19
This article was downloaded by: [Nipissing University] On: 10 October 2014, At: 07:15 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Journal of Mental Health Research in Intellectual Disabilities Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/umid20 Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression Sigan L. Hartley a & Denis G. Birgenheir a a Department of Psychology , University of Wyoming Published online: 31 Dec 2008. To cite this article: Sigan L. Hartley & Denis G. Birgenheir (2008) Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression, Journal of Mental Health Research in Intellectual Disabilities, 2:1, 11-28, DOI: 10.1080/19315860802601317 To link to this article: http://dx.doi.org/10.1080/19315860802601317 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms- and-conditions

Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

  • Upload
    denis-g

  • View
    212

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

This article was downloaded by: [Nipissing University]On: 10 October 2014, At: 07:15Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Mental Health Research inIntellectual DisabilitiesPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/umid20

Nonverbal Social Skills of Adults withMild Intellectual Disability Diagnosedwith DepressionSigan L. Hartley a & Denis G. Birgenheir aa Department of Psychology , University of WyomingPublished online: 31 Dec 2008.

To cite this article: Sigan L. Hartley & Denis G. Birgenheir (2008) Nonverbal Social Skills of Adultswith Mild Intellectual Disability Diagnosed with Depression, Journal of Mental Health Research inIntellectual Disabilities, 2:1, 11-28, DOI: 10.1080/19315860802601317

To link to this article: http://dx.doi.org/10.1080/19315860802601317

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the“Content”) contained in the publications on our platform. However, Taylor & Francis,our agents, and our licensors make no representations or warranties whatsoever as tothe accuracy, completeness, or suitability for any purpose of the Content. Any opinionsand views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Contentshould not be relied upon and should be independently verified with primary sourcesof information. Taylor and Francis shall not be liable for any losses, actions, claims,proceedings, demands, costs, expenses, damages, and other liabilities whatsoever orhowsoever caused arising directly or indirectly in connection with, in relation to or arisingout of the use of the Content.

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Page 2: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

Journal of Mental Health Researchin Intellectual Disabilities, 2:11–28, 2009Copyright © Taylor & Francis Group, LLCISSN: 1931-5864 print / 1931-5872 onlineDOI: 10.1080/19315860802601317

11

UMID1931-58641931-5872Journal of Mental Health Research in Intellectual Disabilities, Vol. 2, No. 1, November 2008: pp. 1–30Journal of Mental Health Research in Intellectual Disabilities

Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed

with Depression

Nonverbal Social SkillsS. L. Hartley and D. G. Birgenheir

SIGAN L. HARTLEY AND DENIS G. BIRGENHEIRDepartment of Psychology

University of Wyoming

Depression is one of the most common psychiatric disorders inadults with intellectual disability (ID), yet little is known aboutdepressive behaviors in an ID population. This study examined thenonverbal social skills of 18 adults with mild ID diagnosed withdepression and a matched sample of adults with mild ID withoutdepression. Nonverbal social skills were coded from videotapes ofactual social interactions. Results indicate that adults with mildID diagnosed with depression evidence a profile of maladaptivenonverbal social skills including limited body movement, arestricted range of facial expressions, infrequent smiling, speakingin a flat and quiet voice, and taking a long time to respond to thequestions or comments of a social partner. Findings from thisstudy have implications for enhancing the early detection anddiagnosis of depression and guiding theories of and treatments fordepression in an ID population.

KEYWORDS intellectual disability, depression, social skills, nonverbal

The point prevalence of depression in adults with intellectual disability(ID) is estimated to 4%, making depression one of the most commonpsychiatric disorders in this population (Cooper & Bailey, 2001; Cooper,Smiley, Morrison, Williamson, & Allan, 2007; Smiley & Cooper, 2003). Yet,there remains a paucity of research on the presentation of depression in

Address correspondence to Sigan L. Hartley, Department of Psychology, University ofWyoming, Waisman Center, 1500 Highland Avenue, Madison, WI 53705. E-mail: [email protected]

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 3: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

12 S. L. Hartley and D. G. Birgenheir

adults with ID. Identifying behavioral symptoms of depression is of partic-ular importance given that adults with ID often do not have the verbal orcognitive abilities to describe how they think or feel (e.g., Clarke &Gomez, 1999; Marston, Perry, & Roy, 1997). Studies suggest that adultswith ID exhibit many of the same depressive behaviors as their typicallydeveloping peers yet also display a unique set of depressive behaviors.For instance, depression is related to increased aggression, loss of skills,and a rise in behavior problems in adults with ID (Marston et al., 1997;Matson et al., 1999; McBrien, 2003). Identification of the similarities anddifferences in depressive behaviors between the typically developingpopulation and adults with ID is important for enhancing early detectionand diagnosis of depression. It is also essential for informing theories ofand designing interventions to treat depression in an ID population. Thepurpose of this study is to determine whether adults with mild ID evi-dence the same profile of depressive nonverbal social skills as seen in thegeneral population.

In the general population, people with depression exhibit a uniqueprofile of depressive nonverbal social skills characterized by reducedinvolvement in interactions and responsiveness to social partners (e.g.,Dykman, Horowitz, Abramson, & Usher, 1991; Fauber, Forehand, Long,Burke, & Faust, 1987; Lewinsohn, Mischel, Chaplin, & Barton, 1980). Peo-ple with depression speak slower, speak with lower volume and in amore monotone voice, and take longer to respond to social partners thanpeople without depression (e.g., Bouhuys & van der Meulen, 1984;Darby, Simmons, & Berger, 1984; Greden & Carroll, 1980; Nilsonne, 1988;Pope, Blass, Siegman, & Raher, 1970). People with depression also havelow levels of eye contact with social partners, frown more and smile less,and demonstrate less overall body movement and gesturing than peoplewithout depression (e.g., Dow & Craighead, 1987; Fossi, Faravelli, &Paoli, 1984). In addition, people with depression exhibit less head nod-ding (as if indicating “yes” or agreement) and more head shaking (as ifindicating “no” or disagreement) and display more tearfulness thanpeople without depression (e.g., Kazdin, Sherick, Esveldt-Dawson, &Rancurello, 1985).

