Journal of Autism and Developmental Disorders

, Volume 48, Issue 2, pp 341–350 | Cite as

Diagnosing Autism in Adults with Intellectual Disability: Validation of the DiBAS-R in an Independent Sample

  • Manuel Heinrich
  • Julia Böhm
  • Tanja Sappok
Original Paper


The study assessed the diagnostic validity of the diagnostic behavioral assessment for autism spectrum disorders-revised (DiBAS-R; 19-item screening scale based on ratings by caregivers) in a clinical sample of 381 adults with ID. Analysis revealed a sensitivity of 0.82 and a specificity of 0.67 in the overall sample (70.3% agreement). Sensitivity (0.79) and specificity (0.84) were balanced in individuals with mild to moderate ID (83.3% agreement), while specificity was lower in individuals with severe to profound ID (sensitivity: 0.83, specificity: 0.34, 51% agreement). The level of ID as well as its interaction with ASD explained a significant proportion of the variance in the DiBAS-R scores. The DiBAS-R is an adequate screening tool, especially in individuals with mild to moderate ID.


Autism spectrum disorder (ASD) Intellectual disability Diagnostic behavioral assessment for autism spectrum disorders-revised DiBAS-R Screening 



We are grateful to the participants, their families, and caregivers for participation. Thanks a lot to Heika Kaiser for the psychometric evaluations (SCQ, PDD-MRS, ADOS, and ADI-R) and to the hospital staff, especially the nurses and special needs caregivers, who helped in data collection.

Author contributions

TS and JB collected the data. All authors contributed in data analysis and interpretation and writing of the manuscript. All authors read and approved the final manuscript.

Compliance with Ethical Standards

Ethical Approval

The study was approved by the respective ethics committee (Berlin: KEH ethics committee, approval granted 06/10/2009 and Landeskrankenhausgesetz §25.1, version 9/2011).

Informed Consent

All participants provided informed consent, or a consultee of legal guardian did so on their behalf.

