Anxiety Depression And Mood Scale Adams Pdf
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A review of the literature revealed that there was no adequate assessment instrument available that screens comprehensively for anxiety and depression in persons with mental retardation. The purpose of this research was to develop the Anxiety, Depression, and Mood Scale (ADAMS), an instrument intended to fill this gap. We developed a preliminary rating scale that included 55 symptom items. We examined the factor structure of these items by an exploratory factor analysis of behavior ratings on 265 individuals. A five-factor solution emerged that was both statistically sound and clinically meaningful. These factors were labeled "Manic/Hyperactive Behavior," "Depressed Mood," "Social Avoidance," "General Anxiety" and "Compulsive Behavior." We validated this solution by conducting a confirmatory factor analysis on ratings of 268 additional individuals. Model fit was acceptable. Internal consistency of the subscales and retest reliability for both the total scale and the subscales was high. Interrater reliability was satisfactory. The validity of the ADAMS was assessed with a clinical sample of 129 individuals with mental retardation who were seen in a psychiatric clinic; this provided additional support for the subscales. The ADAMS appears to be a psychometrically sound instrument for screening anxiety, depression and mood disorders among individuals with mental retardation.
We found that scores on anxiety subscales were intermediate in range with respect to other behavioral constructs measured by the RSBQ, ADAMS, and ABC-C. Age did not affect scores, and severity of general anxiety was inversely correlated with clinical severity. We demonstrated that the internal consistency of the anxiety-related subscales were among the highest. Test-retest and intra-rater reliability was superior for the ADAMS subscales. Convergent and discriminant validity were measured by inter-scale correlations, which showed the best profile for the social anxiety subscales. Of these, only the ADAMS Social Avoidance showed correlation with quality of life.
We estimated convergent validity by measuring the level of agreement between the five anxiety-related subscales. Discriminant validity was determined by the level of disagreement between these five subscales and subscales of the RSBQ and ABC-C measuring a different construct (e.g., RSBQ Breathing Problems, ABC-C Stereotypy). Because of the close relationship between anxiety and mood, we hypothesized that there would be an intermediate level of agreement between subscales measuring these two constructs. Therefore, mood-related subscales would not be informative in terms of either convergent or discriminant validity. These correlations were performed by one-tailed Spearman regression analyses since we expect all relationships to be in the same direction. As shown in Table 6, which includes the five anxiety-related subscales as well as one of the mood subscales (RSBQ General Mood) and another subscale partially reflecting mood behaviors (ABC-C Irritability), there were strong correlations between the three social anxiety subscales (ADAMS Social Avoidance, ABC-C Lethargy/Social Withdrawal, ABC-C Social Avoidance) and between the two general anxiety subscales (RSBQ Fear/Anxiety, ADAMS General Anxiety). While the ADAMS Social Avoidance was also correlated with the ADAMS General Anxiety and the RSBQ Fear/Anxiety, these relationships were weaker. On the other hand, the ABC-C social subscales were borderline or not correlated with the two general anxiety subscales. Table 6 also demonstrates that anxiety measures correlated more variably with mood subscales. In terms of discriminant validity, the two general anxiety subscales were also correlated with subscales measuring other constructs (only correlations with ABC-C Irritability shown on Table 6; other examples include RSBQ Body Rocking and ABC-C Hyperactivity). In contrast, with exception of subscales representing stereotypic behavior, the social anxiety scales correlated only with the mood or anxiety measures.
