Abstract
Individuals with Autism Spectrum Disorder (ASD) and/or intellectual and developmental disabilities (DD) often struggle with behavior management and emotion-regulation (ER). In this manuscript, we describe the results of a chart review examining a group treatment program designed to address ER deficits in youth with ASD and/or DD. The intensive 5 week program utilizes cognitive behavior, applied behavior analysis, and mindfulness techniques and includes biweekly child and parent groups. Results indicate that this program is feasible and associated with high caregiver satisfaction. Pre-and-post outcome results indicate statistically significant improvement on behavioral measures, but did not demonstrate significant improvment on the Pediatric Quality of Life Family Impact Module. Based on overall positive outcomes, a randomized controlled trial of the program is indicated.
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References
Achenbach, T. M., & Rescorla, L. (2001). ASEBA school-age forms & profiles. Burlington: ASEBA.
Aldao, A., & Nolen-Hoeksema, S. (2013). One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. Cognition & Emotion, 27(4), 753–760. https://doi.org/10.1080/02699931.2012.739998.
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237. https://doi.org/10.1016/j.cpr.2009.11.004.
Ali, A., Hall, I., Blickwedel, J., & Hassiotis, A. (2015). Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with intellectual disabilities. Cochrane Database System Reviews. https://doi.org/10.1002/14651858.CD003406.pub4.
Aman, M. G., McDougle, C. J., Scahill, L., Handen, B. L., Arnold, L. E., Johnson, C. R., et al. (2009). Medication and parent training in children with pervasive developmental disorders and serious behavior problems: Results from a randomized clinical trial. Journal of American Academy of Child and Adolescent Psychiatry, 48(12), 1143–1154. https://doi.org/10.1097/CHI.0b013e3181bfd669.
Aman, M. G., & Singh, N. N. (1986). Aberrant behavior checklists: Manual. East Aurora: Slosson Educational Publications.
Bandura, A. (1989). Regulation of cogntivie processes through perceived self-efficacy. Developmental Psychology, 25, 729–735.
Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., et al. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. JAMA, 313(15), 1524–1533. https://doi.org/10.1001/jama.2015.3150.
Blackledge, J. T., & Hayes, S. C. (2001). Emotion regulation in acceptance and commitment therapy. Journal of Clinical Psychology, 57(2), 243–255.
Blake, M. J., Sheeber, L. B., Youssef, G. J., Raniti, M. B., & Allen, N. B. (2017). Systematic review and meta-analysis of adolescent cognitive-behavioral sleep interventions. Clinical Child and Family Psychology Review, 20(3), 227–249. https://doi.org/10.1007/s10567-017-0234-5.
Burckhardt, R., Manicavasagar, V., Batterham, P. J., Hadzi-Pavlovic, D., & Shand, F. (2017). Acceptance and commitment therapy universal prevention program for adolescents: A feasibility study. Child and Adolescent Psychiatry and Mental Health, 11, 27. https://doi.org/10.1186/s13034-017-0164-5.
Buron, K., & Curtis, M. (2003). The incredible 5-point scale: Assisting students with autism spectrum disorders in understanding social interactions and controlling their emotional responses. Shawnee Mission: Autism Asperger Publishing Company.
Campos, J. J., Frankel, C. B., & Camras, L. (2004). On the nature of emotion regulation. Child Development, 75(2), 377–394. https://doi.org/10.1111/j.1467-8624.2004.00681.x.
Chang, Y. C., Laugeson, E. A., Gantman, A., Ellingsen, R., Frankel, F., & Dillon, A. R. (2014). Predicting treatment success in social skills training for adolescents with autism spectrum disorders: The UCLA Program for the Education and Enrichment of Relational Skills. Autism, 18(4), 467–470. https://doi.org/10.1177/1362361313478995.
Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion regulation and the anxiety disorders: An integrative review. Journal of Psychopathology and Behavioral Assessment, 32(1), 68–82. https://doi.org/10.1007/s10862-009-9161-1.
Coleman, P. K., & Karraker, K. H. (1998). Self-efficacy and parenting quality: Findings and future applications. Developmental Review, 18, 47–85.
Cotton, S., Luberto, C. M., Sears, R. W., Strawn, J. R., Stahl, L., Wasson, R. S., et al. (2016). Mindfulness-based cognitive therapy for youth with anxiety disorders at risk for bipolar disorder: A pilot trial. Early Intervention in Psychiatry, 10(5), 426–434. https://doi.org/10.1111/eip.12216.
de Bruin, E. I., Blom, R., Smit, F. M., van Steensel, F. J., & Bogels, S. M. (2015). MYmind: Mindfulness training for Youngsters with autism spectrum disorders and their parents. Autism, 19(8), 906–914. https://doi.org/10.1177/1362361314553279.
