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MacKenzie KT, Crown MJ, Northrup JB, Rutenberg E, Hartman AG, Mazefsky CA. Correlates of Impairment and Growth in Families of Young Autistic Children. J Autism Dev Disord 2024:10.1007/s10803-024-06339-w. [PMID: 38625489 DOI: 10.1007/s10803-024-06339-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 04/17/2024]
Abstract
The purpose of this project was to investigate potential correlates of family life impairment in families of young autistic children. This project incorporated measures of specific child and parent challenges in addition to a commonly used unidimensional measure of autism characteristics. In this way, we could assess whether such challenges explain variance in family life impairment, and whether their inclusion diminish associations between autism characteristics and family life impairment. Cross-sectional data were collected from 564 parents of autistic children aged 2 to 5 years who participated in a larger online study. Participants completed measures on child characteristics (autism characteristics, emotion dysregulation, speaking ability, flexibility, and sleep problems), parent depression, and family life impairment, using the Family Life Impairment Scale (FLIS). Multiple linear regression models were generated to examine whether any of the independent variables were associated with the four domains of the FLIS. Models controlled for child age and sex, parent education, and single-parent homes. All independent variables were associated with impairment in one or more FLIS domains. None of the primary independent variables were significantly associated with positive growth. More overt characteristics and behaviors (e.g., autism characteristics, reactivity, speaking ability, and flexibility) were associated with impairment in domains that reflected a family's ability to navigate the community. However, sleep challenges and parent and child emotional difficulties were most strongly associated with parent impairment. Findings suggests that families may have different needs across contexts and provide new avenues through which they might be better supported.
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Affiliation(s)
| | - Mario J Crown
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Amy G Hartman
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carla A Mazefsky
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Restoy D, Oriol-Escudé M, Alonzo-Castillo T, Magán-Maganto M, Canal-Bedia R, Díez-Villoria E, Gisbert-Gustemps L, Setién-Ramos I, Martínez-Ramírez M, Ramos-Quiroga JA, Lugo-Marín J. Emotion regulation and emotion dysregulation in children and adolescents with Autism Spectrum Disorder: A meta-analysis of evaluation and intervention studies. Clin Psychol Rev 2024; 109:102410. [PMID: 38401510 DOI: 10.1016/j.cpr.2024.102410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 01/14/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
Children and adolescents with Autism Spectrum Disorder (ASD) often experience challenges in emotion regulation (ER) and emotion dysregulation (ED) which can interfere with their adaptive functioning. This study aimed to systematically review and meta-analyze the evidence on ER/ED in children and/or adolescents with ASD, examining its relationship with the following variables: internalizing and externalizing symptoms, cognitive function and social skills, and the effectiveness of non-pharmacological interventions addressing ER difficulties. Both electronic and manual searches were conducted to identify potential studies. Fifty-five studies were included in the meta-analysis. A statistically significant between-group difference was found, suggesting greater ER/ED challenges in the ASD group. Also, the ASD group showed more maladaptive ER strategies and fewer adaptive ER strategies compared to the non-ASD participants. Additionally, more severe ASD and poorer social skills were associated with greater ED and poorer ER skills, respectivelly. Furthermore, there was a significant correlation between internalizing symptomatology and both adaptive and maladaptive ER strategies. Studies of non-pharmacological interventions showed significant improvement in both ER and ED. These results imply that assessing ER/ED in children and adolescents with ASD should be part of the evaluation process, and it should also be a focal point for intervention in this population.
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Affiliation(s)
- Damián Restoy
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | | | - Teresa Alonzo-Castillo
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - María Magán-Maganto
- Centro de Atención Integral al Autismo-InFoAutismo. INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain
| | - Ricardo Canal-Bedia
- Centro de Atención Integral al Autismo-InFoAutismo. INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain
| | - Emiliano Díez-Villoria
- Centro de Atención Integral al Autismo-InFoAutismo. INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain
| | - Laura Gisbert-Gustemps
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Imanol Setién-Ramos
- Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - María Martínez-Ramírez
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Jorge Lugo-Marín
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Centro de Atención Integral al Autismo-InFoAutismo. INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
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Northrup JB, Mazefsky CA, Day TN. Valence and Intensity of Emotional Expression in Autistic and Non-Autistic Toddlers. J Autism Dev Disord 2024:10.1007/s10803-024-06268-8. [PMID: 38315319 DOI: 10.1007/s10803-024-06268-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE Differences in emotional experience and expression have long been recognized as common in the presentation of autism, yet research examining emotional expression in early childhood is limited, with mixed findings. Understanding emotional reactivity and expression in autism in early life is an essential step towards uncovering the mechanisms of these risks and identifying targets for intervention. METHODS The present study examined emotional expression in autistic (N = 17) and non-autistic (N = 20) toddlers (mean age = 25.27; SD = 1.88) during emotion elicitation tasks aimed at eliciting joy, frustration, and unease. Video recorded tasks were coded in ten second intervals for emotional valence and intensity, and the following variables were computed: proportion of time in positive, neutral, and negative affect; maximum intensity of positive and negative affect; and range of affect (i.e., most negative to most positive intensity). RESULTS Autistic toddlers spent more time in neutral facial expressions, less time displaying positive affect, and had somewhat less intense positive emotional expression than non-autistic peers. Small differences were apparent in intensity of negative affect expression, while no differences emerged in duration of time spent in negative affect. CONCLUSION Findings emphasize that differences may be more apparent in duration, rather than intensity of emotional expression, and that it may be particularly important to examine periods of "neutral" affect in young autistic children. Future research should consider the best ways to understand emotional reactivity in this population considering their unique interests, challenges, and communication styles.
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Affiliation(s)
- Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Taylor N Day
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Sung YS, Lin CY, Chu SY, Lin LY. Emotion Dysregulation Mediates the Relationship Between Sensory Processing and Behavior Problems in Young Children with Autism Spectrum Disorder: A Preliminary Study. J Autism Dev Disord 2024; 54:738-748. [PMID: 36441430 DOI: 10.1007/s10803-022-05839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
Emotion dysregulation is one of the challenges that children with autism spectrum disorder (ASD) and their families face. It is unclear whether emotion dysregulation plays a mediating role in the relationship between sensory processing patterns and problem behaviors among these children. This study examined the relations between emotion dysregulation, behavioral problems, and sensory processing patterns among fifty-seven young children with ASD. Behavioral problems and sensory processing patterns were moderately to strongly correlated with emotion dysregulation. The relationship between sensory processing patterns and behavioral problems was significant with emotion dysregulation as a mediator. These findings help identify the relationship between emotion dysregulation, sensory processing patterns, and behavioral problems to facilitate the planning of intervention strategies for young children with ASD.
