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Emotion Regulation in Young Children with Autism Spectrum Disorders

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Emotion Regulation in Young Children with Autism Spectrum Disorders J Autism Dev Disord (2017) 47:68–79 DOI 10.1007/s10803-016-2922-2 ORIGINAL PAPER Emotion Regulation in Young Children with Autism Spectrum Disorders Lauren Berkovits1 · Abbey Eisenhower2 · Jan Blacher3 Published online: 12 November 2016 © Springer Science+Business Media New York 2016 Abstract There has been little research connecting under- Introduction lying emotion processes (e.g., emotion regulation) to fre- quent behavior problems in young children with autism Extensive research documents the heightened behavioral spectrum disorder (ASD). This study examined the stabil- difficulties facing children with autism spectrum disorders ity of emotion regulation and its relationship with other (ASD; e.g., Georgiades et al. 2011; Hill et al. 2014), but aspects of child functioning. Participants included 108 a specific focus on emotion regulation, particularly during children with ASD, ages 4–7, and their primary caregiv- the early school years, is lacking with few exceptions (Jah- ers. ASD symptoms and cognitive/language abilities were romi et al. 2012, 2013; Mazefsky et al. 2013). This limited assessed upon study entry. Parents reported on children’s research suggests that emotion regulation and elevations in emotion regulation, social skills and behavior problems emotion-related symptoms is an area of particular difficulty at two time points, 10 months apart. Emotion dysregula- for children with ASD (Totsika et al. 2011). In the general tion was stable and related strongly to social and behavio- developmental literature, the term “emotion regulation” ral functioning but was largely independent of IQ. Further refers to the range of cognitive, physiological, and behavio- analyses suggested that emotion dysregulation predicts ral abilities that allow an individual to monitor and modu- increases in social and behavioral difficulties across time. late the occurrence, valence, intensity, and expression of Implications for intervention are discussed. one’s emotions and arousal (Cole et al. 1994; Morris et al. 2007; Thompson 1994). Emotion regulation underlies mul- Keywords Emotion regulation · Emotional development · tiple key areas of development for children, as it is central Social development · Self-regulation to children’s abilities to interact successfully with their sur- rounding social and physical environment. Successfully regulating one’s emotions theoretically requires a child to be able to: (a) recognize his or her own emotional states at age-appropriate levels, (b) access strat- egies to self-soothe or relax when experiencing a nega- We appreciate the collaboration of The Help Group-UCLA tive emotion or strong levels of excitement or arousal, and Autism Research Alliance and its Director, Dr. Elizabeth (c) maintain progress in current activities in the face of Laugeson, for facilitating this study. We also appreciate the potentially interfering emotions (Gratz and Roemer 2004; efforts of our doctoral students, staff, and participating families. Southam-Gerow and Kendall 2002). In contrast, children who exhibit high levels of emotion dysregulation lack these * Lauren Berkovits [email protected] abilities and, thus, have difficulties modulating their emo- tional intensity such that their emotions frequently interfere 1 Department of Psychology, University of California, Los with goal-directed and interpersonal activities. Emotion Angeles, 405 Hilgard Ave, Los Angles, CA 90095, USA regulation is considered to be one aspect of the broader 2 University of Massachusetts, Boston, Boston, MA, USA construct of self-regulation, or the ability to control one’s 3 University of California, Riverside, Riverside, CA, USA actions and responses to stimuli in order to effectively 1 3 J Autism Dev Disord (2017) 47:68–79 69 pursue a goal. Two other aspects of self-regulation that are the symptoms associated with ASD (e.g., social difficul- frequently discussed are cognitive regulation, such as exec- ties, repetitive behaviors, sensorysensitivities) as well as utive functioning and goal-directed reasoning, and behav- frequent comorbid mental health conditions (e.g., anxiety ioral regulation, such as the monitoring of physical move- disorders, disruptive behavior disorders) within this popu- ment and inhibiting or delaying impulses or gratification lation. If emotion regulation is linked to increases or main- (Jahromi and Stifter 2008; Williford et al. 2013). Though tenance of these symptoms, then targeting emotion regula- these three facets of self-regulation are related, evidence tion may be a more parsimonious way to provide effective suggests that they may hold independent predictive power interventions. for children’s development. For