Eisenberg, N., & Spinrad, T. L. (2004). Emotion-related regulation: Sharpening the definition. Child Development, 75(2), 334–339. https://doi.org/10.1111/j.1467-8624.2004.00674.x.
Frankel, F., Myatt, R., Sugar, C., Whitham, C., Gorospe, C. M., & Laugeson, E. (2010). A randomized controlled study of parent-assisted children’s friendship training with children having autism spectrum disorders. [Randomized Controlled Trial Research Support, N. I. H., & Extramural]. Journal of Autism and Developmental Disorders. 40(7), 827–842, https://doi.org/10.1007/s10803-009-0932-z.
Gowen, J. W., Johnson-Martin, N., Goldman, B. D., & Applebaum, M. (1989). Feelings of depression and parenting competence of mothers of handicapped and nonhandicapped infants: A longitudinal study. American Journal on Mental Retardation, 94, 259–271.
Granpeesheh, D., Tarbox, J., & Dixon, D. R. (2009). Applied behavior analytic interventions for children with autism: A description and review of treatment research. Annals of Clinical Psychiatry, 21(3), 162–173.
Guy, W. (1976). ECDEU assessment manual for psychopharmacology, publication No. 76–338. Washington, DC: U.S. DHEW, NIMH.
Hastings, R. P., & Brown, T. (2002). Behavior problems of children with autism, parental self-efficacy, and mental health. American Journal on Mental Retardation, 107(3), 222–232, https://doi.org/10.1352/0895-8017(2002)107%3C0222:bpocwa%3E2.0.co;2.
Hesse, T., Holmes, L. G., Kennedy-Overfelt, V., Kerr, L. M., & Giles, L. L. (2015). Mindfulness-based intervention for adolescents with recurrent headaches: A pilot feasibility study. Evidence-Based Complementary and Alternative Medicine, 2015, 508958, https://doi.org/10.1155/2015/508958.
Hill, A. L., Degnan, K. A., Calkins, S. D., & Keane, S. P. (2006). Profiles of externalizing behavior problems for boys and girls across preschool: The roles of emotion regulation and inattention. Developmental Psychology, 42(5), 913–928. https://doi.org/10.1037/0012-1649.42.5.913.
Hwang, Y. S., & Kearney, P. (2013). A systematic review of mindfulness intervention for individuals with developmental disabilities: Long-term practice and long lasting effects. Research in Developmental Disabilities, 34(1), 314–326. https://doi.org/10.1016/j.ridd.2012.08.008.
Jahromi, L. B., Meek, S. E., & Ober-Reynolds, S. (2012). Emotion regulation in the context of frustration in children with high functioning autism and their typical peers. Journal of Child Psychology and Psychiatry, 53(12), 1250–1258. https://doi.org/10.1111/j.1469-7610.2012.02560.x.
King, B. H., Hollander, E., Sikich, L., McCracken, J. T., Scahill, L., Bregman, J. D., et al. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: Citalopram ineffective in children with autism. Archives of General Psychiatry, 66(6), 583–590. https://doi.org/10.1001/archgenpsychiatry.2009.30.
Konstantareas, M. M., & Stewart, K. (2006). Affect regulation and temperament in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 36(2), 143–154. https://doi.org/10.1007/s10803-005-0051-4.
Kumar, S., Feldman, G., & Hayes, A. (2008). Changes in mindfulness and emotion regulation in an exposure-based cognitive therapy for depression. Cognitive Therapy and Research, 32(6), 734. https://doi.org/10.1007/s10608-008-9190-1.
Kuypers, L. M. (2011). The zones of regulation. San Jose: Social Thinking Publishing.
Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil, C. (2012). Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Autism and Developmental Disorders, 42(6), 1025–1036. https://doi.org/10.1007/s10803-011-1339-1.
Laugeson, E. A., Frankel, F., Mogil, C., & Dillon, A. R. (2009). Parent-assisted social skills training to improve friendships in teens with autism spectrum disorders. [Clinical Trial Comparative Study Research Support, N.I.H., Extramural]. Journal of Autism and Developmental Disorders, 39(4), 596–606. https://doi.org/10.1007/s10803-008-0664-5.
Lovaas, O. I., Koegel, R., Simmons, J. Q., & Long, J. S. (1973). Some generalization and follow-up measures on autistic children in behavior therapy. Journal of Applied Behavior Analysis, 6, 131–166.
Madrigal, S., & Garcia Winner, M. (2008). Superflex… A superhero social thinking curriculum. San Jose: Social Thinking Publishing.
