DSM5智力障碍诊断实用实用标准及原文

1、标准实用文案诊断标准：智力障碍（智力发育障碍）是起病于发育时期，在概念、社交和实用领域中的智力和适应功能的缺陷。须符合以下三个诊断标准：A经临床评估和个体化、标准化的智力评测确认的智力功能障碍，如推理、问题解决、计划、抽象思维、判断、学业学习和基于经 验的学习。B适应功能缺陷造成未能达到发育及社会文化相称的个人独立性及社会责任标准。在没有持续帮助的情况下，该适应功能缺陷限制 了其在多个环境中，如家庭、学校、工作和社区，的一个或多个日常生活功能，如交流、社会参与和独立生活。C智力和适应缺陷起病于发育时期。严重程度则基于ICD-10-CM 编码如下:严重度概念领域社交领域实用领域文档轻在学龄前儿童

2、，可能没有 明显的概念区别。对于学 龄儿童和成人，存在学习 困难，包括读、写、计算、 时间金钱的概念，在一个 或多个领域需要帮助以达 到年龄预期的水平。在成 人，则有抽象思维、执行 功能（如计划、策略、最 优设定及认知灵活性）、 短时记忆以及对学业能力的应用（如读、财务管理）相较之下，其社交技巧不成熟。比如， 在准确感知同伴的社交线索方面存在 困难。交流、对话和语言相较于匹配年 龄更为具体化及不成熟。往往能被同伴 注意到其在以年龄相称的方式控制行 为及情绪方面存在困难。 难以完全体会 到社交风险，社交判断不成熟，存在被 他人控制的风险（受骗）。在个人护理方面其能力与年龄相称。但是在复 杂的日常

3、生活行为上与同龄相较需要帮助。在成人身上，购物、交通、家务及照顾儿童及 财务管理等方面需要帮助。娱乐活动的技能则 与同龄人相近，不过在安全相关及组织方面任 需要帮助。在成人，可胜任不需要抽象思维的 的工作。在作出医疗卫生及法律相关决策以及 学习胜任完成熟练技巧性的工作等方面需要 帮助。在供养家庭方面也是典型的需要帮助。严重度概念领域社交领域实用领域中虽然有在成长，但是概念技 巧洛后于同龄儿。在学龄 前儿童，语言能力及入学 前学业技巧发展缓慢。在 学龄期儿童，读、写、计 算、理解时间和金钱方面 进展缓慢，并且与同伴相 较明显受限。在成人，学业能力发展典型 而言仅限于初级水平，在 工作和生活中需要

4、学业技在整个发育阶段，社交及交流行为与同 龄儿相比有显著不同。通常主要的交流方式是口语，但是与同龄儿相比显著 的更简单。发展关系显著与家庭及朋友相关，但个 体可能在人生中获得成功的友情关系 甚至在成人期获得浪漫关系。然而个体 可能不能准确的接受或解读社交线索。社交判断及决策能力有限，监护人需要 在生活决策提供帮助。与正常个体发 展友谊经常为交流及社会能力的局限作为成年人，可以完成诸如进食、穿衣、排泄 及卫生等个人需求。虽然需要更多的教育及时 间才能在这些方面获得独立，并且需要人提 醒。相应的，成人期亦可完成在家务活动， 但是同 样需要额外的教育，并且要完成成人水平的 工作往往需要持续帮助。个体

5、作为雇员可以完成需要有限的概念及 交流技巧的工作，但需要同事、上司等的帮 助来应对涉及到社会期望、复杂性工作及附 带责任的如计划安排、交通、健康福利及财巧的地方均需要帮助。完所影响。在需要成功完成的工作上，显务管理严重度概念领域社交领域实用领域重概念化技能的习得有限。个 体通常对书面语言及涉及 到数字、数量、时间及金 钱的概念理解有限。在一 身中监护人均需要提供解 决问题的额外帮助。在词汇及语法方面个体的口语水平有限。话语可能是单独的字或词， 以及可 能通过辅助的方式补充。交流的内谷局 限于当下的日常生活事件。 语言更多地 用于社会交流而不是表达。个体能够理 解简单的演讲及手势交流。同家庭成员

