Cited by 130Autism Spectrum Disorder ResearchChild and Adolescent Psychosocial and Emotional DevelopmentChild Nutrition and Feeding Issues

Emotion Dysregulation is Substantially Elevated in Autism Compared to the General Population: Impact on Psychiatric Services

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Conner, Caitlin M., Golt, Josh, Shaffer, Rebecca, Righi, Giulia, Siegel, Matthew, Mazefsky, Carla A.·2021·Autism Research

Abstract

Emerging evidence suggests that emotion regulation (ER) impairment in those with ASD is associated with poor mental health. This study used the Emotion Dysregulation Inventory, a new norm‐referenced ER measure with clinical cut‐offs, developed and validated in ASD and non‐ASD samples, to establish rates of ER impairment and understand its association with psychiatric service use in ASD. Parents of 6–17 year olds in three well‐characterized samples (nationally representative US n = 1,000; community ASD n = 1,169; inpatient ASD n = 567) completed a battery of questionnaires about their child. The prevalence of ER impairment was significantly higher in the ASD groups compared to the nationally representative sample and highest in the psychiatric Inpatient ASD group. The community ASD and inpatient ASD samples were four and seven times more likely, respectively, to exceed clinical cutoffs for emotional reactivity than the general US sample. Similarly, history of psychiatric hospitalization, recent emergency services use (police contact, emergency room visits, or in‐home crisis evaluations for emotional or behavioral concerns in the past 2 months), and psychotropic medication prescriptions were significantly higher in the ASD groups. ER impairment was significantly associated with all forms of psychiatric service use, after controlling for demographics (age, sex, race), co‐occurring intellectual disability, and ADHD symptoms. This is the first large‐scale study to document substantially higher rates of ER impairment in youth with ASD compared to the general population. The importance of ER impairment is underscored by its association with higher utilization of inpatient, emergency, and medication services in ASD, after accounting for demographics and ADHD‐related symptoms. Lay Summary: This study compared problems with emotion regulation in large samples of youth with and without ASD. An ASD community sample had two to four times more youth with clinically elevated regulation impairments compared to youth without ASD. Emotion regulation impairment was also related to using psychiatric hospitalizations, emergency services, and medications in the ASD group. This study suggests that screening for emotion regulation difficulties in ASD is important and treatment may have a wide ranging impact.

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  • Difficulties with emotion regulation are up to four times more likely in autistic adolescents than non-autistic adolescents.

    “Difficulties with ER are up to four times more likely in autistic adolescents than non-autistic adolescents (Conner et al., 2021)”

    From The relationship between distress tolerance and behavioral activation on anxiety and depression symptomatology in autistic youth: Leveraging self and caregiver perspectives (2024) · cites this paper as Conner et al., 2021

    The Results (Aim 2) report that clinically elevated ER Reactivity was nearly four times as common in community autistic youth as in the general US youth sample (53.2% versus 13.6%). The fourfold figure is not reported specifically for adolescents or for ER difficulties overall: the sample included children, and clinically elevated Dysphoria was about twice as common. (LLM, conf=0.86)

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  • Clinically impairing ED was two to four times more common in autistic young people compared to non-autistic youth aged 6-17 years, after controlling for demographic differences and ADHD-related symptoms.

    “A previous large-scale study using the EDI found that clinically impairing ED was two to four times more common in autistic young people compared to non-autistic youth aged 6–17 years, after controlling for demographic differences and ADHD-related symptoms (Conner et al., 2021).”

    From Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation. (2025) · cites this paper as Conner et al., 2021

    Results, Aim 2 (page not provided), reports nearly four times as many community autistic youth in the clinically elevated EDI Reactivity range and twice as many in the clinical Dysphoria range as in the general US sample. Methods, Analyses, Aim 2 (page not provided), says those clinical-range percentages were depicted descriptively; the group comparison of EDI scores controlled for sex and race, not ADHD symptoms. ADHD symptoms were controlled for in separate analyses of psychiatric service use, so the claim incorrectly applies that adjustment to the two-to-four-times prevalence finding. (LLM, conf=0.91)

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Authors
Conner, C. M., Golt, J., Shaffer, R., Righi, G., Siegel, M., & Mazefsky, C. A.
Affiliations
  • University of Pittsburgh (US)
  • University of Alabama (US)
  • Cincinnati Children's Hospital Medical Center (US)
  • Brown University (US)
  • Tufts University (US)
Corresponding author
Mazefsky, Carla A.
Venue
Autism Research
Publisher
Wiley
Published
2020-12-08
Volume
14
Issue
1
Pages
169-181
ISSN
  • 1939-3792 (ISSN-L)
  • 1939-3806
OpenAlex
W3111428827
Cited by
130
References
48
Citations by year
2026: 26 · 2025: 22 · 2024: 31 · 2023: 26 · 2022: 19 · 2021: 6
FWCI
6.85
Type
journal article
Language
en
Open access
Locations
  • Autism Research (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Patient-Centered Outcomes Research Institute
  • Nancy Lurie Marks Family Foundation
  • Simons Foundation Autism Research Initiative (SFARI #296318, NICHD R01 HD079512)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
autism spectrum disorder, emotional dysregulation, mental health service utilization, psychiatric hospitalization, psychotropic drugs, emotional reactivity, autistic youth, intellectual disability, ADHD symptoms
MeSH terms
Autism Spectrum Disorder, Emotional Regulation, Adolescent, Autistic Disorder, Child, Emotions, Humans, Mental Health Services

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