(PS4-44) Examining the Role of Emotion Dysregulation and Intolerance of Uncertainty in the Manifestation of Restricted and Repetitive Behaviors

Emotion dysregulation (ED) and intolerance of uncertainty (IU) are both transdiagnostic constructs that have recently been increasingly examined in relation to elevated levels of anxiety in autistic youth (Vasa et al., 2023). ED is defined as difficulty modulating both mood-based (dysphoria) and behavioral (reactivity) aspects of one's own emotions in response to environmental triggers (Mazefsky et al., 2021), while IU is a dispositional transdiagnostic characteristic involving maladaptive responses to states of uncertainty (Keefer et al., 2022). Prior research indicates a positive association between IU and maladaptive emotion regulation strategies (Sahib et al., 2023). Both factors have also been explored as contributing factors to increased expressions of restricted and repetitive behaviors (RRBs) in autism, with IU and ED both predicting restrictive and repetitive behaviors (RRBs;  McDonald et al., 2023; Vasa et al., 2018). However, profiles of ED and RRBs have not yet been examined in combination with IU. Therefore, the current study seeks to clarify the relationship amongst IU, ED, and RRBs.

Seventy-five neurodiverse youth (M_age=11.56, SD_age=3.2; 60% male; 49.3% White, 15.9% Asian/SouthAsian/MENA; 6.7% Black, 16% Multiracial; 43 autistic) completed parent-reported measures of ED (Emotion Dysregulation Index; Mazefsky et al., 2021), IU (Anxiety Scale for Children-Autism Spectrum Disorder; Rogers et al., 2016), and RRBs (Repetitive Behavior Scale-Revised; Bodfish et al., 2000).

Bivariate correlations indicated that ED and IU were correlated with each other (rs=.31, p=.01) and both are significantly related to all facets of RRBs (e.g., repetitive behavior, self-injury, sameness, compulsive behavior, and interests; all rs =.31, p< .001). Mediation analyses suggest that greater IU partially mediated the relationships between ED reactivity and greater repetitive behavior (b_indirect= .5, 95% CI[.01,.10]), interests (b_indirect= .03, CI[.01, .05]), compulsions (b_indirect= .02, CI[.00, .03]), self-injury (b_indirect= .03, CI[.00, .06]), and sameness (b_indirect= .07, CI[.01, .14]). IU partially mediated the relationship between dysphoria and greater interests (b_indirect= .05, CI[.02,.11]), self-injury (b_indirect= .05, CI[.01, .14]) and sameness (b_indirect= .15, CI[.06,.26]), and fully mediated ED dysphoria and compulsions (b_indirect= .03, CI[.00, .06]) and repetitive behavior (b_indirect= .10, CI[.03,.18]).

Results suggest that the relationship amongst ED and RRBs, despite strong, may be in part explained by IU, particularly when considering ED dysphoria. These findings provide important information about the significant impact that ED has on specified profiles of RRBs, ultimately alluding to strategies to refine interventions aimed at supporting autistic youth, particularly those whose RRBs frequently manifest in response to distress (Baribeau et al., 2020). When considering treatment opportunities for mental health conditions, it may be important to consider both IU and ED, of which some treatment methods have begun to do (Keefer et al., 2021). Future research should explore how transdiagnostic treatment methods targeting both IU and ED could impact RRBs.