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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.)
Table 31.3-2
Developmental Characteristics of Intellectual Disability
Level of Intellectual
Disability
Preschool Age (0 to 5 yrs)
Maturation and Development
School Age (6 to 20 yrs)
Training and Education
Adult (21 yrs and Above) Social
and Vocational Adequacy
Profound
Gross disability; minimal capacity
for functioning in sensorimotor
areas; needs nursing care;
constant aid and supervision
required
Some motor development present;
may respond to minimal or
limited training in self-help
Some motor and speech
development; may achieve very
limited self-care; needs nursing
care
Severe
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;
can be trained in elemental
health habits; profits from
systematic habit training;
unable to profit from vocational
training
May contribute partially to self-
maintenance under complete
supervision; can develop self-
protection skills to a minimal
useful level in controlled
environment
Moderate
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 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
May achieve self-maintenance in
unskilled or semiskilled work
under sheltered conditions; needs
supervision and guidance when
under mild social or economic
stress
Mild
Can develop social and
communication skills; minimal
retardation in sensorimotor
areas; often not distinguished
from normal until later age
Can learn academic skills up to
approximately sixth-grade level
by late teens; can be guided
toward social conformity
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
(Adapted from
Mental Retarded Activities of the US Department of Health, Education and Welfare
. Washington, DC: US Government Printing Office;
1989:2, with permission.)
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
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.