These depressive nonverbal social skills impede people with depressionfrom positively connecting with their social environment. Specifically, thesedepressive nonverbal social skills violate the basic expectation that peoplewill contribute to social interactions and appropriately respond to social part-ners by showing interest in and support for social partners (e.g., Amstutz &Kaplan, 1987; Gotlib & Beatty, 1985; Gurtman, 1986; Segrin, 1992; Segrin &Abramson, 1994). This violation causes conversations to break down and beperceived as dull, aversive, and unrewarding to social partners (e.g., D.Davis, 1982; D. Davis & Holtgraves, 1984; D. Davis & Perkowitz, 1979;Harper & Hughey, 1986; Wilfong, Saylor, & Elksnin, 1991). Subsequently,

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 4: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

Nonverbal Social Skills 13

social partners limit their interactions with people with depression or theseinteractions become negative. In this way, people with depression experi-ence less positive social support and more interpersonal stress, which con-tributes to further depressed affect (Lewinsohn, 1974; Libet & Lewinsohn,1973). The large body of research on depressive nonverbal social skills hasinformed interpersonal theories of and interventions for depression in thegeneral population (e.g., Barkham & Hardy, 2001; Goldstein, 1980).

Whether depression is related to a similar profile of depressive nonverbalsocial skills in adults with mild ID has yet to be systematically examined.Many of the depressive nonverbal social skills seen in the general populationhave been shown to occur across a wide developmental age range. Adults,adolescents, and children with depression evidence a profile of depressivenonverbal social skills including infrequent body movement, gesturing andeye contact, frequent head shaking (i.e., as if indicating disagreement) andtearfulness, and speaking in a quiet and monotone voice (e.g., Fauber et al.,1987; Greden, & Carroll, 1980; Kazdin et al., 1985; Nilsonne, 1988). Adultswith mild ID are developmentally similar to typical children and adolescentsand therefore may also display these depressive nonverbal social skills.In addition, there is strong evidence that facial expressions, including smilingand frowning, are universal expressions of emotions that occur regardless ofdevelopmental level or culture (e.g., Eckman & Rosenberg, 1997; Fridlund,1994). Thus, as in the general population, it is likely that depression is relatedto an increase in frowning and a decrease in smiling in adults with mild ID.

The few studies that have investigated social skills in an ID popula-tion have shown a relation between poor verbal and nonverbal socialskills and depressive symptoms in samples of adults with borderline IQ tomoderate ID (Benson, Reiss, Smith, & Laman, 1985; Heiman & Margalit,1998; Helsel & Matson, 1988; Laman & Reiss, 1987; Payne & Jahoda, 2004;Reiss & Benson, 1985). However, conclusions from these studies arelimited in that they largely included participants who did not have a diag-nosis of depression, and thus results do not reflect whether adults withmild ID diagnosed with depression exhibit a unique profile of maladaptivesocial skills. Moreover, previous studies examined the association betweendepressive symptoms and social skills broadly, using the total score fromself- or caregiver-rated measures. An investigation of the specific nonver-bal social skills that differentiate adults with mild ID with and withoutdepression is needed.

Caregiver ratings and self-report measures can provide meaningfulinformation on the nonverbal social skills related to depression in adultswith mild ID. However, these measures require raters to recall subtlebehaviors that they were likely not cognizant of at the time of occurrence.It may be difficult for these raters to be mindful of subtle and often fleet-ing nonverbal social skills (e.g., response latency, facial expressions, andintonation) during their daily interactions. Caregiver ratings and self-report

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 5: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

14 S. L. Hartley and D. G. Birgenheir

measures can also be biased by systematic errors, such as leniency inratings, halo effects, contrast errors due to comparisons with particularsets of others, recency effects stemming from recent interactions, andsocial desirability (e.g., Bernard, Killworth, Kronenfeld, & Sailor, 1984;Lilienfeld & Fowler, 2006; Renk, Donnelly, McKinney, & Baksh, 2007).Observations of nonverbal social skills in actual social situations can avoidthese difficulties and may provide greater insight into the depressive non-verbal social skills of adults with mild ID. There has not been a publishedstudy of observed nonverbal social skills in adults with ID with and with-out depression.

In this study, we examined the nonverbal social skills of 18 adults withmild ID diagnosed with depression and 18 adults with mild ID withoutdepression. The participants with and without depression were matched onIQ, age, gender, and ethnicity in order to limit differences in nonverbalsocial skills between the groups due to variables other than depressive diag-nosis status. Nonverbal social skills were coded from observations of anactual social interaction. Adults with mild ID diagnosed with depressionwere predicted to speak in a quieter and more monotone voice, take longerto respond, use fewer gestures and head nodding but more head shaking,have less overall facial expressiveness, frown more, smile less, have moretearfulness, and make less eye contact with social partners than adults withmild ID without depression.

METHOD

Participants

Participants were selected from a larger participant pool of adults with mildID (IQ 55–70 and concomitant impairments in adaptive behavior) recruitedfrom 10 disability service providers in the Rocky Mountain region of theUnited States. All participants had adequate oral communication skills(i.e., orally communicate without the aid of another person). Participantswith a diagnosis of autism were excluded given that impaired socialfunctioning is a core aspect of this disorder. In order to be consistent withprevious studies of depression (e.g., Esbensen & Benson, 2007; Hartley &MacLean, 2005; Lunsky, 2003; Lunsky & Benson, 2001), participants had var-ious etiologies for ID, with the largest portion being of unknown etiology.This study is based on the 18 participants diagnosed with a current depressivedisorder (8 Major Depressive Disorder, 3 Dysthymia, and 6 Depression nototherwise specified (NOS) who could be matched on age (within 6 years),gender, ethnicity (White vs. non-White), and IQ (within 5 points) to partici-pants without a depressive disorder. The majority of participants diagnosedwith depression were taking medication to manage their depression. The par-ticipant characteristics of the 18 matched pairs with and without depression

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 6: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

Nonverbal Social Skills 15

are presented in Table 1. The participants with and without depression weresuccessfully matched on gender and ethnicity. Independent samples t testsindicated that there was no significant difference between the groups in age,t(31) = –.34, p = .74 or IQ, t(31) = –1.02, p = .31. Six of the 18 (33.3%) partici-pants without depression had a diagnosis of an alternative psychiatric disorder;one of these participants had two alternative psychiatric disorder diagnoses.Five of the 18 (27.8%) participants diagnosed with depression had a diagnosisof an alternative psychiatric disorder in addition to depression. The prevalenceof alternative psychiatric disorders is consistent with epidemiology research onco-occurring mental health disorders in adults with ID (Borthwick-Duffy, 1994;White, Chant, Edwards, Townsend, & Waghorn, 2005).

