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The Underlying Structure of Emotion Regulation Impairment in ASD
Impaired emotion regulation (ER) is strongly associated with a range of psychopathology and poor functioning. Studies of verbal individuals with ASD indicate reliance on maladaptive ER strategies. Understanding of the phenomenology of ER in severely affected and less verbal individuals with ASD is limited given the dependence of most measures on verbal indicators or self-report. Further, despite substantial variability in emotional presentation in ASD, empirically-based dimensions of emotion dysregulation have not been identified.
Objectives:
To identify empirically-derived dimensions of emotion dysregulation in an ASD sample with a wide range of verbal and cognitive functioning, and explore how they are associated with psychiatric and cognitive factors.
Methods:
The Emotion Dysregulation Inventory (EDI) was developed to capture the full presentation of affective experiences and emotional control in individuals with ASD of any verbal ability. PROMIS® guidelines for item development and piloting were followed to create the 66-item EDI with a 5-point intensity scale (“not at all” to “very severe”). The EDI was completed by the parents/guardians of 190 children (mean age 13, range 4-20; 77% male) with ADOS-confirmed ASD who were admitted to one of six specialized psychiatric inpatient units for ASD. The mean non-verbal IQ based on the Leiter-3 was 74 with a wide range (SD = 30, Range = 30-145) and 53% were non- or minimally-verbal. Parents completed a battery of questionnaires including the Child and Adolescent Symptom Inventory(CASI) as a measure of psychiatric symptoms. A maximum likelihood factor analysis with oblique rotation was conducted with EDI items and the association between the resultant factor scores and other participant characteristics was explored.
Results:
The EDI total score was normally distributed, not correlated with IQ or age, and did not differ based on verbal ability level, suggesting lack of IQ and verbal ability biases. Factor analysis of EDI items justified a 2-factor model, based on a higher eigenvalues for the first two factors (17.4; 4.8), scree plot inflexions, and factor loading patterns. The factors were moderately correlated (r = .34) but no items had a rotated factor loading above .4 on both factors. Factor one accounted for the most variance and included indicators of poor ER (e.g., rapidly escalating, intense, and labile reactions, difficulty calming down once upset) and negative mood (e.g., angry/irritable, agitated behavior, etc.). Factor 2 included symptoms characteristic of anxiety and depressive disorders (e.g., nervousness, decreased positive affect and vitality). Different patterns of correlations with CASI and Leiter subscale scores and administrator ratings also supported a distinction between the two factors.
Conclusions:
Two distinct dimensions of emotion dysregulation were identified. The results support theories arguing that the experience of negative emotion and its regulation are difficult to separate, as the primary factor included indicators of poor ER as well as heightened reactivity and more negative affect. However, specific manifestations of negative affect, namely anxiety and depression symptoms, loaded onto a separate factor. Identifying dimensions of emotion dysregulation in ASD will aid in the development of targeted intervention efforts and support the detection of underlying biological mechanisms.