How can you comprehensively assess psychiatric symptoms and medication side effects in patients with SMI/IDD who are non-verbal or have very limited communication abilities?

One of the big challenges of the the rating scales that we use is that a lot of the clinical work we do in psychiatry really relies on the patient being able to tell us about their internal world. For youth and persons transitioning into adulthood, we may not be able to get that information if they are non-verbal. This is where including the family and the caregiver goes a long way, that provides at least some evidence about things like irritability and behavior changes that may help us start to monitor. For example, after starting a medication, a patient might begin engaging in head banging behavior (when they had never engaged in such behavior in the past). That should really raise a question and concern about whether our treatment is helping or only causing adverse effects. There is an excellent reference text, NADD’s DM-ID-II: Diagnostic Manual-Intellectual Disability: A Textbook of Diagnosis of Mental Disorders in Persons with Intellectual Disability. It is a phenomenal resource when it comes to teasing apart the way the IDD and the SMI may be co-presenting.

There are also some scales/screening tools available for use in assessing psychiatric symptoms and side effects for patients with SMI/ IDD who are nonverbal or have limited communication abilities, by utilizing additional sources of information or collateral. Clinicians should use “simple vocabulary” and language when interviewing patients. In addition, clinicians should consider potential stressors, reports of thoughts and perceptions, observe medical history/charts, and use rating scale/self-report instruments. Some examples of useful scales/screening tools for symptom identification, severity, and psychiatric diagnoses are:

  • Emotional Problems Scale (EPS-R) – used with ages 14-75 with IDD; both self-report and informant sections
  • Repetitive Behavior Scale (RBS-R) – used with children, adolescents, and adults with ASD (also RBS-EC available for early childhood); informant report utilized
  • Diagnostic Assessment for the Severely Handicapped (DASH-ii) – studied with ages 6-56 with IDD; informant report utilized
  • Behavior Problems Inventory (BPI) – studied with ages 14-91 with IDD; informant report utilized
  • Anxiety, Depression and Mood Scale (ADAMS)- studied with ages 10-79 with IDD and comorbid psychiatric condition; informant report utilized

For more information on the care and treatment of transitional age youth patients with co-morbid SMI and IDD, please view this free SMI Adviser webinar: Transitional Age Youth: Caring for Comorbid Serious Mental Illness and Intellectual Developmental Disability (February 2020).

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