Intrinsic and Extrinsic Predictors of Emotion Regulation in Children with Autism Spectrum Disorder

A non-systematic overview review of self-focused emotion regulation in autistic individuals through the lens of the extended process model

Difficulties regulating emotions have been coined as inherent to autism, possibly even presenting a core difficulty of autism. While several models of emotion regulation have been proposed in the past, in this targeted review article, we aim to map emotion regulation difficulties in autistic individuals within the framework of the extended process model of emotion regulation. This model can be considered the most comprehensive one currently incorporating not only different emotion regulation strategy groups but also different stages and processes involved in successful self-focused emotion regulation. Within this model, we will identify areas and domains as specifically impacted by autistic individuals. We will also outline gaps in the literature and provide suggestions for future research that can help deepen our understanding of the emotion regulation processes of autistic individuals. The ultimate goal is to develop specific support programs that address specific emotion regulation mechanisms, providing a much more individualized support approach.Lay abstractWhat do we already know about emotion regulation in autism?We know that many autistic children, youth, and adults experience difficulties regulating emotions. Existing research has focused mainly on the differences in emotion regulation capabilities between autistic and non-autistic individuals, the relationships between autistic traits and emotion regulation, and how emotion regulation relates to other outcomes, such as social skills and mental health.What does this paper add?We want to take a new approach to review the existing emotion regulation research through the lens of a specific theoretical model: the extended process model of emotion regulation. Professor James Gross developed this model. It consists of four emotion regulation phases: identification, selection, implementation, and monitoring.Our review revealed specific areas within these emotion regulation phases that could significantly impact the emotion regulation experiences of autistic individuals. We also outline the gaps in the research and propose avenues for future investigation.Implications for practiceBy deepening our understanding of emotion regulation in autistic individuals through the proposed future research, researchers and clinicians can pave the way for the development of tailored support programs. These programs will directly target specific emotion regulation mechanisms, offering a much-needed individualized support approach.

The social skills of autistic boys in preschool: the contributions of their dyadic and triadic interactions with their parents

BACKGROUND

The interactions of typically developing (TD) children within the family context are associated with their social skills in preschool, and the question guiding this study, which focused on boys, was whether the same would be true for autistic children. A specific focus was on the importance of the boys' engagement in triadic, mother-father-child interactions over and above their engagement in dyadic, parent-child interactions. The boys' social skills were assessed concurrently with their family interactions and one year later.

METHODS

Seventy-five autistic preschooler boys (Age in months: M = 49.45, SD = 11.03) and both of their parents were recruited through treatment centers and social media. The boys' dyadic engagement was assessed from observations of their interactions with their mothers and fathers (separately), and their triadic engagement from an observation of mother-father-child interactions. The boys' social skills in preschool were assessed using a Q-sort completed by observers and teachers and by the Social Responsiveness Questionnaire (SRS) completed by teachers.

RESULTS

Controlling for the severity of the boys' symptoms and IQ, their dyadic engagement was associated with the concurrent observer Q-sort and teacher-reported SRS measures, and their triadic engagement did not explain additional variance in these measures. Predicting over one year, dyadic engagement was associated again with the observer Q-sort and teacher SRS measures, while the boys' triadic engagement accounted for additional variance in these measures as well as the teacher Q-sort. Finally, boys' dyadic engagement predicted gains in social skills on the observer Q-sort, and their triadic engagement was predictive of gains in the observer and teacher Q-sort.

CONCLUSIONS

The engagement that autistic preschool-age boys displayed in the context of their dyadic and triadic interactions with their parents appears to be transferred to the preschool setting, and triadic interactions are of particular significance.

The Impact of Art-Based Interventions on Emotional Regulation in Chinese Children with Autism: A Drawing Therapy Approach

PURPOSE

The study of effective measures to improve emotional regulation and social responsiveness in children with Autism Spectrum Disorder (ASD) is of significant importance for the adaptation of this group of children. The aim of this research was to evaluate the impact of a 6-month drawing therapy program on preschool-aged children with ASD.

