Severe mood problems in adolescents with autism spectrum disorder Emily Simonoff, 1 Catherine R.G. Jones, 2 Andrew Pickles, 3 Francesca Happe ´, 4 Gillian Baird, 5 and Tony Charman 6 1 Department of Child and Adolescent Psychiatry, King’s College London, Institute of Psychiatry and NIHR Biomedical Research Centre for Mental Health, De Crespigny Park, London, UK; 2 Department of Psychology, University of Essex, Wivenhoe Park, Colchester, Essex, UK; 3 Department of Biostatistics, King’s College London, Institute of Psychiatry, London, UK; 4 MRC SDGP Research Centre, King’s College London, Institute of Psychiatry, London, UK; 5 Guy’s & St Thomas’ NHS Foundation Trust, Newcomen Centre, London, UK; 6 Centre for Research in Autism and Education, Institute of Education, London, UK Introduction: Severe mood dysregulation and problems (SMP) in otherwise typically developing youth are recognized as an important mental health problem with a distinct set of clinical features, family history and neurocognitive characteristics. SMP in people with autism spectrum disorders (ASDs) have not previously been explored. Method: We studied a longitudinal, population-based cohort of adolescents with ASD in which we collected parent-reported symptoms of SMP that included rage, low and labile mood and depressive thoughts. Ninety-one adolescents with ASD provided data at age 16 years, of whom 79 had additional data from age 12. We studied whether SMP have similar correlates to those seen in typically developing youth. Results: Severe mood problems were associated with current (parent-rated) and earlier (parent- and teacher-rated) emotional problems. The number of prior psychiatric diagnoses increased the risk of subsequent SMP. Intellectual ability and adaptive functioning did not predict to SMP. Maternal mental health problems rated at 12 and 16 years were associated with SMP. Autism severity as rated by parents was associated with SMP, but the relationship did not hold for clinician ratings of autistic symptoms or diagnosis. SMP were associated with difficulty in identifying the facial expression of surprise, but not with performance recognizing other emotions. Relationships between SMP and tests of executive function (card sort and trail making) were not significant after controlling for IQ. Conclusions: This is the first study of the behavioural and cognitive correlates of severe mood problems in ASD. As in typically developing youth, SMP in adolescents with ASD are related to other affective symptoms and maternal mental health problems. Previously reported links to deficits in emotion recognition and cognitive flexibility were not found in the current sample. Further research is warranted using categorical and validated measures of SMP. Keywords: Severe mood dysregulation, mood disorders, childhood autism, autism spectrum disorder, SNAP. Introduction Severe mood problems (SMP) in children and ado- lescents include high levels of irritability, often manifested by temper tantrums, as well as low and labile mood; together, these have been identified as an important cause of psychosocial impairment. Debate has raged about the aetiology of mood dys- regulation symptoms, most specifically the extent to which these are best conceptualized as part of the spectrum of juvenile bipolar disorder, attention def- icit hyperactivity disorder (ADHD) or as a separate syndrome (Leibenluft, 2011). Leibenluft Cohen, Gorrindo, Brook, & Pine, (2006) argue persuasively for a new diagnostic category, severe mood dysre- gulation (SMD), currently under consideration for DSM-5 (www.dsm5.org). Under current proposals, SMD would include severe and prominent mood abnormalities, hyperarousal and increased reactivity to negative emotional stimuli, with consequent functional impairment. In support of this new diag- nosis, Leibenluft and colleagues provide evidence for distinctive presenting and longitudinal clinical fea- tures, family history and neurocognitive profile (Lei- benluft, 2011). They argue that, while features aligned with irritability are included in several diag- nostic categories, the syndrome of severe and impairing irritability with predominant negative mood includes features not adequately captured by other diagnoses. Unlike classic juvenile bipolar dis- order, manic episodes do not appear to be common adult outcomes in SMD (Brotman et al., 2006), whereas unipolar depression and anxiety are (Stringaris et al., 2009). One small family study failed to find elevated rates of bipolar disorder in parents of children with SMD, in contrast with the parents of children with juvenile bipolar disorder (Brotman et al., 2007). Neurocognitive differences exist in young people with SMD in relation to: labelling facial emotions (Guyer et al., 2007); response to frustration (Rich et al., 2011); and performance on response reversal paradigms Conflict of interest statement: No conflicts declared. Journal of Child Psychology and Psychiatry 53:11 (2012), pp 1157–1166 doi:10.1111/j.1469-7610.2012.02600.x Ó 2012 The Authors. Journal of Child Psychology and Psychiatry Ó 2012 Association for Child and Adolescent Mental Health. Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA