Skip to main content

Diagnostic Overshadowing

  • Reference work entry


Diagnostic overshadowing refers to the negative bias impacting a clinician’s judgment regarding co-occurring disorders in individuals who have intellectual disabilities or other mental illness. Symptoms or behaviors that may be due to a specific mental illness are attributed to another disorder, historically Mental Retardation, without considering alternative etiology.

Historical Background

Reiss, Levtan, and Szyszko first coined the term “diagnostic overshadowing” to describe the tendency to assess individuals with intellectual disability less accurately (Reiss, Levitan, & McNally, 1982; Reiss, Levitan, & Szyszko, 1982; Reiss & Szyszko, 1983). Subsequent research has consistently demonstrated that the cognitive deficits displayed by an individual negatively impacted the ability of clinicians to make accurate judgments with regard to other co-occurring disorders (c.f., Jopp & Keys, 2001; White et al., 1995).

Jopp and Keys provide a review of the concept of diagnostic...

This is a preview of subscription content, access via your institution.

Buying options

USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD   1,799.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References and Readings

  • Bryson, S. E., & Smith, I. (1998). Epidemiology of autism: Prevalence, associated characteristics, and implications for research and service delivery. Mental Retardation and Developmental Disabilities Research Reviews, 4, 9–103.

    CrossRef  Google Scholar 

  • Charman, T., Pickles, A., Chandler, S., Wing, L., Bryson, S., Simonoff, E., et al. (2009). Commentary: Effects of diagnostic thresholds and research vs service and administrative diagnosis on autism prevalence. International Journal of Epidemiology, 38(5), 1234–1238. author reply 1243–1234.

    CrossRef  PubMed  Google Scholar 

  • Jopp, D. A., & Keys, C. B. (2001). Diagnostic overshadowing reviewed and reconsidered. American Journal on Mental Retardation, 106(5), 416–433.

    CrossRef  PubMed  Google Scholar 

  • Lotter, V. (1974). Factors related to outcome in autistic children. Journal of Autism and Childhood Schizophrenia, 4(3), 263–277.

    CrossRef  PubMed  Google Scholar 

  • Minnes, P., & Steiner, K. (2009). Parent views on enhancing the quality of health care for their children with fragile X syndrome, autism or Down syndrome. Child: Care, Health and Development, 35(2), 250–256.

    CrossRef  Google Scholar 

  • Reiss, S., Levitan, G. W., & McNally, R. J. (1982). Emotionally disturbed mentally retarded people: An underserved population. American Psychologist, 37(4), 361–367.

    CrossRef  PubMed  Google Scholar 

  • Reiss, S., Levitan, G. W., & Szyszko, J. (1982). Emotional disturbance and mental retardation: Diagnostic overshadowing. American Journal of Mental Deficiency, 86(6), 567–574.

    PubMed  Google Scholar 

  • Reiss, S., & Szyszko, J. (1983). Diagnostic overshadowing and professional experience with mentally retarded persons. American Journal of Mental Deficiency, 87(4), 396–402.

    PubMed  Google Scholar 

  • Simonoff, E., Pickles, A., Charman, T., Chandler, T. L., & Baird, G. (2008). Psychiatric disorders in children with autism spectrum disorders: Prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry, 47(8), 921–929.

    CrossRef  PubMed  Google Scholar 

  • White, M. J., Nichols, C. N., Cook, R. S., Spengler, P. M., Walker, B. S., & Look, K. K. (1995). Diagnostic overshadowing and mental retardation: A meta-analysis. American Journal on Mental Retardation, 100(3), 293–298.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Steve Kanne .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this entry

Cite this entry

Kanne, S. (2013). Diagnostic Overshadowing. In: Volkmar, F.R. (eds) Encyclopedia of Autism Spectrum Disorders. Springer, New York, NY.

Download citation