METHOD

It employed a quasi-experimental design with two groups: an experimental group participating in drawing therapy and a control group receiving no intervention. Emotional regulation was assessed using pre-test and post-test measures on the Social Responsiveness Scale (SRS).

RESULTS

The results indicated a significant improvement in social responsiveness in the experimental group post-intervention, as evidenced by paired and independent sample t-tests, indicating statistically significant differences between pre- and post-testing scores in the experimental group, as well as between the experimental and control groups. This study concludes that art therapy can significantly enhance the emotional-social responsiveness of children with ASD, highlighting its potential for practical application in therapeutic settings.

CONCLUSIONS

The findings suggest the necessity of incorporating drawing-based therapeutic strategies into intervention programs for children with ASD, offering meaningful opportunities to enhance their social skills and overall quality of life.

Differential Relations Between Parenting and Emotion Regulation in Children with ASD Across Dyadic and Independent Contexts

Many children with ASD exhibit difficulties with emotion regulation that greatly impair functioning. Certain intrinsic correlates of dysregulation have been identified in this population, but the search for potential environmental influences has been less fruitful. The current study examined several aspects of parenting as correlates of observed regulation in Autistic children, as measured in both parent-child and independent regulatory contexts. A diverse sample of 76 children with ASD aged 6 to 10 years participated in frustrating laboratory tasks with and without their primary caregivers, and the caregivers completed a parenting questionnaire. Emotion regulation, parental scaffolding, and gentle guidance were coded from videotaped interaction, and scores of parental involvement, positive parenting, and inconsistent discipline were obtained through parent report. Differential relations were observed between parenting and children's regulation when considered across contexts, with parental scaffolding associated with children's dyadic regulation and parents' reports of their involvement and discipline associated with children's independent regulation. Findings support previous evidence identifying a potential delay in the internalization of parental co-regulatory support in Autistic children, and highlight parental involvement as a previously unidentified unique correlate of independent regulation in this population. Implications for conceptualizations of emotion regulation in autism are discussed as is the importance of extending findings through further longitudinal research.

Parent Facilitation of Child Emotion Regulation in ASD: An Ecological Momentary Assessment Study

Parents play a substantial role in their children's emotion regulation (ER) abilities. Children with autism spectrum disorder (ASD) often have difficulties regulating their emotions, which can manifest as externalizing behavioral issues. Parents of children with ASD facilitate their children's ER development in response to unique challenges and stressors, often developing resiliency but other times contributing to their children's dysregulation and behavioral challenges. It is unclear how much momentary stress attenuates parents' emotional facilitation of child ER and its effect on child behavioral functioning. Using an ecological momentary assessment approach, the current study explores this process by considering how parents of children with ASD facilitate child ER through (1) parent ER ability, (2) emotion socialization style, and (3) expressed emotion. Multilevel models explored the relative influences of parent ER facilitation on the association between momentary parent stress and behavioral intensity. Results suggest that parent ER abilities and specific emotion socialization styles interact with momentary parent stress and child behavior, whereas emotional climate of the home impacts child behavior more directly. The role of parent ER facilitation in the context of parent stress and children with ASD and behavioral problems is complex and multifaceted. Implications for further supporting children's emotional development via parent involvement are discussed.

Examining the feasibility and utility of heart rate variability on intervention outcomes targeting emotion regulation in autism: a brief report

Autistic youth experience several behavioral and emotional characteristics that can predispose them to emotion dysregulation (ED). Current literature examining ED in autism spectrum disorder (ASD) is limited to parent- and self-reported measures, indicating a need for biological or physiological methods to better assess emotion regulation in ASD. Utilizing the autonomic nervous system, specifically heart rate variability (HRV), may be a promising method to objectively measure ED in ASD, given it is one of the body's primary means of regulating physiological arousal. Our pilot study is one of the first to examine the feasibility, utility, and construct validity of HRV along with clinical measures within an intervention targeting ED-specific symptoms in ASD. Participants included 30 autistic youth ages 8-17 years who participated in the pilot study of Regulating Together, a group-based intervention targeting emotion regulation. We demonstrate HRV is feasible, demonstrates adequate test-retest reliability, and is complimentary to clinician- and parent-reported measures. Our preliminary findings also point to certain HRV profiles being indicative of long-term outcomes after receiving treatment. HRV may be a useful, objective tool in determining differential needs of long-term follow-up care for treatment maintenance at screening or baseline stages.

