What are the odds? Predicting the likelihood of a negative episode in a sample of toddlers with autism spectrum disorder

Abstract

Children with autism spectrum disorder exhibit challenges in regulating negativity and modifying emotional responses, a process known as emotion regulation. Such challenges affect social outcomes and response to intervention in children with autism spectrum disorder. Caregivers of children with autism spectrum disorder facilitate children’s emotion regulation through a process known as co-regulation, but there have been no attempts to describe how dyadic use of strategies interact to impact the likelihood of negativity in real time. This study used video observations of 71 toddlers (mean age = 31.2\u2009months) with autism spectrum disorder and their caregivers engaged in a frustrating, goal-oriented task. A mixed-effects logistic regression revealed that caregivers’ use of co-regulation strategies was not a significant predictor of changes in the likelihood children’s expressed negativity. Caregiver unresponsiveness and proactiveness, however, predicted increased likelihood of children’s subsequent negativity. Children’s use of high energy, non-instrumental behaviors (tension release), was also a robust predictor of increased likelihood of subsequent negativity. These findings shed a light on the effectiveness of child and caregiver strategies in facilitating emotion regulation in toddlers with autism spectrum disorder. Lay abstract Children with autism spectrum disorder sometimes have challenges with regulating their negative emotions. These difficulties can impact children’s social outcomes and how well they respond to intervention. We know that caregivers of children with autism spectrum disorder can help their children regulate negative emotions in a process known as co-regulation, but not much is known about how child and caregiver strategy use impacts children’s negativity in real time. In this study, 71 caregivers of toddlers with autism spectrum disorder were asked to encourage their child to unlock a locked toy box, a task which is designed to elicit frustration. Video observations of the participants completing the task were used to examine whether specific child and caregiver behaviors increased or decreased the likelihood that the child will become upset. No child strategies were predictive of a decreased likelihood of a child becoming upset, but when children used high-energy behaviors that did not serve a purpose, such as running back and forth, they were more likely to then show signs of being upset a few seconds later. The way that caregivers responded to their child was a potent caregiver predictor of the likelihood of children’s negativity, with caregivers’ unresponsiveness and proactiveness both emerging as salient predictor of increased likelihood of the child being upset a few moments later. These findings give insight into how children with autism spectrum disorder and their caregiver navigate challenging and frustrating tasks, and have the potential to influence clinical practice by giving an indication off which parent and child behaviors are most effective in reducing children’s negativity while interacting with parents and caregivers.