Supporting Emotional Regulation in Children with Autism

Emotional Regulation (ER) is a foundational developmental skill that supports adaptive functioning and goal-directed behavior. Mazefsy et al. (2013) defined ER as the automatic or intentional modification of an individual’s emotional state that promotes such adaptive or goal-oriented behavior. For children with Autism, difficulties with ER are common and may result in behavioral responses such as tantrums, aggression or self injury, in response to emotional stimuli. Understanding emotional regulation requires an important distinction between mood, emotion, and emotional regulation. Mood refers to a relatively stable and enduring state, such as depression, wheras emotion reflects an individual’s interpretation of situations and behavioral response, such as sadness. Emotional regulation, in contrast, involves the ability to increase, decrease or maintain emotional states, either positive or negative, based on situational demands. 

Research has identified several factors that influence emotional regulation in children with autism. In a literature review, Cibralic, et al. (2019) found that lower emotional regulation skills are associated with greater ASD symptom severity and reduced executive functioning abilities. Higher receptive language skills may be associated with greater ER abilities. These findings point to an important link between communication, cognition and emotion regulation.

Emotional regulation develops through both intrinsic and extrinsic process, as discussed by Cibralic, et al. (2019).  Infants primarily rely on extrinsic processes, relying on caregivers for co-regulation, while utilizing self-soothing reflexes, such as sucking. In toddlerhood, children begin utilizing more intrinsic strategies for self-regulation, such as self-soothing behaviors, task avoidance and self-distraction as a means to self-regulate.  Throughout childhood, caregivers continue to play an important role in external ER processes, by supporting children with co-regulation of emotions. Children with autism often rely more heavily on co-regulation than their typically developing peers, underscoring the importance of caregiver involvement in ER interventions.

For caregivers supporting children with Autism, here are some keys to effectively engaging in co-regulation:

1. Build rapport: Building rapport is the key to success for any caregiver, but is especially important in co-regulation. Magito McLaughlin and Carr (2005) found that when rapport improved, problem behaviors decreased and task completion increased. In order to build rapport, it is important that caregivers view it as an ongoing process. This process should include daily check ins, and 1:1 time where caregivers are engaged in the child’s preferred activities with them.

2. Communication Development: At times it can be difficult for children, especially children with Autism to express their emotions. Caregivers can support this by explicitly teaching emotions. This can be done during the check ins throughout the day by referencing an emotions chart, picture cards or something similar. When children with Autism are experiencing difficulty in communication, caregivers can prompt language. For example, if a child is feeling overwhelmed by an environment that is loud, a caregiver can notice this and say, “It is getting loud in here, we can go outside where it is more quiet” to help provide the language and potential solution to the situation.     

3. Sensory Sensitivity Awareness: Whether children with Autism are hyper sensitivite to sounds or light or hypo-sensitive to pressure, it is important that caregivers understand what those sensitivities are and stay attuned to the impact the environment and day to day activities may have on the child’s experience of the world in regard to these sensitivities.   

4. Environmental Modifications: In addition to being aware of the interaction between the environment and a child’s sensory sensitivities, caregivers can alter an environment to reduce overwhelm. For example, if a child has a light sensitivity, caregivers can install blinds or curtains in the child’s room to reduce the exposure to light. All children would benefit from a designated calming area where they can go throughout the day. This calming area should encompass simplicity, neutral color, soft textures and include a few preferred calming activities, such as coloring books, books, and puzzles. Caregivers should encourage children to utilize this calming space throughout the day, as well as when escalating or de-escalating. 

5. Identifying and working with individual strengths: There are many emotional regulation tools and skills that caregivers can teach, model and practice with children with Autism. The choice of activities to encourage should take into consideration the child’s strengths and interests. Here are a few examples:

   1. Progressive Muscle Relaxation: systematically squeeze and release muscles

   2. Belly breathing: Place hands on belly and breathe in deeply to belly to see belly rise, and subsequently fall.

   3. Box Breathing: Imagine you are following the outline of a box. Breathe in as you go up the side of the box. Hold breathe in as you move across the box. Breathe out as you down the other side of the box, and hold breathe out as you move across the bottom of the box.

   4. Other calming activities: 

      1. Washing Hands

      2. Going for a walk

      3. Listening to calming music

      4. Drinking a cup of water

6. Modeling emotional regulation: Caregivers can teach emotional regulation skills directly, but indirectly can be just as powerful. When a child is escalating, it is important the the caregiver maintain calmness, a kind voice, slow movements, and positive communication. When caregivers model a behavior, they are not only providing more exposure for the child to learn the tool, they are also engaging in emotional regulation tools themself, which is helpful to them. Caregivers are encouraged to engage in their own emotional regulation practices as part of co-regulation.

References:

Cibralic, S., Kohlhoff, J., Wallace, N., McMahon, C., & Eapen, V. (2019). A systematic review of emotion regulation in children with Autism Spectrum Disorder. Research in Autism Spectrum Disorders, 68, 101422.

Magito McLaughlin, D., & Carr, E. G. (2005). Quality of rapport as a setting event for problem behavior: Assessment and intervention. Journal of Positive Behavior Interventions, 7(2), 68-91.

Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. W. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679-688.

Amanda Ross, Behavior Specialist, Miren Behavior