Kaplan + Sadock's Synopsis of Psychiatry, 11e

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Chapter 31: Child Psychiatry

Table 31.3-1 DSM-5 Diagnostic Criteria for Intellectual Disability

Intellectual disability (intellectual development disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The following three criteria must be met: A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing. B. Deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community. C. Onset of intellectual and adaptive deficits during the developmental period. Note: The diagnostic term intellectual disability is the equivalent term for the ICD-11 diagnosis of intellectual developmental disorder. Although the term intellectual disability is used throughout this manual, both terms are used in the title to clarify relationships with other classification systems. Moreover, a federal statute in the United States (Public Law 111–256, Rosa’s Law) replaces the term mental retardation with intellectual disability, and research journals use the term intellectual disability. Thus, intellectual disability is the term in common use by medical, educational, and other professions and by the lay public and advocacy groups. Specify current severity: 317 (F70) Mild 318.0 (F71) Moderate 318.1 (F72) Severe 318.2 (F73) Profound

(Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Copyright ©2013). American Psychiatric Association. All Rights Reserved.)

subclinical lead intoxication and prenatal exposure to drugs, alcohol, and other toxins have been implicated as contributors to intellectual disability. Certain genetic syndromes associated with intellectual disability such as fragile X syndrome, Down syndrome, and Prader-Willi syndrome, have characteristic pat- terns of social, linguistic, and cognitive development and typi- cal behavioral manifestations.

disability category. This is typically defined by a Full Scale IQ between 50 and 70 and an adaptive function severity in the mild range. Adaptive function includes skills such as communication, self-care, social skills, work, leisure, and understanding of safety. Intellectual disability is influenced by genetic, environmental, and psychosocial factors. A host of subtle environmental and developmental factors, including

Table 31.3-2 Developmental Characteristics of Intellectual Disability

Level of Intellectual Disability

Preschool Age (0 to 5 yrs) Maturation and Development Gross disability; minimal capacity for functioning in sensorimotor areas; needs nursing care; constant aid and supervision required Poor motor development; speech minimal; generally unable to profit from training in self-help; little or no communication skills Can talk or learn to communicate; poor social awareness; fair motor development; profits from training in self-help; can be managed with moderate supervision Can develop social and communication skills; minimal retardation in sensorimotor areas; often not distinguished from normal until later age

School Age (6 to 20 yrs) Training and Education

Adult (21 yrs and Above) Social and Vocational Adequacy Some motor and speech development; may achieve very limited self-care; needs nursing care May contribute partially to self- maintenance under complete supervision; can develop self- protection skills to a minimal useful level in controlled environment May achieve self-maintenance in unskilled or semiskilled work under sheltered conditions; needs supervision and guidance when under mild social or economic stress Can usually achieve social and vocational skills adequate to minimal self-support, but may need guidance and assistance when under unusual social or economic stress

Profound

Some motor development present; may respond to minimal or limited training in self-help

Severe

Can talk or learn to communicate; can be trained in elemental health habits; profits from systematic habit training; unable to profit from vocational training Can profit from training in social and occupational skills; unlikely to progress beyond second-grade level in academic subjects; may learn to travel alone in familiar places Can learn academic skills up to approximately sixth-grade level by late teens; can be guided toward social conformity

Moderate

Mild

(Adapted from Mental Retarded Activities of the US Department of Health, Education and Welfare . Washington, DC: US Government Printing Office; 1989:2, with permission.)