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ASD with ID and Language Impairment — MRCPsych Paper B MCQ

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ModerateChild & Adolescent PsychiatryASD with ID and Language ImpairmentMRCPsych Paper B

A 5-year-old boy meets ICD-11 diagnostic requirements for autism spectrum disorder. Standardised assessment shows significant impairment in both intellectual functioning and adaptive behaviour, consistent with a disorder of intellectual development. He has no spoken language but consistently uses a small repertoire of single signs to request food, drink and the toilet. He cannot combine signs or use language for conversation. Which ICD-11 classification best describes his presentation?

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Correct answer: A — Autism spectrum disorder with disorder of intellectual development and with impairment of functional language

The correct answer is A. ICD-11 classifies autism spectrum disorder according to the presence of a disorder of intellectual development and the level of functional language. Significant impairment in both intellectual and adaptive functioning establishes the former. Although he has no speech, he purposefully uses signs to communicate basic needs, so functional language is present but substantially impaired rather than absent. Option B is excluded by his intellectual and adaptive impairment. Option C would require mild or no functional-language impairment. Option E is the closest distractor, but absence of functional language means there is no meaningful spoken or signed language for instrumental communication. Option D is inconsistent with both his intellectual-development profile and his purposeful signed communication.

Reference: Silleresi S, Prévost P, Zebib R, et al. Identifying Language and Cognitive Profiles in Children With ASD via a Cluster Analysis Exploration: Implications for the New ICD-11. Autism Research. 2020;13:777–789. https://pubmed.ncbi.nlm.nih.gov/39568757/