Mandelberg, J., Frankel, F., Cunningham, T., Gorospe, C., & Laugeson, E. A. (2014). Long-term outcomes of parent-assisted social skills intervention for high-functioning children with autism spectrum disorders. Autism, 18(3), 255–263. https://doi.org/10.1177/1362361312472403.
Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., et al. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679–688. https://doi.org/10.1016/j.jaac.2013.05.006.
Mazefsky, C. A., Pelphrey, K. A., & Dahl, R. E. (2012). The need for a broader approach to emotion regulation research in autism. Child Development Perspectives, 6(1), 92–97. https://doi.org/10.1111/j.1750-8606.2011.00229.x.
Mazefsky, C. A., & White, S. W. (2014). Emotion regulation: Concepts & practice in autism spectrum disorder. Child and Adolescent Psychiatric Clinics of North America, 23(1), 15–24. https://doi.org/10.1016/j.chc.2013.07.002.
Mazefsky, C. A., Yu, L., White, S. W., Siegel, M., & Pilkonis, P. A. (2018). The emotion dysregulation inventory: Psychometric properties and item response theory calibration in an autism spectrum disorder sample. Autism Research, 11(6), 928–941. https://doi.org/10.1002/aur.1947.
Mcclure, K. S., Halpern, J., Wolper, P. A., & Donahue, J. (2009). Emotion regulation and intellectual disability. Journal of Developmental Disabilities, 15(2), 38–44.
McDougle, C. J., Scahill, L., Aman, M. G., McCracken, J. T., Tierney, E., Davies, M., et al. (2005). Risperidone for the core symptom domains of autism: Results from the study by the autism network of the research units on pediatric psychopharmacology. American Journal of Psychiatry, 162(6), 1142–1148. https://doi.org/10.1176/appi.ajp.162.6.1142.
McGillivray, J. A., & Kershaw, M. (2015). Do we need both cognitive and behavioural components in interventions for depressed mood in people with mild intellectual disability? Journal of Intellectual Disability Research, 59(2), 105–115. https://doi.org/10.1111/jir.12110.
Medrano, G. R., Berlin, K. S., & Hobart Davies, W. (2013). Utility of the PedsQL family impact module: Assessing the psychometric properties in a community sample. Quality of Life Research, 22(10), 2899–2907. https://doi.org/10.1007/s11136-013-0422-9.
Minshawi, N. F., Wink, L. K., Shaffer, R., Plawecki, M. H., Posey, D. J., Liu, H., et al. (2016). A randomized, placebo-controlled trial of D-cycloserine for the enhancement of social skills training in autism spectrum disorders. Molecular Autism, 7, 2. https://doi.org/10.1186/s13229-015-0062-8.
Noguchi, R., Sekizawa, Y., So, M., Yamaguchi, S., & Shimizu, E. (2017). Effects of five-minute internet-based cognitive behavioral therapy and simplified emotion-focused mindfulness on depressive symptoms: A randomized controlled trial. BMC Psychiatry, 17(1), 85. https://doi.org/10.1186/s12888-017-1248-8.
Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics North America, 33(3), 557–577. https://doi.org/10.1016/j.psc.2010.04.002.
Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. (2012). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: A randomized trial. Journal of Child Psychology and Psychiatry, 53(4), 410–419.
Rieffe, C., Oosterveld, P., Terwogt, M. M., Mootz, S., van Leeuwen, E., & Stockmann, L. (2011). Emotion regulation and internalizing symptoms in children with autism spectrum disorders. Autism, 15(6), 655–670. https://doi.org/10.1177/1362361310366571.
Samson, A. C., Huber, O., & Gross, J. J. (2012). Emotion regulation in Asperger’s syndrome and high-functioning autism. Emotion, 12(4), 659–665. https://doi.org/10.1037/a0027975.
Scahill, L., Bearss, K., Lecavalier, L., Smith, T., Swiezy, N., Aman, M. G., et al. (2016). Effect of parent training on adaptive behavior in children with autism spectrum disorder and disruptive behavior: Results of a randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 55(7), 602–609.e603. https://doi.org/10.1016/j.jaac.2016.05.001.
Scarpa, A., & Reyes, N. M. (2011). Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders: A pilot study. Behavioural and Cognitive Psychotherapy, 39(4), 495–500. https://doi.org/10.1017/s1352465811000063.
Schneider, R. L., Arch, J. J., Landy, L. N., & Hankin, B. L. (2016). The longitudinal effect of emotion regulation strategies on anxiety levels in children and adolescents. Journal of Clinical Child & Adolescent Psychology. https://doi.org/10.1080/15374416.2016.1157757.
Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.
