Page 16 - Social networks of people with mild intellectual disabilities: characteristics and interventions

Chapter 1
1.4 People with intellectual disabilities
The Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5), defines intellectual disabilities as a disorder with onset during the developmental period that includes both intellectual and adaptive functioning deficits in conceptual, social, and practical domains. Three criteria should be met: (a) deficits in intellectual functions, confirmed by both clinical assessment and an individualized standardized IQ test (IQ < 70); (b) deficits in adaptive functioning that result in failure to meet developmental and sociocultural standards for personal independence and social responsibility; (c) onset in the developmental period (American Psychiatric Association, 2013, p. 17). In the fourth edition of the DMS the levels of severity of the ID were defined by IQ. People with IQ 55-70 had a mild ID; people with IQ 40-55 had a moderate ID; people with IQ 25-40 had a severe ID; and people with IQ < 25 had a profound ID (American Psychiatric Association, 1994). However, in the DSM-5, the various levels of severity are not defined on the basis of IQ scores, but on the basis of adaptive functioning (i.e. functioning in the conceptual, social and practical domains). This is because it is this adaptive functioning that determines the level of support required. In de DSM-5 mild ID is characterized by a set of impairments. In adults with mild ID, abstract thinking, executive function (i.e. planning, priority setting and cognitive flexibility) and the functional use of academic skills are impaired (cognitive functioning). They also experience limitations in social interactions, such as in perceiving social cues, in regulating emotion and behaviour and in understanding of risk (social domain). Moreover, they are able to function appropriately in terms of personal care and in jobs that do not emphasize conceptual skills, but they need support in, for instance, home and child care organization, money management and in making difficult decisions (American Psychiatric Association, 2013). Moreover, research shows that people with ID experience lower self-esteem (Valås, 1999), less autonomy and decreased well-being (Sheppard-Jones, 2003). In the Netherlands there are about 142,000 people with ID (IQ < 70) amongst which 74,000 people have a mild ID (Woittiez, Ras, Putman, Eggink, & van der Kwartel, 2015). In the Netherlands people with a borderline ID (IQ 70-85) who have additional problems in adaptive behaviour also receive support from organizations for people with ID (Moonen & Verstegen 2006). Just as in people with IQ < 70 they benefit from treatments which are characterized by repetition, concretization
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