Emotional Regulation In Autism: A Relational, Therapeutic Perspective

Background : For typically developing infants, interpersonal contact with caregivers entails mutual regulation of affect and with this, expanding and deepening intersubjectivity (Tronick et al. 1988). Autism involves early-occurring limitations in the capacity to engage in affective contact with others (Kanner, 1943; Hobson, 1993; Mundy, 1986). Such limitations may lead to disturbances in mutual emotion-regulation between the children and their caregivers. Gulsrud, Jahroni and Kasari (2010) illustrated how toddlers with autism showed high levels of distress and negativity. The greater these emotional difficulties, the more stress reported by their parents, and the more difficult parents found it to manage their children’s distress.

Objectives : Our aims were to assess how far, for parent-child dyads involving children with autism: (a) individual differences in quality of parent-child interaction corresponds with the children’s social-communication impairment as measured by the ADOS (also Beurkens, 2010); (b) quality of parent-child interaction might change over the course of an intervention intended to foster such interaction; and (c) any observed changes in parent-child interaction are accompanied by changes in the children’s social-communication.

Methods : Participants were 18 children with autism (16 boys, 2 girls), ranging in age from three to 12 years. With their parents, the children took part in Relationship Development Intervention (RDI). At baseline and again approximately 18-months later, children and their caregivers participated in a semi-structured assessment of parent-child interaction. This assessment was videotaped, and later coded for qualities of relatedness by blind, independent judges using the Dyadic Coding Scales (DCS: Humber & Moss, 2005). The subscales included: Coordination, Communication, Partner Roles, Emotional Expression, Responsiveness/Sensitivity, Tension/Relaxation, Mood, Enjoyment, and an Overall Score (ICC = .86). Videotapes of the ADOS administered at baseline and outcome are currently being coded.

Results : At baseline, the sample of children with autism participating in RDI received scores on the DCS which were significantly lower than the typically developing sample of Humber & Moss (2005) and very similar to the autism sample of Beurkens (2010).  Parent-child interaction differences on the DCS were significantly associated with individual variability in severity of social-communication impairment. At outcome, dyads participating in RDI showed significant change on the DCS, t(17) = 2.82, p < .05, with outcome scores similar to those received by typically developing children. We will report whether changes in parent-child interaction corresponded with changes in the children’s social-communication scores on the ADOS.

Conclusions : In autism, difficulties with interpersonal engagement may disrupt the caregiver-child emotion regulation system. Relationship Development Intervention attempts to foster dyadic regulation.  The present study reports objectively evaluated improvements in parent-child interaction within families receiving RDI, and now comparison with control groups is indicated.  The relation between changes in dyadic interaction and changes in children’s social-communication will be reported.  Treatment approaches which focus on interaction between children with autism and their caregivers have the potential to affect the children’s emotion regulation abilities which, in turn, are likely to influence other areas of emotional, cognitive, and social development.