Reliability of the ICD 10 version of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD)

Reliability and validity of the Dutch Anxiety, Depression And Mood Scale in adults aged <50 years with intellectual disabilities

Background

Reliable and valid screening instruments for depression and anxiety are needed for adults with intellectual disabilities.

Methods

Internal consistency (n = 198), inter‐rater reliability (n = 41), test–retest reliability (n = 37) and criterion validity (n = 43) were studied in adults aged between 18 and 49 years. Internal consistency was also studied in a sample with epilepsy (n = 98).

Results

Internal consistencies of the Dutch ADAMS total scale and subscales were satisfactory to good (α = 0.76–0.92), as well as in the subgroup with epilepsy (α = 0.74–0.88). Inter‐rater reliability and test–retest reliability were fair to excellent for the total scale (ICC’s: 0.57–0.84) and subscales (ICC’s: 0.43–0.86). The criterion validity of the Dutch ADAMS Depressive Mood subscale was good with a sensitivity of 88% (95% CI: 53%–98%) and a specificity of 80% (95% CI: 64%–90%).

Conclusions

Our study shows that the Dutch ADAMS is a reliable and valid instrument for adults aged between 18 and 49 years with intellectual disabilities (and comorbid epilepsy).

Epidemiology of mental health problems in adults with learning disability: an update

Epidemiological studies measuring prevalence rates and factors associated with mental health problems in adults with learning disability have produced very different and sometimes contradictory results, mainly because of methodological problems. Consequently, much of the epidemiology of mental health problems in this population is still unknown, although improved methodology and additional information are emerging. This article describes the methodological difficulties of studies, the reported prevalence rates in the context of these difficulties and what is currently known about the factors associated with mental health problems in this population.

Anxiety disorders in people with learning disabilities

People with learning disabilities are much more vulnerable to psychiatric illnesses, and will increasingly be accessing generic services. Treatment and management of psychiatric disorders is problematic, primarily because of difficulties in diagnosis, since classificatory systems are standardised on people with average intellectual functioning. This article provides an overview of the clinical implications of anxiety disorders within the context of learning disability.

Psychometric evaluation of a Dutch version of the Mini PAS-ADD for assessing psychiatric disorders in adults with different levels of intellectual disability

BACKGROUND

People with intellectual disabilities (ID) have an increased vulnerability to develop psychiatric problems. Moreover, the early recognition and the accurate diagnosis of psychiatric disorders in the population of persons with ID are challenging.

METHOD

A Dutch version of the Mini PAS-ADD, which is a screening instrument for identification of mental health problems in people with ID, was evaluated in terms of internal consistency, interinformant reliability, item grouping and criterion validity based on a large-scale random sample (n = 377) and a clinical sample (n = 99) of adults with ID.

RESULTS

The Dutch version of the Mini PAS-ADD showed moderate internal consistency, and moderate concordance among informants. Both aspects of the reliability were comparable for different levels of ID. A factor analysis largely confirmed the scale structure. Concurrent validity with the Reiss Screen for Maladaptive Behavior was high for the Depression, Psychosis and Autism scale. The outcome of the criterion-validity analysis indicated high specificity. The sensitivity for specific psychiatric disorders by the corresponding scales was moderate, but the general sensitivity for the presence of psychopathology on the basis of any of the scales was satisfying.

CONCLUSIONS

The present research reconfirmed the use of the Mini PAS-ADD as a primary screening device for the identification of mental health problems among people with ID.

Reliability and validity of the Dutch version of the Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID)

BACKGROUND

In the Netherlands, no self-report screening questionnaire for anxiety in people with intellectual disabilities (ID) was available yet. Therefore, we have translated the Glasgow Anxiety Scale for people with an Intellectual Disability (GAS-ID) into Dutch and studied its reliability and validity in adults with borderline, mild or moderate ID.

METHOD

Test-retest reliability was studied in 66 participants, convergent validity against the Anxiety sub-scale of the Hospital, Anxiety and Depression Scale (HADS-A) in 96, and criterion validity against psychiatric diagnosis in 195 participants.

RESULTS

Internal consistency was α = 0.86 and test-retest reliability ICC = 0.89 (95% CI: 0.82-0.93). Correlation with the HADS-A was r = 0.61 (95% CI: 0.47-0.72); sensitivity was 83.9% (95% CI: 72.2-91.2) and specificity was 51.8% (95% CI: 43.6-59.9) using a cut-off score of 17. Missed diagnoses (false-negatives) were mostly specific phobias. Of the false-positives, 38 of 66 participants (58%) had another psychiatric diagnosis.

