Regulating Together: Emotion Regulation Treatment for Children and Teens with ASD in an Intensive, Group, Parent-Assisted Program Pilot Trial

Background: Individuals with Autism Spectrum Disorder (ASD) consistently present to treatment with non-compliance, temper tantrums, and aggression. At age 8, >95% of youth with ASD demonstrate co-occurring behavioral and emotional symptoms that are related to negative outcomes throughout development. Across all cognitive functioning levels, these clinical issues are hypothesized to arise from difficulties in emotion regulation (ER). Inadequate ER skills in individuals with ASD have been linked to higher rates of hospitalizations, school disciplinary action, peer rejection, failed transitions to college and employment, and use of psychotropic medications. Unfortunately, there are no empirically-validated interventions to address this impactful issue in ASD. Due to the severity of concerns associated with weak ER skills in ASD, traditional school- and outpatient-based programs are not equipped to deal with this population, and thus children with ASD are often excluded from treatment. Moreover, traditional interventions are typically individual-based and do not actively include caregivers. Thus, a group-based, parent-assisted model may be an effective method of treating many individuals with ASD who have ER deficits. CBT-based approaches have been shown to be effective at improving select aspects of ER in ASD and general child psychology indicate mindfulness and acceptance are needed for long-term ER skills, but their usefulness is untested for individuals with ASD.

Objectives: Our group developed Regulating Together (RT), a unique comprehensive program including both caregivers and children in a group format that uses elements of CBT, ABA, and Mindfulness approaches. Here, we aim to determine the feasibility and efficacy from a pilot study containing child (8-12 years) and adolescent (13-18 years) groups that met twice weekly for 5 weeks.

Methods: We examined a multi-diagnostic clinical RT group via a chart review of 59 participants (40 8-12, 19 13-18), 31 with ASD (20 8-12, 11 13-18), comparing pre- and post-treatment scores on the Aberrant Behavior Checklist, Pediatric Quality of Life Family Impact Module (PedsQL), and clinician rated CGI-I⁷. Each age group was analyzed separately.

Results: The ASD child group had statistically significant changes on all subscales of the Aberrant Behavior Checklist and the ASD teen group had significant changes on the Irritability, Lethargy, and Stereotypy subscales. Regarding CGI-I, 53% of the children were rated as Much Improved, 24% minimally improved, 21% no change, and one participant minimally worse post-treatment and 28.6% of adolescents were rated as Much Improved and 71.4% minimally improved. Parents provided overwhelmingly positive feedback in regard to learning, enjoying the program, and increased confidence in behavior management. There was a 15% attrition and a 13% absence rate suggesting overall feasibility. No significant changes were found on the PedsQL for either group.

Conclusions: ER is a critically under-studied and under-treated issue in ASD and other developmental disorders leading to high rates of hospitalizations and social and academic difficulties. Thus, we developed a short-term parent-assisted group intervention approach aimed at increasing ER. Our novel Regulating Together treatment program shows promising short-term preliminary findings, and thus indicate further evaluation of efficacy, identification of treatment responder characteristics and active components, and long-term benefits is warranted.