Angela Scarpa

The Role of Emotion Regulation in Autism Spectrum Disorder

OBJECTIVE Autism spectrum disorder (ASD) is associated with amplified emotional responses and poor emotional control, but little is known about the underlying mechanisms. This article provides a conceptual and methodologic framework for understanding compromised emotion regulation (ER) in ASD. METHOD After defining ER and related constructs, methods to study ER were reviewed with special consideration on how to apply these approaches to ASD. Against the backdrop of cognitive characteristics in ASD and existing ER theories, available research was examined to identify likely contributors to emotional dysregulation in ASD. RESULTS Little is currently known about ER in youth with ASD. Some mechanisms that contribute to poor ER in ASD may be shared with other clinical populations (e.g., physiologic arousal, degree of negative and positive affect, alterations in the amygdala and prefrontal cortex), whereas other mechanisms may be more unique to ASD (e.g., differences in information processing/perception, cognitive factors [e.g., rigidity], less goal-directed behavior and more disorganized emotion in ASD). CONCLUSIONS Although assignment of concomitant psychiatric diagnoses is warranted in some cases, poor ER may be inherent in ASD and may provide a more parsimonious conceptualization for the many associated socioemotional and behavioral problems in this population. Further study of ER in youth with ASD may identify meaningful subgroups of patients and lead to more effective individualized treatments.

Community Violence Exposure in a Young Adult Sample Lifetime Prevalence and Socioemotional Effects

This study extends findings of the prevalence and consequences of community violence exposure in at-risk youth to a young adult and low-risk population. A total of 476 male and female university students (mean age = 20.26 years) completed a survey of lifetime exposure to community violence. Based on high and low reports of exposure as a witness or victim, 54 (mean age = 20.5) returned to complete questionnaires on depression, anxiety, and aggression. Of the full sample, 95.6% of respondents reported witnessing and 82% reported being victimized by some form of violence; 81.6% and 44.8% reported experiencing at least three different forms of violence as a witness or victim, respectively. Of the returning subsample, high- versus low-exposure groups reported significantly greater aggression and depression. These findings underscore the persistence of violence-related problems into young adulthood and the unfortunate prevalence of violence even among populations traditionally thought of as low risk.

Community Violence Victimization and Symptoms of Posttraumatic Stress Disorder The Moderating Effects of Coping and Social Support

This study tested the relationship of community violence (CV) victimization to severity of posttraumatic stress disorder (PTSD), and the roles of coping style and perceived social support in moderating that relationship. Three-hundred seventy-two men and women (age 18 to 22 years) self-reported on CV exposure, traumatic experiences, PTSD symptoms, perceived support from family and friends, and coping strategies. Results indicated that high CV victimization, high disengagement coping (i.e., avoidant styles), and low perceived social support from family and friends significantly predicted increased PTSD scores. Significant moderating effects indicated that the relationship between victimization and heightened PTSD severity was stronger at high levels of perceived friend support and disengagement. Thus, the protective function of friend support seemed to break down at increasing levels of victimization, whereas, as expected, avoidant styles of coping increased the risk for negative outcome. Findings are discussed in terms of event controllability, negative social reactions, and coping resources.

The importance of physician knowledge of autism spectrum disorder: results of a parent survey

BackgroundEarly diagnosis and referral to treatment prior to age 3–5 years improves the prognosis of children with Autism Spectrum Disorder (ASD). However, ASD is often not diagnosed until age 3–4 years, and medical providers may lack training to offer caregivers evidence-based treatment recommendations. This study tested hypotheses that 1) children with ASD would be diagnosed between ages 3–4 years (replicating prior work), 2) caregivers would receive little information beyond the diagnosis from their medical providers, and 3) caregivers would turn to other sources, outside of their local health care professionals, to learn more about ASD.Methods146 ASD caregivers responded to an online survey that consisted of questions about demographics, the diagnostic process, sources of information/support, and the need and availability of local services for ASDs. Hypotheses were tested using descriptives, regression analyses, analyses of variance, and chi-squared.ResultsThe average age of diagnosis was 4 years, 10 months and the mode was 3 years. While approximately 40% of professionals gave additional information about ASD after diagnosis and 15–34% gave advice on medical/educational programs, only 6% referred to an autism specialist and 18% gave no further information. The diagnosis of Autism was made at earlier ages than Aspergers Disorder or PDD-NOS. Developmental pediatricians (relative to psychiatrists/primary care physicians, neurologists, and psychologists) were associated with the lowest age of diagnosis and were most likely to distribute additional information. Caregivers most often reported turning to the media (i.e., internet, books, videos), conferences, and other parents to learn more about ASD.ConclusionThe average age of ASD diagnosis (4 years, 10 months) was later than optimal if children are to receive the most benefit from early intervention. Most professionals gave caregivers further information about ASDs, especially developmental pediatricians, but a sizeable minority did not. This may reflect a lack of training in the wide range of behaviors that occur across the autism spectrum. Parents turned to outside sources to learn more about ASD. We recommend that all physicians receive specialized training about ASDs to improve upon early screening and diagnosis, and then advise caregivers about empirically-supported services.

