View in EDS HTML Full Text PDF Full Text

What Are the Odds? Predicting the Likelihood of a Negative Episode in a Sample of Toddlers with Autism Spectrum Disorder

Saved in:
Bibliographic Details
Title: What Are the Odds? Predicting the Likelihood of a Negative Episode in a Sample of Toddlers with Autism Spectrum Disorder
Language: English
Authors: Dimachkie Nunnally, Amanda (ORCID 0000-0001-6272-9882), Sterrett, Kyle, Gulsrud, Amanda, Kasari, Connie
Source: Autism: The International Journal of Research and Practice. Nov 2021 25(8):2254-2264.
Availability: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: http://sagepub.com
Peer Reviewed: Y
Page Count: 11
Publication Date: 2021
Document Type: Journal Articles
Reports - Research
Descriptors: Autism, Pervasive Developmental Disorders, Toddlers, Behavior Problems, Emotional Response, Self Control, Intervention, Predictor Variables, Probability, Negative Attitudes, Caregiver Role, Individual Characteristics, Language Skills, Severity (of Disability), Parent Background, Educational Attainment, Coping
Assessment and Survey Identifiers: Autism Diagnostic Observation Schedule, Mullen Scales of Early Learning, Reynell Developmental Language Scales
DOI: 10.1177/13623613211015001
ISSN: 1362-3613
Abstract: Children with autism spectrum disorder exhibit challenges in regulating negativity and modifying emotional responses, a process known as emotion regulation. Such challenges affect social outcomes and response to intervention in children with autism spectrum disorder. Caregivers of children with autism spectrum disorder facilitate children's emotion regulation through a process known as co-regulation, but there have been no attempts to describe how dyadic use of strategies interact to impact the likelihood of negativity in real time. This study used video observations of 71 toddlers (mean age = 31.2 months) with autism spectrum disorder and their caregivers engaged in a frustrating, goal-oriented task. A mixed-effects logistic regression revealed that caregivers' use of co-regulation strategies was not a significant predictor of changes in the likelihood children's expressed negativity. Caregiver unresponsiveness and proactiveness, however, predicted increased likelihood of children's subsequent negativity. Children's use of high energy, non-instrumental behaviors (tension release), was also a robust predictor of increased likelihood of subsequent negativity. These findings shed a light on the effectiveness of child and caregiver strategies in facilitating emotion regulation in toddlers with autism spectrum disorder.
Abstractor: As Provided
Entry Date: 2021
Accession Number: EJ1312128
Database: ERIC
Full text is not displayed to guests.
FullText Links:
  – Type: pdflink
    Url: https://content.ebscohost.com/cds/retrieve?content=AQICAHj0k_4E0hTGH8RJwT4gCJyBsGNe_WN95AvKlDbXJGqwxwEXurRLtOEa4fDLKhvyDfe-AAAA4jCB3wYJKoZIhvcNAQcGoIHRMIHOAgEAMIHIBgkqhkiG9w0BBwEwHgYJYIZIAWUDBAEuMBEEDHrIyt5bNb4lSBNYgAIBEICBmvu0PSMmZoTYkzh0da5T41nLmmxI8mHvi5B-CerPV1Gnqb0J4-SH2xOckFAvq9Mik49kefSbEBcXMTID9lsjtTE6QA1su7e_QVDBCl5eJ9CYNRLpZ7Kvwmn1co4yT-9_pGiQWzJOAdqCJAtxxi46ynzi0sblNuneaspjYB8yy-q2sZHg00CtFUgFgQocPcNEdf0RUtynXBoh4-E=
Text:
  Availability: 1
  Value: <anid>AN0152489940;f9d01nov.21;2021Sep20.02:24;v2.2.500</anid> <title id="AN0152489940-1">What are the odds? Predicting the likelihood of a negative episode in a sample of toddlers with autism spectrum disorder </title> <p>Children with autism spectrum disorder exhibit challenges in regulating negativity and modifying emotional responses, a process known as emotion regulation. Such challenges affect social outcomes and response to intervention in children with autism spectrum disorder. Caregivers of children with autism spectrum disorder facilitate children's emotion regulation through a process known as co-regulation, but there have been no attempts to describe how dyadic use of strategies interact to impact the likelihood of negativity in real time. This study used video observations of 71 toddlers (mean age = 31.2 months) with autism spectrum disorder and their caregivers engaged in a frustrating, goal-oriented task. A mixed-effects logistic regression revealed that caregivers' use of co-regulation strategies was not a significant predictor of changes in the likelihood children's expressed negativity. Caregiver unresponsiveness and proactiveness, however, predicted increased likelihood of children's subsequent negativity. Children's use of high energy, non-instrumental behaviors (tension release), was also a robust predictor of increased likelihood of subsequent negativity. These findings shed a light on the effectiveness of child and caregiver strategies in facilitating emotion regulation in toddlers with autism spectrum disorder. Children with autism spectrum disorder sometimes have challenges with regulating their negative emotions. These difficulties can impact children's social outcomes and how well they respond to intervention. We know that caregivers of children with autism spectrum disorder can help their children regulate negative emotions in a process known as co-regulation, but not much is known about how child and caregiver strategy use impacts children's negativity in real time. In this study, 71 caregivers of toddlers with autism spectrum disorder were