DSM 5智力障碍诊断标准及原文

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：

说明：

严重水平是通过适应功能，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。

附：

DSM 5 原文

Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. The f ollowing three criteria must be m et:

A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract

thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.

B. Deficits in adaptive functioning that result in failure to meet developmental and socio-

cultural standards for personal independence and social responsibility. Without ongo-ing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, and independent living, across multiple environments, such as home, school, work, and community.

C. Onset of intellectual and adaptive deficits during the developmental period.

Note: The diagnostic term intellectual disability is the equivalent term for the ICD-11 diag-nosis of intellectual developmental disorders. Although the term intellectual disability is used throughout this manual, both terms are used in the title to clarify relationships with other classification systems. Moreover, a federal statute in the United States (Public Law 111-256, Rosa’s Law) replaces the term mental retardation with intellectual disability, and research journals use the term inte//ecfua/ disability. Thus, intellectual disability is the term in common use by medical, educational, and other professions and by the lay public and advocacy groups.

Coding note: The ICD-9-CM code for intellectual disability (intellectual developmental disorder) is 319, which is assigned regardless of the severity specifier. The ICD-10-CM code depends on the severity specifier (see below).

Specify current severity (see Table 1):

(F70) Mild

(F71) Moderate

(F72) Severe(F73)

Profound

Specifiers

The various levels of severity are defined on the basis of adaptive functioning, and not IQ scores, because it is adaptive functioning that determines the level of supports required. Moreover, IQ measures are less valid in the lower end of the IQ range.

Diagnostic Features

The essential features of intellectual disability (intellectual developmental disorder) are deficits in general mental abilities (Criterion A) and impairment in everyday adaptive functioning, in comparison to an individual’s age-, gender-, and socioculturally matched