Book review

Diagnostic Manual – Intellectual Disability

Robert Fletcher, D.S.W., Earl Loschen, M.D., Chris-soula Stavrakaki, M.D.,Ph.D, Michael First, M.D.

National Association for the Dually Diagnosed, New York.2007. 552 pp., £73.60 (pbk). ISBN 1 57256 125 4.

The stated aim of this book is to facilitate a moreaccurate psychiatric diagnosis in people with intel-lectual disability (ID). The Diagnostic Manual –Intellectual Disability (DM-ID) is clearly a followon from the ‘Diagnostic Criteria – LearningDisability (DC-LD)’ published by The RoyalCollege of Psychiatrists in 2001 (Royal College ofPsychiatrists 2001), and the ‘Practice Guidelinesfor the Assessment and Diagnosis of Mental HealthProblems in Adults with Intellectual Disability’,produced by The European Association for MentalHealth in Mental Retardation in 2001 (Deb et al.2001). The DM-ID contrastingly keeps to the struc-ture of the Diagnostic and Statistical Manual ofMental Disorders Fourth Edition (DSM-IV-TR),while the DC-LD though complementary to theICD-10, came up with a new classification system.The initial chapters discuss more general principlesof assessment and diagnostic procedures andvarious behavioural phenotypes of genetic disorders.Subsequent chapters cover individual DSM-IV-TRcategories wherein diagnostic criteria are elaboratedupon and discussed, followed by issues related todiagnosis in persons with ID and adaptation ofdiagnostic criteria.

The recurring comment through most of thediagnostic categories is that often it is not the crite-ria that need to be adapted, but a different methodof eliciting the necessary information needs to be

adopted. The criteria are divided into adapted crite-ria for mild to moderate IDs, and adapted criteriafor severe to profound ID. As would be expected,adaptations to the diagnostic criteria are mostlymade in the severe to profound ID category. Insome conditions, such as sub-classification ofschizophrenia, and delusional disorder, the diagnos-tic criteria do not apply and the reader is advisednot to use these diagnostic categories in people withsevere to profound ID.

The book is written in a lucid style with chaptersthat are concise and of manageable lengths. It workswell as a manual.The authors systematically go overeach diagnostic category in the DSM-IV-TR, firstelaborating on the criteria as in the DSM-IV-TR andthen giving useful pointers and tips to elicit the eli-gible criteria, or safeguards to observe while doingso.There is also good discussion regarding the crite-ria that do need to be adapted and the reasons fordoing so. At the end of each chapter, there are veryuseful summary tables that list out the DSM-IV-TRdiagnostic criteria and the corresponding adapta-tions that need to be applied when considering aperson with ID.The tables are a good quick-reference tool.The authors have also maintained astrong evidence-based perspective throughout. Eachchapter has a section that reviews the current evi-dence or highlights the lack of it.The extensive refer-ences that follow the chapters will be of benefit tothose who want to delve deeper into the subject orlook at some of the landmark papers.The chapter onBehavioural Phenotypes of Genetic Disorders alsolists out some useful website addresses that givefurther information on various genetic conditions.The strength of evidence for each conclusion is indi-cated by using the Cochrane library’s five levels of

Journal of Intellectual Disability Research doi: 10.1111/j.1365-2788.2008.01050.x

volume 52 part 11 pp 1013–1014 november 20081013

© 2008 The Author. Journal Compilation © 2008 Blackwell Publishing Ltd

evidence.The expert consensus model was used toarrive at the adapted criteria, which were then fieldtested by clinicians from 11 different countries.

The DM-ID could well be a mandatory text forall trainee psychiatrists who intend to work withpeople with ID. It will be a valuable reference bookfor all professionals who are involved in the diagno-sis of mental disorder in people with ID. In myopinion, the depth of information and the nuggetsof wisdom offered serve well in achieving the aim ofthe book.

Andrew Isaac

Lea Castle Centre, Kidderminster, UK

References

Deb S., Matthews T., Holt G. & Bouras N. (2001). Prac-tice Guidelines for the Assessment and Diagnosis of MentalHealth Problems in Adults with Intellectual Disability.Pavilion, UK. Available at: www.estiacentre.org(retrieved 6 March 2008).

Royal College of Psychiatrists (2001) Diagnostic CriteriaFor Psychiatric Disorders For UseWith AdultsWith Learn-ing Disabilities/Mental Retardation (DC-LD). Gaskell,London. Occasional Paper OP 48.

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Book review

© 2008 The Author. Journal Compilation © 2008 Blackwell Publishing Ltd