Journal of Autism and Developmental Disorders

, Volume 40, Issue 10, pp 1171–1178 | Cite as

Behavior Problems, Psychiatric Symptoms, and Quality of Life for Older Adults With Intellectual Disability With and Without Autism

  • Vasiliki TotsikaEmail author
  • David Felce
  • Michael Kerr
  • Richard P. Hastings
Original Paper


The evidence base on outcomes associated with autism in older adulthood is limited. The expected increase in the prevalence of older adults with autism highlights the need to describe their profiles and service needs. Adults 50 years or older with an intellectual disability (ID) and the triad of impairments characteristic of autism spectrum disorders (ASD) were compared to peers with ID only, and younger adults with ASD and ID. After accounting for ability differences, older adults with ASD did not differ from those with ID in terms of behavior problems, psychiatric disorder, and quality of life. Any differences in the skills of adults with ASD were associated with decreased adaptive skills, and not the presence of ASD per se.


Older adults Autism spectrum disorders Intellectual disability Ageing 


  1. Acion, L., Peterson, J. J., Temple, S., & Arndt, S. (2006). Probabilistic index: An intuitive non-parametric approach to measuring the size of treatment effects. Statistics in Medicine, 25, 591–602.CrossRefPubMedGoogle Scholar
  2. Aman, M. G., & Singh, N. N. (1986). The aberrant behavior checklist. New York: Slosson Educational Publications.Google Scholar
  3. Barnard, J., Harvey, V., Potter, D., & Prior, A. (2001). Ignored or ineligible? The reality of adults with autism spectrum disorders. London: The National Autistic Society.Google Scholar
  4. Baxter, H., Lowe, K., Houston, H., Jones, G., Felce, D., & Kerr, M. (2006). Previously unidentified morbidity in patients with intellectual disability. British Journal of General Practice, 56, 93–98.PubMedGoogle Scholar
  5. Beadle-Brown, J., Murphy, G., & DiTerlizzi, M. (2009). Quality of life for the Camberwell cohort. Journal of Applied Research in Intellectual Disabilities, 22, 380–390.CrossRefGoogle Scholar
  6. Bhaumik, S., Branford, D., McGrother, C., & Thorp, C. (1997). Autistic traits in adults with learning disabilities. British Journal of Psychiatry, 170, 502–506.CrossRefPubMedGoogle Scholar
  7. Bhaumik, S., Tyrer, F. C., McGrother, C., & Ganghadaran, S. K. (2008). Psychiatric service use and psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 52, 986–995.CrossRefPubMedGoogle Scholar
  8. Billsted, E., Gillberg, I. C., & Gillberg, C. (2007). Autism in adults: symptom patterns and early childhood predictors. Use of the DISCO in a community sample followed from childhood. Journal of Child Psychology and Psychiatry, 48, 1102–1110.CrossRefGoogle Scholar
  9. Bradley, E. A., Summers, J. A., Wood, H. L., & Bryson, S. E. (2004). Comparing rates of psychiatric and behavior disorders in adolescents and young adults with severe intellectual disability with and without autism. Journal of Autism and Developmental Disorders, 34, 151–161.CrossRefPubMedGoogle Scholar
  10. Cederlung, M., Hagberg, B., Billsted, E., Gillberg, I. C., & Gillberg, C. (2008). Asperger syndrome and autism: A comparative longitudinal follow-up study more than 5 years after original diagnosis. Journal of Autism and Developmental Disorders, 38, 72–85.CrossRefGoogle Scholar
  11. Charman, T. (2002). The prevalence of autism spectrum disorders. European Child and Adolescent Psychiatry, 11, 249–256.CrossRefPubMedGoogle Scholar
  12. Davidson, P. W., Janicki, M. P., Ladrigan, P., Houser, K., Henderson, C. M., & Cain, N. N. (2003). Associations between behavior disorders and health status among older adults with intellectual disability. Aging & Mental Health, 7, 424–430.CrossRefGoogle Scholar
  13. Eaves, L. C., & Ho, H. H. (2008). Young adult outcome of autism spectrum disorders. Journal of Autism and Developmental Disorders, 38, 739–747.CrossRefPubMedGoogle Scholar
  14. Felce, D., Jones, E., Lowe, K., & Perry, J. (2003). Rational resourcing and productivity: Relationships among staff input, resident characteristics and group home quality. American Journal on Mental Retardation, 108(3), 161–172.CrossRefPubMedGoogle Scholar
  15. Felce, D., Kerr, M., & Hastings, R. P. (2009). A general-practice based of the relationship between indicators of mental illness and challenging behaviour among adults with intellectual disabilities. Journal of Intellectual Disabilities Research, 53, 243–254.CrossRefGoogle Scholar
  16. Felce, D., Lowe, K., & Jones, E. (2002). Association between the provision characteristics and operation of supported housing services and resident outcomes. Journal of Applied Research in Intellectual Disabilities, 15, 404–418.CrossRefGoogle Scholar
