The current international classification manuals have limitations
when used with persons with intellectual disabilities (PWID), and
cannot be applied in severe and profound cases. Misdiagnosis is due
to self-report unreliability, limitations in cognitive skills and
ability to articulate complex concepts such as depressed mood, and
eagerness to please, different symptom expression, behavioural
equivalents, and problems in classifying behavioural phenotypes.
The National Association for the Dually Diagnosed (NADD), has
developed a diagnostic manual for PWID to facilitate psychiatric
diagnosis in this population group based on DSM-IVTR. A major feature
of the Manual is that it provides detailed instructions on how to
apply DSM-IV-TR criteria to people with intellectual disability using
modified criteria where applicable. The Manual provides a guide
for the clinician in ways to assess and diagnose people who have
limited verbal skills. The manual is based on a consensus adaptation
of those diagnostic criteria that could not be applied in ID, follows
available scientific evidence and has incorporated in the review
process an international panel including several WPA section
members, who also participated in the usability testing of the
manual. This activity followed previous cooperation between NADD and
the WPA ID section. This initiative provides a framework to
facilitate research and progress in the area and it will certainly
increase awareness on ID and facilitate the diagnostic process to clinicians.
Luis Salvador-Carulla, MD
Section Psychiatry of Intellectual Disability (Mental Retardation)
World Psychiatric Association
[The DM-ID Textbook is] a major contribution to the field . .
. . I am sure that it will be of great help to those involved
in Dual Diagnosis for PWID for years to come.
Nick Bouras, MD, PhD, FRCPsych
Professor of Psychiatry
Institute of Psychiatry - King's College London
As a practitioner resource, the Diagnostic Manual-Intellectual
Disability (DM-ID) provides state of the art guidance to
accurately diagnose and treat a significant consumer population in
need of appropriate mental health services-persons with intellectual
disability. This resource will help to advance the quality of mental
health services to this often overlooked consumer population.
Brian J. Boon, Ph. D., President/CEO, CARF.
The mental health service providers in the I/DD field have been
looking forward to an organized approach to applying diagnostic
rigor. While the APA's Diagnostic and Statistical Manual (DSM)
has provided the starting point, the Diagnostic Manual:
Intellectual Disabilities (DM:ID) text book and clinical guide
provide the opportunity for clinicians to improve reliability and
validity in their practice with this complex population.
Recognition that people with I/DD experience mental illness has only
been a relatively recent development, but the capacity of the general
mental health system to understand the diagnostic challenges has
generally been overwhelming.
The publication of the DM:ID begins the opportunity to examine
needs and services in ways that have been unattainable thus far, but
it will depend upon implementation as well. With the goal of
improving the quality of life for people who are the most vulnerable,
clinical and research tools will now have the potential to take a
great step forward. Tremendous efforts have been put into these
publications, bringing together research and expert-consensus to
build on the contributions of Frank Menolascino, Robert Sovner, and
other pioneers in our specialized field.
Paul D. Kolstoe, PhD
Clinical Director/Licensed Psychologist
Chair - AAIDD Mental Health Services SIG
The "Diagnostic Manual - Intellectual Disability" (DM-ID)
is a significant step forward in support of the fact that individuals
with intellectual disability can and do have mental disorders. It is
a culmination of a vision by the leaders of NADD and many years of
work by experienced professionals dedicated to providing a more
organized way to recognize and diagnose mental disorders in
individuals with intellectual disability. Collaboration with the
American Psychiatric Association (APA) further legitimizes the
correlation of the symptoms seen in individuals with intellectual
disability and those in the APA's "Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition ,Test
Revision" (DSM IV - TR) . It should be used by all mental health
clinicians as the most up to date tool available to guide their work.
Nancy N. Cain, MD, DLFAPA
Associate Professor of Clinical Psychiatry
Strong Behavioral Health Adult Ambulatory Clinic
Rochester, New York
As a clinician who evaluates and treats a large number of individuals
with severe/profound IDD, I find the adaptation of diagnostic
criteria in the DM-ID to be of immense benefit. The comments and
literature searches are also quite helpful, providing a concise and
focused review of recent literature on each criterion set. The
edition is a must for any clinician working in the field of dual diagnosis.
Jarrett Barnhill MD DFAPA, FAACA; Professor
Department of Psychiatry Director,
Developmental Neuropharmacology Clinic
University of North Carolina School of Medicine
Chapel Hill NC
As a primary care physician with more than forty years' experience
working with people with intellectual disability and psychiatric
behavioral problems, I really feel that the new DM-ID will be
particularly helpful for primary health care providers who serve this
population and for interdisciplinary teams-not just psychiatrists and
psychologists. We all really want to know that we have a reasonably
feasible diagnostic postulate when we begin, continue, change, or
discontinue psychotropic medications as well as other treatment modalities.
Ann R. Poindexter, M.D.
The DM-ID is a must read for any clinician who provides mental
health services to people who have intellectual disabilities
(ID). Both versions of the DM-ID instructs the reader on
how to apply DSM-IV-TR diagnostic criteria or adaptive
criteria and teaches how to identify signs and symptoms of specific
psychiatric disorders in persons who have ID.
Dr. Robert J. Fletcher
Chief Executive Officer
Rob, Congratulations on the DM - ID. It is truly a work of art
and science and I know it will be a monumental contribution to the field.
Fondly, Marklyn P. Champagne