The Neglected Frontier: The Dimensional Spectrum of Irritability in Young Children with Developmental Disabilities

• In Event: MAPping Emotional and Behavioral Dysregulation in Youth

Abstract

Background: Relative to the general population, children with autism and developmental disabilities (DD) display higher rates of difficulties with emotion regulation (Conner et al., 2021), and are at an increased risk of developing co-occurring psychiatric and behavioral problems (e.g., Mazefsky et al., 2014). Yet, few standardized tools have been utilized to quantify and describe the frequency and/or intensity of externalized behaviors of emotion dysregulation (ED) among DD children during early childhood (e.g., temper tantrums and aggression). Such tools are critical to identifying differences in the early presentation of ED in DD children and guiding intervention support tailored to their unique needs.
The Multidimensional Assessment of Preschool Disruptive Behavior (MAP-DB; Wakschlag et al., 2014) is a well-established caregiver-report measure that distinguishes developmentally appropriate from clinically significant misbehaviors. As the MAP-DB was validated among non-DD children, the extent to which behavioral expressions of ED, as measured using the MAP-DB Temper Loss (TL) and Aggression (AG) scales, differ between preschool children with and without DDs is unknown. Additional comparisons with newly developed measures of ED severity, validated for both DD and non-DD preschoolers, including the Emotion Dysregulation Inventory-Young Child (EDI-YC; Day et al., 2022) are also needed.
Methods: Caregivers of 1098 DD children (“clinical sample”) and 692 non-DD children (“general sample”) between 2-5 years were recruited through the Simons Powering Autism Research (SPARK) registry and the local community to complete the MAP-DB TL and AG scales and the EDI-YC. Groups were compared based on the proportion of TL and AG behaviors occurring frequently over the past month (i.e., “most days” or greater). Select items on the MAP-DB TL scale and EDI-YC Reactivity scale (i.e., severe or very severe intensity over the past week), were compared at the item level to understand how frequency and severity patterns may be related on key concepts (i.e., explosiveness, tantrums, difficulty calming down).
Results: The proportion of children with DDs that exhibited frequent TL-related behaviors was significantly higher than non-DD children for most behaviors, with notable frequent behaviors including being frustrated more easily and having a “short fuse”, tantrums to get something or when tired, hungry, or sick, crying or screaming when frustrated, and difficulty calming down, which were endorsed by 30-49% in children with DD versus 7-20% in non-DD children (Table 2). Both groups were less likely to engage in frequent AG than TL-related behaviors. Consistent patterns of frequency and severity were observed between TL items and corresponding EDI-YC Reactivity items.
Discussion: Overall, these findings suggest that children with DDs have difficulties with temper loss and aggression much more frequently than non-DD children, adding to the literature on emotion dysregulation in older autistic and DD youth and suggesting a need to emphasize early emotion regulation interventions in preschoolers with DDs. Although frequency was uniformly higher in DD, there was some variability in the degree of difference between groups on individual items. These findings could help inform what behavioral manifestations of ED may be especially indicative of atypical emotional development in early DD.

Authors

• Shalini Sivathasan, University of Pittsburgh School of Medicine
  Presenting Author

• Lan Yu

• Lauren S Wakschlag, Northwestern University

• Carla Mazefsky