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Ramazan Romanov
Ramazan Romanov

The Development and Validation of the Anxiety Depression and Mood Scale (ADAMS) for Adults with Intellectual Disabilities



Anxiety Depression and Mood Scale (ADAMS): A Comprehensive Assessment Tool for Adults with Intellectual Disabilities




Mental health concerns are often underdiagnosed or misdiagnosed in adults with intellectual disabilities (ID) due to various challenges such as communication difficulties, atypical symptom presentation, lack of training among clinicians, and limited availability of valid and reliable assessment tools. However, undetected and untreated mental health problems can have serious consequences for the well-being and quality of life of individuals with ID and their caregivers. Therefore, it is essential to have appropriate instruments that can accurately assess mental health symptoms and disorders in this population.




Anxiety depression and mood scale adams pdf



One such instrument is the Anxiety Depression and Mood Scale (ADAMS), which was developed by Esbensen et al. (2003) to assess anxiety, depression, and mood among individuals with ID. The ADAMS is a 28-item scale that covers five domains: manic/hyperactive behavior, depressed mood, social avoidance, general anxiety, and obsessive-compulsive behavior. The ADAMS is completed by an informant or caregiver who knows the target individual well. The ADAMS has several advantages over other existing measures such as its wide applicability across different levels of ID severity, its sensitivity to change over time, its compatibility with DSM-IV criteria, and its strong psychometric properties.


In this article, we will provide a comprehensive overview of the ADAMS scale, including its administration, scoring, reliability, validity, and clinical utility. We will also provide some useful information and resources for obtaining and using the ADAMS scale in practice and research.


What is ADAMS and why is it important?




The ADAMS is a 28-item scale that was developed by Esbensen et al. (2003) to assess symptoms of anxiety and depression among individuals with ID. The scale was based on a review of existing literature on mental health problems in ID populations, as well as input from experts and focus groups. The scale was designed to capture both typical and atypical manifestations of anxiety and depression in individuals with ID.


The ADAMS consists of five subscales that correspond to five domains of mental health symptoms:


  • Manic/hyperactive behavior: This subscale measures symptoms such as increased activity level, impulsivity, irritability, euphoria, grandiosity, distractibility, and sleep problems.



  • Depressed mood: This subscale measures symptoms such as sadness, hopelessness, low self-esteem, guilt, anhedonia (loss of interest or pleasure), suicidal ideation or behavior.



  • Social avoidance: This subscale measures symptoms such as social withdrawal, isolation, lack of eye contact, fear of strangers, and reluctance to participate in social activities.



  • General anxiety: This subscale measures symptoms such as nervousness, worry, fear, panic, phobias, and somatic complaints.



  • Obsessive-compulsive behavior: This subscale measures symptoms such as repetitive behaviors, rituals, checking, hoarding, and preoccupation with order or cleanliness.



The ADAMS is important because it fills a gap in the assessment of mental health problems in individuals with ID. Unlike other measures that are either too general or too specific, the ADAMS covers a broad range of symptoms that are relevant and meaningful for this population. The ADAMS also has the advantage of being sensitive to change over time, which makes it suitable for monitoring treatment progress and outcomes. Furthermore, the ADAMS is compatible with the DSM-IV criteria for anxiety and mood disorders, which facilitates the diagnosis and classification of mental health problems in individuals with ID.


How is ADAMS administered and scored?




The ADAMS is administered by an informant or caregiver who knows the target individual well. The informant can be a family member, a staff member, a teacher, or a clinician. The informant should have observed the target individual for at least two weeks prior to completing the scale. The administration time is about 15 minutes.


The ADAMS consists of 28 items that are rated on a 4-point Likert scale from 0 (never) to 3 (very often). The items are worded in simple and clear language that is easy to understand by informants with different levels of education and literacy. The items are also accompanied by examples or explanations to clarify the meaning of the symptoms. For example, item 1 asks "Does he/she seem more active than usual?" and provides the following examples: "He/she runs around more than usual; he/she talks more than usual; he/she has trouble sitting still."


The scoring of the ADAMS is straightforward and can be done by hand or by computer. The total score is obtained by summing up the ratings of all 28 items. The subscale scores are obtained by summing up the ratings of the items that belong to each subscale. The total score ranges from 0 to 84, and the subscale scores range from 0 to 18 for manic/hyperactive behavior, 0 to 21 for depressed mood, 0 to 12 for social avoidance, 0 to 15 for general anxiety, and 0 to 18 for obsessive-compulsive behavior. Higher scores indicate higher levels of symptoms or distress.


The interpretation of the results is based on normative data and cut-off scores that were derived from a large sample of individuals with ID (Esbensen et al., 2003). The normative data provide mean scores and standard deviations for each subscale and for the total score according to different levels of ID severity (mild, moderate, severe, profound) and age groups (18-29 years, 30-49 years, 50 years and older). The cut-off scores provide thresholds for identifying individuals who are likely to have clinically significant levels of symptoms or disorders. For example, a cut-off score of 10 or higher on the depressed mood subscale indicates a high probability of having major depression.


How reliable and valid is ADAMS?




The ADAMS has been extensively tested for its psychometric properties in several studies involving individuals with ID of different ages, levels of severity, and settings (Esbensen et al., 2003; Esbensen & Benson, 2006; Esbensen et al., 2010; Esbensen et al., 2011). The results have shown that the ADAMS has high levels of reliability and validity as an assessment tool for anxiety and depression in this population.