6、个体在日常生活的所有活动均需要帮助，包括进食、穿衣、洗澡级排泄。在任何时间个体 均需要监护。个体无法在涉及自己及他人安 全上做出负责任的决策。在成人，参与家庭 任务、娱乐及工作均需要帮助。在所有领域 的技能均需要长期的教学及不断的帮助。不显著概念化技巧往往涉及实体 世界而非象征性过程。个 体能够使用对象通过目标 导向的方式完成自我照 顾、工作及娱乐。一些特定的视觉空间技能， 如通过物质特性匹配和排 序可能可以习得。然而， 共患的动作及感觉障碍可及熟悉个体的天糸是快乐及帮助的来个体对于语言或手势的象征性交流的理 解十分局限，可能理解一些简单的指导 或手势。其表达自己的需求和感情大多 通过非语言非

7、象征的交流方式。个体享受同熟悉的家庭成员、监护人、 熟人的关系，并且通过手势或情感线索 发起或回应社交互动。共患的感觉或躯 体损伤可能影响一些社会行为。适应行为，如自残，在极少数群体中有表现。 个体在身体照顾、健康及安全方面完全依赖于他人，虽然其可能也能够参与其中一些活动。 没有严重躯体损伤的个体可以协助一些家庭 的日常工作，如端菜上桌。使用物体的简单 活动可能是在高度持续的协助下参与一些职 业活动的基础。娱乐活动可能涉及，如享受 音乐、看电影、散步、水上活动，均需要他 人帮助。共患的躯体及感觉障碍常常是参与 家庭、娱乐及工作活动的障碍 （除了观看）。标准实用文案说明：严重水平是通过适应功能，

8、而非IQ水平来定义，因为所需帮助的水平是由适应功能决定的。此外，在低值 IQ测试的可信度较低。诊断特点：智力障碍的基本特征是全面心智能力的缺陷（诊断标准A），及于个体在年龄、性别、社会文化相匹配的对照的日常适应功能的障碍（诊断标准B）,起病与发育时期（诊断标准C），诊断应该基于临床评估及标准化的智力和适应功能评测的结合。DSM 涉及到的调整：1、 适应功能结构的调整： DSM 5将DSM IV TR中，适应功能涵盖包括沟通交际、 自我照顾、居家生活、社会/人际技能、社会资源运用、自我指示、功能性学科 技能、工作、休闲娱乐、健康和安全等10个方面，在其中至少两个方面存在缺 陷即可认为适应功能存在

9、缺陷，调整为概念、社交和实用三个领域，并规定在其 中一个领域存在缺陷即可诊断为适应功能缺陷。2、分类标准的调整：DSM 5将DSM IV TR中根据IQ分数对智力障碍进行分类调 整为根据个体适应功能缺陷的严重程度将智力障碍标注为轻度、中度、重度和极重度四种，并列举出了轻度、中度、重度和极重度患者在概念、社交和实用领域 的表现。“因为所需帮助的水平是由适应功能决定的。此外，在低值IQ测试的可信度较低。”并且“可能影响测评分数的因素包括练习效应和“ Flynn效应”（即由于过时的测评常模造成过高分数）。” “智商测评分数是对概念功能的粗略估 计,不能充分地评估现实生活情况中的推理能力和对实用任务的

10、掌握能力，例如，智商得分70以上的个体可能在社交判断、社交理解和适应功能的其他领域上有 严重的适应性行为问题，以致其实际功能与智商得分更低的个体的表现相当，因此,在解释智商测评的结果时需要临床判断”3、 障碍发生时间的调整： DSM 5将DSM IV TR中诊断标准是障碍发生在 18岁以 前调整为发育时期。因为由于智力障碍成因的复杂性，很难严格定义障碍发生时间的范围，故而采取了更为宽泛的表达。文档附：DSM 5 原文In tellectual disability (in tellectual developme ntal disorder) is a disorder with on set

