Enhancing Flexibility: A Biosocial Model for Resilience to Adversity in Youth With Autism

A Scarpa,D M Swain,J R Bertollo,A V Dahiya,R S Factor

doi:10.1177/21582440211037997

Abstract

Flexibility is often associated with resilience from adversity. Youth with autism spectrum disorder (ASD) are at risk of stress and trauma yet have inherent difficulties with flexibility, including rigid behaviors, routines, “insistence on sameness,” and lack of social reciprocity. This review highlights literature of physiological and psychological processes related to inflexibility in ASD and proposes a heuristic model to understand mechanisms of resilience in the aftermath of adversity. This article presents the Biosocial Model for Resilience, which posits that interventions that target changes in central, autonomic, and endocrine dysregulation may in turn enhance processes of psychological flexibility (i.e., executive cognitive, emotional, and interpersonal regulation) that increase the likelihood of resilient adjustment in response to stressful experiences. This model of resilience is optimistic in positing that, in addition to critical programs on the prevention of social adversity, future research on flexibility can inform intervention programs that target this specific mechanism to minimize harmful aftereffects in youngsters with ASD.

Highlights

Flexibility is associated with resilience, but what if an individual has inherent difficulties with flexibility? Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by a range of symptoms in two core areas as presented in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013): deficits in communication and reciprocal social interactions and excesses in repetitive and restricted behaviors (RRBs)
Thematic keywords used in our search included terms such as, “autism,” “autism spectrum disorder,” “trauma,” “stress,” “inflexibility,” “restricted repetitive behaviors,” “rigidity,” “perseveration,” “rumination,” “flexibility,” “resilience,” “central nervous system,” “neurobiological,” “autonomic nervous system,” “endocrine,” “HPA,” “heart rate variability,” “cardiac vagal control,” “cortisol,” “executive cognitive functions,” “emotion regulation,” “anxiety,” “depression,” “aggression,” “posttraumatic stress disorder (PTSD),” “posttraumatic stress,” “cognitive behavioral,” “exercise,” “relaxation,” “biofeedback,” “transcranial,” and “mindfulness.” Articles were manually reviewed, and their reference list was searched for additional relevant articles
Research is needed to adapt such interventions for youth with ASD and co-occurring language or intellectual impairments. In this narrative literature review, research is presented on the inherent physiological inflexibility processes that contribute to psychological inflexibility in ASD, with a focus on central, autonomic, and endocrine functioning

Summary

Introduction

Flexibility is associated with resilience, but what if an individual has inherent difficulties with flexibility? Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by a range of symptoms in two core areas as presented in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013): deficits in communication and reciprocal social interactions and excesses in repetitive and restricted behaviors (RRBs). Strang et al (2017) identified five factors related to flexibility: routines/rituals, transitions/change, special interests, social flexibility, and generativity. Previous work has noted the dearth of research on resilience in ASD, which, to date, has focused primarily on identifying the “opposite” of risk factors (Elsabbagh, 2020; Szatmari, 2018) These authors suggest that the field should instead focus on skills needed to decrease the impact of risk factors and target these protective mechanisms. In this narrative literature review, we will present (a) research on inherent physiological inflexibility processes that contribute to psychological inflexibility in ASD; (b) effects of extrinsic stress and trauma in this population that can exacerbate such processes; and (c) a model of resilience that we hope will be empirically tested in future research. The purpose of this narrative literature review is to survey recent literature on the theme of flexibility or inflexibility in autistic youth to build upon prior work and offer a conceptual model of resilience through enhancing flexibility, based on a biosocial theoretical framework

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