Emotion regulation and emotion dysregulation in children and adolescents with Autism Spectrum Disorder: A meta-analysis of evaluation and intervention studies

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.

Emotion Dysregulation Mediates the Relationship Between Sensory Processing and Behavior Problems in Young Children with Autism Spectrum Disorder: A Preliminary Study

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.

Systematic Review and Meta-Analysis: Altered Autonomic Functioning in Youths With Emotional Dysregulation

OBJECTIVE

To systematically investigate if there is a significant association between markers of autonomic functioning and emotional dysregulation (ED) in children and adolescents.

METHOD

Based on a preregistered protocol (PROSPERO: CRD42021239635), PubMed, Web of Knowledge/Science, Ovid MEDLINE, Embase, and APA PsycInfo databases were searched until April 21, 2021, to identify empirical studies reporting indices of autonomic nervous system (ANS) functioning in youths meeting DSM (version III, IV, IV-TR, 5 or 5-TR) or International Classification of Diseases (ICD) (version 9 or 10) criteria for any psychopathological/neurodevelopmental condition and assessed for ED with a validated scale. Eligible outcomes included correlation coefficients between ED and ANS measures or differences in ANS measures between youths with and without ED. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS) and the Newcastle-Ottawa Scale (NOS) for cohort studies. Random-effects meta-analyses were used for data synthesis.

RESULTS

There were 12 studies (1,016 participants) included in the descriptive review and 9 studies (567 participants) included in the meta-analyses. No evidence of a significant association between ED and altered cardiac or electrodermal functioning was found. However, exploratory meta-regressions suggested a possible association between reduced resting-state cardiac vagal control and increased ED.

CONCLUSION

This study did not find evidence of an association between ED and autonomic dysfunction. However, preliminary evidence that reduced vagal control at rest might be a transdiagnostic marker of ED in young people was found. Additional studies comparing autonomic measures in youths with and without ED are needed and should also assess the effects of interventions for ED on ANS functioning.

STUDY PREREGISTRATION INFORMATION

Systematic Review and Meta-Analysis: Is Autonomic Nervous System Functioning Atypical in Children and Adolescents With Emotional Dysregulation? https://www.crd.york.ac.uk/prospero/; CRD42021239635.

The biosocial correlates and predictors of emotion dysregulation in autistic adults compared to borderline personality disorder and nonclinical controls

BACKGROUND

Emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), whose aetiology has been attributed to biosocial factors. In autism spectrum condition (ASC), although ED is prevalent and is associated with decreased well-being (e.g. self-harm, suicidality), it has been understudied, especially in adults. It is therefore crucial to further understand ED in autistic adults to improve its treatment. Our study investigates ED, its behavioural correlates (e.g. self-harm, suicidality) and biosocial predictors in autistic adults relative to BPD and nonclinical controls (NC).

METHODS

A total of 724 participants (ASC = 154; BPD = 111; NC = 459) completed 11 self-reported questionnaires assessing ED, ASC and BPD traits, co-occurring disorders, alexithymia, emotional vulnerability and invalidating experiences (e.g. bullying, autistic camouflaging). The occurrence of ED behavioural correlates (i.e. self-harm, history of suicide attempts, and psychiatric hospitalizations) was collected. In addition, between-groups analyses, linear regressions and machine learning (ML) models were used to identify ED predictors in each group.

RESULTS

ED and its behavioural correlates were higher in ASC compared to NC, but milder than in BPD. While gender did not predict ED scores, autistic women had increased risk factors to ED, including sexual abuse and camouflaging. Interestingly, BPD traits, emotional vulnerability and alexithymia strongly predicted ED scores across the groups. Using ML models, sensory sensitivity and autistic camouflaging were associated with ED in ASC, and ADHD symptoms with ED in BPD.

