Intellectual disability in international classification of Diseases-11: A developmental perspective

Historically Intellectual Disability (ID) has been included in the International Classification of Disease and related Health Problems [ICD] and Diagnostic and Statistical manual Of Mental Disorders [DSM] from the beginning. There has been a significant change in the terminology, placement of the condition, classification, and defining features as a result of advances in unraveling the development and functionality of the brain and identifying the etiologic basis of intellectual disability. Current approaches view ID from a developmental perspective and rely on both intellectual abilities and adaptive functioning. This article looks into the salient features of “Disorders of Intellectual Development” as it is termed in ICD-11 in comparison with “Mental Retardation” as it was termed in previous ICD-10 and “Intellectual Developmental Disorder” in latest DSM-5 version, and examines the commonalities and differences

Sexuality in Adolescents with Intellectual disability: Felt Needs of Parents

Introduction: Felt needs of primary caregivers of adolescents with intellectual disabilities (AWID) with regard to sexuality issues have been an under researched area. The present study aimed to develop scientific knowledge in this area. This study gave a better insight into the less spoken area of sexuality among adolescents with intellectual disability, especially in the Indian context. Methodology: An exploratory design was adopted for this study which involved analysing the review of the literature, 20 unstructured interviews, 35 structured individual interviews, 10 key person interviews and 4 focus group discussions with 16 participants.    Result: The specific concerns of parents with regard to educating sexuality issues of their Intellectually Disabled adolescents were identified. Conclusion: The findings emphasised the need for adequate knowledge attitude and practice among the parents in order to deal with the sexuality issues of adolescents with intellectual disability. This also laid the base for developing suitable tools and intervention programs for this population.   Keywords: Adolescents, sexuality, intellectual disability, needs, parent

Immune aberrations in children with Autism Spectrum Disorder: a case-control study from a tertiary care neuropsychiatric hospital in India

Multiple studies have identified the presence of peripheral immune aberrations in subjects with Autism Spectrum Disorder (ASD). However, comprehensive assessment of these peripheral immune aberrations, in the cellular and systemic compartments, in a single group of subjects with ASD is lacking. We assessed proportions of various subsets of immune cells in peripheral blood (T helper cells, T regulatory cells, B cells, monocytes, Natural Killer cells, dendritic cells) by multi-parametric flow cytometry in 50 children with ASD and compared it with thirty healthy controls matched for age, gender, socio-economic status and body mass index. There were no significant differences noted in the proportion of T regulatory cells, B cells, monocytes and Natural Killer cells, between ASD subjects and controls. On the contrary, the proportion of activated Th17 and myeloid dendritic cells were significantly higher in children with ASD. Based on these findings, group comparison of serum levels of Th17 cytokines (interleukin-6, interleukin-17A) was performed. Elevated serum levels of interleukin-6 and interleukin-17A in children with ASD corroborated our immunophenotyping findings. We did not find any significant differences among the pro-inflammatory (interleukin-1 beta), Th1 (interferon-gamma) and Th2 (interleukin-4) cytokines. This is the first evidence with concurrent findings from immunophenotyping and cytokine data demonstrating activation of the Th17 pathway in subjects with ASD. This finding assumes significance in the light of recent maternal immune activation mouse model study that has highlighted the role of Th17 pathway in the pathophysiology of ASD. Future longitudinal studies are needed to clarify the role of this dysregulated immune pathway in the development of ASD

Moving beyond intelligence in the revision of ICD-10: specific cognitive functions in intellectual developmental disorders

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Moving beyond intelligence in the revision of ICD-10: specific cognitive functions in intellectual developmental disorders

A lower level of intelligence, as measured by IQ, has historically been the central defining criterion of mental retardation (MR). The use of IQ scores in terms of standard deviation units from the mean is the basis for defining MR in the ICD-10 and DSM-IV-TR, and more recently for defining intellectual disability (ID) in the DSM-5. Similarly, ID is defined by the American Association on Intellectual and Developmental Disabilities as an IQ score approximately two standard deviations below the mean (1). However, in recent years, an increasing number of researchers and clinicians have expressed the view that measurements of IQ fail to capture individual differences in cognitive dysfunction. The heterogeneity of cognitive dysfunction and consequent adaptive behavior profile in persons with MR is one of the reasons leading the working group in charge of this issue within the revision of the ICD-10 to propose a new definition for intellectual developmental disorders (IDD) in the upcoming 11th edition of the diagnostic system (2)

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

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