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Affiliation(s)
- Yi-Shan Sung
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Shin Ying Chu
- Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), National University of Malaysia, Kuala Lumpur, Malaysia
| | - Ling-Yi Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Day TN, Mazefsky CA, Yu L, Zeglen KN, Neece CL, Pilkonis PA. The Emotion Dysregulation Inventory-Young Child: Psychometric Properties and Item Response Theory Calibration in 2- to 5-Year-Olds. J Am Acad Child Adolesc Psychiatry 2024; 63:52-64. [PMID: 37422108 PMCID: PMC10770291 DOI: 10.1016/j.jaac.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 04/03/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE The Emotion Dysregulation Inventory (EDI) was designed and validated to quantify emotion dysregulation (ED) in children aged 6+ years. The purpose of this study was to adapt the EDI for use in young children (EDI-YC). METHOD Caregivers of 2,139 young children (aged 2-5 years) completed 48 candidate EDI-YC items. Factor and item response theory (IRT) analyses were conducted separately for clinical (neurodevelopmental disabilities; N = 1,369) and general population (N = 768) samples. The best-performing items across both samples were selected. Computerized adaptive testing simulations were used to develop a short-form version. Concurrent calibrations and convergent/criterion validity analyses were performed. RESULTS The final calibrated item banks included 22 items: 15 items for Reactivity, characterized by rapidly escalating, intense, and labile negative affect, and difficulty down-regulating that affect; and 7 items for Dysphoria, characterized primarily by poor up-regulation of positive emotion, as well an item each on sadness and unease. The final items did not show differential item functioning based on age, sex, developmental status, or clinical status. IRT co-calibration of the EDI-YC Reactivity with psychometrically robust measures of anger/irritability and self-regulation demonstrated its superiority in assessing emotion dysregulation in as few as 7 items. EDI-YC validity was supported by expert review and its association with related constructs (eg, anxiety, depression, aggression, temper loss). CONCLUSION The EDI-YC captures a broad range of emotion dysregulation severity with a high degree of precision in early childhood. It is suitable for use in all children aged 2 to 5 years, regardless of developmental concerns, and would be an ideal broadband screener for emotional/behavioral problems during well-child checks and to support early childhood irritability and emotion regulation research.
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Affiliation(s)
- Taylor N Day
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carla A Mazefsky
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Lan Yu
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | | | - Paul A Pilkonis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Day TN, Northrup JB, Mazefsky CA. A PROMIS®ing New Measure for Quantifying Emotion Dysregulation in Toddlers and Preschoolers: Development of the Emotion Dysregulation Inventory-Young Child. J Autism Dev Disord 2023; 53:2261-2273. [PMID: 35403207 PMCID: PMC9550886 DOI: 10.1007/s10803-022-05536-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 11/27/2022]
Abstract
The Emotion Dysregulation Inventory (EDI) was designed and validated to quantify emotion dysregulation (ED) in school-age children, with a particular emphasis on capturing ED in youth with ASD. We saw a need to adapt the EDI for use in young children (ages 2-5) given early childhood is a formative time for emotion regulation development. The present study discusses the adaptation process for the EDI-Young Child (EDI-YC), including item refinement/generation and cognitive interviews (N = 10 with ASD), consistent with the Patient-Reported Outcomes Measurement Information System (PROMIS®) methodology. The item bank was piloted in a sample of 2-year-olds with and without ASD (N = 31), which provided initial support for the EDI-YC as a valid and reliable measure.
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Affiliation(s)
- Taylor N Day
- Department of Psychiatry, University of Pittsburgh School of Medicine, 101 N. Dithridge St, Suite #300, Pittsburgh, PA, USA
- Florida State University, Tallahassee, FL, USA
| | - Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, 101 N. Dithridge St, Suite #300, Pittsburgh, PA, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, 101 N. Dithridge St, Suite #300, Pittsburgh, PA, USA.
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Day TN, Mazefsky CA, Wetherby AM. Characterizing difficulties with emotion regulation in toddlers with autism spectrum disorder. RESEARCH IN AUTISM SPECTRUM DISORDERS 2022; 96:101992. [PMID: 36798961 PMCID: PMC9928168 DOI: 10.1016/j.rasd.2022.101992] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Difficulties with emotion regulation (ER) underlie emotional/behavioral challenges and co-occurring psychiatric symptoms in autism spectrum disorder (ASD), yet very little is known about the early development of emotion dysregulation. The present study aimed to identify differences in positive and negative emotional reactivity and regulation strategies in toddlers with and without ASD. Method Nine tasks from the Laboratory Temperament Assessment Battery (Lab-TAB) were completed with 37 toddlers with and without ASD (22-28 months). Video-recordings of these tasks were coded by research assistants using a behavioral coding scheme tapping facial, bodily, and vocal affect and the frequency of ER strategies. Mixed model analyses were performed to examine the mean affect and total regulation strategies across each task and t-tests were conducted to assess the types of ER strategies utilized. Results Toddlers with ASD showed significantly less positive affect and greater frustration compared to non-ASD toddlers; reactivity was comparable between the groups for fear. Both groups used ER strategies in a similar pattern across tasks, with the exception that toddlers with ASD more often engaged in distraction to regulate. Effects of age and developmental level are discussed. Conclusions Toddlers with ASD were robustly characterized by greater frustration and lower joy despite frequent and age appropriate attempts to regulate their emotions. This study provides preliminary evidence that observable indicators of emotion dysregulation are present by two years of age. Clinical implications and future research directions are discussed.
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Affiliation(s)
- Taylor N. Day
- Florida State University, Department of Psychology, Tallahassee, FL, USA
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Carla A. Mazefsky
- University of Pittsburgh School of Medicine, Department of Psychiatry, Pittsburgh, PA, USA
| | - Amy M. Wetherby
- Florida State University College of Medicine, Department of Clinical Sciences, Tallahassee, FL, USA
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The Quality of Life for Children with Autism Spectrum Disorder Scale: Factor Analysis, MIMIC Modeling, and Cut-Off Score Analysis. J Autism Dev Disord 2022:10.1007/s10803-022-05610-2. [PMID: 35657447 DOI: 10.1007/s10803-022-05610-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
Our purpose in this study was to further examine the psychometric properties of the Quality of Life for Children with Autism Spectrum Disorder (QOLASD-C) scale. We first investigated the factor structure and the internal consistency of the scale. The bifactor model showed good fit and strong reliability. Second, we used multiple-indicators multiple-causes (MIMIC) modeling to examine the associations between demographic variables and the QOLASD-C dimensions. Results showed differences on overall QOL based on age, race/ethnicity, and autism spectrum disorder severity, but no relationships with gender. All demographic variables were associated with one or all three subscales (i.e., interpersonal relationships, self-determination, emotional well-being) of the QOLASD-C. Third, an optimal cut-off score of 37 was identified. Implications for research and practice are discussed.
