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Cited by 323Autism Spectrum Disorder ResearchChild and Adolescent Psychosocial and Emotional DevelopmentChild Nutrition and Feeding Issues

Emotion Regulation

Open access
Mazefsky, Carla A., White, Susan W.·2014·Child and Adolescent Psychiatric Clinics of North America
DOI 10.1016/j.chc.2013.07.002PMC PMC3830422
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Abstract

The purpose of this article is to describe emotion regulation, and how emotion regulation may be compromised in patients with autism spectrum disorder (ASD). This information may be useful for clinicians working with children with ASD who exhibit behavioral problems. Suggestions for practice are provided.

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Registry

Crossref · 10.1016/j.chc.2013.07.002

Cites

60 of 60 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 56 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Impulsivity and impaired inhibition are present in as many as 50% of children with autism spectrum disorder.

    “Impulsivity and impaired inhibition, which are present in as many as 50% of children with ASD,26”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Murray, 2010, Attention-deficit/hyperactivity disorder in the context of autism spectrum disorders, Curr Psychiatry Rep source

      Not checked in the free run.

  • Premisecitation

    Disrupted emotion regulation is likely a significant factor in producing aberrant behavior in autism spectrum disorder.

    “Although much less studied in autism spectrum disorder (ASD) than in other psychiatric disorders, disrupted ER is likely to be a significant factor in producing aberrant behavior in ASD as well.10,11”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [10] Mazefsky, 2013, The role of emotion regulation in autism spectrum disorders, J Am Acad Child Psychiatry source

      Not checked in the free run.

    • cites [11] Mazefsky, 2012, The need for a broader approach to emotion regulation research in autism, Child Dev Perspect source

      Not checked in the free run.

  • Interpretationreasoning

    Serious behavioral disturbance is one likely manifestation of emotion regulation failure in autism spectrum disorder.

    “One likely manifestation of ER failure in ASD is serious behavioral disturbance.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Recognizing and understanding one's own emotions is necessary for effortful emotion regulation.

    “Although not essential for all forms of ER, recognizing and understanding your own emotions is necessary for effortful ER.20”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [20] Ciarrochi, 2008, The link between emotion identification skills and socio-emotional functioning in early adolescence: a 1-year longitudinal study, J Adolesc

      Not checked in the free run.

  • Premisecitation

    Inappropriate behavioral reactions in autism spectrum disorder more often stem from ineffective management of emotional states in response to stress or overstimulation than from defiance or deliberate behavior.

    “While this interpretation is likely accurate in some circumstances, it is more often the case that these inappropriate behavioral reactions stem from ineffective management of emotional states in response to stress or overstimulation.12”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] Konstantareas, 2006, Affect regulation and temperament in children with autism spectrum disorder, J Autism Dev Disord source

      Not checked in the free run.

  • May combine two claims. 11
  • Classified as probably not a substantial claim. 7

  • May combine two claims.

    Interpretationcitation

    Children with autism spectrum disorder may focus on the wrong information or misinterpret others' intentions due to failures in perspective-taking and lack of appreciation of others' perceptions and experiences, which could increase frustration.

    “Children with ASD may focus on the wrong information or misinterpret others’ intentions due to failures in perspective-taking and lack of appreciation of others’ perceptions and experiences (e.g., theory of mind deficits),25 which could increase frustration.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Baron-Cohen, 1997

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    Many secondary psychiatric problems in autism spectrum disorder may be more accurately conceptualized as part of autism spectrum disorder itself or as stemming from a fundamental problem in emotion regulation.

    “Many ‘secondary’ psychiatric problems may be more accurately conceptualized as part of the ASD itself or may stem from a fundamental problem in ER.10”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] Mazefsky, 2013, The role of emotion regulation in autism spectrum disorders, J Am Acad Child Psychiatry source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The mechanisms that produce emotional dysregulation and the way emotion regulation manifests are more specific to each disorder.