Research Involving with Human Participants

All procedures involving human participants were performed in accordance with the ethical standards of the institutional research committees where the data were collected, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. APA. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  2. Bergmann, T., Diefenbacher, A., Heinrich, M., Riedel, A., & Sappok, T. (2016). Perspektivenverschränkung: Multiprofessionelle Autismusdiagnostik bei erwachsenen Menschen mit Intelligenzminderung. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie. doi: 10.1024/1661-4747/a000287.Google Scholar
  3. Bergmann, T., Sappok, T., Diefenbacher, A., Dames, S., Heinrich, M., Ziegler, M., et al. (2015). Music-based autism diagnostics (MUSAD)—A newly developed diagnostic measure for adults with intellectual developmental disabilities suspected of autism. Research in Developmental Disabilities. doi: 10.1016/j.ridd.2015.05.011.PubMedGoogle Scholar
  4. 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.CrossRefPubMedGoogle Scholar
  5. Brooks, W. T., & Benson, B. A. (2013). The validity of the social communication questionnaire in adults with intellectual disability. Research in Autism Spectrum Disorders. doi: 10.1016/j.rasd.2012.10.002.Google Scholar
  6. Charman, T., & Gotham, K. (2013). Measurement Issues: Screening and diagnostic instruments for autism spectrum disorders—Lessons from research and practice. Child and Adolescent Mental Health. doi: 10.1111/j.1475-3588.2012.00664.x.PubMedGoogle Scholar
  7. Derks, O., Heinrich, M., Brooks, W., Sterkenburg, P., McCarthy, J., Underwood, L., et al. (2017). The social communication questionnaire for adults with intellectual disability: SCQ-AID. Autism Research. doi: 10.1002/aur.1795.PubMedGoogle Scholar
  8. Dilling, H. (Ed.). (2014). Internationale Klassifikation psychischer Störungen: ICD-10 Kapitel V (F), Klinisch-diagnostische Leitlinien (9th edn.). Bern: Huber.Google Scholar
  9. Glascoe, F. P. (2005). Screening for developmental and behavioral problems. Developmental Disabilities Research Reviews, 11(3), 173–179.Google Scholar
  10. Goldman, S., Wang, C., Salgado, M. W., Greene, P. E., Kim, M., & Rapin, I. (2009). Motor stereotypies in children with autism and other developmental disorders. Developmental Medicine and Child Neurology. doi: 10.1111/j.1469-8749.2008.03178.x.PubMedGoogle Scholar
  11. Holmes, N., Shah, A., & Wing, L. (1982). The disability assessment schedule: A brief screening device for use with the mentally retarded. Psychological Medicine, 12(4), 879–890.CrossRefPubMedGoogle Scholar
  12. Horovitz, M., Matson, J. L., Hattier, M. A., Tureck, K., & Bamburg, J. W. (2013). Challenging behaviors in adults with intellectual disability: The effects of race and autism spectrum disorders. Journal of Mental Health Research in Intellectual Disabilities. doi: 10.1080/19315864.2011.605989.Google Scholar
  13. Kim, S. H., & Lord, C. (2012). Combining information from multiple sources for the diagnosis of autism spectrum disorders for toddlers and young preschoolers from 12 to 47 months of age. Journal of Child Psychology and Psychiatry, and Allied Disciplines. doi: 10.1111/j.1469-7610.2011.02458.x.Google Scholar
  14. Kraijer, D., & de Bildt, A. (2005). The PDD-MRS: An instrument for identification of autism spectrum disorders in persons with mental retardation. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-005-5040-0.Google Scholar
  15. 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: JIDR. doi: 10.1111/j.1365-2788.2003.00567.x.PubMedGoogle Scholar
  16. Looney, S. W., & Hagan, J. L. (2015). Analysis of biomarker data: A practical guide (1st ed.). London: Wiley.Google Scholar
  17. Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., et al (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.CrossRefPubMedGoogle Scholar
  18. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism diagnostic interview-revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.CrossRefPubMedGoogle Scholar
  19. Matson, J. L., Boisjoli, J. A., González, M. L., Smith, K. R., & Wilkins, J. (2007). Norms and cut off scores for the autism spectrum disorders diagnosis for adults (ASD-DA) with intellectual disability. Research in Autism Spectrum Disorders. doi: 10.1016/j.rasd.2007.01.001.Google Scholar
  20. Matson, J. L., Dempsey, T., Lovullo, S. V., & Wilkins, J. (2008a). The effects of intellectual functioning on the range of core symptoms of autism spectrum disorders. Research in Developmental Disabilities. doi: 10.1016/j.ridd.2007.06.006.Google Scholar
  21. 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. doi: 10.1016/j.ridd.2009.05.008.Google Scholar
  22. Matson, J. L., & Shoemaker, M. (2009). Intellectual disability and its relationship to autism spectrum disorders. Research in Developmental Disabilities. doi: 10.1016/j.ridd.2009.06.003.Google Scholar
  23. Matson, J. L., Wilkins, J., & Ancona, M. (2008b). Autism in adults with severe intellectual disability: An empirical study of symptom presentation. Journal of Intellectual and Developmental Disability. doi: 10.1080/13668250701829837.Google Scholar
  24. Matson, J. L., Wilkins, J., Boisjoli, J. A., & Smith, K. R. (2008c). The validity of the autism spectrum disorders-diagnosis for intellectually disabled adults (ASD-DA). Research in Developmental Disabilities. doi: 10.1016/j.ridd.2007.09.006.Google Scholar
