Research in Developmental Disabilities 30 (2009) 1406–1412

Contents lists available at ScienceDirect

Research in Developmental
Disabilities

Emotional development and adaptive abilities in adults with

intellectual disability. A correlation study between the
Scheme of Appraisal of Emotional Development (SAED)
and Vineland Adaptive Behavior Scale (VABS)
Giampaolo La Malfa a,b,d, Stefano Lassi a,b,d,e,*, Marco Bertelli a,b,f,
Giorgio Albertini a,c, Anton Dosen d,g
a
Italian Association on Mental Retardation (SIRM), Italy
b
Department of Psychiatry, University of Florence, Italy
c
IRRCS San Raffaele Pisana, Rome, Italy
d
EAMHID European Association for Mental Health in Intellectual Disability, The Netherlands
e
ODA Diacceto, Florence, Italy
f
WPA- section psychiatry of intellectual disability, Italy
g
Radboud University, Nijmegen, Netherlands

A R T I C L E I N F O A B S T R A C T

Article history: The importance of emotional aspects in developing cognitive and

Received 13 June 2009 social abilities has already been underlined by many authors even if
Accepted 19 June 2009 there is no unanimous agreement on the factors constituting
adaptive abilities, nor is there any on the way to measure them or on
Keywords: the relation between adaptive ability and cognitive level. The
Emotional development purposes of this study was to test the psychometric characteristics
Adaptive abilities of a specific tool for the assessment of the emotional development
Intellectual disability
and correlating such test with the Vineland Adaptive Behavior
Behavior
Scale, one of the most widely used tools to assess adaptive abilities
Assessment
in order to verify possible correlations between emotional
development and adaptive abilities.
Thirty-three adults living in residential centres for people with
Intellectual Disability without psychiatric/behavioral disorders of
clinical significance, were evaluated by administering the Scheme
of Appraisal of Emotional Development (SAED) and the Vineland
Adaptive Behavior Scale (VABS) and a statistical analysis was been
conducted to verify possible correlations. The SAED proved to be a
reliable psychometric tool and a strong positive correlation has

* Corresponding author at: Via Casentinese, 73/f, 50068 Diacceto, Firenze, Italy. Tel.: +39 0558327004; fax: +39 0558327004.
E-mail address: stefanolassi@libero.it (S. Lassi).

0891-4222/$ – see front matter ß 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ridd.2009.06.008
 G. La Malfa et al. / Research in Developmental Disabilities 30 (2009) 1406–1412 1407

indeed emerged between VABS’ and SAED’s general scores, therefore as

the emotional development age increases so does at the same time
adaptive age. The need to complete the assessment of adaptive abilities
with that of emotional development seems therefore confirmed. Such
tools provide the opportunity to gather extremely important information
on the emotional needs of particular person regardless of the presence or
absence of Intellectual Disability.
ß 2009 Elsevier Ltd. All rights reserved.

