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Key points
- Emotional regulation can be challenging for children on the autism spectrum.
- Emotional regulation challenges are correlated with social and behavior challenges.
- CBI is a key evidence practice for addressing mental health challenges in autistic young persons.
- Emotional regulation is an essential focus for nurturing autistic children's emotional wellness.
More and more, the experiences and perspectives of autistic individuals are contributing to our understanding of neurodiversity. One example is Chamak et al.’s (2008) study of autobiographical writings of autistic individuals, aimed to explore their narratives relating to their inner experience (together with interviews).
The above-mentioned authors found that unlike the current diagnostic criteria for autism that focuses on a dyad of challenges with social communication and restrictive and repetitive behavior, participants in their study described, as their priority, challenges with emotional regulation (along with others relating to atypical perception and information processing). Researchers visualized these as two overlapping circles that interrelate and influence one another. It makes sense. Differences in information processing, for instance preferences for detail and interest focus, impact on how individuals appraise situations. In turn, appraisal is an important activity that impacts the unfolding of an emotional experience.
Statistics relating to high percentages of comorbid symptoms of anxiety and depression in autistic children make emotional regulation a priority for this population. The majority (67 to 79 percent) of children on the spectrum experience comorbid symptoms of anxiety and many (42 to 54 percent) depression (Mayes et al. 2010). Emotional regulation challenges are correlated with social and behavioral challenges (Mayes et al., 2011) and externalizing and internalizing strategies such as aggression and self-harm (Folstein, 2012).
Guy et al. (2014) defined emotional self-regulation as a “complex and multifaceted construct that involves physiological, behavioral, and cognitive processes, which allow an individual to monitor, evaluate, and modify emotional reactions to accomplish one’s goals.”
In addition to the above-mentioned information processing characteristics, autistic individuals experience particular biological processes that are influential to their experience of emotional regulation. For instance, Pitskel et al. (2010) found a relative lack of prefrontal-amygdala connectivity in autistic individuals when downregulating disgust emotion, in comparison to neurotypical peers, and a lack of modulation of insula. Authors implied that these findings suggest potential downregulation challenges for autistic individuals. Various neurological patterns of “long-range functional underconnectivity” have been additionally suggested, for instance between the two brain hemispheres, or associated with the fusiform area involved with facial recognition processes. Hypothesized functional underconnectivity between various brain areas impacts processes involved in emotional regulation, such as comprehension of emotions, including introspection, or behavioral inhibitory processes.
Another notable biological process associated with emotional regulation in autistic school-aged children is a decreased respiratory sinus arrhythmia (RSA) (Guy et al., 2014), a measure of heart rate fluctuations associated with the activity of the parasympathetic nervous system. The authors suggest that decreased RSA implies potential challenges for autistic individuals with downregulating internal states.
There are numerous other neuro-physiological and neuro-social processes that impact emotional regulation in autistic individuals including atypical sensory processing, differences in joint attention, and unique patterns of nonverbal expressiveness.
Strategies for Nourishing Emotional Regulation
A classic therapeutic strategy for addressing mental health concerns in autistic young persons, one that boasts the strongest research evidence, is cognitive behavioral interventions (CBI).
Wong et al.’s (2014) Evidence-Based Practices for Children Report lists CBI as a key evidence practice for addressing mental health challenges in autistic young persons. They suggest that cognitive behavioral interventions are helpful for use in “conjunction with other evidence-based practices including social narratives, reinforcement,” and can target a wide variety of emotions. CBI strategies explore cognitive processes and interpretations. They expand individuals’ awareness of their inner beliefs and thoughts, and how these impact their emotions.
An example of a CBI strategy is paying attention to thoughts and beliefs at times of experiencing a challenging emotion. A personal example is asking my 9-year-old son to draw a “thought bubble” and, inside it, write down what he says to himself and believes. We then explore what emotional experiences are associated (for him) with the thoughts he listed. Next, we add to his thought bubble ideas about ways of looking after himself, or perceptions from alternative points of view.
