Transcript Dual Diagnosis: Finding a Reliable and Easy Assessment

Dual Diagnosis and SelfDetermination: Any
Relationship?
Karen L. Hobden & Barbara W. LeRoy
Developmental Disabilities Institute
Wayne State University
268-4809 Woodward, Detroit, MI 48202
Dual Diagnosis
Dual Diagnosis: co-occurring intellectual
disability and mental health problems
(NADD, 2007).
 Historically, individuals with intellectual
disabilities were assumed to be free from
mental health concerns
 Recent research has suggested that
people with intellectual disabilities may be
at an increased risk. (Deb, Thomas, &
Bright, 2001)

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Assessment of a Dual
Diagnosis

Mini PAS-ADD (Prosser & Moss et al.,
1998)
A
semi-structured interview
 No background in psychology needed, but
must be trained to administer the interview.
 Asks questions of an informant who knows
the individual well.
 Reasonable validity and reliability.
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Mini PAS-ADD - 7 Subscales:
1.
2.
3.
4.
5.
6.
Depression
Anxiety
Expansive Mood Disorder (Bipolar)
Obsessive-Compulsive Disorder
Psychosis
Unspecified Disorder (including
Dementia)
7. Autism
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Self-determination
At the core of person-centered planning.
 Current best practice model for service
delivery
 The law in Michigan -- Individuals with
intellectual disabilities must be given the
opportunity to make choices regarding
their needs and goals

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Our Research Goals
Evaluate the effectiveness of the Mini
PAS-ADD in assessing mental illness in
individuals with intellectual disabilities.
 Examine the relationship between dual
diagnosis and self-determination

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MORC
We conducted this research in
collaboration with the Macomb Oakland
Regional Center (MORC)
 MORC serves 1000 adults with mild or
moderate intellectual disabilities.

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Procedure
The Mini PAS-ADD was administered by a
trained interviewer, typically in the
informant's home or place of employment.
 The interviewers were employees of
MORC and were either psychologists or
social workers.
 The Mini PAS-ADD takes about 20
minutes to administer.

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Assessment of
Self-determination
22 Item Scale
 Assessing choice making – living
arrangements, community involvement,
employment/finances
 Completed by supports coordinator in
collaboration with individual

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Self Determination Scale



Living arrangements – amount of choice
exercised in terms of where they live, who they
live with, what they eat, when they bathe, etc.
Community involvement – do they vote, attend
a place of worship regularly, belong to cultural
groups, clubs, or social organizations?
Employment/finances– do they have an ATM
card, control over their budget, are they
employed, do they make minimum-wage or
higher?
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Our Sample
231 participants (100 assessed on the
Mini PAS-ADD, 151 on the SD Checklist).
 49% female; 51% male
 The mean age was 49 (range of 18 to 87)
 89% White; 7% African-American
 86% had a guardian.
 62% had a pre-existing dual diagnosis

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Severity of
Intellectual disability
Level of Intellectual
Disability
Borderline
Mild
Moderate
Severe
Profound
N
%
2
101
123
4
1
.9
43.7
53.2
1.7
.4
12
Type of Residence
Type of Residence
Own home/apartment
Shared apartment/house
Parents'/family home
Group home
Foster care
Other
N
7
27
16
153
9
10
%
3.0
11.7
6.9
66.2
3.9
4.3
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Results – Mini PAS-ADD

29% had a dual diagnosis according to the
Mini PAS-ADD
 4%
Depression
 10% Anxiety
 3% Expansive Mood (Bipolar Disorder)
 11% Obsessive-Compulsive
 10% Psychosis
 5% Unspecified Disorder
 4% Autism
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Comparison of Diagnoses
Diagnosis
Anxiety disorder
Autism
Bipolar disorder
Dementia / Alzheimer's
Depression / dysthymic disorder
Obsessive-compulsive disorder
Schizophrenia / psychotic disorders
# of Diagnoses
No Axis I disorder
1 disorder
2 disorders
3 disorders
More than 3 disorders
On File (%)
PAS-ADD (%)
5.6
4.3
9.5
1.7
10.0
5.2
20.3
10
4
3
5
4
11
10
On File (%)
PAS-ADD (%)
38.5
43.3
16.9
1.3
0
71
19
6
2
2
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Mini PAS-ADD vs Diagnosis
on File
Diagnostic Match ?
Different diagnoses given
Mini PAS-ADD diagnosis, but no pre-existing
diagnosis
Pre-existing diagnosis, but no diagnosis on the
Mini PAS-ADD
Exact diagnostic match
Pre-existing diagnosis not covered by Mini
PAS-ADD
Total
%
12
8
41
38
1
100
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Pre-existing Diagnosis, but No
Mini PAS-ADD: Why?



57% taking psychotropic medication that
could have reduced or eliminated
symptoms.
Individuals’ symptoms may have stabilized
over time
Some individuals may have been
misdiagnosed.
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Diagnostic Match by
Psychotropic Medication
Diagnostic Match
Different diagnoses given
Any Meds?
No
Yes
7.7
14.8
Mini PAS ADD, but no pre-existing
15.4
3.3
Pre-existing diagnosis, but no Mini
PAS-ADD
Diagnostic match
23.1
52.5
51.3
29.5
Pre-existing diagnosis not covered
by PAS-ADD
Total
2.6
0
100
100
χ2 (4) = 14.89 p<.01
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Results - Self-Determination
by Diagnosis
SD Scale
% YES Living
Arrangements
% YES Community
Involvement
% YES Employment
and Finances
Total
61.1
Dual Diagnosis
No
Yes
63.4
59.9
49.8
51.9
48.7
37.7
35.7
36.4
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Self-Determination Rankings for Persons
with Dual Diagnosis - Top Third
Rank
Indicator
% Present
1
Has unstructured Time
98.2
2
Shops in Community
95.9
3
Chooses TV Program
94.2
4
Has access to private space
91.8
5
Has a Bank Account
87.6
6
Chooses when to bathe
71.9
7
Lives in typical residence in the
community
71.5
8
Chooses what to eat
63.9
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Self-Determination Rankings for Persons
with Dual Diagnosis - Middle Third
Rank
Indicator
% Present
9
Plans/takes vacations
60.8
10
Chooses where to live
60.2
11
Attends Worship Service
43.3
12
Chooses personal doctor
37.6
13
Goes on spontaneous outings
37.5
14
Sees family members when
chooses
33.5
15
Joins community
organizations
29.4
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Self-Determination Rankings for Persons
with Dual Diagnosis - Bottom Third
Rank
Indicator
% Present
16
Chooses roommate
29.4
17
Has personal budget
28.4
18
Has access to telephone for
personal use
21.1
19
Has employment
15.2
20
Makes minimum wage or more
14.7
21
Votes in community elections
14.3
22
Uses ATM for discretionary
funds
5.9
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Conclusions - Mini PAS-ADD
Mini PAS-ADD is a quick, easy-to-use
screen for psychiatric disorders in
individuals with intellectual disabilities.
 May be most effective in individuals
not currently on psychotropic
medication.

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Conclusions – Self Determination
No one is very self-determined
 No overall differences by type of diagnosis
 Some indication that people with a dual
diagnosis have less choice in whether
they:

•
•
•
•
Vote (χ²=6.42, p < 05)
Join social organizations or clubs (χ²=4.52, p <
05)
See family members regularly (χ²=10.47, p < 01)
Have their own phone (χ²=5.81, p < 05)
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Contact Info

Karen Hobden

email: [email protected]
 phone: 313-577-7980
 website http://ddi.wayne.edu/
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