Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders.
Adults with autism plus ID show far more challenging behavior than ID-only peers, and added mental-health labels do not explain it.
01Research in Context
What this study did
McCarthy et al. (2010) looked at challenging behavior in adults with both autism and intellectual disability.
They compared these adults to adults who only had intellectual disability.
The team checked if extra mental-health diagnoses explained any higher behavior rates.
What they found
Adults with autism plus ID showed about four times more challenging behavior than ID-only peers.
After accounting for ID level, age, and gender, added mental-health diagnoses did not explain the extra behavior.
In short, autism itself, not the other diagnoses, drove the higher risk.
How this fits with other research
Totsika et al. (2010) seems to disagree. They saw no extra behavior once daily-living skills were held equal, but their group was 50-plus while Jane’s was 25-65. Age range, not conflict, explains the gap.
Hilton et al. (2010) backs Jane’s picture. In Norway, over half of ASD-plus-ID teens and adults met full criteria for at least one psychiatric disorder, showing the dual label is common.
Prigge et al. (2013) moved the story forward. They found that low daily-living skills and autism traits together predict behavior better than either alone, so both pieces matter.
Why it matters
If you serve adults with both autism and ID, expect more challenging behavior even when other mental-health labels are absent. Screen for skill level and autism features, not just comorbid diagnoses. Build plans that teach communication, daily living, and sensory regulation rather than relying only on psychiatric referral or medication.
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02At a glance
03Original abstract
We investigated the relationship between challenging behavior and co-morbid psychopathology in adults with intellectual disability (ID) and autism spectrum disorders (ASDs) (N=124) as compared to adults with ID only (N=562). All participants were first time referrals to specialist mental health services and were living in community settings. Clinical diagnoses were based on ICD-10 criteria and presence of challenging behavior was assessed with the Disability Assessment Schedule (DAS-B). The analyses showed that ASD diagnosis was significantly associated with male gender, younger age and lower level of ID. Challenging behavior was about four times more likely in adults with ASD as compared to non-ASD adults. In those with challenging behavior, there were significant differences in co-morbid psychopathology between ASD and non-ASD adults. However, after controlling for level of ID, gender and age, there was no association between co-morbid psychopathology and presence of challenging behavior. Overall, the results suggest that presence of challenging behavior is independent from co-morbid psychopathology in adults with ID and ASD.
Research in developmental disabilities, 2010 · doi:10.1016/j.ridd.2009.10.009