Characterising the behaviours in most severe and least severe emotional outbursts in young people

Abstract

Emotional outbursts are displays of intense, challenging behaviour and are prevalent in individuals with neurodevelopmental disorders. Outbursts present a danger to individuals and their carers and are cited as reasons for referral to mental health services. However, it is currently unclear how the characteristics of outbursts may determine their severity. Carers (n = 214) of individuals aged between 6 and 25 and experiencing outbursts at least once per month completed the Emotional Outburst Questionnaire. Questionnaire items were used to compare behaviours observed in most severe and least severe outbursts through quantitative and content analyses of open ended data. Signs of physiological arousal and aggression were seen significantly more in most severe outbursts compared to least severe outbursts. Least severe outbursts were seen more frequently, but most severe outbursts were reported to have a longer duration, be at a higher intensity, and have a longer recovery time. Additionally, associations were found between reduced eye contact and most severe outbursts, as well as expression of suicidal ideation and most severe outbursts. Certain behaviours, notably forms of aggression and physiological arousal, are associated with most severe outbursts. Findings of this study may allow future work examining cross-disorder differences in outbursts to inform targeted interventions aiming to reduce outburst severity and impact. Additionally, identification of such outburst characteristics could aid in measurement of outburst severity, which would allow for more reliable and valid studies on outburst interventions.

Figure 1

(a–d) Differences in duration, intensity, frequency and recovery time of most and least severe emotional outbursts. Duration is displayed on a scale of 1 (less than 5 min) and 7 (a day or more). Intensity is displayed on a scale of 1 (‘not at all angry or upset’) to 7 (‘as angry or upset as I have ever seen them’). Frequency is displayed on a scale of 1 (never occurs) to 8 (occurs more than once per day). Recovery is displayed on a scale of 1 (recovers in less than 5 min) to 7 (takes more than a day to recover). Full details on the scale are shown in the EOQ, found in the supplementary materials.

Figure 2

Association between individual behaviours and most severe outbursts. ***Indicates p < 0.001, **Indicates p < 0.01, *Indicates p < 0.05. Dotted line at 0.15 indicates boundary between small and medium effect size, dotted line at 0.25 indicates boundary between medium and large effect size.