Quality of life as a mediator between behavioral challenges and autistic traits for adults with intellectual disabilities

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Abstract

A multiple mediation model was proposed to integrate core concepts of challenging behaviors with autistic traits to increase understanding of their relationship to quality of life (QoL). It was hypothesized that QoL is a possible mediator between the severity of challenging behaviors and autistic traits in adults with intellectual disability. These constructs are of vital importance because they are essential variables for people with autism, and obviously they influence their psychosocial development. Participants were 70 adults with autism spectrum disorders (ASD) and moderate intellectual disabilities (ID). Results indicated that several dimensions of QoL mediated the relationships between autistic traits and challenging behaviors. The dimensions of QoL, Satisfaction, Competence/Productivity, and Autonomy/Independence are mediators between autistic traits and challenging behaviors. Implications of these data are discussed.

Highlights

► Multiple mediation model was proposed to integrate core concepts of behavioral challenges and autistic traits. ► Participants were 70 adults with autism spectrum disorders and moderate intellectual disabilities. ► Results indicated that several dimensions of quality of life (satisfaction, competence/productivity, and autonomy/independence) mediated the relations hips between autistic traits and challenging behaviors.

Introduction

Autism spectrum disorders (ASD) and intellectual disabilities (ID) often co-occur at high rates with the relationship between the two disorders being enigmatic (Matson & Shoemaker, 2009). With the increase in life expectancy in occidental societies, the concern for promoting a positive quality of life (QoL) for adults who have both ASD and ID is growing (Billstedt et al., 2011, Cappe et al., 2011, Cottenceau et al., 2012, Garcia-Villamisar and Dattilo, 2010, Gerber et al., 2011, Kamio et al., 2013, Mahan and Kozlowski, 2011, Sheldrick et al., 2012).

Although educational and cognitive-behavioral programs are now accepted in most advanced countries as important to helping adults with ASD and ID improve their QoL (Gerber et al., 2011, Thorn et al., 2007), there is little research addressing co-morbid psychopathology associated with adults with ASD and ID (Kearney and Healy, 2011, Totsika et al., 2010). However, some research has examined implications of challenging behaviors since these types of behaviors negatively impact a wide range of life domains (e.g., leisure, vocational, social) that influence QoL for people with ASD and ID (Hastings, 2002).

There are a variety of co-morbid psychopathologies that exist with adults who have both an ASD and an ID. These adults have higher vulnerability for developing psychiatric disorders and behavioral challenges than those individuals who do not have both of these disabling conditions (Ghaziuddin, 2005). More specifically, these individuals are at risk for behavior problems such as self-injurious actions, stereotyped movements, and aggressive/destructive behaviors, and other psychiatric conditions (Einfeld and Aman, 1995, Matson et al., 2009a, Matson et al., 2009b, Smith and Matson, 2010, Tenneij et al., 2009).

Although behavioral challenges are not pathognomonic symptoms of individuals with ASD and ID, several studies have demonstrated that approximately 13–30% of people with ASD and ID demonstrate some type of challenging behavior (Sturmey, Laud, Cooper, Matson, & Fodstad, 2010). As a result of these behavioral challenges and potential risk of injury, some adults reside in public or private residential facilities (Gerber et al., 2011, Rojahn and Meier, 2009, Rojahn and Tasse, 1996, Totsika et al., 2010). Such behavioral challenges often negatively influence the QoL of these individuals (Gerber et al., 2008, Totsika et al., 2010).

Since the early 1970s, interest in the concept of QoL has increased significantly, both in research and clinical practice and it has been increasingly applied to people with ASD (Billstedt et al., 2011: Cappe et al., 2011, Cottenceau et al., 2012, Gerber et al., 2011, Kamp-Becker et al., 2010, Plimley, 2007, Shipman et al., 2011, Totsika et al., 2010). QoL has emerged as an important parameter for evaluating the outcomes of health care and associated services (Moons, Budts, & De Geest, 2006), particularly for people with ASD (Johnson et al., 2011, Kamp-Becker et al., 2010, Kuhlthau et al., 2010, Moons et al., 2006)

In the present study we explored the relationship between the level of QoL in a group of adults with ID and ASD and the severity of behavioral challenges. Our aim was to determine if these behavioral challenges were mediated by QoL over time. We hypothesized that a possible link exists between reduction in the severity of behavior problems and increase in QoL.

Section snippets

Participants

Participants included 70 adults between 18 and 43 years (M = 26.60; SD = 10.01) with ID and ASD. The average of Leiter Test was 53.39 (SD = 9.94). Participants were recruited from a facility for people with ASD located in Las Rozas, a residential community of Madrid, Spain and other institutions for people with ID. All participants were diagnosed with an ID and ASD by a psychiatrist or clinical psychologist with several years of diagnostic experience with people who have both an ID and ASD.

Correlational analysis

To establish basic relationships between variables we first computed first-order correlations between IV, DV, and mediators. The means, standard deviations, and inter-correlations of ASD traits (ASD-DA), behavior problems (ASD-PBA), and the dimensions of QoL (Satisfaction, Competence/Productivity, Autonomy/Independence and Community Involvement) are presented in Table 1. Scores for ASD-DA were significantly and positively correlated with ESD-PBA total scores and the total score for ASD-PBA and

Discussion

The presence of challenging behaviors is one of the most significant variables affecting the QoL of individuals with ID and ASD and their caregivers (Gardner, Graeber-Whalen, & Ford, 2001). These challenging behaviors can present substantial risks to people's health and their QoL. For those with an ID and an ASD, a challenging behavior can further impede daily functioning, given the symptomatology associated with ID and ASD (Matson et al., 2012, Matson and Rivet, 2008).

The purpose of this study

Acknowledgements

The essential contribution of the therapeutic staff of Nuevo Horizonte Association and the individuals with autism and intellectual disability who participated in this study is gratefully appreciated.

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    Department of Personality and Clinical Psychology, Avda. Juan XXIII, sn, 28040 Madrid. Spain. Tel.: +34 913946123.

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