1. Introduction

The importance of emotion in developing cognitive and social abilities had been emphasized by
Vygotskij (1973). Additionally, attachment theory stresses that in every age and culture, affectivity,
cognitivity and behaviors are closely correlated to the normal development of infants (Waters &
Cummings, 2000).
Affective states seem to have a particular influence on attentive processes, reconfirming that the
interaction between emotion and cognition in developing social competence is highly significant
(Keenan, 2002). The interaction between emotion and acquisition of social competence starts in early
infancy through the mother/infant relationship (Kirsh, Crnic, & Greenberg, 1995), but is later
influenced by the relation between child and teacher (Ellis, 2000).
During adolescence, the relation between affectivity and cognitivity continues, although the
number of studies on this topic is limited (Rosso, Young, Femia, & Yurgelun-Todd, 2004). At this stage
of life, activation patterns in the prefrontal cortex mediate cognitive control in emotional situations.
Various neurobehavioral changes connected with puberal development also have important
consequences not only on motivation and emotion but also on acquisition of social competence
(Dahl, 2004; Lewis & Stieben, 2004). These factors also hold for the development of children and
adolescents with Intellectual Disabilities.
Currently, Intellectual Disability is defined as significant limitations in intellectual functioning
and in adaptive behavior with onset before age 18 years of age (AAMR, 2002). The diagnostic criteria
point out the importance of adaptive abilities, yet, this concept is extremely broad and includes three
different domains (conceptual, social, practical) that, in their turn, comprise several abilities. To date,
there is no unanimous agreement on the factors constituting adaptive abilities, nor is there any one
best way to measure them or on the relation between adaptive ability and intelligence; therefore,
although their importance is self-evident in defining and diagnosing Intellectual Disability,
‘‘adaptive abilities’’ remain an ‘‘open question’’ (Schalock, 1999). Different authors from a
Developmental Perspective (Cicchetti & Ganiban, 1990; Izard & Harris, 1995; Kasari & Bauminger,
1998) argue that other aspects, among which emotional development, play an important role in
adaptive abilities and behavior. Unfortunately until recently the issue of emotional development in
persons with Intellectual Disability has received little attention from professionals. According to
different investigations (Dosen, 2005a; Greenspan & Wieder, 1998; Whitman, O’Callaghan, &
Sommer, 1997) persons with Intellectual Disability are not only cognitively, but also emotionally
different from typically developing children. Additionally, there are meanings that emotional
development in persons with Intellectual Disability is often more affected than intellectual
development.
At each level of emotional development, different emotional needs and motivations, different
coping abilities and different abilities to adapt to the environment, and consequently different
behavioral patterns can be found. Apparently, the aspect of emotional development is an important
factor which should be counted in the measurement of adaptive behavior. The level of emotional
development is an important factor in onset and presentation of maladaptive behavior as well as in
onset and presentation of psychopathology (Dosen, 2005a,b). This factor is important for
understanding psychopathology in its chronological development, from very early infancy to
adulthood.
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In the light of the above considerations, an integrated, multilevel and biopsychosocial model of
psychopathology has developed in the past few years (Cicchetti & Ganiban, 1990; Izard & Harris, 1995;
Kasari & Bauminger, 1998). This approach highlights the influence of numerous factors on correlated
disorders and phenotypes; the combined influence of variables of different levels of analysis (i.e.
genetic, biochemical, physiological, cognitive, social, emotional, environmental) on outcomes; the
dynamical and probabilistic relations of behavioral outcomes. A growing theoretical interest has been
raised by this approach to psychopathology.
On the other hand, there is a lack of specific tools for the assessment of the emotional development
and basic psychosocial needs. The work carried out by Harris (1998) has suggested an integrated view
of the emotional and cognitive development of children and of its psychopathology at a theoretical
level, but few authors have given practical application to these concepts (Bax, 2002).
One of the few exception is represented by Greenspan (Greenspan, 1997) who, starting from the
notion that human emotions are the main factor underlying the development of all human intellectual
activities, has identified seven significant stages in emotional development (Greenspan & Benderly,
1998). Following such an approach, Briggs-Gowan and Carter have drawn up a specific tool for
assessing these stages, the Brief Infant-Toddler Social and Emotional Assessment (BITSEA) that has
been validated and recently used to study mental health problems in infants under 2 years of age
(Briggs-Gowan, Carter, Irwin, Wachtel, & Cicchetti, 2004).
Dosen has recently pointed out how the psychosocial development lines postulated in infants by
different theories (Piaget’s cognitive, Mahler’s psychodynamical, Erickson’s and Bolbwy’s relational
theories) can also be found in infants and adults with Intellectual Disability (Dosen, 2001). Combining
these basic theoretical concepts, has given rise to an assessment tool specific to the emotional
development of people, both in their infancy and adulthood, called ‘‘Scheme of Appraisal of Emotional
Development’’ (SAED, Dosen, 2005a). It is a tool that has met with great interest by professionals.
Although theoretical studies have confirmed the validity of this tool, especially in Dutch, where it is
used in their daily clinical practice, there is still a lack of satisfactory standardization and reliability.
The purposes of this study were to: a) correlate the SAED with the Vineland Adaptive Behavior
Scale (VABS), one of the most widely used tools to assess adaptive abilities in order to verify possible
correlations between emotional development and adaptive abilities, and; b) to test the psychometric
characteristics of the SAED.

2. Methods

2.1. Participants

This study had 33 adult participants, 27% females and 73% males, with a 39.55 average age (age
range 20–59), living in residential centres for people with Intellectual Disability. Personal records gave
the opportunity to determine level of Intellectual Disability, which was moderate in 46%, severe in 51%
and profound in 3% of the cases.
Inclusion in the study required the absence of psychiatric/behavioral disorders of clinical
significance, which was evaluated by administering the Diagnostic Assessment for the Severely
Handicapped–revised (DASH-II, Matson, 1995), in the Italian validated version (Guaraldi, Ruggerini,
Nevian, & Vicini, 2002).
The emotional development of participants was assessed by the Scheme of Appraisal of Emotional
Development (SAED, Dosen, 2005a,b). SAED involves five development stages (1.0–6 months
corresponds to the adaptation and integration of sensory stimuli, the integration of spatial and
temporal structures and of people; 2.6–18 months corresponds to socialization, secure attachment to
bonding, basic emotional security; 3.18–36 months corresponds to the identification, differentiation
of the Self from others, separation, autonomy; 4.3–7 years corresponds to the identification and
formation of the Ego; 5.7–12 years corresponds to reality awareness).
During each of these phases 10 psychosocial factors are appraised (the way in which the person
deals with his/her body; the interaction with the caregiver; the interaction with one’s peers; the
manipulation of objects; affective differentiation; verbal communication; anxiety; the permanence of
the object; the experience of the self; the control of aggressiveness), evaluating what level of
 G. La Malfa et al. / Research in Developmental Disabilities 30 (2009) 1406–1412 1409

