Emotion Dysregulation in Autism: A Structural Equation Model of Core Symptoms and Executive Dysfunction

• In Event: Social-Emotional Skills, Regulation, and Flexibility in Children with Developmental Disabilities and Parents

Abstract

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by social communication difficulties and restricted, repetitive behavior. Emotion dysregulation is highly common among youth with ASD, with prevalence estimates ranging from 50-80% (Keluskar et al., 2021). Indeed, emotion dysregulation is linked to substantial life impairment including behavior problems, psychiatric comorbidities, and emergency service use and hospitalization (Conner et al., 2021). However, little is known about what symptoms and associated features of ASD predispose individuals to more issues with emotion dysregulation – with many studies showing mixed findings (Keluskar et al., 2021). Further, the role of executive functioning in emotion dysregulation, relative to core ASD symptoms, remains unclear. This study used structural equation modeling to examine the relative influence of core ASD symptoms and executive functioning. We hypothesized that more severe core symptoms and executive dysfunction would be associated with higher emotion dysregulation, with executive dysfunction demonstrating the strongest relationship.

Methods: Caregivers (N = 511) of youth with ASD, ages 4 – 18, completed the Social Communication Questionnaire, Repetitive Behavior Scale, Parenting Stress Index – Short Form (PSI), a Child Anger scale, and the Eyberg Child Behavior Inventory (ECBI). Items from the Difficult Child subscale of the PSI and the Child Anger scale were used to create a latent emotion dysregulation variable. Executive functioning items (n = 8) from the ECBI were used to measure symptoms consistent with Attention-Deficit/Hyperactivity Disorder.

Results: A structural equation model was fit to the data. As chi square is often significant with complex models, fit was determined using the Comparative Fit Index (CFI > .90) and the Standardized Root Mean Square Error of Approximation (SRMR > .08). Fit indices suggested the model (Fig. 1) was an adequate fit to the data, CFI = .93, SRMR = .06. Further, Child Anger domains and the PSI-Difficult Child subscale loaded significantly onto the emotion dysregulation factor (standardized loadings ranged from .67 - .83). There were significant associations between emotion dysregulation and both executive dysfunction and repetitive behaviors; however, when accounting for these clinical variables, social communication was not a significant predictor of emotion dysregulation. All exogenous variables (social communication, repetitive behaviors, and executive dysfunction) covaried significantly. Overall, results suggest greater executive dysfunction and repetitive behaviors were related to greater emotion dysregulation, with executive dysfunction demonstrating the strongest relation.

Discussion: Findings highlight the relative importance of executive dysfunction’s association with emotion dysregulation compared to core ASD symptoms. Given that we conceptualized emotion dysregulation largely using items related to anger and behavioral dysregulation, these findings suggest interventions targeting executive dysfunction may have unique utility for youth exhibiting externalizing symptoms. These results demonstrate the importance of comprehensive assessment of co-occurring symptoms when treating emotion dysregulation in youth with ASD.

Authors

• Monica Sofia Trevino, University of Missouri - Saint Louis
  Presenting Author

• Rebecca Scott Bradley, University of Arkansas

• Emily Navina Shah, James Madison University

• Lauren B Quetsch, University of Arkansas

• Cynthia E Brown, Pacific University

• Lindsey S Aloia, University of Arkansas

• Stephen M Kanne, Weill Cornell Medical College