How Does Emotional Dysregulation Differ Across Child Psychiatric Disorders?

What you need to know

• Emotional dysregulation is common across many child psychiatric disorders, but its severity varies
• Children with ADHD and additional disorders like oppositional defiant disorder show the highest levels of dysregulation
• Identifying different patterns of dysregulation could help tailor treatments to individual children’s needs

What is emotional dysregulation?

Emotional dysregulation refers to difficulties managing and responding to emotional experiences. For children, this can manifest as:

• Intense emotional reactions that seem out of proportion to the situation
• Trouble calming down when upset
• Rapid mood swings
• Angry outbursts or aggression
• Anxiety and depression symptoms

While all children experience big emotions at times, persistent dysregulation can significantly impact a child’s functioning and relationships.

Examining dysregulation across disorders

Researchers have become increasingly interested in emotional dysregulation as a factor that cuts across many different psychiatric diagnoses in children. This study aimed to examine how dysregulation profiles differ between various child psychiatric disorders.

The researchers looked at dysregulation in over 900 children aged 6-18 who were referred for psychiatric evaluation. The children were diagnosed with one of the following:

• Tic disorders
• Anxiety disorders
• Obsessive-compulsive disorder (OCD)
• Depression
• Attention-deficit/hyperactivity disorder (ADHD)
• ADHD + tic disorder
• ADHD + oppositional defiant disorder (ODD)

They also included a comparison group of children with learning disorders but no psychiatric diagnosis.

Dysregulation was measured using the Child Behavior Checklist (CBCL), a questionnaire filled out by parents. It looks at three key areas:

1. Anxious/depressed symptoms
2. Attention problems
3. Aggressive behavior

By combining scores in these three domains, researchers can identify children with a “dysregulation profile” indicating difficulties regulating emotions, behavior, and cognition.

Key findings on dysregulation levels

The study found that dysregulation was common across all the psychiatric disorders examined, but there were some key differences:

Lowest dysregulation: Tic disorders

Children diagnosed with tic disorders showed the lowest average levels of dysregulation. This was true even when looking only at more severe, chronic tic disorders.

However, it’s important to note that their dysregulation scores were still elevated compared to children without psychiatric disorders. This suggests that even in disorders not typically associated with emotional issues, some level of dysregulation is common.

Highest dysregulation: ADHD + other disorders

The highest average levels of dysregulation were seen in children diagnosed with ADHD plus another disorder - either tics or oppositional defiant disorder (ODD).

This finding highlights how the combination of ADHD with other conditions can create more severe regulatory difficulties for children. The impulsivity and emotional reactivity associated with ADHD may interact with symptoms of other disorders to amplify dysregulation.

Varying patterns across disorders

Each disorder showed a somewhat different pattern of dysregulation:

• Children with depression scored highest on the anxious/depressed subscale
• Those with ADHD + tics scored highest on attention problems
• Children with ADHD + ODD scored highest on aggressive behavior

This suggests that while dysregulation is common across disorders, it can manifest in different ways depending on a child’s specific diagnosis.

How common is severe dysregulation?

The researchers also looked at how many children in each group met criteria for severe dysregulation. They used a few different methods to classify severity:

Severe dysregulation

Using the strictest criteria, rates of severe dysregulation ranged from about 5% to 18% across the different disorder groups. The highest rates were seen in:

• Depression (18%)
• ADHD + ODD (17%)
• ADHD + tics (15%)

Borderline dysregulation

When including children with borderline dysregulation scores, the rates were much higher - ranging from about 40% to 80% across disorders. Over 80% of children with depression or ADHD plus another disorder fell into this category.

These high rates highlight just how common regulatory difficulties are among children referred for psychiatric evaluation. Even when dysregulation isn’t severe enough to warrant its own diagnosis, it’s often present as an additional challenge for children and families.

Different types of dysregulation profiles

To dig deeper into patterns of dysregulation, the researchers used a statistical technique called latent class analysis. This allowed them to identify subgroups of children with similar symptom profiles.

They found five distinct dysregulation profiles:

1. Negligible dysregulation (about 50% of children)

   • Mild anxiety/depression and attention problems
   • Low aggression

2. Moderate general dysregulation (about 20%)

   • Moderate difficulties across all three domains

3. Severe dysregulation with low aggression (small subgroup)

   • High anxiety/depression and attention problems
   • Low aggression

4. Severe general dysregulation (about 20%)

   • High difficulties across all three domains

5. Severe dysregulation with high aggression (about 5%)

   • Extremely high aggression
   • High anxiety/depression and attention problems

These profiles cut across diagnostic categories. For example, children with ADHD might fall into any of these subgroups depending on their specific symptom pattern.

Identifying these distinct profiles could potentially help clinicians tailor treatment approaches. A child with severe dysregulation but low aggression may need a different intervention than one with high aggression, even if they have the same primary diagnosis.

Implications for understanding and treating childhood disorders

This study highlights several important points about emotional dysregulation in child psychiatry:

Dysregulation as a transdiagnostic factor

The findings support the idea that dysregulation is a common factor across many different childhood psychiatric disorders. While its severity and specific manifestation may vary, regulatory difficulties appear to be the rule rather than the exception for children referred for mental health treatment.

This suggests that assessing for and addressing dysregulation could be beneficial regardless of a child’s specific diagnosis. Treatments that focus on building emotion regulation skills may have wide applicability.

The impact of comorbidity

The study found that children with multiple diagnoses - specifically ADHD combined with another disorder - showed the highest levels of dysregulation. This emphasizes the cumulative impact that co-occurring conditions can have on a child’s regulatory abilities.

For clinicians, this highlights the importance of comprehensive assessment. When severe dysregulation is present, it may be worth considering whether multiple underlying issues are at play.

Personalized treatment approaches

The identification of distinct dysregulation profiles suggests that a one-size-fits-all approach to treatment may not be sufficient. Children with similar diagnoses may have very different patterns of regulatory difficulties.

Tailoring interventions to a child’s specific dysregulation profile could potentially lead to more effective outcomes. For example:

• A child with severe anxiety/depression symptoms may benefit most from emotion-focused therapies
• One with high aggression might need more emphasis on behavioral interventions
• A child with severe attention problems might require strategies specifically targeting cognitive regulation

Conclusions

• Emotional dysregulation is common across childhood psychiatric disorders, but its severity and specific manifestation can vary widely
• Children with multiple diagnoses, particularly ADHD combined with another disorder, tend to show the highest levels of dysregulation
• Different subtypes of dysregulation profiles exist that cut across diagnostic categories
• Assessing for and addressing dysregulation may be beneficial as part of treatment for many childhood mental health conditions
• Tailoring interventions to a child’s specific dysregulation profile could potentially improve treatment outcomes

While more research is needed, this study highlights the importance of looking beyond diagnostic labels to understand the regulatory challenges facing children with mental health concerns. By taking a more nuanced view of emotional dysregulation, clinicians may be better equipped to provide personalized, effective care.