The British Journal of Developmental Disabilities

Vol. 46, Part 1, JANUARY 2000, No. 90

THE RELATIONSHIP OF SOCIAL SKILLS TO

PSYCHOPATHOLOGY FOR INDIVIDUALS WITH MILD
AND MODERATE MENTAL RETARDATION

Johnny L. Matson, Stephen J. Anderson and Jay W. Bamburg

Introduction higher percentage of mental illness than

Dual diagnosis refers to the presence
of psychopathology, or mental illness, in
persons with mental retardation (Matson,
1985, 1997; Matson and Barret, 1993).
Though this condition has been noted by
numerous researchers and service pro-
viders for over 100 years, the field as a
whole has primarily developed since
1980 (Maclean, 1993). Several factors have
both hindered past development and in-
fluenced recent development of the field
of dual diagnosis, including changes in
the nature of service delivery in develop-
mental disabilities, changes in the termi-
nology and definition of mental retarda-
tion and the difficulty in identifying psy-
chopathology in persons with mental re-
tardation.
It has been well estabilshed that per-
sons with mental retardation have a
persons of normal intellectual function-
ing (Dosen, 1993; Rojahn and Tasse, 1996).
Many researchers have concluded that
the incidence of mental illness in persons
with mental retardation is highest for
persons classified as mildly or moder-
ately mentally retarded (Jacobsen, 1982;
Iverson and Fax, 1989). There are a
number of reasons for this conclusion.
First, diagnostic criteria used for the non-
developmentally delayed population can
easily be applied to this population. Sec-
ond, individuals functioning in the mild
to moderate range often have the verbal
skills to respond to questions concerning
internal stimuli and subjective matters.
Finally, this population is often more
aware of being stigmatised or treated dif-
ferently; therefore, the likelihood of anxi-
ety or mood disorders is greatly in-
creased. Additionally, the interplay of

*Johnny L. Matson, Ph.D.

Professor and Director of Clinical Training, Department of Psychology, Audubon Hall, Louisi-
ana State University, Baton Rouge, Louisiana 70803-5501, USA. Tel. 001 504 388 8745
Stephen Anderson, Ph.D.
Recent graduate of Louisiana State University, Consulting Psychologist for the East Tennesse
Region - Mental Retardation.
Jay W. Bamburg, M.S.
4th year graduate student in clinical psychology at Louisiana State University

