The Missing Link: Delayed Emotional Development Predicts Challenging Behavior in Adults with Intellectual Disability

Abstract

Individuals with intellectual disability (ID) show high rates of challenging behavior (CB). The aim of this retrospective study was to assess the factors underlying CB in an adult, clinical ID sample (n = 203). Low levels of emotional development (ED), as measured by the Scheme of Appraisal of ED, predicted overall CB, specifically irritability and self-injury, high unemployment and low occupation rates, while severity of ID controlled for ED did not. Autism was the only mental disorder associated with overall CB, stereotypy, lethargy, and predicted antipsychotic drug usage. Given the persistence and clinical significance of CB, evaluation of autism and ED may suggest priority areas for diagnostics and therapy, to provide the prerequisites for participation in society and living up one's potentials.

A study on the usefulness and reliability of the “Scheme of Appraisal of Emotional Development” (SAED) for persons with ID using direct observation in a group-based assessment procedure

“…These results are in line with findings in the international literature (Izard et al, 2006;Mayer, Roberts, Barsade, 2008;Sappok et al, 2014;Matson 2009a,b;Totsika 2010). Divergent from the design in which we used the setting of a team, the intra-and inter-raterreliability was based on scores given by single team members.…”

“…In a previous study, we were able to show the effectiveness of a team-based approach of the SAED; after only 4 weeks of training, a psychiatric team learned to use this instrument and was able to perform reliably a SAED-rating within about 11 minutes (Elstner, Diefenbacher, Heinrich, 2015). This reduces the time for assessment to at least half the time used for the traditional assessment (Sappok et al, 2014). However, as a team with more than three members is involved in the scoring process, this might mitigate the time saving effect.…”

“…Therefore, an integrative approach, combining pedagogical, psychological, pharmaceutical, and social treatment and support methods is warranted (Dosen, 2007). From this point of view, it might be relevant in terms of an efficient therapeutic process to evaluate the level of development in different dimensions, including cognitive functions, social-adaptive behaviour, and emotional abilities (La Malfa, 2009;Matson, 2009a,b;Totsika, 2010;Sappok, 2014).…”

“…Applying the SAED helps to understand psychological developmental aspects. The emotional development is related to a scheme of developmental steps in the first 12 years of life, which are appropriate for both children and adults, as the emotional development typically stagnates in persons with ID (de Schipper & Schuengel 2010;Sappok 2014), although qualitative changes within the different domains may still be observed. Moreover, quite often a discrepancy is observed between a higher cognitive and a lower emotional development (Dosen, 2005a).…”

Sex Education, Sexual Health, and Autism Spectrum Disorder

“…Emotional development (or, the development of emotional competence) is impacted in many ways in ASD and has a notable effect on success in adulthood [19]. As an example of how this might occur, typically developing people certainly may feel the urge to engage in sexual behaviors (e.g., self-stimulation) while in public.…”