DM-ID and Other Tools to Assist Clinical Judgment

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and Other Tools to Assist Clinical Judgment Ann R. Poindexter, M.D. Overview of the Diagnostic Manual for Persons with Intellectual Disabilities Robert J.

Mental Disorders in Persons with Intellectual Disability An adaptation to the DSM-IV-TR Designed to facilitate a more accurate psychiatric diagnosis Diagnostic Manual

1 and Other Tools to Assist Clinical Judgment Ann R. Poindexter, M.D. Overview of the Diagnostic Manual for Persons with Intellectual Disabilities Robert J. Fletcher, DSW, ACSW, FAAIDD Chief Editor of Founder & CEO of NADD DM ID: Two Manuals Description of Diagnostic Manual Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons with Intellectual Disability An adaptation to the DSM-IV-TR Designed to facilitate a more accurate psychiatric diagnosis Diagnostic Manual Intellectual Disability: A Clinical Guide for Diagnosis of Mental Disorders in Persons with Intellectual Disability Based on Expert Consensus Model Covers all major diagnostic categories as defined in DSM-IV-TR 1

2 Description of Description of Provides information to help with diagnostic process Provides clear examples of how items should be interpreted Addresses pathoplastic effect of ID on psychopathology Designed with a developmental perspective to help clinicians to recognize symptom profiles in adults and children with ID Empirically-based approach to identify specific psychiatric disorders in persons with ID Provides state-of-the-art information about mental disorders in persons with ID Provides adaptations of criteria, where appropriate Description of Information on how to recognize challenging behaviors Information on how to differentiate behavioral problems from psychiatric disorders Review of Diagnostic Criteria General description of the disorder Summary of DSM-IV-TR criteria Issues related to diagnosis in people with ID Review of Literature/Research Evaluating level of evidence 2

3 Application of Diagnostic Criteria to People with ID General considerations Adults with Mild to Moderate ID Adults with Severe or Profound ID Children and adolescents with ID Etiology and Pathogenesis Risk Factors Biological Factors Psychological Factors Genetic Syndromes Diagnostic Criteria Adaptation of the DSM-IV-TR Criteria DSM-IV-TR Criteria Adapted Criteria Mild-Moderate ID Adapted Criteria Severe-Profound ID Addition of symptom equivalents Omission of symptoms Changes in symptom count Modification of symptom duration 3

4 Adaptation of the DSM-IV-TR Criteria Modification of age requirements Addition of explanatory notes Criteria Sets that do not apply Adaptation of DSM-IV-TR Criteria Change in Count and Symptom Equivalent Major Depressive Episode DSM-IV-TR Criteria A. Five or more of the following symptoms have been present during the same 2 week period and represent a change from previous functioning. At least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Adapted Criteria for Mild to Profound ID A. Four or more symptoms have been present during the same 2 week period and represent a change from previous functioning. At least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure or (3) irritable mood. Two Special Added-Value Chapters Assessment and Diagnostic Procedures Behavioral Phenotype of Genetic Disorders Phenotype and Proposed Behavioral Phenotype for Down Syndrome Phenotype Proposed Behavioral Phenotype Behavioral Phenotype of Genetic Disorders: Chapter 3 Small head, mouth; upward slant to eyes; epicanthal folds; broad neck; hypothyroidism; hearing loss; visual impairments; cardiac problems; gastrointestional; orthopedic, and skin disorders; obesity Childhood Oppositional and defiant; Attention- Deficit/Hyperactivity Disorder (ADHD); social, charming personality stereotype Adulthood Depressive disorders; Obsessive-Compulsive Disorder; other anxiety disorders; dementia of the Alzheimer s Type; mental disorders associated with hypothyroidism Levitas, et al,

5 THANK YOU! For more information, please contact: Dr. Robert J. Fletcher NADD 132 Fair Street, Kingston, NY 12401, USA HELPFUL TOOLS TO MAKE A PSYCHIATRIC DIAGNOSIS, IN ADDITION TO rfletcher@thenadd.org Web site: Making a running problem list, going back a very long way, including all diagnoses and medications, is very important. This list can be updated regularly, and copies furnished to consultants. Early information should not be deleted. Vegetative information should be carefully examined, particularly weight changes up and down, and sleep patterns, going back as far as possible. 5

6 Careful examination of all present medications should be made, including any possible exposures to non-prescription medications, illegal drugs, and alcohol. Possible side-effects of these medications that might be causing behavioral problems should be considered. Any recent changes in the person s life, such as changes in living arrangements, personal life, and staffing assistance should be noted carefully. THE IMPORTANCE OF CLINICAL JUDGEMENT SHOULD NEVER BE IGNORED!!!!! Do not be daunted by the enormity of the world s grief. Do justly now. Love mercy now. You are not obligated to complete the work. Neither are you free to abandon it. The Talmud 6

Establishing the Link: Assessment and Intervention of Children and Adults October 23, 2018

Establishing the Link: Assessment and Intervention of Children and Adults October 23, 2018 Mental Health Aspects in Persons with Intellectual/Developmental Disabilities: Assessment and Diagnostic Practices (Keynote Speaker) Robert J. Fletcher, DSW, ACSW, LCSW, NADD-CC NADD Founder & CEO Emeritus