Parent-reported Emotion Regulation Research Articles

Treatment Engagement as a Predictor of Therapy Outcome Following Cognitive Behaviour Therapy for Autistic Children.

Active engagement in one's therapy is a key contributor to successful outcomes. Research on child engagement in cognitive behaviour therapy (CBT) has largely focused on youth without autism. This longitudinal study examined multiple indicators of child engagement in relation to outcomes for autistic children who took part in CBT for emotion regulation. Data were collected from 60 autistic children who were between 8 and 13 years of age (86.7% male; Mage = 9.58 years, SD = 1.44 years; 75% White). Indicators of child engagement included independent observer ratings of in-session involvement, as measured by the Child Involvement Rating Scale, and therapist ratings of the therapeutic relationship and homework completion using single-item measures. Indicators of engagement were measured at early (i.e., first third), middle (i.e., mid third), and late (i.e., final third) stages of treatment. Parent-reported emotion regulation was the primary treatment outcome, as measured by the Emotion Regulation Checklist. After controlling for pre-treatment scores, in-session involvement significantly predicted some aspects of post-treatment emotion regulation, whereas therapeutic relationship and homework completion did not. Child in-session involvement throughout therapy may be particularly relevant for treatment change. Addressing issues related to in-session involvement early in treatment may help to promote therapeutic success for autistic children.

Executive Functioning and Emotion Regulation in Children with and without ADHD.

Difficulties with emotion regulation affect the majority of youth with attention-deficit/hyperactivity disorder (ADHD) and predict greater functional impairment than ADHD symptoms alone. Deficits in executive functioning are also present for most children with ADHD, and have been linked with emotion regulation difficulties in both clinical and neurotypical populations throughout development. The current study was the first to assess all three core executive functions (working memory, inhibitory control, set shifting) simultaneously in a clinically-diverse sample of children with and without ADHD and common comorbidities and investigate the extent to which they uniquely predict emotion dysregulation. A sample of 151 children ages 8-13years (M = 10.36, SD = 1.52; 52 girls; 70.2% White/Non-Hispanic) were assessed using a criterion battery of executive functioning tasks, teacher-reported ADHD symptoms, and parent-reported emotion regulation. Results of the bias-corrected, bootstrapped conditional effects path model revealed that better-developed working memory predicted better emotion regulation (β = 0.23) and fewer ADHD symptoms (β = -0.21 to -0.37), that ADHD symptoms (β = -0.18 to -0.20) independently predicted emotion dysregulation, and that working memory exerted indirect effects on emotion regulation through both inattention and hyperactivity/impulsivity (β = 0.04-0.07). Sensitivity analyses indicated that these effects were generally robust to control for age, sex, executive function interrelations, and inclusion/exclusion of children with co-occurring ASD. These findings underscore the importance of working memory (relative to inhibitory control and set shifting) and its relations with ADHD symptoms for understanding children's emotion regulation skills, and may help explain the limited efficacy of first-line ADHD treatments, which do not target working memory, for improving emotion regulation skills.

Self-reported emotion regulation in children with autism spectrum disorder, without intellectual disability

BackgroundEmotion regulation (ER) may be a critical underlying factor contributing to mental health disorders in children with Autism Spectrum Disorder (ASD). Scant literature has utilised self-reported ER in children with ASD and explored the association between mental health and social skills. This study explored the association between self-reported ER skills, and parent/teacher proxy reports of ER, social skills, autism severity and mental health. MethodThe pre-existing data set included a community sample of 217 students aged seven to 13-years (Mage = 9.51, SD = 1.26; 195 Male, 22 Female) with ASD. The study employed a correlational design, whereby existing variables were explored as they occurred naturally (Hills, 2011). Children self-rated ER, while parents and teachers rated ER, social skills, and mental health difficulties via standardised questionnaires. ResultsMultiple regression analyses were conducted separately for parent and teacher reports. The linear combination of parent-reported emotion regulation, social skills, autism severity, and child-reported ER accounted for 46.5 % of the variance, compared to 58.7 % for the teacher-report analysis. Social skills appeared to be a stronger predictor of mental difficulties than emotional regulation irrespective of source. ConclusionsThe current study suggests self-reported ER to be a significant contributor to mental health when in isolation. However, in the context of social skills and autism severity, ER is no longer a significant contributor in a child and adolescent community sample, in determining mental health. This suggests, that for children aged seven to 13-years with ASD, without ID, to reduce mental health difficulties, social skills may be the focus of intervention, with some focus on ER ability.

