Heterogeneities in Cognitive and Socio-Emotional Development in Children With Autism Spectrum Disorder and Severe Intellectual Disability as a Comorbidity

Abstract

Introduction: Intellectual disability (ID) is frequently associated as a comorbidity in autism spectrum disorders (ASD). This study investigated a) how similar the heterogeneity in the cognitive and socio-emotional developmental profiles was for children with ASD and ID, b) the difference between the subjects' profiles and those of typically developing children (TD) matched for developmental levels, c) the skills existing with the lowest and highest developmental levels, and d) the relationship between developmental profiles in ASD and the severity of autism, ID, and the overall developmental level. Participants: The sample was comprised of 119 children (101 boys and 18 girls) who ranged in chronological age (CA) from 21 months to 14 years (M = 5 years 2 months; SD = 2 years 6 months) with developmental levels lower than 24 months. They came from three countries (France = 40, Brazil = 40, and Algeria = 39). The control group was comprised of 40 TD children from these same countries who ranged in CA from 4 to 24 months (M = 1 year 3 months; SD = 5 months). The ASD diagnosis was carried out according to International Statistical Classification of Diseases and Related Health Problems-10th Edition (ICD-10), Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR), Diagnostic and Statistical Manual of Mental Disorders-5th ed (DSM-5) criteria and the Childhood Autism Rating Scale (CARS). Measures: Children were tested using the Social Cognitive Evaluation Battery (SCEB; Adrien, 2007) by trained psychologists from public and private institutions specialized in the diagnosis of autism and interventions in this field. The SCEB explores 16 functional abilities, in both cognitive and socio-emotional areas, and allows the calculation of domain and area developmental levels and heterogeneity indices for the global, cognitive, and socio-emotional areas. Results: Children with ASD developmental profiles show very high heterogeneity as opposed to TD children. Regardless of the country of origin, there are similarities between the heterogeneous cognitive and socio-emotional developmental profiles of the children with ASD, whose profiles are characterized by lower developmental levels of language and vocal imitation skills, and a relationship between these developmental heterogeneities and the degree of severity of autistic symptomatology, intellectual disability, and overall development level. The implications of this study are presented for clinical assessment and intervention purposes in ASD and ID.

Keywords: Comorbidity; The Social Cognitive Evaluation Battery; autism spectrum disorder; cognitive and socioemotional developmental profiles; heterogeneities; intellectual disability.

Figure 1

Example of a cognitive and socio-emotional developmental profile of a child with autism spectrum disorder (ASD) obtained from the Social Cognitive Evaluation Battery (SCEB). Legend: The four developmental levels (from 1 to 4) are represented by four concentric circles. Each domain of development is represented by a radius of the circles. Socio-emotional domains: Behavior Regulation (BR, level 2), Social Interaction (SI, level 2), Joint Attention (JA, level 1), Expressive Language (EL, level 1), Receptive Language (RL, level 2), Vocal Imitation (VI, level 1), Gestural Imitation (GI, level 2), Affective Relation (AR, level 2), and Emotional Expression (EE, level 2). Cognitive domains: Self-Image (SI, level 2), Symbolic Play (SP, level 3), Object relation schemata (Sch, level 2), Operational Causality (OC, level 3), Means–Ends (ME, level 2), Spatial Relations (SR, level 3), and Object Permanence (OP, level 2).

Figure 2

Profiles of median developmental level scores (from 1 to 4) in all the 16 cognitive and socio-emotional domains on SCEB, for the three groups and for French children with ASD as well as the typical development groups from Algeria and Brazil. Legend: Socio-emotional domains: BR, Behavior Regulation, SI, Social Interaction, JA, Joint Attention, EL, Expressive Language; RL, Receptive Language; VI, Vocal Imitation; GI, Gestural Imitation; AR, Affective Relation; EE, Emotional Expression. Cognitive domains: SI, Self-Image; SP, Symbolic Play; Sch, Object relation schemata; OC, Operational Causality; ME, Means–Ends; SR, Spatial Relations; OP, Object Permanence.