Affect dysregulation (AD) is characterized by heightened reactivity to strong emotions, difficulty calming down when upset, and mood instability. This phenomenon has not been widely examined in older foster youth, yet it may be an avenue to improve behavior and functioning in young adulthood. This study examines two dimensions of AD—affect skills deficits and affect instability—in a sample of 17-year-old foster youth, assessing the relationship of each dimension to risk factors and behavioral health service use at age 17, and as predictors of functional outcomes at age 19. We found that the level of AD among older foster youth was similar to a clinical sample and was associated with a history of physical abuse, depression, attention deficit hyperactivity disorder, and disruptive behavioral disorders. Higher levels of affect skills deficits were associated with use of intensive types of services such as psychiatric hospitalization, residential treatment, and psychiatric medications but affect instability was not. Higher levels of affect skills deficits were negatively related to graduating from high school and positively related to being arrested. AD, especially affect skills deficits, are a promising target for inclusion in interventions to support older foster youth with mental health problems.
AldaoA.Nolen-HoeksemaS. (2012). When are adaptive strategies most predictive of psychopathology?Journal of Abnormal Psychology, 121, 276–281.
3.
AldaoA.Nolen-HoeksemaS.SchweizerS. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30, 217–237.
4.
AllenB. (2011). Childhood psychological abuse and adult aggression: The mediating role of self-capacities. Journal of Interpersonal Violence, 26, 2093–2110. doi:10.1177/0886260510383035
5.
AllenB.CramerR. J.HarrisP. B.RufinoK. A. (2013). Borderline personality symptomatology as a mediator of the link between child maltreatment and adult suicide potential. Archives of Suicide Research: Official Journal of the International Academy For Suicide Research, 17, 41–51. doi:10.1080/13811118.2013.748413
6.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
7.
AppletonA. A.KubzanskyL. D. (2014). Emotion regulation and cardiovascular disease risk. In GrossJ. J. (Ed.), Handbook of emotion regulation (2nd ed., pp. 596–612). New York, NY: Guilford.
8.
BerkingM.SchwarzJ. (2014). Affect regulation training. In GrossJ. J. (Ed.), Handbook of emotion regulation (2nd ed., pp. 529–547). New York, NY: Guilford.
9.
BerkingM.WuppermanP. (2012). Emotion regulation and mental health: Recent findings, current challenges, and future directions. Current Opinion in Psychiatry, 25, 128–134.
10.
BernsteinD. P.FinkL. (1998). The Childhood Trauma Questionnaire manual. San Antonio, TX: The Psychological Corporation.
11.
BohusM.HaafB.SimmsT.LimbergerM. F.SchmahlC.UnckelC.. . . LinehanM. M. (2004). Effectiveness of inpatient dialectical behavioral therapy for borderline personality disorder: A controlled trial. Behaviour Research and Therapy, 42, 487–499. doi:10.1016/S0005-7967(03)00174-8
12.
BriereJ. (2000). Inventory of altered self-capacities: Professional manual. Odessa, FL: Psychological Assessment Resources.
13.
BriereJ.HodgesM.GodboutN. (2010). Traumatic stress, affect dysregulation, and dysfunctional avoidance: A structural equation model. Journal of Traumatic Stress, 23, 767–774.
14.
BriereJ.RuntzM. (2002). The Inventory of Altered Self-Capacities (IASC): A standardized measure of identity, affect regulation, and relationship disturbance. Assessment, 9, 230–238.
15.
BurnsB. J.PhillipsS. D.WagnerH.BarthR. P.KolkoD. J.CampbellY.LandsverkJ. (2004). Mental health need and access to mental health services by youths involved with Child Welfare: A national survey. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 960–970. doi:10.1097/01.chi.0000127590.95585.65
16.
ChenE.MillerG. E. (2012). “Shift and persist” strategies: Why being low in socioeconomic status isn’t always bad for health. Perspectives on Psychological Science, 7, 135–138.
17.
Child and Family Services Improvement and Innovation Act of 2011; Public Law 112-34.
18.
CloitreM.StolbachB. C.HermanJ. L.van der KolkB.PynoosR.WangJ.PetkovaE. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22, 399–408.
19.
CookA.SpinazzolaJ.FordJ.LanktreeC.BlausteinM.CloitreM.. . . van der KolkB. (2005). Complex trauma in children and adolescents. Psychiatric Annals, 35, 390–398.
20.
