Does Quality of Life Differ for Children With Autism Spectrum Disorder and Intellectual Disability Compared to Peers Without Autism?

  • Víctor B. Arias
  • Laura E. Gómez
  • Mª Lucía Morán
  • Mª Ángeles Alcedo
  • Asunción Monsalve
  • Yolanda Fontanil
Original Paper

Abstract

The main goal was to test if children with intellectual disability (ID) and autism spectrum disorder (ASD) show lower quality of life (QOL) in comparison to those with only ID. The KidsLife Scale was applied to 1060 children with ID, 25% of whom also had ASD, aged 4–21 years old. Those with ASD showed lower scores in several QOL domains but, when the effect of other variables was controlled, lower scores were only kept for interpersonal relationships, social inclusion, and physical wellbeing. Slightly higher scores were found for material wellbeing. ASD, Level of ID and support needs were the covariables with the greatest influence in most domains, while gender was only significant for social inclusion (girls scored lower than boys).

Keywords

Quality of life Autism spectrum disorder Intellectual disability Support needs Gender Children 

References

  1. Amiet, C., Gourfinkel-An, I., Bouzamondo, A., Tordjman, S., Baulac, M., Lechat, P., et al. (2008). Epilepsy in autism is associated with intellectual disability and gender: Evidence from a meta-analysis. Biological Psychiatry, 64(7), 577–582. doi:10.1016/j.biopsych.2008.04.030.CrossRefPubMedGoogle Scholar
  2. Biggs, E. E., & Carter, E. W. (2016). Quality of life for transition-age youth with autism or intellectual disability. Journal of Autism and Developmental Disorders, 46, 190–204. doi:10.1007/s10803-015-2563-x.CrossRefPubMedGoogle Scholar
  3. 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(2), 151–161. doi:10.1023/B:JADD.0000022606.97580.19.CrossRefPubMedGoogle Scholar
  4. Brown, R. I., Schalock, R. L., & Brown, I. (2009). Special issue: Quality of life and its applications. Journal of Policy and Practice in Intellectual Disability, 6, 1.CrossRefGoogle Scholar
  5. Brown, T. A. (2006). Confirmatory factor analysis for applied research. New York: Guilford.Google Scholar
  6. Bryson, S. E., Bradley, E. A., Thompson, A., & Wainwright, A. (2008). Prevalence of autism among adolescents with intellectual disabilities. Canadian Journal of Psychiatry, 53, 449–459.CrossRefPubMedGoogle Scholar
  7. Buntinx, H. E., & Schalock, R. L. (2010). Models of disability, quality of life, and individualized supports: implications for professional practice in intellectual disability. Journal of Policy and Practice in Intellectual Disabilities, 7(4), 283–294.CrossRefGoogle Scholar
  8. Carbó-Carreté, M., Guàrdia-Olmos, J., & Giné, C. (2015). Psychometric properties of the Spanish version of the personal outcomes scale. International Journal of Clinical and Health Psychology, 15, 236–252.Google Scholar
  9. Centers for Disease Control. (2012). Prevalence of autism spectrum disorders—Autism and Developmental Disabilities Monitoring Network, 14 Sites, United States, 2008. Surveillance Summaries, 61(SS03), 1–19. Retrieved from https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6103a1.htm.
