Intellectual developmental disorders: towards a new name, definition and framework for “mental retardation/intellectual disability” in ICD‐11

Abstract

Although "intellectual disability" has widely replaced the term "mental retardation", the debate as to whether this entity should be conceptualized as a health condition or as a disability has intensified as the revision of the World Health Organization (WHO)'s International Classification of Diseases (ICD) advances. Defining intellectual disability as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. This paper presents the consensus reached to date by the WHO ICD Working Group on the Classification of Intellectual Disabilities. Literature reviews were conducted and a mixed qualitative approach was followed in a series of meetings to produce consensus-based recommendations combining prior expert knowledge and available evidence. The Working Group proposes replacing mental retardation with intellectual developmental disorders, defined as "a group of developmental conditions characterized by significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills". The Working Group further advises that intellectual developmental disorders be incorporated in the larger grouping (parent category) of neurodevelopmental disorders, that current subcategories based on clinical severity (i.e., mild, moderate, severe, profound) be continued, and that problem behaviours be removed from the core classification structure of intellectual developmental disorders and instead described as associated features.

Communication Services and Supports for Individuals With Severe Disabilities: Guidance for Assessment and Intervention

“…Consistent with AAIDD’s definition, the DSM-5 focuses on adaptive behavior (referred to as adaptive functioning) in conceptual, practical, and social domains without specifying the age of onset (developmental period). The DSM-5 includes a severity rating and uses the phrase “intellectual developmental disorder.” In contrast, reports from the working group on intellectual disability for the WHO ICD-11 suggest that it will incorporate adaptive functioning in the definition; however, it appears that the WHO ICD-11 classification recommendations may still retain terms reflecting level of deficit (mild/moderate/severe/profound) rather than a support-based system (Carulla et al, 2011; http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3188762/). …”

Nuevas consideraciones sobre la salud de las personas con trastornos del desarrollo intelectual

“…Así pues, los TDI se definen como un grupo heterogéneo de afecciones del desarrollo caracterizadas por un deterioro significativo de las funciones cognitivas, que se asocian con limitaciones en el aprendizaje, la conducta adaptativa y las habilidades. 1 Los autores los describen como un meta-síndrome clínico, enmarcado en una condición de salud y evidenciado por un déficit en el funcionamiento cognitivo previo a la adquisición de competencias a través del aprendizaje. 2 Una aproximación similar ha sido recogida en el Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5), que define la discapacidad intelectual como un trastorno del neurodesarrollo caracterizado por la presencia de déficits en las habilidades intelectuales generales y en el funcionamiento adaptativo.…”

Acceso y morbilidad hospitalaria en personas con trastornos del desarrollo intelectual

“…De acuerdo con las clasificaciones actuales, es necesario que estas dificultades aparezcan durante el periodo de desarrollo. 1 En Europa, los costos sociales y sanitarios asociados con los TDI son de una magnitud extraordinaria. 2 Aunque la DI no es una enfermedad en sí misma, estas personas suelen precisar de una atención más frecuente e intensa que el resto de la población debido a las diferentes condiciones médicas que pueden tener asociadas.…”