1、診斷標(biāo)準(zhǔn)：智力障礙（智力發(fā)育障礙）是起病于發(fā)育時期，在概念、社交和實用領(lǐng)域中的智力和適應(yīng)功能的缺陷。須符合以下三個診斷標(biāo)準(zhǔn)：A經(jīng)臨床評估和個體化、標(biāo)準(zhǔn)化的智力評測確認(rèn)的智力功能障礙，如推理、問題解決、計劃、抽象思維、判斷、學(xué)業(yè)學(xué)習(xí)和基于經(jīng) 驗的學(xué)習(xí)。B適應(yīng)功能缺陷造成未能達(dá)到發(fā)育及社會文化相稱的個人獨立性及社會責(zé)任標(biāo)準(zhǔn)。在沒有持續(xù)幫助的情況下，該適應(yīng)功能缺陷限制 了其在多個環(huán)境中，如家庭、學(xué)校、工作和社區(qū)，的一個或多個日常生活功能，如交流、社會參與和獨立生活。C智力和適應(yīng)缺陷起病于發(fā)育時期。嚴(yán)重程度則基于ICD-10-CM編碼如下：嚴(yán)重度概念領(lǐng)域社交領(lǐng)域?qū)嵱妙I(lǐng)域輕在學(xué)齡前兒童，可能沒有 明顯的

2、概念區(qū)別。對于學(xué) 齡兒童和成人，存在學(xué)習(xí) 困難，包括讀、寫、計算、 時間金錢的概念，在一個 或多個領(lǐng)域需要幫助以達(dá) 到年齡預(yù)期的水平。在成 人，則有抽象思維、執(zhí)行 功能（如計劃、策略、最 優(yōu)設(shè)定及認(rèn)知靈活性）、 短時記憶以及對學(xué)業(yè)能力 的應(yīng)用（如讀、財務(wù)管理） 的受損。對于問題及解決 方案相較于同齡人更顯得 具體化。相較之下，其社交技巧不成熟。比如， 在準(zhǔn)確感知同伴的社交線索方面存在 困難。交流、對話和語言相較于匹配年 齡更為具體化及不成熟。往往能被同伴 注意到其在以年齡相稱的方式控制行 為及情緒方面存在困難。難以完全體會 到社交風(fēng)險，社交判斷不成熟，存在被 他人控制的風(fēng)險（受騙）。在個人護(hù)理

3、方面其能力與年齡相稱。但是在復(fù) 雜的日常生活行為上與同齡相較需要幫助。在成人身上，購物、交通、家務(wù)及照顧兒童及 財務(wù)管理等方面需要幫助。娛樂活動的技能則 與同齡人相近，不過在安全相關(guān)及組織方面任 需要幫助。在成人，可勝任不需要抽象思維的 的工作。在作出醫(yī)療衛(wèi)生及法律相關(guān)決策以及 學(xué)習(xí)勝任完成熟練技巧性的工作等方面需要 幫助。在供養(yǎng)家庭方面也是典型的需要幫助。嚴(yán)重度概念領(lǐng)域社交領(lǐng)域?qū)嵱妙I(lǐng)域中雖然有在成長，但是概念技 巧落后于同齡兒。在學(xué)齡 前兒童，語言能力及入學(xué) 前學(xué)業(yè)技巧發(fā)展緩慢。在 學(xué)齡期兒童，讀、寫、計 算、理解時間和金錢方面 進(jìn)展緩慢，并且與同伴相 較明顯受限。在成人，學(xué)業(yè)能力發(fā)展典型

4、而言僅限于初級水平，在 工作和生活中需要學(xué)業(yè)技 巧的地方均需要幫助。完 成日常生活中概念性任務(wù) 時需要持續(xù)的幫助，甚至 需要他人完全接管。在整個發(fā)育階段，社交及交流行為與同 齡兒相比有顯著不同。通常主要的交 流方式是口語，但是與同齡兒相比顯著 的更簡單。發(fā)展關(guān)系顯著與家庭及朋友相關(guān)，但個 體可能在人生中獲得成功的友情關(guān)系 甚至在成人期獲得浪漫關(guān)系。然而個體 可能不能準(zhǔn)確的接受或解讀社交線索。 社交判斷及決策能力有限，監(jiān)護(hù)人需要 在生活決策提供幫助。與正常個體發(fā) 展友誼經(jīng)常為交流及社會能力的局限 所影響。在需要成功完成的工作上，顯 著的需要社交及交流的幫助。作為成年人，可以完成諸如進(jìn)食、穿衣、排