example, in one study, only The few studies that have attempted to understand emo- cognitive self-regulation predicted theory of mind devel- tion regulation in children with ASD have consistently opment, while emotional and behavioral regulation were found more emotional dysregulation compared to typically unrelated to theory of mind (Jahromi and Stifter 2008). developing children throughout early childhood develop- Furthermore, ratings of emotion regulation have not shown ment. For example, Garon et al. (2009) found that ‘ASD strong connections to general cognitive or language abili- sibs’ (children at high-risk for ASD because they had an ties in typically developing children (Graziano et al. 2007). older sibling with ASD and who were themselves also Among typically developing children, the preschool-age diagnosed with ASD at age 3) exhibited a reduced ability to period is commonly considered the period of largest growth manage negative emotions at age 2 compared to high-risk in self-regulation abilities (Jahromi and Stifter 2008; Willi- siblings who did not develop ASD and compared to low- ford et al. 2013), and has strong implications for children’s risk controls. Two studies observed emotion regulation of social functioning. Preschool children with higher levels of preschool and early school-aged children in the laboratory emotional intensity and dysregulation in the classroom are by coding children’s behaviors in the face of frustration rated to have fewer social skills, are less accepted by peers, (e.g., abrupt removal of a desired toy). Jahromi et al. (2012) and engage in more peer conflict (Eisenberg et al.1993 ; found that children with ASD (ages 3–7) exhibited less Miller et al. 2004). For children with developmental dis- advanced emotion regulation when frustrated compared to abilities not including ASD, emotion regulation has been typically developing peers, and that use of emotion regula- shown to predict children’s social difficulties above and tion strategies among children with ASD did not consist- beyond cognitive ability (Wilson et al. 2007). ently predict improvements in negativity or resignation, as Among children with ASD, in spite of the limited infor- it did for typically developing children. Konstantareas and mation about emotion regulation capacities, certain other Stewart (2006) also reported that children with ASD (ages aspects of emotional development are well understood. 3–10) had significantly lower average ratings of emotion For instance, research on facial perception and emotion regulation strategies, demonstrating more hiding of the toy, labeling has largely indicated difficulties in recognizing fewer attempts to ask the examiner directly to play longer emotional facial expressions (e.g., Uljarevic and Hamilton with the toy, and fewer instances of complying with the 2013), despite some inconsistencies across studies (e.g., examiner’s request for the toy. Begeer et al. 2008). Additionally, it is clinically recog- Difficulties with emotion regulation among youth nized that many children with ASD have difficulties with with ASD, including higher use of maladaptive and one or more emotion regulation abilities. For example, involuntary emotion regulation strategies, appear to con- some children with ASD exhibit disruptive behaviors in tinue into later childhood and adolescence and relate to the face of negative emotions (e.g., engaging in tantrums higher levels of internalizing and externalizing symp- or physical aggression when frustrated or angry) while oth- toms (Mazefsky et al. 2014). Teachers rate school-age ers may experience emotions in a way that interferes with children with ASD (ages 6–10) as significantly more their goal-directed behaviors (e.g., overexcitement or frus- emotionally labile than their peers without ASD, with a tration impeding with one’s ability to maintain focus on a much higher percentage of students with ASD falling in task/activity or interact successfully with others). However, the borderline-clinical and clinical ranges of standard- “emotion regulation” is a term not often used in the autism ized measures of dysregulation (Ashburner et al. 2010). spectrum literature, as the behavioral symptoms that likely Parents also tended to report that their 12-year-old chil- represent emotion regulation difficulties, including tan- dren with ASD experienced negative emotions (i.e., sad- trums, “meltdowns,” aggression, and self-injury, are high- ness, fear, anger, shame, and guilt) more frequently and lighted instead (e.g., Mazefsky et al. 2013). While this is a positive emotions (i.e., joy) less frequently than reported subtle distinction, it hasimplications for our understanding by parents of typically developing children (Capps et al. of intervention programs and their efficacy. In particular, 1993). Among studies of children and adolescents with a
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