‘Diagnostic Overshadowing’ Amongst Clinicians Working with People with Intellectual Disabilities in the UK

Abstract

Background Mental health problems are known to be hard to recognize in people with intellectual disabilities. One factor that may contribute to this is the diagnostic overshadowing bias, which describes the tendency of the clinicians to overlook symptoms of mental health problems in this client group and attribute them to being part of ‘having an intellectual disability’. Although a small amount of research has investigated this in the USA, very little has taken place in the UK. Materials and methods Two clinical vignettes were produced. Both described identical clinical problems, except that one vignette described a man with an IQ of 58 and impaired social functioning (i.e. an intellectual disability) and one a man with an IQ of 108 and normal social functioning (i.e. non‐intellectually impaired). Psychiatrists (n = 274) and clinical psychologists (n = 412) throughout UK were randomly assigned to either the low IQ or normal IQ condition, and sent a corresponding clinical vignette. Results One hundred and thirty‐three psychologists and 90 psychiatrists responded. Diagnostic overshadowing did appear to be present. Clinicians were more likely to recognize a range of symptoms in those with IQs in the normal range than those with intellectual disabilities. Furthermore, psychiatrists appeared more likely to make this error under some circumstances than clinical psychologists. Conclusions Diagnostic overshadowing may contribute to the difficulties that mental health professionals commonly experience in identifying mental health problems in people with intellectual disabilities. However, the methodology commonly used in this type of research has a number of weaknesses, and would benefit from an alternative approach.

Models of disability: their influence in nursing and potential role in challenging discrimination

“…The term 'abuse' is used to embrace the concept 'maltreatment' which has been defined as harm via health providers, with or without intention (Hassouneh-Phillips et al 2005). 'Diagnostic overshadowing', the process whereby medical personnel are so overwhelmed by the clients' 'disabled' identity along with the accompanying negative mind set (Mason and Scior 2004), becomes an additional barrier to healthcare when it is required by disabled people (Drainoni et al 2006). Failure to provide healthcare when required is itself a form of abuse.…”

Diagnosis and management of attention-deficit hyperactivity disorder in children and adults with and without learning disability

“…Studies have shown a higher prevalence of ADHD in children with learning disability (Handen et al, 1994;Dekker & Koot, 2003). There is growing evidence that ADHD can be successfully treated in children with learning disability (Handen et al, 1999;Barkley et al, 2002;Pearson et al, 2003) but it is very difficult to make a diagnosis in these children because of 'diagnostic overshadowing' (Reiss & Szyszko, 1983;White et al, 1995;Jopp & Keys, 2001;Mason & Scior, 2004).…”

“…Consultants might be more confident about making a diagnosis of ADHD in patients without learning disability because of 'diagnostic overshadowing' in the latter group (Reiss & Szyszko, 1983;White et al, 1995;Jopp & Keys, 2001;Mason & Scior, 2004). This is a well-described problem in the diagnosis of psychiatric Buckley et al ADHD and learning disability original papers conditions in people with learning disabilities.…”

Intellectual disability nursing and transcultural care

“…Therefore, RNIDs must develop skills to conduct a cultural assessment with each patient and understand disease incidence and prevalence among ethnic groups. Without this knowledge, diagnostic overshadowing may occur (Drainoni et al, 2006); this is when health issues are seen as part of the patient's disability rather than the health professional seeking potentially treatable causes (Mason and Scior, 2004). This knowledge is essential in effective nursing practice as although illnesses or conditions may occur in any individual, people with intellectual disability experience have different patterns of health (Krahn et al, 2006;Melville et al, 2009).…”