    “The mechanisms that give rise to emotional dysregulation and how ER manifests itself, however, are more disorder-specific.9”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] Aldao, 2010, Emotion-regulation strategies across psychopathology: a meta-analytic review, Clin Psychol Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Labeling one's emotion has been proposed as critical to successful emotion regulation.

    “Labeling of one’s emotion has been proposed as critical to successful ER,21”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] Barrett, 2001, Knowing what you’re feeling and knowing what to do about it: mapping the relation between emotion differentiation and emotion regulation, Cogn Emot source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Core deficits in theory of mind may be related to poor emotion regulation in autism spectrum disorder.

    “As proposed by Samson, Huber, and Gross,23 core deficits in theory of mind, or ability to take others’ perspectives cognitively and affectively and to recognize one’s own state of mind, may be related to poor ER.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] Samson, 2012, Emotion regulation in Asperger’s syndrome and high-functioning autism, Emotion source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Individuals with autism spectrum disorder tend to engage in suppression and struggle with reappraisal.

    “In light of evidence that individuals with ASD tend to engage in suppression and struggle with reappraisal, targeting increased cognitive flexibility in treatment is recommended.23”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [23] Samson, 2012, Emotion regulation in Asperger’s syndrome and high-functioning autism, Emotion source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Incredible Five Point Scale is widely used to teach basic emotion skills.

    “One example of a visual system that is widely used to teach these basic emotion skills is The Incredible Five Point Scale.55”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [55] Buron, 2003

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Exploring Feelings program is a cognitive-behavioral therapy-based intervention for school-age children with specific curricula for anxiety and for anger.

    “The Exploring Feelings program42 is a CBT-based intervention for school-age children, with specific curricula for anxiety and for anger.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [42] Attwood, 2004, Cognitive behaviour therapy for children and adults with Asperger’s syndrome, Behav Change source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Mindfulness and acceptance-based interventions are associated with strong and durable improvements in symptoms of anxiety and depression and increased use of adaptive emotion regulation strategies.

    “MABIs are associated with strong and durable improvements in symptoms of anxiety and depression and increased use of adaptive ER strategies,49”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [49] Kumar, 2008, Changes in mindfulness and emotion regulation in an exposure-based cognitive therapy for depression, Cognit Ther Res source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Many cognitive regulatory strategies, such as suppression and rumination, load onto a single latent factor and are more strongly associated with psychopathology than adaptive cognitive strategies such as reappraisal and problem-solving.

    “There is empirical evidence that many of the cognitive regulatory strategies (i.e., suppression, rumination) load onto a single latent factor and that these cognitive strategies are more strongly associated with psychopathology than adaptive cognitive strategies (e.g., reappraisal, problem-solving).9”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Aldao, 2010, Emotion-regulation strategies across psychopathology: a meta-analytic review, Clin Psychol Rev source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A premise of dialectical behavior therapy is balancing acceptance of self with desire for change.

    “Indeed, a premise of dialectical behavior therapy (DBT46), a well-supported treatment for borderline personality disorder which is characterized by extreme emotion dysregulation, is balancing acceptance of self (as is) with desire for change.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Linehan, 1993

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The Exploring Feelings program was recently modified for use with younger children (5-7 years) with autism spectrum disorder, and results of an initial open trial indicated improvement in emotion lability and regulation.

    “This program was recently modified for use with younger children (5–7 years) with ASD,44 and results of an initial open trial indicated improvement in emotion lability and regulation.45”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [44] Scarpa, 2013

      Not checked in the free run.

    • cites [45] Scarpa, 2011, Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders: a pilot study, Behav Cogn Psychother source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    Clients may develop a default regulatory approach that overwhelms their ability to use newly learned, more adaptive strategies such as reappraisal.

