Mother –Child Dyadic Interaction in Preschoolers with ASD: Emotion Regulation and Cortisol Levels During Positive and Negative Emotion Eliciting Situations

Background:  

Clinical experience and research findings indicate that emotional difficulties are more common among children with Autism Spectrum Disorders (ASD), as compared to typically developing (TD) children. The ability to regulate emotions is a global developmental achievement at the preschool years and difficulties in emotion regulation (ER) at this stage have been associated with less optimal development across childhood and adolescence. Developmental research suggests that children use a variety of emotion regulation strategies (such as diversion, self-soothing) to help regulate negative and positive emotional states, such as fear, anger, or joy, with varying degrees of efficacy. The development of ER strategies depends on physiological control systems (e.g. sensory sensitivity, physiological arousal), but also on practice in the context of parent-child interaction.

Objectives:  

To compare the ER strategies of children with ASD to those of TD children during presentation of positive and negative emotions and during mother-child interaction. The effect of children's stress reactivity, as measured by Cortisol levels, on ER strategies was also explored.

Methods:

The study included 77 parents and preschoolers- 38 pre-school children with ASD and 39 TD controls, matched for gender and mental age. Children were videotaped during mother-child free-play, and two procedures eliciting mild frustration: toy-removal and parental still-face paradigms. Videos were micro-coded for regulatory behaviors and the quality of the interaction was globally coded using the Coding of Interactive Behavior protocol.  Cortisol levels from mother and child were measured at baseline and following the stressors. 

Results:

Children with ASD exhibited less mature ER strategies as compared to TD children in the regulation of both negative and positive emotions. Similarly, cortisol reactivity patterns were less optimal in children with ASD and were correlated with ER patterns. During the still-face paradigm children with ASD used simpler ER strategies, such as protest, withdrawal, or idiosyncratic behavior, and were less efficient in employing more complex strategies, such as distraction, or use of play to manage negative emotions.  There were no differences in ER strategies on the toy-removal paradigm, in which parents were able to be active soothers. During parent-child interaction, although children with ASD showed less social engagement and compliance than TD children, no differences were found in parental sensitivity, intrusiveness, and limit-setting behavior.

Conclusions:

The study is among the first to demonstrate ER difficulties in preschoolers with ASD during the regulation of emotions within a social context. Despite deficient ER in children with ASD, their mothers show similar parenting behaviors to mothers of TD children. The study illustrates the importance of parental support in scaffoldings ER strategies for children with ASD. These findings have important clinical implications for parents of young children with ASD.