Trauma Symptomatology, Emotional Dysregulation, and Autism Spectrum Disorder in Children and Adolescents in an Inpatient Setting

Background and Purpose: Recent examination of inpatient youth with autism spectrum disorder (ASD) and an endorsed history of trauma has shown a possible increase in risk for comorbidity of PTSD. Investigations have found children and adolescences with ASD and a history of trauma can exhibit higher levels of psychopathology than those without endorsed trauma histories. Findings from youth with ASD, who experienced trauma, have shown an increase in risk for intrusive thoughts and memories, negative mood, irritability, maladaptive behaviors and reduced interest. In an effort to further examine the impact of trauma and emotional dysregulation in youth with ASD, this study sought to assess the associations between trauma, emotion dysregulation and autism symptomatology.

Method: Hospitalized children and adolescence with ASD(N=423) were recruited across six states (Colorado, Maryland, Maine, Ohio, Pennsylvania, and Rhode Island) as part of the Autism and Developmental Disorders Inpatient Research Collaborative. Trauma symptoms were evaluated utilizing a modified Child Behavior Checklist (CBCL)-PTSD scale, the Emotion Dysregulation Inventory was used to assess emotional dysregulation, and the Autism Diagnostic Observation Schedule was used to assess ASD symptoms. Mediator analyses were used to examine the association between trauma symptomatology and ASD symptoms through heightened emotion dysregulation. Moderator analyses were used to examine the consistency of relationships across gender, race/ethnicity, and socioeconomic status.

Results: Overall, participants with high levels of trauma symptoms showed a greater risk for elevated emotional dysregulation (ß = .45, p< .001), contributing to an increase in ASD symptoms (ß = .13, p = .016),z= 2.36, p = .018. With regard to social affect, inpatient youth with trauma symptoms presented with higher levels of emotional dysregulation leading to an increase in social affect impairments in ASD, z = 2.35, p=.019. Despite, the positive correlation between emotional dysregulation and trauma symptoms, it did mediate the relationship between trauma and restricted/repetitive behaviors in ASD, z= 1.00, p= .320. Evidence suggests that sociodemographics may have moderating effects on these relationships.

Conclusion and Implications: Statistical outcomes indicate that trauma symptoms may increase emotional dysregulation in inpatient youth with ASD, which could also influence autism symptomatology, particularly social impairment. These findings signify a need for the development of increased trauma screening and accessibility of evidence-based trauma treatment for ASD patients in inpatient settings.