Investigating the Effects of Transdiagnostic Processes on Anxiety and Depression Symptoms in Autistic Young People: the Mediating Role of Emotion Dysregulation.
Anxiety
Autism
Child
Depression
Emotion dysregulation
Journal
Journal of autism and developmental disorders
ISSN: 1573-3432
Titre abrégé: J Autism Dev Disord
Pays: United States
ID NLM: 7904301
Informations de publication
Date de publication:
04 Mar 2024
04 Mar 2024
Historique:
accepted:
12
01
2024
medline:
5
3
2024
pubmed:
5
3
2024
entrez:
4
3
2024
Statut:
aheadofprint
Résumé
Internalising symptoms are elevated in autism compared to the general population. Few studies have investigated emotional dysregulation (ED) as a potential mediator between specific transdiagnostic processes and anxiety and depression symptoms in autistic youth. In a sample of 94 autistic young people aged 5-18 years referred to a specialist clinic for an autism evaluation, we tested the effects of ED as a mediator between cognitive inflexibility (CI), intolerance of uncertainty (IU) and alexithymia with anxiety and depression symptoms, using structural equation modelling. Effect sizes were compared to a non-autistic comparison group (n = 84). CI and alexithymia did not significantly predict depression symptoms in autistic young people, directly nor via ED. Relationships between CI/alexithymia and depression were fully mediated by ED in the non-autistic sample. There was a direct effect of CI on anxiety in the non-autistic group but not in those with a diagnosis. IU predicted depression symptoms in the autism group; and ED mediated this relationship only in those who did not receive a diagnosis. IU directly predicted anxiety in both groups and this relationship did not occur via ED. The finding of a direct pathway from IU to anxiety and depression in autistic youth is consistent with the literature. The finding that CI did not predict anxiety or depression in those with autism is novel, as was the finding that ED mediated relationships between alexithymia and anxiety/depression symptoms in both samples. The findings may have important implications for the delivery of psychological interventions for autistic youth.
Identifiants
pubmed: 38438816
doi: 10.1007/s10803-024-06246-0
pii: 10.1007/s10803-024-06246-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s).
Références
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Author.
doi: 10.1176/appi.books.9780890425596
Armbruster, D. J., Ueltzhöffer, K., Basten, U., & Fiebach, C. J. (2012). Prefrontal cortical mechanisms underlying individual differences in cognitive flexibility and stability. Journal of Cognitive Neuroscience, 24(12), 2385–2399.
doi: 10.1162/jocn_a_00286
Beck, K., Conner, C., Breitenfeldt, K., Northrup, J., White, S., & Mazefsky, C. (2020). Assessment and treatment of emotion regulation impairment in autism spectrum disorder across the life span: Current state of the science and future directions. Child and Adolescent Psychiatric Clinics of North America, 29(3), 527–542.
pmcid: 7810097
doi: 10.1016/j.chc.2020.02.003
Bougeard, C., Picarel-Blanchot, F., Schmid, R., Campbell, R., & Buitelaar, J. (2021). Prevalence of autism spectrum disorder and co-morbidities in children and adolescents: A systematic literature review. Frontiers in Psychiatry, 12, 744709.
pmcid: 8579007
doi: 10.3389/fpsyt.2021.744709
Boulter, C., Freeston, M., South, M., & Rodgers, J. (2014). Intolerance of uncertainty as a framework for understanding anxiety in children and adolescents with autism spectrum disorders. Journal of Autism and Developmental Disorders, 44, 1391–1402.
doi: 10.1007/s10803-013-2001-x
Buhr, K., & Dugas, M. J. (2009). The role of fear of anxiety and intolerance of uncertainty in worry: An experimental manipulation. Behaviour Research and Therapy, 47(3), 215–223.
doi: 10.1016/j.brat.2008.12.004
Cai, R., Richdale, A., Dissanayake, C., & Uljarević, M. (2018). Brief report: Inter-relationship between emotion regulation, intolerance of uncertainty, anxiety, and depression in youth with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48, 316–325.
doi: 10.1007/s10803-017-3318-7
Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26(3), 468–479.
doi: 10.1016/j.janxdis.2012.01.011
Carleton, R. N., Norton, M. P. J., & Asmundson, G. J. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105–117.
doi: 10.1016/j.janxdis.2006.03.014
Charlton, A., Smith, I., Mazefsky, C., & White, S. (2020). The role of emotion regulation on co-occurring psychopathology in emerging adults with ASD. Journal of Autism and Developmental Disorders, 50, 2585–2592.
doi: 10.1007/s10803-019-03983-5
Chorpita, B. F., Moffitt, C. E., & Gray, J. (2005). Psychometric properties of the Revised Child Anxiety and Depression Scale in a clinical sample. Behaviour Research and Therapy, 43(3), 309–322.
