The Use of the Anxiety, Depression and Mood Scale (ADAMS) as a Screening Instrument for Depression and Mental Health Diagnoses in a Down Syndrome Specialty Clinic.
Mary Witt, Anna J Esbensen, Ayesha Harisinghani and 3 others
PMID 40702689WHAT IT FOUND
The standard ADAMS screening cutoffs missed many mental health symptoms in adults with Down syndrome, showing low sensitivity.
Lowering the threshold by two points on each subscale improved detection rates to acceptable levels. Clinicians should consider adjusted cutoffs to avoid overlooking depression and anxiety in this group.
Key findings
01At the original 75th percentile cutoffs, the ADAMS had low sensitivity (68.18%) and did not meet the study's efficacy criteria of ≥70% for both sensitivity and specificity.
02Lowering the subscale cutoffs by two points from the original values achieved sensitivity and specificity both ≥70% for the overall screen.
03The study proposes specific new subscale thresholds for adults with Down syndrome: depressed mood >5, manic/hyperactive behaviour >6, social avoidance >6, generalised anxiety >7, and obsessive/compulsive behaviour >3.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study was conducted at a single specialty clinic, so results may not generalise to adults with Down syndrome without access to such care. The sample was predominantly White (94%) and non-Hispanic (93%), limiting applicability to other racial and ethnic groups. Chart review was done by a single reviewer, and the presence of mental health symptoms was assessed retrospectively from notes, which may introduce bias. The subgroups of participants with and without dementia were small, making it difficult to determine if different cutoffs are needed for those with dementia.
Declared interests
None reported.
The easy way to misread this
Do not assume the standard ADAMS cutoffs are sufficient for all adults with Down syndrome. The study found that original thresholds missed cases (low sensitivity), so relying on them without considering the adjusted lower cutoffs could lead to under-diagnosis of depression and anxiety.