Gender Differences in Emotion Dysregulation in an Autism Inpatient Psychiatric Sample

Background: Research on gender differences in Autism Spectrum Disorder (ASD) has shown that females are more likely to present with emotional problems such as anxiety and depression. These emotional difficulties may be related to underlying deficits with emotion regulation (ER), defined as modifications of one’s emotional state to promote adaptive behavior. In general, it has been found that poor ER in ASD exacerbates social impairment and increases risk for psychiatric and behavioral problems. Although there is growing appreciation for ER impairments in ASD, understanding factors that increase risk for poor ER is limited. Given the higher rates of internalizing problems in females vs. males with ASD, it is possible that females are particularly vulnerable to ER deficits. It is also possible that other characteristics that vary widely in ASD impact the association between gender and ER.

Objectives: This study aimed to: 1) Explore gender differences in ER in a psychiatric sample of children, adolescents, and young adults with ASD and a wide range of functioning; 2) Investigate whether other characteristics, such as age, nonverbal IQ, or verbal ability moderate the association between ER and gender.

Methods: Data from psychiatrically hospitalized youth diagnosed with ASD (n = 698; 144 females) aged 4-20 years were collected as part of the Autism Inpatient Collection (AIC). This is an ideal dataset for this question, given the full range of ER impairments and wide variability in functioning level, with approximately half of the sample being nonverbal. ER was assessed with the Emotion Dysregulation Inventory (EDI; Mazefsky et al., 2016, 2018), a caregiver-report which produces theta scores (M= 0, SD= 1) for Reactivity (EDI-R; poor ER and high emotional intensity) and Dysphoria (EDI-D). Nonverbal IQ was assessed with the Leiter International Performance Scale (Leiter-3; Roid et al., 2013). Verbal ability was estimated based on the Autism Diagnostic Observation Schedule (ADOS-2; Lord et al., 2012) modules.

Results: Significant gender difference was found for the EDI-R [0.80 (0.84) vs. 0.97 (0.78), p = 0.026] and EDI-D [0.51 (0.84) vs. 0.71 (0.78), p = 0.013], with females showing significantly higher emotion dysregulation compared to males. Age did not significantly moderate the association between ER and gender (Reactivity: F(1, 694) = 0.19, p = 0.66; Dysphoria: F(1, 683) = 3.00, p = .08). Similarly, verbal ability (Reactivity: F(1, 694) = 0.08, p = 0.77; Dysphoria: F(1, 683) = 0.62, p = .43) and non-verbal IQ (Reactivity: F(1, 578) = 0.14, p = 0.71; Dysphoria: F(1, 566) = 1.79, p = .18) did not significantly moderate the association between ER and gender.

Conclusions: Results indicate that female psychiatric inpatients with ASD have more severe dysregulation than inpatient males with ASD. None of the analyzed factors (i.e., age, nonverbal IQ, verbal ability) moderated the association between gender and ER, indicating that gender alone contributed to the differences in ER. Improved understanding of ER presentation in females with ASD is critical, as these symptoms may differentially impact females and/or warrant a different treatment emphasis.