* For Correspondence

15
many factors account for the expression
of mental illness in this population, in-
cluding organic, developmental, and be-
havioural factors as well as the individu-
al's level of social/adaptive skills (Matson
and Sevin, 1994).
Social skills are crucial to adjustment
and normal interpersonal functioning.
Persons with severe psychopathology
without mental retardation have consist-
ently demonstrated less social skills than
their more well adjusted counterparts
(Glynn, 1998). Futher, treatments includ-
ing social skills training in conjuction
with pharmacologial interventions have
proven to be superior to traditional psy-
chological treatments or drug treatments
alone for individuals with severe
pathologies such as schizophrenia and
depression (Bellack, 1986). Available re-
search indicates considerable success in
teaching individuals social skills and in
demonstrating their importance for effec-
tive communication and assertivemess
(Bellack, et al., 1984). Deficits in social
skills are at the core of the difficulties ex-
perienced by persons with mental retar-
dation. Social deficits can lead to isola-
tion from friendships and peer interac-
tions and can limit further opportunities
to improve social skills (Grossman, 1977,
1983). These limitations can create a cyclic
pattern of isolation or peer rejection
(Oden, 1980). Deficits in social function-
ing are always seen in persons with men-
tal retardation. Therefore, it is critically
important to persons with disabilities
that accurate assessment and treatment of
social skills be part of any credible effort
to improve quality of life (Grossman,
1983; Matson, 1995).
The development of measures for as-
sessment of social skills and psychopa-
thology in persons with mental retarda-
tion has made it possible to study the
16
relationship between these domains
(Matson, et al., 1991; Matson, 1995).
Duncan (1997) investigated the relation-
ship between maladaptive behaviours
and social skills and found significant
differences in both clinical and control
groups. Further, 80% of individuals in
the study were correctly classified into
maladaptive behaviour groups based on
social skills profiles. In a similar study,
Matson, et al., (1998) investigated the rela-
tionship between psychopathology and
social skills in 846 individuals with men-
tal retardation. Their linear regression
analysis indicated that increases in symp-
toms of psychopathology predicted in-
creased negative behaviours. Further,
persons with the diagnoses of stereotypic
movement disorder and autism differed
significantly from controls in general
positive and positive nonverbal behav-
iours.
While the relationships between psy-
chopathology and social skills has been
established in persons with severe and
profound mental retardation (Matson et
al., 1998), researchers have not evaluated
comparable relationships in persons with
mild or moderate mental retardation.
This study represents a first attempt to
identify relationships between psychopa-
thology and social skills in persons with
mild or moderate mental retardation uti-
lising DSM-IV diagnostic criteria. A rela-
tionship appears to exist between these
variables in this population (Editoral
Board, 1996; Matson and Hammer, 1996).
However, the establishment of stronger
links are needed along with more specif-
ics on the relationship between social
skills and psychopathology. Successful
skills training and problem remediation
need to be related to improvements in
quality of life for persons with mental re-
tardation. In this way an empirically
based, humane treatment regimen can be
demonstrated for the benefit of both
persons with disabilities and those who
support them.
Method
Subjects
Subjects for the study were 127 per-
sons with mild (n=43) or moderate
(n=84) mental retardation. These indi-
viduals ranged from 18 to 80 years of aged
and lived in either community placement
(n=44) or a large developmental centre in
central Louisiana (n=83). Males (n=85)
outnumbered females (n=42) and Cauca-
sians (n=93) were more prevalent than
African Americans (n=34). Demographics
may be found in TABLE I.
Measures
Assessment of Dual Diagnosis: The As-
sessment of Dual Diagnosis (AAD) (Matson,
1997) is a reliable informant report index
of symptoms of psychopathology based
on DSM-IV criteria. The measure contains
79 items covering 13 diagnostic catego-
ries. Diagnostic categories of the ADD in-
clude mania, depression, anxiety, post-
traumatic stress disorder, substance abuse,
somatoform disorders, dementia, conduct
disorder, prevasive developmental disor-
der, schizophrenia, personality disorders,
eating disorders and sexual disorders. Ini-
tial studies of the psychometric proper-
ties of the ADD have shown excellent in-
ternal consistency, test-retest and
interrater reliability (Matson and
Bamburg, 1998).
Social Performance Survey Schedule
(SPSS): The Social Performance Survey
Schedule (SPSS) (Matson et al., 1983) is a 57
item assessment of social skills for persons
with mild or moderate mental retarda-
tion. It was adapted from Lowe and
Cantela’s Social Performance Survey Sched-
ule (1978) and is one of the only reliable
checklists for assessing social skills in this
population (Matson and Hammer, 1996).
The SPSS has two positive subscales (Ap-
propriate Social Skills and Communica-
tion Skills) and two negative subscales
(Inappropriate Assertion and Sociopathic
Behaviour). The SPSS has good internal
consistency and interrater reliability
(Matson and Hammer, 1996).
Procedure
Trained graduate students conducted
the assessments under the supervision
of a licensed psychologist. Training in-
volved classroom instruction followed by
successful achievement of interrater reli-
ability of .90 or better on three test admin-
istrations. The rater or interviewer was re-
sponsible for administering the ADD and
the SPSS. Raters were students in a doc-
toral programme in clinical psychology
with at least a masters degree. Informants
were either Qualified Mental Retardation
Personnel (QMRPs) or direct care staff
who were acquainted with the indi-
vidual being evaluated. Informants had a
minimum of six months' working knowl-
edge of the individual, defined as having
assisted in programme development, im-
plementation, client assessments and staff
training. Administration time for the in-
struments was 30-35 minutes. Upon com-
pleting the administration, results from
the scales were entered into a computer-
ised statistical package for analyses.
17
 TABLE I
Demographic Variables by Group and Total

