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

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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.

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Acknowledgments

We thank the foundation “von Bodelschwinghsche Stiftungen Bethel” for funding the study. Sven Bölte was supported by the Swedish Research Council (Grant No. 523-2009-7054). We thank the clinicians who helped in data collection. We appreciate Manuel Heinrich for his thorough data search from patient charts, data entry, support in data analysis, and layout. Thanks to Heika Kaiser who thoroughly performed the SAED, SCQ, PDD-MRS, ADOS, and ADI-R evaluations. We appreciate the comprehensive elaboration of the reviewer as it substantially strengthened the methodology and intelligibility of the study.

Conflict of interest

Sven Bölte receives royalties for the German version of the ADOS and ADI-R from Hans Huber Publishers. Beyond that, the authors declare no conflicts of interest.

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Authors and Affiliations

  1. Department of Psychiatry, Psychotherapy and Psychosomatics, Königin-Elisabeth-Herzberge Hospital, University Affiliated Hospital of the Charité, Herzbergstr.79, 10365, Berlin, Germany

    Tanja Sappok & Albert Diefenbacher

  2. Department of Pathology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany

    Jan Budczies

  3. Cluster of Excellence Languages of Emotion, Freie Universität Berlin, Habelschwerdter Allee 45, 14195, Berlin, Germany

    Isabel Dziobek

  4. Department of Women’s and Children’s Health, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), 17176, Stockholm, Sweden

    Sven Bölte

  5. Department of Psychiatry, University Hospital, Radboud University, Comeniuslaan 4, 6525 HP, Nijmegen, Netherlands

    Anton Dosen

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  1. Tanja Sappok
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Correspondence to Tanja Sappok.

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Sappok, T., Budczies, J., Dziobek, I. et al. The Missing Link: Delayed Emotional Development Predicts Challenging Behavior in Adults with Intellectual Disability. J Autism Dev Disord 44, 786–800 (2014). https://doi.org/10.1007/s10803-013-1933-5

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