  10. Chen, F. F. (2007). Sensitivity of goodness of fit indexes to lack of measurement invariance. Structural Equation Modeling, 14(3), 464–504.CrossRefGoogle Scholar
  11. Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9, 233–255.CrossRefGoogle Scholar
  12. Chiang, H., & Wineman, I. (2014). Factors associated with quality of life in individuals with autism spectrum disorders: A review of literature. Research in Autism Spectrum Disorders, 8, 974–986. doi:10.1016/j.rasd.2014.05.003.CrossRefGoogle Scholar
  13. Claes, C., van Hove, G., van Loon, J., Vandevelde, S., & Schalock, R. L. (2010). Quality of life measurement in the field of intellectual disabilities: Eight principles for assessing quality of life-related personal outcomes. Social Indicators Research, 98(1), 61–72. doi:10.1007/s11205-009-9517-7.CrossRefGoogle Scholar
  14. Claes, C., van Hove, G., Vandevelde, S., van Loon, J., & Schalock, R. L. (2012). The influence of supports strategies, environmental factors, and client characteristics on quality of life-related personal outcomes. Research in Developmental Disabilities, 33, 96–103. doi:10.1016/j.ridd.2011.08.024.CrossRefPubMedGoogle Scholar
  15. Clark, B. G., Magill-Evans, J. E., & Koning, C. J. (2015). Youth with autism spectrum disorders: Self- and proxy-reported quality of life and adaptive functioning. Focus on Autism and Other Developmental Disabilities, 30, 57–64. doi:10.1177/1088357614522289.CrossRefGoogle Scholar
  16. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2. Auflage). Hillsdale, NJ: Erlbaum.Google Scholar
  17. Cummins, R. A. (2005). Moving from the quality of life concept to a theory. Journal of Intellectual Disability Research, 49, 699–706. doi:10.1111/j.1365-2788.2005.00738.x.CrossRefPubMedGoogle Scholar
  18. De Vries, M., & Geurts, H. M. (2015). Influence of autism traits and executive functioning on quality of life in children with an autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(9), 2734–2743. doi:10.1007/s10803-015-2438-1.CrossRefPubMedPubMedCentralGoogle Scholar
  19. Felce, D., & Perry, J. (1995). Quality of life: Its definition and measurement. Research in Developmental Disabilities, 16, 51–74.CrossRefPubMedGoogle Scholar
  20. Felce, D., Perry, J., Lowe, K., & Jones, E. (2011). The impact of autism or severe challenging behaviour on lifestyle outcome in community housing. Journal of Applied Research in Intellectual Disabilities, 24, 95–104.CrossRefGoogle Scholar
  21. Gómez, L. E., Alcedo, M. Á., Arias, B., Fontanil, Y., Arias, V. B., Monsalve, A., & Verdugo, M. Á. (2016b). A new scale for the measurement of quality of life in children with intellectual disability. Research in Developmental Disabilities, 53, 399–410. doi:10.1016/j.ridd.2016.03.005.CrossRefPubMedGoogle Scholar
  22. Gómez, L. E., Arias, B., Verdugo, M. Á., Tassé, M. J., & Brown, I. (2015b). Operationalisation of quality of life for adults with severe disabilities. Journal of Intellectual Disability Research, 59(10), 925–941. doi:10.1111/jir.12204.CrossRefPubMedGoogle Scholar
  23. Gómez, L. E., Peña, E., Alcedo, M. Á., Monsalve, A., Fontanil, Y., Arias, B., & Verdugo, M. Á. (2014). The construct of quality of life concept in children and adolescents with profound and multiple disabilities: A proposal for its assessment. Siglo Cero, 45(1), 56–69.Google Scholar
  24. Gómez, L. E., Peña, E., Arias, B., & Verdugo, M. Á. (2016a). Impact of individual and organizational variables on quality of life. Social Indicators Research, 125(2), 649–664. doi:10.1016/j.evalprogplan.2013.05.001.CrossRefGoogle Scholar
  25. Gómez, L. E., Verdugo, M. A., Arias, B., Navas, P., & Schalock, R. L. (2013). The development and use of provider profiles at the organizational and systems level. Evaluation and Program Planning, 40, 17–26.CrossRefPubMedGoogle Scholar