Caregivers from participants’ disability service provider, largely casemanagers, who worked with the participant at least twice a week were alsorecruited to complete measures. Caregivers reported working with theparticipant for an average of 3.4 years (range 0.5 to 8.0 years). Twenty-one

TABLE 1 Subject Characteristics of Participants

Depressed n = 18

Non-Depressed n = 18

Gender (n)Female 12 12Male 6 6

Age in years (M, SD) 36.38 (8.87) 37.88 (11.45)

Ethnicity (n)Caucasian 16 29Hispanic 1 1African American 0 1Native American 0 0Asian 1 0Other 0 0

Living status (n)Alone or with one roommate 3 3Group home 13 13Family/host family 2 2

Composite IQ (M, SD) 65.07 (6.99) 64.77 (6.85)Adaptive GAC (M, SD) 63.63 (12.99) 63.49 (11.50)

Psychiatric Disorder (n)*None 0 12Depressive Disorder 18 0Other 5 6

Bipolar Disorder 0 0Anxiety Disorder 2 2Conduct Disorder 2 1Personality Disorder 1 2ADHD 0 1Adjustment 0 1

Note: One participant in the Non-Depressed group had two diagnosed psychiatric disorders.

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 7: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

16 S. L. Hartley and D. G. Birgenheir

of the caregivers were female and 11 were male and their average age was28.2 years (SD = 6.02 years).

Measures

Participant characteristics. The Kaufman Brief Intelligence Test, 2ndEdition (K-BIT-2; Kaufman & Kaufman, 2004), an individually administeredmeasure of verbal and nonverbal cognitive abilities, was used to assessparticipants’ IQ. The K-BIT-2 IQ Composite score has satisfactory internalconsistency (.86 to .96), test-retest reliability (.88 to .92), and concurrentvalidity (Kaufman & Kaufman, 2004). Staff reported on the age, gender,living status, and ethnicity of the participants. Staff also completed theAdaptive Behavior Assessment System, 2nd Edition (ABAS-II; Harrison &Oakland, 2006) to assess the everyday living skills of the participants. TheABAS-II General Adaptive Composite score has adequate internal consis-tency (.97 to .99), test-retest reliability (.86 to .99), and concurrent validity(Harrison & Oakland, 2006).

Depression. The Glasgow Depression Scale for People with a LearningDisorder (GDS; Cuthill, Espie, & Cooper, 2003) was used to verify thatparticipants with a diagnosis of depression were currently experiencingmore depressive symptoms than the participants without depression. Boththe 20-item GDS self-report and 16-item GDS caregiver supplement wereused. GDS items are based on criteria for depression in the Diagnostic Criteriafor Psychiatric Disorders for use with adults with Learning Disabilities/MentalRetardation (DC-LD; Royal College of Psychiatrists, 2001) and rated on a3-point scale (“Never/No,” “Sometimes,” and “Always/A Lot”). The self-report GDS has satisfactory internal consistency (0.97), test-retest reliability(0.97), and criterion validity (Cuthill et al., 2003). The caregiver supplementGDS also has adequate interrater reliability (0.93), internal consistency(0.88), and test-retest reliability (0.98; Cuthill et al., 2003). In this study, theself-report GDS (0.83) and caregiver supplement GDS (0.87) had adequateinternal consistency. There was a significant positive correlation betweenthe GDS self-report and GDS caregiver supplement (r = .43, p < .01).A paired sample t test indicated that the participants diagnosed with depres-sion had a significantly higher GDS self-report score (M = 17.81, SD = 6.87)than the participants without depression (M = 13.31.78, SD = 5.87), t(17) = 3.00,p = .01, d = 0.70. The participants diagnosed with depression (M = 11.91,SD = 6.01) also had a significantly higher GDS caregiver supplement scorethan the participants without depression (M = 7.04, SD = 6.24), t(17) = 3.07,p < .01, d = 0.79.

Social interaction. In accordance with studies of typically developingchildren and adults, a semistructured videotaped interview was used toobserve the nonverbal social skills of the participants (e.g., Arkowitz,Lichtenstein, McGovern, & Hines, 1975; Jacobson & Anderson, 1982; Kazdin

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 8: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

Nonverbal Social Skills 17

et al., 1985; Lewinsohn et al., 1980). The interview was conducted individuallywith each participant in a private setting. Interview questions and procedurewere based on a previous study of nonverbal social skills of depressedchildren (ages 7 to 12 years) in the general population (Kazdin et al., 1985);however, some questions were slightly altered to be appropriate for adultswith mild ID (e.g., “What have you been doing in school?” was changed to“What have you been doing at your work/day program?”). Participants wereasked 10 questions about their everyday experiences: “Tell me what you didtoday,” “What shows on TV do you like?,” “What have you been doing atwork/your day program?,” “What makes you happy?,” “What makes yousad?,” “What makes you angry?,” “What do you like to do on the week-ends?,” “What kinds of chores do you have to do around the house?,” “Haveyou gone on a vacation lately? Where did you go (where would you liketo go)?,” and “What do you do when you get home from work/day pro-gram at night?” All interviews were conducted by the same femaleresearcher who was naïve to group membership (i.e., depressive disorderstatus). The positioning of the interview chairs and camera was constantacross participants.

In line with protocols used in the general population (Arkowitz et al.,1975; Jacobson & Anderson, 1982; Kazdin et al., 1985; Lewinsohn et al.,1980), the interview followed a standardized script yet attempted to modelnatural conversation. Therefore, following the participant’s initial responseto each of the 10 questions, the interview provided one follow-up questionand one comment regarding their opinion or experience. The interviewerwas then instructed to be responsive to the participant’s initiations to main-tain the conversation by commenting or answering questions but did notprovide his or her own efforts to maintain the conversation. To ensure fidelityto the interview protocol, each interview was rated to determine whetherthe protocol was followed (i.e., yes or no) for each of the 10 questions forall participants. For 3 participants, one question was rated as not havingfollowed the interview protocol; this question was eliminated from analyses.Therefore, ratings for each nonverbal social skill were summed across ques-tions and then divided by the total number of questions.

