Department of Child and Adolescent Psychiatry, King's College London, Institute of Psychiatry and NIHR Biomedical Research Centre for Mental Health, De Crespigny Park, London, UK.
J Child Psychol Psychiatry. 2012 Nov;53(11):1157-66. doi: 10.1111/j.1469-7610.2012.02600.x. Epub 2012 Aug 22.
Severe mood dysregulation and problems (SMP) in otherwise typically developing youth are recognized as an important mental health problem with a distinct set of clinical features, family history and neurocognitive characteristics. SMP in people with autism spectrum disorders (ASDs) have not previously been explored.
We studied a longitudinal, population-based cohort of adolescents with ASD in which we collected parent-reported symptoms of SMP that included rage, low and labile mood and depressive thoughts. Ninety-one adolescents with ASD provided data at age 16 years, of whom 79 had additional data from age 12. We studied whether SMP have similar correlates to those seen in typically developing youth.
Severe mood problems were associated with current (parent-rated) and earlier (parent- and teacher-rated) emotional problems. The number of prior psychiatric diagnoses increased the risk of subsequent SMP. Intellectual ability and adaptive functioning did not predict to SMP. Maternal mental health problems rated at 12 and 16 years were associated with SMP. Autism severity as rated by parents was associated with SMP, but the relationship did not hold for clinician ratings of autistic symptoms or diagnosis. SMP were associated with difficulty in identifying the facial expression of surprise, but not with performance recognizing other emotions. Relationships between SMP and tests of executive function (card sort and trail making) were not significant after controlling for IQ.
This is the first study of the behavioural and cognitive correlates of severe mood problems in ASD. As in typically developing youth, SMP in adolescents with ASD are related to other affective symptoms and maternal mental health problems. Previously reported links to deficits in emotion recognition and cognitive flexibility were not found in the current sample. Further research is warranted using categorical and validated measures of SMP.
在其他方面发育正常的青少年中，严重的情绪失调和问题（SMP）被认为是一个重要的心理健康问题，具有独特的临床特征、家族史和神经认知特征。自闭症谱系障碍（ASD）患者的 SMP 以前尚未被探讨过。
我们研究了一个纵向的、基于人群的 ASD 青少年队列，在该队列中，我们收集了父母报告的 SMP 症状，包括愤怒、情绪低落和不稳定以及抑郁想法。91 名 ASD 青少年在 16 岁时提供了数据，其中 79 名在 12 岁时有额外的数据。我们研究了 SMP 是否与在典型发育青少年中看到的具有相似的相关性。
严重的情绪问题与当前（父母评定）和早期（父母和教师评定）的情绪问题有关。先前的精神科诊断次数增加了随后发生 SMP 的风险。智力能力和适应功能不能预测 SMP。12 岁和 16 岁时母亲的心理健康问题与 SMP 相关。父母评定的自闭症严重程度与 SMP 相关，但与临床医生评定的自闭症症状或诊断无关。SMP 与识别惊讶面部表情的困难有关，但与识别其他情绪的表现无关。在控制智商后，SMP 与执行功能测试（卡片分类和轨迹制造）之间的关系并不显著。
这是 ASD 中严重情绪问题的行为和认知相关性的首次研究。与在典型发育青少年中一样，ASD 青少年的 SMP 与其他情感症状和母亲的心理健康问题有关。在当前样本中，先前报告的与情绪识别和认知灵活性缺陷的关联未被发现。需要使用分类和验证的 SMP 测量方法进一步研究。
