Topography and Correlates of Emotional Response in Psychiatrically Hospitalized Children and Adolescents with ASD

Background: Poor emotion regulation (ER) in individuals with ASD contributes to the high rates of co-morbid psychiatric and behavioral problems, psychotropic medication prescription, and psychiatric hospitalizations. While research on ER in ASD has increased recently, it has mostly relied on questionnaire data from higher functioning individuals or structured tasks in very young children. We lack understanding of the topography and correlates of poor ER in more severely affected older children and adolescents who require intensive treatment for serious emotional and behavioral disturbance.

Objectives: The present study assessed emotional response to distressing tasks in youth with ASD during psychiatric hospitalizations. We: 1) Describe behavioral and affective responses to tasks, and 2) Analyze relations between individual differences in functioning and autism severity and response to tasks.

Methods: Participants include 112 children and adolescents from the Autism Inpatient Collection (AIC) who were administered a subset of modified paradigms from the Laboratory Temperament Assessment Battery (Lab-TAB) designed to elicit negative affect. Participants represented the full spectrum of intellectual and functional abilities (see Table 1 for participant characteristics).

Affect (valence and intensity) and behavioral response (BR; e.g. inappropriate behavior, aggression) were coded in 10 second intervals from videotapes of assessments. The following variables were calculated from coded data: proportion of intervals with negative response (negative affect or BR), mean intensity of negative response [from 1 (mild) to 5 (highly negative)], average length (i.e. number of intervals) of negative response, range of affect [from -3 (highly negative) to +3 (highly positive)], and negative lability (i.e. proportion of intervals with large negative changes in affect [≥ 3 unit changes] from previous interval).

Results: Table 2 displays descriptive statistics for the six variables describing affect and BR in the initial baseline period (prior to distressing tasks) and during the task portions of the Lab-TAB assessment. As can be seen in the table, mean intensity of negative response, length of response, and range of affect were significantly higher during tasks than baseline.

Furthermore, children with lower adaptive functioning displayed more intense and longer negative responses and more negative lability. Individuals administered ADOS Module 1 (non-verbal/single words) showed more frequent, more intense, longer, and more labile negative responses than individuals administered Module 2 (phrase speech), 3 (fluent speech, child), or 4 (fluent speech, adolescent/adult). Interestingly, despite this relation to verbal ability, negative response variables were largely unrelated to non-verbal IQ and ADOS severity score, with the exception that lower IQ participants displayed higher negative lability.

Conclusions: This is the first study to empirically examine emotional response in children and adolescents with ASD and severe emotional and behavioral problems across the full spectrum of functioning. Results indicate huge variability in response to frustrating tasks that appears to be related, in part, to adaptive functioning and communication abilities. Results highlight the importance of examining ER in non-verbal and severely affected individuals.