This document discusses labelling and classifications in developmental disabilities. It explores both the advantages and disadvantages of labelling, noting that while labels can help facilitate support and treatment, they also risk oversimplifying complex individuals and pathologizing normal human variation. The document provides an overview of key developmental disabilities like intellectual disability, autism spectrum disorder, and ADHD based on DSM-5 criteria and changes. It also discusses prevalence rates, co-occurrence of disorders, and the high risk of psychiatric disorders among those with developmental or intellectual impairments.

1. Labelling & Classifications inLabelling & Classifications in
Developmental Disabilities:Developmental Disabilities:
Curse or Blessing?Curse or Blessing?
Jeremy TurkJeremy Turk
Institute of Psychiatry, King’s College,University of LondonInstitute of Psychiatry, King’s College,University of London
Southwark Child & Adolescent Mental Health,Southwark Child & Adolescent Mental Health,
Neurodevelopmental Service, Sunshine House,Neurodevelopmental Service, Sunshine House,
South London & Maudsley NHS Foundation TrustSouth London & Maudsley NHS Foundation Trust
Great Ormond Street Hospitals NHS Foundation TrustGreat Ormond Street Hospitals NHS Foundation Trust

2. HistoricalHistorical
Les enfants du bon dieu
Children of a lesser god
Irrecupables
Incarceration & institutionalisation
Fatalistic nihilism
Naïve idealism
Overmedicalisation versus oversocialisation

3. What are developmentalWhat are developmental
disorders?disorders?
Early onset
Long-term
Frequently multiple
Interferences in normally fluent skill acquisitions
Necessary for maximisation of potential and
quality of life
Producing adverse physical & psychological
functional consequences
& multiple social adversities & social

4. Intellectual DisabilityIntellectual Disability
General level of intellectual functioning
– Within the lowest 2-3% of the population
– IQ less than approximately 70
Significant impairments in adaptive behaviours and life
skills
– Self-care
– Self-occupancy
– Self-sufficiency
– Self-determination
– Safety

5. DSM-5 Intellectual DisabilityDSM-5 Intellectual Disability
Impairments of general mental abilities that impact
adaptive functioning & determine how well everyday tasks
are coped with: 3 domains
Conceptual domain: language, reading, writing, maths,
reasoning, knowledge, memory
Social domain: empathy, social judgement, interpersonal
communication skills, making & retaining friendships
Practical domain: personal care, job responsibilities,
money, recreation, organising school & work tasks
Diagnosis based on severity of deficits in adaptive
functioning

6. DSM-5: Intellectual DisabilityDSM-5: Intellectual Disability
Intellectual disability; not mental retardation
AKA intellectual developmental disorder
Spectrum of disability cognitively and functionally
Avoids hierarchical diagnoses
Moves away from multiaxial classificatory systems
All mental disorders considered on single axis and given
equal weight
i.e. co-morbidities or co-occurrences
Often occurs with other mental disorders e.g. depression,
ADHD, ASD

7. What is IQ?What is IQ?
That which is measured by an IQ test

8. What does an IQ test measure?What does an IQ test measure?
IQ
The ratio of chronological age to
mental age
Multiplied by 100

9. Intellectual DisabilityIntellectual Disability
Mild 50 – 70
Moderate 35 – 50
Severe 20 – 35
Profound < 20
Learning DifficultiesLearning Difficulties
Moderate 50 – 70
Severe < 50

10. Terminology
Idiot, imbecile, feeble-minded
Mental retardation
Mental subnormality
Mental impairment
Developmental Delay
Learning Disability, Learning Disabilities
Learning difficulties
Intellectual Disability

11. Autistic
Spectrum
Disorder
A.D.H.D.
Intellectual
disability

12. Intellectual Disabilities, AutismIntellectual Disabilities, Autism
Spectrum Conditions & ADHD:Spectrum Conditions & ADHD:
are developmental disabilities
are not psychiatric disorders
But they predispose individuals to mental health
problems for a variety of biological, psychological,
educational and social reasons

13. DSM-5 Autism Spectrum DisorderDSM-5 Autism Spectrum Disorder
Single diagnostic term
Communication deficits
– Receptive & expressive
– Verbal & non-verbal
Social impairments
Obsessional interests, behaviours, routines & insistence on
sameness
Features from early childhood even if not recognised until
later

14. Attention Deficit-Attention Deficit-
Hyperactivity DisordersHyperactivity Disorders
 Overactivity
 Inattentiveness
 Restlessness
 Fidgetiness
 Impulsiveness
 Distractibility
 All-pervasive

15. ADHD: DSM-5 CHANGESADHD: DSM-5 CHANGES
 Recognises adult presentations
 Children: at least 6 items from inattention
&/or hyperactive-impulsive group
 Adults: only 5 items needed
 Several symptoms must be present prior
to 12 years
 No exclusion criteria for those with ASCs

16. Prevalence: how common?Prevalence: how common?
Intellectual Disability
– Mild: 2-3%
– Moderate-to-profound: 0.5%
ADHD / Hyperkinetic Disorder
– DSM: 3-5%
– ICD: 0.5-1%
Autism Spectrum Disorders 1-2%

17. Diagnosable Psychiatric DisorderDiagnosable Psychiatric Disorder
with Significant Functionalwith Significant Functional
Impairment in Young PeopleImpairment in Young People
General population 7%
Physical Impairment 11%
Impaired brain functioning 33%
“Severe learning difficulties” 50%
Deprivation & disadvantage doubles the percentages

18. Cerebral PalsyCerebral Palsy
Psychiatric disorder in 40%
No gender predominance for boys
Hemiplegia:
– 25% conduct/emotional disorder
– 10% hyperkinetic disorder
– 3% autistic disorder
Best predictor = low IQ
Disorders manifest identically to those of
psychosocial origin

19. Multi-axial Classification System
1. Psychiatric diagnostic label(s) ADHD combined type
2. Specific developmental delays (Specific learning
difficulties) working memory & fine motor impairments
3. General level of intellectual functioning IQ = 63
4. Medical Associations
 Causal fragile X syndrome
 Consequential repetitive bruising & fractures
 Co-occurring epilepsy
 Coincidental & complicating eczema & hay fever
1. Social factors single parent, financial hardship
2. Degree of functional impairment extreme

20. The Importance of DiagnosisThe Importance of Diagnosis
(Turk, 2003)(Turk, 2003)
 the right of the individual & family to know
 relief from uncertainty
 facilitation of grief resolution
 focusing on the future
 genetic counselling
 information on likely strengths & needs
 early instigation of appropriate interventions
 linking with appropriate support networks

21. Advantages of LabellingAdvantages of Labelling
 Convenient & helpful shorthand
 Emphasises similarities & shared attributes
 Facilitates linking between diagnosis,
prevalence, symptomatology, treatments &
supports & prognosis
 Facilitates research
 Enables individuals and families to relate to
others with similar challenges

22. Disadvantages of LabellingDisadvantages of Labelling
 Oversimplifies & stereotypes complex life
situations
 Denies uniqueness of each individual
 Imposes “one size fits all” thinking by supporting
professionals
 Pathologises human developmental &
psychological variation
 Risks placing those at the margins statistically in
the margins of society