CourtneyM. E. (2009). The difficult transition to adulthood for foster youth in the US: Implications for the state as corporate parent. Social Policy Report, 23, 3–18.
dosReisS.YoonY.RubinD. M.RiddleM. A.NollE.RothbardA. (2011). Antipsychotic treatment among youth in foster care. Pediatrics, 128, e1459–e1466. doi:10.1542/peds.2010-2970
23.
EkkekakisP. (2012). Affect, mood, and emotion. In TenenbaumG.EklundR. C.KamataA. (Eds.), Measurement in sport and exercise psychology (pp. 321–332). Champaign, IL: Human Kinetics.
24.
FordJ. D.HawkeJ. (2012). Trauma affect regulation psychoeducation group and milieu intervention outcomes in juvenile detention facilities. Journal of Aggression, Maltreatment & Trauma, 21, 365–384. doi:10.1080/10926771.2012.673538
25.
FrehF. M.ChungM. C.DallosR. (2013). In the shadow of terror: Posttraumatic stress and psychiatric co-morbidity following bombing in Iraq-the role of shattered world assumptions and altered self-capacities. Journal of Psychiatric Research, 47, 215–225. doi:10.1016/j.jpsychires.2012.10.008
26.
GrossJ. J. (2013). Emotion regulation: Taking stock and moving forward. Emotion, 13, 359–365. doi:10.1037/a0032135
27.
GrossJ. J. (2014). Emotion regulation: Conceptual and empirical foundations. In GrossJ. J. (Ed.), Handbook of emotion regulation (2nd ed., pp. 3–20). New York, NY: Guilford.
28.
GrossJ. J.ThompsonR. A. (2007). Emotional regulation: Conceptual foundations. In GrossJ. J. (Ed.), Handbook of emotional regulation (pp. 3–24). New York, NY: Guilford.
29.
HavlicekJ. (2011). Lives in motion: A review of former foster youth in the context of their experiences in the child welfare system. Children and Youth Services Review, 33, 1090–1100.
30.
HavlicekJ.GarciaA. R.SmithD. C. (2013). Mental health and substance use disorders among foster youth transitioning to adulthood: Past research and future directions. Children and Youth Services Review, 35, 194–203.
31.
HayesS. C.StrosahlK. D.WilsonK. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). New York, NY: Guilford.
32.
HorshamS.ChungM. C. (2013). Investigation of the relationship between trauma and pain catastrophising: The roles of emotional processing and altered self-capacity. Psychiatry Research, 208, 274–284. doi:10.1016/j.psychres.2012.11.031
33.
HortonJ.ComptonW. M.CottlerL. B. (1998). Assessing psychiatric disorders among drug users: Reliability of the revised DIS-IV. In HarrisL. (Ed.), NIDA research monograph—Problems of drug dependence (NIH Publication No. 99–4395, p. 205). Washington, DC: National Institutes of Health.
34.
JazaieriH.UrryH.GrossJ. J. (2013). Affective disturbance and psychopathology: An emotion regulation perspective. Journal of Experimental Psychopathology, 4, 584–599. doi:10.5127/jep.030312
35.
JohnO. P.EngJ. (2014). Three approaches to individual differences in affect regulation: Conceptualizations, measures and findings. In GrossJ. J. (Ed.), Handbook of emotion regulation (2nd ed., pp. 321–345). New York, NY: Guilford.
36.
KellerT. E.CusickG. R.CourtneyM. E. (2007). Approaching the transition to adulthood: Distinctive profiles of adolescents aging out of the child welfare system. Social Service Review, 81, 453–484.
37.
KellerT. E.SalazarA.CourtneyM. (2010). Prevalence and timing of diagnosable mental health, alcohol, and substance use problems among older adolescents in the child welfare system. Children and Youth Services Review, 32, 626–634. doi:10.1016/j.childyouth.2009.12.010
38.
Kim-SpoonJ.CicchettiD.RogoschF. A. (2013). A longitudinal study of emotion regulation, emotion lability-negativity, and internalizing symptomatology in maltreated and nonmaltreated children. Child Development, 84, 512–527.
39.
LappalainenR.LehtonenT.SkarpE.TaubertE.OjanenM.HayesS. C. (2007). The impact of CBT and ACT models using psychology trainee therapists: A preliminary controlled effectiveness trial. Behavior Modification, 31, 488–511.
40.
LinehanM. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York, NY: Guilford.
41.
LinehanM. M.DimeffL. A.ReynoldsS. K.ComtoisK. A.WelchS. S.HeagertyP.KivlahanD. R. (2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.
42.
MarwahaS.HeZ.BrommeM.SinghS. P.ScottJ.EydenJ.WolkeD. (2014). How is affective instability defined and measured? A systematic review. Psychological Medicine, 44, 1793–1808. doi:10.1017/S0033291713002407
43.
