Establishing the transdiagnostic contextual pathways of emotional outbursts

Behaviours that Challenge in SATB2-associated Syndrome: Correlates of Self-injury, Aggression and Property Destruction

SATB2-associated syndrome (SAS) is a genetic syndrome characterised by intellectual disability, severe speech delay, and palatal and dental problems. Behaviours that challenge (BtC) are reported frequently; however, there is limited research on specific forms of BtC and the correlates of these behaviours. The current study explores correlates of well-defined BtC, self-injury, aggression, and property destruction, in SAS. Eighty-one parents/caregivers of individuals with SAS (53.1% male, Mage 10.12 years) completed questionnaire measures of health, behavioural, emotional, and autism characteristics. Individuals with SAS were grouped based on caregiver responses to the presence or absence of self-injury, aggression, and property destruction on the Challenging Behaviour Questionnaire. Rates of self-injury, aggression and property destruction were 42%, 77% and 49%, respectively. Between-group comparisons were conducted to compare characteristics between behaviour groups. Significantly differing characteristics were entered into separate hierarchical logistic regressions for each form of BtC. Behavioural comparisons indicated variation in the characteristics associated with each behaviour. All hierarchical logistic regression models were significant (p < .001): self-injury (χ2(5) = 38.46, R2 = 0.571), aggression (χ2(4) = 25.12, R2 = 0.414), property destruction (χ2(4) = 23.70, R2 = 0.346), explaining between 34.6% and 57.1% of the variance in behaviour presence. This is the first study to identify correlates of self-injury, aggression, and property destruction in SAS. Variability in the characteristics associated with each behaviour highlights the importance of specificity when examining BtC. Understanding correlates of specific forms of BtC has important implications for informing SAS-associated pathways to behavioural outcomes and the implementation of tailored behavioural interventions.

Understanding Emotional Outbursts: A Cross-Cultural Study in Latin American Children with Autism Spectrum Disorder

OBJECTIVES

One of the behavioral problems strongly associated with emotional dysregulation (ED) in ASD is emotional outbursts (EOs) characterized by a pattern of challenging behavior that varies across individuals and across time. Cultural factors can modulate the expression of EOs. This study aimed to characterize the profile of emotional outbursts (EOs) in children with autism spectrum disorder (ASD) across various countries in Latin America and to identify clinical, emotional, and contextual factors that contribute to the onset and frequency of EOs within this diverse sample.

METHODS

A cross-sectional and cross-cultural study was conducted between 2023 and 2024 comprising samples from five countries in the Latin American Network for Autism-REAL: Argentina, Brazil, Chile, Uruguay, and the Dominican Republic. We studied 689 children with ASD (age x = 8.7 ± 2.6 years) using the Emotional Outburst Questionnaire (EOQ).

RESULTS

We identified different types of EO among children with ASD in our sample. The most frequent was the 'behavioral indicators of emotion' (52.0%) followed by 'increased motor activity' (28.3%), 'non-speech vocalizations', (27.6%), 'mild verbal aggression' (23.8%), and 'avoidance' (21.5%). Children in a bad mood or having a bad day or experiencing irritability were the most significant factors that increased the likelihood of EOs.

CONCLUSIONS

Our results revealed that irritability is an important trigger for EOs and should not be disregarded or underestimated when monitoring the mental health of children with ASD.

Characterising the behaviours in most severe and least severe emotional outbursts in young people

Emotional outbursts are displays of intense, challenging behaviour and are prevalent in individuals with neurodevelopmental disorders. Outbursts present a danger to individuals and their carers and are cited as reasons for referral to mental health services. However, it is currently unclear how the characteristics of outbursts may determine their severity. Carers (n = 214) of individuals aged between 6 and 25 and experiencing outbursts at least once per month completed the Emotional Outburst Questionnaire. Questionnaire items were used to compare behaviours observed in most severe and least severe outbursts through quantitative and content analyses of open ended data. Signs of physiological arousal and aggression were seen significantly more in most severe outbursts compared to least severe outbursts. Least severe outbursts were seen more frequently, but most severe outbursts were reported to have a longer duration, be at a higher intensity, and have a longer recovery time. Additionally, associations were found between reduced eye contact and most severe outbursts, as well as expression of suicidal ideation and most severe outbursts. Certain behaviours, notably forms of aggression and physiological arousal, are associated with most severe outbursts. Findings of this study may allow future work examining cross-disorder differences in outbursts to inform targeted interventions aiming to reduce outburst severity and impact. Additionally, identification of such outburst characteristics could aid in measurement of outburst severity, which would allow for more reliable and valid studies on outburst interventions.

