Intellectual Disability: Definition, Diagnosis and Classification
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The way that society sees people with intellectual disability has changed over times. Individuals with intellectual disability have been described using many terms over the centuries and decades. It is important to think about the values that underpin these terms and changes, as these same values also inform the services that support people with intellectual disability and influence how professionals provide support. Those people we call intellectual disability is a disability characterized by significant limitations in both intellectual functioning and conceptual, social, and practical adaptive skills. In actuality, whom we call people with intellectual disability and where we draw the line between people with intellectual disability and the normal depends upon our understanding and the purpose of our classification. Without a clear and universally accepted definition of intellectual disability, efforts to understand its nature and improve the lives of persons with intellectual disability will be impossible. Therefore, the purpose of this paper was to examine the theory and identification of intellectual disability, to explore the limitations of the current system of classification, and to make clear understanding of intellectual disability to the health care professionals. The article found that there are many essential assumptions to the application of the stated definition of intellectual disability; for the useful definition and the essential features of intellectual disability it must be clearly communicated to both professionals and the general public.Keywords:
Borderline intellectual functioning
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Disability is possibly one of the most difficult social objects to define. It’s also one of the specific welfare issues which requires a clear well-delimited definition. Disability is a social object which fluctuates between two definitions: on the one hand a medical definition focusing on the nature of deficiencies and related disabilities, on the other hand a social explanation to the existence of disability. But rather than going from point A which might be a strictly medical definition of disability to a point B which would be a social environmental understanding of disability, outlooks about disability have swung over the years between these two poles.
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The International Classification of Functioning, Disability and Health (ICF, WHO 2001) made a great advancement over ICIDH of 1980 in the understanding of the human functioning and disability. However, in both of them there is an important 'missing' element. That is the subjective dimension of functioning and disability. One of the authors (S. Ueda) published on this topic in 1981 both in Japanese and English. It had originated from his clinical experience in rehabilitation medicine. The understanding of the inner world of the client has proved a great asset in clinical practice. This paper explains its importance and provides a definition. It also proposes a tentative framework of a classification of subjective dimension of functioning and disability as the starting point for more intensive and extensive discussion on this important problem, and for its future inclusion into ICF.
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Intellectual disability is a descriptive term not a condition in itself and although the number of identifiable disorders that alter neurodevelopment and create an associated intellectual disability is steadily increasing, we are only beginning to understand the many ways in which the altered neural substrate modifies the course and presentation of coexisting psychiatric disorders. Save in the case of relatively common conditions, such as Down syndrome or fragile-X syndrome, studies in intellectual disability usually involve patients with ill-defined, heterogeneous aetiologies grouped on the basis of their degree of intellectual impairment rather than aetiology. It is clear, however, that adults with intellectual disability are susceptible to the whole range of psychiatric disorders seen in the general population. In addition, our understanding of behaviour phenotypes has developed over recent years; this concept has helped us understand some of the links between genetics and behaviour (O'Brien & Yule, 1995). The term intellectual disability is used throughout this chapter because it has been adopted by the Royal College of Psychiatrists and is used internationally. The evidence base in this area of ECT use is composed almost entirely of case reports. The limited nature of this evidence, compounded with specific issues regarding diagnosis and consent, partially explains why ECT seems to be used rarely in people with intellectual disability. Diagnostic issues Principles of psychiatric assessment in this population are similar to those in general adult and child psychiatry; particular attention is given to the person's level of communication and understanding, developmental history, direct observation and information from informants, as well as the exploration of associated disabilities. The predominant view is that psychiatric disorder can be reliably diagnosed using standard diagnostic classifications in people with mild intellectual disability (Meins, 1995; Hurley, 2006). However, diagnosis is more difficult in those with a more severe level of intellectual disability. Diagnostic criteria are very much language-based, so they are less relevant to people with significant communication difficulties. It is then much more difficult, if not impossible, to assess cardinal features of psychiatric disorder such as low self-esteem, guilt (Hemmings, 2007), delusions or hallucinations. The presence of intellectual disability will alter the way that signs of psychiatric disorder manifest themselves. Psychiatric diagnosis can be difficult because of the frequent assumption that symptoms could be part of the presentation of the intellectual disability because of ‘diagnostic overshadowing’ (Santosh & Baird, 1999).