MastenA. S. (2011). Resilience in children threatened by extreme adversity: Frameworks for research, practice, and translational synergy. Development and Psychopathology, 23, 493–506. doi:10.1017/S0954579411000198
44.
McMillenJ. C.Cary KatzC.ClaypoolE. J. (2014). An emotion regulation framework for child welfare intervention and programming. Social Service Review, 88, 443–468.
45.
McMillenJ. C.RaghavanR. (2009). Pediatric to adult mental health service use of young people leaving the foster care system. Journal of Adolescent Health, 44, 7–13. doi: 10.1016/j.jadohealth.2008.04.015
46.
McMillenJ. C.ScottL. D.ZimaB. T.OllieM. T.MunsonM. R.SpitznagelE. L. (2004). Use of mental health services among older youths in foster care. Psychiatric Services, 55, 811–817.
47.
McMillenJ. C.ZimaB. T.ScottL. D.AuslanderW. F.MunsonM. R.OllieM. T.SpitznagelE. L. (2005). Prevalence of psychiatric disorders among older youths in the foster care system. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 88–95.
48.
MillerA.RathusJ.LinehanM. (2007). Dialectical behavior therapy with suicidal adolescents. New York, NY: Guilford.
49.
NarendorfS. C.McMillenJ. C. (2010). Substance use and substance use disorders as foster youth transition to adulthood. Children and Youth Services Review, 32, 113–119.
50.
PisaniA. R.WymanP. A.PetrovaM.Schmeelk-ConeK.GoldstonD. B.XiaY.GouldM. S. (2013). Emotion regulation difficulties, youth-adult relationships, and suicide Attempts among high school students in underserved communities. Journal of Youth and Adolescence, 42, 807–820. doi:10.1007/s10964-012-9884-2
51.
RaghavanR.McMillenJ. (2008). Use of multiple psychotropic medications among adolescents aging out of foster care. Psychiatric Services, 59, 1052–1055.
52.
RobinsL.CottlerL.BucholzK.ComptomW. (1995). Diagnostic interview schedule for DSM-IV. St. Louis, MO: Washington University in St. Louis.
53.
RoemerL.OrsilloS. M.Salters-PedneaultK. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 1083–1089.
54.
RubinD.MatoneM.HuangY.-S.dosReisS.FeudtnerC.LocalioR. (2012). Interstate variation in trends of psychotropic medication use among Medicaid-enrolled children in foster care. Children and Youth Services Review, 34, 1492. doi:10.1016/j.childyouth.2012.04.006
55.
RussellD. E. H. (1986). The secret trauma: Incest in the lives of girls and women. New York, NY: Basic Books.
56.
ShoreyR. C.BrasfieldH.FebresJ.StuartG. L. (2011). An examination of the association between difficulties with emotion regulation and dating violence perpetration. Journal of Aggression, Maltreatment & Trauma, 20, 870–885. doi:10.1080/10926771.2011.629342
57.
StiffmanA. R.HorwitzS. M.HoagwoodK. (2000). The Service Assessment for Children and Adolescents (SACA): Adult and child reports. Journal of American Academy of Child & Adolescent Psychiatry, 39, 1032–1039.
58.
TeplinL. A.AbramK. M.McClellandG. M.DulcanM. K.MericleA. A. (2002). Psychiatric disorders in youth in juvenile detention. Archives of General Psychiatry, 59, 1133–1143. doi:10.1001/archpsyc.59.12.1133
59.
United States Government Accountability Office. (2011, December1). Foster children: HHS guidance could help states improve oversight of psychotropic prescriptions (GAO-12-270T). Retrieved from http://www.gao.gov/products/GAO-12-270T
60.
ValdezC. E.BaileyB. E.SantuzziA. M.LillyM. M. (2014). Trajectories of depressive symptoms of foster youth transitioning to adulthood: The roles of emotion regulation and PTSD. Child Maltreatment, 19, 209–218. doi:10.1177/1077559514551945
61.
van den BoschL. M. C.VerheulR.SchippersG. M.van den BrinkW. (2002). Dialectical Behavior Therapy of borderline patients with and without substance use problems. Implementation and long-term effects. Addictive Behaviors, 27, 911–923.
62.
VaughnM. G.OllieM. T.McMillenJ.ScottL.Jr.MunsonM. (2007). Substance use and abuse among older youth in foster care. Addictive Behaviors, 32, 1929–1935. doi:10.1016/j.addbeh.2006.12.012
