Observations on the use of the ICD-10 Guide for Mental Retardation

In acknowledgement of the challenges pored by the diagnosis of mental disor ders in people with intellectual disability (ID), the World Health Organiza tion (WHO) has recently published a multi-axial guide to assist clinicians in applying the ICD-IO to this group of people. The WHO has invited users t o review of the ICD-IO Guide for Mental Retardation. In order to review its usefulness in clinical practice, the present authors used the Guide togeth er with the ICD-IO in the psychiatric assessment of 106 young people with I D, and emotional and behavioural problems of varying severity. Strengths an d weaknesses in the utility of the Guide were noted. As a result of the cli nical audit process, the present authors identified a number of inconsisten cies, significant gaps and assertions unsupported by the available literatu re in the Guide. They also noted aspects of the ICD-IO itself which are pro blematic when applied to people with ID. Despite these limitations, the Gui de is a valuable first attempt to establish a standardized structure for mu lti-axial diagnosis in this population. A number of suggestions for major c hanges and refinements to future editions are made, and a strategy for deve lopment of research to establish validity and reliability is proposed.