Low Medium High Total

Endorsement Endorsement Endorsement Endorsement
N = 42 N = 44 N = 41 N = 127
33.1% 34.6% 32.3% 100%

Age
Mean 48.15 48.20 44.68 47.04
SD 15.42 14.51 15.45 15.11
Range 21-80 18-71 18-78 18-80
Age Group
18-29 5 3 7 15
11.9% 6.8% 17.1% 11.8%
30-39 9 12 11 32
21.4% 27.3% 26.8% 25.2%
40-49 11 9 9 29
26.2% 20.5% 22.0% 22.8%
50-59 5 8 5 18
11.9% 18.2% 12.2% 14.2%
60+ yrs. 12 12 9 33
28.6% 27.3% 22.0% 26.0%
Sex
Male 28 33 24 85
66.7% 75% 58.5% 66.9%
Female 14 11 17 42
33.3% 25% 41.5% 33.1%
Race
White 26 33 34 93
61.9% 75% 82.9% 73.2%
Black 16 11 7 34
38.1% 25% 16.1% 26.8%
MR Level
Mild 19 12 12 43
45.2% 27.3% 29.3% 33.9%
Moderate 23 32 29 84
54.8% 72.7% 70.7% 66.1%
Location
Large Institution 28 34 21 83
66.7% 77.3% 52.1% 65.4%
Group Home 14 10 20 44
33.3% 22.7% 48.8% 34.6%