Two research assistants who were naïve to group membership inde-pendently coded the nonverbal social skills of the participants. Definitionsand coding responses for the nonverbal social skills are shown in Table 2.The definitions and coding response categories were developed in a previ-ous study (Kazdin et al., 1985). Prior to coding the actual videotapes, theresearch assistants were required to obtain at least 90% agreement in theircoding with both with the leading author and other research assistant. Dur-ing this training, all discrepancies in coding were discussed until consensuswas reached.

Each interview question was viewed three times for each participant.During the first viewing, Overall Body Movement, Head Nodding and Low-

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 9: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

18 S. L. Hartley and D. G. Birgenheir

ering, and Head Shaking were coded. During the second viewing, FacialExpressiveness, Frowning, Smiling, Intonation, and Tearfulness were coded.During the third viewing, Gesturing, Volume of Voice, Response Latency,and Eye Contact were coded. All nonverbal social skills were rated on a3-point scale. Head Shaking, Frowning, and Tearfulness were reversescored prior to analyses so that lower ratings indicate more impairment for

TABLE 2 Definition of Nonverbal Behaviors, Viewing Order, and Coding Responses

First ViewingOverall Body Movement—the degree to

which the torso and head of the participant changed positions while seated

Little movement 1

Moderate 2 Active, lots movement 3

Head Nodding and Lowering—movement of the head up and down as if gesturing yes

None/Little 1 Moderate 2 Lots 3

Head Shaking—movement of the head from side to side while the head is in an upright position as if gesturing no*

None/Little 1 Moderate 2 Lots 3

Second ViewingFacial Expressiveness—the diversity or

range of different facial expressions of the participant (smiling, laughing, frowning, etc)

Little/No diversity 1

Moderate 2 Wide range 3

Frowning—the extent to which the participant evinced a sad look (the corners of the mouth turned downward or the brow furrowed)*

None/Little frowning 1

Some 2 Lots 3

Smiling—the extent to which the participant smiled (the corners of the mouth turned upward, or lips extended as in showing pleasure)

None/Little smiling 1

Some 2 Lots of smiling 3

Intonation—the amount of inflection and emotion the participant used in his or her speech, ranging from flat or unemotional to lively intonation

Flat, unemotional 1

Moderate, average 2

Very lively 3

Tearfulness—the extent to which the participant was on the verge of crying or showed tears*

None/Positive demeanor 1

Some 2 Crying/Verge of crying 3

Third ViewingGesturing—the number of hand, arm, or

shoulder gestures the participant used to illustrate his or her speech such as pointing to the interviewer to emphasize an answer or a shoulder shrug to illustrate indecision

None/Little 1 Moderate 2 Lots 3

Volume of Voice—loudness of the voice during the response

Quiet 1 Moderate 2 Loud 3

Response Latency—the amount of time in seconds the participant took to respond to each question

Slow to respond 1

Moderate 2 Responds quickly 3

Eye Contact—the amount of time in seconds the participant spent looking or listening during the time of a question or answer

Little, not sustained 1

Moderate 2 Lots of eye contact 3

Note: *Item reverse scored for analyses so that for all items, lower scores denote more ‘depressed’behavior.

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 10: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

Nonverbal Social Skills 19

all nonverbal social skills. A Total Lack of Involvement/Responsivenessscore was computed by taking the average of the summed scores for eachnonverbal social skill.

Interrater reliability was assessed by calculating Cohen’s Kappa for thetwo coders for each nonverbal social skill across all 10 questions. There wasa moderate to substantial mean interrater agreement between coders for allnonverbal social skills (Landis & Koch, 1977): Overall Body Movement (κ = .73,range = .69 to .76), Head Nodding and Lowering (κ = .68, range = .66to .69), Head Shaking (κ = .72, range = .69 to .76), Facial Expressiveness(κ = .78, range = .76 to .79), Frowning (κ = .72, range = .69 to .76), Smiling(κ = .72, range = .69 to .76), Intonation (κ = .73, range = .71 to .76), Tear-fulness (κ = .72, range = .69 to .76), Gesturing (κ = .72, range = .69 to .76),Volume of Voice (κ = .72, range = .69 to .74), Response Latency (κ = .72,range = .69 to .76), and Eye Contact (κ = .66, range = .62 to .70).

Procedure

A researcher naïve to group membership (i.e., depressive disorder status)administered assessments. Participants were informed that their participationwas voluntary, responses would be confidential, and they could withdrawfrom the study at any time. A training procedure was used to ensure thatparticipants could reliably use a 3-point Likert-type scale. Participants wereasked to arrange three clear containers with varying amounts of coloredwater by quantity of water. Participants were then asked to match thesecontainers to written descriptors (“No,” “Sometimes,” and “Extremely”) anda numerical scale (0 to 2). Finally, participants were asked to use thecontainers, written descriptors, or numbers to indicate their preference fortheir most favorite and least favorite food. Only participants who successfullypassed this training procedure were included in the study. This trainingprocedure has been shown to result in a low rate of response bias forLikert-type scales in actual testing (Hartley & MacLean, 2005). Participantswere given the K-BIT-2. They were then read the GDS self-report. Clearcontainers with varying amounts of colored water were paired with the GDSLikert-type scale to provide a visual representation of response options. Thevideotaped interview was administered. The procedure took 35 to 75 minutes.

RESULTS

Paired sample correlations were first conducted to examine the importanceof matching the participants with and without depression on key participantcharacteristics including age, gender, ethnicity, and IQ. Paired sample corre-lations were positive for 10 of the 13 nonverbal social skills and significant fortwo scores (r = .39 to .43, p < .05), suggesting that participant characteristics

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 11: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

20 S. L. Hartley and D. G. Birgenheir

do indeed impact nonverbal social skills. Given that the groups were suc-cessfully matched on age, gender, ethnicity, and IQ, paired sample t testswere used to identify differences between the depressed and nondepressedgroups. Cohen’s d calculations based on the original standard deviations (orbetween group t test values) were used to estimate effect size (Dunlop,Cortina, Vaslow, & Burke, 1996).

