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22-09-2023 | Original Contribution

Systematic review: emotion dysregulation and challenging behavior interventions for children and adolescents on the autism spectrum with graded key evidence-based strategy recommendations

Authors: Heather J. Nuske, Amanda V. Young, Farzana Y. Khan, Emma H. Palermo, Bukola Ajanaku, Melanie Pellecchia, Giacomo Vivanti, Carla A. Mazefsky, Lauren Brookman-Frazee, James C. McPartland, Matthew S. Goodwin, David S. Mandell

Published in: European Child & Adolescent Psychiatry

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Abstract

Challenging behavior, such as aggression, is highly prevalent in children and adolescents on the autism spectrum and can have a devastating impact. Previous reviews of challenging behavior interventions did not include interventions targeting emotion dysregulation, a common cause of challenging behavior. We reviewed emotion dysregulation and challenging behavior interventions for preschoolers to adolescents to determine which evidence-based strategies have the most empirical support for reducing/preventing emotion dysregulation/challenging behavior. We reviewed 95 studies, including 29 group and 66 single case designs. We excluded non-behavioral/psychosocial interventions and those targeting internalizing symptoms only. We applied a coding system to identify discrete strategies based on autism practice guidelines with the addition of strategies common in childhood mental health disorders, and an evidence grading system. Strategies with the highest quality evidence (multiple randomized controlled trials with low bias risk) were Parent-Implemented Intervention, Emotion Regulation Training, Reinforcement, Visual Supports, Cognitive Behavioral/Instructional Strategies and Antecedent-Based Interventions. Regarding outcomes, most studies included challenging behavior measures, while few included emotion dysregulation measures. This review highlights the importance of teaching emotion regulation skills explicitly, positively reinforcing replacement/alternative behaviors, using visuals and metacognition, addressing stressors proactively, and involving parents. It also calls for more rigorously designed studies and for including emotion dysregulation as an outcome/mediator in future trials.
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Literature
1.
go back to reference Hattier MA, Matson JL, Belva BC, Horovitz M (2011) The occurrence of challenging behaviours in children with autism spectrum disorders and atypical development. Dev Neurorehab 14(4):221–229 CrossRef Hattier MA, Matson JL, Belva BC, Horovitz M (2011) The occurrence of challenging behaviours in children with autism spectrum disorders and atypical development. Dev Neurorehab 14(4):221–229 CrossRef
2.
go back to reference Lecavalier L, Leone S, Wiltz J (2006) The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. J Intellect Disabil Res 50(3):172–183 CrossRefPubMed Lecavalier L, Leone S, Wiltz J (2006) The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. J Intellect Disabil Res 50(3):172–183 CrossRefPubMed
3.
go back to reference Cohen IL, Yoo JH, Goodwin MS, Moskowitz L (2011) Assessing challenging behaviors in Autism Spectrum Disorders: Prevalence, rating scales, and autonomic indicators. Int Handb Autism Pervas Dev Dis Springer. p. 247–270. Available from: http://​link.​springer.​com/​chapter/​ https://​doi.​org/​10.​1007/​978-1-4419-8065-6_​15 [Accessed Apr 3, 2016] Cohen IL, Yoo JH, Goodwin MS, Moskowitz L (2011) Assessing challenging behaviors in Autism Spectrum Disorders: Prevalence, rating scales, and autonomic indicators. Int Handb Autism Pervas Dev Dis Springer. p. 247–270. Available from: http://​link.​springer.​com/​chapter/​ https://​doi.​org/​10.​1007/​978-1-4419-8065-6_​15 [Accessed Apr 3, 2016]
4.
go back to reference Hastings RP, Brown T (2002) Coping strategies and the impact of challenging behaviors on special educators’ burnout. Ment Retard 40(2):148–156 CrossRefPubMed Hastings RP, Brown T (2002) Coping strategies and the impact of challenging behaviors on special educators’ burnout. Ment Retard 40(2):148–156 CrossRefPubMed
7.
go back to reference Thompson RA (1994) Emotion regulation: a theme in search of definition. Monogr Soc Res Child Dev 59(2–3):25–52 CrossRefPubMed Thompson RA (1994) Emotion regulation: a theme in search of definition. Monogr Soc Res Child Dev 59(2–3):25–52 CrossRefPubMed
9.