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Hudock RL, Esler AN. Clinical considerations when conducting diagnostic evaluations to identify autism spectrum disorder in young children. Clin Neuropsychol 2022; 36:921-942. [DOI: 10.1080/13854046.2022.2025907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Rebekah L. Hudock
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Amy N. Esler
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Medical School, University of Minnesota, Minneapolis, MN, USA
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Beck KB, Northrup JB, Breitenfeldt KE, Porton S, Day TN, MacKenzie KT, Conner CM, Mazefsky CA. Stakeholder informed development of the Emotion Awareness and Skills Enhancement team-based program (EASE-Teams). AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:586-600. [PMID: 34903083 DOI: 10.1177/13623613211061936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Emotion dysregulation (ED) impacts mental health symptoms and well-being in autistic individuals. In prior work, we developed the Emotion Awareness and Skills Enhancement (EASE) to improve emotion dysregulation with autistic adolescents (aged 12-17). The study team partnered with autistic individuals, their caregivers, and expert clinicians to adapt EASE for autistic adolescents and adults with co-occurring intellectual disability and autistic elementary-aged children, groups that often benefit from caregiver support in treatment. In three phases, we (1) gathered caregiver and expert feedback to adapt the original EASE program for autistic adults with intellectual disability, (2) revised the treatment after using it with six autistic adults with intellectual disability, and (3) tested the newly developed caregiver-client team-based treatment, called EASE-Teams, in a small group of 10 autistic individuals with and without intellectual disability (aged 7-25). Families found EASE-Teams to be acceptable and helpful. We found improvements in emotion dysregulation and mental health symptoms for autistic participants. Caregivers reported less stress from their child's dysregulation after participating. These results show that EASE-Teams can be appropriate for different developmental and cognitive needs. Future studies will need to test the benefits of the treatment in community clinics.
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Martínez-González AE, Cervin M, Piqueras JA. Relationships Between Emotion Regulation, Social Communication and Repetitive Behaviors in Autism Spectrum Disorder. J Autism Dev Disord 2021; 52:4519-4527. [PMID: 34709530 PMCID: PMC8551658 DOI: 10.1007/s10803-021-05340-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 01/26/2023]
Abstract
The relationship between emotion regulation, social interaction and different types of restricted and repetitive behaviors is poorly understood. In the present study, structural equation modeling based on information about 239 individuals with autism was used to examine whether emotion regulation and social communication were associated with self-injury and stereotyped behaviors. Results showed that poor emotion regulation had a unique association with self-injury while difficulties with social communication was uniquely associated with stereotyped behaviors. Emotion regulation and social communication were strongly associated and self-injury and stereotyped behaviors moderately associated. This implies that these types of behaviors are often expressions of broader negative emotional states in autism. Treatments that help improve coping and social communication strategies may benefit individuals with autism.
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Affiliation(s)
- Agustín E Martínez-González
- Department of Developmental Psychology and Didactics, University of Alicante. Education Faculty, Carretera San Vicente del Raspeig s/n, Campus San Vicente del Raspeig, Edificio Facultad de Educación, Apdo. Correos, PO 99, 03080, Alicante, Spain.
| | - Matti Cervin
- Lund University and Skane Child and Adolescent Psychiatry, Lund, Sweden
| | - Jose A Piqueras
- Department of Health Psychology, Miguel Hernández University of Elche, Edificio Altamira, Avda. de La Universidad, s/n Elche, 03202, Alicante, Spain
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Costescu C, Șogor M, Thill S, Roșan A. Emotional Dysregulation in Preschoolers with Autism Spectrum Disorder-A Sample of Romanian Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010683. [PMID: 34682429 PMCID: PMC8535493 DOI: 10.3390/ijerph182010683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/29/2021] [Accepted: 10/02/2021] [Indexed: 11/23/2022]
Abstract
Emotional dysregulation problems seem to affect more than 80% of people with autism spectrum disorder (ASD) and may include irritability, aggressive behaviors, self-injury, and anxiety. Even though these types of problems are very common and affect the well-being of individuals with ASD, there are no objective assessment tools developed for this population and there are only a few intervention techniques meant to address these symptoms. This study investigates the feasibility of using off-the-shelf wearable devices to accurately measure heart rate, which has been associated with emotional dysregulation, and to test the effectiveness of functional communication training in reducing the emotional outburst in preschoolers with ASD. We used a single-case experiment design with three preschoolers with ASD to test if the duration of the emotional outburst and the elevated heart rate levels can be reduced by using functional communication training. Our results show that for two of the participants, the intervention was effective in reducing the duration of behaviors associated with emotional outburst, and that there were significant differences between baseline and intervention phase in terms of heart rate levels. However, our results are inconclusive regarding the association between elevated heart rates and the occurrence of the emotional outburst. Nevertheless, more research is needed to investigate the use of off-the-shelf wearable devices in predicting challenging behaviors in children with ASD.
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Affiliation(s)
- Cristina Costescu
- Special Education Department, Faculty of Psychology and Educational Sciences, Babes-Bolyai University, 400029 Cluj-Napoca, Romania; (M.Ș.); (A.R.)
- Correspondence:
| | - Mălina Șogor
- Special Education Department, Faculty of Psychology and Educational Sciences, Babes-Bolyai University, 400029 Cluj-Napoca, Romania; (M.Ș.); (A.R.)
| | - Serge Thill
- Donders Institute for Brain, Cognition, and Behaviour, Radboud University Nijmegen, 6525 GD Nijmegen, The Netherlands;
| | - Adrian Roșan
- Special Education Department, Faculty of Psychology and Educational Sciences, Babes-Bolyai University, 400029 Cluj-Napoca, Romania; (M.Ș.); (A.R.)
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Nuske HJ, Shih WI, Sparapani N, Baczewski L, Dimachkie Nunnally A, Hochheimer S, Garcia C, Castellon F, Levato L, Fischer E, Atkinson-Diaz ZL, Li J, Mandell DS, Kasari C. Self-regulation predicts companionship in children with autism. INTERNATIONAL JOURNAL OF DEVELOPMENTAL DISABILITIES 2021; 68:889-899. [PMID: 36568619 PMCID: PMC9788710 DOI: 10.1080/20473869.2021.1917109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 04/08/2021] [Accepted: 04/08/2021] [Indexed: 06/17/2023]
Abstract
Self-regulation is associated with many positive outcomes in children with and without autism, including increased mental health and academic achievement, and decreased problem behavior. Less is known regarding whether and how self-regulation and symptoms of mental health challenges (internalizing and externalizing problems) relate to social outcomes, such as friendship quality and loneliness. Parents and teachers of 106 children with autism aged 5-12 reported on children's self-regulation difficulties and externalizing and internalizing symptoms. Four-to-five months later, children reported on the quality of their friendship with their best friend (companionship, conflict, helpfulness, sense of relationship security, closeness), and their feelings of loneliness. Linear regression was used to examine the effects of self-regulation and symptoms of mental health challenges on friendship quality and loneliness. Less self-regulation difficulties predicted stronger companionship and girls had better quality friendships with their best friend than did boys, in terms of companionship, helpfulness, security and closeness, confirming that they have a protective advantage in friendship development. Autism symptoms, IQ, and age were not associated with friendship quality or loneliness. Results highlight the importance of self-regulation and mental health interventions for school-aged children with autism.