11、duringthe developmental period that includesbothintellectualand adaptivefun cti oningdeficits in con ceptual, social, and practical doma ins. The follow ingthree criteria must be met:A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, aca

12、demic learning, and learning from experienee, con firmed by both cli ni cal assessme nt and in dividualized, sta ndardizedin tellige nee testi ng.B. Deficits in adaptive functioning that result in failure to meet developmental andsocio- cultural standards for personal independence and social respons

13、ibility. Without on go-ing support, the adaptive deficits limit fun cti oning in one ormore activities of daily life, such as commu ni cati on, social participati on, andin depe ndent liv ing, across multipleen viro nmen ts, such as home, school, work,and commu ni ty.C. On set of in tellectual and a

14、daptive deficits duri ng the developme ntal period.Note: The diag no stic term in tellectual disability is the equivale nt term for the ICD-11 diag-no sisof in tellectualdevelopme ntal disorders. Although the termintellectual disabilityis used throughout this manual, both terms are used in thetitle

15、to clarify relati on ships with other classificati on systems. Moreover, a federal statute in the United States (Public Law 111-256, Rosa s Law) replaces the term mental retardationwith intellectual disability, and research journals use the termin te/ecfua/disability. Thus, in tellectual disability

16、is the term in com mon use bymedical, educati on al,and other professi ons and by the lay public and advocacygroups.Codi ng note: The ICD-9-CM code forin tellectualdisability(i ntellectualdevelopme ntaldisorder) is 319, which is assig ned regardless of the severity specifier.The ICD-10-CM code depen

17、ds on the severity specifier (see below).Specify current severity (see Table 1):(F70) Mild(F71) Moderate(F72) Severe (F73)Profou ndSpecifiersThe various levels of severity are defined on the basis of adaptive functioning, and not IQ scores, because it is adaptivefunctioningthat determinesthe level o

18、fsupports required. Moreover, IQ measures are less valid in the lower end of the IQ ran ge.Diag no stic FeaturesThe esse ntial features of i ntellectual disability (in tellectual developme ntal disorder)are deficits in general mental abilities (Criterion A) and impairment in everyday adaptivefun cti

19、 oning,in comparis onto an in dividual s age-, gen der-, andsocioculturallymatched peers (Criteri on B). On set is duri ng the developme ntalperiod (Criteri on C). The diag no sisof in tellectual disability is based on both cli ni calassessme nt and sta ndardized testi ng of in tellectual and adapti

20、ve fun cti ons.标准实用文案TABLE 1 Severity levels for in tellectualdisability (in tellectualdevelopme ntaldisorder)Severity evelCon ceptual doma inSocial doma inPractical domai nMildFor preschool childre n, there may be no obvious con ceptual differe nces. For school-age childre n and adults, there are d

21、ifficulties in lear ning academic skills in volvi ng readi ng, writi ng, arithmetic, time,ormon ey, with supportn eededn one or more areas to meet age-related expectati ons. In adults, abstract thi nking, execu tive fun cti on (i.e., pla nning, strategiz ing, prioritysett ing,and cog nitive flexibil

22、ity), and short-term memory, as well as functional use ofacademicskills (e.g., read ing,moneyban ageme nt), areimpaired.Compared with typically develop ing agemates, the in dividual is immature in social n teracti ons. For example, there maybediffi- culty in accurately perceiving peerssocial cues. C

23、ommunication, conversation, and lan- guage are more concrete or mmature tha n expected for age. There may be difficulties reg-ulat ing emoti on andbehavior in age-appropri-ate fashi on; thesedifficulties are no ticed bypeers in socialsituati ons. There is limitedun dersta ndingof risk in social situ

24、ati ons;social judgme nts immature for age, and the person is at risk of being mani pulated by others (gullibility).The in dividual may fun cti on age-appropriately in pers onal care. In dividuals n eed somesupportwith complex daily living tasks in comparison to peers. In adulthood, supports typical

