The Role of Emotion Regulation in Autism Spectrum Disorder
Open accessAbstract
Objective Autism spectrum disorder (ASD) is associated with amplified emotional responses and poor emotional control, but little is known about the underlying mechanisms. This article provides a conceptual and methodologic framework for understanding compromised emotion regulation (ER) in ASD.Method After defining ER and related constructs, methods to study ER were reviewed with special consideration on how to apply these approaches to ASD. Against the backdrop of cognitive characteristics in ASD and existing ER theories, available research was examined to identify likely contributors to emotional dysregulation in ASD.Results Little is currently known about ER in youth with ASD. Some mechanisms that contribute to poor ER in ASD may be shared with other clinical populations (e.g., physiologic arousal, degree of negative and positive affect, alterations in the amygdala and prefrontal cortex), whereas other mechanisms may be more unique to ASD (e.g., differences in information processing/perception, cognitive factors [e.g., rigidity], less goal-directed behavior and more disorganized emotion in ASD).Conclusions Although assignment of concomitant psychiatric diagnoses is warranted in some cases, poor ER may be inherent in ASD and may provide a more parsimonious conceptualization for the many associated socioemotional and behavioral problems in this population. Further study of ER in youth with ASD may identify meaningful subgroups of patients and lead to more effective individualized treatments.
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Issues in executive functioning and emotion regulation are increasingly being addressed, though they are not yet included as specifiers in the formal diagnostic systems.
“Issues in executive functioning (Corbett et al. 2009) and emotion regulation (Mazefsky et al. 2013) are also increasingly being addressed, though are not yet included as specifiers in the formal diagnostic systems.”
From The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond (2021) · cites this paper as Mazefsky et al. 2013
The introductory passage under Abstract > Conclusions addresses emotion regulation in ASD and says the paper aims to accelerate research on it. It lists the bases for an ASD diagnosis, but does not establish whether emotion regulation is included as a specifier in formal diagnostic systems. The separate executive-functioning citation is not assessed here. (LLM, conf=0.78)
Experimental — accuracy not yet measuredAutistic children have a higher risk of suffering episodes of emotional dysregulation than their neurotypical peers.
“De hecho, los niños autistas tienen un mayor riesgo de sufrir episodios de DRE que sus compañeros neurotípicos (Mazefsky et al., 2013;Samson et al., 2014).”
From Ansiedad y trastornos del espectro del autismo: notas para la intervención psicoeducativa (2022) · cites this paper as Mazefsky et al., 2013
The ER Research in ASD section reports that children with ASD were less likely than children without ASD to use adaptive coping strategies, and the paper describes intense outbursts or “meltdowns” as a common presenting complaint. It does not establish that autistic children have a higher risk of dysregulation episodes specifically than their neurotypical peers; the claim turns related findings into a comparison of episode risk. (LLM, conf=0.82)
Experimental — accuracy not yet measuredAnxiety in autism is linked to reduced use of adaptive and/or increased use of maladaptive emotion regulation strategies.
“considerable evidence that links anxiety in autism to reduced use of adaptive and/or increased use of maladaptive emotion regulation strategies (for reviews, see Cai et al., 2018; Mazefsky et al., 2013; Weiss, 2014; White et al., 2014).”
From Self-guided mindfulness and cognitive behavioural practices reduce anxiety in autistic adults: A pilot 8-month waitlist-controlled trial of widely available online tools. (2020) · cites this paper as Mazefsky et al., 2013
The ER Research in ASD section reports less cognitive reappraisal, more suppression, and less adaptive coping in people with ASD than in controls. The Discussion proposes that impaired emotion regulation may help explain anxiety in ASD, but the paper does not establish that anxiety specifically is linked to use of those strategies or support the claim of considerable evidence for that link. (LLM, conf=0.86)
Experimental — accuracy not yet measuredEmotion dysregulation (ED) has been identified as an important risk factor for self-harm and suicidal behaviors in autistic individuals.
“Emotion dysregulation (ED), the difficulty in modulating emotions, has been identified as an important risk factor.”
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 et al., 2013
In the passage labeled Abstract > Conclusions (page unavailable), the paper says autistic individuals may respond to emotional stimuli with self-injury because of inadequate emotion regulation. It does not identify emotion dysregulation as an established risk factor for suicidal behavior, and its account of the self-injury link is tentative. (LLM, conf=0.85)
Experimental — accuracy not yet measuredDisrupted 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”
From Emotion Regulation (2014) · cites this paper as [10]
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”
From Emotion Regulation (2014) · cites this paper as [10]
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Depression in adolescents with ASD: a pilot RCT of a group intervention
Santomauro, D., Sheffield, J., & Sofronoff, K. (2016) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-015-2605-4 · Cited by 69 · see citing works
Chen, Y., Lin, H., Chien, Y., Tung, Y.-H., Ni, Y., & Gau, S. S. (2022) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2022.08.015 · Cited by 67 · see citing works
Chen, M., Wei, H.-T., Chen, L.-C., Su, T., Bai, Y., Hsu, J.-W., Huang, K., Chang, W.-H., Chen, T., & Chen, Y.-S. (2014) · Research in Autism · doi:10.1016/j.rasd.2014.10.014 · Cited by 68 · see citing works
Kourtesis, P., Kouklari, E.-C., Ρούσσος, Π., Mantas, V., Papanikolaou, Κ., Skaloumbakas, C., & Pehlivanidis, A. (2023) · Behavioral Sciences · doi:10.3390/bs13040336 · Cited by 78 · see citing works
Goldsmith, S. F., & Kelley, E. A. (2018) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-018-3483-3 · Cited by 67 · see citing works
Selective Mutism and Its Relations to Social Anxiety Disorder and Autism Spectrum Disorder
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Gallagher, S. (2023) · doi:10.1093/oso/9780198873068.001.0001 · Cited by 67 · see citing works
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“Other authors have tailored CBT approaches to target a broad range of emotion-regulation skills due to the considerable evidence that links anxiety in autism to reduced use of adaptive and/or increased use of maladaptive emotion regulation strategies (for reviews, see Cai et al., 2018; Mazefsky et al., 2013; Weiss, 20…”
Background
- Authors
- Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. W.
- Affiliations
- University of Pittsburgh (US)
- Children's Hospital of Philadelphia (US)
- Tufts Medical Center (US)
- Virginia Tech (US)
- Emory University (US)
- Corresponding author
- Mazefsky, Carla A.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2013-07
- Volume
- 52
- Issue
- 7
- Pages
- 679-688
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC3719386
- OpenAlex
- W2033011309
- Cited by
- 881
- References
- 107
- Citations by year
- 2026: 94 · 2025: 86 · 2024: 83 · 2023: 101 · 2022: 72 · 2021: 90 · 2020: 61 · 2019: 68 · 2018: 75 · 2017: 51 · 2016: 34 · 2015: 33 · 2014: 24 · 2013: 5 · 2012: 1
- FWCI
- 2.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH099021)
- 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
- autism spectrum disorder, emotion regulation, emotional dysregulation, autistic youth, amygdala, prefrontal cortex, cognitive inflexibility, goal-directed behavior, psychiatric comorbidity
- MeSH terms
- Brain, Child Development Disorders, Pervasive, Emotions, Humans
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
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