Preliminary psychometric properties of the Brazilian Portuguese version of the emotional outburst questionnaire

This study focuses on the cross-cultural adaptation of the Emotional Outburst Questionnaire (EOQ) to Brazilian Portuguese and preliminarily assesses its predictive validity. The EOQ evaluates aspects of emotional outbursts (EO), including frequency, duration, intensity, types, associated behaviours, recovery time, triggers, and effectiveness of calming strategies. Two independent translators performed the translation, with subsequent synthesis and analysis revealing that only 33 items (24.81%) required revision. Among these, one item needed partial modification, and two needed total modification. The study demonstrated strong content validity and adaptation in terms of conceptual, idiomatic, and semantic aspects. The EOQ's predictive validity was assessed by analysing the interruption of mental health services in Brazil due to Covid-19 (T1) compared to when services resumed after social distancing measures were lifted (T2). Parents of 25 individuals with developmental disabilities (ASD, DS and ID), with a mean of 11 y/o, mostly male (76%), completed the EOQ. Service interruption during T1 led to increased frequency and duration of severe emotional outbursts reported by caregivers compared to T2 (frequency: p < .001; duration: p = 0.05). This suggests that the EOQ exhibits predictive validity and sensitivity to changes influenced by individual contexts. These findings highlight the EOQ's potential as an outcome measure for intervention development.

Cross-Cultural Comparison of the Contexts Associated with Emotional Outbursts

The causal relationship between emotional outbursts and emotion dysregulation is proposed to be heterogeneous, but cultural influences have not been considered despite established cultural differences in emotional processes (e.g., increased motivation to suppress emotions in interdependent cultures). Responses to the Brazilian Portuguese version of the Emotional Outburst Questionnaire were collected from 327 caregivers of young people (6-25 years) with autism spectrum disorder, Down's syndrome, or intellectual disability. Responses were compared to a previous sample of 268 responses from the English version of the questionnaire. The latent factor structure of the contextual items was measurement invariant across both versions. The Brazilian responses were classified into three distinct clusters (Sensory Sensitivity; Perceived Safety; Perceived Unsafety) which considerably overlapped with the English clusters.

A case study on the effect of light and colors in the built environment on autistic children's behavior

Background

The importance of strategies and services by caregivers and family members substantially impact the psychological and emotional wellbeing of autistic children. The rapid research developments in clinical and non-clinical methods benefit the features of autistic children. Among various internal and external factors, the influence of the built environment also impacts the characteristics of autistic children. This study investigates primarily the psychological effect of light and colors on the mood and behavior of autistic children to identify the most favorable and preferred indoor lights and color shades.

Methods

A questionnaire survey was conducted at an autism center among autistic children and their parents. This study included autistic children aged between 6 and 16 (45 males, 42 females, mean age 8.7 years, standard deviation 2.3). Eighty-seven participants were involved in the survey to determine the sensory perceptions, intolerance, preferences, and sensitivities of children with an autism spectrum disorder toward colors and lighting. The margin of error at the statistical analysis's 95% confidence level is ± 0.481.

Results

As per this case report, the children have various color preferences and respond differently to different shades. Different hues have varying effects on autistic children, with many neutral tones and mellow shades proven to be autistic-friendly with their calming and soothing effect, while bright, bold, and intense colors are refreshing and stimulating. The stimulus of bright-lighting causes behavioral changes in autistic children prone to light sensitivity.

Conclusion

The insights gained from this interaction with parents and caretakers of autistic children could be helpful for designers to incorporate specific autistic-friendly design elements that make productive interior spaces. A complete understanding of the effect of factors like color and lighting on the learning ability and engagement of autistic children in an indoor environment is essential for designers and clinicians. The main findings of this study could be helpful for a designer and clinicians to address designing an autism-friendly built environment with a color palette and lighting scheme conducive to their wellbeing and to maximize their cognitive functioning.