A systematic review of emotion regulation in parent-mediated interventions for autism spectrum disorder

Abstract

Autistic individuals are at elevated risk for difficulties with emotion regulation (ER) that emerge early in life and are associated with a range of internalizing and externalizing disorders. Existing interventions that support ER have focused on school-age autistic children and adolescents as well as adults. Proactive approaches to improving ER in early childhood are thus needed, as is understanding the approaches by which ER skills can be feasibly supported in this young population. This review summarizes how ER has been measured within parent-mediated interventions for children at or under the age of 6 years and the extent to which ER is measured concurrently with or distinctly from observable behaviors that have been referenced in existing literature as externalizing or challenging behavior. Using PsycInfo, EBSCOhost, and PubMed databases, we searched for peer-reviewed journal articles published through August 2021, that focused on the use of parent-mediated interventions targeting ER and/or challenging behavior. The systematic search resulted in 4,738 publications; following multi-stage screening, the search yielded 20 studies. Eighteen of 20 studies were designed to target challenging behavior using manualized curricula or behavior analytic methodologies and assessed child outcomes through validated caregiver rating scales and/or direct behavioral observation. One study measured changes in ER as secondary to the social communication skills that were targeted in the intervention. Only one study specifically supported ER skill development and measured changes in ER as the primary intervention outcome. Findings highlight the need for better assessment of ER outcomes within the context of parent-mediated interventions for toddlers and young autistic children.

Addressing disruptive behaviors within naturalistic developmental behavioral interventions: Clinical decision-making, intervention outcomes, and implications for practice

“…However, many clinicians shared that the connections between core social communication strategies and emotion regulation are not explicitly discussed within intervention materials. The finding that regulation is implied in Project ImPACT, but not explicitly stated, is consistent with a recent review indicating that almost no studies of caregiver-mediated interventions for young children with autism, including NDBIs, have measured emotion regulation as an outcome (Hendrix et al, 2022). Results suggest that these connections could be made more explicit and also measured within NDBI research.…”

“…Despite the prevalence of disruptive behaviors among autistic children, most caregiver-mediated NDBIs do not include manualized approaches or guidelines to manage disruptive behavior (Bruinsma et al, 2020;Schreibman et al, 2015), and only a small number of studies have examined changes in disruptive behaviors or emotion regulation following participation in a caregiver-mediated NDBI (Hendrix et al, 2022). For example, Gulsrud et al (2010) demonstrated significant reductions in child negative affect and increases in maternal emotional scaffolding throughout the course of a caregiver-mediated NDBI.…”

What Therapy for My Child? Features, Strengths, and Gaps to Fill for the Implementation of Early Autism Interventions

“…In parent-mediated interventions, parents are taught a combination of techniques to promote the child's social engagement, language, imitation, and play skills. Parents are also trained to become more responsive to the children's communication style and needs, with an effect also in emotional regulation [52].…”

Evaluation of a Two-Tiered Coaching Programme for Parents of Young Autistic Children

“…However, quantitative measures for these outcomes that are based on non-Autistic populations may not adequately capture unique Autistic perspectives and experiences (Pellicano & den Houting, 2022). Therefore, as well as a need for the development and subsequent use of outcome measures that can objectively measure these constructs with Autistic populations (Hendrix et al, 2022;Trembath et al, 2022), understanding participant perspectives may provide an important insight into the subjective outcomes of Autism support programmes (Jurek et al, 2022;Wainer et al, 2017). In this research therefore, it was a strength that parents reflected on the perceived benefits of the programme on their child's and family's outcomes.…”

“…A few parents also described how their child improved their emotional regulation skills, tolerance for transitions, "rigidity" (i.e., insistence on sameness), and/or reduced their self-injurious behaviours. Challenges with emotional regulation often appear early for Autistic children and are linked to social and behavioural functioning and the development of internalising and externalising disorders during late childhood, adolescence, and adulthood (Hendrix et al, 2022). It is also possible that internal factors such as heightened anxiety can result in externalised behaviours such as insistence on sameness or challenges with transitions, as well as expressions of distress such as aggression and selfinjurious behaviours (Gotham et al, 2013).…”