Psychiatrists Propose Change to Intellectual Disability Criteria

The American Psychiatric Association (APA) is currently considering altering the entry for intellectual disability in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). The DSM-5 is an essential tool for psychiatrists, researchers, insurers, and others who rely on it to determine whether someone is worthy of a diagnosis.

Proposed Change

At issue in the change is the connection between two of the three criteria diagnosing intellectual disability. The three criteria for diagnosis are: 1) deficits in intellect; 2) deficits in adaptive functioning or daily life skills; and 3) onset in childhood. One sentence included in the DSM-5 seems to suggest that adaptive functioning deficits are required to be caused by deficits in intellect. It reads, “the deficits in adaptive functioning must be directly related to the intellectual impairments.”

In 2018, the American Association on Intellectual and Developmental Disabilities (AIDD) requested that the sentence be struck from the DSM-5. The APA has instead proposed that the language be replaced with language that states “deficits in adaptive functioning are a consequence of intellectual deficits.” A date has not been determined for when the language will be replaced.

Concerns About the Change

Experts agree that intellect and adaptive behavior are separate concepts. It is impossible to distinguish which adaptive functioning deficits are caused by IQ, educational opportunities, or mental health issues. This would make it difficult to diagnose intellectual disability because it cannot be established whether the adaptive functioning was a consequence of intellectual deficits. This could lead to an under-identification of individuals with intellectual disability and prevent people from receiving the services they need.

The state of Texas, in the case of Moore v. Texas, used the language currently in the DSM-5 to find a man who would be executed as not having an intellectual disability. Texas noted that his adaptive functioning deficits were the result of a lack of education and not directly related to his intellectual functioning. The Supreme Court overturned the case and found that Moore did have an intellectual disability.

If you or a loved one has a mental disability and has been arrested or convicted of a crime, you need an experienced criminal defense attorney on your side. Elizabeth Kelley specializes in representing individuals with mental disabilities. To schedule a consultation call (509) 991-7058.