Impact of Challenging Behavior, Inhibition, and Emotion Regulation Skills on Developmental Outcomes in Preschoolers with Autism

Background: Three quarters of school-aged children with ASD present with emotional dysregulation and almost two thirds present with challenging behaviors. Decades of research has shown strong associations between emotional dysregulation and challenging behaviors; these behaviors affect academic outcomes in typically developing children and predict teacher burnout. Their effect in academic outcomes in preschoolers with ASD is not yet known.

Objectives:  To examine the impact of challenging behaviors (i.e. aggression, bullying) and emotional regulation skills on developmental outcomes in children with ASD

Methods:  A total of 44 preschoolers (3-5 years) with ASD receiving community based intervention services participated in the study, data on the first 20 are presented here (data collection is ongoing). Children were given a standardized developmental assessment (the Mullen Scales of Early Learning; Mullen) at baseline and then 9 months later. Teachers completed questionnaires assessing challenging behaviors (the Social Skills Improvement System: Problem Behaviors Scale) and emotional regulation (the Behavior Rating Inventory of Executive Function: Emotional Control scale), and children completed a novel task of ”hot” (socio-affective) executive function skills, the Tongue Task. This task measured the time in seconds for which children resisted eating a candy, thus tapping inhibition skills with a rewarding stimulus that should invoke impulsive behavior, which may be relevant for emotion regulation capacity. Multiple linear regression analyses controlling for age and sex were conducted to examine the impact of emotion regulation and hot inhibition on Mullen developmental quotient (DQ) change scores over 9 months.

Results:  In an adjusted analysis, only teacher-rated emotion regulation was statistically significantly associated with Mullen DQ change scores, b = .38, t(17) = 2.34, p= .03, with more difficulties in emotion regulation at baseline associated with greater cognitive and language gains. Hot Inhibition skills were marginally associated with developmental gains, b = .44, t(17) = 1.91, p= .07, such that stronger hot inhibition skills were also associated with greater gains in DQ. Teacher-rated emotion regulation was unrelated to hot inhibition skills (r(23) = .10, p= .64). Teacher-rated challenging behaviors did not predict developmental outcomes (ps > .28).

Conclusions: Results suggest that emotion regulation and hot inhibition skills have parseable moderation effects on cognitive outcomes in preschoolers with autism, with an unexpected negative relationship between emotion regulation and developmental outcomes. As expected, higher hot inhibition skills were related to greater developmental gains which fits with current knowledge on these as prerequisite skills for learning. This pattern of findings is indicative of a potential bootstrapping effect that hot inhibition skills may have on emotion regulation difficulties, to be tested in future research designs. Contrary to research in typical development, in this study challenging behavior did not impact outcomes. Results will be updated to include the final sample.