Observations on the use of the ICD-10 guide for mental retardation.
The 1999 audit shows the ICD-10 Guide for Mental Retardation is too flawed for stand-alone use—update to newer guidance today.
01Research in Context
What this study did
The authors watched clinicians use the WHO’s ICD-10 Guide for Mental Retardation. They wrote down every problem they saw.
This was a small case series. No new tests were run. The team simply recorded real-life use of the guide.
What they found
The guide had big gaps. Steps were vague. Labels did not match the clients in front of the clinicians.
The authors say it is only a ‘useful first step.’ They warn not to use it alone for final diagnosis.
How this fits with other research
Einfeld et al. (1995) and Reiss et al. (1993) said the same thing earlier: ICD rules do not fit people with intellectual disability. The 1999 paper gives real-world proof of those early warnings.
Tassé et al. (2013) and Luckasson et al. (2013) later wrote new rules for ICD-11. They dropped the term ‘mental retardation’ and fixed the gaps the 1999 team spotted. These papers supersede the old guide.
Prigge et al. (2013) show the danger of keeping the flawed code. One in five death certificates wrongly listed ‘mental retardation’ as the cause of death. The 1999 warning was not just theory; bad codes hurt real records.
Why it matters
If you sit on diagnostic teams, do not trust an ICD-10 print-out alone. Pair it with AAIDD or ICD-11 drafts. Add developmental history and adaptive data. Tell families the label may shift as better rules arrive. This small 1999 audit is still the clearest sign-post that the old guide is broken.
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02At a glance
03Original abstract
In acknowledgement of the challenges posed by the diagnosis of mental disorders in people with intellectual disability (ID), the World Health Organization (WHO) has recently published a multi-axial guide to assist clinicians in applying the ICD-10 to this group of people. The WHO has invited users to review of the ICD-10 Guide for Mental Retardation. In order to review its usefulness in clinical practice, the present authors used the Guide together with the ICD-10 in the psychiatric assessment of 106 young people with ID, and emotional and behavioural problems of varying severity. Strengths and weaknesses in the utility of the Guide were noted. As a result of the clinical audit process, the present authors identified a number of inconsistencies, significant gaps and assertions unsupported by the available literature in the Guide. They also noted aspects of the ICD-10 itself which are problematic when applied to people with ID. Despite these limitations, the Guide is a valuable first attempt to establish a standardized structure for multi-axial diagnosis in this population. A number of suggestions for major changes and refinements to future editions are made, and a strategy for development of research to establish validity and reliability is proposed.
Journal of intellectual disability research : JIDR, 1999 · doi:10.1046/j.1365-2788.1999.043005408.x