Self-Regulation in Neurodivergent Children and Adolescents With and Without Co-occurring Anxiety and Depression

Neurodevelopmental disorders (NDDs) frequently co-occur with internalizing psychopathologies, such as anxiety and depression. Self-regulation, encompassing behavioral, cognitive, and emotion regulation, is a transdiagnostic process associated with both internalizing disorders and NDDs. This study sought to compare self-regulation abilities of youth with monodiagnostic versus co-occurring NDDs and internalizing disorders and youth with neither disorder. Participants included 164 youth (70.7% male; 78.7% White) aged 6-17 who completed a comprehensive assessment at a community clinic. Primary and secondary caregivers completed questionnaires about their child's self-regulation. One-way ANOVA was used to compare self-regulation indexes across groups. Primary caregivers reported that youth with NDDs with and without co-occurring internalizing disorders had significantly more difficulties in behavioral, cognitive, and overall self-regulation compared to those with monodiagnostic internalizing and the comparison group. Emotion regulation difficulties were significantly higher in the NDD and co-occurring groups than in the comparison group, but similar to internalizing group. Secondary caregiver reports confirmed that the NDD and co-occurring groups had more significant self-regulation issues across all indexes compared to the comparison group. The internalizing group showed higher emotion regulation difficulties compared to the comparison group per secondary caregivers. This study highlights significant self-regulation difficulties in youth with NDDs compared to peers without these diagnoses, even when co-occurring internalizing diagnoses are present. The lack of increased difficulties in these cases suggests that co-occurring anxiety and/or depression may not exacerbate self-regulation. These findings underscore the need for interventions addressing multiple aspects of self-regulation for youth with NDDs.