Why Emotional Regulation Is Hard for Autistic Children

More and more, the experiences and perspectives of autistic individuals are contributing to our understanding of neurodiversity, beyond the limits of the observable characteristics (usually by neurotypical researchers) that dominate the Diagnostic and Statistical Manual for Mental Disorders' (DSM) criteria for autism. One example is Chamak et al. (2008)’s analysis of autobiographical writings of autistic individuals, together with interviews, in efforts to explore their narratives relating to their inner experience.

Chamak et al. found that unlike autism's diagnostic criteria included in the DSM-5 (a dyad of challenges with social communication and restrictive and repetitive patterns of behavior), participants in their study described challenges with emotional regulation, along with others related to atypical perception and information processing. The researchers conceptualized the above variables as two overlapping circles that interrelate and influence one another.

Atypical perception and information processing include variables such as sensitivities to sensory information, a unique understanding of implicit social rules, finding adapting to transitions challenging, or a preference for detail focus and enhanced discrimination of differences, to name a few.

Statistics relating to high percentages of comorbid symptoms of anxiety and depression in autistic children make emotional regulation a priority for this population. The majority (67 to 79 percent) of children on the spectrum experience comorbid symptoms of anxiety and many (42 to 54 percent) depression (Mayes et al. 2010). Emotional regulation challenges are correlated with social and behavioral challenges (Mayes et al., 2011) and maladaptive externalizing and internalizing strategies such as aggression and self-harm (Folstein, 2012).

Guy et al. (2014) defined emotional self-regulation as a “complex and multifaceted construct that involves physiological, behavioral, and cognitive processes, which allow an individual to monitor, evaluate, and modify emotional reactions to accomplish one’s goals.”

In addition to the above-mentioned information processing characteristics, biological processes associated with emotional regulation include neuro-inflammatory reactions, atypical neurotransmitter activity, or altered brain structures (i.e. the amygdala). While some magnetic resonance imaging (MRI) studies found decreased volume of the amygdala in autistic adults (suggesting “underdevelopment of neural connections of limbic structures” (Shuid et al., 2020)), others found enlarged volumes of the amygdala and hippocampus, suggesting increased activity within these structures (associated with emotional and social challenges (Shuid et al., 2020)).

Pitskel et al. (2010) found a relative lack of prefrontal-amygdala connectivity in autistic individuals when downregulating disgust emotion, in comparison to neurotypical peers, and a lack of modulation of insula. The authors implied that these findings suggest potential downregulation challenges for autistic individuals.

Another notable biological process associated with emotional regulation is a decreased respiratory sinus arrhythmia (RSA) in autistic school-aged children (Guy et al., 2014), a measure of heart rate fluctuations associated with the activity of the parasympathetic nervous system. The authors suggest that decreased RSA implies potential challenges for autistic individuals with downregulating internal states.

Strategies for Nourishing Emotional Regulation

A classic therapeutic strategy for addressing mental health concerns in autistic young persons, one that boasts the strongest research evidence, is cognitive behavioral interventions (CBI).

Wong et al.’s (2014) Evidence-Based Practices for Children Report lists CBI as a key evidence practice for addressing mental health challenges in autistic young persons. They suggest that cognitive behavioral interventions are helpful for use in “conjunction with other evidence-based practices including social narratives, reinforcement,” and can target a wide variety of emotions. CBI strategies explore cognitive processes and interpretations. They expand individuals’ awareness of their inner beliefs and thoughts, and how these impact their emotions.

An example of a CBI strategy is paying attention to thoughts and beliefs at times of experiencing a challenging emotion. A personal example is asking my 9-year-old son to draw a “thought bubble” and, inside it, write down what he says to himself and believes. We then explore what emotional experiences are associated (for him) with the thoughts he listed. Next, we add to his thought bubble ideas about ways of looking after himself, or perceptions from alternative points of view.

In addition to CBI, mindfulness has also been an effective strategy for supporting autistic young persons with emotional regulation. Mindfulness interventions target a variety of components such as nurturing present-moment awareness, naming feelings, practicing inner compassion and non-judgment, as well as making use of self-observation (Baer, 2006).

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A personal example of a mindfulness strategy is asking my 9-year-old to notice what he hears, feels, and sees in a particular moment, in this way helping him to pause the cognitive narrative in his head and come back to the direct experience of the present moment. He may further savor this exercise by making a drawing of one aspect of what he feels, hears, or sees, or through an activity such as making a sensory collage.

Despite many encouraging preliminary results, there are unfortunately insufficient meta-analyses (to date) that evaluate the effectiveness of mindfulness as a strategy for emotional regulation for autistic young persons, due to small and varied sample sizes as well as limited control groups, to establish mindfulness as an evidence-based practice alongside CBI.

Emotional regulation can be challenging for children on the autism spectrum, due to differences in the processing of information and biological variables such as decreased respiratory sinus arrhythmia (RSA). Strategies that support them in staying within an optimal range of arousal that’s conducive to reflection and problem solving such as CBI, mindfulness, or other means of self-soothing are an essential focus for nurturing their emotional wellness.