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Affiliation(s)
- Heather J. Nuske
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Wendy I. Shih
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Nicole Sparapani
- University of California Davis MIND Institute, University of California, Davis, CA, USA
| | - Lauren Baczewski
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | | | - Samantha Hochheimer
- Developmental and Behavioral Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Consuelo Garcia
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Fernanda Castellon
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Lynne Levato
- Developmental and Behavioral Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Erin Fischer
- Developmental and Behavioral Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Jennica Li
- University of California Davis MIND Institute, University of California, Davis, CA, USA
| | - David S. Mandell
- Penn Center for Mental Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Connie Kasari
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
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Dimachkie Nunnally A, Sterrett K, Gulsrud A, Kasari C. What are the odds? Predicting the likelihood of a negative episode in a sample of toddlers with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:2254-2264. [PMID: 34098753 DOI: 10.1177/13623613211015001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
LAY ABSTRACT Children with autism spectrum disorder sometimes have challenges with regulating their negative emotions. These difficulties can impact children's social outcomes and how well they respond to intervention. We know that caregivers of children with autism spectrum disorder can help their children regulate negative emotions in a process known as co-regulation, but not much is known about how child and caregiver strategy use impacts children's negativity in real time. In this study, 71 caregivers of toddlers with autism spectrum disorder were asked to encourage their child to unlock a locked toy box, a task which is designed to elicit frustration. Video observations of the participants completing the task were used to examine whether specific child and caregiver behaviors increased or decreased the likelihood that the child will become upset. No child strategies were predictive of a decreased likelihood of a child becoming upset, but when children used high-energy behaviors that did not serve a purpose, such as running back and forth, they were more likely to then show signs of being upset a few seconds later. The way that caregivers responded to their child was a potent caregiver predictor of the likelihood of children's negativity, with caregivers' unresponsiveness and proactiveness both emerging as salient predictor of increased likelihood of the child being upset a few moments later. These findings give insight into how children with autism spectrum disorder and their caregiver navigate challenging and frustrating tasks, and have the potential to influence clinical practice by giving an indication off which parent and child behaviors are most effective in reducing children's negativity while interacting with parents and caregivers.
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Greenlee JL, Stelter CR, Piro-Gambetti B, Hartley SL. Trajectories of Dysregulation in Children with Autism Spectrum Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:858-873. [PMID: 33872096 DOI: 10.1080/15374416.2021.1907752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: This study determined whether child and family environment factors are associated with differences in developmental trajectories of emotional and behavioral dysregulation in children with autism spectrum disorder (ASD).Method: Participants included 186 families of a child with ASD (5-12 years old at baseline; 86% male; 83% non-Hispanic Caucasian; 35% comorbid intellectual disability). At each of the four time points (each spaced 12 months apart), mothers and fathers within each family completed well-validated measures on their own mental health, their child's dysregulation, their parent-child relationship, and their parent couple relationship. Longitudinal multi-level modeling was used to describe trajectories of dysregulation across 3 years and test whether parent depression, closeness in the parent-child relationship, and positive parent dyadic coping were associated with differences in child trajectories.Results: On average, child dysregulation decreased across time. Closer mother-child and father-child relationship quality was associated with lower baseline dysregulation. More severe child restricted and repetitive behaviors, fewer maternal depression symptoms, and more positive parent dyadic coping were associated with declines in child dysregulation over time.Conclusions: On average, children with ASD become less dysregulated across time. However, there is important variability in dysregulation trajectories of children with ASD. Children with ASD who have a high (versus low) severity of restricted and repetitive behaviors appear to be at risk for greater dysregulation. The family environment, and specifically a closer parent-child relationship, better maternal mental health, and more positive couple coping, may contribute to a pattern of improved child regulation across time in ASD.
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Beck KB, Conner CM, Breitenfeldt KE, Northrup JB, White SW, Mazefsky CA. Assessment and Treatment of Emotion Regulation Impairment in Autism Spectrum Disorder Across the Life Span: Current State of the Science and Future Directions. Psychiatr Clin North Am 2021; 44:95-110. [PMID: 33526240 DOI: 10.1016/j.psc.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Emotion regulation (ER) is the ability to modify arousal and emotional reactivity to achieve goals and maintain adaptive behaviors. ER impairment in autism spectrum disorder (ASD) is thought to underlie many problem behaviors, co-occurring psychiatric symptoms, and social impairment, and yet is largely unaddressed both clinically and in research. There is a critical need to develop ER treatment and assessment options for individuals with ASD across the life span, given the multitude of downstream effects on functioning. This article summarizes the current state of science in ER assessment and treatment and identifies the most promising measurement options and treatments.
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Affiliation(s)
- Kelly B Beck
- Department of Rehabilitation Science and Technology, University of Pittsburgh School of Health and Rehabilitation Sciences, 5036 Forbes Tower, 3600 Atwood Street, Pittsburgh, PA 15260, USA.
| | - Caitlin M Conner
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA 15213, USA
| | - Kaitlyn E Breitenfeldt
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 142M, Pittsburgh, PA 15213, USA
| | - Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA 15213, USA
| | - Susan W White
- Center for Youth Development and Intervention, Department of Psychology, University of Alabama, 200 Hackberry Lane 101 McMillan Building, Tuscaloosa, AL 35401, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA 15213, USA
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Macari SL, Vernetti A, Chawarska K. Attend Less, Fear More: Elevated Distress to Social Threat in Toddlers With Autism Spectrum Disorder. Autism Res 2020; 14:1025-1036. [PMID: 33283976 DOI: 10.1002/aur.2448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/01/2020] [Accepted: 11/21/2020] [Indexed: 01/10/2023]
Abstract
Differential emotional reactivity to social and nonsocial stimuli has been hypothesized but rarely examined empirically in ASD despite its potential importance for development of social motivation, cognition, and comorbid psychopathology. This study examined emotional reactivity, regulation, and attention to social and nonsocial threat in toddlers with ASD (n = 42, Mage : 22 months) and typically developing (TD) toddlers (n = 22, Mage : 23 months), and their mutual associations with autism symptom severity. Participants were exposed to social (stranger), nonsocial (mechanical objects), and ambiguous (masks) threats, and their intensity of distress (iDistress), attention to threat (Attention), and presence of emotion regulation (ER) strategies were measured. Autism symptom severity was quantified using the Autism Diagnostic Observation Schedule-2. In response to social threat, toddlers with ASD exhibited elevated iDistress (P < 0.038) but lower Attention (P < 0.002) and a wider variety of ER strategies (P < 0.040) compared to TD controls, though their ER strategies were less likely to be social. However, nonsocial and ambiguous threat elicited lower iDistress in ASD than in TD toddlers (P = 0.012 and P = 0.034, respectively), but comparable Attention and ER strategy use. Autism severity was not associated with iDistress. The study demonstrates elevated emotional salience but diminished attentional salience of social threat in ASD. A failure to attend adequately to social threats may restrict opportunities to appraise their threat value and engender often observed in ASD negative emotional responses to novel social situations. Early atypical emotional reactivity may independently contribute to the shaping of complex autism phenotypes and may be linked with later emerging affective and behavioral symptoms. LAY SUMMARY: Compared to typically developing toddlers, toddlers with ASD show diminished attention yet enhanced distress in response to social threat. Poor attention to potential social threat may limit opportunities to assess its threat value and thus contribute to often observed negative emotional responses to novel social situations. Identifying the precursors of atypical emotional reactivity in infancy and its links with later psychopathology will inform about novel treatment targets and mechanisms of change in the early stages of ASD. Autism Res 2021, 14: 1025-1036. © 2020 International Society for Autism Research, Wiley Periodicals, LLC.
