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.

Researchers created a new questionnaire to measure how emotionally difficult school can be for teenagers with ADHD and/or autism. They found that these students experience upsetting school events more often and react more intensely than other students. The emotional stress from school contributed to depression and anxiety separately from other emotion regulation difficulties. Different types of school situations were particularly upsetting for students with ADHD versus autism.

This study developed the My Emotions in School Inventory (MESI), a co-produced self-report measure to assess emotional burden in schools among adolescents with ADHD and/or autism. The study included 735 secondary school students across four groups: ADHD (n=100), autism (n=104), ADHD+autism (n=79), and neurotypical controls (n=452). Results showed that neurodivergent adolescents experienced significantly higher frequency and intensity of commonly upsetting events (CUEs) in school settings. The MESI demonstrated ability to discriminate between neurodivergent and neurotypical students.

Importantly, emotional burden and emotion regulation deficits independently predicted depression and anxiety symptoms, suggesting distinct pathways to mental health problems. Different CUEs generated emotional burden in autism versus ADHD groups, indicating condition-specific triggers.

The MESI provides a tool for identifying school-based emotional stressors in neurodivergent adolescents. Findings suggest interventions should address both emotional burden from environmental factors and emotion regulation skills. School-based accommodations may need to be tailored differently for ADHD versus autism presentations to address condition-specific triggers.

Cross-sectional design prevents causal inferences. Study acknowledges need for longitudinal investigation. Sample characteristics and recruitment methods not fully detailed in abstract. Validation limited to secondary school students, limiting generalizability to other age groups.

Mental health problems are elevated in adolescents with ADHD and/or autism. Emotion regulation deficits (ERD) have been hypothesised as a key driver of such difficulties. The Regulating Emotions - Strengthening Adolescent Resilience (RE-STAR) programme is examining an alternative pathway from neurodivergence to mental health problems, mediated by elevated emotional burden (EB) resulting from the interplay of increased exposure and an unusually intense emotional reaction to commonly upsetting events (CUEs). We present the development and application of the My Emotions in School Inventory (MESI), a self-report questionnaire co-produced with neurodivergent young people, focusing on EB in schools - a setting thought to be of particular significance in this regard.

The MESI, containing 25 school-related CUEs rated on their frequency and the intensity of negative emotions they induce, was completed by secondary school students meeting symptom cut-offs on clinically validated scales of ADHD (n = 100), autism (n = 104), ADHD + autism (n = 79) and neurotypical students (n = 452). Psychometric properties were examined. The ability of the MESI to discriminate adolescents with ADHD and/or autism from neurotypical adolescents, and to predict depression and anxiety, independently of ERD, was explored. Adolescents in the ADHD and/or autism groups experienced higher CUE frequency and intensity of reaction than their neurotypical peers.

Overall levels of EB, most robustly indexed by 24 MESI CUEs, were higher in the three neurodivergent groups, though they did not differ from each other. EB in the autism and ADHD groups was generated by distinctly different CUEs. EB and ERD each contributed independently to the prediction of higher depression or anxiety. Our findings illustrate the potential value of the MESI as an instrument to measure the contribution of EB alongside ERD in relation to adolescent mental health risks in ADHD and/or autism.

Future studies need to investigate its role longitudinally.