Emotional Regulation Across the Autism Spectrum: Why it Matters and How to Help

Featuring Carla Mazefsky, Ph.D. - 11/05/20

Individuals with autism spectrum disorder (ASD) frequently struggle with emotion regulation, in which their emotions are stronger than their regulatory capacity and they cannot adequately modify the intensity or duration of their emotional responses (Mazefsky, et al., 2013). Moreover, rates of reactivity and dysphoria on the Emotional Dysregulation Inventory (EDI) are much higher in inpatient and community ASD populations than in the general US population. Research on emotional regulation in autism has been increasing in recent years, and the EDI is a tool that can be used for universal screening, progress monitoring, and research. In addition, treatments are being developed to help individuals with ASD learn skills to improve their emotion regulation and reduce anxiety and depression symptoms

What We Learned

  • Common triggers for dysregulated emotion include hunger, thirst, pain, fatigue, medication side effects, and menses. Clinicians should also pay attention to early signs of distress, including whining, rocking, tense body, pacing, not answering, and increased escape/avoidance behaviors.
  • The Emotional Awareness and Skills Enhancement (EASE) Program, developed at the University of Pittsburgh, focuses on the awareness of emotion, mindfulness, distress tolerance, and emotion regulation strategies that leads to decreased psychiatric symptoms, problem behaviors, and functional impairment across settings.
  • Mindfulness can be used to increase one’s awareness of emotions, sensations, and thoughts to promote the ability to slow down before actions and decrease tendencies to escape or suppress (Kabat-Zinn, et al., 1985). Mindfulness can be adapted for individuals with autism; clinicians should be aware of common client challenges, such as brief attention span, limited internal awareness, and impatience/avoidance, as well as clinician pitfalls, such as inflexibility, over-processing, and excessive labeling.

Play in Young Children with Autism Spectrum Disorder

Featuring Stephanny Freeman, Ph.D., and Kristen Hayashida, M.Ed., BCBA - 10/08/20

Play is an important, developmentally appropriate context in which children develop cognitive, language, social, and emotional skills. However, children with autism spectrum disorder often demonstrate challenges engaging in functional and symbolic play. Instead, they may engage in repetitive, non-functional, and disorganized play. Further, their pretend play skills are often delayed. Due to the many benefits of play, it is important that play skills be an area of focus in a child’s early intervention program.

What We Learned

  • Play skills can be assessed and taught! Toy play can be broken down into functional play, which includes simple, combination, and pre-symbolic levels, and symbolic play. It is also important to measure the frequency and diversity of a child’s play acts. After a child’s play level is evaluated, clinicians should provide instruction for the next developmental step in the zone of proximal development.
  • When teaching play, clinicians should be sure to set up developmentally appropriate toys, arrange toys on shelves within reach, remove distractions, and ensure the appropriate amount of stimulation. They should also follow the child’s lead, respond to child’s focus of attention, allow opportunities for mastered play, imitate and expand on play acts, violate routines in a playful manner, and use language.
  • There are many different instructional styles to teach play, such as developmental, behavioral, and naturalistic developmental behavioral interventions (NDBIs). There are also resources available online and as applications to teach play.

Integrating Developmental and Behavioral Perspectives Outside of the Lab: Successes and Pitfalls Related to Community-Based Intervention, Parent Training, and Provider Collaboration

Featuring Amy Fuller, Ph.D. - 03/05/2020

While the literature suggests early intervention is important for children with autism spectrum disorder (ASD; Mundy & Crowson, 1997), there is still little known about what treatment approaches work best for which children. While some treatment approaches under the umbrella of Applied Behavior Analysis (ABA) have evidence of being effective for improving skills in children with ASD (e.g., I.Q., adaptive functioning skills, joint attention skills, play skills, communication, social behavior), many approaches that are commonly used in the community are not evidence-based. Due to the wide variety of available interventions, it is challenging for providers and families to know what treatments to use with their children. In addition, it is important to consider the individual child, the context, treatment targets, delivery, and intensity when deciding what treatment modality to use. Even with an extensive and diverse array of available interventions, it is not always clear what course of treatment is the best fit for each individual with ASD.

What We Learned

  • Some early intervention approaches within Applied Behavior Analysis include Discrete Trial Training (DTT), Pivotal Response Treatment (PRT), Joint Attention, Symbolic Play, Engagement, and Regulation (JASPER), Natural Environment Training (NET), and Early Start Denver Model (ESDM).
  • Characteristics of Discrete Trial Training (DTT) include frequent learning opportunities, clear expectations for the child, and increased exposure to adult-directed activities. Characteristics of Naturalistic Developmental Behavioral Interventions (NDBIs, e.g., PRT, JASPER, NET, ESDM) include implementation in natural settings (e.g., within the context of play routines, home routines), child-initiated teaching episodes, natural contingencies, and shared-control between child and adult.
  • A blend of structured and naturalistic ABA strategies may best fit the needs of young children with ASD. Particular approaches may be more effective depending on the treatment target.

Sleep and Autism: Practical Behavioral Approaches

Featuring Beth Malow, M.D. - 02/06/2020

Sleep challenges are common in individuals with autism spectrum disorder (ASD) and are often associated with increased physical aggression, irritability, inattention, and hyperactivity during the day (Mazzone, et al., 2018; Veatch et al., 2017). Among individuals with ASD, common sleep concerns include difficulties falling asleep, experiencing restless sleep, frequent nighttime awakenings, unwillingness to fall asleep in own bed, and difficulty arousing in the morning (Williams et al,. 2004). It is important for providers to consider a person’s sleep in overall treatment planning as it can significantly contribute to a person’s behavior during the day and overall family functioning. Interventions that incorporate behavioral strategies are often effective in improving a person’s sleep and benefit the overall well-being of the person with ASD and their family.

What We Learned

  • It is important for individuals and families to receive support and guidance around sleep hygiene. Daytime habits (e.g., exercise, abundant light, limited caffeine), evening habits (limited stimulating activities, less light), bedtime routine, and sleep environment (e.g., temperature, texture, sound, light, electronics) all influence a person’s sleep.
  • Often simple behavioral strategies (e.g., using rewards such as stickers, a prize basket, a bedtime pass that can be exchanged for a prize) can provide additional motivation for a child to overcome sleep challenges (e.g., sleep resistance, nighttime awakenings). Using rewards can be effective for changing behavior in the short term and can be faded as a child reaches their goals and no longer needs them.
  • There are several resources related to sleep and ASD available online, including the ATN/AIR-P Strategies to Improve Sleep in Children with Autism Toolkit, the ATN/AIR-P Sleep Strategies for Teens with Autism Toolkit, and the ATN/AIR-P Melatonin and Sleep Problems: A Guide for Parents Toolkit, which are all available on the Autism Speaks website.