CONCLUSIONS

The Dutch version of the GAS-ID is a reliable screening instrument with satisfactory sensitivity, but moderate specificity for anxiety disorders. Although specificity for anxiety disorders is only moderate, high scores appear to be indicative of other psychiatric problems too, justifying referral for psychiatric assessment of false-positives.

Factors associated with depression and anxiety in older adults with intellectual disabilities: results of the healthy ageing and intellectual disabilities study

OBJECTIVE

The objective of this article is to study which factors are associated with depression and anxiety in older adults with intellectual disabilities (ID).

METHODS

Depressive and anxiety symptoms were studied in 990 participants with borderline to profound ID, aged ≥ 50 years, using self-report and informant-report screening questionnaires. In 290 participants, major depression and anxiety disorders were assessed with a standardised psychiatric interview. Associations with personal, medical and psychosocial factors, which were collected through questionnaires and participants' medical and psychological records, were studied using multiple logistic regression analysis.

RESULTS

Increased depressive symptoms were positively associated with increased anxiety symptoms, number of life events during the past year and chronic diseases (heart failure, stroke, chronic obstructive pulmonary disease, coronary artery disease, diabetes mellitus and malignity in the previous 5 years) and negatively with instrumental activities of daily living (IADL) abilities. Major depression was positively associated with chronic diseases and negatively with IADL abilities. Increased anxiety symptoms were positively associated with borderline or mild ID and increased depressive symptoms and negatively associated with Down syndrome, epilepsy and social contacts. Anxiety disorders showed no significant associations.

CONCLUSIONS

To develop effective prevention and treatment policies, factors associated with depression and anxiety in older adults with ID should be further examined in longitudinal research.

Prevalence, associations, and predictors of apathy in adult survivors of infantile (<5 years of age) posterior fossa brain tumors

BACKGROUND

Apathy is associated with pervasive and disadvantageous effects on daily functioning. It has been observed transiently in some children after surgery for posterior fossa tumors. In this study, our objective was to examine prevalence, associations, and predictors of apathy in adult survivors of an infantile posterior fossa brain tumor (PFT).

METHODS

One hundred seventeen adult survivors of a childhood PFT diagnosed before age 5 years and 60 of their siblings were assessed in a cross-sectional study a mean of 32 years (range, 18-53 years) after survivors' initial tumor diagnoses, using the Marin Apathy Evaluation Scale (AES), the Weschler Abbreviated Scale of Intelligence and the Composite International Diagnostic Interview for psychiatric disorders.

RESULTS

Marin Apathy Evaluation Scale, the Weschler Abbreviated Scale of Intelligence reached or exceeded a criterion score for clinically significant apathy in 35% of survivors, compared with 18% in a sibling comparison group. In both siblings and survivors, apathy was associated with lower verbal and full-scale IQ and, among survivors, with having undergone partial rather than total tumor resection (independent of irradiation status). Apathy was not related to presence of concurrent International Classification of Diseases, 10(th) Revision, depression. Female sex was associated with late apathy after a PFT, with increased likelihood of women reaching the apathy criterion relative to men if they were survivors.

CONCLUSIONS

Clinically significant and potentially treatable apathy occurs relatively commonly in adult survivors of an infantile childhood PFT, particularly women. Clinicians, including those managing posterior fossa pathology in very young children, should be aware of this association, and future research should clarify whether specific treatment-related variables are implicated in increasing this risk of apathy.

Prevalence of depression and anxiety in older users of formal Dutch intellectual disability services

BACKGROUND

Little is known about the prevalence of depression and anxiety among older people with intellectual disabilities (ID). Therefore, the aim of this study was to study the prevalence of depression and anxiety in this population.

METHOD

This study is a cross-sectional epidemiologic multicentre study which was part of the "Healthy Ageing and Intellectual Disabilities" study. The study population consisted of 990 participants aged ≥50 years with borderline to profound ID which were screened with self-report and informant-report instruments; 290 of them were assessed with a standardized diagnostic interview.

