Cognitive Emotion Regulation in Autism

Background: Autism is a heterogeneous neurodevelopmental condition. Co-occurring mental health conditions such as depression are more prevalent amongst autistic individuals. These conditions show sex/gender differences in prevalence in the neurotypical (NT) population, with more women being diagnosed with depression. Having heightened autistic traits, but not an autism diagnosis, has also been related to a higher rate of depression, and cognitive emotion regulation (CER) strategies have been shown to influence depressive symptomatology. Bruggink and colleagues (2016, Research in Autism Spectrum Disorders) found that autistic individuals used more “Other Blame” and less “Positive Reappraisal” CER techniques than NT individuals, as measured by the CER Questionnaire (CERQ). However, differences in sex/gender or influence of autistic traits were not measured.

Objectives: To test for group and sex/gender differences in CER strategies between autistic and NT adults. We hypothesise that (1) the autism group and the high autistic trait group use more negative coping strategies and less positive CER strategies than the low autistic trait NT group and (2) any sex/gender differences would be attenuated in the autism group.

Methods: Participants were recruited through the Cambridge Autism Research Database (CARD) and included 854 individuals who completed the CERQ, Autism Spectrum Quotient (AQ) and the Patient Health Questionnaire (PHQ-9), a depression symptom questionnaire. Participants were divided into three groups based on diagnosis and AQ score (high > 26): 172 autistic males, 51 high-AQ NT males; 60 low-AQ NT males; 212 autistic females; 120 high-AQ NT females; and 239 low-AQ NT females. NT participants included did not suspect an autism diagnosis. All participants were matched on gender assigned at birth and gender currently identified.

Results: Two MANCOVAs were run to test for overall difference in adaptive or maladaptive strategy use. Alpha level was set at .025 to correct for multiple comparisons. Factorial ANCOVAs were done to examine group and sex/gender differences in strategy use (False Discovery Rate corrected within adaptive or maladaptive strategies). Bonferroni corrected pairwise-t-tests were used to test for group differences within single strategies. No group-by-sex/gender interactions were found in use of CER strategies. Across group, sex differences were found on “Other-Blame”, with men tending to use this strategy more often than women. Group differences were found on 7 of the 9 subscales of the CERQ, after controlling for age and depression scores. The autism and high-AQ groups scored higher on depression symptoms and employed negative coping strategies (“Self-blame”, “Catastrophizing”) more often and positive styles (“Positive Refocusing”, “Refocus on Planning”, “Positive Reappraisal”, “Putting things into Perspective”) less often than the low-AQ NT group.

Conclusions: Autistic and high-AQ individuals show higher levels of depression symptomatology and use more negative coping styles, and less positive coping styles than low-AQ NT individuals, even after controlling for group differences in depression scores. Future research will examine if use of CER strategies, or if differences general wellbeing, life events and alexithymia moderate or mediate depressive symptomatology. If CER styles mediate or moderate depression in these groups, targeting CER use may be a helpful avenue for therapy.