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Affiliation(s)
- Suzanne L Macari
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, 06511, USA
| | - Angelina Vernetti
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, 06511, USA
| | - Katarzyna Chawarska
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut, 06511, USA
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18
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Vernetti A, Shic F, Boccanfuso L, Macari S, Kane-Grade F, Milgramm A, Hilton E, Heymann P, Goodwin MS, Chawarska K. Atypical Emotional Electrodermal Activity in Toddlers with Autism Spectrum Disorder. Autism Res 2020; 13:1476-1488. [PMID: 32896980 PMCID: PMC10081486 DOI: 10.1002/aur.2374] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 07/19/2020] [Accepted: 07/23/2020] [Indexed: 01/22/2023]
Abstract
Past studies in autism spectrum disorder (ASD) indicate atypical peripheral physiological arousal. However, the conditions under which these atypicalities arise and their link with behavioral emotional expressions and core ASD symptoms remain uncertain. Given the importance of physiological arousal in affective, learning, and cognitive processes, the current study examined changes in skin conductance level (ΔSCL) in 41 toddlers with ASD (mean age: 22.7 months, SD: 2.9) and 32 age-matched toddlers with typical development (TD) (mean age: 21.6 months, SD: 3.6) in response to probes designed to induce anger, joy, and fear emotions. The magnitude of ΔSCL was comparable during anger (P = 0.206, d = 0.30) and joy (P = 0.996, d = 0.01) conditions, but significantly lower during the fear condition (P = 0.001, d = 0.83) in toddlers with ASD compared to TD peers. In the combined samples, ΔSCL positively correlated with intensity of behavioral emotional expressivity during the anger (r[71] = 0.36, P = 0.002) and fear (r[68] = 0.32, P = 0.007) conditions, but not in the joy (r[69] = -0.15, P = 0.226) condition. Finally, ΔSCL did not associate with autism symptom severity in any emotion-eliciting condition in the ASD group. Toddlers with ASD displayed attenuated ΔSCL to situations aimed at eliciting fear, which may forecast the emergence of highly prevalent internalizing and externalizing problems in this population. The study putatively identifies ΔSCL as a dimension not associated with severity of autism but with behavioral responses in negatively emotionally challenging events and provides support for the feasibility, validity, and incipient utility of examining ΔSCL in response to emotional challenges in very young children. LAY SUMMARY: Physiological arousal was measured in toddlers with autism exposed to frustrating, pleasant, and threatening tasks. Compared to typically developing peers, toddlers with autism showed comparable arousal responses to frustrating and pleasant events, but lower responses to threatening events. Importantly, physiological arousal and behavioral expressions were aligned during frustrating and threatening events, inviting exploration of physiological arousal to measure responses to emotional challenges. Furthermore, this study advances the understanding of precursors to emotional and behavioral problems common in older children with autism. Autism Res 2020, 13: 1476-1488. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
- Angelina Vernetti
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Frederick Shic
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA.,Seattle Children's Research Institute, Seattle, Washington, USA.,Division of General Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | | | - Suzanne Macari
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Finola Kane-Grade
- Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Anna Milgramm
- Center for Autism and Related Disabilities, University at Albany, SUNY, New York City, New York, USA
| | - Emily Hilton
- Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Perrine Heymann
- Early Childhood Behavior Lab, Florida International University, Miami, Florida, USA
| | - Matthew S Goodwin
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Katarzyna Chawarska
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut, USA
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Beck KB, Conner CM, Breitenfeldt KE, Northrup JB, White SW, Mazefsky CA. Assessment and Treatment of Emotion Regulation Impairment in Autism Spectrum Disorder Across the Life Span: Current State of the Science and Future Directions. Child Adolesc Psychiatr Clin N Am 2020; 29:527-542. [PMID: 32471600 PMCID: PMC7810097 DOI: 10.1016/j.chc.2020.02.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Emotion regulation (ER) is the ability to modify arousal and emotional reactivity to achieve goals and maintain adaptive behaviors. ER impairment in autism spectrum disorder (ASD) is thought to underlie many problem behaviors, co-occurring psychiatric symptoms, and social impairment, and yet is largely unaddressed both clinically and in research. There is a critical need to develop ER treatment and assessment options for individuals with ASD across the life span, given the multitude of downstream effects on functioning. This article summarizes the current state of science in ER assessment and treatment and identifies the most promising measurement options and treatments.
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Affiliation(s)
- Kelly B Beck
- Department of Rehabilitation Science and Technology, University of Pittsburgh School of Health and Rehabilitation Sciences, 5036 Forbes Tower, 3600 Atwood Street, Pittsburgh, PA 15260, USA.
| | - Caitlin M Conner
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA 15213, USA
| | - Kaitlyn E Breitenfeldt
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 142M, Pittsburgh, PA 15213, USA
| | - Jessie B Northrup
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA 15213, USA
| | - Susan W White
- Center for Youth Development and Intervention, Department of Psychology, University of Alabama, 200 Hackberry Lane 101 McMillan Building, Tuscaloosa, AL 35401, USA
| | - Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Webster Hall Suite 300, Pittsburgh, PA 15213, USA
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20
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England-Mason G. Emotion Regulation as a Transdiagnostic Feature in Children with Neurodevelopmental Disorders. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020. [DOI: 10.1007/s40474-020-00200-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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21
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Nuske HJ, Pellecchia M, Kane C, Seidman M, Maddox BB, Freeman LM, Rump K, Reisinger EM, Xie M, Mandell DS. Self-Regulation is Bi-Directionally Associated with Cognitive Development in Children with Autism. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2020; 68:101139. [PMID: 34177028 PMCID: PMC8232541 DOI: 10.1016/j.appdev.2020.101139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Children with autism are at high risk for self-regulation difficulties because of language delays and emotion-regulation difficulties. In typically-developing children, language development helps promote self-regulation, and in turn, cognitive development. Little research has examined the association between self-regulation and cognitive-skill development in children with autism. Children with autism (5-8 years), who were minimally-verbal (n=38) or typically-verbal (n=46) participated in a structured cognitive assessment and were observed for self-regulation difficulties during the cognitive assessment at the beginning and end of an academic year. Results showed that children with autism who were minimally- compared to typically-verbal had more self-regulation difficulties. Increase in self-regulation difficulties predicted less cognitive-skill gains, regardless of verbal ability, and cognitive skill gains also predicted changes in self-regulation difficulties. Interventions targeting self-regulation may be appropriate for all children with autism and should be adapted for minimally-verbal children.
