When assessing patients who may be nonverbal, many psychiatrists struggle and must depend on caretakers or family members to describe problematic behaviors or symptoms. The excellent chapter on assessment by Stephanie Hamarman, M.D., presents many issues to consider for thorough assessments. She defines “diagnostic overshadowing” in which mental retardation “overshadows” other psychiatric diagnoses, such as depression, anxiety, and psychosis, and results in a failure to make the additional diagnosis. Many states separate mental retardation from mental health services, with the effect of blocking treatment of psychiatric disorders. The authrodiscusses studies showing the prevalence of both mental retardation and psychiatric disorders (dual diagnosis) and questions whether traditional DSM or ICD diagnosis is applicable for persons with mental retardation who are not able to participate fully in an assessment. As severity of retardation increases, so too does the difficulty in recognizing and distinguishing a psychiatric diagnosis. Behaviors that require psychiatric intervention include hyperactivity, inattention, irritability, and aggression, which can improve with medications even if the diagnosis is not clearly established. Dr. Hamarman completes the chapter with a discussion of diagnostic scales, including autism instruments, medical conditions, speech delay, eating disorders, and psychosis.