Clinical and Biological Correlates of Emotional Dysregulation in Children and Adolescents: A Transdiagnostic Approach to Developmental Psychopathology
Annarita Milone
Gianluca Sesso
SimpleOriginal

Summary

This article addresses Emotional Dysregulation (ED) in youth, a prevalent psychopathology. It covers ED's causes, development, symptoms, assessment, and treatment, emphasizing its significance in child and adolescent mental health.

Clinical and Biological Correlates of Emotional Dysregulation in Children and Adolescents: A Transdiagnostic Approach to Developmental Psychopathology

Keywords Emotional Dysregulation; youth; adolescents; ADHD; Post-Traumatic Stress Disorder (PTSD); mood disorders; self-harm; suicidality

1. Introduction

Emotion regulation may be defined as the ability to regulate behavioral and physiological reactivity to sensory stimuli and environmental situations. It entails any kind of strategy that aims to monitor, assess, and modulate emotions in the context of various conditions [1]. On the other hand, the failure to regulate one’s own emotions, that is, Emotional Dysregulation (ED), has become a diagnostic challenge in recent decades due to the great heterogeneity of clinical presentations and the various definitions of the construct proposed; it has also been recently considered a core dimension of psychopathology in youths in a trans-nosographic conceptualization.

In childhood and adolescence, ED affects at least 1–6% of the general population, and significantly and negatively impacts school functioning and professional outcomes, social adjustment and acceptability by peers, and current and later quality of life [2]. For these reasons, ED represents a highly relevant construct in psychiatry research and clinical practice in terms of developmental outcomes and prognostic implications [3]. In light of this, clinicians should always aim to detect the presence of ED when dealing with challenging children and adolescents by means of several validated clinical measures (e.g., [4]). In addition, neurofunctional findings based on brain imaging techniques and peripheral indexes regarding the functioning of the autonomic nervous system have recently emerged as reliable transdiagnostic biomarkers of ED in psychopathology [5].

The principal aim of this Special Issue was thus to address some major aspects of ED in youths: (1) the etiology and early precursors of ED in youth; (2) the developmental trajectories of ED from early childhood to adulthood; (3) the clinical presentation, comorbidities and correlates of ED in youth, including irritability and suicidality; (4) the clinical assessment of ED by means of standardized measures; and (5) psychosocial interventions, psychotherapy, and pharmacological treatment options. In this Special Issue, six relevant contributions, comprising four original articles, one systematic review, and one narrative review that provide significant insights into the clinical assessment and management of ED in youth, were included (see Table A1). This Special Issue gathers different perspectives on ED across varying contexts, highlighting its significant implications for mental health.

2. Summary of Included Studies

Conti and colleagues [6] conducted a systematic review examining the interplay between ED and post-traumatic stress symptoms in adolescents and young adults. The authors found that ED may represent a risk factor that mediates the vulnerability of young people to the development of stress symptoms after trauma exposure. Although most included studies reported inconclusive findings, this systematic review emphasizes the importance of developing emotion regulation strategies as part of Post-Traumatic Stress Disorder (PTSD) prevention programs.

Brancati and coworkers [7] focused on the developmental trajectory of Attention-Deficit/Hyperactivity Disorder (ADHD), particularly regarding early referral to specialty care or treatment with Methylphenidate. They found that early Methylphenidate treatment is associated with reduced ED symptoms and lower rates of mood disorders in adulthood, with negative emotionality mediating the relationship between pharmacotherapy and comorbidity. They also reported higher rates of past disruptive behaviors and current externalizing features in patients with early referral during childhood. Taken together, these findings highlight the fact that ED, especially its externalizing component, can be regarded as a core target of ADHD treatment.

Serra et al. [8] explored the factors associated with high irritability scores in early-onset mood disorders using the Affective Reactivity Index. They identified severe ED as a key factor influencing both parent and self-rated irritability scores, highlighting its importance in differentiating diagnostic profiles and treatment approaches in adolescent mood disorders.

Cerniglia’s workgroup [9] employed a network analysis approach to study risk-taking and self-harm behaviors in typically developing adolescents. This comprehensive nomological approach linked these behaviors to deficits in emotion regulation strategies and maladaptive psychological functioning. Their findings highlight the critical role of effective emotion regulation strategies to mitigate risk-taking and self-harm behaviors, thus informing psychosocial interventions and prevention strategies targeting adolescents engaging in risky conducts.