doi: 10.1016/j.brat.2004.02.004
Cibralic, S., Kohlhoff, J., Wallace, N., McMahon, C., & Eapen, V. (2019). A systematic review of emotion regulation in children with Autism Spectrum Disorder. Research in Autism Spectrum Disorders, 68, 101422.
doi: 10.1016/j.rasd.2019.101422
Conner, C., Golt, J., Shaffer, R., Righi, G., Siegel, M., & Mazefsky, C. (2021). Emotion dysregulation is substantially elevated in autism compared to the general population: Impact on psychiatric services. Autism Research, 14(1), 169–181.
doi: 10.1002/aur.2450
Conner, C., Kim, P., White, S., & Mazefsky, C. (2022). The role of emotion dysregulation and intolerance of uncertainty in autism: Transdiagnostic factors influencing co-occurring conditions. Research in Developmental Disabilities, 130, 104332.
doi: 10.1016/j.ridd.2022.104332
Conner, C., & White, S. (2018). Brief report: Feasibility and preliminary efficacy of individual mindfulness therapy for adults with autism spectrum disorder. Journal of Autism and Developmental Disorders, 48, 290–300.
doi: 10.1007/s10803-017-3312-0
Conner, C., White, S., Scahill, L., & Mazefsky, C. (2020). The role of emotion regulation and core autism symptoms in the experience of anxiety in autism. Autism, 24(4), 931–940.
pmcid: 7773149
doi: 10.1177/1362361320904217
Connor-Smith, J. K., Compas, B. E., Wadsworth, M. E., Thomsen, A. H., & Saltzman, H. (2000). Responses to stress in adolescence: Measurement of coping and involuntary stress responses. Journal of Consulting and Clinical Psychology, 68(6), 976–992.
doi: 10.1037/0022-006X.68.6.976
Dajani, D., & Uddin, L. (2015). Demystifying cognitive flexibility: Implications for clinical and developmental neuroscience. Trends in Neurosciences, 38(9), 571–578.
pmcid: 5414037
doi: 10.1016/j.tins.2015.07.003
Day, T., Northrup, J., & Mazefsky, C. (2022). A PROMIS® ing new measure for quantifying emotion dysregulation in toddlers and preschoolers: Development of the emotion dysregulation inventory-young child. Journal of Autism and Developmental Disorders, 53, 2261.
doi: 10.1007/s10803-022-05536-9
Eisenberg, N. (2000). Emotion, regulation, and moral development. Annual Review of Psychology, 51(1), 665–697.
doi: 10.1146/annurev.psych.51.1.665
Freeston, M. H., & Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and Individual Differences, 17, 791–802.
doi: 10.1016/0191-8869(94)90048-5
Ford, T., Last, A., Henley, W., Norman, S., Guglani, S., Kelesidi, K., Martin, A.M., Moran, P., Latham-Cork, H., & Goodman, R. (2013). Can standardized diagnostic assessment be a useful adjunct to clinical assessment in child mental health services? A randomized controlled trial of disclosure of the Development and Well-Being Assessment to practitioners. Social Psychiatry and Psychiatric Epidemiology, 48, 583–593.
doi: 10.1007/s00127-012-0564-z
Gabrys, R. L., Tabri, N., Anisman, H., & Matheson, K. (2018). Cognitive control and flexibility in the context of stress and depressive symptoms: The cognitive control and flexibility questionnaire. Frontiers in Psychology, 9, 2219.
pmcid: 6252356
doi: 10.3389/fpsyg.2018.02219
Goodman, A., Heiervang, E., Collishaw, S., & Goodman, R. (2011). The ‘DAWBA bands’ as an ordered-categorical measure of child mental health: description and validation in British and Norwegian samples. Social Psychiatry and Psychiatric Epidemiology, 46, 521–532.
doi: 10.1007/s00127-010-0219-x
Griffin, C., Lombardo, M. V., & Auyeung, B. (2016). Alexithymia in children with and without autism spectrum disorders. Autism Research, 9(7), 773–780.
doi: 10.1002/aur.1569
Gross, J. (1999). Emotion and emotion regulation. Handbook of Personality: Theory and Research, 2, 525–552.
Hemming, L., Haddock, G., Shaw, J., & Pratt, D. (2019). Alexithymia and its associations with depression, suicidality, and aggression: An overview of the literature. Frontiers in Psychiatry, 10, 203.
pmcid: 6470633
doi: 10.3389/fpsyt.2019.00203
Hofman, N. L. (2014). Emotion regulation deficits as mediators of the relationship between trauma, emotional intelligence, antisocial behaviors, posttraumatic stress symptoms, and alcohol use and related problems. University of South Dakota.
