Assessment and diagnosis of depression in people with intellectual disability.
No perfect depression test exists for adults with ID, so blend caregiver reports, simple questions, and clinical judgment.
01Research in Context
What this study did
Dewsbury (2003) looked at every paper on spotting depression in adults with intellectual disability. The team read studies that used standard mood tests, caregiver reports, and doctor checklists. They wanted to see if any tool gave a clear yes-or-no answer for this group.
What they found
No single test won. For people with mild or moderate ID, regular depression questions work if you allow extra explanation. For severe or profound ID, the picture is muddy. Challenging behavior alone is not enough proof that the person is depressed.
How this fits with other research
Hermans et al. (2010) later ran a tighter search and picked four front-runners: the Glasgow Depression Scale for self-report and three caregiver forms. They agreed with Dewsbury (2003) that none are perfect, but gave you the best current choices.
Rojahn et al. (1994) had already shown that different depression tests often label the same person differently. Dewsbury (2003) echoed that warning and widened it to include severe ID.
Ahlborn et al. (2008) built a quick three-item carer checklist. It lines up with Dewsbury (2003): keep tools short, use carers, and stay cautious.
Why it matters
You still have no gold-standard screen, so combine tools. Start with a caregiver scale like the Glasgow or the three-item checklist. Add direct questions for clients who can answer. Record mood, interest, and social changes over two weeks before you call it depression. Document why you ruled out pain, medication side-effects, or life changes. This guards both your client and your license.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add a three-item carer mood checklist to your intake packet and score it before every re-assessment.
02At a glance
03Original abstract
BACKGROUND: Despite widespread acceptance that depression can occur in adults with intellectual disability (ID), the difficulties encountered in its assessment and diagnosis have hampered the individual clinician, and meant that questions of prevalence, treatment choice and outcome remain problematic. METHOD: The present paper reviews the progress in this field since three reviews, all published in the mid-1990s, recommended further attention to three interlinked issues: diagnostic criteria, the symptoms of depression in this group and the lack of rating scales. RESULTS: Despite a further 11 published papers and other studies in progress, the method of diagnosis for people with severe and profound ID remains debatable, with some authors advocating adherence to standard criteria, others suggesting adding criteria to the standard ones and yet others believing that substitute criteria are called for. However, for those with mild to moderate ID, a consensus is emerging that standard diagnostic criteria are appropriate. There has been progress in examining some of the symptoms which might constitute depression in people with ID. New diagnostic criteria issued by the Royal College of Psychiatrists are to be welcomed. There is an assumption in much of the research that symptoms of behaviour commonly termed challenging or maladaptive must be atypical symptoms of depression, but none of the studies reviewed demonstrate this effectively. This is compounded by methodological flaws in the way that depressed samples are arrived at for further study. Although new rating scales have emerged, there is as yet no gold standard diagnostic tool for depression amongst people with ID. CONCLUSIONS: It is suggested that, given these difficulties, the validity of the conceptual frameworks for depression is still in doubt. It remains the case that large-scale, collaborative, prospective studies are called for.
Journal of intellectual disability research : JIDR, 2003 · doi:10.1046/j.1365-2788.2003.00455.x