Diagnosis

IQ assessment, personality tests, and measuring adaptive behaviour can provide extra background information that may be useful to the diagnosis. Specific tests, for example of thought disorder in schizophrenia, may be helpful in establishing the diagnosis, but are not yet standardized for the mentally retarded population. Non-invasive neuroimaging techniques promise to be potentionally valuable diagnostic tools particularly for non-verbal severely retarded individuals in the future. Structured interview schedules and rating scales are being used increasingly in an attempt to improve diagnostic accuracy. Instruments developed for use with the non-retarded rely heavily on the ability of the patient to describe subjective feelings and are thus of limited value. Diagnostic rating scales that are to be used with the mentally retarded should, as far as possible, reflect behavioural rather than subjective components. An early attempt was made by Day and colleagues, (2) who published diagnostic criteria for mania, depression, and schizophrenia for use with the mentally retarded; these have been further refined by Sovner and Hurley (1) and by Menolascino and Weiler. (21) Recently a number of scales have been developed specifically for use with the mentally retarded. These include the Psychopathology Inventory for Mentally Retarded Adults, which includes self-report and informant versions, (22) the Reiss Screen for maladaptive behaviour,(23) the Diagnostic Assessment for the Severely Handicapped scale,(24) and most recently the Psychiatric Assessment of Adults with Developmental Disability, which is a semistructured interview/2.5) and the Mental Retardation Depression Scale/2.6) These scales were primarily developed for use as research instruments and whilst they play an invaluable role in epidemiological studies and population screening as well as being useful for monitoring the response to treatment, they are of limited value in clinical practice and rarely, if ever, solve a diagnostic problem.

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