18
Results
ADD scores were divided into three
groups to reflect low (Group 1, ADD total
score 0-5, n=42), medium (Group 2, ADD
total score 6-12, n=44) or high psychopa-
thology (Group 3, ADD total score 13 or
above, n=41) based on endorsement of
items indicating symptoms of psychopa-
thology. These groups were established
by determining total ADD scores for the
entire sample and splitting into three
groups based on percentile splits. A
multivariate analysis of variance
(MANOVA) was then conducted using
Group as the independent variable and
SPSS subscale score as the dependent vari-
able. Based on level of psychopathology,
significant differences were identified be-
tween groups for Appropriate Social
Skills (F=4.93, p<.009), Communication
Skills (F=8.34, p<.001), Inappropriate As-
sertion (F=7.97, p<.001), and Sociopathic
Behaviour (F=7.21, p<.001). This analysis
was follwed by one-way analyses of vari-
ance (ANOVAs) with Tukey post-hoc tests
to identify specific patterns of significant
relationships. In general, Group 3 (high
psychopathology) manifested lower lev-
els of positive social behaviour (Appro-
priate Social Skills and Communication
Skills) and higher levels of maladaptive
behaviour (Inappropriate Assertion and
Sociopathic Behaviour) than both
Groups 1 and 2 (low and medium psy-
chopathology groups).
Item analysis employed ANOVAs
with Tukey post-hoc tests to evaluate sta-
tistically significant differences between
groups on item endorsement. Numerous
items significantly differentiated the
groups. On the Appropriate Social Skills
subscale, 4 items significantly differenti-
ated the groups (remembers and dis-
cusses topics previously discussed with
others; asks how others have been, what
they've been up to, etc.; is able to make
people who are anxious or upset feel bet-
ter by talking to them; and gives positive
feedback to others). On the Communica-
tion Skills subscale, 7 items significantly
differentiated the groups (shows appre-
ciation when someone does something
for him/her; gets to know people in
depth; keeps in touch with friends;
stands up for friends; knows when to
leave people alone; takes care of others'
property as if it were his/her own; keeps
commitments he/she makes). On the In-
appropriate Assertion subscale, 8 items
significantly differentiated the groups
(puts self down; talks repeatedly about
his/her problems and worries; dominates
conversations; complains; gets into argu-
ments; blames others for his/her prob-
lems; interrupts others; makes embarrass-
ing comments). Lastly, on the Sociopathic
Behaviour subscale, 10 items significantly
differentiated the groups. These included
“is aggressive when taking issue with
someone”; “takes advantage of others”;
“hurts other people while striving to
reach his/her goals”; “reacts with more
anger than a situation calls for”; “threat-
ens others verbally or physically”; “takes
or uses things that aren't his/hers without
permission”; and “easily becomes
angry”.
Discussion
Based on this study, it appears that
there is a relationship between psychopa-
thology and social skills in persons with
mild and moderate mental retardation.
The greater the degree of impairment in
psychopathology, the greater the impair-
ment in social skills. Thus, the ADD ap-
pears to be obtaining some measure of
psychological dysfunction. Further, nu-
merous items on the SPSS significantly
19
differentiated groups based on endorse-
ment of symptoms of psychopathology
on the ADD.
Current findings are consistent with
Duncan's (1997) study of individuals with
severe and profound mental retardation
and with findings of numerous research-
ers working with schizophrenic persons
(Glynn, 1998). In addition, Matson et al.,
(1998) found that increases in symptoms
of psychopathology among individuals
with severe and profound mental retar-
dation correspond with increases in
negative behaviour. Yet, they found no re-
lationship between symptoms of psycho-
pathology and positive behaviours. These
researchers explained that the general
lack of positive skills in persons with se-
vere intellectual disabilities restricts the
range of responding for this analysis.
Therefore, it also appears that social skills
profiles of persons with and without
dual diagnosis differ by level of mental
retardation. Data of this sort should be ef-
ficacious for professionals involved in
planning treatment.
Individuals with mental retardation
and high levels of psychopathology
present the need for skill acquisition and
training. Social skills training has been
shown to be applicable to skills training
in persons with psychopathology includ-
ing schizophrenia, deperession and so-
cial anxiety (Bellack et al., 1976; Marchetti
and Campbell, 1990). While historical
trends of overmedicating behavioural ex-
cesses are slowly declining, excessive
medication is still far too prevalent for
persons with behaviour problems in both
institutional and community settings. Re-
cent outplacement emphasis has seen
many persons moved from institutions to
the community. Outplacement is, by
policy, unrelated to an individual's abil-
ity to function in the community. For this
reason, many persons with a limited base
20
of social skills and high levels of psycho-
pathology are placed in the community
without proper support. Therefore, it is
crucial that assessment instruments such
as the ADD and the SPSS be widely uti-
lised to ensure that deficits in social func-
tioning and symptons of psychopathol-
ogy be identified and addressed in be-
haviour support protocols.
Summary