In addition to CBI, mindfulness has also been an effective strategy for supporting autistic young persons with emotional regulation. Mindfulness interventions target a variety of components such as nurturing present-moment awareness, naming feelings, practicing inner compassion and non-judgment, as well as making use of self-observation (Baer, 2006).
A personal example of a mindfulness strategy is asking my 9-year-old to notice what he hears, feels, and sees in a particular moment, in this way helping him to pause the cognitive narrative in his head and come back to the direct experience of the present moment. He may further savor this exercise by making a drawing of one aspect of what he feels, hears, or sees, or through an activity such as making a sensory collage.
Despite many encouraging preliminary results, there are unfortunately insufficient meta-analyses (to date) that evaluate the effectiveness of mindfulness as a strategy for emotional regulation for autistic young persons, due to small and varied sample sizes as well as limited control groups.
Emotional regulation can be challenging for children on the autism spectrum, due to differences in the processing of information and biological variables such as decreased respiratory sinus arrhythmia (RSA). Strategies that support them in staying within an optimal range of arousal that’s conducive to reflection and problem solving such as CBI, mindfulness, or other means of self-soothing are an essential focus for nurturing their emotional wellness.
References
Baer, R. A., Smith, G. T., Hopkins, J., Krietemeyer, J., & Toney, L. (2006). Using Self-Report Assessment Methods to Explore Facets of Mindfulness. Assessment (Odessa, Fla.), 13(1), 27–45. https://doi.org/10.1177/1073191105283504
Chamak, B., Bonniau, B., Jaunay, E., & Cohen, D. (2008). What Can We Learn about Autism from Autistic Persons? Psychotherapy and Psychosomatics, 77(5), 271–279. https://doi.org/10.1159/000140086
Croen, L. A., Zerbo, O., Qian, Y., Massolo, M. L., Rich, S., Sidney, S., & Kripke, C. (2015). The health status of adults on the autism spectrum. Autism : the International Journal of Research and Practice, 19(7), 814–823. https://doi.org/10.1177/1362361315577517
Gray, J. A. (1990). Brain Systems that Mediate both Emotion and Cognition. Cognition and Emotion, 4(3), 269–288. https://doi.org/10.1080/02699939008410799
Guy, L., Souders, M., Bradstreet, L., DeLussey, C., & Herrington, J. D. (2014). Brief Report: Emotion Regulation and Respiratory Sinus Arrhythmia in Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 44(10), 2614–2620. https://doi.org/10.1007/s10803-014-2124-8
Mayes, S. D., Calhoun, S. L., Murray, M. J., & Zahid, J. (2011). Variables Associated with Anxiety and Depression in Children with Autism. Journal of Developmental and Physical Disabilities, 23(4), 325–337. https://doi.org/10.1007/s10882-011-9231-7
Pitskel, N. B., Bolling, D. Z., Kaiser, M. D., Pelphrey, K. A., & Crowley, M. J. (2014). Neural systems for cognitive reappraisal in children and adolescents with autism spectrum disorder. Developmental Cognitive Neuroscience, 10(C), 117–128. https://doi.org/10.1016/j.dcn.2014.08.007
Shuid, A.N., Jayusman, P.A., Shuid, N., Ismail, J., Kamal Nor, N. & Naina Mohamed, I. 2020, "Update on Atypicalities of Central Nervous System in Autism Spectrum Disorder", Brain sciences, vol. 10, no. 5.
Wong, C., Odom, S. L., Hume, K. A., Cox, A. W., Fettig, A., Kucharczyk, S., Brock, M. E., Plavnick, J. B., Fleury, V. P., & Schultz, T. R. (2015). Evidence-Based Practices for Children, Youth, and Young Adults with Autism Spectrum Disorder: A Comprehensive Review. Journal of Autism and Developmental Disorders, 45(7), 1951–1966. https://doi.org/10.1007/s10803-014-2351-z