Table 3 presents the means, standard deviations, and results of thepaired sample t tests for the nonverbal social skills observed during theinterview for the depressed and nondepressed groups. The depressedgroup had a significantly lower (i.e., more impaired) score than the nonde-pressed group for Overall Body Movement (t(17) = 2.08, p = .05, d = 0.67),Facial Expressiveness (t(17) = 4.64, p < .01, d = 1.49), Smiling (t(17) = 3.59,p < .01, d = 1.39), Intonation (t(17) = 4.72, p < .01, d = 1.59), Volume ofVoice (t(17) = 3.97, p < .01, d = 1.21), Response Latency (t(17) = 2.26, p = .04,d = 0.75), Eye Contact (t(17) = 2.09, p = .05, d = 0.44), and Total Lack ofInvolvement/Responsiveness score (t(17) = 4.85, p < .01, d = 1.71). Therewas not a significant difference between the depressed and nondepressedgroups in Head Nodding/Lowering (t(17) = 0.99, p = .34), Head Shaking(t(17) = 1.13, p = .28), Frowning (t(17) = –1.44, p = .17), Tearfulness (t(17) = 0.67,p = .51), or Gesturing (t(17) = 1.44, p = .17).

In order to determine whether depressive symptoms were associatedwith nonverbal social skills regardless of diagnosis of depression, correla-tions were conducted between the GDS caregiver supplement and GDSself-report and the nonverbal social skills. There was a significant positivecorrelation between the GDS caregiver supplement and Facial Expressiveness

TABLE 3 Mean, Standard Deviation and Results of the Paired Sample t-tests for ObservedDepressive Social Skills

Depressed M (SD)

Non-Depressed M (SD) T-test P Value Cohen’s d

Overall Body Movement 1.70 (0.36) 2.40 (1.44) 2.08 0.05 0.67Head Nodding/Lowering 1.63 (0.46) 1.82 (0.53) 0.99 0.34 0.36Head Shaking 1.23 (0.35) 1.35 (0.27) 1.13 0.28 0.30Facial Expressiveness 1.52 (0.37) 1.99 (0.25) 4.64 <0.01 1.49Frowing 1.45 (0.44) 1.28 (0.22) −1.44 0.17 0.49Smiling 1.48 (0.33) 1.96 (0.36) 3.59 <0.01 1.39Intonation 1.62 (0.37) 2.11 (0.23) 4.72 <0.01 1.59Tearfulness 1.09 (0.12) 1.06 (0.86) 0.67 0.51 0.51Gesturing 1.42 (0.40) 1.60 (0.35) 1.44 0.17 0.48Volume of Voice 1.52 (0.43) 1.93 (0.21) 3.97 <0.01 1.21Response Latency 1.87 (0.29) 2.08 (0.27) 2.26 0.04 0.75Eye Contact 1.79 (0.41) 2.08 (0.27) 2.09 0.05 0.44Total Lack of Involvement/

Responsiveness1.90 (0.16) 2.15 (0.13) 4.85 <0.01 1.71

Note: Items rated on a 3-point scale (1 to 3), with lower items indicating more problems with the socialskill

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 12: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

Nonverbal Social Skills 21

(r = .38, p = .02), Intonation (r = .49, p < .01), Smiling (r = .31, p = .04), andTotal Lack of Involvement/ Responsiveness (r = .41, p = .01). The GDScaregiver supplement was not significantly correlated with the remainingnonverbal social skill scores. There was a significant correlation betweenthe GDS self-report and Response Latency (r = .23, p = .45), Intonation(r = .23, p = .45), Volume (r = .31, p = .04), and Total Lack of Involvement/Responsiveness (r = .23, p = .45). The GDS self-report was not significantlycorrelated with the remaining nonverbal social skills.

DISCUSSION

Despite the high prevalence of depression in adults with ID (Cooper &Bailey, 2001; Cooper et al., 2007), little research has been devoted to identi-fying depressive behaviors in this population. In the general population,people with depression exhibit a profile of depressive nonverbal socialskills involving a lack of involvement in interactions and responsiveness tosocial partners (e.g., Darby et al., 1984; Fossi et al., 1984; Kazdin et al., 1985;Nilsonne, 1988). Findings from this study suggest that adults with mild IDdisplay a similar profile of depressive nonverbal social skills. Adults withmild ID diagnosed with depression exhibited less body movement, showedless smiling, had a more restricted range of facial expressions, spoke in amore flat and quiet voice, and took longer to respond to the questions orcomments of a social partner than adults with mild ID without depression.Moreover, adults with mild ID who had more depressive symptoms, regard-less of whether they were diagnosed with depression, evidenced a moreoverall “depressive” profile of nonverbal social skills than adults with mildID who had fewer depressive symptoms. Having more depressive symp-toms was also positively associated with having a more restricted range offacial expressions, speaking more quietly and in a more monotone voice,having a longer response delay, and smiling less often.

Unlike findings from the general population (e.g., Dow & Craighead,1987; Kazdin et al., 1985), there was no significant difference between theadults with mild ID with and without depression in frowning or tearfulness.This unexpected finding may be due to the limited variability in ratings forthese behaviors; most participants did not exhibit frowning or tearfulnessduring the interview, possibly because questions largely pertained to every-day, ordinary experiences and did not evoke strong emotional responses.Although similar questions were used with typically developing childrenand depression was related to increased frowning and tearfulness, the dif-ference between the depressed and nondepressed groups was rather small(Kazdin et al., 1985). Future studies should include questions intended toevoke a range of emotions to better assess the relevance of tearfulness andfrowning for depression among adults with mild ID. In addition, adults with

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 13: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

22 S. L. Hartley and D. G. Birgenheir

mild ID diagnosed with depression did not evidence significant differencesin gesturing or head nodding and shaking as compared with adults with mildID without depression, despite variability in ratings for these behaviors.These nonverbal social skills may not be part of a depressive presentationin adults with mild ID. Further research using a larger sample of adults withmild ID diagnosed with depression is needed to investigate this possibility.

