Social Inclusion of Children with ASD Who Have Moderate to Severe Intellectual Disabilities

Background:  For children with moderate to severe intellectual disabilities (ID), there are often barriers to participating in social situations. This issue may be particularly salient in those children who additionally have a diagnosis of autism spectrum disorders (ASD). Research has shown that children with ASD have fewer friends, are invited less frequently to peer events and generally experience more instances of exclusion than typically developing peers. However, among children with ASD with co-morbid ID, it is difficult to know whether the social isolation experienced derives from intellectual disability or whether the impairment in social skills found in ASD further exacerbates this issue. Although efforts are made by teachers and parents to integrate children with ASD in these situations, understanding the social needs and experiences of children with ASD, over and above those with moderate to severe intellectual disabilities, may allow for true inclusion in schools and the community.

Objectives:  In this study, children with ID with and without ASD were observed at a social, community (e..g, sports, scouts) or school setting (i.e. at recess or during gym class) with a coding scheme designed for behavior observed. We measured the available opportunities for interaction and the rate of actual interactions “in situ”, in order to assess the inclusion of these children in activities with peers and adults to determine the differential experiences of children with ASD and those without.

Methods: 10 children with ASD and ID and 13 children with an ID (ranging from 6.6 to 17.5 years of age; median IQ = 38.68) were observed in unstructured social settings. Total number of available interactions (defined as another person being in close proximity, or within 2 meters, during a social event), total interactions (spoken, play, physical contact, etc.) and who the interaction was with (typically developing peer, peer with a developmental disability or adult). To standardize for differences in observation length, all available opportunities and interactions were calculated as rates per 15 minutes.

Results:  There was no difference between the ID and the ASD + ID groups in the overall proportions of interactions (p > 0.05). However, children with ASD + ID had fewer interactions with peers who had developmental disabilities (13% of available opportunities) compared with children with just ID (36%), t(45) = 2.80, p < 0.01). Within the ASD group, adults had significantly more frequent interactions (33% of available opportunities compared to 13%) than children with developmental disabilities (t(37)= 2.35, p = 0.02).

Conclusions: These results indicate that children with ASD and ID have fewer social interactions with children with developmental disabilities than children with ID alone in unstructured social situations. This lack of interaction with this key group of peers who face similar barriers can exacerbate the isolation experienced by children with ASD. Also, the increased interactions with adults compared to this group, may give caregivers a false impression of social inclusion. Further analyses examining differences in the proportion of interactions within groups, and relations to social and adaptive measures are ongoing.