Study: Emotional Burden, Dysregulation Predict Anxiety, Depression in Neurodivergent Youth
Emotional burden and regulation difficulties due to distressing, traumatic events independently predicted higher rates of depression or anxiety in adolescents with ADHD, autism, or both conditions, finds a new study.
December 17, 2025
Among autistic and ADHD children, the risk of developing comorbid depression or anxiety in adulthood is driven largely by emotional exposures in childhood and how intensely they are experienced, suggests a new study published in the Journal of Child Psychology and Psychiatry.1 In other words, it’s not the ADHD and autistic traits alone that increase the risk for comorbidities, but the emotional load and regulation problems that often come with trauma.
The study found that emotional burden (EB) and emotional regulation difficulty (ERD) independently predicted higher rates of depression or anxiety in autistic youth with and without ADHD, as well as among teens with ADHD alone. Adolescents within these groups also experienced greater frequency and intensity of common upsetting events (CUEs) and substantially higher overall EB, especially during unstructured or socially complex situations at school, compared to their neurotypical peers. The frequency and intensity of CUEs, and higher EB, were uniquely associated with depression or anxiety.
The researchers identified distinctive sets of CUEs with discriminating burden among the ADHD, autistic, and ADHD-autistic groups.
ADHD-Autistic Group: Burdensome CUEs
- last-minute change of plans
- not allowed self-regulation strategies
- being rushed to move on from task to task
ADHD Group: Burdensome CUEs
- teachers don’t listen
- boring lessons or tasks
- stopped from doing something enjoyable
- losing and forgetting things
- being told to try harder
- being unfairly accused of something
Autistic Group: Burdensome CUEs
- peer gossip
- unexpected wait in a queue
- sensory discomfort
- being rushed to complete work
- not understanding others
Lowering stressors and emotional triggers, the researchers suggest, may be just as important as learning emotion regulation skills.
“The concept of induced EB has the potential to expand, or even to shift, the focus of emotion-related interventions from attempts to reduce ERD within an individual through emotion regulation training alone to ones that incorporate EB reduction — by decreasing CUEs and/or improving ways such provocations might be managed to ameliorate the intensity of emotional reactions they induce,” the researchers wrote.
How Autistic and ADHD Traits Relate to Emotional Burden
The study also revealed that autistic adolescents with ADHD appeared to experience only the same level of burden as those with ADHD or autism alone, rather than the conditions acting additively. “This was a surprising finding, which needs to be replicated in future studies,” the researchers wrote.
One possibility is that there exists a ‘ceiling’ in emotional burden experienced by neurodivergent individuals. “Another possibility,” the researchers wrote, “is that the co-occurrence of ADHD and autism leads to the former cancelling out the latter effect and vice-versa, leading to each contributing to a smaller proportion of emotional burden than each condition alone.”
More longitudinal studies are needed to explore how EB and ERD relate to depression and anxiety in ADHD and/or autistic individuals.
“EB could add significant power to explain the emergence of mental health problems in adolescents with ADHD and/or autism, over and above more traditional measures of emotion dysregulation,” the researchers wrote.
By adulthood, about half of autistic people and 30% of those with ADHD will have a clinical depression and/or anxiety diagnosis. 2, 3
“Understanding — not undermining — the lived experiences of those who live with ADHD and/or autism is critical,” explained Karen Saporito, Ph.D., in the ADDitude webinar “AuDHD Guidance: Why Autism is So Difficult to Diagnose in Women and Girls with ADHD.” “The experiences, traits, symptoms, and challenges of our patients do not always align with textbook definitions and available research findings, and firsthand accounts can offer a more accurate and comprehensive understanding of these conditions… When patients feel heard and respected, they are more likely to engage in their care and advocate for themselves, leading to better outcomes.”
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1Lukito, S., Chandler, S., Kakoulidou, M., Griffiths, K., Wyatt, A., Funnell, E., Pavlopoulou, G., Baker, S., Stahl, D., & Sonuga-Barke, E. Emotional burden in school as a source of mental health problems associated with ADHD and/or autism: Development and validation of a new co-produced self-report measure. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.70003
2Dow, D., Morgan, L., Hooker, J.L., Michaels, M.S., Joiner, T.E., Woods, J., & Wetherby, A.M. (2021). Anxiety, depression, and the interpersonal theory of suicide in a community sample of adults with autism spectrum disorder. Archives of Suicide Research.
3Wilens, T., Nierenberg, A.A., Rostain, A., & Spencer, T.J. (2008). Adult attention-deficit hyperactivity disorder and the role of depression. CNS Spectrums.
