Research in Developmental Disabilities 36 (2015) 537–542

Contents lists available at ScienceDirect

Research in Developmental Disabilities

Validity and reliability of the Spanish version of the diagnostic assessment for the severely handicapped (DASH-II) Carmen Vargas-Vargas a,*, Anna Rafanell b, Du´nia Montalvo a, Montse Estarlich b, Edith Pomarol-Clotet c,d, Salvador Sarro´ c,d a

Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Spain Centre Psicopedago`gic Mare de De´u de Montserrat, Caldes de Malavella, Spain FIDMAG Germanes Hospitala`ries Research Foundation, Barcelona, Spain d CIBERSAM, Madrid, Spain b c

A R T I C L E I N F O

A B S T R A C T

Article history: Received 10 October 2014 Received in revised form 17 October 2014 Accepted 23 October 2014 Available online 14 November 2014

Background and objectives: The DASH-II scale is a specific instrument for measuring psychopathological symptoms in people with severe and profound intellectual disability (ID). The aim of the study is the validation of the Spanish version, evaluating its reliability and validity. At the same time we examine the prevalence of mental disorders in our sample. Material and methods: Two reviewers independently passed the Spanish version of the DASH-II (DASH-II-S) to 83 users to establish inter-rater reliability. To assess inter-rater reliability or test–retest reliability, fifty participants were reassessed by the same rater within 7 days. Results: DASH-II-S showed good internal consistency (Cronbach’s a = 0.879) and good reliability, both intra and inter-rater reliability. The prevalence of psychopathology in the sample is 94%, and the use of psychotropic drugs is also high, with 61.4% receiving one or more antipsychotics. Conclusions: DASH-II-S is a valid and reliable instrument that can be used for the assessment of psychopathology in people with ID. The translated version retains the psychometric properties of the original English version. Moreover, the high prevalence of mental disorders in this population may explain the widespread use of psychotropic drugs, but it forces us to continuous reassessment and justification. ß 2014 Elsevier Ltd. All rights reserved.

Keywords: Intellectual disability Rating scale Validation Prevalence Comorbidity Assessment

1. Introduction Persons with intellectual disabilities (ID) are at high risk of presenting with mental health disorders and psychopathology occurs at much high rates among persons with ID than in the general population (Mohr, Tonge, & Einfeld, 2005). Additional diagnoses vary widely between 7 and 97% (Cooper, Smiley, Morrison, Williamson, & Allan, 2007). The differences may be due to different diagnostic criteria and methods used (Borthwick-Duffy, 1994; Deb, Thomas, & Bright, 2001). Furthermore, in hospital or institutionalised populations, the prevalence is even higher (Chaplin et al., 2010), with several disorders at rates

* Corresponding author at: Servicio de Atencio´n a Personas con Discapacidad Benito Menni CASM, C/ Dr. Antoni Pujadas, 38, E-08830 Sant Boi de Llobregat, Barcelona, Spain. Tel.: +34 93 652 99 99; fax: +34 93 640 02 68. E-mail address: [email protected] (C. Vargas-Vargas). http://dx.doi.org/10.1016/j.ridd.2014.10.034 0891-4222/ß 2014 Elsevier Ltd. All rights reserved.

