Examining Children with Autism Spectrum Disorder’s Negativity/Lability: Teaching Emotion Regulation Strategies through the Stress and Anger Management Program (STAMP)

Background: Emotion Regulation (ER) is critical in children’s social and emotional development and is often delayed or impaired in children with Autism Spectrum Disorder (ASD). Poor ER has been associated with increased anxiety, irritability, and poor self-regulation, leading to behavioral outbursts and potentially more restricted and repetitive behaviors. The Stress and Anger Management Program (STAMP) adapts Cognitive Behavioral Therapy (CBT) for younger children with ASD (4-7 years; preschool/kindergarten developmental level) and adds a parent training component. STAMP teaches children ER strategies, specifically what they can do to manage their emotions, and views parents as co-facilitators. A pilot study indicated group level differences (STAMP vs. Waitlist control) in ER measured post-treatment.

Objectives: The current study expands the original sample (from 11 to 23 participants) to test if STAMP decreases negative affect expression in young children with ASD compared to a Waitlist group in order to provide stronger evidence of the efficacy of STAMP in a Randomized Control Trial (RCT) design.

Methods: Twenty-three parent/child dyads (19 boys; 100% Caucasian) ranging from 4 to 7 years old (M = 5.46; SD = 1.01) participated in STAMP groups. Each dyad was randomly assigned to the Treatment (TX; i.e., STAMP; n = 12) or Waitlist control (WL; n = 11) group. All completed more than 50% of sessions. Eleven families participated in the original pilot study (n = 5 TX, 6 WL), and 12 families were added post-pilot (n = 6 per group). To qualify, children were required to meet criteria for ASD on the ADOS or ADOS-2, communicate verbally, understand basic verbal instructions (e.g., sit here), have parent-reported difficulties managing anger or anxiety, and be able to tolerate a group setting. Parents completed the Emotion Regulation Checklist (ERC), which assesses two dimensions of ER: regulation (ER) and negativity (Lability/Negativity; L/N). The L/N subscale targets expression of negative emotions, inflexibility, and mood, which is the focus of the STAMP intervention. The ER subscale was not examined.

Results: Paired samples t-test for TX revealed a significant difference in L/N for Time 1 vs. Time 2, t(9)= 2.45, p = .03, with decreased L/N at Time 2. For WL, there was no significant difference in L/N for Time 1 vs. Time 2, t(7)= 1.02, p = .34. TX gains for all participants revealed a significant difference in L/N pre-treatment (Time 1 for Treatment group and Time 2 for WL combined; M = 39.28, SD = 5.34) to post-treatment (Time 2 for TX and Time 3 for WL combined; M= 35.11, SD = 4.46), t(17)= 3.26, p < .01, Cohen’s d = .77, suggesting a medium effect size.

Conclusions: Results support previous findings regarding benefits of STAMP in improving ER in young children with ASD. This study provides further support for using CBT with young children’s ER skills. Improvements in children’s ER skills may be important in the development of social relationships as well as reductions in psychopathology and therefore, it is critical that future research continue to explore the most effective way to elicit these skills.