emotional development can be attributed for that particular factor. When five or more factors are
evaluated on or under a particular phase boundary, this development phase can be indicated as
average emotional development level for that participant.
The SAED is drawn up by trained professionals who directly monitor the participant (also by means
of videos) or interview caregivers. With regard to the interview each item comes in three questions
which help assessing number of endorsements on that particular factor.
Adaptive abilities are appraised by the Vineland Adaptive Behavior Scale (Sparrow, Balla, &
Cicchetti, 1984) in its Italian version (Balboni & Pedrabissi, 2004). The VABS is a semistructured
interview including four domains with related subdomains: Communication area (Receptive,
Expressive and Written); Daily Living Skills area (Personal, Domestic, Community); Socialization area
(Interpersonal Relationships, Play and Leisure time, Coping Skills); Motor Skills (Gross and Fine).
This study was performed by expert clinicians specifically training for administering both VABS
and SAED (the latter was directly overseen by Prof. A. Dosen). Previously, an inter-rater reliability had
been established with a coefficient K of 0.75 defined as ‘‘substantial’’ following Landis’ and Koch’s
terminology (Landis & Koch, 1977). With respect to gender, age and Intellectual Disability, severity of
our sample as opposed to VABS and SAED data a multivaried analysis was used. The trend and average
of the data obtained by the two scales were examined by means of Pearson’s calculation of the
correlation by matched samples and, consequently, by means of the t-test. Pearson’s correlation test
was applied between the average of SAED overall result and the averages of VABS subdomains:
‘‘Communication’’, ‘‘Daily Living Skills’’, ‘‘Socialization’’, ‘‘Motor Skills’’. SAED underwent the reliability
test.

3. Results

The multivaried analysis showed that gender, age and Intellectual Disability level did not influence
data significantly (see Table 1).
The results acquired by Pearson’s correlation of matched samples on the trend of SAED and VABS
values were a significant at .002 (see Table 2). The t-test applied to SAED (2.73) and VABS (2.61) trend
values showed substantial overlapping (see Table 3).
The statistical analysis of Pearson’s matched samples correlation (see Table 4) applied to the
average values of the two tests showed a positive correlation .657 (sig. .000). The t-test application to
the VABS and SAED average values did not show statistically significant differences (see Table 5).
A positive correlation of <.001 between SAED values and ‘‘Communication’’, ‘‘Daily Living Skills’’,
‘‘Socialization’’ subdomains was highlighted, whereas there resulted no statistically significant
correlation with the ‘‘Motor Skills’’ subdomains (see Table 6).
The reliability analysis, correspondence and internal consistency of SAED were verified by the
reliability test (Crowder, Kimber, Sweeting, & Smith, 1991), which underscored an alfa of Cronbach of
.958.
Within the reliability test, internal consistency gave a correlation value between the overall SAED
result and the 10 psychosocial aspects ranging from a .924 high for ‘‘interaction with peers’’ to a .624
low for ‘‘control of aggressiveness’’. The internal test correspondence was appraised by the Anova
reliability analysis, with a value of F = 8.450 and P  .000 and df 10. High significance allows to state
that values do not differ random (Fisher, 1958, 1973).

Table 1
SAED and VABS analysis by gender, severity and subject’s age covariance.

Items Mean Square F Sig.

Gender  Severity SAED Stage Level .536 .396 .534

VABS Trend Age .653 .117 .735
VABS Average Age 4.519 1.347 .256

Subjects’ age SAED Stage Level 2.999 2.217 .148

Covariance VABS Average Age 1.594 .284 .598

VABS Average Age .100 .030 .864
1410 G. La Malfa et al. / Research in Developmental Disabilities 30 (2009) 1406–1412

Table 2
Pearson’ test of SAED and VABS total scores and trend.

N Correlation Sig.

SAED Stage Level and VABS Age Trend 33 .512 .002

Table 3
t-Test Trend of SAED and VABS.

Trend N Standard deviation

SAED Stage Level 2.73 33 1.306

VABS age (years) 2.61 33 2.499

Differences (by) couples t df Sig. (2-code)

Difference Trend Standard Deviation

SAED Stage Level and VABS Age Years .121 2.147 .324 32 .748

Table 4
Pearson’ test Average of SAED and VABS total scores.

