Emotion dysregulation as cross-disorder trait in child psychiatry predicting quality of life and required treatment duration

Abstract

Background Emotion dysregulation (ED) is increasingly under investigation as a cross-disorder trait, and is by some considered as the core feature in mental disorders. The underlying assumptions are that ED is a trait that manifests similarly across disorders and with similar impact. The aims of this study are to examine the shared and specific features of ED in relation to DSM-categories in a large sample of clinically referred youth. Methods Information on clinical diagnosis (Attention Deficit/Hyperactivity Disorder ADHD, Autism Spectrum Disorder, Oppositional Defiant Disorder/Conduct Disorder, Anxiety and Mood Disorders), ED (measured by the CBCL-Emotion Dysregulation Index), Quality of Life (Qol, measured by the Kidscreen-27), and treatment duration (measured by Electronic Health Records) was retrieved from two large samples of toddlers (1.5-5 year old; N = 1,544) and school aged children (6–18 year old; N = 7,259). Frequency scores and logistic regression were used to study symptom profiles of ED, as measured with CBCL-EDI, across all disorders. Linear regression was used to determine the predictive value of ED (CBCL-EDI total score) regarding QoL and treatment duration in addition to - and in interaction with - clinical diagnosis. Results Across disorders, equal levels of total ED were found, which predicted lower QoL and a longer treatment duration in addition to clinical diagnosis. The majority of items (11/15 and 16/18) were of equal relevance to the disorders; items that were not, largely reflected disorder specific DSM definitions (i.e. externalizing symptoms in ODD/CD and internalizing symptoms in Anxiety and Mood disorders). Conclusions ED is a clinically useful cross-disorder trait to predict severity of impairment as well as required treatment duration. In addition, ED is largely composed of shared features across disorders, with certain disorder specific coloured elements.

Prevalence of comorbidity of autism and ADHD and associated characteristics in school population: EPINED study

“…Regarding the rate of ADHD comorbidity in autistic children, our figure (32.8%) is remarkably similar to the 29.5% referred in community samples by the meta‐analysis of Rong et al (2021), but lower than those found in clinical samples (40.4%–61.8%) (Casseus et al, 2023; Houghton et al, 2017; Rau et al, 2020; Rong et al, 2021). However, considering the age group, the 21.9% found in preschoolers was similar to the 20.4% rate shown by Fucà et al (2023) and the 17% by Bierens et al (2023) in Italian and Netherlands clinical samples, respectively. We found a significantly higher rate of autism and ADHD comorbidity in school‐aged children (46.2%) than in preschool‐age children (21.9%), differences also shown by Casseus et al (2023) (45.4% and 14.6%, respectively) but not obtained by other authors (Fucà et al, 2023; Houghton et al, 2017; Rong et al, 2021).…”

“…Also, without reaching significant differences probably due to the small size of this sample, the emotional DP showed a slightly higher score in the comorbid compared with the other clinical groups. Other authors have found that impaired emotional self‐regulation is more prevalent in youth with ADHD or/and autism (Bierens et al, 2023; Ventura et al, 2022) and that the shared association of these characteristics could predict social challenges (Jaisle et al, 2023).…”

“…In clinical samples, according to DSM‐5 criteria, ADHD was present in 61.8% of autistic youth in the U.S. (Rau et al, 2020) while in Italy, the rate was lower in both preschoolers (20.4%) and school‐age children (21%) and followed by adolescents (7.3%) (Fucà et al, 2023). In contrast, Bierens et al (2023) reported in the Netherlands clinical population a higher rate of ADHD in autistic children from 6 to 18 years (34.8%) than in preschoolers (17%). According to recent data from the U.S. National Survey of Children's Health, 43.8% of children were also presenting comorbidity with ADHD at an older age (Casseus et al, 2023), similarly found in the meta analysis conducted by Rong et al (2021).…”