5、泄 及衛(wèi)生等個人需求。雖然需要更多的教育及時 間才能在這些方面獲得獨立，并且需要人提 醒。相應(yīng)的，成人期亦可完成在家務(wù)活動，但是同 樣需要額外的教育，并且要完成成人水平的 工作往往需要持續(xù)幫助。個體作為雇員可以完成需要有限的概念及 交流技巧的工作，但需要同事、上司等的幫 助來應(yīng)對涉及到社會期望、復(fù)雜性工作及附 帶責(zé)任的如計劃安排、交通、健康福利及財 務(wù)管理。個體可發(fā)展出眾多的娛樂技能。但往往需要 額外的幫助及時間來教學(xué)。極個別的存在適 應(yīng)性不良行為并導(dǎo)致社會問題。嚴(yán)重度概念領(lǐng)域社交領(lǐng)域?qū)嵱妙I(lǐng)域重概念化技能的習(xí)得有限。個 體通常對書面語言及涉及 到數(shù)字、數(shù)量、時間及金 錢的概念理解有限。在一 身

6、中監(jiān)護(hù)人均需要提供解 決問題的額外幫助。在詞匯及語法方.面?zhèn)€體的口語水平有 限。話語可能是單獨的字或詞，以及可 能通過輔助的方式補充。交流的內(nèi)容局 限于當(dāng)下的日常生活事件。語言更多地 用于社會交流而不是表達(dá)。個體能夠理 解簡單的演講及手勢交流。同家庭成員 及熟悉個體的關(guān)系是快樂及幫助的來 源。個體在日常生活的所有活動均需要幫助，包括 進(jìn)食、穿衣、洗澡級排泄。在任何時間個體 均需要監(jiān)護(hù)。個體無法在涉及自己及他人安 全上做出負(fù)責(zé)任的決策。在成人，參與家庭 任務(wù)、娛樂及工作均需要幫助。在所有領(lǐng)域 的技能均需要長期的教學(xué)及不斷的幫助。不 適應(yīng)行為，如自殘，在極少數(shù)群體表現(xiàn)。顯著概念化技巧往往涉及實體

7、世界而非象征性過程。個 體能夠使用對象通過目標(biāo) 導(dǎo)向的方式完成自我照 顧、工作及娛樂。一些特定的視覺空間技能， 如通過物質(zhì)特性匹配和排 序可能可以習(xí)得。然而， 共患的動作及感覺障礙可 能影響對物體的功能使 用。個體對于語言或手勢的象征性交流的理 解十分局限，可能理解一些簡單的指導(dǎo) 或手勢。其表達(dá)自己的需求和感情大多 通過非語言非象征的交流方式。個體享受同熟悉的家庭成員、監(jiān)護(hù)人、 熟人的關(guān)系，并且通過手勢或情感線索 發(fā)起或回應(yīng)社交互動。共患的感覺或軀 體損傷可能影響一些社會行為。個體在身體照顧、健康及安全方面完全依賴于 他人，雖然其可能也能夠參與其中一些活動。 沒有嚴(yán)重軀體損傷的個體可以協(xié)助一些

8、家庭 的日常工作，如端菜上桌。使用物體的簡單 活動可能是在高度持續(xù)的協(xié)助下參與一些職 業(yè)活動的基礎(chǔ)。娛樂活動可能涉及，如享受 音樂、看電影、散步、水上活動，均需要他 人幫助。共患的軀體及感覺障礙常常是參與 家庭、娛樂及工作活動的障礙（除了觀看）。 在極少數(shù)個體存在不適應(yīng)行為。說明：嚴(yán)重水平是通過適應(yīng)功能，而非IQ水平來定義，因為所需幫助的水平是由適應(yīng)功能 決定的。此外，在低值IQ測試的可信度較低。診斷特點：智力障礙的基本特征是全面心智能力的缺陷（診斷標(biāo)準(zhǔn)A），及于個體在年齡、性別、 社會文化相匹配的對照的日常適應(yīng)功能的障礙（診斷標(biāo)準(zhǔn)B），起病與發(fā)育時期（診斷 標(biāo)準(zhǔn)C），診斷應(yīng)該基于臨床評估及標(biāo)