  17. Felce, D., Lowe, K., Perry, J., Baxter, H., Jones, E., Hallam, A., et al. (1998). Service support to people in Wales with severe intellectual disability and the most severe challenging behaviours in Wales: Processes, outcomes and costs. Journal of Intellectual Disability Review, 42, 390–408.CrossRefGoogle Scholar
  18. Felce, D., & Perry, J. (2007). Living with support in the community: Factors associated with quality-of-life outcome. In S. L. Odom, R. H. Horner, M. E. Snell, & J. Blacher (Eds.), Handbook of developmental disabilities (pp. 410–428). New York: Guilford Press.Google Scholar
  19. Felce, D., Perry, J., Lowe, K., & Jones, E. (in press). The impact of autism or severe challenging behaviour on lifestyle outcome in community housing. Journal of Applied Research in Intellectual Disabilities. Google Scholar
  20. Filipek, P. A., Accardo, P. J., Baranek, G. C., Cook, E. H., Dawson, G., Gordon, B., et al. (1999). The screening and diagnosis of autistic spectrum disorders. Journal of Autism and Developmental Disorders, 29, 439–484.CrossRefPubMedGoogle Scholar
  21. Fombonne, E. (2005). The changing epidemiology of autism. Journal of Applied Research in Intellectual Disabilities, 18, 281–294.CrossRefGoogle Scholar
  22. Ganz, M. L. (2007). The lifetime distribution of the incremental societal costs of autism. Archives of Pediatric and Adolescent Medicine, 161, 343–349.CrossRefGoogle Scholar
  23. Gerber, F., Baud, M. A., Giroud, M., & Carminati, G. C. (2008). Quality of life of adults with pervasive developmental disorders and intellectual disabilities. Journal of Autism and Developmental Disorders, 38, 1654–1665.CrossRefPubMedGoogle Scholar
  24. Hastings, R. P., & Mount, R. H. (2001). Early correlates of behavioural and emotional problems in children and adolescents with severe intellectual disabilities: A preliminary study. Journal of Applied Research in Intellectual Disabilities, 14, 381–391.CrossRefGoogle Scholar
  25. Hefziba, L., Merrick, J., & Morad, M. (2008). Health status and ADL functioning of older persons with intellectual disability: Community residence versus residential care centers. Research in Developmental Disabilities, 29, 301–315.CrossRefGoogle Scholar
  26. Holden, B., & Gitlesen, J. P. (2006). A total population study of challenging behaviour in the county of Hedmark, Norway: Prevalence and risk markers. Research in Developmental Disabilities, 27, 456–465.CrossRefPubMedGoogle Scholar
  27. Holmes, N., Shah, A., & Wing, L. (1982). The disability assessment schedule: A brief screening device for use with the mentally retarded. Psychological Medicine, 12, 879–890.CrossRefPubMedGoogle Scholar
  28. Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45, 212–229.CrossRefPubMedGoogle Scholar
  29. Järbrink, K., & Knapp, M. (2001). The economic impact of autism in Britain. Autism, 5, 7–22.CrossRefPubMedGoogle Scholar
  30. Jones, E., Felce, D., Lowe, K., Bowley, C., Pagler, J., Stong, G., et al. (2001). Evaluation of the dissemination of active support training and training trainers. Journal of Applied Research in Intellectual Disabilities, 14, 79–99.CrossRefGoogle Scholar
  31. La Malfa, G., Lassi, M., Bertelli, R., Salvini, R., & Placidi, G. F. (2004). Autism and intellectual disability: A study of prevalence on a sample of the Italian population. Journal of Intellectual Disability Research, 48, 262–267.CrossRefPubMedGoogle Scholar
  32. Matson, J. L. (1988). The psychopathology instrument for mentally retarded adults (PIMRA). Worthington, Ohio: International Diagnostic Systems.Google Scholar
  33. Matson, J. L., Wilkins, J., & Ancona, M. (2008). Autism in adults with severe intellectual disability: An empirical study of symptom presentation. Journal of Intellectual and Developmental Disability, 33, 36–42.CrossRefPubMedGoogle Scholar
  34. McClintock, K., Hall, S., & Oliver, C. (2003). Risk markers associated with challenging behaviours in people with intellectual disabilities: a meta-analytic study. Journal of Intellectual Disability Research, 47, 405–416.CrossRefPubMedGoogle Scholar
  35. Melville, C. A., Cooper, S. A., Morrison, J., Smiley, E., Allan, L., Jackson, A., et al. (2008). The prevalence and incidence of mental ill-health in adults with autism and intellectual disabilities. Journal of Autism and Developmental Disorders, 38, 1676–1688.CrossRefPubMedGoogle Scholar
  36. Morgan, C. N., Roy, M., Nasr, A., Chance, P., Hand, M., Mlele, T., et al. (2002). A community survey establishing the prevalence rate of autistic disorder in adults with learning disability. Psychiatric Bulletin, 26, 127–130.CrossRefGoogle Scholar
