Emotion Regulation Patterns in Adolescents with High-Functioning Autism Spectrum Disorder: Comparison to Typically-Developing Adolescents and Association with Psychiatric Symptoms

Background: Autism spectrum disorder (ASD) is often associated with poor emotional control and psychopathology, such as anxiety and depression. However, little is known about the underlying mechanisms. Emotion regulation (ER) is a potential contributing factor, but there has been limited research on ER and its role in comorbid psychopathology in ASD. We know especially little about the rate at which individuals with ASD engage in involuntary ER responses as the few existing studies have focused on effortful control strategies (e.g. cognitive re-appraisal). 

Objectives: This study aimed to: 1) Explore patterns of both voluntary and involuntary forms of ER in adolescents with high-functioning ASD; 2) Investigate how ER corresponds to manifestations of psychopathology.

Methods: Participants included 25 high-functioning adolescents with ASD and 23 age- and IQ-matched typically-developing (TD) controls. Participants completed the Response to Stress Questionnaire, Social Stress Version (RSQs) as a measure of voluntary and involuntary ER processes. Parent- and self-reports of psychopathology were obtained, including broad measures of internalizing and externalizing problems and specific assessments of anxiety and depression.

Results: Contrary to expectations, both groups reported similar levels of adaptive, effortful control forms of ER (re-appraisal, problem-solving, acceptance, etc.). However, the ASD group reported significantly greater use of involuntary forms of ER that are typically maladaptive, including involuntary engagement (rumination, intrusive thoughts, emotional arousal, and involuntary action) and involuntary disengagement (emotional numbing, cognitive interference, inaction, and escape). Associations between ER and psychopathology were generally more robust using self- rather than parent-report. For both groups, greater endorsement of involuntary ER strategies was associated with higher ratings of psychopathology, whereas the use of effortful control approaches was significantly associated with lower levels of psychopathology. The magnitude and direction of association between ER types and psychopathology were similar for measures of depression and anxiety.

Conclusions: This was the first study to examine ER in adolescents with ASD. Our finding that the ASD and TD groups did not differ in their use of effortful ER (primary and secondary control) differs from prior studies with children [Rieffe et al., 2011] and adults [Samson et al., 2012]. Longitudinal follow-up studies are warranted to clarify whether adolescence is an ideal window for ER-related prevention and treatment efforts in ASD. The ASD group did report significantly higher rates of involuntary ER approaches that are usually considered maladaptive. This finding lends some support to the previously untested contention that ER in ASD may be characterized by more internally-driven responses that are less organized and goal-directed than in non-ASD populations [Mazefsky et al., 2013]. Further, greater use of involuntary forms of ER was related to higher levels on broad measures of internalizing and externalizing behaviors as well as specific assessments of anxiety and depressive symptoms.  These findings can help guide the development of psychosocial treatments targeting dysfunctional ER in adolescents with ASD. Given that patterns of association were fairly similar for both anxiety and depression, a transdiagnostic approach targeting ER skills, rather than discrete disorders, may prove useful across the different manifestations of emotional distress in ASD.