Exploring the relationship between challenging behaviour and mental health disorder in autistic individuals with intellectual disabilities

Abstract

BackgroundFew studies have explored the relationship between challenging behaviour and mental health symptoms in autistic individuals with intellectual disabilities, and findings have been mixed. While the prevalence of mental health disorder in this population is high, recognition and identification of these disorders may be challenging. No previous study of the relationship with challenging behaviour has used mental health measures specifically developed for this population. MethodUsing a standardised tool for challenging behaviour (Aberrant Behavior Checklist, ABC), differences between participants were explored according to whether they were diagnosed with a mental health disorder, in a clinical sample of 175 autistic individuals with co-occurring intellectual disabilities (ages 14–68) referred for mental health assessment. The relationship between severity of challenging behaviour and severity of mental health symptoms reported on the Psychopathology in Autism Checklist (PAC) was also explored. ResultsFew group differences were identified for challenging behaviour according to diagnosis, but clear associations were identified between PAC and ABC scales. These included general/non-specific associations and more specific associations that remained significant when controlling for the underlying conditions. Potential interactions were found involving different PAC scales and age, gender, autism-related characteristics, level of intellectual disability, and communication skills, respectively, but these varied for each ABC scale. ConclusionsThe relationship between challenging behaviour and mental health disorder appears to be complex and multifaceted. The lack of specificity of challenging behaviour indicates that these cannot reliably be used to identify specific mental health disorders, even if these behaviours may constitute atypical expressions of mental health symptoms.