Emotion regulation impairments in autism spectrum disorderPersistence of autism spectrum disorder (ASD) throughout the lifespan, along with better identification approaches, is contributing to a steadily growing population of adolescents and adults with ASD (Seltzer et al., 2004). The successful transition to adulthood is largely dependent on the foundation set in adolescence through the achievement of critical milestones including increased independence, autonomy, and responsibility (Arnett, 2000). Yet, adolescence is also characterized by heightened reactivity to social and emotional stimuli, which appears to increase the risk of psychopathology (Dahl and Gunnar, 2009;Kessler et al., 2005). Unfortunately, research indicates that ageappropriate adaptive skills and independence lag, and cooccurring psychiatric problems often worsen during adolescence and early adulthood for people with ASD

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 cutoffs , 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.

Evidence suggests increased rates of suicidality in autism spectrum disorder (ASD), but the research has rarely used comparison samples and the role of emotion dysregulation has not been considered. We compared the prevalence of parent-reported suicidal ideation and considered the role of emotion dysregulation in 330 psychiatric inpatient youth with ASD, 1,167 community youth with ASD surveyed online, and 1,000 youth representative of the US census. The prevalence of suicidal ideation was three and five times higher in the community and inpatient ASD samples respectively compared to the general US sample. In the ASD groups, greater emotion dysregulation was associated with suicidal ideation. Implications include consideration of emotion regulation as a potential mechanism and treatment target for suicidality in ASD.

Emotional reactivity (e.g. explosive outbursts, tantrums) is a common but understudied challenge for individuals with autism spectrum disorder. Prior research has relied primarily on questionnaire data or observations of very young children. The current study coded emotional reactivity and recovery during a series of standardized frustration tasks in a sample of psychiatrically hospitalized youth with autism spectrum disorder ( N = 150; mean age: 12.76) inclusive of the full spectrum of intellectual and functional abilities and explored relationships between emotional reactivity and participant characteristics. The amount, intensity, and duration of negative affect and total range of affect significantly increased from a baseline period to frustration tasks and significantly decreased during recovery. Younger children displayed more negative affect overall; however, age did not moderate change in affect from baseline to frustration tasks or recovery. Adaptive functioning and verbal ability both moderated change in affect, with individuals with lower adaptive functioning and minimally verbal individuals displaying greater reactivity and less recovery. Reactivity was unrelated to non-verbal IQ, overall autism symptom severity, and parent-reported psychiatric/behavioral problems. The results highlight the feasibility and importance of examining emotional reactivity in more severely affected individuals and suggest the need to develop more targeted interventions for emotional reactivity in this group. Lay Abstract Large emotional reactions (e.g. outbursts, tantrums) can be common and distressing in the lives of individuals with autism spectrum disorder and their families. Most previous research that has examined these types of emotional responses have used questionnaire data or focused only on young children. In addition, very little research has included individuals across a large range of intellectual and functional abilities or individuals with more severe emotional and/or behavioral difficulties. This study examined emotional reactions to frustrating tasks in 6–21-year-olds with autism spectrum disorder who were psychiatrically hospitalized due to emotional and/or behavioral difficulties. We describe change in the amount, intensity, duration, and range of emotional reactions that the participants displayed from a neutral activity to the frustrating tasks and then to a neutral recovery period. We also examined associations between characteristics of the participants and these emotional reactions. We found that younger children displayed more negative emotions across the neutral and frustrating tasks; however, age did not relate to how big their reactions to frustration were. Furthermore, we found that individuals with fewer adaptive skills (i.e. age-appropriate life skills) and minimally verbal individuals had bigger reactions and recovered less following the frustration tasks. The results highlight the importance of examining emotional reactions in individuals with lower verbal and adaptive abilities and for interventions to consider the connection between verbal and adaptive skills and emotional reactions.