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Journal article

A comparison of WAIS-R and WAIS-III in the lower IQ range: implications for learning disability diagnosis

Authors:
FITZGERALD Suzanne, GRAY Nicola S., SNOWDEN Robert J.
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 20(4), July 2007, pp.323-330.
Publisher:
Wiley-Blackwell

Whether the Flynn effect (the increase in the populations’ IQ over time) affects the IQ scores of people with learning disability or borderline learning disability remains unclear. The issue is important as the Flynn effect should alter the number of people eligible for health service resources. A comparison of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) with the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) in individuals with learning disability or borderline learning disability was conducted. All participants completed the WAIS-R and the WAIS-III. Discrepancy scores were calculated for the Full Scale IQ score and the Verbal and Performance subscale scores. WAIS-III Full Scale scores were significantly lower by over 4 IQ points. Verbal and Performance Scale IQ scores were also significantly lower than the corresponding WAIS-R scores. The shift from WAIS-R to WAIS-III means that 66% more people meet criterion A for the diagnosis of learning disability and hence this has major resource implications for health service providers.

Journal article

I-CAN: the classification and prediction of support needs

Authors:
ARNOLD Samuel R.C., RICHES Vivienne Catherine, STANCLIFFE Roger J.
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 27(2), 2014, pp.97-111.
Publisher:
Wiley-Blackwell

Background: Since 1992, the diagnosis and classification of intellectual disability has been dependent upon three constructs: intelligence, adaptive behaviour and support needs (Luckasson et al. 1992. Mental Retardation: Definition, Classification and Systems of Support. American Association on Intellectual and Developmental Disability, Washington, DC). While the methods and instruments to measure intelligence and adaptive behaviour are well established and generally accepted, the measurement and classification of support needs is still in its infancy. This article explores the measurement and classification of support needs. Method: A study is presented comparing scores on the ICF (WHO, 2001) based I-CAN v4.2 support needs assessment and planning tool with expert clinical judgment using a proposed classification of support needs. A logical classification algorithm was developed and validated on a separate sample. Results: Good internal consistency (range 0.73–0.91, N = 186) and criterion validity (κ = 0.94, n = 49) were found. Conclusions: Further advances in our understanding and measurement of support needs could change the way disability is assessed, described and classified. (Edited publisher abstract)

Journal article

Intelligence involves risk-awareness and intellectual disability involves risk-unawareness: implications of a theory of common sense

Authors:
GREENSPAN Stephen, SWITZKY Harvey N., WOODS George W.
Journal article citation:
Journal of Intellectual and Developmental Disability, 36(4), December 2011, pp.246-257.
Publisher:
Informa Healthcare

The concepts of intelligence and common sense are discussed in this article in the context of defining intellectual disability. The article suggests that measures of intelligence, such as IQ tests, do not adequately address the core deficit in intellectual disability. It discusses a theory of common sense, defining common sense as "awareness of obvious social or practical risk". It presents a content model of risk, and discusses risk-awareness and unawareness, why people with intellectual disability are especially at risk, and the implications of a dynamic model of common sense for defining and diagnosing intellectual disability. The authors argue for adoption of the approach that intellectual disability is a common sense deficit disorder.

Journal article

Learning disability classification: time for re-appraisal?

Author:
LEYIN Alan
Journal article citation:
Tizard Learning Disability Review, 15(2), April 2010, pp.33-44.
Publisher:
Emerald

This paper examines the nature of the classifications of learning disabilities as circulated within the diagnostic manuals. It suggests that, by leaving aside all doubts and controversies that surround the concept and measurement of intellectual functioning, weaknesses are exposed from within those manuals' own frames of reference. The difficulties arising from using the international sub-classifications of learning disabilities when the national classifications should apply are discussed. Three main conclusions are drawn: there are inherent difficulties with the measurement of the fine-grained classification system which leads to a best guess approach; there are difficulties resulting from the incursion of the internationally promoted classification into the national context; and without acknowledging these two failings, problems will compound, appearing in unlikely places. The difficulties fundamentally arise from trying to mould the categories of learning disabilities into a strict medical diagnostic framework.

Journal article

Autism spectrum disorders in genetic syndromes: implications for diagnosis, intervention and understanding the wider autism spectrum disorder population

Authors:
MOSS J., HOWLIN P.
Journal article citation:
Journal of Intellectual Disability Research, 53(10), October 2009, pp.852-873.
Publisher:
Wiley

There is growing interest in the association between autism spectrum disorders (ASDs), or ASD-related phenomenology, and a number genetically linked conditions. This systematic review examines the possibility of such an association in the following syndrome groups; Fragile X, Rett, Tuberous Sclerosis Complex, Down, Angelman, CHARGE, and Phenylketonuria. Special consideration is given to the role of intellectual disability (ID) in assessing the association. The first section looks specifically at the possible associations while the second section focuses on the clinical implications in terms of diagnosis and intervention, and the implication for conceptual and theoretical frameworks. Formal diagnostic assessments suggest an association between ASD and specific syndrome groups but detailed investigation reveals subtle but qualitative differences in the presentation of ASD-like phenomenology in particular groups. The degree of ID of the individual appears to play a part in the development and presentation of ASD-like characteristics but cannot solely account for the heightened prevalence of ASD characteristics in some specific syndromes. The authors suggest that caution is needed in interpreting the significance of superficial similarities between ASD and the behavioural phenotypes of certain genetically determined syndromes. However, recognition of ASD-like characteristics in individuals with genetic syndromes is crucial in ensuring that individuals receive appropriate support.