Findings from this study are important for enhancing the diagnosticprocess of depression in adults with mild ID. As our understanding of thebehavioral symptoms of depression in adults with ID increases, so does ourability to appropriately screen for and detect depression early on in thispopulation. Findings from this study are also important for informing theo-ries of and treatments for depression in adults with mild ID. The large bodyof research on depressive nonverbal social skills in the general populationhas informed interpersonal theories of depression. These theories suggestthat depressive nonverbal social skills are both a consequence of and con-tributor to further depressed affect by evoking negative social interactions(e.g., Segrin & Abramson, 1994; Youngren & Lewinsohn, 1980). Previousresearch has shown that depression is also related to a heightened experi-ence of negative social interactions in adults with mild ID (Hartley &MacLean, 2005; Lunsky & Benson, 2001). One reason for this heightenedexperience of negative social interactions may be that adults with mild IDdiagnosed with depression also evidence a profile of nonverbal social skillscharacterized by a lack of involvement in interactions and responsiveness tosocial partners. Subsequently, these depressive nonverbal social skills maymake interactions seem dull, aversive, and unrewarding to social partners,and thereby social partners may limit their interactions with adults with mildID diagnosed with depression or these interactions may become negative.Further research is needed to investigate this possibility.

Skill training programs are often used with adults with ID and may behelpful in teaching adults with mild ID diagnosed with depression adaptivenonverbal social skills such as making better eye contact and smilingperiodically during conversations. Although these programs alone are notsufficient to treat depression, they can help adults with mild ID better accesspositive social interactions and support, which is important for improvingdepressed affect. Perhaps more important, findings from this study can beused to develop interventions aimed at educating care professionals andfamily about the potential for depressive nonverbal social skills to makesocial interactions seem boring, dull, and aversive. More specifically, careprofessionals and family could be educated about depressive nonverbalsocial skills and strategies for not getting frustrated or aggravated by theseinterpersonal behaviors. For instance, care professionals and family couldbe taught to remind themselves that these behaviors are common amongpeople who are depressed and use these behaviors as a reminder to givethe adult with mild ID more positive support.

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 14: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

Nonverbal Social Skills 23

There are several strengths to this study. This is the first study ofnonverbal social skills among adults with mild ID diagnosed with depres-sion. The study employed a standardized protocol developed for typicallydeveloping children to elicit nonverbal social skills during an actual socialinteraction and had multiple trained coders rate these skills. Moreover,adults with mild ID with and without depression were closely matched onseveral key participant characteristics. There are also several limitations tothis study. A priori hypotheses regarding differences between the matcheddepressed and nondepressed groups were tested through repeated pairedsample t tests. Our hypothesis-driven approach limits concern for chancefindings, although the use of multiple t tests can result in alpha inflation.This study also had a relatively small sample size and a larger study isneeded to increase confidence in the generalizability of results. In addition,diagnosis of depression was made by participants’ disability serviceprovider and included an evaluation by a licensed mental health provider.In support of the accuracy of diagnoses, participants with a diagnosis ofdepression had significantly more depressive symptoms on the GDS thanparticipants without a depressive diagnosis. However, an in-depth evaluationof depressive diagnoses was not conducted by the present research team.Given the paucity of information on depression in adults with mild ID, andlikely problems with the dissemination of this information to mental healthproviders and physicians, there is a potential for unreliable diagnoses. It isalso important to note that several participants diagnosed with depressionwere being treated with medication and therapy services and this may havelimited their presentation of depressive social skills.

Adults with mild ID in the nondepressed group often had an alternativepsychiatric disorder. Differences between the depressed and nondepressedgroups may have been stronger if a more “healthy” sample of adults withmild ID without depression were used. Moreover, using adults with mild IDas their own comparison group in a longitudinal design, by assessingnonverbal social skills prior to and during a depressive episode, wouldprovide an even stronger methodology. However, the inclusion of adultswith mild ID with alternative psychiatric disorders in the nondepressedgroup increases confidence that the nonverbal social skill problems identi-fied in this study are uniquely related to a depressive social skill profile.

This study only examined the limited set of depressive nonverbal socialskills found to be important in the general population. However, additionalnonverbal social skills may also be seen in depression in adults with mild ID.For instance, previous research suggests that depression is related toincreased anger and/or aggression in adults with ID (e.g., J. P. Davis, Judd, &Herman, 1997; Laman & Reiss, 1987). Nonverbal social skill problemsrelated to anger management (e.g., scowling or aggressive posturing) maythus also be part of the depressive social skill profile in an ID population.We encourage future researchers to use discussion groups made up of

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 15: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

24 S. L. Hartley and D. G. Birgenheir

experts in the field of ID and people with ID to compile a list of additionalnonverbal social skills that may be unique to an ID population. This study isalso limited in that it included a cross-sectional examination of the associationbetween depression and nonverbal social skills. This methodology cannotinform understanding of the direction of the relation between thesevariables. In the general population, depressive nonverbal social skills bothprecede and follow the occurrence of a depressive episode (Segrin, 2000).Furthermore, an interpersonal model of depression was used to discuss theimpact of depressive nonverbal social skills for maintaining and exacerbatingdepressed affect. However, alternative explanations are also relevant forexplaining a relation between depressive nonverbal social skills and negativesocial interactions. For instance, repeated exposure to negative social inter-actions may cause adults with mild ID to provide slower and less reactivenonverbal social responses. Thus, a longitudinal study is needed to deter-mine the time-order relation between depressive episodes, nonverbal socialskill problems, and negative social interactions in an ID population.

In summary, this study suggests that adults with mild ID diagnosedwith depression evidence a profile of nonverbal social skills characterized bya lack of involvement in interactions and responsiveness to social partners.Findings from this study have important implications for enhancing theearly detection and diagnosis of depression in adults with mild ID. Findingsare also important for guiding interpersonal theories of and interventions fordepression in an ID population. Research studies are now needed to deter-mine whether these depressive nonverbal social skills contribute to theheightened experience of negative social interactions in adults with mild ID.Efforts to improve nonverbal social skills of adults with mild ID and toeducate caregivers about depressive nonverbal social skills may help adultswith mild ID diagnosed with depression better access positive social inter-actions and support.