  26. Gómez, L. E., Verdugo, M. Á., & Arias, B. (2010). Individual quality of life: Advances on its conceptualization and emerging challenges in the intellectual disability field. Behavioral Psychology, 18, 453–472.Google Scholar
  27. Gómez, L. E., Verdugo, M. Á., & Arias, B. (2015a). Validity and reliability of the INICO-FEAPS Scale: An assessment of quality of life for people with intellectual and developmental disabilities. Research in Intellectual and Developmental Disabilities, 36, 600–610. doi:10.1016/j.ridd.2014.10.049.Google Scholar
  28. Halladay, A. K., Bishop, S., Constantino, J. N., Daniels, A. M., Koenig, K., Palmer, K., et al. (2015). Sex and gender differences in autism spectrum disorder: summarizing evidence gaps and identifying emerging areas of priority. Molecular Autism, 6, 36–41. doi:10.1186/s13229-015-0019-y.CrossRefPubMedPubMedCentralGoogle Scholar
  29. Howlin, P., Goode, S., Hutton, J., & Rutter, M. (2004). Adult outcome for children with autism. Journal of Child Psychology and Psychiatry, 45(2), 212–229.CrossRefPubMedGoogle Scholar
  30. Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. doi:10.1080/10705519909540118.CrossRefGoogle Scholar
  31. Ikeda, E., Hinckson, E., & Krägeloh, C. (2014). Assessment of quality of life in children and youth with autism spectrum disorder: A critical review. Quality of Life Research, 23, 1069–1085. doi:10.1007/s11136-013-0591-6.CrossRefPubMedGoogle Scholar
  32. Ikeda, E., Krägeloh, C., Water, T., Erica, A., & Hinckson, E. A. (2016). An exploratory study of self-reported quality of life in children with autism spectrum disorder and intellectual disability. Child Indicators Research, 9, 133–153. doi:10.1007/s12187-015-9307-5.CrossRefGoogle Scholar
  33. Jenaro, C., Verdugo, M. A., Caballo, C., Balboni, G., Lachapelle, Y., Otbrebski, W., et al. (2005). Cross-cultural study of person-centered quality of life domains and indicators: A replication. Journal of Intellectual Disability Research, 49, 734–739. doi:10.1111/j.1365-2788.2005.00742.x.CrossRefPubMedGoogle Scholar
  34. Jöreskog, K., & Goldberger, A. S. (1975). Estimation of a model with a multiple indicators and multiple causes of a single latent variable. Journal of American Statistical Association, 70, 631–639.Google Scholar
  35. Kamp-Becker, I., Schröder, J., Muehlan, H., Remschmidt, H., Becker, K., & Bachmann, C. J. (2011). Health-related quality of life in children and adolescents with autism spectrum disorder. Zeitschrift für. Kinder- und Jugendpsychiatrie und Psychotherapie, 39, 123–131. doi:10.1024/1422-4917/a000098.CrossRefPubMedGoogle Scholar
  36. Kirkovski, M., Enticott, P. G., & Fitzgerald, P. B. (2013). A review of the role of female gender in autism spectrum disorders. Journal of Autism and Developmental Disorders, 43, 2584–2603. doi:10.1007/s10803-013-1811-1.CrossRefPubMedGoogle Scholar
  37. Kose, S., Erermis, S., Ozturk, O., Ozbaran, B., Demiral, N., Bildik, T., et al. (2013). Health related quality of life in children with autism spectrum disorders: The clinical and demographic related factors in Turkey. Research in Autism Spectrum Disorders, 7, 213–220. doi:10.1016/j.rasd.2012.09.009.CrossRefGoogle Scholar
  38. Kuhlthau, K., Kovacs, E. A., Hall, T., Clemmons, T., Orlich, F., Delahaye, J., & Sikora, D. (2013). Health-related quality of life for children with ASD: Associations with behavioral characteristics. Research in Autism Spectrum Disorders, 7, 1035–1042. doi:10.1016/j.rasd.2013.04.006.CrossRefGoogle Scholar
  39. Kuhlthau, K., Orlich, F., Hall, T. A., Sikora, D., Kovacs, E. A., Delahaye, J., et al. (2010). Health-related quality of life in children with autism spectrum disorders: Results from the autism treatment network. Journal of Autism and Developmental Disorders, 40, 721–729. doi:10.1007/s10803-009-0921-2.CrossRefPubMedGoogle Scholar