9、準(zhǔn)化的智力和適應(yīng)功能評測的結(jié)合。DSM涉及到的調(diào)整：1、適應(yīng)功能結(jié)構(gòu)的調(diào)整：DSM 5將DSM IV TR中，適應(yīng)功能涵蓋包括溝通交際、自 我照顧、居家生活、社會/人際技能、社會資源運用、自我指示、功能性學(xué)科技 能、工作、休閑娛樂、健康和安全等10個方面，在其中至少兩個方面存在缺陷 即可認(rèn)為適應(yīng)功能存在缺陷，調(diào)整為概念、社交和實用三個領(lǐng)域，并規(guī)定在其中 一個領(lǐng)域存在缺陷即可診斷為適應(yīng)功能缺陷。2、分類標(biāo)準(zhǔn)的調(diào)整：DSM 5將DSM IV TR中根據(jù)IQ分?jǐn)?shù)對智力障礙進(jìn)行分類調(diào)整為 根據(jù)個體適應(yīng)功能缺陷的嚴(yán)重程度將智力障礙標(biāo)注為輕度、中度、重度和極重度 四種，并列舉出了輕度、中度、重度和極重度患

10、者在概念、社交和實用領(lǐng)域的表 現(xiàn)?！耙驗樗鑾椭乃绞怯蛇m應(yīng)功能決定的。此外，在低值IQ測試的可信度 較低?！辈⑶摇翱赡苡绊憸y評分?jǐn)?shù)的因素包括練習(xí)效應(yīng)和“Flynn效應(yīng)”（即由于 過時的測評常模造成過高分?jǐn)?shù)）?！薄爸巧虦y評分?jǐn)?shù)是對概念功能的粗略估計， 不能充分地評估現(xiàn)實生活情況中的推理能力和對實用任務(wù)的掌握能力，例如,智 商得分70以上的個體可能在社交判斷、社交理解和適應(yīng)功能的其他領(lǐng)域上有嚴(yán)重 的適應(yīng)性行為問題,以致其實際功能與智商得分更低的個體的表現(xiàn)相當(dāng)，因此，在 解釋智商測評的結(jié)果時需要臨床判斷”3、障礙發(fā)生時間的調(diào)整：DSM 5將DSM IV TR中診斷標(biāo)準(zhǔn)是障礙發(fā)生在18歲以前調(diào) 整

11、為發(fā)育時期。因為由于智力障礙成因的復(fù)雜性，很難嚴(yán)格定義障礙發(fā)生時間的 范圍，故而采取了更為寬泛的表達(dá)。附：DSM 5原文Intellectual disability (intellectual developmental disorder) is a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual,social, and practical domains. Thefollowi

12、ng three criteria must be met:A. Deficits in intellectual functions, such as reasoning, problem solving, planning, abstract thinking, judgment, academic learning, and learning from experience, confirmed by both clinical assessment and individualized, standardized intelligence testing.B. Deficits in

13、adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility. Without ongoing support, the adaptive deficits limit functioning in one or more activities of daily life, such as communication, social participation, an

14、d independent living, across multiple environments, such as home, school, work, and community.C. Onset of intellectual and adaptive deficits during the developmental period.Note: The diagnostic term intellectual disability is the equivalent term for the ICD-11 diagnosis of intellectual developmental

15、 disorders. Although the term intellectual disability is used throughout this manual, both terms are used in the title to clarify relationships with other classification systems. Moreover, a federal statute in the United States (Public Law 111-256, Rosa sLaw) replaces the term mental retardation wit

16、h intellectual disability, and research journals use the term inte/ecfua/ disability. Thus, intellectual disability is the term in common use by medical, educational, and other professions and by the lay public and advocacy groups.Coding note: The ICD-9-CM code for intellectual disability (intellect

17、ual developmental disorder) is 319, which is assigned regardless of the severity specifier. The ICD-10-CM code depends on the severity specifier (see below).Specify current severity (see Table 1):(F70) Mild(F71) Moderate(F72) Severe (F73)ProfoundSpecifiersTABLE 1 Severity levels for intellectual dis

18、ability (intellectual developmental disorder)Severity levelConceptual domainSocial domainPractical domainMildFor preschool children, there may be no obvious conceptual differences. For school-age children and adults, there are difficulties in learning academic skills involving reading, writing, arit

19、hmetic, time, or money, with supportneeded in one or more areas to meet age-related expectations. In adults, abstract thinking, executive function (i.e.,planning, strategizing, prioritysetting, and cognitive flexibility), and short-term memory, as well as functional use ofacademic skills (e.g., read

20、ing,money management), areimpaired. There isa somewhat concrete approach to problems and solutions compared with age-mates.Compared with typically developing agemates, the individual is immature in social interactions. For example, there maybe difficulty in accurately perceiving peers' social cu

