Mapping the time course of overt emotion dysregulation, self‐injurious behavior, and aggression in psychiatrically hospitalized autistic youth: A naturalistic study

Challenges with emotion dysregulation, self‐injurious behavior (SIB), and aggression are common in autistic individuals. Prior research on the relationships between these behaviors is limited mainly to cross‐sectional correlations of parent‐report data. Understanding how emotion dysregulation, SIB, and aggression present and relate to one another in real‐time could add to our understanding of the context and function of these behaviors. The present study examined the real‐time occurrence and temporal relationships between these behaviors in 53 psychiatrically hospitalized autistic youth. Over 500 hours of behavioral observation occurred during everyday activities in the hospital. Start and stop times for instances of overt emotion dysregulation, SIB, and aggression were coded live using a custom mobile phone app. Results indicated large individual variability in the frequency and duration of these behaviors and their co‐occurrence. Both SIB and aggression co‐occurred with overt emotion dysregulation at above‐chance levels, suggesting a role for emotional distress in the occurrence of these behaviors. However, there was substantial variability within and between individuals in co‐occurrence, and SIB and aggression often (and for some individuals, almost always) occurred without overt emotion dysregulation. Relatedly, cross‐recurrence quantitative analysis revealed that SIB and aggression preceded emotion dysregulation more often than emotion dysregulation preceded SIB and aggression. Future research, perhaps using ambulatory psychophysiological measures, is needed to understand whether emotion dysregulation may sometimes be present but not easily observed during SIB and aggression. Lay Summary This study provides insight into how overt emotion dysregulation (i.e., visible distress), aggression, and self‐injury unfold in real‐time for autistic individuals. Participants were 53 autistic youth staying in a psychiatric hospital. Research staff observed participants in everyday activities on the hospital unit and noted instances of aggression, self‐injurious behavior, and emotion dysregulation. Results suggest that aggression and self‐injury sometimes occur with visible signs of distress but also often occur without visible distress. In addition, observable distress was more common in the moments after these behaviors than in the moments before.