The impact of emotional development in people with autism spectrum disorder and intellectual developmental disability

Abstract

Background Intellectual developmental disabilities (IDDs) and autism spectrum disorders (ASDs) are developmental conditions, which may also be associated with impairments in emotional development (ED). ED can be assessed using the Scale of Emotional Development – Short (SED‐S), a five‐stage model consisting of eight domains, which allows to study the relationship between ASD and ED in people with IDD. Methods In this retrospective study, the level of ED was compared in 327 adults with IDD with [n = 83; mean age 38.3 years; level of IDD: mild (6), moderate (21), severe (45) and profound (11)] and without [n = 244, mean age 36.9 years; level of IDD: mild (67), moderate (73), severe (68) and profound (36)] ASD. The discriminative ability of the SED‐S was determined by a regression in a training and a validation sample. Results The level of ED correlated with the severity of IDD (rs = −.654) and the presence of ASD (rs = −.316). People with additional ASD showed lower levels of ED compared with those with IDD only (mean reference ages 7–18 vs 19–36 months). The developmental profiles were equally balanced in ASD and IDD‐only. A regression analysis revealed three domains (‘Relating‐to‐Peers’, ‘Differentiating‐Emotions’, and ‘Regulating‐Affect’) to be useful for ASD assignment (AUC > 0.70, sensitivity 0.76–0.80, specificity 0.62–0.63). Conclusions In people with IDD, additional ASD was associated with delays in ED, which may be considered in diagnostics, treatment and care.

A review of recent clinical measures that can be used to support psychological therapies with adults with intellectual disabilities

“…It is noteworthy that children with ID and comorbid autism spectrum condition (ASC) have scored significantly lower on the SED-S than children with ID and no ASC diagnosis (Sterkenburg et al, 2021). This has also been shown in adults, where ED can be used to differentiate between participants with and without ASC within the ID population (Sappok et al, 2020). This suggests that the SED-S could help to support the diagnosis of ASC, when the person has a prior diagnosis of ID.…”

“…Both measures reported good inter-rater reliability and validity, internal and convergent validity in the case of the SED-S, concurrent validity in the case of the FAIT. Furthermore, the SED-S could support diagnosis of comorbid ASC, which can be difficult within the ID population (Sappok et al , 2020). Meanwhile, evidence further supported the FAIT’s interpretability, feasibility and responsiveness.…”

An AAIDD-informed framework for cognitive behavioral case formulation and cognitive behavior therapy for young people with mild intellectual disabilities or borderline intellectual functioning.

“…While problems in adaptive functioning and delays/deficits in social-emotional development are seen as essential for the diagnosis of ID (APA, 2013; Schalock et al, 2021), there are few publications in the literature which focus specifically on tailoring CBT according to this AAIDD dimension. However, suggestions from other sources (i.e., literature on social-emotional development in ID; Sappok et al, 2022) may also be relevant. Clinicians can take the adaptive skills/social-emotional development of the young person into account when selecting, dosing but also delivering CBT techniques by, for example, strengthening social-emotional and emotion regulation skills (e.g., via affective education) prior to starting CBT; involving parents/caregivers for coregulation and support during CBT; and investing in a strong therapeutic alliance/working relationship and a positive and safe learning environment during CBT (Te Brinke et al, 2021; van den Bogaard et al, 2020).…”

Scale of Emotional Development – Short: reliability and validity in adults with intellectual disability

“…Moreover, certain mental disorders may affect emotional functioning. Autism spectrum disorders, for example, are associated with lower levels of ED Sappok et al 2020b;Sterkenburg et al 2021). A pilot study suggested that during acute depressive episodes, the level of emotional functioning decreases (Schmidt et al 2021).…”