Preliminary Outcomes of an Emotion Regulation Intervention for Children with Autism Spectrum Disorder

Background: Children with Autism Spectrum Disorder (ASD) often present with associated psychopathology, including problems with emotion regulation (ER), ‘‘the extrinsic and intrinsic processes responsible for monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal features, to accomplish one’s goals’’ (Thompson, 1994, pp. 27–28). Evidence suggests that cognitive behavior therapy (CBT) can address symptoms of anxiety in many children with ASD without intellectual disability, however we know little about how CBT can address broader underlying features of ER, and thereby, impact not only anxiety, but problems managing anger and depression.

Objectives: To investigate the acceptability and preliminary effectiveness of a manualized CBT program (Secret Agent Society: Operation Regulation), for improving ER. This 10-week intervention was developed based on a group-based social skills program (Beaumont & Sofronoff, 2008).

Methods: Participants included 13 males, aged 8 to 12 (M = 10.3, SD = 1.2), who had IQ scores > 80 (M = 108.54, SD = 10.4) and had been diagnosed by regulated health professionals with ASD, confirmed via scores on the Social Communication Questionnaire (SCQ; Berument, Rutter, Lord, Pickles, & Bailey, 2003) and Social Responsiveness Scale, 2^nd Edition (SRS-2; Constantino & Gruber, 2012). Children and parents completed pre and post measures of intervention acceptability and ER via parent report on the Emotion Regulation Checklist (ERC; Shields & Cicchetti, 1997) and child report on the Children’s Emotion Management Scale: Anger, Sadness, Worry (CEM; Zeman, Cassano, Suveg, & Shipman, 2010); parent reports of child psychopathology and adaptive behavior via the Behavior Assessment System for Children, 2^nd Edition (BASC-2; Reynolds & Kamphaus, 2006) and the Anxiety Disorders Interview Schedule (ADIS-P-IV; Silverman & Albano, 1996). A blind clinician rater assessed treatment response using the Clinical Global Impressions scale (CGI; Guy, 1976), severity (CGI-S) and improvement (CGI-I).

Results: Children and their parents completed all sessions (100%) and reported high satisfaction with the weekly session activities and the program overall. Therapist ratings of session activities and therapeutic alliance with children and parents were also high. Overall treatment integrity was 89.6% across 26 sessions (SD = 9.94, range = 65.4 – 100%). Parents reported significant improvements in children’s emotional lability (t = 3.13, p = .005), a reduction in total psychiatric diagnoses (t =2.80, p = .016) and diagnosis severity (t = 3.39, p = .005) on the ADIS-P-IV, and in internalizing difficulties on the BASC-2 (t = 3.18, p  = .008). Blind clinician ratings on the CGI-I indicated that 69% (n = 9) children showed some level of improvement and a significant decrease in mean severity on the CGI-S (t = 3.95, p = .002). Children reported an overall decrease in dysregulation on the CEM (t = 2.14, p = .056) and increase in the ability to inhibit emotional responding (t = -2.32, p = .04.). Data collection is ongoing.   

Conclusions: Preliminary outcomes demonstrate acceptability of the intervention and potential effectiveness in improving ER and decreasing psychopathology in children with ASD, an important area of further investigation due to the lack of evaluations of ER interventions for youth with ASD.