Being hot-tempered: Autonomic, emotional, and behavioral distinctions between childhood reactive and proactive aggression

Reactive aggression (RA) is an angry response to perceived provocation. Proactive aggression (PA) is a pre-meditated act used to achieve some goal. This study test hypotheses that (1) individuals high in RA and PA will differ in resting levels of autonomic arousal and (2) RA will be related to emotional and behavioral problems, while PA only to behavioral problems. Parents of 68 children (age 6-13) reported on child symptoms, reactive/proactive aggression, and behavior problems. Resting heart rate (HR), skin conductance (SC), and HR variability (HRV) were measured in 42 of the children. RA was significantly related to decreased HRV and a trend for decreased SC, while PA was significantly related to increased SC and HRV. RA was significantly related to increased internalizing behaviors and attention deficits, while PA was significantly related to increased hyperactivity/impulsivity and delinquent behavior problems. Findings support a distinction between child reactive (hot-tempered) and proactive (cold-tempered) aggression in autonomic, emotional (i.e., internalizing problems), and behavioral (i.e., attention deficits, hyperactivity/impulsivity, and delinquent behavior) functioning, and are discussed in relation to theories of antisocial behavior.

The Effects of Child Maltreatment on the Hypothalamic-Pituitary-Adrenal Axis

Abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis, a critical mammalian stress response system, has been associated with emotional responses such as anxiety and depression, as well as with behavioral and cognitive processes such as aggression, learning and memory deficits, and failure of response inhibition. This review examines the evidence for HPA axis dysregulation related to childhood maltreatment. It is concluded that child maltreatment may lead to disruptions in HPA axis functioning, and that factors such as age of maltreatment, parental responsiveness, subsequent exposure to stressors, type of maltreatment, and type of psychopathology or behavioral disturbance displayed may influence the degree and patterning of HPA disturbance.

Respiratory sinus arrhythmia: a marker for positive social functioning and receptive language skills in children with autism spectrum disorders.

The current study builds on the emerging autism spectrum disorder (ASD) literature that associates autonomic nervous system activity with social function, and examines the link between respiratory sinus arrhythmia (RSA) and both social behavior and cognitive function. The RSA response pattern was assessed in 23 4- to 7-year-old children diagnosed with an ASD. Higher baseline RSA amplitudes were associated with better social behavior (i.e., more conventional gestures, more instances of joint attention) and receptive language abilities. Similar to reports of typically developing children, ASD children with higher RSA amplitude at baseline showed greater RSA and HP reactivity during an attention-demanding task. These results highlight the importance of studying RSA as a marker of positive function in children with ASD.

Community Violence Exposure in University Students A Replication and Extension

This study validates a survey for community violence exposure, provides details of exposure in young adults, and determines psychological effects. 518 university students completed the Survey of Exposure to Community Violence (SECV) and questionnaires regarding trauma and socioemotional outcomes. Participants were divided into high, moderate, or low witnessing and victimization groups. Results showed SECV validity, with violent trauma more frequently reported in moderate/high victimization groups. 93.2% of respondents reported witnessing and 76.4% being victimized by violence. The most frequent events involved being hit, threatened, or seeing a gun/knife used as a weapon. The most frequent perpetrators were non-family members, except for domestic violence. The most frequent location was near home, although school was noted for peer victimization. High-exposure groups reported greater depression, aggression, interpersonal problems, and post-traumatic stress disorder symptoms. This replicates and extends previous findings on the prevalence of violence exposure and its negative effects in todays young adults.

Heart rate and skin conductance in behaviorally inhibited Mauritian children.

This study tested predictions that inhibited versus uninhibited children exhibit higher heart rate (HR) and skin conductance (SC) arousal. Mauritian children (N = 1,795) were tested at age 3 and classified as inhibited, middle, or uninhibited on the basis of social behavior. HR level and several SC measures were obtained immediately before or during a tone task. Inhibited children displayed significantly higher HR and SC levels and longer SC latency relative to uninhibited children. Results remained regardless of ethnicity, gender, height, weight, respiratory complaints, or crying behavior. Findings suggest that HR and SC levels may be early indicators of inhibited or uninhibited behavior at age 3 and support the notion of heightened sympathetic reactivity due to limbic arousal in inhibited children.

Improving Emotion Regulation with CBT in Young Children with High Functioning Autism Spectrum Disorders: A Pilot Study

BACKGROUND AND AIMS This pilot study tested the efficacy of a developmentally modified CBT for young children with Autism Spectrum Disorders (ASD) to teach emotion regulation strategies for reducing anger and anxiety, commonly noted problems in this population. METHOD Eleven 5-7 year-old children participated in a CBT-group while parents participated in psychoeducation. Children were randomly assigned to an experimental or delayed-treatment control group. RESULTS From pre- to post-treatment, all children had less parent reported negativity/lability, better parent reported emotion regulation, and shorter outbursts, and also generated more coping strategies in response to vignettes. Parents also reported increases in their own confidence and their childs ability to deal with anger and anxiety. CONCLUSIONS This study suggests that young children with high functioning ASD may benefit from CBT to improve regulation of anger and anxiety, and parent training may improve parental self-efficacy. Future studies are needed to make conclusions about its efficacy.