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Affiliation(s)
- Heather J. Nuske
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
| | | | - Cary Kane
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
| | - Max Seidman
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
| | - Brenna B. Maddox
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
| | | | - Keiran Rump
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
| | | | - Ming Xie
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
| | - David S. Mandell
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
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22
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Wieckowski AT, Luallin S, Pan Z, Righi G, Gabriels RL, Mazefsky C. Gender Differences in Emotion Dysregulation in an Autism Inpatient Psychiatric Sample. Autism Res 2020; 13:1343-1348. [PMID: 32222097 DOI: 10.1002/aur.2295] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/20/2020] [Accepted: 03/05/2020] [Indexed: 11/09/2022]
Abstract
There is a wide range of emotion regulation (ER)-related impairment observed in autism spectrum disorder (ASD), which is associated with both internalizing and externalizing problems. Although the importance of ER is widely acknowledged in the ASD literature, little is known about factors associated with variability in ER impairment. Given the identified gender differences in ASD, gender may be a potential contributor to ER. This study examined gender differences in ER in an ASD inpatient psychiatric sample (n = 722; 146 females) aged 4-20 years, collected as part of the Autism Inpatient Collection. In addition, the study investigated whether age, nonverbal intelligence quotient (NVIQ), or verbal ability moderate the association between ER and gender. While both male and female inpatients with ASD presented with clinically elevated emotion dysregulation compared to general population norms, results suggest that female psychiatric inpatients have more severe dysregulation, including higher reactivity and dysphoria, than inpatient males. NVIQ and verbal ability did not moderate the association between gender and ER. Age moderated the association between gender and ER, with greater gender difference seen in older individuals, but only for dysphoria. However, overall, these effects were small. Improved understanding of ER presentation in males and females with ASD is critical, as these symptoms may differentially impact individuals with ASD and may warrant a different treatment emphasis. LAY SUMMARY: Previous research has identified several gender differences in presentation of autism spectrum disorder (ASD) symptoms, as well as difficulties with emotion regulation in individuals with ASD. In order to better understand the factors that may contribute to emotion regulation in ASD, this study examined whether psychiatrically hospitalized males and females with ASD differed in emotion regulation and what factors influenced the differences. Results suggest that females with ASD have slightly but significantly more difficulty with emotion regulation compared to males. Autism Res 2020, 13: 1343-1348. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
| | - Stephanie Luallin
- Department of School Psychology, University of Northern Colorado, Greeley, Colorado, USA
| | - Zhaoxing Pan
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Giulia Righi
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Robin L Gabriels
- Department of Psychiatry and Pediatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Carla Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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23
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Northrup JB, Goodwin M, Montrenes J, Vezzoli J, Golt J, Peura CB, Siegel M, Mazefsky C. Observed emotional reactivity in response to frustration tasks in psychiatrically hospitalized youth with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:968-982. [PMID: 32169018 DOI: 10.1177/1362361320908108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Large emotional reactions (e.g. outbursts, tantrums) can be common and distressing in the lives of individuals with autism spectrum disorder and their families. Most previous research that has examined these types of emotional responses have used questionnaire data or focused only on young children. In addition, very little research has included individuals across a large range of intellectual and functional abilities or individuals with more severe emotional and/or behavioral difficulties. This study examined emotional reactions to frustrating tasks in 6-21-year-olds with autism spectrum disorder who were psychiatrically hospitalized due to emotional and/or behavioral difficulties. We describe change in the amount, intensity, duration, and range of emotional reactions that the participants displayed from a neutral activity to the frustrating tasks and then to a neutral recovery period. We also examined associations between characteristics of the participants and these emotional reactions. We found that younger children displayed more negative emotions across the neutral and frustrating tasks; however, age did not relate to how big their reactions to frustration were. Furthermore, we found that individuals with fewer adaptive skills (i.e. age-appropriate life skills) and minimally verbal individuals had bigger reactions and recovered less following the frustration tasks. The results highlight the importance of examining emotional reactions in individuals with lower verbal and adaptive abilities and for interventions to consider the connection between verbal and adaptive skills and emotional reactions.
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Affiliation(s)
| | | | | | | | - Josh Golt
- University of Pittsburgh, USA.,The University of Alabama, USA
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24
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Korbut S, Hedley D, Chetcuti L, Sahin E, Nuske HJ. Temperament predicts challenging behavior in children with autism spectrum disorder at age 5. RESEARCH IN AUTISM SPECTRUM DISORDERS 2020; 71:101492. [PMID: 35633756 PMCID: PMC9137884 DOI: 10.1016/j.rasd.2019.101492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Challenging behaviors during early childhood have a significant impact on cognitive and social development. The present study aimed to identify the developmental predictors of these behaviors in preschool aged children with Autism Spectrum Disorder (ASD) at 2-year follow-up. We examined temperament, which has been identified as key to emotion regulation in typical development, as well as developmental level and ASD symptom severity, as potential predictors of parent-reported challenging behavior. METHOD Forty-three parents of preschool aged children with ASD from a previous study were invited to participate. Data from 26 children with ASD aged 4-6 years (M = 5, SD = .60) were available for follow-up analyses. Developmental level, ASD symptom severity, and temperamental difficulty at baseline were considered as potential predictors of frequency and severity of challenging behavior at follow-up. RESULTS Baseline negative affectivity was uniquely predictive of frequency of challenging behavior at follow-up. Although no individual variable was identified as a unique predictor of variance, the combined effects of temperament were predictive of the severity of challenging behavior at follow-up, contributing to 46 % of variance in scores. CONCLUSIONS These findings highlight the potential impact of emotion-regulation related aspects of temperament on later emerging challenging behavior in young children with ASD, suggesting opportunities for early intervention. Results also identified a role for developmental level in the severity of challenging behavior, but suggest that the effect may be metered by temperament.
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Affiliation(s)
- Siobhan Korbut
- Olga Tennison Autism Research Centre, La Trobe University, VIC, Australia
| | - Darren Hedley
- Olga Tennison Autism Research Centre, La Trobe University, VIC, Australia
| | - Lacey Chetcuti
- Olga Tennison Autism Research Centre, La Trobe University, VIC, Australia
| | - Ensu Sahin
- Olga Tennison Autism Research Centre, La Trobe University, VIC, Australia
| | - Heather J. Nuske
- Penn Center for Mental Health, University of Pennsylvania, PA, USA
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25
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Hepach R, Hedley D, Nuske HJ. Prosocial attention in children with and without autism spectrum disorder: Dissociation between anticipatory gaze and internal arousal. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 48:589-605. [DOI: 10.1007/s10802-019-00606-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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26
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Nuske HJ, Finkel E, Hedley D, Parma V, Tomczuk L, Pellecchia M, Herrington J, Marcus SC, Mandell DS, Dissanayake C. Heart rate increase predicts challenging behavior episodes in preschoolers with autism. Stress 2019; 22:303-311. [PMID: 30822219 DOI: 10.1080/10253890.2019.1572744] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Identifying triggers for challenging behavior is difficult in some children with autism because of their limited communication abilities. Physiological indicators of stress may provide important insights. This study examined whether heart rate (HR) predicts challenging behavior in children with autism. While wearing an electrocardiograph monitor, 41 children with autism aged 2- to 4-years participated in tasks designed to induce low-level stress (e.g. waiting for a snack). Coders identified 106 time periods during which challenging behaviors occurred and also coded 106 randomly selected time samples that did not include challenging behaviors. Thirteen (32%) participants exhibited challenging behaviors and were included in the study. Baseline-corrected HR was computed for each behavior/time sample. On average, children with autism showed a 22 ± 16% HR increase from baseline 58 ± 22 seconds before the onset of a challenging behavior episode. Peak HR change had moderate predictive utility (area under the curve = .72, p < .001). The increase in HR before challenging behaviors was similar for children of different characteristics (age, autism severity, expressive language ability, overall developmental ability). Results highlight the promise of using physiological stress to predict challenging behavior in preschoolers with autism; although, they need to be replicated in larger samples. Given recent advances in wearable biosensing, it may be useful to incorporate HR monitoring in autism intervention. Lay summary In children with autism, changes in heart rate (HR) may help us predict when challenging behavior is about to occur - but this hypothesis has not been well studied. In this study, HR increase moderately predicted challenging behavior in preschoolers with autism. Given recent advances in wearable sensors, it may be useful to incorporate HR monitoring in autism intervention.