  40. La Malfa, G., Lassi, S., Bertelli, M., 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(3), 262–267. doi:10.1111/j.1365-2788.2003.00567.x.CrossRefPubMedGoogle Scholar
  41. Lee, L., Harrington, R. A., Louie, B. B., & Newschaffer, C. J. (2008). Children with autism: Quality of life and parental concerns. Journal of Autism and Developmental Disorders, 38, 1147–1160. doi:10.1007/s10803-007-0491-0.CrossRefPubMedGoogle Scholar
  42. Lombardi, M., Croce, L., Claes, C., Vandevelde, S., & Schalock, R. L. (2016). Factors predicting quality of life for people with intellectual disabilities: Results from the ANFFAS-study in Italy. Journal of Intellectual & Developmental Disability, 41, 338–347.CrossRefGoogle Scholar
  43. Marsh, H. W., Lüdtke, O., Muthén, B., Asparouhov, T., Morin, A. J., Trautwein, U., & Nagengast, B. (2010). A new look at the big five factor structure through exploratory structural equation modeling. Psychological Assessment, 22(3), 471.CrossRefPubMedGoogle Scholar
  44. Matson, J. L., Rivet, T. T., Fodstad, J. C., Dempsey, T., & Boisjoli, J. A. (2009). Examination of adaptive behavior differences in adults with autism spectrum disorders and intellectual disability. Research in Developmental Disabilities, 30(6), 1317–1325.CrossRefPubMedGoogle Scholar
  45. Matson, J. L., & Shoemaker, M. (2009). Intellectual disability and its relationship to autism spectrum disorders. Research in Developmental Disabilities, 30(6), 1107–1114. doi:10.1016/j.ridd.2009.06.003.CrossRefPubMedGoogle Scholar
  46. Meredith, W. (1993). Measurement invariance, factor analysis and factorial invariance. Psychometrika, 58(4), 525–543.CrossRefGoogle Scholar
  47. Morán, L., Gómez, L. E., & Alcedo, M. A. (2015). Relaciones interpersonales en niños y jóvenes con trastornos del espectro del autismo y discapacidad intelectual. Revista Española de Discapacidad, 3, 77–91.CrossRefGoogle Scholar
  48. Plimley, L. A. (2007). A review of quality of life issues and people with autism spectrum disorders. British Journal of Learning Disabilities, 35(4), 205–213. doi:10.1111/j.1468-3156.2007.00448.x.CrossRefGoogle Scholar
  49. Renty, J. O., & Roeyers, H. (2006). Quality of life in high-functioning adults with autism spectrum disorder: The predictive value of disability and support characteristics. Autism, 10(5), 511–524. doi:10.1177/1362361306066604.CrossRefPubMedGoogle Scholar
  50. Rubenstein, E., Wiggins, L. D., & Lee, L. (2015). A review of the differences in developmental, psychiatric, and medical endophenotypes between males and females with autism spectrum disorder. Journal of Developmental and Physical Disabilities, 27, 119–139. doi:10.1007/s10882-014-9397-x.CrossRefPubMedPubMedCentralGoogle Scholar
  51. Saldaña, D., Ávarez, R., Lobatón, S., López, A. M., & Rojano, M. (2009). Objective and subjective quality of life in adults with autism spectrum disorders in southern Spain. Autism, 13, 303–316. doi:10.1177/1362361309103792.CrossRefPubMedGoogle Scholar
  52. Schalock, R. L., Brown, I., Brown, R., Cummins, R. A., Felce, D., Matikka, L., Keith, K. D., & Parmenter, T. (2002). Conceptualization, measurement, and application of quality of life for persons with intellectual disabilities: Report of an international panel of experts. Mental Retardation, 40, 457–470.CrossRefPubMedGoogle Scholar
  53. Schalock, R. L., Gómez, L. E., Verdugo, M. A., & Claes, C. (2017). Evidence and evidence-based practices: Are we there yet? Journal of Intellectual and Developmental Disabilities, 55, 112–119. doi:10.1352/1934-9556-55.2.112.CrossRefPubMedGoogle Scholar
  54. Schalock, R. L., Keith, K. D., Verdugo, M. A., & Gómez, L. E. (2010). Quality of life model development and use in the field of intellectual disability. In R. Kober (Ed.), Enhancing the quality of life for people with intellectual disability (pp. 17–32). Dordrecht: Springer.CrossRefGoogle Scholar