RESULTS

Depressive symptoms were prevalent in 16.8% (95% CI: 14.4-19.1) and significantly associated with higher age. Anxiety symptoms were prevalent in 16.3% (95% CI: 14.0-18.6) and significantly associated with female gender and borderline to mild ID. Major depressive disorder was prevalent in 7.6% (95% CI: 5.2-11.0), anxiety disorders in 4.4% (95% CI: 2.6-7.0) and both in 0.7% (95% CI: 0.2-1.6). There was no relationship with gender, age or level of ID.

LIMITATIONS

For most participants, informant-report instruments have been used instead of self-report to overcome communication difficulties or inabilities. Also, a standardized psychiatric diagnostic interview has been used instead of psychiatric diagnoses made by an experienced psychiatrist.

CONCLUSION

Prevalence of major depressive disorder is higher and of anxiety disorders lower than in the Dutch general older community-dwelling population.

Treatments for the challenging behaviours of adults with intellectual disabilities

OBJECTIVE

To provide an overview and critical assessment of common problems and best evidence practice in treatments for the challenging behaviours (CBs) of adults with intellectual disabilities (IDs).

METHOD

Commonly observed problems that present obstacles to successful treatment plans are discussed, followed by an analysis of available research on the efficacy of behavioural and pharmacological therapies.

RESULTS

Behavioural and pharmacological interventions are most commonly used when addressing CBs in people with IDs. However, within each of these techniques, there are methods that have support in the literature for efficacy and those that do not. As clinicians, it is important to follow research so that we are engaging in best practices when developing treatment plans for CBs.

CONCLUSIONS

One of the most consuming issues for psychiatrists and other mental health professionals who work with people who evince developmental disabilities, such as IDs, are CBs. These problems are very dangerous and are a major impediment to independent, less restrictive living. However, there is a major gap between what researchers show is effective and much of what occurs in real-world settings.

Life events and their associations with depression and anxiety in older people with intellectual disabilities: results of the HA-ID study

BACKGROUND

People with intellectual disabilities (ID) may be exposed to more life events due to different living circumstances and limited coping abilities. The frequency of life events may increase with age due to age-related decline, loss of significant others and forced relocations. We studied the occurrence of life events in adults with mild to profound ID aged ≥ 50 years and their association with depression and anxiety.

METHODS

Occurrence and burden of life events were assessed with a checklist of 28 items, completed by professional caregivers. Depression and anxiety were assessed with self-report and informant-report screening instruments (n=988) and with a psychiatric interview (n=286). Associations with depression and anxiety were studied for life events in general and for specific life events.

RESULTS

97% of the participants had been exposed to multiple life events during the preceding year and 72% had been exposed to one or more negative life events. The frequency was significantly higher in participants aged 65 years or over, in participants with mild or moderate ID and in participants with depression or anxiety. Minor physical illness and problems with a fellow resident were significantly associated with depression and anxiety, decline or loss of mobility and loss of leisure-time activities with depression and change at work or from work with anxiety.

LIMITATIONS

This study was cross-sectional and therefore lacks reliable information about causality.

CONCLUSIONS

Given the high prevalence of life events and their association with depression and anxiety, life events should be better monitored and, if possible, prevented.

Reliability and validity of the SPAID-G checklist for detecting psychiatric disorders in adults with intellectual disability

SPAID (Psychiatric Instrument for the Intellectually Disabled Adult) is the first Italian tool-package for carrying out psychiatric diagnosis in adults with Intellectual Disabilities (ID). It includes the "G" form, for general diagnostic orientation, and specific checklists for all groups of syndromes stated by the available classification systems. SPAID was established to provide an easy and quick tool for daily practice of the personnel working with ID. The present study was aimed at evaluating psychometric and psychodiagnostic characteristics of the SPAID-G and at supplying new data on the prevalence rate of psychiatric disorders in a multicentric Italian sample of people with ID living in different settings. The SPAID-G was randomly applied to 304 participants with ID attending residential facilities or assessment services across Italy. A part of the sample was also consecutively assessed through the use of DASH, PDD-MRS and by the clinical application of the DSM-IV TR criteria. The correlation between SPAID-G scores and those provided by other evaluation tools was over 60%. Additionally, the internal consistency and inter-rater reliability resulted to be good. Psychopathological symptoms were detected in approximately 40% of the sample. Respectively, autistic spectrum disorders, impulse control disorders, mood disorders, and dramatic personality disorders were the diagnostic orientations providing the most prevalent over-threshold scores. SPAID-G seems to be a valid diagnostic tool, quick and easy to use in psychiatric disorders assessment within the Italian population with ID.

