Cognitive shifting and externalising problem behaviour in intellectual disability and autism spectrum disorder

TLDR

Behavioural problems are common in residential care for people with intellectual disability, especially when also diagnosed with autism spectrum disorder, and impairment in cognitive shifting may be linked to such problems. This study investigates whether cognitive shifting and ASD symptom severity predict externalising problem behaviour in individuals with ID, and whether shifting impairment is a better predictor than an ASD diagnosis. Forty‑one adolescents and young adults with mild ID, with and without ASD, were assessed using Pearson correlations and t‑tests to examine relationships between shifting impairment, ASD severity, and externalising behaviour. Shifting impairment measured by rating scales, but not ASD symptom severity, predicts externalising problem behaviour, and behaviour scores differ by shifting impairment status rather than ID or ASD diagnosis, supporting a cognition‑based approach.

Abstract

Abstract Background Behavioural problems are frequently reported in residential care for people with an intellectual disability ( ID ) in particular when they are additionally diagnosed with autism spectrum disorder ( ASD ). There are indications that impairment in cognitive shifting may be associated with problem behaviour. The objectives of this study were (1) to examine the relationship of cognitive shifting and severity of ASD symptoms with externalising problem behaviour in individuals with ID , with and without ASD , and (2) to examine whether a diagnosis based on shifting impairment is more predictive of externalising problem behaviour than an ASD diagnosis. Method Participants consisted of adolescents and young adults with mild ID , with and without ASD ( n = 41). Pearson intercorrelations were computed to explore the relationship between shifting impairment and severity of ASD symptoms on the one hand and ratings of externalising problem behaviour on the other hand. t ‐Tests were performed to analyse differences in externalising problem behaviour. Results Unlike ASD symptom severity, shifting scores were found to be associated with externalising problem behaviour, but only if shifting was measured using rating scales and not when using neuropsychological tasks. Externalising problem behaviour scores significantly differed when groups were classified according to shifting impairment (impaired vs. non‐impaired) but not when they were classified according to ID and ASD diagnoses. Conclusions It is proposed to use a cognition‐based approach when analysing problem behaviour, thus concentrating not so much on ID and ASD diagnosis and their corresponding symptoms, but rather placing the focus on cognitive symptoms.