The role of emotion regulation and core autism symptoms in the experience of anxiety in autism

Abstract

Youth with autism spectrum disorder are at elevated risk for impaired emotion regulation and clinically impairing anxiety. A prior developmental framework posited that impaired emotion regulation leads to co-occurring psychiatric conditions such as anxiety, with outcome determined in part by autism spectrum disorder–specific moderating factors. Using measures developed and validated in autism spectrum disorder, this study evaluated (1) the association between emotion regulation and anxiety in a large, community-based sample of youth with autism spectrum disorder and a wide range of intellectual and verbal abilities and (2) whether greater core autism spectrum disorder symptoms strengthened the association between impaired emotion regulation and anxiety. Parents of 1107 children with a community diagnosis of autism spectrum disorder (881 boys; age 6–17 years) participated in an online survey assessing their child’s emotion regulation, anxiety, and autism spectrum disorder symptoms. Emotion regulation impairment significantly predicted whether participants had elevated levels of anxiety, after controlling for demographic variables and autism spectrum disorder symptoms; however, there was no interaction of emotion regulation and autism spectrum disorder symptoms. This study is the first to support the anxiety–emotion regulation association with measures developed and validated specifically for autism spectrum disorder, in a large sample with co-occurring intellectual disability and minimally verbal youth with autism spectrum disorder. Lay abstract Many children with autism spectrum disorder have problems with managing their emotions (emotion regulation) and anxiety. In this study, over 1000 parents completed an online survey which showed that emotion regulation and anxiety are closely linked. Although emotion regulation and anxiety are inter-connected, the results also show that autism symptoms play an important role in anxiety in autism spectrum disorder. Emotion regulation problems may be an important target for the treatment of anxiety in autism.