Fetal alcohol spectrum disorder (FASD) is the largest known cause of intellectual disability (ID), and forensic experts are often called upon to determine if a defendant with FASD qualifies for a diagnosis of ID. Whether such a diagnosis is made may depend upon the diagnosing expert's choice of diagnostic manual: guidelines published by the American Association on Intellectual and Developmental Disabilities (now in its 12th edition [AAIDD-12]) or the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Although both manuals use the same three diagnostic “prongs” (i.e., intellectual deficits, adaptive deficits, and developmental onset), there are substantial differences in the way all three prongs are assessed—differences that increased with the publication of AAIDD-12. In particular, AAIDD-12 uses a bureaucratic “disability” model, with narrow emphasis on a small number of quantitative indicators and limited opportunity for clinical integration, while DSM-5 (and the little-changed forthcoming DSM-5-TR) uses a medical “disorder” model, with flexible reliance on a broad array of indicators and opportunity for clinical integration. The origins and nature of these differences are explored, and an argument is made that compared to the AAIDD formulation, the DSM model provides a more valid basis for forensic diagnosis of ID in individuals with FASD.

中文翻译：

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诊断胎儿酒精谱系障碍患者的智力障碍：使用哪个诊断手册的功能？

胎儿酒精谱系障碍 (FASD) 是导致智力障碍 (ID) 的最大已知原因，法医专家经常被要求确定患有 FASD 的被告是否有资格诊断为智力障碍。是否做出这样的诊断可能取决于诊断专家选择的诊断手册：美国智力和发育障碍协会发布的指南（现在在其第 12 版 [AAIDD-12]）或诊断和统计手册的第五版精神障碍 (DSM-5)。尽管两本手册都使用相同的三个诊断“分支”（即智力缺陷、适应性缺陷和发育开始），但评估所有三个分支的方式存在显着差异——随着 AAIDD-12 的发布，差异越来越大。特别是，AAIDD-12 使用官僚“残疾”模型，狭隘地强调少量定量指标和有限的临床整合机会，而 DSM-5（以及即将推出的变化不大的 DSM-5-TR）使用医学“障碍” ”模型，灵活依赖广泛的指标和临床整合机会。探讨了这些差异的起源和性质，并提出了一个论点，即与 AAIDD 公式相比，DSM 模型为 FASD 个体 ID 的法医诊断提供了更有效的基础。灵活依赖广泛的指标和临床整合机会。探讨了这些差异的起源和性质，并提出了一个论点，即与 AAIDD 公式相比，DSM 模型为 FASD 个体 ID 的法医诊断提供了更有效的基础。灵活依赖广泛的指标和临床整合机会。探讨了这些差异的起源和性质，并提出了一个论点，即与 AAIDD 公式相比，DSM 模型为 FASD 个体 ID 的法医诊断提供了更有效的基础。