6.27 Under Pressure: Expressed Emotion and Stress in Youth With Autism Spectrum Disorder

Abstract

While underlying mechanisms linking expressed emotion (EE) to patient outcomes remain under investigation, it has been suggested that high EE constitutes a significant family-level stressor, leading to an increased likelihood of relapse and poor outcomes in vulnerable individuals, particularly those with autism spectrum disorder (ASD), who often have difficulty regulating their stress responses. High EE appears to be present in a significant proportion of families with an individual with neurodevelopmental disabilities (NDDs). The goal of the current study is to investigate our hypotheses: 1) EE is correlated with self-reported stress in both neurotypical (NT) youth and youth with ASD; 2) the correlation between EE and stress will be stronger in individuals with ASD compared to their neurotypical counterparts. The current analysis includes 30 adolescents aged 13 to 17 years (N = 16 ASD, 12.5% female; N = 14 NT, 21% female). The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) Psychological Stress Experiences Form was administered to measure stress as experienced by the adolescents. EE was determined using the Five-Minute Speech Sample (FMSS) administered to the primary caregiver. In adolescents with ASD, those with high EE had significantly higher self-reported stress than those with low EE (p < 0.01). While a similar direction of effect was found between high EE and self-reported stress in the overall sample, this result did not reach statistical significance (p = 0.09). The correlation between EE and self-reported stress was not significantly different in adolescents with ASD compared to neurotypical subjects (p = 0.22). The significant association found between EE and self-reported stress in adolescents with ASD lays a foundation for future clinical work aimed at decreasing familial stress for youth with NDDs. While the association between high EE and self-reported stress in subjects overall did not reach statistical significance in our preliminary results, the trend mirrors existing literature demonstrating that neurotypical youth are also deleteriously affected by EE and suggests that future study with a larger sample size may uncover a significant association. Further investigation regarding the direction of these effects would provide additional insight into appropriate targets for stress reduction and clinical intervention.