LIMITATIONS

ASC and BPD diagnoses were self-reported, which did not allow us to check their accuracy. Additionally, we did not explore the transactional and the moderating/mediating relationships between the different variables. Moreover, our research is cross-sectional and cannot draw conclusions regarding the direction and causality of relationships between ED and other clinical dimensions.

CONCLUSIONS

ED and its behavioural correlates are heightened in BPD compared to ASC and nonclinical controls. In the ASC group, there were no gender differences in ED, despite the heightened exposure of autistic women to ED risk factors. BPD traits, emotional vulnerability, and alexithymia are core to ED regardless of diagnosis. Although less central, sensory sensitivity and autistic camouflaging seem to be specific predictors of ED in autistic adults.

The role of intellectual disability and emotional regulation in the autism-depression relationship

LAY ABSTRACT

Many people with autism and intellectual disability have significant levels of depressive symptoms. However, this relationship is not clear. For this reason, knowing the factors that are associated with having depression in autism and intellectual disability is important. Emotion regulation is associated with depression in autism spectrum disorder and intellectual disability. After evaluating a group of people with autism and intellectual disability, we found that people with mild intellectual disability have problems regulating their emotions which lead them to develop depressive symptoms. These findings suggest that interventions designed to prevent or reduce depressive symptoms in people with autism spectrum disorder and mild intellectual disability should include among their goals emotional regulation.

Linehan's biosocial model applied to emotion dysregulation in autism: a narrative review of the literature and an illustrative case conceptualization

Emotion dysregulation (ED) is a transdiagnostic difficulty prevalent in autism spectrum condition (ASC). Importantly, recent research has suggested that ED is involved in self-harm and suicidality. Pre-existing models on the etiology of ED in ASC focus mainly on biological factors to ASC features, such as sensory sensitivities, poor flexibility, and sensitivity to change. However, although psychosocial factors seem to play a role in the emergence of ED in ASC as well (e.g., childhood maltreatment and camouflaging), there is a lack of a comprehensive model conceptualizing biosocial factors involved in ED in autistic people. Linehan's biosocial model (1993) is one of the leading etiological models of ED in borderline personality disorder (BPD). It conceptualizes ED as emerging from transactions between a pre-existing emotional vulnerability in the child and an invalidating developmental environment. Beyond its clinical relevance, Linehan's model has gathered empirical evidence supporting its pertinence in BPD and in other psychiatric disorders. Although ASC and BPD are two distinct diagnoses, because they may share ED, Linehan's biosocial model might be useful for understanding the development of ED in ASC. Hence, this article aims to provide an application and extension of Linehan's model to conceptualize ED in ASC. To do so, we conducted a narrative review of the literature on ED and its underlying factors in ASC from a developmental perspective. To investigate the pertinence of the biosocial model applied to ED in autistic people, we were interested on data on (i) ED and its behavioral correlates in ASC, in relation to the biosocial model, (ii) the potential biological and psychosocial correlates of ED in ASC and (iii) the overlapping difficulties in ASC and BPD. Finally, to assess the pertinence of the model, we applied it to the case of an autistic woman presenting with ED and suicidal behaviors. Our review and application to the case of an autistic woman suggest that ED in ASC encompasses factors related to both biological and psychosocial risk factors as conceptualized in the BPD framework, although in both domains ASC-specific factors might be involved.