538

C. Vargas-Vargas et al. / Research in Developmental Disabilities 36 (2015) 537–542

four to five times higher than in the general population (Rush, Bowman, Eidman, Toole, & Mortenson, 2004). Autism, selfinjurious behaviours, attention deficit hyperactivity disorder, anxiety, depression and psychosis are very frequent (Matson & Shoemaker, 2011). Furthermore, studies show that psychopathology is usually very stable over time in both children (Dekker & Koot, 2003) and adults (Horovitz et al., 2011). In the last two decades, various scales have been developed to measure psychopathology in people with intellectual developmental disorder. Since the appearance in 1983 of the first specific scale for these disorders, the psychopathology instrument for adults with mental retardation (PIMRA) (Kazdin, Matson, & Senatore, 1983), different scales have been developed, some having greater or lesser impact in their use and on the literature (see the recent review by Matson, Belva, Hattier, and Matson (2012)). There are specifically three scales to assess the presence of psychopathology in ID, the assessment for dual diagnosis (ADD) (Matson & Bamburg, 1998) designed for people with mild or moderate ID, the diagnostic assessment for the severely handicapped II (DASH-II) (Matson, Coe, Gardner, & Sovner, 1991) for people with severe or profound disability and the latest psychopathology checklists for adults with intellectual disability (P-AID) (Hove & Havik, 2008). DASH-II is a scale developed by Matson, Gardner, Coe, and Sovner (1991) to evaluate those persons with severe and profound ID. DASH-II consists of 84 items and measures 13 mental health disorders derived from the DSM-IV-R. Subscales consist of organic syndromes, anxiety, mood, mania, pervasive developmental disorder (PDD)/autism, schizophrenia, stereotypies, self-injurious behaviour, eliminating disorders, eating disorders, sleep disorders and sexual disorders. Primary caregivers who have been in charge of patients for least 6 months rate the frequency, duration and severity of the symptoms on a 3-point scale. The frequency is rated as 0, no occurrence at all; 1, has occurred between 1 and 10 times in the preceding 2 weeks; or 2, has occurred more than 10 times in the previous 2 weeks. Duration is rated as 0, less than 1 month; 1, 1–12 months; or 2, over 12 months. Severity of symptoms is 1, caused no disruption or damage; 2, caused no damage, but interrupted activities of others at least once; or 2, caused injury or property damage at least once. The 13 symptom scales have cut-off scores indicating when a diagnosis should be considered. For the first eight scales, Matson set the cut-off point for diagnostic indication at a score of 1 SD above the mean of the standardisation sample. For the last five scales, at least one subscale item must have been rated at a severity level of 1 or 2 to reach the cut-off point. The reliability of the DASH-II has been well established with 0.86 mean percentage agreement between respondents and 0.84 test–retest reliability (Sevin, Matson, Williams, & Kirkpatrick-Sanchez, 1995). Several of the subscales have evidence supporting their validity including the mania (Matson & Smiroldo, 1997; Sturmey, Laud, Cooper, Matson, & Fodstad, 2010a, 2010b), sleep (Matson & Malone, 2006) and schizophrenia (Bamburg, Cherry, Matson, & Penn, 2001) subscales. The aim of this study is to test the reliability of the Spanish version of the DASH-II (DASH-II-S) (Novell, Rueda, SalvadorCarulla, & Forgas, 2003) and to describe the prevalence of psychopathological symptoms in a sample of severe or profound ID in two residential centres in Catalunya, Spain. 2. Methods 2.1. Participants The present study included 83 women in two residential centres of the Hermanas Hospitalarias del Sagrado Corazo´n de Jesu´s, Benito Menni Complex Asistencial en Salut Mental (Sant Boi de Llobregat) and Centre Psicopedago`gic Mare de De´u de Montserrat (Caldes de Malavella). These resources provide care and a variety of different services to individuals with a wide variety of intellectual and developmental disabilities. This was an adult population (mean 53.92 years; SD 10.89), entirely made up of Caucasian who were all single, and have not been ever married. All included patients had a previous diagnosis of severe to profound ID. Two of the authors (C.V. and A.R.), on-site clinical licenced psychologists, carried out the diagnosis using DSM-IV-TR criteria for intellectual disability (American Psychiatric Association, 2000) after the administration of a standardised IQ test. The study protocol was explained to the participants and/or to their significant others if necessary and written informed consent was obtained before the evaluation. Other data used in the study was gathered from pre-existing clinical sources. All of the participants were receiving treatment as usual at the time of recruitment. This study was in accordance with the Declaration of Helsinki, and an approval was obtained from the local ethics committee. 2.2. Procedure Two independent evaluators administered the DASH-II-S scale to the 83 residents. Evaluators were clinical staff at one of the centres, who were performing direct care work with the participants and had known them for at least three years. To perform the test–retest reliability, 50 participants were reassessed with the DASH-II-S scale by the same evaluator over a period of between 2 and 7 days. 2.3. Statistical analyses A descriptive analysis of the characteristics of the sample was performed, as well as scores on the DASH-II-S questionnaires.

C. Vargas-Vargas et al. / Research in Developmental Disabilities 36 (2015) 537–542

539

Table 1 Socio-demographic and clinical characteristics of the sample (N = 83).

Autonomus deambulation Comorbidity Epilepsy Autism Physical illness Medication Antidepressants Anticonvulsants Benzodiazepines Hypnotics Antipsychotics First generation AP Second generation AP Combination

X2

p value

38

0.223

0.637

15 2 13

16 8 18

0.039 3.325 0.507

0.844 0.068 0.476

12 22 20 3 27 7 18 2

14 25 15 13 24 10 9 5

0.011 0.001 2.506 6.345 1.882

0.918 0.970 0.113 0.012 0.170

X2

p value

%

Number of diagnoses ID severe

ID profound

88.0

35

37.3 12.0 37.3 31.3 56.6 42.2 19.3 61.4 20.5 32.5 8.4

AP, antipsychotic medication.