  25. McCarthy, J., Hemmings, C., Kravariti, E., Dworzynski, K., Holt, G., Bouras, N., et al. (2010). Challenging behavior and co-morbid psychopathology in adults with intellectual disability and autism spectrum disorders. Research in Developmental Disabilities. doi: 10.1016/j.ridd.2009.10.009.Google Scholar
  26. Meins, W., & Sussmann, D. (1993). Evaluation of an adaptive behaviour classification for mentally retarded adults. Social Psychiatry and Psychiatric Epidemiology, 28(4), 201–205.CrossRefPubMedGoogle Scholar
  27. Mutsaerts, C. G., Heinrich, M., Sterkenburg, P. S., & Sappok, T. (2016). Screening for ASD in adults with ID-moving toward a standard using the DiBAS-R and the ACL. Journal of Intellectual Disability Research: JIDR. doi: 10.1111/jir.12290.PubMedGoogle Scholar
  28. Norris, M., & Lecavalier, L. (2010). Screening accuracy of Level 2 autism spectrum disorder rating scales. A review of selected instruments. Autism: The International Journal of research and practice. doi: 10.1177/1362361309348071.Google Scholar
  29. Planelles-Fernández, I., Gallardo-Pujol, D., Labad, A., Godall, D., Cristia, N., Gutiérrez-Zotes, A., et al. (2017). Spanish adaptation of the autism spectrum disorders—diagnosis for adults (ASD-DA) in adults with severe and profound intellectual disability. Journal of Developmental and Physical Disabilities. doi: 10.1007/s10882-017-9541-5.Google Scholar
  30. R Core Team (2016). R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing.Google Scholar
  31. Risi, S., Lord, C., Gotham, K., Corsello, C., Chrysler, C., Szatmari, P., et al. (2006). Combining information from multiple sources in the diagnosis of autism spectrum disorders. Journal of the American Academy of Child and Adolescent Psychiatry. doi: 10.1097/01.chi.0000227880.42780.0e.PubMedGoogle Scholar
  32. Robin, X., Turck, N., Hainard, A., Tiberti, N., Lisacek, F., Sanchez, J. -C., et al. (2011). pROC: An open-source package for R and S + to analyze and compare ROC curves. BMC Bioinformatics. doi: 10.1186/1471-2105-12-77.PubMedPubMedCentralGoogle Scholar
  33. Rutter, M., Bailey, A., Lord, C., & Berument, S. K. (2003). Social Communication Questionnaire. LA: Western Psychological Services.Google Scholar
  34. Saemundsen, E., Juliusson, H., Hjaltested, S., Gunnarsdottir, T., Halldorsdottir, T., Hreidarsson, S., et al. (2010). Prevalence of autism in an urban population of adults with severe intellectual disabilities—a preliminary study. Journal of Intellectual Disability Research : JIDR. doi: 10.1111/j.1365-2788.2010.01300.x.PubMedGoogle Scholar
  35. Sappok, T., Bergmann, T., Kaiser, H., & Diefenbacher, A. (2010). Autismus bei erwachsenen Menschen mit geistiger Behinderung. Der Nervenarzt, 81(11), 1333–1345.CrossRefPubMedGoogle Scholar
  36. Sappok, T., Budczies, J., Dziobek, I., Bolte, S., Dosen, A., & Diefenbacher, A. (2014a). The missing link: Delayed emotional development predicts challenging behavior in adults with intellectual disability. Journal of Autism and Developmental Disorders. doi: 10.1007/s10803-013-1933-5.PubMedGoogle Scholar
  37. Sappok, T., Diefenbacher, A., Budczies, J., Schade, C., Grubich, C., Bergmann, T., et al. (2013). Diagnosing autism in a clinical sample of adults with intellectual disabilities: How useful are the ADOS and the ADI-R? Research in Developmental Disabilities. doi: 10.1016/j.ridd.2013.01.028.PubMedGoogle Scholar
  38. Sappok, T., Diefenbacher, A., Gaul, I., & Bölte, S. (2015a). Validity of the social communication questionnaire in adults with intellectual disabilities and suspected autism spectrum disorder. American Journal on Intellectual and Developmental Disabilities. doi: 10.1352/1944-7558-120.3.203.PubMedGoogle Scholar
  39. Sappok, T., Gaul, I., Bergmann, T., Dziobek, I., Bölte, S., Diefenbacher, A., et al. (2014b). The diagnostic behavioral assessment for autism spectrum disorder—Revised: A screening instrument for adults with intellectual disability suspected of autism spectrum disorders. Research in Autism Spectrum Disorders. doi: 10.1016/j.rasd.2013.12.016.Google Scholar
  40. Sappok, T., Heinrich, M., & Diefenbacher, A. (2014c). Psychometrische Eigenschaften der Autismus-Checkliste (ACL) für erwachsene Menschen mit Intelligenzminderung. Psychiatrische Praxis. doi: 10.1055/s-0033-1343193.Google Scholar
  41. Sappok, T., Heinrich, M., & Underwood, L. (2015b). Screening tools for autism spectrum disorders. Advances in Autism. doi: 10.1108/AIA-03-2015-0001.Google Scholar
  42. Stevenson, M. (2016). epiR: Tools for the Analysis of Epidemiological Data. R package version 0.9–79.Google Scholar
  43. Wei, T., Chesnut, S. R., Barnard-Brak, L., & Richman, D. (2015). Psychometric analysis of the social communication questionnaire using an item-response theory framework: Implications for the use of the lifetime and current forms. Journal of Psychopathology and Behavioral Assessment. doi: 10.1007/s10862-014-9468-4.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Department of Education and Psychology, Clinical-Psychological InterventionFreie Universität BerlinBerlinGermany
  2. 2.Department of Psychiatry, Psychotherapy and PsychosomaticsEv. Krankenhaus Königin Elisabeth Herzberge (KEH)BerlinGermany
  3. 3.Department of Education and Psychology, Zentrum für Seelische GesundheitFreie Universität BerlinBerlinGermany

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