REFERENCES

Amstutz, D. K., & Kaplan, M. F. (1987). Depression, physical attractiveness andinterpersonal acceptance. Journal of Social and Clinical Psychology, 5, 365–377.

Arkowitz, H., Lichtenstein, E., McGovern, K., & Hines, P. (1975). The behavioralassessment of social competence in males. Behavior Therapy, 6, 3–13.

Barkham, M., & Hardy, G. E. (2001). Counseling and interpersonal therapies for depres-sion: Toward securing an evidence-base. British Medical Bulletin, 57, 115–132.

Benson, B. A., Reiss, S., Smith, D. C., & Laman, D. S. (1985). Psychosocial correlatesof depression in mentally retarded adults: II. Poor social skills. AmericanJournal of Mental Deficiency, 89, 657–659.

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 16: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

Nonverbal Social Skills 25

Bernard, H., Killworth, P., Kronenfeld, D., & Sailor, L. (1984). The problem ofinformant accuracy: The validity of retrospective data. Annual Review ofAnthropology, 13, 495–517.

Borthwick-Duffy, S. A. (1994). Epidemiology and prevalence of psychopathology inpeople with mental retardation. Journal of Consulting and Clinical Psychology,62, 17–27.

Bouhuys, A. L., & van der Meulen, W. R. (1984). Speech timing measures of severity,psychomotor retardation, and agitation in endogenously depressed patients.Journal of Communication Disorders, 17, 277–288.

Clarke, D. J., & Gomez, G. A. (1999). Depressive episodes in adults with intellectualdisabilities. Irish Journal of Psychological Medicine, 13, 105–113.

Cooper, S-A., & Bailey, N. M. (2001). Psychiatric disorders amongst adults withlearning disabilities: Prevalence and relationship to ability level. Irish Journal ofPsychological Medicine, 18, 45–53.

Cooper, S-A., Smiley, E., Morrison, J., Williamson, A., & Allan, L. (2007). An epidemi-ological investigation of affective disorders with a population-based cohort of1023 adults with intellectual disabilities. Psychological Medicine, 37, 873–882.

Cuthill, F. M., Espie, C. A., & Cooper, S-A. (2003). Development and psychometricproperties of the Glasgow Depression Scale for people with a Learning Disability.British Journal of Psychiatry, 182, 347–353.

Darby, J. K., Simmons, N., & Berger, P. A. (1984). Speech and voice parameters ofdepression: A pilot study. Journal of Communication Disorders, 17, 75–85.

Davis, D. (1982). Determinants of responsiveness in dyadic interaction. In W. Ickes &E. S. Knowles (Eds.), Personality, roles, and social behavior (pp. 85–139).New York: Springer-Verlag.

Davis, D., & Holtgraves, T. (1984). Perceptions of unresponsive others: Attributions,attraction, understandability, and memory of their utterances. Journal ofExperimental Social Psychology, 20, 383–408.

Davis, D., & Perkowitz, W. T. (1979). Consequences of responsiveness in dyadicinteraction: Effects of probability of response and proportion of content-relatedresponses on interpersonal attraction. Journal of Personality and SocialPsychology, 37, 534–550.

Davis, J. P., Judd, F. K., & Herman H. (1997). Depression in adults with intellectualdisability. Part 1: A review. The Australian and New Zealand Journal ofPsychiatry, 31, 232–242.

Dow, M. G., & Craighead, W. E. (1987). Social inadequacy and depression: Overtbehavior and self-evaluation processes. Journal of Social and ClinicalPsychology, 5, 99–113.

Dunlop, W. P., Cortina, J. M., Vaslow, J. B., & Burke, M. J. (1996). Meta-analysis ofexperiments with matched groups or repeated measures designs. PsychologicalMethods, 1, 170–177.

Dykman, B. M., Horowitz, L. M., Abramson, L. Y., & Usher, M. (1991). Schemeticand situational determinants of depressed and nondepressed students’ interpre-tation of feedback. Journal of Abnormal Psychology, 100, 45–55.

Eckman, P., & Rosenberg, E. (1997). What the face reveals. New York: OxfordUniversity Press.

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 17: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

26 S. L. Hartley and D. G. Birgenheir

Esbensen, A. J., & Benson, B. A. (2007). An evaluation of Beck’s cognitive therapyof depression in adults with intellectual disability. Journal of IntellectualDisability Research, 51, 14–24.

Fauber, R., Forehand, R., Long, N., Burke, M., & Faust, J. (1987). The relationshipof young adolescent Children’s Depression Inventory (CDI) scores to theirsocial and cognitive functioning. Journal of Psychopathology and BehavioralAssessment, 9, 161–172.

Fossi, L., Faravelli, C., & Paoli, M. (1984). The ethological approach to the assessmentof depressed disorders. Journal of Nervous and Mental Disease, 172, 332–341.

Fridlund, A. (1994). Human facial expression: An evolutionary view. San Diego, CA:Academic.

Goldstein, A. P. (1980). Psychological skill training: The structured learningtechnique. New York: Pergamon.

Gotlib, I. H., & Beatty, M. E. (1985). Negative responses to depression: The role ofattributional style. Cognitive Therapy and Research, 9, 91–103.

Greden, J. F., & Carroll, B. J. (1980). Decrease in speech pause times with treatmentof endogenous depression. Biological Psychiatry, 15, 575–587.

Gurtman, M. G. (1986). Depression and the responses of others: Reevaluating thereevaluation. Journal of Abnormal Psychology, 95, 99–101.

Harper, B. H., & Hughey, J. D. (1986). Effects of communication responsiveness uponinstructor judgment grading and student cognitive learning. CommunicationEducation, 35, 147–156.

Harrison, P., & Oakland, R. (2006). Adaptive Behavior Assessment System-SecondEdition (ABAS-II). San Antonio, TX: Harcourt Assessment, Inc.

Hartley, S. L., & MacLean, W. E., Jr. (2005). Perceptions of stress and coping strate-gies among adults with mild mental retardation: Insight into psychologicaladjustment. American Journal on Mental Retardation, 110, 285–297.

