Is Emotion Dysregulation in Autism Similar to Other Clinical Conditions?

Although individuals with autism spectrum disorder (ASD) experience more severe emotional dysregulation than their neurotypical (NT) peers, emotional dysregulation in autism is of a similar magnitude to other clinical conditions. These study results were published in Autism.

Emotional dysregulation occurs when there are problems with an individual’s adaptive regulation strategies or when inappropriate responses are utilized, which can result in a discrepancy between emotional expressions and the environmental context. Individuals with ASD frequently experience emotional dysregulation; however, limited research has examined the magnitude of difference between emotional dysregulation among people with ASD compared with NT individuals and those with other clinical conditions.

To this aim, investigators conducted a meta-analysis to evaluate the comparative severity of emotional dysregulation across the lifespan among individuals with ASD, neurotypical peers, and those with other clinical conditions. The investigators searched publication databases for studies that evaluated emotional regulation among individuals who met the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for ASD, relative to either NT or other clinical condition participants.

The investigators included 35 studies in the analysis, for a pooled sample size of 11,201 individuals. Of the 11,201 individuals, 5316 had a diagnosis of ASD, 3669 were NT, and 2216 had another clinical disorder. The other clinical disorders included attention-deficit/hyperactivity disorder (ADHD), genetic disorder, anxiety, anorexia, and Down syndrome. The studies included parent-reported (k=27), self-reported (k=8), and/or behavioral (k=2) measures of emotional dysregulation.

The investigators found that individuals with ASD had significantly higher emotional dysregulation than the comparison groups (Hedges g,0.68; 95% CI, 0.41-0.95; P <.001), with a medium-large effect size.

When analyses were restricted to NT individuals vs those with ASD, the investigators observed significantly higher emotional dysregulation severity among individuals with ASD (Hedges g,1.07; 95% CI, 0.72-1.41; P <.001), suggesting a large effect. Additionally, the investigators found higher emotional dysregulation severity among ASD individuals relative to other clinical conditions (Hedges g,0.27; 95% CI, 0.02-0.53; P =.03), but the effect was small. These findings indicate that the severity of emotional dysregulation was more similar between the ASD group and those with other clinical conditions.

Results from the moderator analysis revealed that age, sex, autistic traits, informant, outcome measure, and cognitive ability were not significant moderators. However, a comparison of ASD vs NT groups indicated that sex (B = -0.04; P =.07) and age (B =0.04; P =.10) were marginally significant predictors, suggesting that emotional dysregulation was more severe among girls/women and younger participants.

The results of this meta-analysis indicate that individuals with ASD experience greater emotional dysregulation than neurotypical peers, but the magnitude of emotional dysregulation in autism may be similar to other clinical conditions. “These findings highlight the need for vigilance regarding dysregulated presentations by clinicians during the initial assessment process for autism,” the investigators concluded.

Study limitations include heterogeneity across studies, the limited number of female participants, the omission of results from some relevant clinical trials, and the lack of multi-informant perspectives.

This article originally appeared on Psychiatry Advisor