A critique of the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) chapter on non-affective psychotic disorders.
DC-LD psychosis criteria are broader than ICD-10, so test them together before labeling an adult with ID.
01Research in Context
What this study did
Dewsbury (2003) looked at the new DC-LD guide for spotting psychosis in adults with learning disabilities.
The author compared the DC-LD rules with the older ICD-10 rules.
This was a narrative review, so no new data were collected; the paper sums up expert opinion.
What they found
The DC-LD criteria cast a wider net than ICD-10.
Because the rules are looser, more adults with ID could be labeled psychotic.
The paper warns we should test the new criteria side-by-side with standard systems before using them alone.
How this fits with other research
Clarke (2003) wrote in the same year and praised DC-LD for sharpening diagnosis across all psychiatric phenotypes.
The two papers seem to clash, but they look at different angles: Dewsbury (2003) zooms in on psychosis, while David looks at the whole manual and likes the added detail.
Najdowski et al. (2003) extend the story to ADHD, saying DC-LD can fix under-detection there, showing the debate repeats for every diagnosis.
O'Brien (2003) also widens the lens, proposing DC-LD labels for severe problem behavior so clients can access services, yet still urges careful validation, echoing the caution in Dewsbury (2003).
Why it matters
If you assess adults with ID, remember that DC-LD may over-flag psychosis. Use it as a second screen, not the only screen. Pair it with ICD-10 or DSM-5 criteria, document why you chose each label, and watch for false positives that could lead to needless medication.
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02At a glance
03Original abstract
BACKGROUND: There has been a longstanding interest in the study of psychotic disorders in adults with intellectual disability. The DC-LD chapter for non-affective psychotic disorders provides operationalised criteria for use with this population. METHODS: A detailed, structured review of the literature was carried out. Relevant papers were reviewed to provide a framework for a critique of the DC-LD criteria. RESULTS: Most of the research literature focuses on psychotic disorders in adults with mild intellectural disability and suggests that this group experience clinical symptoms similar to those experienced by adults with average abilities. Although the DC-LD criteria for non-affective psychotic disorders are derived from the ICD-10 equivalent categories they are broader than other classification systems, which may affect their reliability, validity and utility. CONCLUSIONS: At this stage, it is important that the DC-LD criteria are used alongside established systems to gather information about their use for clinical and research purposes.
Journal of intellectual disability research : JIDR, 2003 · doi:10.1046/j.1365-2788.47.s1.12.x