Dual Diagnosis and SelfDetermination: Any Relationship

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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

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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)

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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.

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Mini PAS-ADD - 7 Subscales

• Depression
• Anxiety
• Expansive Mood Disorder (Bipolar)
• Obsessive-Compulsive Disorder
• Psychosis
• Unspecified Disorder (including Dementia)
• Autism

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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

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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

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MORC

• We conducted this research in collaboration with
  the Macomb Oakland Regional Center (MORC)
• MORC serves 1000 adults with mild or moderate
  intellectual disabilities.

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Procedure

• 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.

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Assessment of Self-determination

• 22 Item Scale
• Assessing choice making living arrangements,
  community involvement, employment/finances
• Completed by supports coordinator in
  collaboration with individual

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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?

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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

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Severity of Intellectual disability
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Type of Residence
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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

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Comparison of Diagnoses
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Mini PAS-ADD vs Diagnosis on File
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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.

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Diagnostic Match by Psychotropic Medication
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Results - Self-Determination by Diagnosis
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Self-Determination Rankings for Persons with Dual
Diagnosis - Top Third
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Self-Determination Rankings for Persons with Dual
Diagnosis - Middle Third
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Self-Determination Rankings for Persons with Dual
Diagnosis - Bottom Third
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Conclusions - Mini PAS-ADD

• 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.

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Conclusions Self Determination

• 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 (?²6.42, p lt 05)
• Join social organizations or clubs (?²4.52, p lt
  05)
• See family members regularly (?²10.47, p lt 01)
• Have their own phone (?²5.81, p lt 05)

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Contact Info

• Karen Hobden
• email khobden_at_wayne.edu
• phone [phone]
• website http//ddi.wayne.edu/