Intellectual disability is not only associated with impairments in cognition, also the social and emotional development (ED) is often delayed. Recognition of these delays in ED may contribute to our understanding of the emotion-related impairments in adults with ID. On the background of high point prevalence rates of challenging behaviors (CB) in individuals with ID, the developmental approach may offer additional, tailored treatment options. Considering the basic emotional needs and understanding the motivations associated with a certain level of emotional development may be a starting points for treatment and support.
In a retrospective study factors underlying CB in an adult, clinical ID sample (n = 203) were assessed. Aside from chronological age and presence of autism spectrum disorders, the level of ED was the most important predictor for challenging and self-injurious behaviors among people with ID and had an impact on the living and working situation. Moreover, depending on the level of emotional development, different emotional developmental disorders could be identified: First, contact disorder (arrest SAED-1 showing self injury, social withdrawal, stereotyped behaviors), second, disintegrated disorder (arrest in SAED-2 showing high irritability and aggression), and third, disorganized disorder (arrest in SAED-3, showing hyperactivity and attention seeking behavior).
This detailed analysis of the origins of behavioral disorders may suggest priority areas for diagnostics and therapy, as these behaviors create obstacles to learning and productive labour. ED may be stimulated in individuals with ASD and ID to prevent or reduce problem behaviors, develop social and communication skills, and provide the prerequisites for participation in society and living a productive, satisfying life.
Since 2006, Dr. med. Tanja Sappok works as senior physician at the “Berlin Treatment Center for adults with intellectual disabilities (ID) and mental disorders”.
Autism spectrum disorder (ASD) in adults with ID has her special interest. Even though ASD is a frequent co-morbidity (about 25%) in individuals with ID, it may not be recognized until adulthood. Due to the lack of appropriate diagnostic measures in adults with ID, she evaluated the feasibility and validity of instruments commonly used in children such as ADOS, ADI-R, and SCQ and adopted them for the use in adults. In addition, she developed ASD screeners such as the Autism-Checklist (ACL) for physicians and psychologists and the Diagnostic Behavioral Assessment for ASD – Revised (DiBAS-R) for close caregivers. Moreover, she examined the influence of ASD on emotional development and challenging behavior and on conceptualisation of emotional developmental disorders.
Tanja is author and co-author of many articles and book chapters. Keywords: neurology, ASD and ID, emotional development, challenging behavior, diagnosis en treatment.