Masi and colleagues [10] conducted a longitudinal prospective study on non-suicidal self-injury and suicidality in adolescents with mood disorders, revealing that persistent self-injury is associated with higher levels of cyclothymic temperament and an increased risk of suicidal behavior. The authors also found that, at follow-up, patients with persistent and previous self-harming behaviors were more severely impaired than those with no such symptoms; the internalizing problems and ED of these patients also failed to improve. These findings support a continuity between self-injury and suicidality, suggesting the prognostic validity of suggesting that the persistence of symptoms is associated with higher ED and cyclothymic features. The authors concluded by highlighting the need for targeted interventions that address ED and mood symptoms to prevent escalation from self-injury to suicidal ideation and behavior.

Finally, Easdale-Cheele et al. [11] conducted a comprehensive, updated, narrative review summarizing the available findings related to the multimodal interventions targeting ED across the lifespan. They discussed the neurobiological, neuropsychological, and psychosocial factors that influence ED, highlighting both pharmacological and non-pharmacological treatment approaches aimed at enhancing emotional resilience. They also provided evidence with important implications for clinical practice and future research in this field.

3. Conclusions

These six relevant contributions underscore the complex interplay between ED symptoms, psychiatric comorbidities, and developmental trajectories in adolescents and young adults. It is now clear that ED is implicated in the development of post-traumatic stress symptoms, ADHD, irritability in mood disorders, risk-taking behaviors, and non-suicidal self-injury. The authors of these articles propound the need for tailored interventions that address emotion regulation as a pivotal component of therapeutic strategies across various mental health disorders. The findings collectively emphasize the importance of developing targeted interventions to improve ED across various diagnostic profiles, thereby enhancing psychological functioning and mitigating risk behaviors.

Open Article as PDF

Summary

Emotional dysregulation (ED) in youth significantly impacts various developmental outcomes. This special issue explores ED's etiology, developmental trajectories, clinical presentation, assessment, and treatment. Contributions include a systematic review on ED and post-traumatic stress, research on the developmental trajectory of ADHD and its relation to ED, studies examining irritability in mood disorders and the role of ED, a network analysis of risk-taking and self-harm in relation to ED, a longitudinal study on self-injury and suicidality linked to ED, and a narrative review of multimodal interventions for ED.

Summary of Included Studies

A systematic review investigated the relationship between ED and post-traumatic stress symptoms in adolescents and young adults, suggesting ED as a mediating risk factor. Research on ADHD revealed that early methylphenidate treatment is associated with reduced ED symptoms and lower rates of adult mood disorders, with negative emotionality mediating the pharmacotherapy-comorbidity relationship. A study on early-onset mood disorders linked severe ED to higher irritability scores, emphasizing its importance in differentiating diagnostic profiles. Network analysis demonstrated the association between deficits in emotion regulation strategies and risk-taking and self-harm behaviors in adolescents. A longitudinal study found persistent self-injury in adolescents with mood disorders to be associated with higher levels of cyclothymic temperament and increased suicidal behavior, highlighting the prognostic significance of persistent ED and cyclothymic features. Finally, a narrative review summarized findings on multimodal interventions for ED across the lifespan, discussing neurobiological, neuropsychological, and psychosocial factors influencing ED and outlining pharmacological and non-pharmacological treatment approaches.

Conclusions

This special issue highlights the complex relationship between ED, psychiatric comorbidities, and developmental trajectories in youth. ED's involvement in various conditions, including post-traumatic stress, ADHD, irritability in mood disorders, risk-taking behaviors, and self-injury, is evident. The studies strongly advocate for tailored interventions targeting emotion regulation as a crucial component of therapeutic approaches across diverse mental health disorders, underscoring the need for improved ED interventions to enhance psychological well-being and mitigate risk behaviors.

Open Article as PDF

Summary

Emotional dysregulation (ED) significantly impacts youth, affecting school performance, social adjustment, and overall well-being. Its heterogeneity poses diagnostic challenges, making it a key area of research and clinical focus. This special issue examines ED's etiology, developmental trajectory, clinical presentation, assessment, and treatment in adolescents and young adults.

