Usual Care Intervention Practices for Youth with Co-Occurring Autism Spectrum Disorder and Intellectual Disability

Background: Approximately 31% of children with Autism Spectrum Disorder (ASD) have a comorbid intellectual disability (ID) (Baio et al., 2018). As co-occurring ID has been found to predict poor prognosis in ASD (Matson & Shoemaker, 2009), there is a need to better understand the usual care of core social and associated psychiatric symptoms in this population.

Objectives: Understanding usual care for youth (ages 7-22) with ASD and ID is important for advancing the dissemination of evidence-based practices (EBPs) and decreasing treatment disparities in this population. We collected usual care information from expert ASD providers in order to assess self-reported familiarity and use of common practices for treating youth with ASD and ID.

Methods: Expert ASD providers (N= 53) representing multiple disciplines across 5 sites were recruited via purposeful sampling. Experts reviewed and suggested revisions to 49 literature-derived practices through a two-round Delphi poll, then rated a revised list of 55 practices on familiarity and use across three domains: anxiety, externalizing behaviors, and social skills. Round 2 ratings of experts who endorsed frequently treating youth with comorbid ID (n= 26) were compared with those of experts who never or rarely treat youth with comorbid ID (n= 27).

Results: Chi-square analyses indicated that experts who frequently work with individuals with ASD and ID are significantly less familiar with Psychoeducation (c2= 4.337, p= .037). In treating anxiety, they are more likely to use Functional Behavior Assessment (c2= 4.48, p= .034) and Suppression Approach (c2= 4.971, p= .026) and less likely to use Self-Management (c2= 3.927, p= .048). In treating externalizing behaviors, experts who work with youth with ID are more likely to use Didactic Teaching (c2= 4.369, p= .037), Shaping (c2= 4.043, p= .044), Stimulus Control (c2= 7.619, p= .006), Suppression Approach (c2= 3.846, p= .050), and Token Economy (c2= 4.609, p= .032). In treating social skills, they are more likely to use Providing Choices (c2= 5.88, p= .015), Noncontingent Reinforcement (c2= 5.299, p = .021), Response Cost (c2= 4.886, p= .027), Stimulus Control (c2= 8.292, p= .004), Suppression Approach (c2= 7.127, p = .008), Imitating the Child (c2= 4.9, p= .027), and Communicative Temptations (c2= 3.886, p= .049), and less likely to use Self-Management (c2= 8.265, p= .004).

Conclusions: Findings suggest that expert community providers who commonly treat youth with ASD and ID are more likely to use specific discrete intervention strategies, particularly suppression and stimulus control, for treating anxiety, externalizing behaviors, and social skills than those who treat youth with ASD without comorbid ID. This information could inform research on the dissemination and implementation of EBPs for youth with ASD and ID.