ICD-11 Guidelines for Mental and Behavioral Disorders of Children and Adolescents: Reliability and Clinical Utility

Clinical Utility of ICD-11 Clinical Descriptions and Diagnostic Requirements for the Classification of Mental, Behavioral or Neurodevelopmental Disorders: A Systematic Review

Case-controlled field studies, ecological implementation field studies, and qualitative or mixed methodology studies have been conducted to evaluate the clinical utility of the ICD-11 clinical descriptions and diagnostic requirements (ICD-11 CDDR) for the diagnosis of mental disorders. This systematic review sought to analyze and synthesize the clinical utility indices of these guidelines from the perspectives of mental health professionals (MHPs) and patients from different regions of the world. A systematic search was carried out in five databases Science Direct, Google Scholar, PubMed, Web of Science and Scopus. The relevant studies were subjected to explicit eligibility criteria, resulting in 19 included studies. The study characteristics were tabulated, methodological quality was assessed, and findings were summarized using convergent narrative synthesis. The overall findings indicated that the clinical utility of the ICD-11 CDDR was positive for the majority of studies (78.95%) that analyzed a wide range of mental disorders. Analyses at the level of the disorder groups also revealed the same trend. Almost only qualitative or mixed studies have identified negative aspects or obstacles of this diagnostic system. The clinical utility of the ICD-11 CDDR for the diagnosis of mental disorders is supported. Future research could resolve concerns regarding the isolated negative outcomes of ICD-11 CDDR performance. Finally, it is necessary to expand the scope of the training programs for MHPs and policymakers regarding the use of these guidelines in clinical practice.

Implementation of the International Classification of Diseases 11th revision behavioural indicators for disorders of intellectual development with co-occurring autism spectrum disorder

BACKGROUND

The classification of mental, behavioural and neurodevelopmental disorders in the World Health Organization's International Classification of Diseases 11th revision (ICD-11) includes a comprehensive set of behavioural indicators (BIs) within the neurodevelopmental disorders grouping. BIs can be used to assess the severity of disorders of intellectual development in situations in which standardised measures of intellectual functioning and adaptive behaviours are not available or feasible. This international study examines the implementation characteristics of the BIs and compares them to standardised measures for assessing the severity of intellectual impairment and adaptive behaviours in disorders of intellectual development and autism spectrum disorder (ASD). The clinical utility of the ICD-11 and the fidelity of its application in international clinical settings were also assessed.

METHODS

A total of 116 children and adolescents (5-18 years old) with a suspected or established diagnosis of disorders of intellectual development were included across four sites [Italy (n = 18), Sri Lanka (n = 19) and two sites in India (n = 79)]. A principal component analysis was conducted to evaluate the application of the ICD-11 guidance for combining severity levels.

RESULTS

Assessment using the BIs showed a higher proportion of individuals classified with mild severity, whereas the standardised measures indicated a higher proportion of severe ratings. Additionally, individuals with co-occurring ASD tended to have more severe impairments compared with those without ASD, as indicated by both BIs and standardised measures. Overall, the BIs were considered clinically useful, although more time and consideration were required when applying the guidelines for individuals with a co-occurring disorder of intellectual development and ASD. The principal component analysis revealed one principal component representing overall disorders of intellectual development severity levels.

CONCLUSIONS

The ICD-11 BIs can be implemented as intended in international clinical settings for a broad range of presentations of individuals with neurodevelopmental disorders. Use of the BIs results in similar severity diagnoses to those made using standardised measures. The BIs are expected to improve the reliability of severity assessments in settings where appropriate standardised measures for intellectual and adaptive behaviours are not available or feasible.

The Affective Side of Disruptive Behavior: Toward Better Understanding, Assessment, and Treatment

Historically, much of the progress made in youth mental health research can be classified as focusing on externalizing problems, characterized by disruptive behavior (e.g. aggression, defiance), or internalizing problems, characterized by intense negative affect (e.g. depression, anxiety). Until recently, however, less attention has been given to topics that lie somewhere in between these domains, topics that we collectively refer to as the affective side of disruptive behavior. Like the far side of the moon, the affective side of disruptive behavior captures facets of the phenomenon that may be less obvious or commonly overlooked, but are nonetheless critical to understand. This affective side clarifies socially disruptive aspects of traditionally "externalizing" behavior by elucidating proximal causation via intense negative affect (traditionally "internalizing"). Such problems include irritability, frustration, anger, temper loss, emotional outbursts, and reactive aggression. Given a recent explosion of research in these areas, efforts toward integration are now needed. This special issue was developed to help address this need. Beyond the present introductory article, this collection includes 4 empirical articles on developmental psychopathology topics, 4 empirical articles on applied treatment/assessment topics, 1 evidence base update review article on measurement, and 2 future directions review articles concerning outbursts, mood, dispositions, and youth psychopathology more broadly. By deliberatively investigating the affective side of disruptive behavior, we hope these articles will help bring about better understanding, assessment, and treatment of these challenging problems, for the benefit of youth and families.

The interactions between attention deficit hyperactivity syndrome and addictions

In the article, a group of early career psychiatrists presents the results of a discussion about the relationship between attention deficit and hyperactivity disorder (ADHD) and addictions. Modern views on the commonality of the occurrence of these conditions at the genetic, morphological and functional levels are considered. Possible clinical manifestations and the frequency of comorbidity are described. Modern pharmacological and non-pharmacological approaches to the treatment of these comorbid conditions are discussed in detail separately. The features of therapy in the combination of ADHD with various addictions are highlighted.