Evangelisches Krankenhaus Königin-Elisabeth-Herzberge, Department of Psychiatry, Berlin, Germany.
PLoS One. 2013 Sep 16;8(9):e74036. doi: 10.1371/journal.pone.0074036. eCollection 2013.
Individuals with intellectual disability (ID) are at risk for additional autism spectrum disorders (ASD). A large amount of research reveals deficits in emotion-related processes that are relevant to social cognition in ASD. However, studies on the structure and level of emotional development (ED) assessing emotional maturity according to the normative trajectory in typically developing children are scares. The level of ED can be evaluated by the 'Scheme of Appraisal of Emotional Development' (SAED), a semi-structured interview with a close caregiver. The SAED assesses the level of emotional developmental based on a five stage system in 10 domains, for example, 'interaction with peers' or 'object permanence', which are conducive to the overall emotional developmental level. This study examined the ED as measured by the SAED in 289 adults (mean age: 36 years) with ID with and without additional ASD. A lower level in ED was observed in ASD/ID combined that corresponded to the ED of typically developing children aged 1.5-3 years versus an ED with a corresponding age of 3-7 years in ID individuals without ASD. Moreover, distinct strengths in 'object permanence', and weaknesses in 'interaction', 'verbal communication', 'experience of self', 'affect differentiation', 'anxiety', and 'handling of material objects' led to a characteristic pattern of ED in ASD. SAED domains with highest discriminative power between ID individuals with and without ASD (5/10) were used to predict ASD group membership. The classification using a selection of SAED domains revealed a sensitivity of 77.5% and a specificity of 76.4%. ASD risk increased 2.7-fold with every SAED level. The recognition of delayed and uneven pattern of ED contributes to our understanding of the emotion-related impairments in adults with ID and ASD these individuals. Assessment of intra-individual ED could add value to the standard diagnostic procedures in ID, a population at risk for underdiagnosed ASD.
个体患有智力障碍 (ID) 时，同时患有自闭症谱系障碍 (ASD) 的风险会增加。大量研究表明， ASD 患者在与社会认知相关的情绪相关过程中存在缺陷。然而，评估情绪发展 (ED) 结构和水平的研究很少，这些研究根据典型发育儿童的规范轨迹来评估情绪成熟度。ED 水平可以通过“情绪发展评估方案”（SAED）进行评估，这是一种与亲密照顾者进行的半结构化访谈。SAED 根据 10 个领域的五个阶段系统评估情绪发展水平，例如“与同龄人互动”或“物体恒常性”，这些都有利于整体情绪发展水平。本研究通过 SAED 评估了 289 名 ID 合并 ASD 或不合并 ASD 的成年人的 ED。在 ASD/ID 合并组中观察到 ED 水平较低，这与 ASD 组中典型发育儿童 1.5-3 岁的 ED 水平相对应，而 ID 组中不合并 ASD 的 ED 水平对应于 3-7 岁。此外，“物体恒常性”方面的优势明显，而“互动”、“言语交流”、“自我体验”、“情感分化”、“焦虑”和“物质对象处理”方面的劣势明显，这导致了 ASD 中 ED 的特征模式。在 ID 患者中，SAED 领域具有最高鉴别力（5/10），可用于预测 ASD 组的成员。使用一组 SAED 领域进行分类的敏感性为 77.5%，特异性为 76.4%。SAED 水平每增加一级，ASD 风险增加 2.7 倍。对 ED 延迟和不平衡模式的识别有助于我们理解 ID 和 ASD 个体的情绪相关障碍。个体 ED 的评估可以为 ID 人群的标准诊断程序增加价值，ID 人群存在未被诊断出的 ASD 风险。
