Emotional Regulation Impairments in individual with Autism Spectrum Disorder

By: Dr. Nidhi Mehta

The word autism ” comes from the Greek  “autos” which means “self”and the term was first used by Bleuler in the year 1911. Autism spectrum disorder (ASD) refers to a wide range of conditions characterized by challenges with social skills, repetitive behaviors, speech and non-verbal communication. Autism spectrum disorder impacts the nervous system and affects the overall cognitive, emotional, social and physical condition of an individual.The incidence statistics for ASD in India is about 11,914 per year and 8 per day.

By the age 2 or 3 years, usually the symptoms appear and among them some of the symptoms may be associated with development delays and might appearat its earliest. Such indicators can be diagnosed as early as 18 months. The impairments associated with ASD are pervasive in nature and includes a significant impact on emotional functioning (Mazefsky& Minshew;2010). Common associated problems include irritability, aggression, self-injury, anxiety, and impulsivity (Lecavalier;2006).These common behavioral problems are often interpreted as deliberate or defiant behavior but actually it might be due to inadequate management of the emotion related to ASD.

James Lange theory of emotion describes emotion as a mind’s perception of physiological conditions that result from some stimulus. On the other hand, the term regulation implies efforts to modify or control the intensity of the emotional reaction. Research suggest that individual with ASD, as compared with normal population have poor and worse emotional responses due to lack of cognitive insight. Available research suggests that individuals with ASD generally lack the emotional insight needed for effective emotion regulation.

Emotion regulation(ER) is a process involved in monitoring, evaluating and modifying one’s own emotional reactions. When we talk about ASD and emotion regulation, ERis a construct that provides an explanatory power for understanding the underlying emotional and behavioral problems found in an individual with ASD. Living with autism has always a chance of amplified emotional responses and poor emotional control.Individuals with ASD are not able to adaptvarious ER strategies. They react impulsively to emotional stimuli with tantrums, aggression or self-injury behaviors.

Characteristics of ASD that Influence ER

• A tendency to react to emotional stimuli intensely without clear goal-directedness.
• Suppression, resignation and avoidance as suggested by  various researchers.
• Impaired ER in ASD includes intense reactions to stress in particular situation.
• Lack of motivation for controlling emotions may lead to poor emotional insight and self-monitoring.
• Problems with cognitive flexibility and difficulties in modulating behavior in people with ASD leads to greater use of maladaptive strategies and less effective implementation of adaptive strategies.
• Lack of sensory sensitivity results in slower processing to environmental cues.
• Resistance to change or adapt new strategies.
• Lower threshold for sensory information in the form of hypersensitivity (intense and easily triggered reactions) whereas hyposensitivity (disruptive and dysregulated behavior).

Risk of ER impairments on individuals with ASD

• Poor ER increases risk for developing a psychiatric disorder and having a psychiatricdisorder impact one’s adaptive regulation.
• A person who lacks emotional self-regulation may overreact to situations when compared to same-age peers.
• Experience of frequent negative emotions for a longer amount of time as compared to normal individual.
• A tendency of short temper and frequent engagement in emotional outbursts.
• Presenting frequent mood swings.
• Co-occurring psychiatric symptoms such as anxiety depression and others may contribute to developing a psychiatric disorder.

Techniques for Emotional Self-Regulation

Researches reveal that ER impairments of individual with ASD can be improved or managed through emotion regulation skill training. Various emotional awareness programs and skills enhancement program has been developed in the past few years to reduce emotion regulation impairment and thereby improve behavioral disturbance. These Emotional awareness and skills enhancement training may be given for 12-18 weeks to an individual. To impart training, it is most important to consider that the individual should be capable of identifying and labeling various common emotions and should initiate and show his/her willingness to participate in these activities. Following are the various methods of teaching emotional self- regulation techniques:

• Using charts for level of emotional reactions such as happy, sad, upset, angry etc.
• To label the levels of emotions like “feeling good,” “a little upset,” “upset” and “very upset.” One should try to express the levels of emotion to certain situations.
• Any professional or family members can facilitate and prompt the individual in several ways. If feasible they can ask to write down different situations that make them feel specific emotional levels. For example – how he/she feel wearing a new dress for social any gathering.
• To teach various coping strategies for controlling negative and positive emotions.
• To identify strategies that a person can use when they are feeling upset or very upset and practice those strategies.
• Enquiring the individual with ASD about what appropriate reactions can be possible to different scenarios.For example –  “if not being able to eat favorite ice-cream, how he/she feel”.
• To use role-play to teach them how to use above mentioned strategies.

It is very important to measure the effectiveness of these intervention time to time. Regular follow-up and monitoring by the professionals can also be proved helpful in managing emotional suppressions in individual with ASD. Along with imparting self-emotion regulation techniques, psychological therapy such as supportive psychotherapy for the purpose of emotional support, behavior therapy to manage the maladaptive behaviors and family therapy to psycho-educate primary caregivers and family members.  Other techniques such as deep breathing and attention control can also result in significant improvement in emotion regulation impairments.

Lastly, it can be said that a holistic treatment approach and early intervention plan can lead to positive outcomes later in life for an individual with ASD.

Dr. Nidhi Mehta

RCI Licensed Clinical Psychologist & Assistant Professor in Clinical Psychology,
Amity University Haryana