Predictors and outcomes associated with therapeutic alliance in cognitive behaviour therapy for children with autism.

Therapeutic alliance is often an important aspect of psychotherapy, though it is rarely examined in clients with autism. This study aims to determine the child pre-treatment variables and treatment outcomes associated with early and late alliance in cognitive behaviour therapy targeting emotion regulation for children with autism. Data were collected from 48 children with autism who participated in a larger randomized-controlled trial. Pre-treatment child characteristics included child, parent, and clinician report of child emotional and behavioural functioning. Primary outcome measures included child and parent-reported emotion regulation. Therapeutic alliance (bond and task-collaboration) was measured using observational coding of early and late therapy sessions. Pre-treatment levels of child-reported emotion inhibition were associated with subsequent early and late bond. Pre-treatment levels of parent and child-reported emotion regulation were related to early and late task-collaboration. Late task-collaboration was also associated with pre-treatment levels of behavioural and emotional symptom severity. Task-collaboration in later sessions predicted improvements in parent-reported emotion regulation from pre- to post-therapy. Future research is needed to further examine the role of task-collaboration as a mechanism of treatment change in therapies for children with autism.

Emotional reactivity to daily events in youth with anxiety disorders

ABSTRACTBackground: Although research supports associations between anxiety and emotional reactivity in adults (Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion regulation and the anxiety disorders: an integrative review. Journal of Psychopathology and Behavioral Assessment, 32(1), 68–82.), few studies have examined emotional reactivity in anxious youth (e.g., Carthy et al., 2010; Tan, P. Z., Forbes, E. E., Dahl, R. E., Ryan, N. D., Siegle, G. J., Ladouceur, C. D., & Silk, J. S. (2012). Emotional reactivity and regulation in anxious and nonanxious youth: a cell-phone ecological momentary assessment study. Journal of Child Psychology and Psychiatry, 53(2), 197–206.). Methods: Using daily diary methodology, this study examined both negative affect (NA) and positive affect (PA) reactivity to daily events in youth diagnosed with anxiety (N = 68; 60% female; 78% non-Hispanic White; M age = 11.18 years, SD = 3.17). We also examined whether parent-reported emotion regulation would predict emotional reactivity. Results: Participants reported more NA on days they experienced more negative parent and teacher events and less PA on days that they experienced more negative peer events. Additionally, better emotion regulation was associated with less NA reactivity to negative teacher events and to both negative and positive academic events. Conclusions: Interpersonal events have a salient effect on daily affect for anxious youth. Youth anxiety therapists should target emotion regulation associated with negative events involving adults and address barriers to developing and maintaining positive peer relationships.

Correspondence between Heart Rate Variability and Emotion Dysregulation in Children, Including Children with ADHD.

Youth and adults with Attention-Deficit/Hyperactivity Disorder (ADHD) experience academic and social impairment and engage in risky behaviors. Emotion dysregulation (ED) is associated with ADHD and may contribute to these impairments and behaviors. Although many measures of ED exist, little is known about the physiological bases of ED, in the context of ADHD. In a large sample of children (M age=9.01years; 62% male) with (n=48) and without (n=56) ADHD, we examined (1) the correspondence between parent-reported ED and heart rate variability (HRV) - a psychophysiological marker of parasympathetic engagement and (2) whether parent-reported ED is predicted by HRV above and beyond ADHD. For both aims, we tested both dichotomous and continuous indices of parent-reported ED. Results indicated (1) a dichotomous index of parent-reported emotion regulation was associated with HRV and (2) this index was predicted by HRV above and beyond ADHD. Together, findings indicate that the correspondence between ED and HRV depends on the specific manifestation of ED that is considered (emotion regulation vs. lability/negativity) and the way in which ED is conceptualized (dichotomous vs. continuous).