Examining reports of mental health in adults with Williams syndrome

Prior research suggests that individuals with Williams syndrome (WS) have a disposition towards anxiety. Information regarding this is typically derived from parents and carers. The perspectives of the individuals with WS are rarely included in research of this nature. We examined the mental health of 19 adults with WS using explicit (psychiatric interview) and implicit (modified Stroop task) measures and compared informant (parents/carers) and respondent (adults with WS) reports of psychiatric symptoms. Informants and respondents both reported more symptoms of anxiety (n=7-9) than depression (n=2). Strong positive correlations were found between informant and respondent reports of symptoms of mental health problems. Compared to informants, respondents reported significantly more symptoms overall and somewhat more symptoms of anxiety. Results from the Stroop task indicated that the adults with WS were more vigilant to anxiety-related words than to depression-related words. The adults with WS provided reliable information regarding their mental health, thus providing further evidence that anxiety is part of the behavioural phenotype of the syndrome.

Instruments assessing anxiety in adults with intellectual disabilities: a systematic review

BACKGROUND

In the last decades several instruments measuring anxiety in adults with intellectual disabilities have been developed.

AIM

To give an overview of the characteristics and psychometric properties of self-report and informant-report instruments measuring anxiety in this group.

METHOD

Systematic review of the literature.

RESULTS

Seventeen studies studying 14 different instruments were found. Methodological quality as measured with the Quality Assessment of Diagnostic Accuracy Studies checklist was insufficient for four studies, sufficient for seven, and good for six. For self-report, the Glasgow Anxiety Scale for people with a learning disability appears most promising, with good internal consistency (a = 0.96), high test-retest reliability (r = 0.95), sensitivity (100%) and specificity (100%). For informant-report, the general anxiety subscale of the Anxiety, Depression and Mood Scale may be promising, with good internal consistency (a = 0.83 and a = 0.84) and excellent test-retest reliability (ICC = 0.78 and ICC = 0.92), but poor interrater reliability (ICC = 0.39).

CONCLUSIONS

Two instruments appear promising. However, these instruments have only been studied once or twice, whereas the methodological quality of these studies was varying.

Mental health problems in adults with Williams syndrome

Although many researchers have investigated emotional and behavioral difficulties in individuals with Williams syndrome, few have used standardized diagnostic assessments. We examined mental health problems in 92 adults with Williams syndrome using the Psychiatric Assessment Schedule for Adults with Developmental Disabilities-PAS-ADD (Moss, Goldberg, et al., 1996). Factors potentially associated with mental health problems were also explored. The PAS-ADD identified mental health problems in 24% of the sample. The most common were anxiety (16.5%) and specific phobias (12%). Other diagnoses included depression, agoraphobia, and social phobia. No association was found between the presence of mental health problems and either individual (e.g., age, IQ, language level) or external (life events) variables.

Mental health assessment of children and adolescents with learning disabilities

Understanding the mental health problems of children who have learning disabilities presents huge challenges across many domains. This paper examines some of the assessment frameworks that may be used, offers clinical guidance on collecting information and suggests ways in which various theoretical approaches can be used to derive comprehensive case formulations. An emphasis is placed on the use of structured methods to improve reliability and validity.

The psychosocial impact of epilepsy in adults with an intellectual disability

Epilepsy has a pervasive impact on the quality of life, and thus the psychosocial well-being, of adults with an intellectual disability. Social and economical well-being appears to be affected by an increase in restrictions on activities and thus social contact. The population has very high rates of challenging behaviors and of mental illness. It is likely that these have a significant impact on epilepsy management. When populations with and without epilepsy are controlled for level of ability, no difference in prevalence of behavior or mental illness is seen between the populations. Current knowledge is limited on crucial issues such as the long-term effect of seizure disorder on mental health, quality of life, and cognition.

Factor structure of the PAS-ADD Checklist with adults with intellectual disabilities

BACKGROUND

The PAS-ADD Checklist is designed to screen for likely mental health problems in people with intellectual disabilities (ID). The specificity of recommended subscales derived from diagnostic criteria is unclear. This paper therefore investigates the factor structure of the PAS-ADD Checklist to determine the adequacy of empirically derived subscales.