  37. Moss, S., Prosser, H., Costello, H., Simpson, N., Patel, P., Rowe, S., et al. (1998). Reliability and validity of the PAS-ADD checklist for detecting psychiatric disorders in adults with intellectual disability. Journal of Intellectual Disability Research, 42, 173–183.CrossRefPubMedGoogle Scholar
  38. Mouridsen, S. E., Brønnum-Hansen, H., Rich, B., & Isager, T. (2008). Mortality and causes of death in autism spectrum disorders: An update. Autism, 12, 403–414.CrossRefPubMedGoogle Scholar
  39. National Autistic Society. (2008). I exist: The message from adults with autism in England. London: The National Autistic Society.Google Scholar
  40. Newcombe, R. G. (2006). Confidence intervals for an effect size measure based on the Mann-Whitney statistic. Part 2: Asymptotic methods and evaluation. Statistics in Medicine, 25, 559–573.CrossRefPubMedGoogle Scholar
  41. Newschaffer, C. J., Croen, L. A., Daniels, J., Giarelli, E., Grether, J. K., Levy, S. E., et al. (2007). The epidemiology of autism spectrum disorders. Annual Review of Public Health, 28, 235–258.CrossRefPubMedGoogle Scholar
  42. Nihira, K., Leland, H., & Lambert, N. (1993). Adaptive behavior scale-residential and community version (2nd ed.). Austin, Texas: Pro-ed.Google Scholar
  43. Perry, J., & Felce, D. (2002). Subjective and objective quality of life assessment: Responsiveness, response bias, and resident: Proxy concordance. Mental Retardation, 40, 445–456.CrossRefPubMedGoogle Scholar
  44. Perry, J., & Felce, D. (2005). Factors associated with outcome in community group homes. American Journal on Mental Retardation, 110, 121–135.CrossRefPubMedGoogle Scholar
  45. Raynes, N. V. (1988). Annotated directory of measures of environmental quality for use in residential services for people with a mental handicap. Manchester: Department of Social Policy and Social Work, University of Manchester.Google Scholar
  46. Raynes, N., Wright, K., Shiell, A., & Pettipher, C. (1994). The cost and quality of community residential care: An evaluation of the services for adults with learning disabilities. London: Fulton.Google Scholar
  47. Rutter, M. (2005). Incidence of autism spectrum disorders: Changes over time and their meaning. Acta Paediatrica, 94, 2–15.CrossRefPubMedGoogle Scholar
  48. Seltzer, M. M., Krauss, M. W., Shattuk, P. T., Orsmond, G., Swe, A., & Lord, C. (2003). The symptoms of autism spectrum disorders in adolescence and adulthood. Journal of Autism and Developmental Disorders, 33, 565–581.CrossRefPubMedGoogle Scholar
  49. Shah, A., Holmes, N., & Wing, L. (1982). Prevalence of autism and related conditions in adults in a mental handicap hospital. Applied Research in Mental Retardation, 3, 303–317.CrossRefPubMedGoogle Scholar
  50. Shattuck, P. T., Seltzer, M. M., Greenberg, J. S., Orsmond, G. I., Bolt, D., Kring, S., et al. (2007). Change in autism symptoms and maladaptive behaviors in adolescents and adults with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 37, 1735–1747.CrossRefPubMedGoogle Scholar
  51. Shavelle, R. M., Strauss, D. J., & Pickett, J. (2001). Causes of death in autism. Journal of Autism and Developmental Disorders, 31, 569–576.CrossRefPubMedGoogle Scholar
  52. Tsakanikos, E., Costello, H., Holt, G., Bouras, N., Sturmey, P., & Newton, T. (2006). Psychopathology in adults with autism and intellectual disability. Journal of Autism and Developmental Disorders, 36, 1123–1129.CrossRefPubMedGoogle Scholar
  53. Tyrer, F., McGrother, C. W., Thorp, C. F., Donaldson, M., Bhaumic, S., Warson, J. M., et al. (2006). Physical aggression towards others in adults with learning disabilities: Prevalence and associated factors. Journal of Intellectual Disability Research, 50, 295–304.CrossRefPubMedGoogle Scholar
  54. Waterhouse, L., Wing, L., Spitzer, R., & Siegel, B. (1992). Pervasive developmental disorders: From DSM-III to DSM-III-R. Journal of Autism and Developmental Disorders, 22, 525–549.CrossRefPubMedGoogle Scholar
  55. Wing, L., & Gould, J. (1979). Severe impairments of social interaction and associated abnormalities in children: epidemiology and classification. Journal of Autism and Developmental Disorders, 9, 11–29.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Vasiliki Totsika
    • 1
    Email author
  • David Felce
    • 2
  • Michael Kerr
    • 2
  • Richard P. Hastings
    • 1
  1. 1.School of PsychologyBangor UniversityBangor, Gwynedd, WalesUK
  2. 2.Welsh Centre for Learning Disabilities, School of MedicineCardiff UniversityCardiff, WalesUK

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