Parasympathetic withdrawal indexes risk for emotion dysregulation in children with autism spectrum disorder

Children with autism spectrum disorder (ASD) experience significant difficulties with emotion regulation. Theory and empirical evidence suggest substantial biological contributions to regulatory challenges, which may be related to core ASD symptoms. Respiratory sinus arrythmia (RSA) is a measure of parasympathetic nervous system activity that serves as a putative biomarker for emotion regulation. Higher baseline RSA and more RSA reactivity (parasympathetic withdrawal; RSA-R) in response to challenge appear adaptive in non-clinical populations, but existing evidence for children with ASD remains inconclusive. The current study examined correlates of observed emotion dysregulation in 61 children with ASD between the ages of 6 and 10 years, including ASD symptom levels as well as both baseline RSA and concurrent RSA reactivity. Consistent with previous research, ASD symptom level was significantly correlated with observed dysregulation whereas additional factors such as child IQ were not. Baseline RSA was unrelated to observed dysregulation, but higher RSA reactivity predicted concurrent dysregulation above and beyond the contribution of child ASD symptoms. Findings contribute to an emerging understanding of dysregulation in these children, raise questions about the utility of traditional baseline RSA measures for this population, and clarify the functional significance of RSA reactivity as a risk factor for emotion dysregulation in children with ASD.

Emotional Dysregulation and Adaptive Functioning in Preschoolers With Autism Spectrum Disorder or Other Neurodevelopmental Disorders

AIM

Emotional dysregulation (ED), defined by deficits in the ability to monitor and modulate the valence, intensity, and expression of emotions, is typically expressed with irritability, tantrums, mood fluctuations, and self-harm in young children with autism spectrum disorder (ASD). Although ED does not represent a diagnostic feature of ASD, its manifestations are an important contributor to functional impairment and clinical referral. This study aims to examine the relationship between ED and adaptive functioning in preschoolers clinically referred for ASD or other neurodevelopmental disorders.

METHODS

A sample of 100 children (74% males, mean age 39.4 ± 12.3 months), consecutively referred to a university clinic for neurodevelopmental disorders, received clinical assessments of psychopathology with the CBCL and the Autism Diagnostic Interview-Revised, of ED- with the CBCL-Attention, Anxious/Depressed, and Aggression index (CBCL-AAA), of autism symptom severity with the ADOS-2 Calibrated Severity Score (ADOS-CSS), and of global developmental/cognitive delay (GDD) with the WPPSI-IV or other age-appropriate standardized scales. Adaptive functioning was measured with the ABAS-II. Sixty-five children met DSM-5 criteria for ASD. Multivariate regression models were applied to evaluate the relative contribution of ED, ASD severity and GDD to the ABAS-II general (GAC), conceptual (CAD), social (SAD), and practical (PAD) adaptive functioning domains.

RESULTS

Overall (n = 100), lower adaptive functioning was associated with higher CBCL-AAA (p = 0.003), higher ADOS-CSS (p < 0.001), and presence of GDD (p = 0.023). In the ASD group (n = 65), worse CAD was predicted by GDD (p = 0.016), and worse SAD and PAD by higher ADOS-CSS (p = 0.032) and ED (p = 0.002). No sex differences were detected in the study variables.

CONCLUSION

Together with the severity of global developmental delay and of autism symptoms, ED is a significant contributor to impairment in adaptive functioning among young children with a neurodevelopmental disorder and, in particular, with ASD. ED could represent a specific target for early interventions aimed at enhancing adaptive functioning in early childhood.

Parental Socialization of Emotion and Psychophysiological Arousal Patterns in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) are at considerable risk for difficulties with emotion regulation and related functioning. Although it is commonly accepted that parents contribute to adaptive child regulation, as indexed by observable child behavior, theory and recent evidence suggest that parenting may also influence relevant underlying child physiological tendencies. The current study examined concurrent associations between two elements of parental socialization of emotion and measures of both sympathetic and parasympathetic nervous system activity in 61 children with ASD aged 6 to 10 years. To index parental socialization, parents reported on their reactions to their children's negative emotions, and parental scaffolding was coded from a dyadic problem-solving task. Children's baseline respiratory sinus arrhythmia (RSA), electrodermal reactivity (EDA-R), and RSA reactivity in response to challenge were obtained as measures of the children's physiological activity. Regression analyses indicated that supportive parent reactions were related to higher child baseline RSA, a biomarker of regulatory capacity. Fewer unsupportive parent reactions and higher quality scaffolding were associated with higher EDA-R, a physiological index of inhibition. The identification of these concurrent associations represents a first step in understanding the complex and likely bidirectional interplay between parent socialization and child physiological reactivity and regulation in this high-risk population.