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Affiliation(s)
- Heather J Nuske
- a Center for Mental Health, University of Pennsylvania , Philadelphia , PA, USA
| | - Emma Finkel
- c Psychology Department, School of Arts and Sciences , University of Pennsylvania , Philadelphia , PA, USA
| | - Darren Hedley
- d School of Psychology and Public Health , Olga Tennison Autism Research Centre, La Trobe University , Melbourne , Australia
| | - Valentina Parma
- e Scuola Internazionale Superiore di Studi Avanzati , Trieste , Italy
| | - Liza Tomczuk
- f Neuroscience Program, Dickinson College , Carlisle , PA, USA
| | - Melanie Pellecchia
- a Center for Mental Health, University of Pennsylvania , Philadelphia , PA, USA
| | - John Herrington
- b Center for Autism Research, Children's Hospital of Philadelphia , Philadelphia , PA, USA
| | - Steven C Marcus
- a Center for Mental Health, University of Pennsylvania , Philadelphia , PA, USA
| | - David S Mandell
- a Center for Mental Health, University of Pennsylvania , Philadelphia , PA, USA
| | - Cheryl Dissanayake
- d School of Psychology and Public Health , Olga Tennison Autism Research Centre, La Trobe University , Melbourne , Australia
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27
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Nuske HJ, Hedley D, Tseng CH, Begeer S, Dissanayake C. Emotion Regulation Strategies in Preschoolers with Autism: Associations with Parent Quality of Life and Family Functioning. J Autism Dev Disord 2019; 48:1287-1300. [PMID: 29192379 DOI: 10.1007/s10803-017-3391-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Children with autism experience challenges with emotion regulation. It is unclear how children's management of their emotions is associated with their family's quality of life. Forty-three preschoolers with autism and 28 typically developing preschoolers were coded on emotion regulation strategies used during low-level stress tasks. Parents reported on their quality of life and family functioning, and their child's internalizing and externalizing behaviors. More externalizing behaviors across groups and use of two emotion regulation strategies (self-soothing, deep exhalation) in the autism group predicted lower family quality of life. Findings suggest that children's emotional outbursts and reduced use of passive comforting strategies are linked to lower family quality of life.
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Affiliation(s)
- Heather Joy Nuske
- Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, USA.
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.
| | - Darren Hedley
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Chen Hsiang Tseng
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Sander Begeer
- Section Clinical Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
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Hilton CL, Ratcliff K, Collins DM, Flanagan J, Hong I. Flourishing in children with autism spectrum disorders. Autism Res 2019; 12:952-966. [PMID: 30912315 DOI: 10.1002/aur.2097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 01/01/2023]
Abstract
Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from the National Survey of Children's Health 2016 as indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) to compare differences in parent perceptions of their children with and without autism spectrum disorder (ASD). We anticipate that these findings will help identify intervention targets to support the well-being of individuals with ASD. Children between 6 and 17 years of age, without intellectual disability, brain injury, cerebral palsy, or Down syndrome were included. Total participants were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in three-factor structures (social competence, behavioral control, and school motivation) with good model fit (root mean square error of approximation = 0.08, comparative fit index = 0.92, Tucker-Lewis index = 0.89). The multivariate regression model and propensity score with inverse probability of treatment weighting (PS-IPTW) method revealed that children with ASD had lower scores in the social competence and behavioral control factors compared to the control group (all P < 0.05). However, no significant differences were found in the school motivation factor between the two groups (P > 0.05) in both multivariate regression model and PS-IPTW method. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD. Autism Res 2019, 12: 952-966. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Flourishing is an indicator of positive mental health and is important for children's development and well-being. We used variables from The National Survey of Children's Health 2016 to examine differences in parent perceptions of the indicators of flourishing (difficulty making friends, is bullied, bullies others, shares ideas with family, argues, finishes tasks, does all homework, shows curiosity, stays calm, and cares about doing well in school) between children with and without autism spectrum disorders (ASD). We anticipate that this information will help to identify therapeutic targets to support the well-being of individuals with ASD. Children between 6 and 17 years old, without intellectual disability (ID), brain injury (BI), cerebral palsy (CP), or Down syndrome (DS) were included. From the total (N = 50,212), we excluded children under age 6 (n = 14,494), those who once, but do not currently have ASD (n = 81), and those with ID (n = 432), BI (n = 170), CP (n = 35), and DS (n = 17), resulting in 34,983 records used. Total participants, age 6-17 years, were 34,171 controls (male/female = 17,116/17,155) and 812 with ASD (male/female = 668/144). Factor analysis resulted in the identification of three flourishing categories among the indicator variables (social competence, behavioral control, and school motivation). Children with ASD had lower scores in the social competence and behavioral control factors compared to the control group. However, there were no significant differences in the school motivation factor between the two groups. Findings suggest that social competence and behavioral control are indicators of flourishing and are important intervention targets to increase flourishing among children with ASD.
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Affiliation(s)
- Claudia L Hilton
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Karen Ratcliff
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Diane M Collins
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Joanne Flanagan
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
| | - Ickpyo Hong
- Occupational Therapy Department, University of Texas Medical Branch, School of Health Professions, 301 University Boulevard, Galveston, Texas, 77555-1142
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Campbell SB, Northrup JB, Tavares AB. Resistance to temptation in toddlers at genetic risk for autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2018; 23:1018-1027. [PMID: 30165745 DOI: 10.1177/1362361318797264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Children with autism spectrum disorder often demonstrate difficulties with self-regulation, although studies of this construct in young children with autism spectrum disorder are limited. In this study, developmental changes were examined using a measure of self-regulation appropriate for young children, resistance to temptation. At 22, 28, and 34 months, toddlers with an older sibling with autism spectrum disorder (high risk) and toddlers with typically developing older siblings (low risk) were presented with an appealing toy and instructed not to touch it. Observers coded whether or not children touched the toy and the strategies they used to resist touching it. At 36 months, children were assessed for autism spectrum disorder, yielding three groups: high risk children with autism spectrum disorder, high risk children without autism spectrum disorder, and low risk children. At 22 months, most children, regardless of group, touched the forbidden toy; at 28 and 34 months, many high risk children without autism spectrum disorder and low risk children resisted the temptation to touch the toy, whereas most of the children with autism spectrum disorder did not. Differences in delay strategies were also evident. Some, but not all group differences, were accounted for by differences in language ability. Results highlight one early index of impulse control that differentiates children with emerging autism spectrum disorder from age-mates prior to the third birthday.