N Correlation Sig.

SAED Stage Level and VABS Age Years Average 33 .657 .000

Table 5
t-Test VABS Average values and SAED Stage.

Average N Standard Deviation Average standard Error

SAED Stage Level 2.73 33 1.306 .227

VABS Age Years 3.24 33 2.194 .382

Differences (by) couples t df Sig. (2-code)

Mean Difference Standard Deviation

SAED Stage Level–VABS Age Years .515 1.661 1.782 32 .084

4. Discussion

There is theoretical unanimous agreement on the mutual interrelation between cognitive and
emotional developments. In our assumption the same is between emotional development and
adaptive abilities. The data gathered by our research are an experimental test of this concept. A strong
positive correlation has indeed emerged between VABS’ and SAED’s general scores, therefore as the
emotional development age increases so does at the same time adaptive age. VABS domains,
‘‘Communication’’, ‘‘Daily Living Skills’’, ‘‘Socialization’’, turned out to be equally positively correlated
with SAED. The reliability of these results is still further confirmed by the lack of statistically
significant correlation with the area of VABS that is not correlated with emotional aspects, ‘‘Motor
Skills’’.
The correlation of adaptive abilities in Intellectual Disability subjects with motivational and,
therefore, emotional aspects has already been underlined, for example, by de Bildt et al. (2005). In
their studies they pointed out that ‘‘subtle adaptive abilities’’ distinguish children with Intellectual
Disability with and without autistic traits. These aspects, which are connected to motivation, are not
generally detected by the usual tools employed in evaluating adaptive abilities. The need to complete
the assessment of adaptive abilities with that of emotional development (Dosen, 2005a,b) seems
therefore confirmed. The evaluation of emotional development, as opposed to adaptive abilities, gives
the opportunity to gather extremely important information on the emotional needs of particular
 G. La Malfa et al. / Research in Developmental Disabilities 30 (2009) 1406–1412 1411

Table 6
Pearson’ test Average of SAED total values and VABS subscale values ‘‘Communication’’, ‘‘Daily Living Skills’’, ‘‘Socialization’’,
‘‘Motor Skills’’.

VABS Domains SAED Stage Level Pearson’s Correlation Sig. (2-code)

COMMUNICATION 0.728 <.001

DAILY LIVING SKILLS 0.598 <.001
SOCIALIZATION 0.687 <001
MOTOR SKILLS 0.216 0.227
COMPOSITE 0.643 <.001

person. Indeed, motivation is closely connected with fulfilling emotional needs, regardless of the
presence or absence of Intellectual Disability. In conclusion, our data confirm the suggestion made by
Lemerise et al. to modify the strictly cognitive method proposed by Crick and Dodge consisting in
processing social information in children, as in adults, adding to it the action of emotional processes
(Lemerise & Arsenio, 2000). In our research we selected participants with Intellectual Disability who
did not present considerable psychopathological/behavioral aspects to prevent this factor from
rendering the correlation study between VABS and SAED scales more difficult. Indeed, it is known how
VABS, for ex., has a typical profile in the presence of considerable autistic features, with a
‘‘Socialization’’ domain which is poorer than other areas. In clinical experience, even the evaluation of
SAED may be negatively influenced by the presence of behavioral problems. To our mind, the
combined use of VABS and SAED may be useful in two different ways. The former is the overall
appraisal of the subject for the planning of services for him/her, irrespective of specific behavioral
issues. The latter consists in using VABS and SAED in evaluating behavioral problems before
processing therapeutic plans (Dosen, Gardner, Griffiths, King, & Lapointe, 2008).
To evaluate psychometric characteristics of the SAED test not only the average of results but also
trends were considered. The SAED score, in fact, uses trends. The statistical result is more reliable if
both the average and trends are compared. Regarding the second objective of our study, that is a first
validation of the SAED test, it is possible to state that it proved a reliable psychometric tool. This is
confirmed by both its high correlation with VABS and the statistical study of internal reliability of the
tool.
Our study has limits that must be taken into account. The number of samples, although adequate
for the statistical analysis, must be increased. There will have to be studies comparing persons with
different Intellectual Disability etiological diagnoses. Environmental variables, such as living in the
family or in an institute, will have to be compared. Future studies should be directed to investigations
of emotional development in persons with behavior problems and psychopathology. In our opinion
knowledge of the level of emotional development can be helpful for understanding of the processes
which lead to psychopathology. For the same purpose correlation studies between cognitive and
emotional development would be important issue for amelioration of psychiatric diagnostic in people
with Intellectual Disability and psychopathology. Lastly, the correlation between VABS and SAED in
the presence of specific psychopathological and/or behavioral issues will have to be considered.

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