  55. Schalock, R. L., Lee, T., Verdugo, M. A., Swart, K., Claes, C., van Loon, J., et al. (2014). An evidence-based approach to organization evaluation and change in human service organizations evaluation and program planning. Evaluation and Program Planning, 45, 110–118. doi:10.1016/j.evalprogplan.2014.03.012.CrossRefPubMedGoogle Scholar
  56. Schalock, R. L., & Verdugo, M. A. (2002). Quality of life for human service practitioners. Washington, DC: American Association on Mental Retardation.Google Scholar
  57. Schalock, R. L., & Verdugo, M. A. (2012). A conceptual and measurement framework to guide policy development and systems change. Journal of Policy and Practice in Intellectual Disabilities, 7, 71–81. doi:10.1111/j.1741-1130.2012.00329.x.Google Scholar
  58. Schalock, R. L., Verdugo, M. A., Bonham, G. S., Fantova, F., & Van Loon, J. (2008). Enhancing personal outcomes: Organizational strategies, guidelines, and examples. Journal of Policy and Practice in Intellectual Disabilities, 5, 18–28.CrossRefGoogle Scholar
  59. Schalock, R. L., Verdugo, M. A., & Gómez, L. E. (2011). Evidence-based practices in the field of intellectual and developmental disabilities: An international consensus approach. Evaluation and Program Planning, 34, 273–282. doi:10.1016/j.evalprogplan.2010.10.004.CrossRefPubMedGoogle Scholar
  60. Schalock, R. L., Verdugo, M. A., Gómez, L. E., & Reinders, H. (2016). Moving us towards a theory of individual quality of life. American Journal of Intellectual and Developmental Disabilities, 121(1), 1–12. doi:10.1352/1944-7558-121.1.1.CrossRefGoogle Scholar
  61. Schalock, R. L., Verdugo, M. A., Jenaro, C., Wang, M., Wehmeyer, M., Xu, J., et al. (2005). Cross-cultural study of quality of life indicators. American Journal on Mental Retardation, 110, 298–311.CrossRefPubMedGoogle Scholar
  62. Shipman, D., Sheldrick, S., & Perrin, E. C. (2011). Quality of life of adolescents with autism spectrum disorders: Reliability and validity of self-reports. Journal of Developmental and Behavioral Pediatrics, 32, 85–89. doi:10.1097/DBP.0b013e318203e558.CrossRefPubMedGoogle Scholar
  63. Simões, C., & Santos, S. (2016). The impact of personal and environmental characteristics on quality of life of people with intellectual disability. Applied Research in Quality Life. doi:10.1007/s11482-016-9466-7.Google Scholar
  64. Taheri, A., Perry, A., & Minne, P. (2016). Examining the social participation of children and adolescents with intellectual disabilities and autism spectrum disorder in relation to peers. Journal of Intellectual Disability Research, 60(5), 4435–4443. doi:10.1111/jir.12289.CrossRefGoogle Scholar
  65. Tavernor, L., Barron, E., Rodgers, J., & McConachie, H. (2013). Finding out what matters: Validity of quality of life measurement in young people with ASD. Child, 39(4), 592–601. doi:10.1111/j.1365-2214.2012.01377.x.Google Scholar
  66. Thompson, J. R., Bradley, V. J., Buntinx, W. H. E., Schalock, R. L., Shogren, K. A., Snell, M. E., et al. (2009). Conceptualizing supports and the support needs of people with intellectual disability. Intellectual and Developmental Disabilities, 47(2), 135–146.CrossRefPubMedGoogle Scholar
  67. Tonnsen, B. L., Boan, A. D., Bradley, C. C., Charles, J., Cohen, A., & Carpenter, L. A. (2016). Prevalence of autism spectrum disorders among children with intellectual disability. American Journal on Intellectual and Developmental Disabilities, 121(6), 487–500. doi:10.1352/1944-7558-121.6.487.CrossRefPubMedGoogle Scholar
  68. Totsika, V., Felce, D., Kerr, M., & Hastings, R. P. (2010). Behavior problems, psychiatric symptoms, and quality of life for older adults with intellectual disability with and without autism. Journal of Autism and Developmental Disorders, 40, 1171–1178.CrossRefPubMedGoogle Scholar