Emotion Regulation Mediates the Association Between ADHD and Depressive Symptoms in a Community Sample of Youth

The purpose of this study was to examine the longitudinal relationship between attention-deficit/hyperactivity disorder (ADHD) symptoms, emotion regulation (ER) ability, and depressive symptoms within a diverse community sample of 277 youth, ages 9-12 (56% male). Participants were drawn from a larger study examining adolescent risk behaviors, and completed annual assessments over 3years. Youth ADHD symptoms were assessed at Time 1 (T1) using the parent-reported Disruptive Behavior Disorders Rating Scale, ER was assessed with the parent-reported Emotion Regulation Checklist at Time 2 (T2), and youth depressive symptoms were assessed using the self-reported Revised Child Anxiety and Depression Scales at Time 3 (T3). Analyses examined T2 ER as a mediator between T1 ADHD symptoms (including the unique contributions of inattentive [IA] versus hyperactive/impulsive [HI] symptoms) and T3 depressive symptoms. Structural equation modeling (SEM) indicated the path model specified provided an excellent fit to the data. Tests of indirect effects suggested that T2 ER appears to be a significant mechanism that underlies the relationship between T1 ADHD and T3 depression, even when accounting for T1 oppositional defiant and depressive symptoms. Furthermore, while both T1 IA and HI symptoms had significant indirect effects on T3 depression through the mechanism T2 ER, HI proved a more robust predictor of T2 ER than IA. Results of this prospective study support cross-sectional findings pointing to ER as a potential mechanism linking ADHD and depressive symptoms in youth. Clinical implications and future directions are discussed.

Disrupted Amygdala Reactivity in Depressed 4- to 6-Year-Old Children

Disrupted amygdala activity in depressed adolescents and adults while viewing facial expressions of emotion has been reported. However, few data are available to inform the developmental nature of this phenomenon, an issue that studies of the earliest known forms of depression might elucidate. The current study addressed this question by examining functional brain activity and its relationships to emotion regulation in depressed 4- to 6-year-old children and their healthy peers. A total of 54 medication-naive 4- to 6-year-olds (23 depressed and 31 healthy) participated in a case-control study using functional magnetic resonance imaging (fMRI). Imaging data were used to compare functional brain activity in children with and without depression during emotion face processing. A right-lateralized pattern of elevated amygdala, thalamus, inferior frontal gyrus, and angular gyrus activity during face processing was found in depressed 4- to 6-year-olds. In addition, relationships between increased amygdala activity during face processing and disruptions in parent-reported emotion regulation and negative affect were found. No between-group differences specific to emotion face type were identified. To our knowledge, this is the earliest evidence of alterations in functional brain activity in depression using fMRI. Results suggest that, similar to findings in older depressed groups, depression at this age is associated with disrupted amygdala functioning during face processing. The findings also raise the intriguing possibility that disrupted amygdala function is a depression-related biomarker that spans development. Additional studies will be needed to clarify whether the current findings are a precursor to or a consequence of very early childhood depression.

Anxiety-Disordered Adolescents With and Without a Comorbid Depressive Disorder

There is a high degree of comorbidity between anxiety and depressive disorders among treatment-seeking adolescents. Comorbid youth often present with greater diagnostic severity, worse social functioning, and more severe anxiety and depressive symptoms, compared with anxiety-disordered youth without depression. However, the degree to which these populations may differ in underlying affect and emotion regulation (ER) is largely unknown. This study compared 44 anxiety-disordered adolescents (ages 12-18 years) with a comorbid depressive disorder (ANX + DEP) and 32 anxiety-disordered adolescents without a comorbid depressive disorder (ANX) on several clinical and emotion-related variables. Results indicated that ANX + DEP adolescents were assigned higher clinician-rated diagnostic severity ratings, and reported greater functional impairment and more severe social anxiety and depressive symptoms, compared with ANX adolescents. In addition, ANX + DEP adolescents demonstrated higher levels of negative affect, lower levels of positive affect, and poorer self-reported and parent-reported ER. Implications for assessment and treatment, as well as directions for future research, are discussed.

Improving Emotion Regulation with CBT in Young Children with High Functioning Autism Spectrum Disorders: A Pilot Study

This pilot study tested the efficacy of a developmentally modified CBT for young children with Autism Spectrum Disorders (ASD) to teach emotion regulation strategies for reducing anger and anxiety, commonly noted problems in this population. Eleven 5-7 year-old children participated in a CBT-group while parents participated in psychoeducation. Children were randomly assigned to an experimental or delayed-treatment control group. From pre- to post-treatment, all children had less parent reported negativity/lability, better parent reported emotion regulation, and shorter outbursts, and also generated more coping strategies in response to vignettes. Parents also reported increases in their own confidence and their child's ability to deal with anger and anxiety. This study suggests that young children with high functioning ASD may benefit from CBT to improve regulation of anger and anxiety, and parent training may improve parental self-efficacy. Future studies are needed to make conclusions about its efficacy.