Emotion regulation impairments are common among individuals with autism spectrum disorder and are believed to often underlie commonly seen problems with aggression, depression, and anxiety. The Emotional Awareness and Skills Enhancement program was developed to reduce emotion regulation impairment and thereby improve behavioral disturbance, via mindfulness. Emotional Awareness and Skills Enhancement consists of a 16-week individual therapy treatment targeting emotion regulation impairments among individuals with autism spectrum disorder. We describe the conceptual framework and development of the program and present data on feasibility and preliminary efficacy from a pilot trial. The Emotional Awareness and Skills Enhancement manual was developed using a participatory action framework, based on emotion regulation research specific to autism spectrum disorder and input from individuals with autism spectrum disorder, therapists, and parents of children with autism spectrum disorder. Emotional Awareness and Skills Enhancement was piloted in a two-site open trial with 20 participants with autism spectrum disorder (12–17 years old, confirmed autism spectrum disorder diagnosis, IQ > 80).Outcome data support program feasibility and acceptability to participants, as well as significant improvement in emotion regulation impairments and related concerns.Findings offer preliminary support for both the feasibility and clinical effectiveness of the Emotional Awareness and Skills Enhancement program.
AldaoANolen-HoeksemaS (2012) The influence of context on the implementation of adaptive emotion regulation strategies. Behaviour Research and Therapy50(7–8): 493–501.
2.
AldaoANolen-HoeksemaSSchweizerS (2010) Emotion-regulation strategies across psychopathology: a meta-analytic review. Clinical Psychology Review30(2): 217–237.
3.
AmanMG (2012) Annotated Biography on the Aberrant Behavior Checklist (ABC) (Unpublished Manuscript). Columbus, OH: The Ohio State University.
4.
AmanMGSinghNNStewartAWet al. (1985) The aberrant behavior checklist: a behavior rating scale for the assessment of treatment effects. American Journal of Mental Deficiency89(5): 485–491.
5.
ArnettJJ (2000) Emerging adulthood: a theory of development from the late teens through the twenties. The American Psychologist55(5): 469–480.
6.
BaerRA (2003) Mindfulness training as a clinical intervention: a conceptual and empirical review. Psychological Science10: 125–143.
BarlowDHAllenLBChoateML (2004) Toward a unified treatment for emotional disorders. Behavior Therapy35(2): 205–230.
9.
Bishop-FitzpatrickLMinshewNJEackSM (2013) A systematic review of psychosocial interventions for adults with autism spectrum disorders. Journal of Autism and Developmental Disorders43(3): 687–694.
10.
Blakeley-SmithAReavenJRidgeKet al. (2012) Parent–child agreement of anxiety symptoms in youth with autism spectrum disorders. Research in Autism Spectrum Disorders6(2): 707–716.
11.
CachiaRLAndersonAMooreDW (2016) Mindfulness in individuals with autism spectrum disorder: a systematic review and narrative analysis. Journal of Autism and Developmental Disorders3(2): 165–178.
12.
CaiRYRichdaleALDissanayakeCet al. (2018a) Emotion regulation in autism: reappraisal and suppression interactions. Autism Research. Epub ahead of print 1 May 2018. DOI: 10.1177/1362361318774558.
13.
CaiRYRichdaleALUljarevicMet al. (2018b) Emotion regulation in autism spectrum disorder: where we are and where we need to go. Autism Research11: 962–978.
14.
ChiesaAMalinowskiP (2011) Mindfulness-based approaches: are they all the same?Journal of Clinical Psychology67(4): 404–424.
ConnerCMWhiteSW (2018) Brief report: feasibility and preliminary efficacy of individual mindfulness therapy for adults with autism spectrum disorder. Journal of Autism and Developmental Disorders48(1): 390–400.
17.
Connor-SmithJCompassBEWadsworthMEet al. (2000) Responses to stress in adolescence: measurement of coping and involuntary stress responses. Journal of Consulting and Clinical Psychology68(6): 976–992.
18.
CooperKLoadesMERusselA (2018) Adapting psychological therapies for autism. Research in Autism Spectrum Disorders45: 43–50.
19.
CroneEADahlRE (2012) Understanding adolescence as a period of social-affective engagement and goal flexibility. Nature Reviews Neuroscience13(9): 636–650.
20.
DahlREGunnarMR (2009) Heightened stress responsiveness and emotional reactivity during pubertal maturation: implications for psychopathology. Development and Psychopathology21(1): 1–6.
21.
DavidsonRJKabat-ZinnJSchmacherJet al. (2003) Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic Medicine65(4): 564–570.