  69. Tureck, K., & Matson, J. L. (2012). An examination of the relationship between autism spectrum disorder, intellectual functioning, and social skills in children. Journal of Developmental and Physical Disabilities, 24, 607–615. doi:10.1007/s10882-012-9292-2.CrossRefGoogle Scholar
  70. van Heijst, B. F. C., & Geurts, H. M. (2015). Quality of life in autism across the lifespan: A meta-analysis. Autism, 19, 158–167. doi:10.1177/1362361313517053.CrossRefPubMedGoogle Scholar
  71. van Loon, J. H., Bonham, G. S., Peterson, D. D., Schalock, R. L., Claes, C., & Decramer, A. E. (2013). The use of evidence-based outcomes in systems and organizations providing services and supports to persons with intellectual disability. Evaluation and Program Planning, 36, 80–87. doi:10.1016/j.evalprogplan.2012.08.002.CrossRefPubMedGoogle Scholar
  72. van Wijngaarden-Cremers, P. J. M., van Eeten, E., Groen, W. B., Van Deurzen, P. A., Oosterling, I. J., & Van der Gaag, R. J. (2014). Gender and age differences in the core triad of impairments in autism spectrum disorders: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 44, 627–635. doi:10.1007/s10803-013-1913-9.CrossRefPubMedGoogle Scholar
  73. Verdugo, M. A., Arias, B., Gómez, L. E., & Schalock, R. L. (2010). Development of an objective instrument to assess quality of life in social services: Reliability and validity in Spain. International Journal of Clinical and Health Psychology, 10(1), 105–123.Google Scholar
  74. Verdugo, M. A., Gómez, L. E., Arias, B., Navas, P., & Schalock, R. L. (2014). Measuring quality of life in people with intellectual and multiple disabilities: Validation of the San Martín scale. Research in Developmental Disabilities, 35, 75–86.CrossRefPubMedGoogle Scholar
  75. Verdugo, M. A., Navas, P., Gómez, L. E., & Schalock, R. L. (2012). The concept of quality of life and its role in enhancing human rights in the field of intellectual disability. Journal of Intellectual Disability Research, 56, 1036–1045.CrossRefPubMedGoogle Scholar
  76. Viecili, M. A., & Weiss, J. A. (2015). Reliability and validity of the pediatric quality of life inventory with individuals with intellectual and developmental disabilities. American Journal on Intellectual and Developmental Disabilities, 120(4), 289–301. doi:10.1352/1944-7558-120.4.289.CrossRefPubMedGoogle Scholar
  77. Vohra, R., Madhavam, S., & Sambamoorthi, U. (2016). Emergency department use among adults with autism spectrum disorders (ASD). Journal of Autism and Developmental disorders, 46, 1441–1454. doi:10.1007/s10803-015-2692-2.CrossRefPubMedPubMedCentralGoogle Scholar
  78. Wang, M., Schalock, R. L., Verdugo, M. A., & Jenaro, C. (2010). Examining the factor structure and hierarchical nature of the quality of life construct. American Journal on Intellectual and Developmental Disabilities, 115(3), 218–233.CrossRefPubMedGoogle Scholar
  79. Wu, A. D., Li, Z., & Zumbo, B. D. (2007). Decoding the meaning of factorial invariance and updating the practice of multi-group confirmatory factor analysis: A demonstration with TIMSS data. Practical Assessment, Research and Evaluation, 12(3), 1–26.Google Scholar
  80. Zerbo, O., Massolo, M., Qian, Y., & Croen, L. A. (2015). A study of physician knowledge and experience with autism in adults in a large integrated healthcare system. Journal of Autism and Developmental Disorders, 45, 4002–4014. doi:10.1007/s10803-015-2579-2.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Víctor B. Arias
    • 1
  • Laura E. Gómez
    • 2
    • 3
  • Mª Lucía Morán
    • 2
  • Mª Ángeles Alcedo
    • 2
  • Asunción Monsalve
    • 2
  • Yolanda Fontanil
    • 2
  1. 1.Universidad de TalcaMauleChile
  2. 2.Universidad de OviedoOviedoSpain
  3. 3.Faculty of PsychologyUniversity of OviedoOviedoSpain

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