Autistic and ADHD adolescents respond differently to upset in school: evidence from a new questionnaire co-designed from the neurodivergent point of view

Rates of depression are elevated in autistic and/or ADHD adolescents, but the reasons for this are unclear. We have previously shown that autistic and/or ADHD adolescents experience twice the school-related emotional burden of the non-ADHD/non-autistic control peers. Using a new self-report measure, the My Emotional Responses in School Inventory (MERSI), we now examine how autistic and/or ADHD students' responses after being upset-often pathologised as "emotional dysregulation"-are associated with mental health. The 20-item MERSI was co-produced with neurodivergent young adults to measure adolescents' responses after being made upset in school. It was administered to 732 secondary school students (ADHD [n = 100]; autism [n = 100]; ADHD+autism [n = 79]; non-ADHD/non-autistic control [n = 453]) alongside measures of depression, anxiety, emotion regulation difficulties, and emotional burden. The MERSI had three factors: (1) outward distress expressions, (2) inward distress expressions, and (3) solution-focused responses, and satisfactory reliability. Outward distress expressions were more likely for ADHD than non-ADHD, and for autistic than the control group. Autistic and/or ADHD students reported similarly higher inward distress expressions than controls. Solution-focused responses were less likely in ADHD. Inward distress expressions improved the prediction of depression and anxiety beyond emotional burden alone. Solution-focused responses were associated with lower anxiety in both ADHD groups relative to controls. Autistic and/or ADHD students respond differently after being upset at school than control peers. Our findings highlight the importance of monitoring students' responses after being upset, especially in the cross-sectional prediction of anxiety and depression, to be further clarified through longitudinal data.