Brain Mechanisms for Emotion Regulation In Children and Adolescents with Autism

Background: Emotional volatility is common among individuals with autism spectrum disorder (ASD), detrimentally impacting the quality of life for those affected and their families. For many higher-functioning children with ASD, maladaptive emotional responses (e.g., behavioral outbursts associated with changes in routines or violation of expectations) are often the first concerns noted by parents or caregivers. Despite the importance of this area, the behavioral and neural underpinnings of emotion dysregulation in ASD remain poorly understood.

Objectives: We sought to examine activity associated with cognitive reappraisal of negative reactions to disgusting images in children and adolescents with and without ASD.

Methods: During functional magnetic resonance imaging (fMRI) children viewed child-appropriate disgust-inducing (“gross”) pictures or neutral pictures. They were instructed to simply attend (“look”), increase (“more gross”), or decrease (“less gross”) their emotional reaction to the disgust-inducing pictures. Strategies were provided (e.g., pretend it’s right in front of you; pretend it’s fake) to facilitate performance, and pre-task training was employed to ensure task understanding. The children rated their level of disgust on a 1-5 visual analogue scale after each trial. Two IQ- and age-matched groups were studied: typically developing children (TD, n = 15, mean age = 13.03, range = 9-18 years); and children with autism spectrum disorder (ASD, n = 16, mean age = 13.82 years, range = 9-17 years). Our hypotheses centered on regions involved in: (1) the experience of disgust (revealed in the contrast between passively viewing gross (i.e., “look gross” condition) versus neutral images), (2) the regulation of emotion (revealed in the contrast between decrease disgust (i.e., “decrease gross”) versus “look gross”), and (3) those regions being regulated (revealed in the contrast between “decrease gross” versus “look gross”).

Results: Ratings of disgust increased for looking at gross relative to neutral pictures equally across the two groups. Moreover, ratings of disgust significantly increased and decreased as expected by regulation condition equivalently across the two groups. Children with and without ASD exhibited robust gross > neutral activity in the right insula, right amygdala, and bilateral fusiform gyri. When instructed to “decrease”, these same regions exhibited decreased activity in TD children, but decreased to a significantly lesser degree in children with ASD. A correlation analysis identified a region of the medial prefrontal cortex in TD children but not children with ASD that exhibited a significant negative correlation with activation in both the right insula and left amygdala, suggesting that this region may serve as a regulator of activity in regions linked to the perception and experience of disgust.

Conclusions: Whereas children with and without ASD exhibited similar behavioral profiles indicating successful cognitive reappraisal of negative emotion in response to disgusting images, fMRI revealed different patterns of brain activity in the two groups associated with this regulation. In particular, children with ASD failed to engage the medial prefrontal cortex in the process of emotion regulation.