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Psych Vivasintellectual disability psychiatry

Psych Vivas · intellectual disability psychiatry

Intellectual disability assessment and classification — structured clinical viva

Fellowship viva on ID diagnostic triad, severity by adaptive function, CMA/fragile X/exome pathway, no core drug, multiagency supports and decision-specific capacity.

clinical1 min readVerification in progress

Target exams

FRANZCPMRCPsychABPNMD-DNB
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Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar in a neurodevelopmental clinic. Parents of a 10-year-old with IQ 58 and major adaptive skill gaps ask: (1) Does a low IQ alone mean intellectual disability? (2) How severe is it and who decides? (3) What blood or gene tests should be done? (4) Is there a tablet that improves intelligence? (5) What supports exist and what happens at 18? Discuss DSM/ICD structure, adaptive domains, aetiological workup, services and capacity.

Interpretation

Reveal interpretationShowHide

IQ alone? No. Diagnosis needs intellectual deficits and adaptive deficits and developmental onset. IQ about 2 SD below mean supports the intellectual criterion but is insufficient alone.[1][3][6]

Severity. Mild/moderate/severe/profound is based primarily on adaptive functioning and support intensity, not the IQ number alone. Use standardised adaptive scales plus real-world function across settings.[3][6]

Tests. Vision/hearing already important. First-tier genetics: chromosomal microarray and fragile X pathway; escalate to exome/genome when indicated (de Ligt landmark in severe ID). MRI/EEG/metabolic only for red flags.[1][2][4]

Tablet for intelligence? No medication treats core ID. Rare treatable metabolic causes are the exception once identified. Focus on education, therapies, communication supports and disability funding (e.g. NDIS).[1][6]

Age 18 / capacity. Plan transition early: adult disability and health services, education/employment, housing. Capacity is decision-specific with supported decision-making — the ID label does not equal global incapacity. Health surveillance matters because premature avoidable death is documented (CIPOLD).[5][6]

Name evidence. Moeschler/Shevell evaluation; Miller CMA; de Ligt exome; Tassé/Schalock adaptive-intellectual relation; Heslop CIPOLD; AAIDD supports framework overview.[1][2][3][4][5][6]

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References6ShowHide
  1. [1]Moeschler JB, Shevell M; Committee on Genetics Comprehensive evaluation of the child with intellectual disability or global developmental delays Pediatrics, 2014.PMID 25157020
  2. [2]Miller DT, Adam MP, Aradhya S, et al. Consensus statement: chromosomal microarray is a first-tier clinical diagnostic test for individuals with developmental disabilities or congenital anomalies Am J Hum Genet, 2010.PMID 20466091
  3. [3]Tassé MJ, Luckasson R, Schalock RL The Relation Between Intellectual Functioning and Adaptive Behavior in the Diagnosis of Intellectual Disability Intellect Dev Disabil, 2016.PMID 27893317
  4. [4]de Ligt J, Willemsen MH, van Bon BW, et al. Diagnostic exome sequencing in persons with severe intellectual disability N Engl J Med, 2012.PMID 23033978
  5. [5]Heslop P, Blair PS, Fleming P, Hoghton M, Marriott A, Russ L The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study Lancet, 2014.PMID 24332307
  6. [6]Schalock RL, Luckasson R, Tassé MJ An Overview of Intellectual Disability: Definition, Diagnosis, Classification, and Systems of Supports (12th ed.) Am J Intellect Dev Disabil, 2021.PMID 34700345
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