25、ly involve grocery shop- ping, tran sportati on, homeandchild-care orga nic-ing, n utritious foodpreparati on, and banking andmoneyman ageme nt. Recreati onal skills resemblethoseof age-mates, although judgme nt related to well-be ing and orga ni zati on arou ndrecreati onrequires support .In adulth

26、ood, competitive employment isoften seen in jobs that do notempha- size conceptual skills. Individuals gen erally n eedsupport to make health caredecisions and legaldecisions, and to learn toperform a skilled vocationcompetently. Supportis typically n eeded to raise afamily.TABLE 1 Severity levels f

27、or in tellectualdisability(in tellectualdevelopme ntaldisorder) con ti nuedSeveritylevelCon ceptual domai nSocial doma inPractical doma inModerateAll through developme nt, the in dividual s con ceptual skills lag markedly behind those of peers. For preschoolers, lan- guage and pre-academic skills de

28、velop slowly. For school-age childre n, progress in read ing, writing, mathematics, and un dersta nding of time and money occurs slowly across the school years and is markedly limited comparedwiththat of peers. For adults, academic skill developme nt is typically at an eleme ntary level, and support

29、 is required for all use of academic skills in work and pers onal life. On go-The in dividual shows marked differe nces from peers in social andcommunicativebehavior across development. Spoken lan guage is typi- cally a primary tool for social commu ni cati onbut is much lesscomplex tha n that of pe

30、ers.Capacity forrelati on ships isevide nt in ties to family andfrien ds, and the in dividual mayhavesuccessful frie ndships across life and sometimes romantic relations in adulthood. However, in dividuals may not perceive or in terpret social cues accurately. Social judg- ment and decision-making a

31、bilities are lim- ited, and caretakers must assist the pers onwith life decisi ons.Frie ndships with typicallydevelop ing peersare ofte n affected by com-muni cati on orsocial limitati ons. Sign ifica ntsocial andcommunicative support isneeded in workThe in dividual can care for pers onal n eeds in

32、volv ing eati ng, dress ing, elim in ati on, and hygiene as an adult, although an extended period of teaching and time is needed for the in dividual to become in depe n-dent in these areas,and remi nders may be n eeded.Similarly,participati on in all household tasks canbeachieved by adulthood, altho

33、ugh anexte ndedperiod of teaching is needed, and ongoing supports will typically occur for adult-level performa nee.Independent employment in jobs that require lim- ited conceptual and communication skills can be achieved, but considerable support from co-work- ers, supervisors, and others is n eede

34、d to man age social expectati on s, job complexities, and ancillary responsibilities such as scheduling, tra nsportati on, health ben efits, and money man ageme nt. A varietyof recreati onal skills caning assista nee on a daily basissett ings for success.be developed. These typi- cally requireSeveri

35、ty levelConceptual domainSocial domain.Practical domainSevereAtta inment of con ceptual skills is limited. The in dividual generally has little un dersta nding of writte n lan guage or ofconcepts in volv ingn umbers,quantity, time, and money. Caretakers provide extensive supports for problem solv in

36、g throughout life.Spoken language is quite limited in terms of vocabulary and grammar. Speech may be sin- gle words or phrases and may be supple- men ted through augme ntative means. Speech and communication are focused on the hereand now withi neveryday eve nts. Lan guage is used for social commu n

37、i cati on more tha n forexplicati on.In dividuals un dersta nd simplespeech andThe in dividual requires support for all activities of daily liv ing, in cludi ng meals, dress ing, bath ing, and elim in ati on. The in dividual requires supervisi on at all times. The in dividual cannot make resp on sib

38、ledecisi ons regard ingwell-be ing of self or others. Inadulthood,participationin tasks at home, recre- ation, andwork requires ongoing support and assis-tan ce.Skill acquisition in all domains involves long- termProfou ndCon ceptual skillsgen erallyin volve the physical world rather tha n symbolic processes. The in dividual may use objects in goal-directed fashion for self-care, work, and recre- ati on. Certain visuospatial skills, such as matchi ng andsort ing basedon physical char- acteristics, may be acquired.However, co-occurri ng motor and sensory impairme