METHOD

A total of 1,115 informants who had known service users for a median of 24 months completed the PAS-ADD Checklist on 1,155 adults with ID living either in the community, in residential care, or in hospital settings in a county in North-East England.

RESULTS

The sample was randomly divided into two, with all item scores dichotomised. An exploratory principal components factor analysis with varimax rotation was conducted on Subsample A, producing an optimal 7-factor solution. However, a confirmatory factor analysis using this factor structure for Subsample B revealed a mediocre to poor fit. Further exploratory and confirmatory factor analyses also indicated that empirically derived PAS-ADD Checklist subscales were inconsistent.

CONCLUSION

Given the inconsistency of empirically derived subscales, we do not recommend using the PAS-ADD Checklist to identify specific types of psychopathology. The Checklist may have more utility as a screening tool for general psychopathology and subsequent referral for more detailed assessment.

Cognitive and behavioural therapy of voices for with patients intellectual disability: two case reports

BACKGROUND

Two case studies are presented to examine how cognitive behavioural therapy (CBT) of auditory hallucinations can be fitted to mild and moderate intellectual disability.

METHODS

A 38-year-old female patient with mild intellectual disability and a 44-year-old male patient with moderate intellectual disability, both suffering from persistent auditory hallucinations, were treated with CBT. Patients were assessed on beliefs about their voices and their inappropriate coping behaviour to them. The traditional CBT techniques were modified to reduce the emphasis placed on cognitive abilities. Verbal strategies were replaced by more concrete tasks using role-playing, figurines and touch and feel experimentation.

RESULTS

Both patients improved on selected variables. They both gradually managed to reduce the power they attributed to the voice after the introduction of the therapy, and maintained their progress at follow-up. Their inappropriate behaviour consecutive to the belief about voices diminished in both cases.

CONCLUSION

These two case studies illustrate the feasibility of CBT for psychotic symptoms with intellectually disabled people, but need to be confirmed by more stringent studies.

The reliability and validity of general psychotic rating scales with people with mild and moderate intellectual disabilities: an empirical investigation

BACKGROUND

Whilst assessment tools have been developed to diagnose schizophrenia in people with mild intellectual disabilities (IDs), little attention has been paid to developing reliable and valid dimensional measures of psychotic experiences with this population. This study investigates the reliability and validity of two such measures developed for the general adult psychiatric population, the Positive and Negative Syndrome Scale (PANSS) and the Psychotic Symptom Rating Scales (PSYRATS), with a population of adults with mild IDs.

METHOD

Sixty-two adults with mild IDs were interviewed using the PANSS and PSYRATS, and independently interviewed using the Psychiatric Assessment Schedule--Adults with Developmental Disability (PAS-ADD) to obtain psychiatric diagnoses to the criteria of the International Classification of Diseases--Tenth Revision (ICD-10). On the basis of ICD-10 diagnosis, participants were divided into three groups: psychosis (n=11); other mental health problem (n=14); no mental health problem (n=37). PANSS and PSYRATS subscale scores were compared across these three groups and were correlated with PAS-ADD symptom scores across a number of PAS-ADD symptom domains.

RESULTS

All PANSS and PSYRATS subscales showed adequate internal reliability, largely good test-retest reliability, and logical inter-correlations between subscales. The PANSS positive symptoms and the PSYRATS auditory hallucinations subscales differentiated between the psychosis group and the other groups; the PANSS general symptoms subscale differentiated between the psychosis and no mental health problem groups; and the PANSS negative symptoms and the PSYRATS delusions subscales did not differentiate between the three groups.

CONCLUSIONS

The PANSS and PSYRATS are promising measures for use with people with mild IDs and psychotic experiences, although further investigation of items relating to negative symptoms and delusions is warranted.

A critique of the Diagnostic Criteria for Psychiatric Disorders for Use with Adults with Learning Disabilities/Mental Retardation (DC-LD) chapter on non-affective psychotic disorders

BACKGROUND

There has been a longstanding interest in the study of psychotic disorders in adults with intellectual disability. The DC-LD chapter for non-affective psychotic disorders provides operationalised criteria for use with this population.

METHODS

A detailed, structured review of the literature was carried out. Relevant papers were reviewed to provide a framework for a critique of the DC-LD criteria.