Shaffer, R. C., & Minshawi, N. F. (2014). Training and supporting caregivers in evidence-based practices. In P. Sturmey, J. Tarbox, D. Dixon & J. L. Matson (Eds.), International handbook of autism and pervasive developmental disorders. New York: Springer Publishing.
Siener, S., & Kerns, K. A. (2012). Emotion regulation and depressive symptoms in preadolescence. Child Psychiatry & Human Development, 43(3), 414–430. https://doi.org/10.1007/s10578-011-0274-x.
Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46(11), 1152–1160. https://doi.org/10.1111/j.1469-7610.2005.00411.x.
Sofronoff, K., Attwood, T., Hinton, S., & Levin, I. (2007). A randomized controlled trial of a cognitive behavioural intervention for anger management in children diagnosed with Asperger syndrome. Journal of Autism and Developmental Disorders, 37(7), 1203–1214. https://doi.org/10.1007/s10803-006-0262-3.
Sofronoff, K., & Farbotko, M. (2002). The effectiveness of parent management training to increase self-efficacy in parents of children with Asperger syndrome. Autism, 6(3), 271–286. https://doi.org/10.1177/1362361302006003005.
Stoneman, Z., & Crapps, J. M. (1988). Correlates of stress, perceived competence, and depression among family care providers. American Journal on Mental Retardation, 93, 166–173.
Tarrasch, R., Margalit-Shalom, L., & Berger, R. (2017). Enhancing visual perception and motor accuracy among school children through a mindfulness and compassion program. Frontiers in Psychology, 8, 281. https://doi.org/10.3389/fpsyg.2017.00281.
Unwin, G., Tsimopoulou, I., Kroese, B. S., & Azmi, S. (2016). Effectiveness of cognitive behavioural therapy (CBT) programmes for anxiety or depression in adults with intellectual disabilities: A review of the literature. Research in Developmental Disabilities, 51–52, 60–75. https://doi.org/10.1016/j.ridd.2015.12.010.
Varni, J. W., Sherman, S. A., Burwinkle, T. M., Dickinson, P. E., & Dixon, P. (2004). The PedsQL Family Impact Module: Preliminary reliability and validity. Health and Quality of Life Outcomes, 2, 55. https://doi.org/10.1186/1477-7525-2-55.
Virues-Ortega, J. (2010). Applied behavior analytic intervention for autism in early childhood: Meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes. Clinical Psychology Review, 30(4), 387–399. https://doi.org/10.1016/j.cpr.2010.01.008.
Vollestad, J., Nielsen, M. B., & Nielsen, G. H. (2012). Mindfulness- and acceptance-based interventions for anxiety disorders: A systematic review and meta-analysis. British Journal of Clinical Psychology, 51(3), 239–260. https://doi.org/10.1111/j.2044-8260.2011.02024.x.
Weiss, J. A., Thomson, K., Burnham Riosa, P., Albaum, C., Chan, V., Maughan, A., et al. (2018). A randomized waitlist-controlled trial of cognitive behavior therapy to improve emotion regulation in children with autism. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.12915.
Wink, L. K., Minshawi, N. F., Shaffer, R. C., Plawecki, M. H., Posey, D. J., Horn, P. S., et al. (2017). d-Cycloserine enhances durability of social skills training in autism spectrum disorder. Molecular Autism, 8, 2. https://doi.org/10.1186/s13229-017-0116-1.
Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234. https://doi.org/10.1111/j.1469-7610.2008.01948.x.
Yang, L., Zhou, X., Zhou, C., Zhang, Y., Pu, J., Liu, L., et al. (2017). Efficacy and acceptability of cognitive behavioral therapy for depression in children: A systematic review and meta-analysis. Academic Pediatrics, 17(1), 9–16. https://doi.org/10.1016/j.acap.2016.08.002.
Acknowledgments
We would like to thank all of the staff at Cincinnati Children’s Hospital Medical Center who assisted with ER-IOP, particularly our behavior assistant Jennifer Harms and additional group leaders Allison Blackburn, Nicole Klein, and Lauren Schmitt. This program would not be possible without their expertise and hard work.
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RCS developed and led the program, analyzed chart review data, and crafted the manuscript, LKW assisted with manuscript development, JR assisted with program development and group implementation, AP assisted with group implementation and manuscript development, RA assisted with data analysis, PCM supported the program implementation, MS supported the program implementation, CAE assisted with program development and manuscript development.
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Shaffer, R.C., Wink, L.K., Ruberg, J. et al. Emotion Regulation Intensive Outpatient Programming: Development, Feasibility, and Acceptability. J Autism Dev Disord 49, 495–508 (2019). https://doi.org/10.1007/s10803-018-3727-2
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DOI: https://doi.org/10.1007/s10803-018-3727-2