Now in Autism Research: Elevated Emotion Dysregulation in Autism Compared to the General Population

Children and adolescents with autism are nine times more likely than peers without autism spectrum disorder (ASD) to require emergency room visits for psychiatric reasons, and twelve times more likely to require psychiatric hospitalization by age 21. Additionally, research suggests that poor emotion regulation is associated with a higher likelihood of co-occurring psychiatric disorders. 

The Emotion Dysregulation Inventory (EDI), developed by Carla Mazefsky, PhD (Associate Professor of Psychiatry), in collaboration with Pitt Psychiatry colleagues, assesses emotion regulation impairment, which is associated with poor mental health in individuals with ASD. In a recent study published in Autism Research, researchers including Dr. Mazefsky and Caitlin Conner, PhD (Research Assistant Professor of Psychiatry), used the EDI to examine rates of emotion dysregulation in two samples of individuals with ASD and a general US sample (ages 6-17 years old). 

They compared rates of psychiatric hospitalization, emergency services, and psychiatric medication utilization across a sample of 1,169 youth with ASD, 567 youth with ASD admitted for psychiatric hospitalization, and a general US sample of 1,000 children and adolescents. They additionally compared rates of emotion regulation impairment across these three samples and investigated whether emotion regulation impairment predicts hospitalization, emergency service use, and psychiatric medication utilization in ASD.

“Previous research on emotion dysregulation in ASD has relied on smaller, clinically based samples, so our primary goal was to establish that emotion dysregulation is significantly elevated in youth with ASD using large and more representative samples,” said Dr. Conner, the paper’s first author. “We also wanted to understand how emotion dysregulation is associated with the use of crisis services like emergency room visits and police contact, hospitalization, and psychiatric medication prescription.” 

Findings from the study revealed that the two ASD samples were more likely to exhibit impaired emotion regulation than the general US sample “Even non-clinically referred youth with ASD were four times more likely to exceed clinical cutoffs on the EDI than those in the general US sample,” noted Dr. Conner. 

Similarly, history of psychiatric hospitalization, recent emergency services use, and psychotropic medication prescriptions were significantly higher in the ASD groups. Impaired emotion regulation was significantly associated with all forms of psychiatric service use.

 “This study sends a clear message that we need to be paying closer attention to emotion dysregulation in ASD,” said Dr. Mazefsky, senior author of the study. “Not only was greater emotion dysregulation associated with the use of costly and stressful crisis services, the difference between the ASD groups and general population youth in rates of clinically elevated emotion dysregulation was striking. The good news is that emotion dysregulation should be treatable. So, I think this is a call to arms to start universal screening and focus on prevention and treatment of emotion dysregulation in those with ASD.”

Emotion Dysregulation is Substantially Elevated in Autism Compared to the General Population: Impact on Psychiatric Services
Autism Research. Volume 14, Issue 1 p. 169-181

Conner CM, Golt J, Shaffer R, Righi G, Siegel M, Mazefsky CA