Temperament in individuals with Autism Spectrum Disorder: A systematic review

The study of temperament in Autism Spectrum Disorder (ASD) has the potential to provide insight regarding variability in the onset, nature, and course of both core and co-morbid symptoms. The aim of this systematic review was to integrate existing findings concerning temperament in the context of ASD. Searches of Medline, PsychInfo and Scopus databases identified 64 relevant studies. As a group, children and adolescents with ASD appear to be temperamentally different from both typically developing and other clinical non-ASD groups, characterized by higher negative affectivity, lower surgency, and lower effortful control at a higher-order level. Consistent with research on typically developing children, correlational findings and emerging longitudinal evidence suggests that lower effortful control and higher negative affect are associated with increased internalizing and externalizing problems in ASD samples. Longitudinal studies suggest there may be temperamental differences between high familial risk infants who do and do not develop ASD from as early as 6-months of age. Limitations of existing research are highlighted, and possible directions for future research to capitalize on the potential afforded through the study of temperament in relation to ASD are discussed.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.

Synchrony of Respiratory Sinus Arrhythmia in Parents and Children with Autism Spectrum Disorder: Moderation by Interaction Quality and Child Behavior Problems

Parent-child physiological synchrony, the matching of physiological states between parents and children, is theorized to be important for typically developing (TD) children, but less is known about this process in families of children with autism spectrum disorder (ASD). In a sample of 29 children (M age = 8.00 years, SD = 1.51 years) with ASD and 39 TD-matched children (M age = 7.32 years, SD = 1.36 years) and their primary caregivers (n = 68), we examined whether parent-child dyads showed physiological synchrony indexed by respiratory sinus arrhythmia (RSA) during an interaction, and whether RSA synchrony differed by parent-child interaction quality and child behavior problems. Results indicated that dyads with TD children showed stronger positive RSA synchrony than dyads with children with ASD. Furthermore, for families of children with ASD, RSA synchrony was stronger in families with higher interaction quality and fewer child internalizing problems. These results provide preliminary evidence of parent-child RSA synchrony in families of children with ASD and identify factors that may influence this physiological process. Implications of these findings for social and emotional development in children with ASD are discussed. LAY SUMMARY: Parents and children can get "in tune" with one another at the biological level - a process called physiological synchrony. We studied physiological synchrony in families of children with autism spectrum disorder (ASD) in comparison to same-aged children who had no mental health disorders. We also examined how physiological synchrony might be associated with parent-child interaction quality and child behavior problems. We found that families with a child with ASD showed weaker physiological synchrony than families with a child who was typically developing. Further, we found that physiological synchrony was stronger when parents and children with ASD showed higher interaction quality and when children with ASD had lower internalizing problems. These findings contribute to our understanding of family functioning in the context of ASD and have potential implications for future work.

Respiratory sinus arrhythmia, parenting, and externalizing behavior in children with autism spectrum disorder

Children with autism spectrum disorder exhibit significant difficulties with emotion regulation. Respiratory sinus arrhythmia is a biomarker for processes related to emotion regulation, with higher baseline rates linked to beneficial outcomes. Although reduction in respiratory sinus arrhythmia in response to challenge can index adaptive processes in community samples, excessive withdrawal may suggest loss of regulatory control among children with clinical concerns. Psychophysiological risk for problems may be protected against or exacerbated by parenting environments more or less supportive of the development of children's regulatory competence. Respiratory sinus arrhythmia was examined in 61 children with autism spectrum disorder ages 6-10 years in relation to externalizing behavior, and parenting was considered as a moderator. Respiratory sinus arrhythmia was obtained during laboratory tasks, and positive parenting, negative parenting, and children's externalizing behaviors were each indexed through multiple methods. Respiratory sinus arrhythmia reactivity interacted with negative, but not positive parenting. Higher respiratory sinus arrhythmia reactivity was associated with more externalizing behavior under conditions of higher negative parenting, but with lower externalizing behavior at lower levels of negative parenting. Similarly, negative parenting was only associated with externalizing behaviors in the context of high child respiratory sinus arrhythmia reactivity. Implications for our understanding of emotion regulation in children with autism spectrum disorder, and for related interventions, are discussed.

