Direct-care workers' attributions of psychopathology in adults with mental retardation

Teri Michelle Edelstein, Fordham University


The mental health needs of individuals with mental retardation are often underrecognized and underdiagnosed. The present study extended past clinical judgment research beyond mental health professionals by examining the processes by which direct-care workers identify psychological disorder and need for treatment in adults with mental retardation. Problem type, client's mental retardation level, and client's sex were varied in a series of clinical vignettes which were presented to 144 direct-care workers in residential, vocational, case management, and day treatment settings. A questionnaire was developed which assessed direct-care workers' judgments regarding the presence of psychopathology, treatment needs, disruptiveness of the behavior, and prognosis with and without treatment. Direct-care workers demonstrated an overall ability to distinguish between cases of psychopathology (i.e., aggressive disorder, depression, and psychosis) and a control condition (i.e., a physical condition with no concomitant-psychopathology) with regard to the presence of psychological disorder and need for treatment. Problem type and client's retardation level, but not work setting or client's sex, were found by the present study to be related to direct-care workers' judgments. These staff members were significantly more likely to identify psychopathology and need for treatment in cases describing aggressive disorder or psychosis than in cases describing depression. Additionally, despite similar rates of identification, cases describing borderline to mild retardation were significantly more likely than those describing moderate to severe retardation to receive a treatment recommendation. Verbal therapy was more likely to be recommended in cases of depression and in cases of borderline to mild retardation, while treatment that included a medication component was more likely to be recommended in cases of aggressive disorder or psychosis and in cases of moderate to severe retardation. Direct-care workers' perceptions of the disruptiveness of various problem types, and of prognosis with and without treatment, appeared to influence judgments of identification of disorder and need for mental health treatment. Implications of the findings for staff training and for increasing the accessibility of mental health services to individuals with mental retardation are discussed.

Subject Area


Recommended Citation

Edelstein, Teri Michelle, "Direct-care workers' attributions of psychopathology in adults with mental retardation" (1997). ETD Collection for Fordham University. AAI9941915.