Recent advances in the field of mental
retardation have included the develop-
ment of instruments for assessing psycho-
pathology and social skills in individuals
with mental retardation. Researchers
have subsequently begun investigating
relationships between these two variables
in persons with mental retardation. We
examined the relationship between psy-
chopathology and social skills in indi-
viduals with mild and moderate mental
retardation. The investigators used the
Assessment for Dual Diagnosis (ADD) to
measure psychopathology and the Social
Performance Survey Schedule-Revised
(SPSS-R) to evaluate social skills in this
sample. Significant differences were ob-
served between groups that were high or
low in symptoms of psychopathology.
Group patterns of social skills, items
which significantly differentiate the
groups are discussed as well as implica-
tions for future research.
References
Bellack, A. S. (1986). Schizophrenia: Behavior
therapy's forgotton child. Behavior Therapy,
17, 199-214.
Bellack, A. S., Hersen, M. and Turner, S. M.
(1976). Generalized effects of social skills
training in chronic schizophrenics: An
 experimental analysis. Behavior Research and
Therapy, 14, 391-398.
Bellack, A. S., Turner, S. M., Hersen, M and
Luber, R. F. (1984). An examination of the
efficacy of social skills training for chronic
schizphhrenic patients. Hospital and
Community Psychiatry, 35, 1023-1028.
Dosen, A. (1993). Diagnosis and treatment of
psychiatric and behavioural disorders in
mentally retarded individuals: The state of
the art. Journal of Intellectual Disability Research,
37, S1-7.
Duncan, D. (1997). Relationship of Self-Injurious
Behavior and Aggression to Social Skills in Persons
with Severe and Profound Mental Retardation.
Louisiana State University, unpublished
doctoral dissertation.
Editorial Board of the APA Division 33. (1996).
Definition of Mental Retardation. In: J. W.
Jacobson and J. A. Mulick (Eds.). Manual of
Diagnosis and Professional Practice in Mental
Retardation. Washington, DC: American
Psychological Association.
Glynn, S. M. Psychopathology and social
functioning in schizophrenia. In: K. T.
Mueser and N. Tarrier (Eds.). Handbook of
Social Functioning in Schizophrenia. Boston:
Allyn and Bacon.
Grossman, H. J. (Ed.). (1977). Manual on
Terminology and Classification in Mental
Retardation. Washington, DC: American
Association on Mental Retardation.
Grossman, H. J. (Ed.). (1983). Manual on
Theminology and Classification in Mental
Retardation. Washington, DC: American
Association on Mental Retardation.
Iverson, J. C. and Fox, R. A. (1989). Prevalence of
psychopathology among mentally retarded
adults. Research in Developmental Disabilities, 10,
77-83.
Jacobson, J. W. (1982). Problem behavior and
psychiatric impairment within a scale to assess social skill deficits in mentally
developmentally disabled population:
Behavior frequency. Applied Research in Mental
Retardation, 3, 121-139.
Lowe, M. R. and Cantela, J. R. (1978). A self-
report measure of social skill. Behavior Therapy,
9, 535-544.
Maclean, Jr., W. E. (1993). Overview. In: J. L.
Matson and R. P. Barrett (Eds.).
Psychopathology in the Mentally Retarded. (pp -1-
16). Boston: Allyn and Bacon.
Marchetti, A. G. and Campbell, V. A. (1990).
Social Skills. In: J. L. Matson (Ed.). Handbook
of Behavior Modification with the Mentally
Retarded (2nd Ed.). New York: Plenum.
Matson, J. L. (1985). Biosocial theory of
psychopathology: A three by three factor
model. Applied Research in Mental Retardation,
6, 199-227.
Matson, J. L. (1995). Matson Evaluation of Social
Skills for Individuals with Severe Retardation
(MESSIER). Baton Rouge: Scientific
Publishers, Inc.
Matson, J. L. (1997). Assessment of Dual Diagnosis
Manual. Baton Rouge: Scientific Publishers,
Inc.
Matson, J. L. and Barrett, R. P. Psychopathology in
the Mentally Retarded. Boston: Allyn and
Bacon.
Matson, J. L. and Bamburg, J. W. (1998).
Reliability of the Assessment of Dual
Diagnosis (ADD). Research in Developmental
Disabilities. 19, 89-95.
Matson, J. L., Gardner, W. I., Coe, D. A. and
Sovner, R. (1991). A scale for evaluating
emotional disorders in severely and profound
mentally retarded persons: Development of
the Diagnostic Assessment for the Severely
Handicapped (DASH) Scale. British Journal of
Psychiatry, 159, 404-409.
Matson, J. L. and Hammer, D. (1996). Assessment
of social functioning. In: J. W. Jacobson and
J. A. Mulick (Eds.). Manual of Diagnosis and
Professional Practice in Mental Retardation.
Washington, DC: American Psychological
Association.
Matson, J. L., Helsel, W. J., Bellack, A. S. and
Senatore, V. (1983). Development of a rating
retarded adults. Applied Research in Mental
Retardation, 4, 399-407.
Matson, J. L. and Sevin, J. A. (1994). Theories of
dual diagnosis in mental retardation. Journal of
Consulting and Clinical Psychology, 62, 6-16.
21
Matson, J. L., Smiroldo, B. B. and Bamburg, J. W.
(1998). The relationship of psychopathology
to social skills in persons with severe and
profound mental retardation. Journal of
Intellectual Disability Research, 23, 137-145.
Oden, S. (1980). A child's social isolation: Origins,
prevention, intervention. In: G. Carteledge
and J. F. Milburn (Eds.). Teaching Social Skills
to Children. New York: Pergamon.
Rojahn, J. and Tasse, M. J. (1996).
Psychopathology in mental retardation. In: J.
W. Jacobson and J. A. Mulick (Eds.). Manual
of Diagnosis and Professional Practice in Mental
Retardation (pp 147-156). Washington, DC:
American Psychological Association.

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