Book

Diagnostic manual - intellectual disability (DM-ID): a textbook of diagnosis of mental disorders in persons with intellectual disability

Authors:
FLETCHER Robert, et al, (eds.)
Publisher:
NADD Press
Publication year:
2007
Pagination:
552p.
Place of publication:
Kingston, NY

This diagnostic manual was developed by the National Association for the Dually Diagnosed (NADD), in association with the American Psychiatric Association (APA). It aims to facilitate a more accurate psychiatric diagnosis of people with Intellectual Disabilities.  Content includes a description of each psychiatric disorder, a summary of the DSM-IV-TR diagnostic criteria, a review of the research and an evaluation of the strength of evidence supporting the literature conclusions.

Journal article

The validity of a personality disorder diagnosis for people with an intellectual disability

Authors:
MORELAND Jessica, HENDY Steve, BROWN Freddy
Journal article citation:
Journal of Applied Research in Intellectual Disabilities, 21(3), May 2008, pp.219-226.
Publisher:
Wiley-Blackwell

It has long been appreciated that people with intellectual disabilities experience mental health problems. Studies into the prevalence of personality disorder in the population of people with an intellectual disability indicate significant variations, which have no clear explanation. This article will outline some of the reasons for the variations in the reported prevalence figures including the impact of diagnostic overshadowing, problems inherent within the diagnostic classification systems and instruments that have a significant impact upon the reliability of a diagnosis. It will also argue that there are some fundamental issues relating to the validity of the construct of personality disorder and its application to the population of people with intellectual disabilities. The article notes that the model of personality, which in itself is not without critics, is derived from research on the general population and has not been integrated with personality research conducted within the population of people with an intellectual disability. It is suggested that the current diagnostic systems need to be reviewed in the context of an existing evidence base from within the field of intellectual disabilities. There are grounds to be cautious with the current diagnostic process and to question its clinical utility. Furthermore, diagnosis may only serve as an intermediate step and as part of a more detailed nomothetic approach.

Journal article

Language, labels and diagnosis: an idiot's guide to learning disability

Author:
McCLIMENS Alex
Journal article citation:
Journal of Intellectual Disabilities, 11(3), September 2007, pp.257-266.
Publisher:
Sage
Place of publication:
London

The phrase `learning disability' is just one in a long succession of descriptors applied to those people in our society who are categorized by a matrix of psycho-medical assessments, marginalized by compromised intellectual function, characterized by increased health needs and excluded from the mainstream on the basis of reduced social opportunity. But what exactly is `learning disability'? Is there an empirical basis to the label, or is it just another example of bureaucratic language objectifying individuals in a process of medicalization? Historical examples will be used to illustrate the origins of the taxonomy that has subsequently formed the basis of the labelling process. The more recent words of individuals labelled with learning disability too will be introduced to offer some grounding to the debate. Any apparent problem belongs to language more than science. Narrative approaches to understanding are suggested as a useful alternative to traditional scientific inquiry.

Journal article Full text available online for free

Prevalence of dementia in intellectual disability using different diagnostic criteria

Authors:
STRYDOM A., et al
Journal article citation:
British Journal of Psychiatry, 191(8), August 2007, pp.150-157.
Publisher:
Royal College of Psychiatrists

Diagnosis of dementia is complex in adults with intellectual disability owing to their pre-existing deficits and different presentation. The aim was to describe the clinical features and prevalence of dementia and its subtypes, and to compare the concurrent validity of dementia criteria in older adults with intellectual disability. The Becoming Older with Learning Disability (BOLD) memory study is a two-stage epidemiological survey of adults with intellectual disability without Down syndrome aged 60 years and older, with comprehensive assessment of people who screen positive. Dementia was diagnosed according to ICD–10, DSM–IV and DC–LD criteria. The DSM–IV dementia criteria were more inclusive. Diagnosis using ICD–10 excluded people with even moderate dementia. Clinical subtypes of dementia can be recognised in adults with intellectual disability. Alzheimer’s dementia was the most common, with a prevalence of 8.6% (95% CI 5.2–13.0), almost three times greater than expected. Dementia is common in older adults with intellectual disability, but prevalence differs according to the diagnostic criteria used. This has implications for clinical practice.

Journal article

Internal consistency and factor structure of personality disorders in a forensic intellectual disability sample

Authors:
LINDSAY William R., et al
Journal article citation:
Journal of Intellectual and Developmental Disability, 32(2), June 2007, pp.134-142.
Publisher:
Informa Healthcare

The publication of the DSM-III (American Psychiatric Association (APA), 1980) prompted a significant increase in interest and research on personality disorder (PD), and the concept has subsequently been incorporated into mental health legislation in the developed world. Despite this, such research on people with intellectual disability (ID) has been sporadic, with widely varying results. The present study addresses a number of criticisms directed at previous research. DSM-IV (APA, 2000) diagnoses of PD were made on 164 participants with ID on the basis of four independent sources of classification. Reliability data for each PD was acceptable and alpha was .74 or above, with the exception of schizotypal PD (.63). Exploratory and confirmatory factor analyses were conducted, with the former revealing a 4-factor solution accounting for 58.9% of the variance, and a 2-factor solution accounting for 37.2% of the variance emerging for the latter. The factors were orthogonal, and the first factor was named "avoidant/rumination/inhibited" and the second factor "acting out". The authors review these findings in relation to previous research on PD and alternative frameworks for the understanding of personality. It is hypothesised consistencies between these findings and previous work on personality and ID. A number of drawbacks to the research are discussed, including a caution on the pejorative nature of a diagnosis of PD in an already devalued population.

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