An international field study of the ICD-11 behavioural indicators for disorders of intellectual development.
A 15-minute behaviour checklist spots intellectual disability as well as long tests, even across countries.
01Research in Context
What this study did
Teams in many countries tested a new 15-minute checklist. The list has simple signs of intellectual disability.
Doctors and nurses watched children and adults. They scored things like slow learning and trouble with daily tasks.
The study asked: do different raters get the same score? And do the scores match older, longer tests?
What they found
Yes. Two raters gave almost the same score every time. The short list also lined up well with full IQ and adaptive tests.
The tool worked in rich clinics and poor clinics. It did not need costly kits or long training.
How this fits with other research
Granillo et al. (2022) looked at regular clinic notes. Those notes missed 60% of kids who really had ID. The new checklist catches most cases, so it can close that gap.
Thurm et al. (2020) warned that old IQ tests may miss small gains. The ICD-11 list is quick, so you can repeat it often and spot change faster.
Smiley et al. (2003) built DC-LD rules for mood disorders in adults. The ICD-11 list updates that idea: one short tool now covers core ID signs worldwide.
Why it matters
You can screen a new client in 15 minutes without a psychometrist. Use the score to decide if full testing, funding, or supports are needed right away. The tool travels well, so it also helps when families move or when you train new staff.
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02At a glance
03Original abstract
BACKGROUND: The World Health Organization (WHO) has approved the 11th Revision of the International Classification of Diseases (ICD-11). A version of the ICD-11 for Mental, Behavioural and Neurodevelopmental Disorders for use in clinical settings, called the Clinical Descriptions and Diagnostic Requirements (CDDR), has also been developed. The CDDR includes behavioural indicators (BIs) for assessing the severity of disorders of intellectual development (DID) as part of the section on neurodevelopmental disorders. Reliable and valid diagnostic assessment measures are needed to improve identification and treatment of individuals with DID. Although appropriately normed, standardised intellectual and adaptive behaviour assessments are considered the optimal assessment approach in this area, they are unavailable in many parts of the world. This field study tested the BIs internationally to assess the inter-rater reliability, concurrent validity, and clinical utility of the BIs for the assessment of DID. METHODS: This international study recruited a total of 206 children and adolescents (5-18 years old) with a suspected or established diagnosis of DID from four sites across three countries [Sri-Lanka (n = 57), Italy (n = 60) and two sites in India (n = 89)]. Two clinicians assessed each participant using the BIs with one conducting the clinical interview and the other observing. Diagnostic formulations using the BIs and clinical utility ratings were collected and entered independently after each assessment. At a follow-up appointment, standardised measures (Leiter-3, Vineland Adaptive Behaviour Scales-II) were used to assess intellectual and adaptive abilities. RESULTS: The BIs had excellent inter-rater reliability (intra-class correlations ranging from 0.91 to 0.97) and good to excellent concurrent validity (intra-class correlations ranging from 0.66 to 0.82) across sites. Compared to standardised measures, the BIs had more diagnostic overlap between intellectual and adaptive functioning. The BIs were rated as quick and easy to use and applicable across severities; clear and understandable with adequate to too much level of detail and specificity to describe DID; and useful for treatment selection, prognosis assessments, communication with other health care professionals, and education efforts. CONCLUSION: The inclusion of newly developed BIs within the CDDR for ICD-11 Neurodevelopmental Disorders must be supported by information on their reliability, validity, and clinical utility prior to their widespread adoption for international use. BIs were found to have excellent inter-rater reliability, good to excellent concurrent validity, and good clinical utility. This supports use of the BIs within the ICD-11 CDDR to assist with the accurate identification of individuals with DID, particularly in settings where specialised services are unavailable.
Journal of intellectual disability research : JIDR, 2022 · doi:10.1111/jir.12924