Regulating Together: Randomized Controlled Trial Examining Predictors, Facilitators, and Barriers to Treatment Success in Emotion Dysregulation and ASD
Abstract
Background and Rationale: Treatment research in autism spectrum disorder (ASD) has almost exclusively focused on addressing core social-communication deficits associated with the disorder, despite individuals with ASD having significant behavioral and emotional symptoms including irritability, reactivity, temper tantrums, and self- and other-directed aggression. These challenges are thought to be due to difficulties regulating emotions (i.e., emotion dysregulation or ED), which is the inability to control the experience, expression, and intensity of emotions in an adaptable manner. ED has also been linked to higher rates of psychiatric hospitalizations, suicidal ideation, school disciplinary action, rejection by peers, failed transitions to college and employment, co-occurring psychiatric diagnoses, and use of psychotropic medications in individuals with ASD compared to their peers with ASD without ED. Our group developed Regulating Together (RT), an intensive outpatient group program addressing ED in youth with ASD. This comprehensive program involves both caregivers and children. Our early work studying RT in more than 70 school-aged children with ASD (8-12 years old) suggests that (1) clinicians can feasibly deliver RT, (2) families like RT, and (3) children who complete RT are less irritable and emotionally reactive and have more knowledge regarding how to regulate their emotions. Importantly, children show continued improvement following completion of RT, and rates of inpatient hospitalizations are decreased. Thus, RT has shown promise to reduce ED in ASD. We have also begun studying which children benefit the most from RT. We now plan to do a study comparing ED outcomes in children who are randomly assigned to RT or to another intervention that does not target ED (i.e., control group). Our first study aim will be to investigate whether children who receive RT show reduced ED compared to the control group 16 and 29 weeks after participating in RT. Our second study aim will be to explore if individuals that receive RT have fewer and less intense emotional outbursts and fewer psychiatric hospitalizations than those in the control group. Finally, our third study aim will be to try to understand which children and caregivers respond best to RT and how to improve access to care for families from diverse backgrounds. Our long-term goal is to improve psychosocial outcomes for all children with ASD with ED and their families. Autism Research Program Areas of Interest Addressed: The impact of the project is broad and far-reaching and applicable to several key areas of interest to ASD stakeholders. Our proposed research aligns well with the following FY20 ARP Clinical Translational Research Award Areas of Interest: (1) behavioral, cognitive, and other non-pharmacological therapies for ASD co-occurring conditions (i.e., ED), (2) understanding heterogeneity or variability in treatment response (i.e., identifying predictive factors), and (3) interventions promoting success in key transitions to adulthood for individuals living with ASD (i.e., improving ED for adolescents). Project Impact: Children with ASD+ED are currently excluded from outpatient programs due to the intensity of their maladaptive behaviors and emotions, and thus critically need access to an intensive, caregiver assisted intervention in which they can learn to use appropriate coping skills; ultimately leading to fewer hospitalizations and school disciplinary actions. The inclusion of caregivers as coaches is a comprehensive approach that increases maintenance and continued use of acquired skills. If successful, RT will provide a model to increase therapist expertise and access to intervention for ASD+ED. Military Relevance: Our research has the potential to improve clinical care for military families. Demonstrating the efficacy and improvements associated with RT will improve the health of individuals with ASD and reduce stress l
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 28, 2022
- Source ID
- W81XWH2210168
Entities
People
- Rebecca Shaffer
Organizations
- United States Army