Bennett Teresa, Jambon Marc, Zaidman-Zait Anat, Duku Eric K, Georgiades Stelios, Elsabbagh Mayada, Smith Isabel M, Vaillancourt Tracy, Zwaigenbaum Lonnie, Kerns Connor M, Richard Annie E, Bedford Rachael, Szatmari Peter
McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada.
Wilfred Laurier University, Waterloo, Ontario, Canada.
J Am Acad Child Adolesc Psychiatry. 2025 Jun;64(6):710-723. doi: 10.1016/j.jaac.2024.11.004. Epub 2024 Nov 11.
Emotional dysregulation (ED) is a common and debilitating problem for autistic children and their families. However, little is known about early-onset patterns of dysregulation, associated risk factors, and child and family outcomes. This study aimed to characterize trajectories of ED in an inception cohort of autistic preschoolers.
Caregivers reported on ED of 396 autistic children using the Aberrant Behavior Checklist Irritability and Hyperactivity/Noncompliance subscales at 6 time points from shortly after autism spectrum disorder diagnosis (ages 2-4 years) to preadolescence (ages 10-11 years). Covariance pattern mixture modeling was used to characterize the number and shape of latent dysregulation trajectories that best fit underlying data. Child and family correlates were measured at baseline and between ages 10 and 11 years to characterize early risk factors and preadolescent profiles associated with distinct latent trajectories.
Three distinct trajectory classes best fit the data: persistently self-regulated (18% of sample), moderate and declining (54%), and persistently dysregulated (28%). Children classified in the persistently dysregulated trajectory lived with more depressed caregivers and in families reporting greater relationship problems and lower household incomes compared with children in lower-risk trajectories. Few associations were found with baseline child characteristics. Persistent dysregulation problems were associated with significantly worse child mental health and functional outcomes during preadolescent years.
Risk of persistent severe ED may be identifiable at the time of early autism diagnosis. Diagnostic assessments should include contextual risk factors and links to evidence-based family supports and interventions.
Emotional dysregulation, in the form of frequent and severe meltdowns, irritability and impulsivity, often cause a lot of stress for children with autism spectrum disorder (ASD) and their families. Using data from the Pathways in ASD follow-up study involving 396 children diagnosed between the ages of 2 and 4 years with ASD, authors found that 28% were at high risk of severe emotional dysregulation that lasted throughout early and middle childhood. Children at highest risk were more likely to live in homes where families experienced parental depression, family relationship stress, and lower household incomes compared to those with fewer self-regulation problems. Clinicians conducting diagnostic assessments should include proactive and family-centered mental health assessments, prevention and early intervention for young children with ASD.
情绪调节障碍（ED）是自闭症儿童及其家庭中常见且令人衰弱的问题。然而，对于失调的早发模式、相关风险因素以及儿童和家庭结局知之甚少。本研究旨在描述一组自闭症学龄前儿童起始队列中情绪调节障碍的轨迹特征。
照顾者在6个时间点报告了396名自闭症儿童的情绪调节障碍情况，这些时间点从自闭症谱系障碍诊断后不久（2至4岁）到青春期前（10至11岁），使用异常行为检查表中的易怒和多动/不依从分量表。协方差模式混合模型用于描述最适合基础数据的潜在失调轨迹的数量和形状。在基线以及10至11岁之间测量儿童和家庭的相关因素，以描述与不同潜在轨迹相关的早期风险因素和青春期前特征。
三种不同的轨迹类别最适合数据：持续自我调节（占样本的18%）、中度且下降（54%）以及持续失调（28%）。与低风险轨迹的儿童相比，被归类为持续失调轨迹的儿童与更多抑郁的照顾者生活在一起，并且其家庭报告有更大的关系问题和更低的家庭收入。在基线儿童特征方面几乎没有发现关联。持续的失调问题与青春期前儿童明显更差的心理健康和功能结局相关。
在早期自闭症诊断时可能可以识别出持续严重情绪调节障碍的风险。诊断评估应包括背景风险因素以及与循证家庭支持和干预措施的联系。
情绪调节障碍，表现为频繁且严重的情绪崩溃、易怒和冲动，常常给自闭症谱系障碍（ASD）儿童及其家庭带来很大压力。利用自闭症谱系障碍随访研究中396名2至4岁被诊断为ASD儿童的数据，作者发现28%的儿童有严重情绪调节障碍的高风险，这种障碍在整个儿童早期和中期持续存在。与自我调节问题较少的儿童相比，风险最高的儿童更有可能生活在家庭中存在父母抑郁、家庭关系紧张和家庭收入较低的环境中。进行诊断评估的临床医生应包括积极主动且以家庭为中心的心理健康评估，对患有ASD的幼儿进行预防和早期干预。