Hollocks, M. J., Charman, T., Baird, G., Lord, C., Pickles, A., & Simonoff, E. (2022a). Exploring the impact of adolescent cognitive inflexibility on emotional and behavioural problems experienced by autistic adults. Autism, 26(5), 1229–1241.
doi: 10.1177/13623613211046160
Hollocks, M. J., Jones, C. R., Pickles, A., Baird, G., Happé, F., Charman, T., & Simonoff, E. (2014). The association between social cognition and executive functioning and symptoms of anxiety and depression in adolescents with autism spectrum disorders. Autism Research, 7(2), 216–228.
doi: 10.1002/aur.1361
Hollocks, M. J., Leno, V. C., Chandler, S., White, P., Yorke, I., Charman, T., & Simonoff, E. (2022b). Psychiatric conditions in autistic adolescents: Longitudinal stability from childhood and associated risk factors. European Child & Adolescent Psychiatry, 32, 2197.
doi: 10.1007/s00787-022-02065-9
Hollocks, M. J., Lerh, J. W., Magiati, I., Meiser-Stedman, R., & Brugha, T. S. (2019). Anxiety and depression in adults with autism spectrum disorder: A systematic review and meta-analysis. Psychological Medicine, 49(4), 559–572.
doi: 10.1017/S0033291718002283
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modelling: A Multidisciplinary Journal, 6(1), 1–55.
doi: 10.1080/10705519909540118
Jenkinson, R., Milne, E., & Thompson, A. (2020). The relationship between intolerance of uncertainty and anxiety in autism: A systematic literature review and meta-analysis. Autism, 24(8), 1933–1944.
pmcid: 7539603
doi: 10.1177/1362361320932437
Kaat, A., & Lecavalier, L. (2015). Reliability and validity of parent-and child-rated anxiety measures in autism spectrum disorder. Journal of Autism and Developmental Disorders, 45, 3219–3231.
doi: 10.1007/s10803-015-2481-y
Khor, A., Melvin, G., Reid, S., & Gray, K. (2014). Coping, daily hassles and behavior and emotional problems in adolescents with high-functioning autism/Asperger’s disorder. Journal of Autism and Developmental Disorders, 44, 593–608.
doi: 10.1007/s10803-013-1912-x
Kinnaird, E., Stewart, C., & Tchanturia, K. (2019). Investigating alexithymia in autism: A systematic review and meta-analysis. European Psychiatry, 55, 80–89.
doi: 10.1016/j.eurpsy.2018.09.004
Lau, B., Leong, R., Uljarevic, M., Lerh, J., Rodgers, J., Hollocks, M., & Magiati, I. (2020). Anxiety in young people with autism spectrum disorder: Common and autism-related anxiety experiences and their associations with individual characteristics. Autism, 24(5), 1111–1126.
doi: 10.1177/1362361319886246
Lawson, R., Papadakis, A., Higginson, C., Barnett, J., Wills, M., Strang, J., & Kenworthy, L. (2015). Everyday executive function impairments predict comorbid psychopathology in autism spectrum and attention deficit hyperactivity disorders. Neuropsychology, 29(3), 445.
doi: 10.1037/neu0000145
Liao, K., & Wei, M. (2011). Intolerance of uncertainty, depression, and anxiety: The moderating and mediating roles of rumination. Journal of Clinical Psychology, 67(12), 1220–1239.
doi: 10.1002/jclp.20846
Lord, C., Risi, S., Lambrecht, L., Cook, E., Leventhal, B., DiLavore, P., & Rutter, M. (2000). The autism diagnostic observation schedule—generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.
doi: 10.1023/A:1005592401947
Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24(5), 659–685.
doi: 10.1007/BF02172145
Mazefsky, C. (2015). Emotion regulation and emotional distress in autism spectrum disorder: Foundations and considerations for future research. Journal of Autism and Developmental Disorders, 45, 3405–3408.
pmcid: 4609632
doi: 10.1007/s10803-015-2602-7
Mazefsky, C., Day, T., Siegel, M., White, S. W., Yu, L., & Pilkonis, P. (2018). Development of the emotion dysregulation inventory: A PROMIS®ing method for creating sensitive and unbiased questionnaires for autism spectrum disorder. Journal of Autism and Developmental Disorders, 48, 3736–3746.
pmcid: 5378674
doi: 10.1007/s10803-016-2907-1
Mazefsky, C., & White, S. (2014). Emotion regulation: Concepts & practice in autism spectrum disorder. Child and Adolescent Psychiatric Clinics, 23(1), 15–24.
doi: 10.1016/j.chc.2013.07.002
Mazefsky, C., Yu, L., & Pilkonis, P. (2021). Psychometric properties of the emotion dysregulation inventory in a nationally representative sample of youth. Journal of Clinical Child & Adolescent Psychology, 50(5), 596–608.
