Controversies and clarifications in the classification of disorders of intellectual development, new genetic findings, epilepsy, bullying, and innovative developmental neuropsychiatric treatments (deep-brain stimulation, electroconvulsive therapy, and oxytocin)

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The current issue begins with a historical review of efforts to reach consensus on the classification of disorders of intellectual development by the chairman and members of the International Classification of Diseases 11th revision (ICD-11) Work Group [1]. A companion article examines the value of using neurocognitive profiles in ICD-11 diagnostic assessments [2]. The concept of the broader behavioral phenotype is introduced and examined in Lesch–Nyhan syndrome (LNS) and its variants [3]. How whole exome sequencing is redefining our understanding of the phenotype/genotype relationship is reviewed in Rett syndrome [4]. The frequency of epilepsy in neurodevelopmental disorders is considered, and neuropsychiatric complications are examined [5]. Innovative new treatments are discussed in three of the articles in this issue: Deep-brain stimulation (DBS) for chronic severe self-injury in LNS [1], electroconvulsive therapy (ECT) for agitated catatonia with intractable self-injury in autism [6] and the evidence base for using oxytocin as a treatment in Prader–Willi syndrome (PWS) [7]. Finally, the role of stigma is specifically examined in autism [8]. Stigma may lead to bullying in children with a diagnosis of autism spectrum disorder (ASD) as well as in epilepsy and other neurodevelopmental disorders. In the United States, bullying of a child with a diagnosis of Down syndrome who was taunted with the word ‘retard’ by peers resulted in Rosa's Law (Pub. L. 111–256) that led to a name change in United States federal law [9]. The bill removes the terms ‘mental retardation’ and ‘mentally retarded’ from federal health, education and labor policy and replaces them with intellectual disability and the requirement to use person first language ‘individual with an intellectual disability’ when referring to affected children.

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