22.
De los ReyesAAugensteinTMWangMet al. (2015) The validity of the multi-informant approach to assessing child and adolescent mental health. Psychological Bulletin141(4): 858–900.
23.
EliasRWhiteSW (2018) Autism goes to college: understanding the needs of a student population on the rise. Journal of Autism and Developmental Disorders48(3): 732–746.
24.
GatesJAKangELernerMD (2017) Efficacy of group social skills interventions for youth with autism spectrum disorder: a systematic review and meta-analysis. Clinical Psychology Review52: 164–181.
25.
GothamKBishopSLBrunwasserSet al. (2015) Rumination and perceived impairment associated with depressive symptoms in a verbal adolescent-adult ASD sample. Autism Research7(3): 381–391.
26.
GotinkRAChuPBusschbachJJVet al. (2015) Standardised mindfulness-based interventions in healthcare: an overview of systematic reviews and meta-analyses of RCTs. PLoS ONE10(4): e0124344.
27.
GriffinCLombardoMVAuyeungB (2016) Alexithymia in children with and without autism spectrum disorders. Autism Research9(7): 773–780.
28.
GrossJJJazaieriH (2014) Emotion, emotion regulation, and psychopathology: an affective science perspective. Clinical Psychological Science2(4): 387–401.
29.
GrossJJThompsonRA (2006) Emotion regulation: conceptual foundations. In: GrossJJ (ed.) Handbook of Emotion Regulation. New York: Guilford Press, pp.3–26.
30.
GuJStraussCBondRet al. (2015) How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? a systematic review and meta-analysis of mediation studies. Clinical Psychology Review37: 1–12.
31.
GuyW (1976) Clinical global impressions. In: GuyW(ed) ECDEU Assessment Manual for Psychopharmacology, Revised. Rockville, MD: National Institute of Mental Health, pp.218–222.
32.
HamletonR (1991) Fundamentals of item response theory. In: LordF (ed) Applications of Item Response Theory to Practical Testing Problems. Mahwah, NJ: Lawrence Erlbaum, p.274.
33.
HayesSCStrosahlKDWilsonKG (1999) Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. New York: Guilford Press.
34.
HerbertJDFormanEM (2011) Evolution of cognitive behavior therapy: the rise of psychological acceptance and mindfulness. In: HerbertJDFormanEM (eds) Acceptance and Mindfulness in Cognitive Behavior Therapy. Hoboken, NJ: John Wiley, pp.1–25.
35.
HollocksMJPicklesAHowlinPet al. (2016) Dual cognitive and biological correlates of anxiety in autism spectrum disorders. Journal of Autism and Developmental Disorders46(10): 3295–3307.
36.
HölzelBKCarmodyJVangelMet al. (2011) Mindfulness practice leads to increases in regional brain gray matter density. Psychiatry Research: Neuroimaging191(1): 36–43.
IrwinDEStuckyBLangerMMet al. (2010) An item response analysis of the pediatric PROMIS anxiety and depressive symptoms scales. Quality of Life Research19(4): 595–607.
39.
Ives-DeliperiVLSolmsMMeintjesEM (2011) The neural substrates of mindfulness: an fMRI investigation. Social Neuroscience6(3): 231–242.
40.
JahromiLBMeekSEOber-ReynoldsS (2012) Emotion regulation in the context of frustration in children with high functioning autism and their typical peers. Journal of Child Psychology and Psychiatry and Allied Disciplines53(12): 1250–1258.
41.
Kabat-ZinnJ (1990) Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York: Delacorte.
42.
Kabat-ZinnJLipworthLBurneyR (1985) The clinical use of mindfulness meditation for the self-regulation of chronic pain. Journal of Behavioral Medicine8(2): 163–190.
43.
KesslerRCChiuWTDemlerOet al. (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry62(6): 617–627.
44.
KhorASMelvinGAReidSCet al. (2014) Coping, daily hassles and behavior and emotional problems in adolescents with high-functioning autism/Asperger’s disorder. Journal of Autism and Developmental Disorders44: 593–608.
KonstantareasMMStewartK (2006) Affect regulation and temperament in children with autism spectrum disorder. Journal of Autism and Developmental Disorders36(2): 143–154.
47.
KraemerHCMorganGALeechNLet al. (2003) Measures of clinical significance. Journal of the American Academy of Child and Adolescent Psychiatry42(12): 1524–1529.
48.
LeonACDavisLLKraemerHC (2011) The role and interpretation of pilot studies in clinical research. Journal of Psychiatric Research45(5): 626–629.
49.