doi: 10.1080/15374416.2019.1703710
McEvoy, P., & Mahoney, A. (2012). To be sure, to be sure: Intolerance of uncertainty mediates symptoms of various anxiety disorders and depression. Behaviour Therapy, 43(3), 533–545.
doi: 10.1016/j.beth.2011.02.007
McEwen, F.S., Stewart, C.S., Colvert, E., Woodhouse, E., Curran, S., Gillan, N., Hallett, V., Lietz, S., Garnett, T., Ronald, A., & Murphy, D. (2016). Diagnosing autism spectrum disorder in community settings using the Development and Well-Being Assessment: validation in a UK population-based twin sample. Journal of Child Psychology and Psychiatry, 57(2), 161–170.
doi: 10.1111/jcpp.12447
Milosavljevic, B., Carter Leno, V., Simonoff, E., Baird, G., Pickles, A., Jones, C. R., & Happé, F. (2016). Alexithymia in adolescents with autism spectrum disorder: Its relationship to internalising difficulties, sensory modulation and social cognition. Journal of Autism and Developmental Disorders, 46, 1354–1367.
doi: 10.1007/s10803-015-2670-8
Mukherjee, S., & Beresford, B. (2023). Factors influencing the mental health of autistic children and teenagers: Parents’ observations and experiences. Autism, 27(8), 2324–2336.
pmcid: 10576903
Oakley, B., Jones, E., Crawley, D., Charman, T., Buitelaar, J., Tillmann, J., & Loth, E. (2022). Alexithymia in autism: Cross-sectional and longitudinal associations with social-communication difficulties, anxiety and depression symptoms. Psychological Medicine, 52(8), 1458–1470.
doi: 10.1017/S0033291720003244
Osmanağaoğlu, N., Creswell, C., & Dodd, H. (2018). Intolerance of Uncertainty, anxiety, and worry in children and adolescents: A meta-analysis. Journal of Affective Disorders, 225, 80–90.
doi: 10.1016/j.jad.2017.07.035
Ozsivadijan, A., Hollocks, M. J., Magiati, I., Happé, F., Baird, G., & Absoud, M. (2021). Is cognitive inflexibility a missing link? The role of cognitive inflexibility, alexithymia and intolerance of uncertainty in externalising and internalising behaviours in young people with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 62(6), 715–724.
doi: 10.1111/jcpp.13295
Rodriguez-Seijas, C., Gadow, K., Rosen, T., Kim, H., Lerner, M., & Eaton, N. (2020). A transdiagnostic model of psychiatric symptom co-occurrence and autism spectrum disorder. Autism Research, 13(4), 579–590.
doi: 10.1002/aur.2228
Sharma, S., Hucker, A., Matthews, T., Grohmann, D., & Laws, K. R. (2021). Cognitive behavioural therapy for anxiety in children and young people on the autism spectrum: A systematic review and meta-analysis. BMC Psychology, 9(1), 1–16.
doi: 10.1186/s40359-021-00658-8
Strang, J., Anthony, L., Yerys, B., Hardy, K., Wallace, G., Armour, A., & Kenworthy, L. (2017). The flexibility scale: Development and preliminary validation of a cognitive flexibility measure in children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 47, 2502–2518.
doi: 10.1007/s10803-017-3152-y
Taylor, G. J. (2000). Recent developments in alexithymia theory and research. The Canadian Journal of Psychiatry, 45(2), 134–142.
doi: 10.1177/070674370004500203
Uddin, L. Q. (2021). Brain mechanisms supporting flexible cognition and behavior in adolescents with autism spectrum disorder. Biological Psychiatry, 89(2), 172–183.
doi: 10.1016/j.biopsych.2020.05.010
Wang, T., Li, M., Xu, S., Liu, B., Wu, T., Lu, F., & Wang, J. (2019). Relations between trait anxiety and depression: A moderation model. Journal of Affective Disorders, 244, 217–222.
doi: 10.1016/j.jad.2018.09.074
Way, I. F., Applegate, B., Cai, X., Franck, L. K., Black-Pond, C., Yelsma, P., & Muliett, M. (2010). Children’s Alexithymia Measure (CAM): A new instrument for screening difficulties with emotional expression. Journal of Child & Adolescent Trauma, 3, 303–318.
doi: 10.1080/19361521.2010.523778
Werner-Seidler, A., Banks, R., Dunn, B. D., & Moulds, M. L. (2013). An investigation of the relationship between positive affect regulation and depression. Behaviour Research and Therapy, 51(1), 46–56.
doi: 10.1016/j.brat.2012.11.001
Yook, K., Kim, K., Suh, S., & Lee, K. (2010). Intolerance of uncertainty, worry, and rumination in major depressive disorder and generalized anxiety disorder. Journal of Anxiety Disorders, 24(6), 623–628.
doi: 10.1016/j.janxdis.2010.04.003