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In health care, respect for autonomy is a prominent moral value. It is used to ground policies and practices about informed choice, the right to refuse treatment (including life sustaining treatment), truth telling, confidentiality, advance directives, and others. It is used as the key argument for controver sial acts such as physician-assisted suicide and abortion. Professional organi zations have written respect for autonomy into their codes of ethics and standards for practice. When moral values conflict, respect for autonomy is often applied to settle the matter. Yet, despite this prominence, people who access health services rarely use the term which suggests that autonomy, at least as it is currently conceived, may not speak to their experi ence or needs. Some attention to those experiences may be useful to guide our understanding of autonomy and to look critically at theories of autonomy that are operative, or potentially operative, in health care contexts. The experiences of people with disabilities are well suited to address this need. Following recent developments in the World Health Organization's International Classification of Impairments, Disabilities and Handicaps, I use the term to refer to an identifiable variation of human functioning. Its three dimensions are impairments, activity limitations and participation restrictions. This biopsychological model of disability brings together both medical and social approaches to disability.1 This view of disability can involve a broad range of physical, intellectual, and sensory impairments that dampen function in some way. It can arise in contexts that are life-threatening (e.g., cancer, heart disease) or non-life-threatening (e.g., quadriplegia, schizophrenia). It can be constant, highly variable, or progres sively deteriorating. It can have early or late onset. In addition to limitations to body function, this view of disability can include limitations to human activity and limitations to participation in a broader social context. So, for example, environmental, cultural, and social barriers that limit opportunities can contribute to the experience of disability.
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This paper critically reviews medical approaches to the identification and treatment of disability. The medical model locates disability within individuals. By contrast, this paper argues that disability cannot be understood outside its social context. As such, some of the assumptions about normality and difference which underpin traditional approaches to the diagnosis and treatment of disabled people are challenged. If it is accepted that disability is located not solely within the mind or body of an individual, but rather in the relationship between people with particular bodily and intellectual differences and their social environment, then greater focus may be placed on ameliorating disability through changes in social policy, culture and institutional practices.
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The strategy of developing an ontology or models of disability as a prior step to settling ethical issues regarding disabilities is highly problematic for two reasons. First, key definitional aspects of disability are normative and cannot helpfully be made value-neutral. Second, if we accept that the contested concept of disability is value-laden, it is far from obvious that there are definitive reasons for choosing one interpretation of the concept over another. I conclude that the concept of disability is better left ethically open-ended or broad enough to encompass the examination of various ethical issues (such as oppression, minority rights, or physical discomfort). Alternatively, the concept of disability could be altogether abandoned in order to focus on specific issues without being hindered by debates about the nature of disability. Only political costs, rather than conceptual considerations internal to the models, could be weighed against such a conclusion.
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Value (mathematics)
Disability studies
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What is a disability? What sorts of limitations do persons with disabilities or impairments experience? What is there about having a disability or impairment that makes it disadvantageous for the individuals with it? Are persons with severe cognitive impairments capable of making autonomous decisions? What role should disability play in the construction of theories of justice? Is it ever ethical for parents to seek to create a child with an impairment? This anthology addresses these and other questions and is a valuable addition to a growing interdisciplinary literature exploring issues at the intersection of disability studies, philosophy, and bioethics. Most of the authors are well-known from their previous work in the disability field and have already made significant philosophical contributions to it.
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Purpose – The purpose of this paper is to reflect on the response to the scandal of abuse in services for people with intellectual disabilities in the light of research evidence and analysis. Design/methodology/approach – Critical reflection and review of literature. In particular, recent research into possible indicators that a service is at risk of becoming abusive is used to test the hypotheses and implied solutions that are currently being adopted. Findings – That some of the responses to recent scandals are necessary but not sufficient to prevent future harm. Furthermore, some of the proposed solutions may actually increase the likelihood of further abuse. Prevention of abuse requires a broader and more evidence-based response. Originality/value – The synthesis of research and analysis presented here has not been presented previously in the published literature.
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Challenging behaviour
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