178 Chapter 7 A related question is whether and when a mild intellectual disability diagnosis changes over time. This dissertation showed that problem behaviors are far more dynamic than static. Lewis (2018) reasoned that framing addiction as a disease, for example, takes away agency from the person but thereby also evokes a sense of chronicity that may induce feelings of hopelessness. If a diagnosis like addiction can already evoke a sense of chronicity, I expect this to be true too for many people with a mild intellectual disability. Specialized care explicitly focuses on reducing problems, but I have never heard a clinician claim to treat a mild intellectual disability. Of course, interventions for people with a mild intellectual disability promote behavioral change, but the language of these interventions differs from most psychological treatments where the diagnosis itself is overtly targeted (e.g., addiction- or depression treatment). Interestingly, the DSM-5 states that the severity levels of someone's intellectual disability may change over time. Adaptive functioning may improve throughout childhood and adulthood as a result of stable new skill acquisition, which in some cases may make the diagnosis no longer appropriate (APA, 2013). It may be that this possibility when communicated to the people with the label, is perceived as empowering. On a daily basis, care professionals strive to maintain a delicate balance between empowering clients without suggesting blame (e.g., implying effort alone will resolve issues) and avoiding absolving responsibility (e.g., implying the person has no control). Research should play a role in providing people with a realistic future prospect of their diagnosis. For example, epidemiological research could shine a light on the development of mild intellectual disability over time, assessing how many individuals who used to require specialized care now live independently. In conclusion, a mild intellectual disability diagnosis has no strict cutoffs, is no explanation for- but a normative description of problems and is subject to change within-persons over time. It has colloquially been reified as the explanation for problems, which is scientifically dubious and may have societal disadvantages. Nevertheless, the diagnosis also has societal advantages. At the very least, it should therefore be a therapeutic dilemma whether or not to give a person this diagnosis. Guidelines have recently been developed to assist therapists with such dilemmas (Nederlandse Vereniging voor Psychiatrie, 2024). In my view, these issues are so fundamental to therapeutic, scientific, and societal contexts that a widespread debate on this topic with relevant stakeholders in the intellectual disability field is necessary.
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