High Risk for Severe Emotional Dysregulation in Psychiatrically Referred Youth with Autism Spectrum Disorder: A Controlled Study
To assess prevalence and severity of emotional dysregulation (ED) in psychiatrically referred youth with autism spectrum disorder (ASD). ASD youth (N = 123) were compared to youth with attention-deficit/hyperactivity disorder (ADHD) and controls. The majority of psychiatrically referred youth with ASD had positive Child Behavior Checklist-ED (CBCL-ED) profile that was significantly higher than in youth with ADHD (82 vs. 53%; p < 0.001). The severe emotional dysregulation (SED) profile was significantly greater in ASD youth than ADHD (44 vs. 15%; p < 0.001). In the presence of SED profile ASD youth suffered from greater severity of autism, associated psychopathology, and psychosocial dysfunction. Greater than expected prevalence of SED in psychiatrically referred youth with ASD that identifies distinct clinical correlates associated with severe morbidity and dysfunction.
KeywordsAutism spectrum disorder Emotional dysregulation CBCL Youth
GJ conceived the study, participated in its design, oversaw the creation of the manuscript; JW conceived the study and participated in its design, assisted in developing the manuscript; MF participated in the design of the study and performed the statistical analysis; SF participated in the design of the study and performed the statistical analysis; RF aided in creating the study, and participated in its design and coordination; MG participated in creating the study's design and oversaw development of the manuscript; SLF assisted in coordinating and performing the study, and drafting the manuscript; KC assisted in coordinating and performing the study, and drafting the manuscript; JRK assisted in coordinating and performing the study and revising the manuscript; AB assisted in drafting, major revising, and assisted in the coordination of the manuscript; JB conceived the study, participated in its design, oversaw the creation of the manuscript. All authors read and approved the final manuscript.
This work is funded in part by the Alan and Lorraine Bressler Clinical and Research Program for Autism Spectrum Disorder, the Saylor Family Fund for Autism Research, the MGH Pediatric Psychopharmacology Council Fund, and by the National Institute of Mental Health (NIMH) grant awarded to Gagan Joshi (#K23MH100450).
Compliance with Ethical Standards
Conflict of interest
Dr. Joshi is supported by the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH) under Award Number K23MH100450. He receives research support from Pfizer and the Simons Center for the Social Brain as a principal investigator (PI) for investigator-initiated studies. Additionally, he has received research support from Duke University and Sunovion Pharmaceuticals as a site PI for multi-site trials. He is a co-investigator for a clinical trial sponsored by the U.S. Department of Defense. He received an honorarium from the Governor’s Council for Medical Research and Treatment of Autism in New Jersey for grant review activities and speaker’s honorariums from the American Academy of Child and Adolescent Psychiatry, Massachusetts General Hospital Psychiatry Academy, and the Medical Society of Delaware. Since January 2015, Dr. Wozniak has received no outside research support. She is author of the book, “Is Your Child Bipolar” published May 2008, Bantam Books. Her spouse has received an honorarium from Otsuka; royalties from Cambridge University Press and UptoDate; consultation fees from Advance Medical, FlexPharma and Merck; and research support from UCB Pharma, NeuroMetrix, and Luitpold. In the past year, Dr. Faraone received income, potential income, travel expenses and/or research support from Rhodes, Arbor, Pfizer, Ironshore, Shire, Akili Interactive Labs, CogCubed, Alcobra, VAYA Pharma, NeuroLifeSciences and NACE. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD. In previous years, he received income or research support from: Shire, Alcobra, Otsuka, McNeil, Janssen, Novartis, Pfizer and Eli Lilly. Dr. Faraone receives royalties from books published by Guilford Press: Straight Talk about Your Child’s Mental Health, Oxford University Press: Schizophrenia: The Facts and Elsevier: ADHD: Non-Pharmacologic Interventions. He is principal investigators of http://www.adhdinadults.com. Dr. Fried is currently receiving research support from the FDA as well as honoraria from the MGH Psychiatry Academy for tuition-funded CME courses. Dr. Fried has also been on an advisory board for Lundbeck. During previous years, Dr. Fried received research support from the National Institutes of Health and Shire. Dr. Biederman is currently receiving research support from the following sources: AACAP, The Department of Defense, Food & Drug Administration, Headspace, Lundbeck, Neurocentria Inc., NIDA, PamLab, Pfizer, Shire Pharmaceuticals Inc., Sunovion, and NIH. Dr. Biederman has a financial interest in Avekshan LLC, a company that develops treatments for ADHD. His interests were reviewed and are managed by Massachusetts General Hospital and Partners HealthCare in accordance with their conflict of interest policies. Dr. Biederman’s program has received departmental royalties from a copyrighted rating scale used for ADHD diagnoses, paid by Ingenix, Prophase, Shire, Bracket Global, Sunovion, and Theravance; these royalties were paid to the Department of Psychiatry at MGH. In 2017, Dr. Biederman is a consultant for Akili, Guidepoint, and Medgenics. He is on the scientific advisory board for Alcobra and Shire. He received honoraria from the MGH Psychiatry Academy for tuition-funded CME courses. He has a US Patent Application pending (Provisional Number #61/233,686) through MGH corporate licensing, on a method to prevent stimulant abuse. In 2016, Dr. Biederman received honoraria from the MGH Psychiatry Academy for tuition-funded CME courses, and from Alcobra and APSARD. He was on the scientific advisory board for Arbor Pharmaceuticals. He was a consultant for Akili and Medgenics. He received research support from Merck and SPRITES. In 2015, Dr. Biederman received honoraria from the MGH Psychiatry Academy for tuition-funded CME courses, and from Avekshan. He received research support from Ironshore, Magceutics Inc., and Vaya Pharma/Enzymotec. Ms. Fitzgerald, Ms. Galdo, Ms. Furtak, Ms. Conroy, Mr. Kilcullen, and Ms. Belser declare that they have no conflict of interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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