RESULTS

Most of the research literature focuses on psychotic disorders in adults with mild intellectural disability and suggests that this group experience clinical symptoms similar to those experienced by adults with average abilities. Although the DC-LD criteria for non-affective psychotic disorders are derived from the ICD-10 equivalent categories they are broader than other classification systems, which may affect their reliability, validity and utility.

CONCLUSIONS

At this stage, it is important that the DC-LD criteria are used alongside established systems to gather information about their use for clinical and research purposes.

The assessment of mood in adults who have severe or profound mental retardation

Empirical literature examining the emotional lives of adults with severe and profound mental retardation is limited. One area to have received attention is mood. It is proposed that the utility of assessment of mood extends beyond psychiatric diagnosis to issues such as the appraisal of quality of life for individuals with limited or no expressive language. Two themes related to the assessment of mood are evident in contemporary literature. First, attempts have been made to clarify presentation of affective disorders, especially depression, and to improve assessment of depressive symptomatology in adults with mental retardation. A review of current methods for assessing depression indicates significant problems with reliability and validity. There is a need to develop appropriate assessment methods for use in relation to adults with severe and profound mental retardation who are unable to self-report and behavioral methodology might be useful in this respect. Second, there is an emerging argument that presentation of depression in adults with mental retardation, particularly in individuals with severe disabilities, includes challenging behaviors, referred to as "atypical symptoms." Methodological and conceptual issues related to this argument warrant closer examination. Finally, it is noted that research drawing on more rigorous methodology is required to interpret the emotional states of individuals with severe and profound mental retardation.

Early-onset schizophrenia in children with mental retardation: diagnostic reliability and stability of clinical features

OBJECTIVES

To investigate the presentation of early-onset schizophrenia in children with mental retardation (MR) and the stability of clinical features over time.

METHOD

A purpose-designed assessment protocol was developed based on best-practice recommendations in the research literature. Diagnostic reliability, investigated in a group of 20 children with MR, was found to be very good (kappa = 0.87). Using this protocol, the clinical service identified 10 children with an initial diagnosis of schizophrenia. This group was then reassessed 2 years later.

RESULTS

At the end of 2 years, 8 of the 10 children with schizophrenia still warranted this diagnosis. However, there was considerable instability in relation to certain diagnostic criteria, notably delusions and visual hallucinations. In all cases some improvements in severity were seen at follow-up. However, the eight whose schizophrenia was confirmed at follow-up showed major deterioration in cognitive level.

CONCLUSIONS

It is possible to make reliable diagnoses of early-onset schizophrenia in people with MR, provided the assessment system is carefully structured and pays attention to all the important sources of information. However, symptoms should be reviewed frequently, particularly those that cannot be substantiated by patient interview.

Feasibility, reliability and validity of the Spanish version of Psychiatric Assessment Schedule for Adults with Developmental Disability: a structured psychiatric interview for intellectual disability

BACKGROUND

Over 30% of people with intellectual disability (ID) have a comorbid psychiatric disorder. However, there are few assessment instruments available for international use and cross-cultural validation studies of these instruments are rare. The aim of the present study was to standardize the Spanish version of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD-10), a semi-structured interview for people with ID.

METHODS

After a conceptual translation, feasibility (i.e. applicability, acceptability and practicality) and reliability analyses were carried out. The predictive validity of the PAS-ADD-10 CATEGO-5 codings was also examined (i.e. positive and negative predictive values). Four independent raters with wide-ranging experience in quantitative evaluation and psychiatric assessment of ID evaluated a sample of 80 subjects with ID and borderline intellectual functioning at the AFANAS occupational centre in Jerez, Southern Spain. The ICD-10 codes were used for psychiatric diagnosis.

RESULTS

The practicality of the PAS-ADD-10 is limited because of the need for previous standardization of SCAN interviews. Nevertheless, its overall feasibility was judged adequate by raters and the PAS-ADD-10 was considered extremely useful for training. Test-retest and inter-rater reliability kappa values were moderate to high. The CATEGO coding showed limited validity because of overdiagnosis of anxiety disorders and underdiagnosis of mood and psychotic disorders (positive predictive value = 74%, negative predictive value = 76%).

CONCLUSIONS

The PAS-ADD-10 is a useful tool for standard psychiatric assessment of people with ID; however, CATEGO codings show low validity and a series of modifications should be considered before this instrument is used extensively in Spain. In this regard, a study on the clinical usefulness of the PAS-ADD-10 in patients with ID and severe mental disorders has been undertaken.