Table 2 Diagnosis prevalence for subscale disorders (N = 83). Subscales

% Total

Number of diagnoses ID severe

Group (a) (more than half of subscale endorsed) Anxiety 6 0 Mood 13 3 Mania 28 9 PDD/autism 31 10 Schizophrenia 12 4 Group (b) (at least one item in subscales with severity level of 1 or 2) Stereotypies 59 22 Self-injurious behaviour 24 7 Eliminating disorders 17 3 Eating disorders 40 8 Sleep disorders 25 9 Sexual disorders 19 9 Organic syndromes 52 16 Impulse control 71 29

ID profound 5 8 14 16 6

4.716 1.979 .789 1.105 .223

.030 .160 .375 .293 .637

27 13 11 25 12 7 27 30

.210 1.520 4.417 11.378 .193 .683 3.425 .384

.647 .218 .036 .001 .661 .409 .064 .536

PDD, pervasive developmental disorder. Bold indicate to correlation is significant at the 0.05 level (two-tailed).

Statistical analysis was carried out using the SPSS-PC + computer software program (version 17.0 for Windows). The reliability of the questionnaire was measured by analysing internal consistency using Cronbach’s a coefficient (Cronbach & Warrington, 1951). Inter-rater and intra-rater reliability was calculated by means of the intra-class correlation coefficient (ICC) (Lord & Novick, 1968). Chi-squared analyses were conducted to determine whether socio-demographic variables were related to the likelihood of diagnosis of severe or profound ID. 3. Results Thirty-nine participants met the DSM-IV diagnostic criteria for severe ID (47%) and 44 for profound ID (53%) with a mean age of the sample of 53.92  10.89 years (minimum = 33, maximum = 80). The profound group was significantly younger (51.57  11.232 years versus 56.56  9.835 years respectively; p = 0.035). Comorbid pathology was frequent in our sample, and 37% showed almost comorbid physical illness and another 37% showed epilepsy. The prevalence of autism was 12% (Table 1). The prevalence of different diagnoses according to the degree of ID (severe or profound) are shown in Table 2. Impulse control disorders (71%), motor stereotypies (59%) and organic disorders (51%) were present in over half of the sample. Both groups had the same prevalence of individual disorders, except for the subscales of anxiety and eating disorders which were significantly more prevalent in patients with profound ID. In our sample, 79 participants (94%) showed one or more disorders. The internal consistency of the scale was good with a Cronbach’s a coefficient of 0.89, and all the items appeared to contribute significantly to the relevant (data available as supplementary material). Table 3 shows the results of the internal consistency for the different subscales.

C. Vargas-Vargas et al. / Research in Developmental Disabilities 36 (2015) 537–542

540

Table 3 Internal consistency feature of the DASH-II-S (N = 83).

1 2 3 4 5 6 7 8 9 10 11 12 13

Subscales

Mean

SD

Cronbach’s a

Impulse control Organic syndromes Anxiety Mood Mania PDD/autism Schizophrenia Stereotypies Self-Injurious behaviour Eliminating disorders Eating disorders Sleep disorders Sexual disorders

4.66 1.96 0.98 3.13 2.35 2.6 1.2 2.1 0.67 0.37 1.09 0.57 0.36

4.5 1.9 1.5 3.3 2.65 2.1 1.5 1.9 1.4 0.8 1.5 1.09 0.67

0.787 0.465 0.607 0.688 0.729 0.347 0.484 0.343 0.683 0.682 0.416 0.475 0.209

PDD, pervasive developmental disorder.

Table 4 Inter-rater reliability (N = 83).

1 2 3 4 5 6 7 8 9 10 11 12 13

Subscales

ICC (95 IC)

p

Impulse control Organic syndromes Anxiety Mood Mania PDD/autism Schizophrenia Stereotypies Self-Injurious behaviour Eliminating disorders Eating disorders Sleep disorders Sexual disorders

0.712 0.763 0.787 0.634 0.747 0.702 0.705 0.804 0.828 0.839 0.863 0.879 0.884

Validity and reliability of the Spanish version of the diagnostic assessment for the severely handicapped (DASH-II).

The DASH-II scale is a specific instrument for measuring psychopathological symptoms in people with severe and profound intellectual disability (ID). ...
278KB Sizes 0 Downloads 7 Views