Participation in a Social Competence Intervention in a Private Clinical Setting and the Impact of Anxiety and Emotion Dysregulation in ASD

Background: Research has indicated high rates of anxiety symptomatology in ASD (White, Oswald, Ollendick, & Scahill, 2009).  A model proposed by White et al. (2014) indicated that in ASD, anxiety may manifest as a result of a disrupted underlying emotion regulation system. Furthermore, there continues to be a gap between research in such areas in controlled laboratory settings and corresponding clinical applications (Habayeb, Rich, & Alvord, 2014). There is therefore a need to understand the relationship between emotion regulation and anxiety in ASD and to develop targeted, community viable, interventions.

Objectives: To understand the clinical profile of children with ASD receiving services in community settings in regard to anxiety and emotion regulation presentation and to assess the effectiveness of the Resilience Builder Program® (RBP) in alleviating such symptoms.

Methods: 34 children with ASD (mean age, 9.74 years) were treated in a large private practice with the RBP, a manualized group therapy that targets social competence and resilience-based skills. Pre- and post- treatment questionnaires included the Behavior Assessment System for Children, 2^nd Edition (BASC-2; Reynolds and Kamphaus 2006), which measured social, emotional and behavioral functioning, the How I Feel questionnaire (HIF; Walden, Harris, & Catron, 2003), which assessed positive and negative emotionality as well as emotion control, and the Self-Report for Childhood Anxiety Related Emotional Disorders (SCARED; Birmaher et al., 1997) which assessed anxiety.

Results:   Based on BASC-2 measures, 36.3%  (n=12) of the participants displayed at-risk levels of emotional dysregulation while another 18.2% (n=6) presented with clinically significant levels. Additionally, 25.8%(n=8) of the sample presented with at-risk levels of anxiety, while an additional 6.1% (n=2) showed clinically significant levels.  Results from the SCARED indicated that 31.2% and 18.8% of the sample (n=5;n=3) presented with clinically elevated levels of general and social anxiety, respectively. Levels of emotional control as measured by the HIF improved significantly pre- to post-treatment (t(12)= -2.21, p = .047).  Based on a median split, in the high emotional control group, improvements in emotional control predicted a decrease in anxiety across treatment (F(1,5)=17.83, R² = .82, p=0.01). This was not found in the low emotion regulation group (F(1,5)=0.23, R² = .06, p=0.66).

Conclusions: Compounded upon the inherent challenges of ASD, our findings indicate that a number of children with ASD receiving services in a clinical service setting present with additional challenges in regard to emotion dysregulation and anxiety.  Approximately 50% of these ASD youth had at-risk or clinically significant elevations in anxiety and emotional dysregulation symptoms.  Therapy effectiveness data found that children with ASD showed improved emotion regulation following the RBP. In the youth with high levels of emotion regulation at therapy onset (but not in those with low levels of emotion regulation), gains in emotion regulation were related to decreases in anxiety. Our findings begin to support White et al.'s (2014) model and allow us to better understand underlying mechanisms of co-occurring and often heterogeneous challenges experienced by individuals with ASD. Such research also provides insight on the importance of conducting intervention research in real-life clinical service settings.