Reliability refers to the consistency and accuracy of a measure. The ADAMS has demonstrated high internal consistency reliability, which means that the items within each subscale measure the same construct. The Cronbach's alpha coefficients for the subscales range from .80 to .90, indicating good to excellent internal consistency. The ADAMS also has high test-retest reliability, which means that the scores are stable over time when there is no change in the individual's condition. The test-retest correlations for the subscales range from .80 to .94, indicating excellent test-retest reliability. Furthermore, the ADAMS has high inter-rater reliability, which means that different informants agree on their ratings of the same individual. The inter-rater correlations for the subscales range from .71 to .86, indicating good to excellent inter-rater reliability.


Validity refers to the extent to which a measure assesses what it claims to measure. The ADAMS has demonstrated strong validity evidence in several domains. First, the ADAMS has good convergent validity, How can ADAMS be used in clinical practice and research?




The ADAMS is a useful tool for both clinical practice and research purposes. In clinical practice, the ADAMS can help clinicians to identify individuals with ID who may have anxiety or mood disorders, and to provide them with appropriate diagnosis and treatment. The ADAMS can also help clinicians to monitor the effectiveness of interventions and to evaluate the outcomes of treatment. For example, Esbensen et al. (2010) used the ADAMS to measure the effects of cognitive-behavioral therapy on anxiety symptoms in adults with ID.


In research, the ADAMS can help researchers to investigate the prevalence, correlates, risk factors, and consequences of anxiety and mood problems in individuals with ID. The ADAMS can also help researchers to test the efficacy and acceptability of different interventions for anxiety and mood disorders in this population. For example, Esbensen et al. (2011) used the ADAMS to compare the effects of pharmacological and behavioral treatments on depression symptoms in adults with ID.


The ADAMS is a versatile and comprehensive instrument that can be applied in various settings and contexts. The ADAMS can be used with individuals with ID who live in residential facilities, community homes, or family homes. The ADAMS can also be used with individuals with ID who attend day programs, educational programs, or vocational programs. The ADAMS can be administered by different types of informants or caregivers who have regular contact with the target individual.


Where can I find more information and resources on ADAMS?




If you are interested in learning more about the ADAMS scale, you can find more information and resources from the following sources:


  • The original article that describes the development and validation of the ADAMS scale: Esbensen AJ, Rojahn J, Aman MG, Ruedrich S. Reliability and validity of an assessment instrument for anxiety, depression, and mood among individuals with mental retardation. J Autism Dev Disord. 2003 Dec;33(6):617-29.



  • The website of Mapi Research Trust, which provides access to the ADAMS scale and related materials such as translations, scoring manuals, and normative data: https://eprovide.mapi-trust.org/instruments/anxiety-depression-and-mood-scale



  • The contact details of Dr. Anna J. Esbensen, who is the author and copyright holder of the ADAMS scale: Anna J. Esbensen, Ph.D., Associate Professor of Pediatrics, Division of Developmental & Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 4002, Cincinnati, OH 45229-3039, USA. Email: anna.esbensen@cchmc.org



Conclusion




In conclusion, the ADAMS is a comprehensive assessment tool for anxiety, depression, and mood among adults with ID. The ADAMS has several advantages over other existing measures such as its wide applicability across different levels of ID severity, its sensitivity to change over time, its compatibility with DSM-IV criteria, and its strong psychometric properties. The ADAMS can be used for both clinical practice and research purposes to identify individuals with ID who may have anxiety or mood disorders, to provide them with appropriate diagnosis and treatment, to monitor their progress and outcomes, and to investigate the factors and interventions related to their mental health.


If you are interested in using the ADAMS scale for your practice or research, we encourage you to contact Dr. Anna J. Esbensen or visit the Mapi Research Trust website for more information and resources. We hope that this article has provided you with a useful overview of the ADAMS scale and its applications.


FAQs




  • Q: What is the difference between anxiety and depression?A: Anxiety is a state of nervousness, worry, fear, or panic that interferes with daily functioning. Depression is a state of sadness, hopelessness, low self-esteem, or loss of interest or pleasure that interferes with daily functioning.



  • Q: What are some signs of anxiety or depression in individuals with ID?A: Some signs of anxiety or depression in individuals with ID may include: changes in mood, behavior, activity level, sleep, appetite, or weight; social withdrawal or avoidance; irritability or aggression; nervousness or restlessness; somatic complaints or self-injury; repetitive behaviors or rituals; suicidal thoughts or actions.



  • Q: How common are anxiety and depression in individuals with ID?A: Anxiety and depression are among the most common mental health problems in individuals with ID. The prevalence rates vary depending on the methods and criteria used, but some studies have estimated that about 10% to 40% of individuals with ID have anxiety disorders, and about 4% to 20% of individuals with ID have mood disorders.



  • Q: What are some causes or risk factors of anxiety and depression in individuals with ID?A: Anxiety and depression in individuals with ID may be caused or influenced by various factors such as: genetic or biological factors; environmental factors such as stress, trauma, abuse, neglect, or loss; social factors such as isolation, stigma, discrimination, or lack of support; cognitive factors such as low self-esteem, negative thinking, or poor coping skills.



  • Q: What are some treatments or interventions for anxiety and depression in individuals with ID?A: Anxiety and depression in individuals with ID can be treated or managed by various interventions such as: pharmacological treatments such as antidepressants or anxiolytics; psychological treatments such as cognitive-behavioral therapy, interpersonal therapy, or mindfulness-based therapy; behavioral treatments such as relaxation training, exposure therapy, or contingency management; psychosocial treatments such as social skills training, peer support groups, or family therapy.



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