Behavioral abnormalities are an important component of the phenotype of RTT [13, 16, 24, 33]. Nonetheless, they are not included in the diagnostic criteria of the disorder and their characterization is still limited. Until recently, most studies had focused on the autistic features of RTT. The incorporation of the RSBQ to the battery of instruments for evaluating individuals with RTT in 2002 brought attention to the frequency and severity of anxiety-like and other problem behaviors in RTT. Nevertheless, no systematic evaluation of anxious behaviors in RTT has been conducted. Taking into consideration the marked communication and motor impairments in the disorder, it is critical to delineate behaviors evaluated by standardized instruments in suitable RTT cohorts and not to assume that these measures are adequate for the disorder. Here, we report on a comprehensive assessment of the anxiety-related subscales of the RSBQ, ADAMS, and ABC-C. We determined both the profiles of anxious behaviors in RTT and the psychometric properties of the abovementioned instruments. We found that anxiety-like behaviors were comparable in severity to other behavioral domains such as mood abnormalities and disruptive behavior, but less pervasive than stereotypic behaviors. We also determined that, although relatively constant during childhood, anxious behaviors were more prominent in RTT children with milder neurologic impairment. Finally, while reliability measures were satisfactory for all five anxiety-related subscales, those evaluating the social domain showed better concurrent (convergent and discriminant) validity and greater functional implications. Based on the available data, the ADAMS Social Avoidance subscale displayed the best overall psychometric profile.
Because of the lack of appropriate gold standards, validity of behavioral instruments is in general assessed by examining construct or concurrent validity. This means establishing that the measure is significant (and usually directly) correlated with other measures that evaluate the same construct (convergent validity), in this case anxiety. Complementing this, discriminant validity is demonstrated by poor correlations with measures of unrelated constructs . These two types of validity can be thought of as sensitivity and specificity, respectively, and should be considered with caution as it is difficult to fully determine the relationship between behavioral constructs. Our data demonstrate that the three social anxiety subscales were strongly correlated among themselves and, among them, only the ADAMS Social Avoidance correlated with the two measures of general anxiety. On the other hand, the ADAMS General Anxiety and the RSBQ Fear/Anxiety were strongly correlated with each other. Although convergent validity was similar for general and social anxiety measures, the main difference was in terms of discriminant validity. While the general anxiety subscales correlated with measures of mood and other constructs such as hyperactivity, the social subscale correlations were restricted to mood and stereotypic behavior (excluding motor stereotypies). We can conclude that, in terms of concurrent validity, the ADAMS Social Avoidance, ABC-C Lethargy/Social Withdrawal, and ABC-C Social Avoidance are the best measures. Beyond psychometric properties, the value of behavioral instruments is also determined by their ability to measure clinically or functionally meaningful behaviors. This is a particularly important feature when selecting a behavioral instrument as an outcome measure in intervention studies. We used two complementary instruments to determine the functional implications of anxiety-related measures in RTT: adaptive behavior, a construct that evaluates cognition in practical aspects, and quality of life [46, 58]. Relationships between anxiety scales and adaptive behavior measures were weak; however, higher scores (i.e., more severe) on the ADAMS Social Avoidance were inversely correlated to a measure of psychosocial quality of life, indicating reduced psychosocial well-being.
The Center for Epidemiologic Studies Depression Scale (CES-D) was designed for use in the general population and is now used as a screener for depression in primary care settings. It includes 20 self-report items, scored on a 4-point scale, which measure major dimensions of depression experienced in the past week. The CES-D can be used for children as young as 6 and through older adulthood. It has been tested across gender and cultural populations and maintains consistent validity and reliability. The scale takes about 20 minutes to administer, including scoring.
The EQ-5D is a standardized, non-disease specific instrument for describing and evaluating health-related quality of life. The instrument measures quality of life in five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. It was introduced as a health-related quality of life measure by a group of European researchers, the EuroQol Group. Respondents can complete the questionnaire in under five minutes. There is a version for adults (age 16 and older) and the EQ-5D-Y for children/adolescents (8 to 15 years). The EQ-5D is available in a wide range of languages and is used worldwide.
The Hamilton Rating Scale for Depression, abbreviated HDRS, HRSD or HAM-D, measures depression in individuals before, during and after treatment. The scale is administered by a health care professionals and contains 21 items, but is scored based on the first 17 items, which are measured either on 5-point or 3-point scales. It takes 15 to 20 minutes to complete and score.
The 10-item Montgomery-Åsberg Depression Rating Scale (MADRS) measures severity of depression in individuals 18 years and older. Each item is rated on a 7-point scale. The scale is an adaptation of the Hamilton Depression Rating Scale and has a greater sensitivity to change over time. The scale can be completed in 20 to 30 minutes. 2b1af7f3a8