"Intellectual developmental disorders": reflections on the international consensus document for redefining "mental retardation-intellectual disability" in ICD-11
"Intellectual developmental disorders": reflections on the international consensus document for redefining "mental retardation-intellectual disability" in ICD-11
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DOI：
10.1108/amhid-10-2015-0050
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发表时间：
2016-01-01
影响因子：
1.1
通讯作者：
Salvador-Carulla, Luis
中科院分区：
文献类型：
--
作者：
Bertelli, Marco O.;Munir, Kerim;Salvador-Carulla, Luis
目的--随着世界卫生组织(世卫组织)《国际疾病分类》(ICD)的修订即将完成，关于智力残疾(ID)应该被概念化为一种健康状况还是一种残疾的辩论愈演愈烈。将ID定义为一种健康状况是ICD保留它的核心，这对卫生政策和获得卫生服务的机会具有重大影响。本文件的目的是对第一个世卫组织MR分类工作组(WHO WG-MR)产生的协商一致文件以及为实现该文件所遵循的过程进行一些思考。协商一致意见报告是拟定提交给世卫组织ICD-11咨询小组的官方建议的基础--设计/方法/方针--在一系列会议中采用了混合定性办法，最终向世卫组织咨询小组提交了协商一致意见报告。这些建议结合了先前的专家知识和可用的证据；名义上的方法始终遵循面对面的会议。结果-工作组建议采用同义词集(“SYSET”)本体论方法来概念化这种健康状况，其基础是诊断的临床理由。它建议用ICD-11中的智力发育障碍(IDD)取代MR，IDD的定义是“一组发育状况，其特征是认知功能显著受损，与学习、适应行为和技能的限制有关”。工作组还建议，应将缺乏症列入神经发育障碍的母类，目前的区别(轻度、中度、严重和严重)应继续作为严重程度限定词，问题行为应从其核心分类结构中删除，改为被描述为相关特征。原创性/价值--在缺失性/缺失性缺乏症集合中，两个不同的名称在一个单一结构下结合了不同的方面，描述了其临床以及社会、教育和政策效用。单一结构包括IDD作为临床元综合征，ID作为其功能和残疾的对应物。IDD和ID不是同义词或镜像概念，因为它们具有不同的科学、社会和政策应用。新的IDD诊断标准应以发展性方法为基础，考虑到已知的影响特定认知能力和适应行为获得的复杂原因因素。本文重点介绍了一种新的诊断IDD的临床框架，该框架还包括和补充了IDD固有的现有社会、教育和政策因素。
Purpose - The debate as to whether intellectual disability (ID) should be conceptualized as a health condition or as a disability has intensified as the revision of World Health Organization's (WHO's) International Classification of Diseases (ICD) is being finalized. Defining ID as a health condition is central to retaining it in ICD, with significant implications for health policy and access to health services. The purpose of this paper is to include some reflections on the consensus document produced by the first WHO Working Group on the Classification of MR (WHO WG-MR) and on the process that was followed to realize it. The consensus report was the basis for the development of official recommendations sent to the WHO Advisory Group for ICD-11.Design/methodology/approach - A mixed qualitative approach was followed in a series of meetings leading to the final consensus report submitted to the WHO Advisory group. These recommendations combined prior expert knowledge with available evidence; a nominal approach was followed throughout with face-to-face conferences.Findings - The WG recommended a synonym set ("synset") ontological approach to the conceptualisation of this health condition underlying a clinical rationale for its diagnosis. It proposed replacing MR with Intellectual Developmental Disorders (IDD) in ICD-11, defined as "a group of developmental conditions characterized by a significant impairment of cognitive functions, which are associated with limitations of learning, adaptive behaviour and skills". The WG further advised that IDD be included under the parent category of neurodevelopmental disorders, that current distinctions (mild, moderate, severe and profound) be continued as severity qualifiers, and that problem behaviours removed from its core classification structure and instead described as associated features.Originality/value - Within the ID/IDD synset two different names combine distinct aspects under a single construct that describes its clinical as well as social, educational and policy utilities. The single construct incorporates IDD as a clinical meta-syndrome, and ID as its functioning and disability counterpart. IDD and ID are not synonymous or mirror concepts as they have different scientific, social and policy applications. New diagnostic criteria for IDD should be based on a developmental approach, which accounts for the complex causal factors known to impact the acquisition of specific cognitive abilities and adaptive behaviours. The paper focuses on a new clinical framework for the diagnosis of IDD that also includes and complements the existing social, educational and policy components inherent in ID.