LernerMDCalhounCDMikamiAYet al. (2012) Understanding parent-child social informant discrepancy in youth with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders42(12): 2680–2692.
50.
LickelAMacLeanWEBlakeley-SmithAet al. (2012) Assessment of the prerequisite skills for cognitive behavioral therapy in children with and without autism spectrum disorders. Journal of Autism and Developmental Disorders42(6): 992–1000.
51.
LordCRutterMDiLavorePCet al. (2012) Autism Diagnostic Observation Schedule-2. Los Angeles: Western Psychological Services.
52.
McEvoyPMNathanPNortonPJ (2009) Efficacy of transdiagnostic treatments: a review of published outcome studies and future research directions. Journal of Cognitive Psychotherapy23(1): 20–33.
53.
MaddoxBBWhiteSW (2015) Comorbid social anxiety disorder in adults with autism spectrum disorder. Journal of Autism and Developmental Disorders45(12): 3949–3960.
54.
MazefskyCA (2015) Emotion regulation and emotional distress in autism spectrum disorder: foundations and considerations for future research. Journal of Autism and Developmental Disorders45(11): 3405–3408.
55.
MazefskyCAWhiteSW (2014) Emotion regulation. Child and Adolescent Psychiatric Clinics of North America23(1): 15–24.
56.
MazefskyCABorueXDayTNet al. (2014) Emotion regulation patterns in adolescents with high-functioning autism spectrum disorder: comparison to typically developing adolescents and association with psychiatric symptoms. Autism Research7(3): 344–354.
57.
MazefskyCADayTNSiegelMet al. (2018a) Development of the Emotion Dysregulation Inventory: a PROMIS®ing method for creating sensitive and unbiased questionnaires for autism spectrum disorder. Journal of Autism and Developmental Disorders48(11): 3736–3746.
58.
MazefskyCAHerringtonJSiegelMet al. (2013) The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child and Adolescent Psychiatry52(7): 679–688.
59.
MazefskyCAKaoJOswaldDP (2011) Preliminary evidence suggesting caution in the use of psychiatric self-report measures with adolescents with high-functioning autism spectrum disorders. Research in Autism Spectrum Disorders5(1): 164–174.
60.
MazefskyCAYuLWhiteSWet al. (2018b) The Emotion Dysregulation Inventory: psychometric properties and item response theory calibration in an autism spectrum disorder sample. Autism Research11: 928–941.
61.
McCrackenJTMcGoughJShahBet al. (2002) Risperidone in children with autism and serious behavioral problems. The New England Journal of Medicine347(5): 314–321.
62.
NicolaidisCRaymakerDMcdonaldKet al. (2011) Collaboration strategies in nontraditional community-based participatory research partnerships: lessons from an academic–community partnership with autistic self-advocates. Progress in Community Health Partnerships5(2): 143–150.
63.
NortonPJBarreraTL (2012) Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: a preliminary randomized controlled noninferiority trial. Depression and Anxiety29(10): 874–882.
64.
PicciGScherfKS (2015) A two-hit model of autism: adolescence as the second hit. Clinical Psychological Science3(3): 349–371.
65.
RieffeCDe RooijM (2012) The longitudinal relationship between emotion awareness and internalising symptoms during late childhood. European Child & Adolescent Psychiatry21(6): 349–356.
66.
RieffeCOosterveldPMiersACet al. (2008) Emotion awareness and internalising symptoms in children and adolescents: the Emotion Awareness Questionnaire revised. Personality and Individual Differences45(8): 756–761.
67.
RieffeCOosterveldPTerwogtMMet al. (2011) Emotion regulation and internalizing symptoms in children with autism spectrum disorders. Autism15(6): 655–670.
68.
SamsonACHardanAYLeeIAet al. (2015a) Maladaptive behavior in autism spectrum disorder: the role of emotion experience and emotion regulation. Journal of Autism and Developmental Disorders45(11): 3424–3432.
69.
SamsonACHuberOGrossJJ (2012) Emotion regulation in Asperger’s syndrome and high-functioning autism. Emotion12(4): 659–665.
70.
SamsonACPhillipsJMParkerKJet al. (2014) Emotion dysregulation and the core features of autism spectrum disorder. Journal of Autism and Developmental Disorders44: 1766–1772.
71.
SamsonACWellsWMPhillipsJMet al. (2015b) Emotion regulation in autism spectrum disorder: evidence from parent interviews and children’s daily diaries. Journal of Child Psychology and Psychiatry and Allied Disciplines56(8): 903–913.
72.
