Implementation of the International Classification of Diseases 11th revision behavioural indicators for disorders of intellectual development with co-occurring autism spectrum disorder
Lemay, K R Kogan, C. S. Rebello, T. J. Keeley, J. W. Bhargava, R. Buono, S. Cooray, S. Ginige, P Kishore, M. T. Kommu, J. V. S.
Lemay, K R
Kogan, C. S.
Rebello, T. J.
Keeley, J. W.
Bhargava, R.
Buono, S.
Cooray, S.
Ginige, P
Kishore, M. T.
Kommu, J. V. S.
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Affiliation
University of Ottawa; Columbia University Vagelos College of Physicians and Surgeons; Research Foundation for Mental Hygiene; Virginia Commonwealth University; All India Institute of Medical Sciences; Oasi Research Institute-IRCCS, Troina; Royal College of Psychiatrists, London; University of Peradeniya; National Institute of Mental Health and Neuro Sciences, Bengaluru; Coventry and Warwickshire Partnership NHS Trust; University of Warwick
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Publication date
2024-10
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Abstract
Background: The classification of mental, behavioural and neurodevelopmental disorders in the World Health Organization's International Classification of Diseases 11th revision (ICD-11) includes a comprehensive set of behavioural indicators (BIs) within the neurodevelopmental disorders grouping. BIs can be used to assess the severity of disorders of intellectual development in situations in which standardised measures of intellectual functioning and adaptive behaviours are not available or feasible. This international study examines the implementation characteristics of the BIs and compares them to standardised measures for assessing the severity of intellectual impairment and adaptive behaviours in disorders of intellectual development and autism spectrum disorder (ASD). The clinical utility of the ICD-11 and the fidelity of its application in international clinical settings were also assessed.
Methods: A total of 116 children and adolescents (5-18 years old) with a suspected or established diagnosis of disorders of intellectual development were included across four sites [Italy (n = 18), Sri Lanka (n = 19) and two sites in India (n = 79)]. A principal component analysis was conducted to evaluate the application of the ICD-11 guidance for combining severity levels.
Results: Assessment using the BIs showed a higher proportion of individuals classified with mild severity, whereas the standardised measures indicated a higher proportion of severe ratings. Additionally, individuals with co-occurring ASD tended to have more severe impairments compared with those without ASD, as indicated by both BIs and standardised measures. Overall, the BIs were considered clinically useful, although more time and consideration were required when applying the guidelines for individuals with a co-occurring disorder of intellectual development and ASD. The principal component analysis revealed one principal component representing overall disorders of intellectual development severity levels.
Conclusions: The ICD-11 BIs can be implemented as intended in international clinical settings for a broad range of presentations of individuals with neurodevelopmental disorders. Use of the BIs results in similar severity diagnoses to those made using standardised measures. The BIs are expected to improve the reliability of severity assessments in settings where appropriate standardised measures for intellectual and adaptive behaviours are not available or feasible.
Citation
Lemay KR, Kogan CS, Rebello T, Keeley JW, Bhargava R, Buono S, Cooray S, Ginige P, Kishore MT, Kommu JVS, Recupero M, Roy A, Sharan P, Reed GM. Implementation of the International Classification of Diseases 11th revision behavioural indicators for disorders of intellectual development with co-occurring autism spectrum disorder. J Intellect Disabil Res. 2024 Oct;68(10):1114-1128. doi: 10.1111/jir.13146. Epub 2024 May 11. PMID: 38733333.
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Article