    “Aldao and Nolen-Hoeksema9 proposed that clients may develop a ‘default’ regulatory approach that, in essence, overwhelms their ability to use newly learned, more adaptive strategies such as reappraisal.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Aldao, 2010, Emotion-regulation strategies across psychopathology: a meta-analytic review, Clin Psychol Rev source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    High rates of mood and anxiety disorders in first-degree family members of children with autism spectrum disorder and conceptualization of such problems as part of the broader autism phenotype raise the possibility of an underlying genetic predisposition to emotion regulation problems in autism spectrum disorder.

    “Finally, high rates of mood and anxiety disorders in the first degree family members of children with ASD,32,33 and conceptualization of such problems as part of the broader autism phenotype,34 raise the possibility of an underlying genetic predisposition to ER problems in ASD as well.”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [32] Mazefsky, 2008, Overrepresentation of mood and anxiety disorders in adults with autism and their first-degree relatives: what does it mean?, Autism Res source

      Not checked in the free run.

    • cites [33] Mazefsky, 2010, Association between depression and anxiety in high-functioning children with autism spectrum disorders and maternal mood symptoms, Autism Res source

      Not checked in the free run.

    • cites [34] Gerdts, 2011, The broader autism phenotype and its implications on the etiology and treatment of autism spectrum disorders, Autism Res Treat source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Dialectical behavior therapy is a well-supported treatment for borderline personality disorder, which is characterized by extreme emotion dysregulation.

    “Indeed, a premise of dialectical behavior therapy (DBT46), a well-supported treatment for borderline personality disorder which is characterized by extreme emotion dysregulation, is balancing acceptance of self (as is) with desire for change.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [46] Linehan, 1993

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Functional behavior analysis with individualized positive behavioral supports is rooted in a long history of behavioral analysis with a wealth of support for its effectiveness dating back to the 1960s.

    “This type of intervention is rooted in a long history of behavioral analysis that has a wealth of support for its effectiveness dating back to the 1960s.57”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [57] Iwata, 1994, Toward a functional analysis of self-injury, J Appl Behav Anal source

      Not checked in the free run.

16 of 16

  • The paper relies on this without support.

    There is a lack of evidence-based tools to accurately assess emotion regulation that have been validated in clients with autism spectrum disorder.

    “At this time, we lack evidence-based tools with which to accurately assess ER that have been validated in clients with ASD.”

  • The paper relies on this without support.

    There is little controlled clinical research on the efficacy of emotion regulation-focused interventions for people with autism spectrum disorder.

    “Although there is little controlled clinical research on the efficacy of ER-focused interventions for people with ASD, there are several plausible and potentially effective intervention approaches to consider.”

  • The paper relies on this without support.

    Evaluation of the relative import of various treatment components, including emotion regulation training, has not been conducted.

    “There is great variability in the degree to which ER training is included in such interventions, however, and evaluation of the relative import of various treatment components, including ER training, has not been conducted.”

  • The paper relies on this without support.

    Few treatment programs have been developed explicitly to improve emotion regulation ability in clients with autism spectrum disorder.

    “Few treatment programs have been developed explicitly to improve ER ability in clients with ASD.”

  • The paper relies on this without support.

    There have been no clinical trials and no published treatment outcome research on dialectical behavior therapy adapted for clients with autism spectrum disorder.

    “Although there has been consideration of how to adapt DBT for clients with ASD,47 there have been no clinical trials and there is no published treatment outcome research.”

  • The paper relies on this without support.

    There has not been any systematic research on The Incredible Five Point Scale.

    “Although there has not been any systematic research on this program, it was developed based on clinical experience, was designed specifically for ASD and related populations, and has been applied across the range of intellectual and verbal abilities.”

  • The paper relies on this without support.

    Research on emotion regulation in autism spectrum disorder is in its infancy.

    “Unfortunately, research on ER in ASD is in its infancy.”

  • The paper relies on this without support.

    There have been no published emotion regulation studies of adolescents with autism spectrum disorder.

    “Although this type of basic and applied research is needed across the lifespan in ASD, it is notable that there have been no published ER studies of adolescents with ASD.”