SaqrYBraunEPorterKet al. (2018) Addressing medical needs of adolescents and adults with autism spectrum disorders in a primary care setting. Autism22(1): 51–61.
73.
ScarpaAWellsAAttwoodT (2012) Exploring Feelings for Young Children with High-Functioning Autism or Asperger’s Disorder: The STAMP Treatment Manual. London: Jessica Kingsley Publishers.
74.
ScarpaAWhiteSWAttwoodT (eds.) (2013) CBT for Children and Adolescents with High-Functioning Autism Spectrum Disorders. New York: Guilford Press.
75.
SegalZVWilliamsJMGTeasdaleJD (2002) Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Relapse Prevention. New York: Guilford Press.
76.
SeltzerMMShattuckPAbbedutoLet al. (2004) Trajectory of development in adolescents and adults with autism. Developmental Disabilities Research Reviews10(4): 234–247.
77.
SempleRJLeeJ (2007) Mindfulness-Based Cognitive Therapy for Anxious Children: A Manual for Treating Childhood Anxiety. Oakland, CA: New Harbinger Publications.
78.
SimonoffEPicklesACharmanTet al. (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. Journal of the American Academy of Child and Adolescent Psychiatry47: 921–929.
79.
SinghNNLancioniGEManikamRet al. (2011a) A mindfulness-based strategy for self-management of aggressive behavior in adolescents with autism. Research in Autism Spectrum Disorders5(3): 1153–1158.
80.
SinghNNLancioniGESinghADAet al. (2011b) Adolescents with Asperger syndrome can use a mindfulness-based strategy to control their aggressive behavior. Research in Autism Spectrum Disorders5(3): 1103–1109.
81.
SmithTScahillLDawsonGet al. (2007) Designing research studies on psychosocial interventions in autism. Journal of Autism and Developmental Disorders37(2): 354–366.
82.
SofronoffKAttwoodTHintonSet al. (2007) A randomized controlled trial of a cognitive behavioural intervention for anger management in children diagnosed with Asperger syndrome. Journal of Autism and Developmental Disorders37(7): 1203–1214.
83.
SpekAAvan HamNCNyklíčekI (2013) Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. Research in Developmental Disabilities34(1): 246–253.
84.
StahlBGoldsteinE (2010) A Mindfulness-Based Stress Reduction Workbook. Oakland, CA: New Harbinger Publications.
85.
TaylorJLSeltzerMM (2012) Employment and post-secondary educational activities for young adults with autism spectrum disorders during the transition to adulthood. Journal of Autism and Developmental Disorders41(5): 566–574.
86.
ThomsonKBurnham RiosaPWeissJA (2015) Brief report of preliminary outcomes of an emotion regulation intervention for children with autism spectrum disorder. Journal of Autism and Developmental Disorders45(11): 3487–3495.
WeissJA (2014) Transdiagnostic case conceptualization of emotional problems in youth with ASD: an emotion regulation approach. Clinical Psychology: Science and Practice21(4): 331–350.
89.
WeissJAMazefskyCARiosaPRet al. (2017) Autism spectrum disorder. In: EssauCOllendickT (eds) Emotion Regulation and Psychopathology in Children and Adolescents. Oxford: Oxford University Press, p.480.
90.
WeissJAThomsonKChanL (2014) A systematic literature review of emotion regulation measurement in individuals with autism spectrum disorder. Autism Research7(6): 629–648.
91.
WestonLHodgekinsJLangdonPE (2016) Effectiveness of cognitive behavioural therapy with people who have autistic spectrum disorders: a systematic review and meta-analysis. Clinical Psychology Review49: 41–54.
92.
WhiteSW (2008) Multimodal anxiety and social skills intervention manual. Unpublished Treatment Manual.
93.
WhiteSWEliasRCapriola-HallNNet al. (2017) Development of a college transition and support program for students with autism spectrum disorder. Journal of Autism and Developmental Disorders47(10): 3072–3078.
94.
WhiteSWEliasRSalinasCEet al. (2016) Students with autism spectrum disorder in college: results from a preliminary mixed methods needs analysis. Research in Developmental Disabilities56: 29–40.
95.
WhiteSWMazefskyCADichterGSet al. (2014) Social-cognitive, physiological, and neural mechanisms underlying emotion regulation impairments: understanding anxiety in autism spectrum disorder. International Journal of Developmental Neuroscience39: 22–36.
96.
WhiteSWOllendickTAlbanoAMet al. (2013) Randomized controlled trial: multimodal anxiety and social skill intervention for adolescents with autism spectrum disorder. Journal of Autism and Developmental Disorders43(2): 382–394.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