go back to reference Siegel M (2018) Arousal, emotion regulation and challenging behaviors: Insights from the Autism Inpatient Collection Siegel M (2018) Arousal, emotion regulation and challenging behaviors: Insights from the Autism Inpatient Collection
10.
go back to reference Carlson GA, Singh MK (2021) Emotion dysregulation and outbursts in children and adolescents: Part I Carlson GA, Singh MK (2021) Emotion dysregulation and outbursts in children and adolescents: Part I
11.
go back to reference Beauchaine TP (2015) Future directions in emotion dysregulation and youth psychopathology. J Clin Child Adolesc Psychol 44(5):875–896 CrossRefPubMed Beauchaine TP (2015) Future directions in emotion dysregulation and youth psychopathology. J Clin Child Adolesc Psychol 44(5):875–896 CrossRefPubMed
12.
go back to reference Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, Ripperger-Suhler J, Rockhill C (2020) Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry Elsevier 59(10):1107–1124 Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, Ripperger-Suhler J, Rockhill C (2020) Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry Elsevier 59(10):1107–1124
13.
go back to reference Vivanti G, Messinger DS (2021) Theories of autism and autism treatment from the dsm iii through the present and beyond: impact on research and practice. J Autism Dev Disord Springer; 1–12 Vivanti G, Messinger DS (2021) Theories of autism and autism treatment from the dsm iii through the present and beyond: impact on research and practice. J Autism Dev Disord Springer; 1–12
14.
go back to reference Demchak M, Sutter C, Grumstrup B, Forsyth A, Grattan J, Molina L, Fields CJ (2020) Applied behavior analysis: Dispelling associated myths. Interv Sch Clin SAGE Publications Sage CA: Los Angeles, CA 55(5):307–312 Demchak M, Sutter C, Grumstrup B, Forsyth A, Grattan J, Molina L, Fields CJ (2020) Applied behavior analysis: Dispelling associated myths. Interv Sch Clin SAGE Publications Sage CA: Los Angeles, CA 55(5):307–312
15.
go back to reference Lovaas OI (1987) Behavioral treatment and normal educational and intellectual functioning in young autistic children. J Consult Clin Psychol 55(1):3–9 CrossRefPubMed Lovaas OI (1987) Behavioral treatment and normal educational and intellectual functioning in young autistic children. J Consult Clin Psychol 55(1):3–9 CrossRefPubMed
16.
go back to reference Lovaas OI, Smith T (2003) Early and intensive behavioral intervention in autism Lovaas OI, Smith T (2003) Early and intensive behavioral intervention in autism
17.
go back to reference Baer DM, Wolf MM, Risley TR (1968) Some current dimensions of applied behavior analysis. J Appl Behav Anal Soc Experim Anal Behav 1(1):91 CrossRef Baer DM, Wolf MM, Risley TR (1968) Some current dimensions of applied behavior analysis. J Appl Behav Anal Soc Experim Anal Behav 1(1):91 CrossRef
18.
go back to reference Horner RH, Carr EG, Strain PS, Todd AW, Reed HK (2002) Problem behavior interventions for young children with autism: A research synthesis. J Autism Dev Disord Springer; 32(5):423–446 Horner RH, Carr EG, Strain PS, Todd AW, Reed HK (2002) Problem behavior interventions for young children with autism: A research synthesis. J Autism Dev Disord Springer; 32(5):423–446
19.
go back to reference Machalicek W, O’Reilly MF, Beretvas N, Sigafoos J, Lancioni GE (2007) A review of interventions to reduce challenging behavior in school settings for students with autism spectrum disorders. Res Autism Spectr Disord 1(3):229–246 CrossRef Machalicek W, O’Reilly MF, Beretvas N, Sigafoos J, Lancioni GE (2007) A review of interventions to reduce challenging behavior in school settings for students with autism spectrum disorders. Res Autism Spectr Disord 1(3):229–246 CrossRef
20.
go back to reference Martinez JR, Werch BL, Conroy MA (2016) School-based interventions targeting challenging behaviors exhibited by young children with autism spectrum disorder: A systematic literature review. Educ Train Autism Dev Disabil JSTOR 265–280 Martinez JR, Werch BL, Conroy MA (2016) School-based interventions targeting challenging behaviors exhibited by young children with autism spectrum disorder: A systematic literature review. Educ Train Autism Dev Disabil JSTOR 265–280
21.
