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High Risk for Severe Emotional Dysregulation in Psychiatrically Referred Youth with Autism Spectrum Disorder: A Controlled Study
Prevalence of ASD is considerably higher in psychiatrically referred populations of youth, ranging from 2-14%. Psychiatric referrals of children with ASD are frequently driven by emotional and behavioral problems. Emotional dysregulation (ED) is characterized by poor self-regulation, including symptoms of low frustration tolerance, impatience, quickness to anger, and emotional reactivity. Within the context of ASD, researchers have defined ED in distinctive ways for assessing deficits in regulation of emotions. We have operationalized different levels of ED using a unique profile of the Child Behavior Checklist (CBCL) (Achenbach, 1991) consisting of elevated scores of the Anxiety/Depression, Aggression, and Attention subscales. The ED profile on the CBCL (CBCL-ED) can help identify moderate [≥1SD and <2SD; Deficient Emotional Self-Regulation (DESR)] or severe [≥2SDs; Severe Emotional Dysregulation profile (SED)] levels of ED in children with emotional and behavioral difficulties. Although deficits in regulation of emotions have been documented in children with ASD the prevalence of ED based on the varying severity levels of CBCL-ED profile and whether the two sub-forms of ED are clinically helpful in distinguishing distinct levels of deficits in children with ASD remains unclear. Considering the empirical nature of the CBCL, its excellent psychometric properties, and its ease of implementation, documenting the magnitude and severity of ED per CBCL operationalized criteria in ASD populations remains an area of very high clinical importance. The knowledge derived from this work could translate into improved recognition and therapeutics for ASD children at risk for differently compromised courses and outcomes.
Objectives:
The main aim of the present study is to: 1) examine the prevalence of the two CBCL based ED profiles in youth with ASD; and 2) investigate whether the two severity levels of CBCL profiles for ED can help distinguish clinically distinct levels of deficits in ASD. We hypothesized that the two CBCL-ED profiles in youth with ASD would identify differentiating patterns of clinical correlates.
Methods:
ASD youth (N=123) were compared to youth with attention-deficit/hyperactivity disorder (ADHD) and healthy controls. We compared the prevalence of the two CBCL-ED profiles in psychiatrically referred population of youth with ASD to those with ADHD and to healthy controls (HC). Furthermore, we directly compared the demographic, psychopathological, and functional correlates associated with the two CBCL-ED profiles in youth with ASD.
Results:
The majority of psychiatrically referred youth with ASD had positive CBCL-ED profile that was significantly higher than in youth with ADHD (82% vs. 53%; p<0.001). The SED profile was significantly greater in ASD youth than ADHD (44% vs. 15%; p<0.001). In the presence of SED profile ASD youth suffered from greater severity of autism, associated psychopathology, and psychosocial dysfunction.
Conclusions:
There is a greater than expected prevalence of SED in psychiatrically referred youth with ASD that identifies distinct clinical correlates associated with severe morbidity and dysfunction.