Pervasive developmental disorder behavior in adolescents with intellectual disability and co-occurring somatic chronic diseases
Introduction
Studies on the association between somatic chronic diseases in adolescents with intellectual disability (ID-adolescents) and the full range of pervasive developmental disorder behavior (PDD behavior), in particular milder forms of PDD behavior (mild PDD behavior), are hardly available. Mild PDD behavior is a term reserved for those who do not meet the criteria for severe PDD behavior like in autism or Asperger syndrome. Mild PDD behavior is widespread among ID-adolescents and has a profound effect on their daily functioning (de Bildt et al., 2005a, de Bildt et al., 2005b, Hartman et al., 2006, Kraijer, 2000).
Literature shows a positive association between severity of ID and mild PDD behavior in adolescents (de Bildt et al., 2005a). This positive association is caused by the fact that ID-adolescents, especially those with lower levels of ID, have a greater chance on both pervasive development disorders (PDD) (de Bildt et al., 2005a, Harris et al., 2008, Matson and Shoemaker, 2009, Walker et al., 2004) and attention deficit hyperactivity disorder (ADHD) (Emerson and Hatton, 2007, Matson and Shoemaker, 2009). Although ADHD and PDD have different nosological diagnoses, both diagnostic categories partly include similar symptoms like deficits in social interaction, impulsivity, attention and hyperactivity deficit (Gallagher, Bellgrove, Hawi, Segurado, & Fitzgerald, 2007). These deficits are also associated with mild PDD behavior (de Bildt et al., 2005a, Hartman et al., 2006, Nijmeijer et al., 2009).
Literature also suggests that adolescents with somatic chronic diseases show more PDD behavior than adolescents in the general population (Ekström et al., 2008, Fombonne, 2009, Freeman et al., 2005, Hendriksen and Vles, 2008, Kilincaslan and Mukaddes, 2009, Nordin and Gillberg, 1996, Steffenburg et al., 1996, Thome-Souza et al., 2004), but only two studies have focused explicitly on ID-adolescents with somatic chronic diseases (Nordin and Gillberg, 1996, Steffenburg et al., 1996). None of the aforementioned studies used instruments that were suitable for screening or diagnosing mild PDD behavior (Hartman et al., 2006).
Studies on the association between somatic chronic diseases in ID-adolescents and PDD behavior, in particular milder forms of PDD behavior, are highly needed. Professionals do not always recognize mild PDD behavior in (ID-)adolescents (de Bildt et al., 2005b, Kilincaslan and Mukaddes, 2009). Evidence on an association between somatic chronic diseases in ID-adolescents and mild PDD behavior may thus increase the attentiveness of professionals for mild PDD behavior, enabling earlier diagnosis and treatment. PDD behavior is very disabling in social and interpersonal situations and hinder successful participation in society (de Bildt et al., 2005a, Haccou and Hamond, 2006, Matson et al., 2008).
The aim of this study is to assess the association between somatic chronic diseases in ID-adolescents and PDD behavior, in particular the milder forms of PDD behavior.
Section snippets
Participants and procedure
We collected data on adolescents with a borderline, mild, moderate or severe ID aged 12–18 years in two provinces in the north of the Netherlands: Groningen and Drenthe (total population about 1.1 million people).
Nearly all adolescents of the target population attended secondary schools (schools for practical training) or special secondary schools (regional expertise centers). ID-adolescents attending schools for practical training can be classified as mainly educable and have IQs between 60
Results
Table 1 shows the background characteristics of the adolescents. The gender ratio, 58.2% boys and 41.8% girls, was similar to the ratio boys and girls with ID in the Netherlands (van Schrojenstein Lantman-de Valk et al., 2002).
Table 2, Table 3 shows the mean scores and standard deviations of the four subgroups of ID-adolescents on all CSBQ scales.
Table 2 shows that, adjusted for level of ID, ID-adolescents with somatic chronic diseases had statistically significant higher mean scores on all
Discussion
ID-adolescents with somatic chronic diseases have more PDD behavior than those without chronic diseases, in particular milder forms of PDD behavior. This association is independent of having PDD/ADHD or not. Our findings suggest a relationship between somatic chronic diseases in ID-adolescents and mild PDD behavior.
Differences are rather large, whereas effect sizes are mostly relative low. This can be explained by the fact that the differences in mean scores on the CSBQ scales between the
Acknowledgement
The authors want to thank Dr. C.A. Hartman from the Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands for her useful comments on earlier drafts of the article.
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