Heiman, T., & Margalit, M. (1998). Loneliness, depression, and social skills amongstudents with mild mental retardation in different educational settings. Journalof Special Education, 32, 154–163.

Helsel, W. J., & Matson, J. L. (1988). The relationship of depression to social skillsand intellectual functioning in mentally retarded adults. Journal of MentalDeficiency Research, 32, 411–418.

Jacobson, N. S., & Anderson, E. A. (1982). Interpersonal skill and depression in college stu-dents: An analysis of the timing of self-disclosures. Behavior Therapy, 13, 271–282.

Kaufman, A. S., & Kaufman, N. L. (2004). KBIT-2: Kaufman Brief IntelligenceTest-Second Edition. Circle Pines, MN: AGS Publishing.

Kazdin, A. E., Sherick, R. B., Esveldt-Dawson, K., & Rancurello, M. D. (1985).Nonverbal behavior and childhood depression. Journal of the AmericanAcademy of Child Psychiatry, 24, 303–309.

Laman, D. S., & Reiss, S. (1987). Social skill deficiencies associated with depressedmood of mentally retarded adults. American Journal of Mental Deficiency, 92,224–229.

Landis, J. R., & Koch, G. G. (1977). The measurement of observer agreement forcategorical data. Biometrics, 33, 159–174.

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 18: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

Nonverbal Social Skills 27

Lewinsohn, P. M. (1974). Psychological measurement of depression. In R. J. Friedman &M. M. Katz (Eds.), The psychology of depression: Contemporary theory andresearch (pp. 157–178). Washington, DC: Winston-Wiley.

Lewinsohn, P. M., Mischel, W., Chaplin, W., & Barton, R. (1980). Social competenceand depression: The role of illusory self-perceptions. Journal of AbnormalPsychology, 89, 203–212.

Libet, J., & Lewinsohn, P. M. (1973). The concept of social skill with special refer-ence to the behavior of depressed persons. Journal of Consulting and ClinicalPsychology, 40, 304–312.

Lilienfeld, S. O., & Fowler, K. A. (2006). The self-report assessment of psychopa-thology: Problems, pitfalls, and promises. In C. J. Patrick (Ed.), Handbook ofpsychopathy (pp. 107–132). New York: Guilford.

Lunsky, Y. (1999). Social support as a predictor of well-being in adults with mildmental retardation. Dissertation Abstracts International, 60 (05B), 2350. (UMI)

Lunsky, Y. (2003). Depressive symptoms in intellectual disability: Does gender playa role? Journal of Intellectual Disability Research, 47, 417–428.

Lunsky, Y., & Benson, B. A. (2001). Association between perceived social supportand strain, and positive and negative outcomes for adults with mild intellectualdisability. Journal of Intellectual Disability Research, 45, 106–114.

Marston, G. M., Perry, D. W., & Roy, A. (1997). Manifestations of depression in peoplewith intellectual disability. Journal of Intellectual Disability Research, 41, 476–480.

Matson, J. L., Rush, K. S., Hamilton, M., Anderson, S. J., Bamburg, J. W., Baglio, C. S.,et al. (1999). Characteristics of depression as assessed by the DiagnosticAssessment for the Severely Handicapped-II (DASH-II). Research in Develop-mental Disabilities, 20, 305–313.

McBrien, J. A. (2003). Assessment and diagnosis of depression in people with intel-lectual disability. Journal of Intellectual Disability Research, 47, 1–13.

Nilsonne, A. (1988). Speech characteristics as indicators of depressive illness. ActaPsychiatrica Scandinavica, 787, 253–263.

Payne, R., & Jahoda, A. (2004). The Glasgow Social Self-Efficacy Scale-A new scalefor measuring social self-efficacy in people with intellectual disability. ClinicalPsychology and Psychotherapy, 11, 265–274.

Pope, B., Blass, T., Siegman, A. W., & Raher, J. (1970). Anxiety and depression inspeech. Journal of Consulting and Clinical Psychology, 35, 128–133.

Reiss, S., & Benson, B. A. (1985). Psychosocial correlates of depression in mentallyretarded adults: I. Minimal social support and stigmatization. American Journalof Mental Deficiency, 89, 331–337.

Renk, K., Donnelly, R., McKinney C., & Baksh, E. (2007). Do Schacter’s seven sinsof memory apply to ratings of children’s emotional and behavioral functioning?Journal of Child and Family Studies, 16, 297–306.

Royal College of Psychiatrists. (2001). DC-LD [Diagnostic Criteria for PsychiatricDisorders for Use with Adults with Learning Disabilities/Mental Retardation].London: Gaskell Press.

Segrin, C. (1992). Specifying the nature of social skill deficits associated with depression.Human Communication Research, 19, 89–123.

Segrin, C. (2000). Social skill deficits associated with depression. Clinical PsychologyReview, 20, 379–403.

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014

Page 19: Nonverbal Social Skills of Adults with Mild Intellectual Disability Diagnosed with Depression

28 S. L. Hartley and D. G. Birgenheir

Segrin, C., & Abramson, L. Y. (1994). Negative reactions to depressive behaviors:A communication theories analysis. Journal of Abnormal Psychology, 103,655–669.

Smiley, E., & Cooper, S-A. (2003). Intellectual disability, depressive episode, diagnosticcriteria and Diagnostic Criteria for Psychiatric Disorders for use with Adults withLearning Disability/Mental Retardation (DC-LD). Journal of Intellectual DisabilityResearch, 47, 62–71.

White, P., Chant, D., Edwards, N., Townsend, C., & Waghorn, G. (2005). The prev-alence of intellectual disability and comorbid mental illness in an Australiancommunity sample. The Australian and New Zealand Journal of Psychiatry,39, 395–400.

Wilfong, E. L., Saylor, C., & Elksnin, N. (1991). Influences on responsiveness:Interactions between mothers and their preterm infants. Infant Mental HealthJournal, 12, 31–40.

Youngren, M. A., & Lewinsohn, P. M. (1980). The functional relation betweendepression and problematic interpersonal behavior. Journal of AbnormalPsychology, 89, 333–341.

Dow

nloa

ded

by [

Nip

issi

ng U

nive

rsity

] at

07:

15 1

0 O

ctob

er 2

014