Summary of Included Studies

A systematic review explored the relationship between ED and post-traumatic stress symptoms, suggesting ED as a potential risk factor mediating vulnerability to stress after trauma. Another study examined the developmental trajectory of ADHD, finding that early methylphenidate treatment reduces ED symptoms and lowers mood disorder rates in adulthood. Research on early-onset mood disorders identified severe ED as a key factor influencing irritability scores, highlighting its importance in differentiating diagnostic profiles. A network analysis linked risk-taking and self-harm behaviors in adolescents to deficits in emotion regulation. A longitudinal study found persistent self-injury is associated with higher levels of cyclothymic temperament and increased suicidal risk, with persistent self-harm linked to higher ED and poorer outcomes. Finally, a narrative review summarized multimodal interventions targeting ED, highlighting both pharmacological and non-pharmacological approaches.

Conclusions

These studies collectively demonstrate the complex relationship between ED, various psychiatric comorbidities, and developmental trajectories in youth. ED’s involvement in post-traumatic stress, ADHD, mood disorders, risk-taking, and self-harm underscores the need for interventions specifically addressing emotion regulation across diverse mental health conditions. Improving ED is crucial for enhancing psychological functioning and reducing risk behaviors.

Open Article as PDF

Summary

Emotion regulation (ER) is the ability to manage emotional responses. Poor emotion regulation (ED) significantly impacts teenagers' lives, affecting school, social relationships, and future well-being. It's a key area of study in adolescent mental health. A recent collection of research explored ED in youth, focusing on its causes, development, clinical presentation, assessment, and treatment.

Summary of Included Studies

One study reviewed the link between ED and post-traumatic stress in young people, suggesting that better ER skills could help prevent PTSD. Another study looked at ADHD and found that early medication treatment might lessen ED symptoms and reduce the risk of later mood disorders. A third study showed that severe ED is a significant factor in teenage mood disorders, affecting both how young people and their parents perceive irritability. Research using network analysis demonstrated a connection between poor ER, risk-taking, and self-harm in teens. A longitudinal study linked persistent self-harm in teens with mood disorders to increased risk of suicide attempts, highlighting the importance of addressing ED in these cases. Finally, a review summarized various treatments for ED, covering biological, psychological, and social factors.

Conclusions

This research shows a strong connection between ED and various mental health issues in adolescents. ED is involved in PTSD, ADHD, mood disorders, risk-taking, and self-harm. The studies highlight the need for treatments focusing on improving emotional regulation skills to help young people with these challenges.

Open Article as PDF

Summary

Problems with controlling emotions, called emotional dysregulation (ED), are common in kids and teens. It can make it hard to do well in school, have friends, and feel good about life. Scientists are studying ED to better understand it and help kids who have it.

1. Introduction

ED means having trouble controlling how you feel and act. It's a big problem because it can show up in lots of ways, and it affects many kids. Experts are learning more about ED and how to identify it. They're also finding ways to use brain scans and other tools to better understand ED. This special report looks at different aspects of ED in kids and teens. It explores what causes ED, how it changes as kids grow up, and how it affects things like irritability and suicidal thoughts. It also discusses how to identify ED, as well as different ways to treat it.

2. Summary of Included Studies

Several studies looked at how ED affects kids and teens. One study looked at the link between ED and stress after something scary happened. Another study looked at how giving ADHD medicine early might help prevent problems with emotions later on. Other studies examined how ED relates to irritability, risky behaviors, and self-harm. One study followed kids over time to see how self-harm was linked to suicidal thoughts. Finally, a review looked at different ways to treat ED.

3. Conclusions

These studies show that ED is important in many mental health issues in kids and teens. It's tied to stress, ADHD, irritability, risky behavior, and self-harm. Doctors and therapists need to address ED when helping kids and teens with mental health problems. It's important to find ways to help kids learn to manage their emotions.

Open Article as PDF

Footnotes and Citation

Cite

Milone, A., & Sesso, G. (2024). Clinical and biological correlates of emotional dysregulation in children and adolescents: A transdiagnostic approach to developmental psychopathology. Brain Sciences, 14(8), 782. https://doi.org/10.3390/brainsci14080782

    Highlights