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Dual Diagnosis and Self-Determination: Any Relationship?. Karen L. Hobden & Barbara W. LeRoy Developmental Disabilities Institute Wayne State University 268-4809 Woodward, Detroit, MI 48202. Dual Diagnosis.

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Dual diagnosis and self determination any relationship

Dual Diagnosis and Self-Determination: Any Relationship?

Karen L. Hobden & Barbara W. LeRoy

Developmental Disabilities Institute

Wayne State University

268-4809 Woodward, Detroit, MI 48202

Dual diagnosis
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)

Assessment of a dual diagnosis
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.

Mini pas add 7 subscales
Mini PAS-ADD - 7 Subscales:

  • Depression

  • Anxiety

  • Expansive Mood Disorder (Bipolar)

  • Obsessive-Compulsive Disorder

  • Psychosis

  • Unspecified Disorder (including Dementia)

  • Autism

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

Our research goals
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


  • We conducted this research in collaboration with the Macomb Oakland Regional Center (MORC)

  • MORC serves 1000 adults with mild or moderate intellectual disabilities.


  • 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.

Assessment of self determination
Assessment of Self-determination

  • 22 Item Scale

  • Assessing choice making – living arrangements, community involvement, employment/finances

  • Completed by supports coordinator in collaboration with individual

Self determination scale
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?

Our sample
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

Severity of intellectual disability
Severity of Intellectual disability

Results mini pas add
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

Pre existing diagnosis but no mini pas add why
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.

Conclusions mini pas add
Conclusions - Mini PAS-ADD - Bottom Third

  • 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.

Conclusions self determination
Conclusions – Self Determination - Bottom Third

  • 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)

Contact info
Contact Info - Bottom Third