go back to reference Steinbrenner JR, Hume K, Odom SL, Morin KL, Nowell SW, Tomaszewski B, Szendrey S, McIntyre NS, Yücesoy-Özkan S, Savage MN (2020) Evidence-based practices for children, youth, and young adults with Autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team Steinbrenner JR, Hume K, Odom SL, Morin KL, Nowell SW, Tomaszewski B, Szendrey S, McIntyre NS, Yücesoy-Özkan S, Savage MN (2020) Evidence-based practices for children, youth, and young adults with Autism. The University of North Carolina at Chapel Hill, Frank Porter Graham Child Development Institute, National Clearinghouse on Autism Evidence and Practice Review Team
22.
go back to reference Conroy MA, Dunlap G, Clarke S, Alter PJ (2005) A descriptive analysis of positive behavioral intervention research with young children with challenging behavior. Top Early Child Spec Educ Sage Publications Sage CA: Los Angeles, CA 25(3):157–166 Conroy MA, Dunlap G, Clarke S, Alter PJ (2005) A descriptive analysis of positive behavioral intervention research with young children with challenging behavior. Top Early Child Spec Educ Sage Publications Sage CA: Los Angeles, CA 25(3):157–166
24.
go back to reference Brookman-Frazee L, Stadnick NA, Lind T, Roesch S, Terrones L, Barnett ML, Regan J, Kennedy CA, F Garland A, Lau AS (2021) Therapist-observer concordance in ratings of EBP strategy delivery: Challenges and targeted directions in pursuing pragmatic measurement in children’s mental health services. Adm Policy Ment Health Ment Health Serv Res Springer; 48:155–170 Brookman-Frazee L, Stadnick NA, Lind T, Roesch S, Terrones L, Barnett ML, Regan J, Kennedy CA, F Garland A, Lau AS (2021) Therapist-observer concordance in ratings of EBP strategy delivery: Challenges and targeted directions in pursuing pragmatic measurement in children’s mental health services. Adm Policy Ment Health Ment Health Serv Res Springer; 48:155–170
25.
go back to reference Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ British Med J Publish Group; 372:n71 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ British Med J Publish Group; 372:n71
26.
go back to reference Beck KB, Conner CM, Breitenfeldt KE, Northrup JB, White SW, Mazefsky CA (2020) Assessment and treatment of emotion regulation impairment in autism spectrum disorder across the life span: Current state of the science and future directions. Child Adolesc Psychiatr Clin Elsevier 29(3):527–542 Beck KB, Conner CM, Breitenfeldt KE, Northrup JB, White SW, Mazefsky CA (2020) Assessment and treatment of emotion regulation impairment in autism spectrum disorder across the life span: Current state of the science and future directions. Child Adolesc Psychiatr Clin Elsevier 29(3):527–542
27.
go back to reference Gerow S, Radhakrishnan S, Davis TN, Zambrano J, Avery S, Cosottile DW, Exline E (2021) Parent-implemented brief functional analysis and treatment with coaching via telehealth. J Appl Behav Anal Wiley Online Library 54(1):54–69 Gerow S, Radhakrishnan S, Davis TN, Zambrano J, Avery S, Cosottile DW, Exline E (2021) Parent-implemented brief functional analysis and treatment with coaching via telehealth. J Appl Behav Anal Wiley Online Library 54(1):54–69
28.
go back to reference Carr EG, Smith CE (1995) Biological setting events for self-injury. Ment Retard Dev Disabil Res Rev Wiley Online Library 1(2):94–98 Carr EG, Smith CE (1995) Biological setting events for self-injury. Ment Retard Dev Disabil Res Rev Wiley Online Library 1(2):94–98
29.
go back to reference Sofronoff K, Attwood T, Hinton S, Levin I (2007) A randomized controlled trial of a cognitive behavioural intervention for anger management in children diagnosed with Asperger syndrome. J Autism Dev Disord Springer 37(7):1203–1214 Sofronoff K, Attwood T, Hinton S, Levin I (2007) A randomized controlled trial of a cognitive behavioural intervention for anger management in children diagnosed with Asperger syndrome. J Autism Dev Disord Springer 37(7):1203–1214
30.