A Cross-Sectional Examination of the Internalization of Emotion Co-regulatory Support in Children with ASD

Cross-sectional data from Fenning et al. (J Autism Dev Disord, 48:3858-3870, 2018) were used to examine age differences in processes related to the development of emotion regulation in children with autism spectrum disorder (ASD). Forty-six children with ASD between the ages of 4 and 11 years and their primary caregivers participated in structured laboratory tasks from which parental scaffolding and child dysregulation were coded. Moderation analyses suggested increased internalization of parental co-regulatory support with age, as evidenced by more coherence in dysregulation across dyadic and independent contexts and a stronger inverse relation between parental scaffolding and independent dysregulation. Children's estimated mental age did not account for these effects. Implications for understanding and promoting the development of emotion regulation in children with ASD are discussed.

Sympathetic-Parasympathetic Interaction and Externalizing Problems in Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) exhibit significant difficulties with emotion regulation and reactivity, which may be linked to underlying psychophysiology. The present study examined associations between autonomic nervous system activity and individual differences in externalizing behavior problems in children with ASD. A multisystem approach was adopted to consider the interplay between markers of sympathetic (electrodermal reactivity-EDA-R) and parasympathetic reactivity (respiratory sinus arrhythmia reactivity-RSA-R) in relation to behavioral challenges. Fifty-two children with ASD ages 6-10 years contributed complete psychophysiological data. Measures of EDA-R and RSA-R (RSA withdrawal) were obtained in response to a laboratory challenge task and parents reported on child externalizing behavior problems using a standardized questionnaire and a structured clinical interview. An equifinality model was supported, with two distinct psychophysiological pathways linked to heightened externalizing behavior problems. Greater RSA-R was associated with more externalizing problems in the context of higher levels of EDA-R, and lower EDA-R was associated with increased externalizing problems at lower levels of RSA-R. Findings underscore the importance of considering the role of psychophysiology in the unfolding of comorbid externalizing problems in children with ASD. Potential implications for tailoring coregulatory supports are discussed. Autism Res 2019, 12: 1805-1816. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism spectrum disorder (ASD) exhibit elevated rates of challenging behavior. This study identified specific psychophysiological profiles (low sympathetic-low parasympathetic reactivity, and high sympathetic-high parasympathetic reactivity) that may place these children at greater risk for behavior problems. Findings have implications for better understanding behavioral challenges in children with ASD, and for tailoring supports to address underlying psychophysiology.

Parental criticism and behavior problems in children with autism spectrum disorder

Associations between parent critical attitudes (a component of the Expressed Emotion construct) and behavior problems have been relatively well established in adolescents and young adults with autism spectrum disorder, but use of systems adapted for children with autism spectrum disorder and additional investigations with younger samples are needed. This study examined parental criticism, derived from a population-specific coding system, as related to behavior problems in children with autism spectrum disorder between the ages of 4 and 11 years, and considered parental warmth and children's psychophysiological reactivity as statistical moderators of these associations. In all, 40 children with autism spectrum disorder and their primary caregivers attended a visit involving collection of child electrodermal activity, parent-child interaction, a parent interview from which critical attitudes and warmth were coded, and parent report of child behavior problems. Criticism was directly related to higher child externalizing but not internalizing problems. Parental criticism interacted with warmth in the prediction of internalizing problems such that criticism was only associated with more problems in the context of moderate but not high warmth. Criticism was positively associated with externalizing problems under conditions of moderate and high, but not low, child electrodermal activity reactivity. Implications for conceptualizations of parental criticism in autism spectrum disorder, for understanding comorbid behavior problems in this population, and for intervention are discussed.