21、es. Communication, conversation, an(flan- guage are more concrete or immature than expected for age. There may be difficulties regulating emotion and behavior in age-appropriate fashion; these difficulties are noticed by peers in social situations. There is limited understanding of risk in social si

22、tuations; socialjudgment isimmature forage, and the person isatriskofbeing manipulated by others (gullibility).The individual may function age-appropriately in personal care.Individuals need somesupport with complex daily living tasks in comparison to peers.In adulthood, supports typically involve g

23、rocery shopping, transportation, homeand child-care organicing, nutritious food preparation, and banking and money management. Recreational skills resemble those of age-mates, although judgment related to well-being and organization around recreation requires support. In adulthood, competitive emplo

24、yment isoften seeninjobs thatdo not emphasize conceptual skills. Individuals generally need support to make health care decisions and legal decisions, and tolearn toperform askilled vocation competently. Support is typically needed to raise a family.TABLE 1 Severity levels for intellectual disabilit

25、y (intellectual developmental disorder) continuedSeverity levelConceptual domainSocial domainPractical domainModerateAll through development, the individual' conceptual skills lag markedly behind those of peers. For preschoolers, language and pre-academic skills develop slowly. For school-age ch

26、ildren, progress inreading, writing, mathematics, and understanding of time and money occurs slowlyacross the school years and is mark-edly limited comparedwith that of peers. For adults, aca-demic skill development is typically at an elementary level, and support isrequired foralluse of academic sk

27、ills inwork and personal life. Ongo- ing assistance on adaily basis is needed tocomplete concep- tual tasks of day-to-day life,and others may take over these responsibilities fully for the individual.The individual shows marked differences from peers in social andcommunicative behavior across develo

28、pment. Spoken language is typically a primary toolfor social communication but is much less complex than that of peers. Capacity forrelationships isevident in ties to family and friends, and the individual may have successful friendships across life and sometimes romantic relations in adulthood. How

29、ever, individuals may not perceive or interpret social cues accurately. Sociajudg- ment and decision-making abilities are limited, and caretakers must assist the person with life decisions. Friendships with typically developing peers are often affected by communication orsocial limitations. Signific

30、ant social and communicative support isneeded in work settings for success.The individual cancare for personal needsinvolving eating, dressing, elimination, and hygiene as an adult, although anextended periodof teaching and time is needed for the individual to become independent in these areas, and

31、reminders may be needed. Similarly, participation in all household tasks cin achieved by adulthood, although anextended period of teaching isneeded, and ongoing supports will typically occur for adult-level performance. Independent employment injobs thatrequire limited conceptual and communication s

32、kills can be achieved, but considerable support from co-workers, supervisors, and others is needed to manage social expectations, job complexities, and ancillary responsibilities such as scheduling, transportation, health benefits, and money management. A varietf recreational skillscanbe developed.

33、These typically require additional supports and learning opportunities over an extended period of time. Maladaptive behavior is present in a significant minority and causes social problems.TABLE 1 Severity levels for intellectual disability (intellectualdevelopmental disorder) confinzzed)Severity le

34、velConceptual domainSocial domainPractical domainSevereAttainment of conceptual skills is limited. The individual generally has little understanding; written language or (concepts involving numbers, quantity, time, and money. Caretakers provide extensive supports for problem solving throughout life.

35、Spoken language isquite limited in terms of vocabulary ancgrammar.Speechmaybe single words or phrases and may be supple-The individual requires support for all activities of daily living, including meals, dressing, bathing, an elimination.Theindividual requiresupervision atmented through augmentativ

36、e means. Speed all times. The individual cannot make responsibleand communication are focused on the here and now within everyday events. Language i used for social communication more than for explication. Individuals understand simpleProfounddecisions regarding well-being of self or others. In adul

37、thood, participation in tasks athome, recreation, and work requires ongoing support and assi tance.Skillacquisition inall domainsinvolves long-speech and gestural communication. Relatiorterm teaching and ongoing support. Maladaptiveships with family members and familiar othe areasource olpleasure an

38、d help.behavior, including self-injury, is present in a icant minority.s-signif-Conceptual skills generally involve the physical world rather than symbolic processes. The individual may use objects in goal-directed fashion for self-care, work, and recreation. Certain visuospatial skills, such as matching and sorting based on physical characteristics, may be acquired. However, co-occurring motor and sensory impairments may prevent functional use of objects.The individual has very limited understandii The individu