Preliminary Results of an Emotion Regulation RCT for Children with Autism Spectrum Disorder
Children with ASD frequently experience associated psychopathology, with approximately 70% meeting requirements for a psychiatric disorder (Leyfer et al., 2006). The heightened prevalence of these emotional problems may be linked to emotion regulation (ER) difficulties (Mazefsky et al., 2013). Cognitive behavior therapy (CBT) targeting ER has been found to be effective in children without ASD (Ehrenreich-May et al., 2013), but there is limited evidence of its efficacy for children with ASD.
To evaluate the efficacy of the Secret Agent Society: Operation Regulation (SAS:OR, Beaumont, 2013), a multi-component CBT program targeting ER difficulties in children with ASD.
Thirty-three children with a confirmed ASD diagnosis (93.9% male) and their parents (78.8% female) participated in the program. Children were 8 to 12 years of age (M = 9.50, SD = 1.13) with at least average IQ (M = 103.19, SD = 14.18, Range: 79-140). Parents, children, and clinicians completed measures of child ER (Emotion Regulation Checklist, Shields & Cicchetti, 1997; Emotion Regulation and Social Skills Questionnaire, ERSSQ-P; Beaumont & Sofronoff, 2008;Children’s Emotion Management Scale, Zeman et al., 2010) and psychopathology (Behavior Assessment System for Children, 2nd Edition, BASC-2, Reynolds & Kamphaus, 2004; Anxiety Disorders Interview Schedule: Parent Interview; Silverman & Albano, 1996; Clinical Global Impressions Scale, Guy 1976) at pre-intervention (baseline), and post-intervention. Following baseline assessment, children were randomly assigned to either a treatment immediately (TI; n = 16) or waitlist control condition (WLC; n = 17). Groups were not significantly different on child age, gender, IQ, or ASD symptom severity at baseline (p > .10).
Using analysis of covariance to control for pre-intervention levels, parents of children in the TI condition reported significantly lower child negative affect compared to children in the WLC condition post-intervention (p = .006). After controlling for baseline levels, additional group main effects were found post-intervention in parent-reported child internalizing symptoms on the BASC-2 (p = .04) and socially-mediated emotion regulation on the ERSSQ-P (p = .001). Children in the TI condition self-reported greater overall emotion inhibition than children in the WLC condition at post-intervention (p = .02). An independent clinician blind to group allocation rated children on an overall improvement in clinical severity, and rated children in the TI condition to have significantly more improvement than those in the WLC condition (p = .003). Post intervention group main effects were also observed with regard to the number of psychiatric diagnoses (p = .014) and severity of clinical impairment (p = .028).
Preliminary results of this RCT support the efficacy of SAS:OR in improving child psychopathology and ER outcomes according to parent, child, and clinician reports.