Capitol Correspondence - 08.09.19

ANCOR Joins AAIDD in Opposing DSM-5 Changes to Intellectual Disability

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As a follow up to this previous article, ANCOR has submitted formal comments to the American Psychiatric Association opposing their proposed changes to the  Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the core diagnostics manual for psychiatrists and other medical experts. Members interested in submitting their own comments should note the August 14 deadline to do so.

As written in our comments:

“We are thankful that the APA is proposing to delete the sentence: “To meet diagnostic criteria for intellectual disability, the deficits in adaptive functioning must be directly related to the intellectual impairments described in Criterion A.” However, the current proposal adds problematic language of: “Adaptive functioning is understood to be the application of intelligence to functioning in everyday life. Criterion A (deficits in intellectual functions) and Criterion B (deficits in adaptive functions) are related in that the deficits in adaptive functioning are a consequence of intellectual deficits defined in Criterion A and are not the result of a co-occurring DSM-5 mental disorder.” This attempt to clarify creates greater confusion and makes it more difficult for clinicians to translate diagnosis to every day supports. We lay this out more below.

ANCOR joins the American Association on Intellectual and Developmental Disabilities (AAIDD) in strong opposition to the current proposal because 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; and
• Creates diagnostic error by creating a fourth diagnostic criterion.”