go back to reference Scarpa A, Reyes NM (2011) Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders: A pilot study. Cambridge University Press Scarpa A, Reyes NM (2011) Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders: A pilot study. Cambridge University Press
32.
go back to reference Nuske HJ, Finkel E, Pellecchia M, Herrington JD, Parma V, Hedley D, Dissanayake C (2018) A window of opportunity for preventing challenging behavior: Increase in heartrate prior to episodes of challenging behavior in preschoolers with autism Nuske HJ, Finkel E, Pellecchia M, Herrington JD, Parma V, Hedley D, Dissanayake C (2018) A window of opportunity for preventing challenging behavior: Increase in heartrate prior to episodes of challenging behavior in preschoolers with autism
33.
go back to reference Nuske HJ, Hedley D, Tomczuk L, Finkel E, Thomson P, Dissanayake C (2018) Emotional coherence difficulties in preschoolers with autism: evidence from internal physiological and external communicative discoordination Nuske HJ, Hedley D, Tomczuk L, Finkel E, Thomson P, Dissanayake C (2018) Emotional coherence difficulties in preschoolers with autism: evidence from internal physiological and external communicative discoordination
36.
go back to reference Mackay BA, Shochet IM, Orr JA (2017) A pilot randomised controlled trial of a school-based resilience intervention to prevent depressive symptoms for young adolescents with autism spectrum disorder: a mixed methods analysis. J Autism Dev Disord Springer 47(11):3458–3478 Mackay BA, Shochet IM, Orr JA (2017) A pilot randomised controlled trial of a school-based resilience intervention to prevent depressive symptoms for young adolescents with autism spectrum disorder: a mixed methods analysis. J Autism Dev Disord Springer 47(11):3458–3478
37.
go back to reference Parent V, Birtwell KB, Lambright N, DuBard M (2016) Combining CBT and behavior-analytic approaches to target severe emotion dysregulation in verbal youth with ASD and ID. J Ment Health Res Intellect Disabil Taylor & Francis 9(1–2):60–82 Parent V, Birtwell KB, Lambright N, DuBard M (2016) Combining CBT and behavior-analytic approaches to target severe emotion dysregulation in verbal youth with ASD and ID. J Ment Health Res Intellect Disabil Taylor & Francis 9(1–2):60–82
38.
go back to reference Mazefsky C (2021) Emotion Awareness and Skills Enhancement (EASE) Program: A Clinical Trial. clinicaltrials.gov; 2020 Aug. Report No.: NCT03432832. Available from: https://​clinicaltrials.​gov/​ct2/​show/​NCT03432832 [Accessed Jul 1, 2021] Mazefsky C (2021) Emotion Awareness and Skills Enhancement (EASE) Program: A Clinical Trial. clinicaltrials.gov; 2020 Aug. Report No.: NCT03432832. Available from: https://​clinicaltrials.​gov/​ct2/​show/​NCT03432832 [Accessed Jul 1, 2021]
39.
go back to reference Cole PM (2014) Moving ahead in the study of the development of emotion regulation. Int J Behav Dev Sage Publications Sage UK: London, England 38(2):203–207 Cole PM (2014) Moving ahead in the study of the development of emotion regulation. Int J Behav Dev Sage Publications Sage UK: London, England 38(2):203–207
40.
go back to reference Crowley SM, Sandbank MP, Bottema-Beutel K, Woynaroski TG (2021) The quality of studies in autism early childhood intervention research. INSAR 2021 INSAR Crowley SM, Sandbank MP, Bottema-Beutel K, Woynaroski TG (2021) The quality of studies in autism early childhood intervention research. INSAR 2021 INSAR
Metadata
Title
Systematic review: emotion dysregulation and challenging behavior interventions for children and adolescents on the autism spectrum with graded key evidence-based strategy recommendations
Authors
Heather J. Nuske
Amanda V. Young
Farzana Y. Khan
Emma H. Palermo
Bukola Ajanaku
Melanie Pellecchia
Giacomo Vivanti
Carla A. Mazefsky
Lauren Brookman-Frazee
James C. McPartland
Matthew S. Goodwin
David S. Mandell
Publication date
22-09-2023
Publisher
Springer Berlin Heidelberg
Published in
European Child & Adolescent Psychiatry
Print ISSN: 1018-8827
Electronic ISSN: 1435-165X
DOI
https://doi.org/10.1007/s00787-023-02298-2