leitlinien (Einträge 028-018 „Gültig bis 04.04.2021“ und 028-047 „Gültig bis 23.03.2026“). https://www.dgkjp.de/wissen/aktuelle-leitlinien/ – Professional society (website in German)
3. Höhne E, Kamp-Becker I. Diagnostik der Autismus-Spektrum-Störung. Pädiatrie (Rosenfluh) 2024;(4+5):27–32. https://rosenfluh.ch/media/paediatrie/2024/04-05/Diagnostik-der-Autismus-Spektrum-Stoerung – Expert overview (in German)
4. DGKJP/DGPPN et al. Autismus-Spektrum-Störungen im Kindes-, Jugend- und Erwachsenenalter. Teil 1: Diagnostik. S3-Leitlinie, AWMF-Reg.-Nr. 028-018, Stand Text 23.02.2016. – Guideline (in German); expired