July 29, 2019 [Silver Spring, MD]
The American Association on Intellectual and Developmental Disabilities (AAIDD) today submitted comments to the American Psychiatric Association (APA) strongly opposing a proposed change to the DSM-5 concerning the diagnostic criteria for intellectual disability (ID, also listed as intellectual developmental disorder in the DSM-5).
AAIDD is the oldest inter-disciplinary professional society with a focus on intellectual disability in the world. Since its inception, AAIDD has produced guidelines naming, defining, and diagnosing the condition known today as “intellectual disability.” In 1910, AAIDD published the first scholarly international terminology and classification system for ID (today the AAIDD manual is in its 11th edition). The AAIDD manual has been revised as the science and understanding of the condition has evolved over time; its approach and evolving understanding of the condition have been shared by other major diagnostic systems, including the DSM and ICD.
On September 7, 2018 AAIDD proposed that the following sentence be deleted from the DSM-5’s diagnostic criteria for ID:
“To meet diagnostic criteria for intellectual disability, the deficits in adaptive functioning must be directly related to the intellectual impairments described in Criterion A.”
The rationale for this modest proposal was that the current text appeared to add a new, fourth criterion to the diagnostic criteria, one that required the deficits in adaptive functioning be “directly related to” (commonly understood to mean “caused by”) the deficits in intellectual functioning, a criterion which is neither possible for clinicians to ascertain nor empirically supported. In its proposal, AAIDD also noted that problems created by this phrase were not merely a theoretical concern, but that the practical impact of this change to the diagnostic criteria could easily be foreseen in matters as diverse as eligibility for supports and services, educational placement and assistance, protection from discrimination, funding for ongoing services and supports, and various legal issues in the criminal and civil justice systems.
On July 8, 2019 APA offered a proposed revision, open for public comment, to address the issues raised by AAIDD; however, AAIDD strongly opposes the current proposed revision as it:
- Is not supported by empirical evidence (there is no empirical evidence supporting the notion of a causal link between intellectual functioning and adaptive behavior);
- Incorrectly assumes that adaptive functioning and intellectual functioning are not separate and independent constructs;
- Plainly requires clinicians to establish that the deficits in adaptive functioning are “a consequence of” intellectual deficits, which is impossible for clinicians to scientifically or clinically establish;
- Creates conceptual confusion by conflating etiology with diagnostic criteria;
- Mistakenly asserts causation that puts a primacy in diagnosis on IQ and creates internal inconsistency in the criteria by anchoring both clinical elements of the diagnosis in IQ;
- Creates diagnostic error by creating a fourth diagnostic criterion; and
- Represents a significant and dramatic departure from previous DSM manuals, contradicts current clinical and scientific consensus, and is out of step with other diagnostic systems (i.e., the World Health Organization’s ICD and AAIDD) that define the same condition.
“I hope that APA sincerely considers the comments it will receive on this proposed revision and brings its entry on ID into alignment with the empirical evidence and the clinical and scientific consensus in our field,” said Robert Schalock, PhD, FAAIDD, lead author of the 11th edition of the AAIDD manual.
The proposed revision and comment portal are available at https://www.psychiatry.org/psychiatrists/practice/dsm/proposed-changes. The proposed revision is open to public comment and the comment period ends August 14, 2019.
AAIDD Comments to APA 7-29-2019
ICD-11 diagnostic criteria for ID
AAIDD definition of ID
Make Comments to the APA on the Proposed Revision to the DSM-5
(Deadline August 14, 2019)