Negative school experiences generate twice the emotional burden in autistic and ADHD adolescents compared to their neurotypical classmates, and this is significantly correlated with depression and anxiety, according to a new study involving a UCL researcher.
The research, published in the Journal of Child Psychology and Psychiatry and led by the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London in partnership with UCL and Anna Freud, aimed to better understand why up to 50 per cent of autistic adults and 30 per cent of those with ADHD end up with a clinical diagnosis of depression or anxiety as adults.
Previous thinking has proposed that depression risk in neurodivergent children is due to deficits in their ability to regulate their negative emotions, which can lead to intense and prolonged reactions to an emotive event.
It found that both emotion regulation deficits and emotional burden were linked to depression, suggesting the value of a more joined up approach to managing mental health risks in neurodivergent youth at school.
735 11-16 year olds took part in the study, with a substantial proportion having elevated traits of either ADHD (100), autism (104), or both ADHD and autism (79), and 213 having a confirmed diagnosis. The rest were neurotypical. All participants were asked to complete the My Emotions in School Inventory (MESI), which asked how frequently they experienced each of 24 common upsetting events and then how upsetting each was on a nine point scale.
Researchers found that neurodivergent participants reported greater frequency of these common upsetting events - such as misunderstanding a social situation, or being accused of being disruptive by a teacher - and experienced the negative emotion they induced more intensely than their neurotypical peers.
Researchers suggest that this creates greater overall emotional burden, which they calculated as the product between the frequency of each upsetting event and its intensity, summed across all common upsetting events.
Co-author and RE-STAR co-investigator Dr Georgia Pavlopoulou (UCL Psychology & Language Sciences and Anna Freud) said: "Accounts of emotional dysregulation in autism and ADHD are too often shaped by adult observations rooted in neurotypical ideas of how emotions should look and be expressed.
"This approach overlooks the real experiences of neurodivergent young people and misses the context behind their emotional responses, context only they can truly provide. That’s why we worked for over 20 months with young people to co-produce MESI, a new tool designed to better understand and support their emotional world on their terms."
Senior author, Professor Edmund Sonuga-Barke (King’s IoPPN and NIHR Maudsley BRC) said: "Understanding why young people with ADHD and autism are at increased risk of mental health problems is an essential step in developing new interventions to improve the mental health of neuro-divergent people.
"We found that emotional burden induced by upsetting experiences in school may contribute to this risk. This highlights the potential value of school-based interventions designed both to help schools reduce upsetting experiences and to help students manage those negative experiences that remain.
"It is clear to us that including neurodivergent young people at the heart of our team and work, has helped us develop new ideas leading to new hypotheses about the origins of depression in autism and ADHD."
Interestingly, while it was found that although ADHD and autism were associated with the same overall experience of emotional burden, different triggers were important for individuals with these different conditions. Autistic participants highlighted that difficult peer interactions were often the driving force behind events that they found upsetting, such as peers talking behind their back, or challenges in understanding social situations. Participants with ADHD on the other hand found that their upsetting events often involved situations with teachers.
Joint first author Dr Susie Chandler (King’s IoPPN) said: "Adolescence is a key time for emotional development, and secondary school plays a role in this. Our study highlights the impact everyday school events and interactions have on young people’s emotions; and how young people with neurodevelopmental conditions in particular can find school a source of emotional challenge. Identifying common upsetting events, the findings provide some pointers for how schools can create supportive environments that promote the wellbeing of autistic young people and those with ADHD."
Joint first author Dr Steve Lukito (King’s IoPPN) said: "Whole-school approaches to mental health should be neurodiversity-informed and include interventions designed to reduce upsetting experiences help students manage those negative experiences when they do occur."
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