High Risk for Severe Emotional Dysregulation in Psychiatrically Referred Youth with Autism Spectrum Disorder: A Controlled Study.
Expect severe emotional dysregulation in nearly half of psychiatrically referred autistic youth and use CBCL-ED to spot those at highest risk.
01Research in Context
What this study did
Joshi et al. (2018) compared kids who were sent to psychiatry clinics. One group had autism. The other group had ADHD.
They used the CBCL Emotional Dysregulation scale to see how many kids in each group showed big mood swings, tantrums, or rapid mood changes.
What they found
Eight out of ten autistic youth in the clinic scored high for emotional dysregulation. Nearly half hit the 'severe' range.
Kids with ADHD also showed dysregulation, but the autism group had much higher scores. Higher autism severity went hand-in-hand with worse dysregulation.
How this fits with other research
Leung et al. (2014) first built the CBCL-ED index and showed autistic kids outpace typical peers on dysregulation. Gagan moves that finding into real-world psychiatry referrals.
Bradley et al. (2026) later created the shorter Emotion Dysregulation Inventory for community samples. Their tool links dysregulation profiles to parent stress and sleep loss, echoing Gagan's call to watch severe cases.
Bowen et al. (2012) used the CBCL earlier and flagged anxiety and ADHD as top concerns in autistic kids. Gagan sharpens the picture by naming severe emotional dysregulation as the standout issue in referred youth.
Why it matters
If you evaluate a child with autism in a mental-health setting, plan on emotional storms. Run the CBCL-ED or the newer EDI at intake. Kids in the severe zone will likely need behavior plans that target mood lability, sensory breaks, and caregiver training. Flagging them early can shorten wait-lists for intensive services and maybe keep them out of the emergency department later.
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02At a glance
03Original abstract
To assess prevalence and severity of emotional dysregulation (ED) in psychiatrically referred youth with autism spectrum disorder (ASD). ASD youth (N = 123) were compared to youth with attention-deficit/hyperactivity disorder (ADHD) and controls. The majority of psychiatrically referred youth with ASD had positive Child Behavior Checklist-ED (CBCL-ED) profile that was significantly higher than in youth with ADHD (82 vs. 53%; p < 0.001). The severe emotional dysregulation (SED) profile was significantly greater in ASD youth than ADHD (44 vs. 15%; p < 0.001). In the presence of SED profile ASD youth suffered from greater severity of autism, associated psychopathology, and psychosocial dysfunction. Greater than expected prevalence of SED in psychiatrically referred youth with ASD that identifies distinct clinical correlates associated with severe morbidity and dysfunction.
Journal of autism and developmental disorders, 2018 · doi:10.1007/s10803-018-3542-9