www.pasadd.co.ik
Munro-Guy’s Hospital
66 Snowsfields
London SE1 3SS
The PAS-ADD schedules were designed to improve three fundamental aspects of mental health assessment in people with intellectual disability: case detection, informant reporting and face-to-face interviewing with the clients themselves. Each of the tools focuses on one of these issues, providing a structured framework within which family members, clinicians and other health professionals can collect standardised information about mental health problems. The system has been widely adopted in intellectual disability services in the UK, Europe and
Australia, as well as other countries, to improve the identification and assessment of mental health problems. Overall, the instruments were designed to provide a flow of information from carers and health professionals to the clinicians responsible for making diagnoses and formulations. The current instruments are: a) The PAS-ADD Checklist The shortest of the instruments, designed specifically to identify potential cases.
b) The Mini PAS-ADD Created to improve the quality of informant reporting. Details of this assessment are given below c) The PAS-ADD 10 Designed for Interviewing the people with intellectual disability themselves. The PAS-ADD 10 was primarily designed for research, but a new version of this assessment, the PAS-ADD Clinical Interview , is currently under development. d) The ChA-PAS The Child and Adolescent Psychiatric Assessment Schedule (ChA-PAS) is for the assessment of mental health problems in children and adolescents with learning disabilities.
Since the original PAS-ADD project (in the 1990s), nurses, social workers and other allied professionals have become increasingly sophisticated in their knowledge of mental health issues, and increasingly pivotal in the roles they fulfil. As a result, the assessment of mental health problems has become an increasingly collaborative venture. A principal aim of the
Mini PAS- ADD is to capitalise on this knowledge, improving the quality of informant reporting by providing an instrument that can be used by a wide range of professionals, not just clinicians. The Mini PAS-ADD provides in-depth information on Axis I psychiatric disorders, either by interviewing an informant, or by collecting together knowledge already possessed.
The tightly structured glossary definitions of symptoms and their severity, coupled with training in their use, has enabled people with disparate professional backgrounds to collect reliable and valid accounts of symptoms from informants. This information can then be used by clinicians, in combination with other sources of information (eg challenging behaviour, environment, early attachment) to produce accurate formulations and diagnoses.
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Training in use of the Mini PAS-ADD takes two days. There are two core skills to be acquired in order to use the assessment: accurate symptom coding, and use of the semi-structured interview. However, it is equally important that users of the assessment are familiar with its theoretical structure, to understand the status of the information it produces. The training therefore gives attention to these aspects. Ultimately, the aim of a mental health assessment is to understand why the person is experiencing the problems that they are, and this usually needs to involve other perspectives, not just psychiatric. A further aim of the course is to give the participants some experience of performing comprehensive formulations of complex cases, incorporating information from the Mini PAS-ADD with other sources of information, such as behavioural and ecological analyses, physical health status and psychodynamic aspects.
The workshops have a strong practical element, the majority of learning taking place through exercises which are run in groups of three.
During the first day participants are given some background on modern thinking on mental health issues in people with intellectual disability, and introduced to both the PAS-ADD
Checklist and the Mini PAS-ADD
The exercises of Day 1 focus primarily on the development of accurate symptom coding in relation to axis I psychiatric disorders.
This is achieved through the use of specially constructed case vignettes, on which the participants work in small groups under the guidance of the workshop presenter. Learning to use the clinical glossary is central to the activities of the first day.
Clinical interviewing is one of the fundamental techniques used to assess people’s mental health status, yet there are many factors that make it potentially unreliable. The Mini PAS-
ADD has been designed to increase reliability and validity of interviewing informants, and Day
2 will start by focussing on the development of the semi-structured interviewing skills necessary to achieve this.
The following components of interviewing will be covered:
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Eliciting the temporal development and expression of the disorder
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Deciding on the rating periods
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Eliciting symptoms
The second part of the day will look at use of the autism screen, and the problems of distinguishing symptoms of autism from those of obsessive compulsive disorder
The final part of day 2 will start with a discussion of case formulation and the various perspectives that need to be considered. This stage in assessment is absolutely crucial because most mental health problems are a complex mix of factors, often leading to a potentially large number of possible logical explanations for the problem having arisen. Participants will work on a complex case involving various types of information, to derive diagnostic hypotheses and case formulations.
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References (For a full list please log on to the website)
Costello, H, Moss, S.C., Prosser, H., & Hatton, C. (1997) Reliability of the ICD 10 version of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD),
Social Psychiatry and Psychiatric Epidemiology , 32 , 339-343
Moss, S.C., Prosser, H., & Goldberg, D.P. (1996) Validity of the Schizophrenia diagnosis of the Psychiatric Assessment Schedule for Adults with Developmental Disability (PAS-ADD).
British Journal of Psychiatry , 168 , 359-367.
Moss, S.C. (2002) The Mini PAS-ADD Interview Pack . Brighton: Pavilion Publishing
Moss, S.C., Lee, P., & Friedlander, R. (2007) The Child and Adolescent Psychiatric
Assessment Schedule (ChA-PAS). Brighton: Pavilion Publishing
Prosser, H., Moss, S.C., Costello, H., Simpson, N., Patel, P, & Rowe, S. (1998) Reliability and validity of the Mini PAS-ADD for assessing psychiatric disorders in adults with intellectual disability . Journal of Intellectual Disability Research 42 , 264-272
Steve Moss has worked for 30 years in disability research, initially in the field of visual impairment, and subsequently in the area of intellectual disability. He has an international reputation for his work in the fields of ageing and of mental health. His work on development of the PAS-ADD system (Psychiatric Assessment Schedules for Adults with Developmental
Disabilities) is particularly well known, and these assessments are now used in many countries throughout the world.. He is currently an associate member of the Estia Centre, Guy's
Hospital, London, and Honorary Senior Lecturer at the Institute of Psychiatry, King’s College
London
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