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Janus M, Bialystok E. Working Memory With Emotional Distraction in Monolingual and Bilingual Children. Front Psychol 2018; 9:1582. [PMID: 30210408 PMCID: PMC6120977 DOI: 10.3389/fpsyg.2018.01582] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 08/08/2018] [Indexed: 12/21/2022] Open
Abstract
Extensive work has demonstrated the benefits of bilingualism on executive functioning (EF) across the lifespan. Concurrently, other research has shown that EF is related to emotion regulation (ER), an ability that is integral to healthy socio-emotional development. However, no research to date has investigated whether bilingualism-related advantages in EF can also be found in emotional contexts. The current study examined the performance of 93 children who were 9-years old, about half of whom were bilingual, on the Emotional Face N-Back Task, an ER task used to assess the interference effect of emotional processing on working memory. Bilingual children were more accurate than monolingual children in both 1-back and 2-back conditions but were significantly slower than monolingual children on the 2-back condition. There were significant effects of emotional valence on reaction time, but these did not differ across language groups. These results confirm previous research showing better EF performance by bilinguals, but no differences in ER were found between language groups. Findings are discussed in the context of our current understanding of the ER literature with potential implications for previously unexplored differences between monolingual and bilingual children.
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Affiliation(s)
| | - Ellen Bialystok
- Department of Psychology, York University, Toronto, ON, Canada
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Fenning RM, Baker JK, Moffitt J. Intrinsic and Extrinsic Predictors of Emotion Regulation in Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 48:3858-3870. [PMID: 29926292 DOI: 10.1007/s10803-018-3647-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Difficulties regulating emotion have been linked to comorbid psychopathology in children with autism spectrum disorder (ASD), but little empirical work has examined predictors of dysregulation in this population. Forty-six families of children with ASD participated in a laboratory visit that included direct measurement of children's IQ, ASD symptoms, and psychophysiological reactivity. Child emotion regulation was observed during independent and co-regulatory tasks, and parental scaffolding was rated in the dyadic context. ASD symptom severity emerged as the strongest predictor of child emotion dysregulation across contexts. Child age and parental scaffolding also uniquely predicted child dysregulation in the dyadic task. Implications for conceptualizing intrinsic and extrinsic influences on emergent emotion regulation in children with ASD are discussed, as are applications to intervention.
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Affiliation(s)
- Rachel M Fenning
- Department of Child and Adolescent Studies, Center for Autism, California State University, Fullerton, 800 N. State College Blvd. EC-560, Fullerton, CA, 92831, USA.
| | - Jason K Baker
- Department of Child and Adolescent Studies, Center for Autism, California State University, Fullerton, 800 N. State College Blvd. EC-560, Fullerton, CA, 92831, USA
| | - Jacquelyn Moffitt
- Department of Child and Adolescent Studies, Center for Autism, California State University, Fullerton, 800 N. State College Blvd. EC-560, Fullerton, CA, 92831, USA
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Mazefsky CA, Yu L, White SW, Siegel M, Pilkonis PA. The emotion dysregulation inventory: Psychometric properties and item response theory calibration in an autism spectrum disorder sample. Autism Res 2018; 11:928-941. [PMID: 29624893 PMCID: PMC6026073 DOI: 10.1002/aur.1947] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 02/21/2018] [Accepted: 03/05/2018] [Indexed: 11/09/2022]
Abstract
Individuals with autism spectrum disorder (ASD) often present with prominent emotion dysregulation that requires treatment but can be difficult to measure. The Emotion Dysregulation Inventory (EDI) was created using methods developed by the Patient-Reported Outcomes Measurement Information System (PROMIS® ) to capture observable indicators of poor emotion regulation. Caregivers of 1,755 youth with ASD completed 66 candidate EDI items, and the final 30 items were selected based on classical test theory and item response theory (IRT) analyses. The analyses identified two factors: (a) Reactivity, characterized by intense, rapidly escalating, sustained, and poorly regulated negative emotional reactions, and (b) Dysphoria, characterized by anhedonia, sadness, and nervousness. The final items did not show differential item functioning (DIF) based on gender, age, intellectual ability, or verbal ability. Because the final items were calibrated using IRT, even a small number of items offers high precision, minimizing respondent burden. IRT co-calibration of the EDI with related measures demonstrated its superiority in assessing the severity of emotion dysregulation with as few as seven items. Validity of the EDI was supported by expert review, its association with related constructs (e.g., anxiety and depression symptoms, aggression), higher scores in psychiatric inpatients with ASD compared to a community ASD sample, and demonstration of test-retest stability and sensitivity to change. In sum, the EDI provides an efficient and sensitive method to measure emotion dysregulation for clinical assessment, monitoring, and research in youth with ASD of any level of cognitive or verbal ability. Autism Res 2018, 11: 928-941. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY This paper describes a new measure of poor emotional control called the Emotion Dysregulation Inventory (EDI). Caregivers of 1,755 youth with ASD completed candidate items, and advanced statistical techniques were applied to identify the best final items. The EDI is unique because it captures common emotional problems in ASD and is appropriate for both nonverbal and verbal youth. It is an efficient and sensitive measure for use in clinical assessments, monitoring, and research with youth with ASD.
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Affiliation(s)
- Carla A Mazefsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Lan Yu
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Susan W White
- Department of Psychology, Virginia Tech, Blacksburg, Virginia
| | - Matthew Siegel
- Maine Medical Center Research Institute, Maine Behavioral Healthcare, Scarborough, Maine
| | - Paul A Pilkonis
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Uljarević M, Hedley D, Nevill R, Evans DW, Cai RY, Butter E, Mulick JA. Brief report: Poor self-regulation as a predictor of individual differences in adaptive functioning in young children with autism spectrum disorder. Autism Res 2018; 11:1157-1165. [DOI: 10.1002/aur.1953] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 03/13/2018] [Accepted: 03/18/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Mirko Uljarević
- Stanford Autism Center, Department of Psychiatry and Behavioral Sciences, School of Medicine; Stanford University; Stanford California
- Olga Tennison Autism Research Centre; La Trobe University; Melbourne Victoria Australia
| | - Darren Hedley
- Olga Tennison Autism Research Centre; La Trobe University; Melbourne Victoria Australia
- Nationwide Children's Hospital; Columbus Ohio
| | - Rose Nevill
- The Ohio State University; Columbus Ohio
- Kennedy Krieger Institute and John Hopkins School of Medicine; Baltimore Maryland
| | | | - Ru Ying Cai
- Olga Tennison Autism Research Centre; La Trobe University; Melbourne Victoria Australia
| | - Eric Butter
- Nationwide Children's Hospital; Columbus Ohio
- The Ohio State University; Columbus Ohio
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