Neurodivergent adolescents experience twice the emotional burden at school compared to their neurotypical peers

New research reveals emotional burden of school on neurodivergent adolescents

New research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, in partnership with Anna Freud and University College London, has found that negative school experiences generate twice the emotional burden in autistic and ADHD adolescents compared to their neurotypical classmates, and that this is significantly correlated with depression and anxiety.

The research, published in the Journal of Child Psychology and Psychiatry, aimed to better understand why up to 50% of autistic adults (Dow et al., 2021) and 30% of those with ADHD (Wilens et al., 2008) end up with a clinical diagnosis of depression or anxiety as adults.

Previous thinking has proposed that depression risk in neurodivergent children is due to deficits in their ability to regulate their negative emotions, which can lead to intense and prolonged reactions to an emotive event.

About the RE-STAR programme

The study is part of the Regulating Emotions – Strengthening Adolescent Resilience (RE-STAR) programme, which is supported by Anna Freud and funded by National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC) and the Medical Research Council. It found that both emotion regulation struggles and school induced emotional burden were linked to depression, suggesting the value of a more joined up approach to managing mental health risks in neurodivergent youth at school.

735 11-16 year olds took part in the study, with a substantial proportion having elevated traits of either ADHD (100), autism (104), or both ADHD and autism (79), and 213 having a confirmed diagnosis. The rest were neurotypical. All participants were asked to complete the My Emotions in School Inventory (MESI), a questionnaire co-developed through RE-STAR with a neurodiverse team of researchers and neurodivergent young people. This asked how frequently they experienced each of 24 common upsetting events and then how upsetting each was on a nine-point scale.

Researchers found that neurodivergent participants reported greater frequency of these common upsetting events and experienced the negative emotion they induced more intensely than their neurotypical peers.

Researchers suggest that this creates greater overall emotional burden, which they calculated as the product between the frequency of each upsetting event and its intensity, summed across all common upsetting events.

What is “emotional burden”?

“Emotional burden” is a concept developed by researchers that aims to place a numeric score on the frequency and intensity with which adolescents experience upsetting events. “Upsetting events” can include challenges in understanding social situations, peers talking behind your back, or being considered disruptive by a teacher.

Reflections from the study authors

Study co-author Dr Georgia Pavlopoulou, Associate Professor at UCL and Anna Freud, a mental health charity for children and young people, and Director of UCL’s Group for Research in Relationships And NeuroDiversity (GRRAND), said:

“Accounts of emotional dysregulation – or difficulty in managing and controlling emotional responses - in autism and ADHD are too often shaped by neurotypical ideas of how emotions should look and be expressed. This often overlooks the real experiences of neurodivergent young people and the context behind their emotional responses, which only they can truly provide.

“That’s why we worked for nearly two years with young people to co-produce the My Emotions in School Inventory (MESI). This new tool allows neurodivergent students to self-report emotions they experience at school and is designed to better understand and support their emotional world on their own terms. We found that neurodivergent participants reported greater frequency of common upsetting events – such as misunderstanding a social situation, or being accused of being disruptive by a teacher - and experienced the negative emotion they induced more intensely than their neurotypical peers.”

Senior author, Professor Edmund Sonuga-Barke, Professor of Developmental Psychology, Psychiatry and Neuroscience at King’s IoPPN and Theme lead for Child Mental Health and Neurodevelopmental Disorders at NIHR Maudsley BRC said:

“Understanding why young people with ADHD and autism are at increased risk of mental health problems is an essential step in developing new interventions to improve the mental health of neuro-divergent people.

“We found that emotional burden induced by upsetting experiences in school may contribute to this risk. This highlights the potential value of school-based interventions designed both to help schools reduce upsetting experiences and to help students manage those negative experiences that remain.”

“It is clear to us that including neurodivergent young people at the heart of our team and work, has helped us develop new ideas leading to new hypotheses about the origins of depression in autism and ADHD.”

Interestingly, while it was found that although ADHD and autism were associated with the same overall experience of emotional burden, different triggers were important for individuals with these different conditions. Autistic participants highlighted that difficult peer interactions were often the driving force behind events that they found upsetting, such as peers talking behind their back, or challenges in understanding social situations. Participants with ADHD on the other hand found that their upsetting events often involved situations with teachers.

Dr Susie Chandler, a Postdoctoral Research Fellow at King’s IoPPN and the study’s joint-first author said:

“Adolescence is a key time for emotional development, and secondary school plays a role in this. Our study highlights the impact everyday school events and interactions have on young people’s emotions; and how young people with neurodevelopmental conditions in particular can find school a source of emotional challenge. Identifying common upsetting events, the findings provide some pointers for how schools can create supportive environments that promote the wellbeing of autistic young people and those with ADHD.”

Dr Steve Lukito, a Post-doctoral Research Associate at King’s IoPPN and the study's joint-first author said:

“Whole-school approaches to mental health should be neurodiversity-informed and include interventions designed to reduce upsetting experiences and help students manage those negative experiences when they do occur.”

This study was co-produced by the RE-STAR team with neurodivergent young people playing a key role. It was funded by the Medical Research Council and the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre (BRC).

Find out more

For more information about the study, click on the link below.

Read the study

Support for schools

We offer support to help education professionals develop a whole-school or college approach to mental health and wellbeing. This includes Autism and Wellbeing in Schools training, which trains staff to support the mental health of autistic young people and help them thrive in school.

Explore NATP

You can also read about the impact of the National Autism Trainer Programme (NATP) here. NATP is a partnership between Anna Freud and AT-Autism, commissioned by NHS England, that delivered training to professionals between 2022-25 to improve autistic people’s experience of mental health care.