  • The paper relies on this without support.

    There is very little clinical trials research in autism spectrum disorder explicitly focused on emotion regulation.

    “Although we described some treatment strategies that incorporate ER as a component of the intervention, there is very little clinical trials research in ASD explicitly focused on ER.”

  • The paper relies on this without support.

    Some treatments that effectively improve emotion regulation in other populations, such as acceptance and mindfulness-based interventions, have yet to be tested in autism spectrum disorder.

    “Further, some treatments that effectively improve ER in other populations, such as acceptance and mindfulness-based interventions, have yet to be tested in ASD.”
10 of 10

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Alexithymia reduces one's ability to label emotional states, which has been shown to reduce the aversive nature of the state.

    “This may be due to alexithymia reducing one’s ability to label emotional states, which has been shown to reduce the aversive nature of the state (Foland-Ross et al., 2010; Lieberman et al., 2007; Mazefsky and White, 2014).”

    From Atypical interoception as a common risk factor for psychopathology: A review (2021) · cites this paper as Mazefsky and White, 2014

    The Introduction’s “ASD-Related Factors that Impede Effective Emotion Regulation” section defines alexithymia as difficulty identifying and describing emotions and says labeling emotions has been proposed as important for successful emotion regulation. It does not say that labeling has been shown to reduce how aversive an emotional state feels. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • In autistic individuals, DBT has been recommended to treat ED but its feasibility and preliminary efficacy have not been investigated.

    “In autistic individuals, DBT has been recommended to treat ED but its feasibility and preliminary efficacy have not been investigated (Hartmann et al., 2012; Mazefsky and White, 2014).”

    From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as Mazefsky and White, 2014

    In Current Approaches to Practice, the paper says DBT has been considered for adaptation to clients with ASD and that there have been no clinical trials or published treatment-outcome research. This supports the lack of published efficacy evidence, but it does not specifically establish that feasibility has not been investigated. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Acceptance-based approaches would likely enable people with ASD to learn emotion regulation skills and cope with their negative emotions in more adaptive ways.

    “This supports Mazefsky and White's (2014) assertion that acceptance-based approaches would likely enable people with ASD to learn emotion regulation skills and cope with their negative emotions in more adaptive ways.”

    From Modeling the cognitive mechanisms linking autism symptoms and anxiety in adults. (2016) · cites this paper as Mazefsky & White (2014)

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Authors
Mazefsky, C. A., & White, S. W.
Affiliations
  • University of Pittsburgh (US)
  • Virginia Tech (US)
Corresponding author
Mazefsky, Carla A.
ORCID
Venue
Child and Adolescent Psychiatric Clinics of North America
Publisher
Elsevier BV
Published
2014-01
Volume
23
Issue
1
Pages
15-24
ISSN
1056-4993 (ISSN-L)
DOI
10.1016/j.chc.2013.07.002
PMC
PMC3830422
OpenAlex
W100976496
Cited by
323
References
60
Citations by year
2026: 30 · 2025: 39 · 2024: 31 · 2023: 31 · 2022: 30 · 2021: 42 · 2020: 36 · 2019: 19 · 2018: 25 · 2017: 19 · 2016: 6 · 2015: 8 · 2014: 6 · 2013: 1
FWCI
3.84
Type
journal article
Language
en
Open access
Licence
Locations
  • Child and Adolescent Psychiatric Clinics of North America (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • U.S. Public Health Service (K23CHD060601)
  • National Institute of Mental Health (K01MH079945)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (K23HD060601)
Topics
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
Keywords
emotion regulation, autism spectrum disorder, behavioral problems, children, clinical guidelines
MeSH terms
Adaptation, Psychological, Behavioral Symptoms, Child, Child Development Disorders, Pervasive, Communication Disorders, Disease Susceptibility, Emotions, Humans, Male, Patient Education as Topic, Cognitive Behavioral Therapy, Emotional Intelligence

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