- Issues with Internal and External Validity
- Proxy evaluation can vary widely
  - Depends on several variables
      - Cultural Level
      - Personal Characteristics
        - Nature of Involvement
        - Affective Involvement

Cedarville University

It is not feasible to obtain self report in individuals with severe IDD. Sometimes the only way to assess the pain level of an individual with IDD is to obtain information from the proxy. While this may not be the best option, it is better than not assessing the pain level at all. There is a lack of understanding in what factors may influence the accuracy of these reports. 


Proxy-Report Biases

Bertelli, M. O., Bianco, A., Rossi, A., Mancini, M., La Malfa, G., & Brown, I. (2019). Impact of severe intellectual disability on proxy instrumental assessment of quality of life. Journal of Intellectual & Developmental Disability, 44(3), 272–281. https://doi.org/10.3109/13668250.2017.1350835

Impact of severe intellectual disability on proxy instrumental assessment of quality of life

Proxy Assessment Troubles

Proxies respond on the behalf of individuals who cannot communicate for themselves so it is thereby difficult for them to avoid projecting their own thoughts and prejudices. 

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