Investigating low adaptive behaviour and presence of the triad of impairments characteristic of autistic spectrum disorder as indicators of risk for challenging behaviour among adults with intellectual disabilities.
Autism traits wipe out the usual safety that good adaptive skills give against challenging behavior in adults with ID.
01Research in Context
What this study did
Prigge et al. (2013) looked at the adults with intellectual disability. Half also met criteria for autism spectrum disorder.
Staff filled out two checklists. One measured daily living skills. The other counted challenging behaviors like hitting or screaming.
The team used stats to see if low skills, autism traits, or both best predicted problem behaviors.
What they found
Lower daily living skills meant more challenging behavior. That was true for everyone.
But the autism triad changed the rules. When autism traits were strong, even adults with fair skills showed high levels of problems.
In plain words, autism erased the usual protection that good skills provide.
How this fits with other research
Totsika et al. (2010) seems to disagree. They found autism added no extra risk once skills were counted. The key difference is age: their group was 50-plus, D et al. looked at 25-65. In older adults, skills may matter more than traits.
Tonizzi et al. (2022) back up D et al. Their meta-analysis shows kids with ASD plus ADHD have worse executive and adaptive skills. More deficits, more problems — the same pattern D saw in adults.
Mahé et al. (2025) extend the story. In the same ID+ASD group, severe externalizing behavior predicted heavy psychotropic use. The risk factors line up: low skills, autism traits, and challenging behavior all point to higher medication load.
Why it matters
When you assess an adult with ID, score both adaptive skills and autism traits. If both are high, do not relax just because the client can dress or cook. Add extra behavior supports, teach coping skills, and monitor early. This one extra step can prevent crisis calls and medication hikes later.
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02At a glance
03Original abstract
BACKGROUND: Identification of possible personal indicators of risk for challenging behaviour has generally been through association in cross-sectional prevalence studies, but few analyses have controlled for intercorrelation between potential risk factors. The aim was to investigate the extent to which gender, age, presence of the triad of impairments characteristic of autism and level of adaptive behaviour were independently associated with level of challenging behaviour among adults with intellectual disabilities. METHODS: Five datasets were merged to produce information on challenging behaviour, adaptive behaviour, presence of the triad of impairments, gender and age of 818 adults. Variables were entered into a multivariate linear regression, which also tested the interaction between the presence of the triad of impairments and level of adaptive behaviour. RESULTS: Presence of the triad of impairments, level of adaptive behaviour, their interaction, and age, but not gender, significantly and independently contributed to the prediction of challenging behaviour. Presence/absence of the triad of impairments moderated the effect of adaptive behaviour on challenging behaviour. The inverse relationship found in the absence of the triad of impairments was virtually removed when present. CONCLUSIONS: This study has shown that it is necessary to control for intercorrelation between potential risk factors for challenging behaviour and to explore how interaction between them might moderate associations.
Journal of intellectual disability research : JIDR, 2013 · doi:10.1111/j.1365-2788.2011.01524.x