Linking the Emotional Self-Control of Children with ASD to ADHD Symptomology: A Moderated Mediation Analysis

Background: Children diagnosed with autism spectrum disorder (ASD) often exhibit ADHD symptomology (Leyfer et al., 2006) and have higher rates for externalizing behaviors than typically developing (TD) children (Tureck et al., 2013). Externalizing behaviors in young children are thought to manifest from an inability to regulate emotionality (Yerys et al., 2013). Further, certain individual characteristics such as high negative emotionality can increase children’s risk for externalizing problems and necessitate that children have good skills for regulating emotion in order to avoid negative outcomes (Eisenberg et al., 2005; Valiente et al., 2003).  Given that prior research suggests ADHD symptoms also increase children’s risk for externalizing problems (Tureck et al., 2013), we reasoned that children’s skills to regulating emotion would serve to buffer them against externalizing problems.  Thus, the purpose of our study was to examine associations among emotional self-control, diagnostic status (TD vs. ASD) and ADHD symptomology.

Objectives: We hypothesized that children with ASD would exhibit higher rates of externalizing behaviors than TD children and that this relation would be mediated by their emotional self-control. Furthermore, we hypothesized that the link between status and emotional self-control would be conditional on children’s levels of ADHD symptomatology.

Methods: Participants included 88 children, ages 3:0 to 6:11, their parents, and teachers. Fifty-seven children (28% female) were TD and the remaining 31 were diagnosed with ASD (6% female). The Behavioral Assessment System for Children – Second Edition Teacher Rating Scale (BASC-2; Reynolds & Kamphaus, 2004) was used to assess children’s emotional self-control and children’s externalizing behaviors as reported by their parents.  The ADHD Index from the Conner’s Parent Rating Scale (CPRS-R-S; Conners, 1997) was used to assess ADHD symptoms. 

Results: We investigated the conditional indirect effects of status on externalizing behaviors through emotional self-control, as moderated by ADHD symptoms (see Figure 1).  We tested this moderated-mediation model using Model 7 in PROCESS (Hayes, 2013).  The overall model was significant.  Although status was a significant predictor of children’s externalizing behaviors (B = -4.45, SE = 1.13, t = -3.94, p < .001), the relation between status and externalizing behaviors was mediated by children’s emotional self-control but only at mean (B = -3.99, SE = 1.20, t = -3.33, p = .001) and high levels (B = -8.01, SE = 1.71, t = -4.69, p < .001) of the moderator, ADHD symptoms, and not at low levels (B = -1.76, SE = 1.87, t = -.95, p = .35).

Conclusions: Our findings help to clarify relations among diagnostic status, ADHD symptoms, emotional self-control, and externalizing behaviors in young children with and without ASD.  Most notably, children with higher levels of ADHD symptomatology required effective emotional self-control in order to buffer them from externalizing behaviors.  This pattern was most pronounced for TD children.  Further research should examine the role of emotional self-control in treatment for children with and without ASD who exhibit ADHD symptoms.