Mania and behavioral equivalents: a preliminary study.
Use the DASH-II mania subscale to catch mania in nonverbal adults with ID—watch for sleep refusal, restlessness, agitation, and irritability as clear behavioral clues.
01Research in Context
What this study did
Sturmey et al. (2010) tested whether the DASH-II mania subscale can spot mania in adults with severe or profound intellectual disability. The team looked at sleep refusal, restlessness, agitation, and irritability as possible behavioral stand-ins for classic manic symptoms. Participants were nonverbal adults living in a large residential center.
What they found
The mania subscale scores lined up with the behavioral signs. Less sleep, more pacing, and quick-to-anger outbursts tracked with the scale items. The tool appears valid for catching mania in clients who cannot describe racing thoughts or elevated mood.
How this fits with other research
Kleinert et al. (2007) already showed that psychomotor agitation and sleep loss are the strongest predictors of mania in severe ID; Peter’s team adds the DASH-II as a quick way to measure those exact signs.
Shabani et al. (2006) linked manic symptoms to feeding problems—longer mealtimes and special positioning—so a high mania score on the DASH-II may also explain sudden food refusal.
LeBlanc et al. (2003) warned not to treat challenging behavior as depression, but Peter’s work shows the same behaviors can flag mania. The difference is the mood domain: aggression is not a depressive equivalent, yet it can be a manic one when paired with decreased sleep and increased activity.
Why it matters
If your client with severe ID stops sleeping, paces the hallway all night, and swats at staff, think mania first. Run the DASH-II mania subscale, note the score, and share it with the psychiatrist. Early recognition means faster mood stabilizer trials and fewer crisis calls.
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02At a glance
03Original abstract
Previous research has failed to address the possibility of behavioral equivalents in people with ID and mania. The relationship between a measure of mania and possible behavioral equivalents was assessed in 693 adults, most with severe or profound ID, living in a large residential setting. The mania subscale of the DASH-II proved to be a homogenous scale, suggesting that this may be a valid measure of mania in individuals with ID. Both item and factor analyses and correlations showed that many behavioral items acceptably correlated with the mania items. There may be some challenging behaviors that are related to mania in individuals with ID. A factor analysis noted a decreased need for sleep, restlessness, agitation, and irritability as items associated with mania.
Research in developmental disabilities, 2010 · doi:10.1016/j.ridd.2010.04.017