Emotion dysregulation(ED) in autistic individuals involves intense emotional reactions, difficulty modulating responses, and challenges communicating feelings. This can exacerbate anxiety and depression symptoms.
Signs include meltdowns, transition difficulties, intense anxiety or frustration, trouble recognizing emotions, rigid thinking, sensory-related outbursts, and poor self-soothing.
Heightened reactivity mayincrease anxietyin social or uncertain situations, while persistent negative affect can contribute to depression.
These difficulties significantly impact daily functioning and mental health, underlining the importance of understanding ED’s role in autism and its relationship to anxiety and depression.
Key Points
Rationale
Autismis associated with elevated rates of internalizing difficulties, particularly anxiety and depression, compared to the general population (Lau et al., 2020; Bougeard et al., 2021).
Recent research has highlighted the role of emotion dysregulation (ED) in pathways to anxiety and depression in autism (Connor et al., 2021).
Additionally, transdiagnostic processes such as intolerance of uncertainty (IU), cognitive inflexibility (CI), and alexithymia have been linked to internalizing symptoms in autistic populations (Jenkinson et al., 2020; Hollocks et al., 2019; Milosavljevic et al., 2016).
However, the interactions between these transdiagnostic processes, ED, and internalizing symptoms in autism remain unclear.
Furthermore, it is uncertain whether these relationships are unique to autism or present in non-autistic populations as well. Understanding these relationships is crucial for developing effective interventions for autistic individuals with co-occurring mental health difficulties.
This study aimed to investigate the associations between key transdiagnostic processes (IU, CI, alexithymia) and anxiety/depression symptoms in autistic youth, explore ED as a potential mediator of these relationships, and compare the effects with a non-autistic comparison group.
Method
Procedure
The study used across-sectional design. Participants were young people referred to a UK specialist neurodevelopmental service for a comprehensive autism assessment. Parents/carers completed questionnaires as part of routine clinical evaluation.
Sample
175 young people aged 5-18 years (M=10.6 years, SD=3.1) were included. 94 children (54%) received an autism diagnosis, while 81 (46%) did not and served as the control group.
Measures
Statistical measures
Structural equation modeling (SEM) was used to investigate process-symptom links and test ED as a potential mediator. Linear regressions were employed to test associations between IU/CI/Alexithymia and ED.
Separate models were run for each cognitive process to test associations with depression and anxiety, controlling for age, sex, and autism symptoms.
Results
Insight
This study provides novel insights into the interplay between transdiagnostic processes, ED, and internalizing symptoms in autistic and non-autistic youth.
The finding of a direct pathway from IU to anxiety and depression in autistic youth is consistent with previous literature (Cai et al., 2018; Hollocks et al., 2014).
However, the lack of association between CI and anxiety/depression in autistic youth is a novel finding, as is the mediating role of ED in the relationship between alexithymia and anxiety/depression symptoms in both samples.
For instance, ED mediated the relationship between CI/alexithymia and depression only in non-autistic youth, suggesting that the pathways to internalizing symptoms may differ between these populations.
These findings highlight the importance of considering ED and specific transdiagnostic processes when developing interventions for autistic youth with co-occurring mental health difficulties.
Future research could explore more specific cognitive, emotional, and behavioral processes that may mediate the relationship between IU and depression in autistic youth, as ED did not explain this relationship in the current study.
Strengths
This study had several methodological strengths, including:
Limitations
This study also had several methodological limitations, including:
Implications
The findings have important implications for clinical practice and intervention development:
These results underscore the importance of considering multiple factors and their interactions when assessing and treating internalizing symptoms in autistic youth.
Clinicians should be aware of the potential differences in pathways to anxiety and depression between autistic and non-autistic individuals and tailor their approaches accordingly.
References
Primary reference
Barnes, G. L., Ozsivadjian, A., Baird, G., Absoud, M., & Hollocks, M. J. (2024). Investigating the effects of transdiagnostic processes on anxiety and depression symptoms in autistic young people: The mediating role of emotion dysregulation.Journal of Autism and Developmental Disorders.Advance online publication.https://doi.org/10.1007/s10803-024-06246-0
Other references
Bougeard, C., Picarel-Blanchot, F., Schmid, R., Campbell, R., & Buitelaar, J. (2021). Prevalence of autism spectrum disorder and co-morbidities in children and adolescents: A systematic literature review.Frontiers in Psychiatry,12, 744709.https://doi.org/10.3389/fpsyt.2021.744709
Cai, R. Y., Richdale, A. L., Dissanayake, C., & Uljarević, M. (2018). Brief report: Inter-relationship between emotion regulation, intolerance of uncertainty, anxiety, and depression in youth with autism spectrum disorder.Journal of autism and developmental disorders,48, 316-325.https://doi.org/10.1007/s10803-017-3318-7
Conner, C. M., Golt, J., Shaffer, R., Righi, G., Siegel, M., & Mazefsky, C. A. (2021). Emotion dysregulation is substantially elevated in autism compared to the general population: Impact on psychiatric services.Autism Research,14(1), 169-181.https://doi.org/10.1002/aur.2450
Hollocks, M. J., Jones, C. R., Pickles, A., Baird, G., Happé, F., Charman, T., & Simonoff, E. (2014). The association between social cognition and executive functioning and symptoms of anxiety and depression in adolescents with autism spectrum disorders.Autism Research,7(2), 216-228.https://doi.org/10.1002/aur.1361
Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: a systematic review and meta-analysis.Psychological medicine,49(4), 559-572.
Jenkinson, R., Milne, E., & Thompson, A. (2020). The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis.Autism,24(8), 1933-1944.https://doi.org/10.1177/1362361320932437
Lau, B. Y., Leong, R., Uljarevic, M., Lerh, J. W., Rodgers, J., Hollocks, M. J., … & Magiati, I. (2020). Anxiety in young people with autism spectrum disorder: Common and autism-related anxiety experiences and their associations with individual characteristics.Autism,24(5), 1111-1126.https://doi.org/10.1177/1362361319886246
Milosavljevic, B., Carter Leno, V., Simonoff, E., Baird, G., Pickles, A., Jones, C. R., … & Happé, F. (2016). Alexithymia in adolescents with autism spectrum disorder: Its relationship to internalising difficulties, sensory modulation and social cognition.Journal of autism and developmental disorders,46, 1354-1367.https://doi.org/10.1007/s10803-015-2670-8
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