asked to encourage their child to unlock a locked toy box, a task which is designed to elicit frustration. Video observations of the participants completing the task were used to examine whether specific child and caregiver behaviors increased or decreased the likelihood that the child will become upset. No child strategies were predictive of a decreased likelihood of a child becoming upset, but when children used high-energy behaviors that did not serve a purpose, such as running back and forth, they were more likely to then show signs of being upset a few seconds later. The way that caregivers responded to their child was a potent caregiver predictor of the likelihood of children's negativity, with caregivers' unresponsiveness and proactiveness both emerging as salient predictor of increased likelihood of the child being upset a few moments later. These findings give insight into how children with autism spectrum disorder and their caregiver navigate challenging and frustrating tasks, and have the potential to influence clinical practice by giving an indication off which parent and child behaviors are most effective in reducing children's negativity while interacting with parents and caregivers.</p> <p>Keywords: autism spectrum disorders; emotion regulation; behavioral measurement; development; family functioning and support</p> <hd id="AN0152489940-2">Introduction</hd> <p>There is growing evidence that individuals with autism spectrum disorder (ASD) have challenges in their emotion regulation (ER) capabilities ([<reflink idref="bib4" id="ref1">4</reflink>]; [<reflink idref="bib27" id="ref2">27</reflink>]; [<reflink idref="bib29" id="ref3">29</reflink>]; [<reflink idref="bib34" id="ref4">34</reflink>]), where ER is defined as the process of modulating emotional reactions in the service of accomplishing social adaptation or achieving a goal ([<reflink idref="bib39" id="ref5">39</reflink>]; [<reflink idref="bib11" id="ref6">11</reflink>]). Emotion dysregulation, the inability to regulate emotions effectively or appropriately ([<reflink idref="bib34" id="ref7">34</reflink>]), may manifest in negativity and problematic behaviors, such as irritability, poor anger control, and temper tantrums ([<reflink idref="bib30" id="ref8">30</reflink>]) which can interfere with interpersonal interactions and goal-oriented activities. Poor ER abilities, in combination with the core social communication deficits that characterize ASD, may compound social communication impairments and moderate response to intervention among children with autism ([<reflink idref="bib4" id="ref9">4</reflink>]; [<reflink idref="bib17" id="ref10">17</reflink>]).</p> <hd id="AN0152489940-3">ER in young typically developing children</hd> <p>In typical development (TD), children show evidence of ER as early as 5 months of age when they display early forms of passive ER strategies such as orienting to their caregiver or assistance-seeking as a means to reduce negativity ([<reflink idref="bib38" id="ref11">38</reflink>]). By preschool, TD children begin to shift from using predominantly other-directed strategies (i.e. orienting to the caregiver) to self-directed strategies (i.e. using positive self-talk) in an attempt to modulate negative emotions ([<reflink idref="bib21" id="ref12">21</reflink>]). During this time, children also shift from passive to more active forms of ER, such as cognitive reappraisal, as a result of a growing sense of autonomy and cognitive development ([<reflink idref="bib21" id="ref13">21</reflink>]; [<reflink idref="bib40" id="ref14">40</reflink>]; [<reflink idref="bib43" id="ref15">43</reflink>]). The ability to successfully regulate emotions has been shown to be a strong predictor of more successful peer interactions, less peer rejection, better mental health outcomes, and better academic achievement in TD children ([<reflink idref="bib10" id="ref16">10</reflink>]; [<reflink idref="bib12" id="ref17">12</reflink>]; [<reflink idref="bib15" id="ref18">15</reflink>]; [<reflink idref="bib22" id="ref19">22</reflink>]), emphasizing its important role in childhood development.</p> <hd id="AN0152489940-4">ER in young children with ASD</hd> <p>There is ample literature to suggest that ER deficits are common among young children on the spectrum ([<reflink idref="bib16" id="ref20">16</reflink>]; [<reflink idref="bib17" id="ref21">17</reflink>]; [<reflink idref="bib29" id="ref22">29</reflink>]) and related to core deficits of ASD ([<reflink idref="bib27" id="ref23">27</reflink>]), as well as other associated characteristics, such as executive dysfunction and sensory differences ([<reflink idref="bib17" id="ref24">17</reflink>]; [<reflink idref="bib34" id="ref25">34</reflink>]). A recent study by [<reflink idref="bib29" id="ref26">29</reflink>] found that preschoolers with ASD used other-directed strategies more frequently than their TD peers, leading the authors to speculate that these differences are indicative of a delay in ER abilities, rather than a deficit. These differences in ER among children with ASD are also reflected in findings of higher rates of negative emotionality ([<reflink idref="bib20" id="ref27">20</reflink>]; [<reflink idref="bib34" id="ref28">34</reflink>]; [<reflink idref="bib44" id="ref29">44</reflink>]) and less successful employment of ER strategies ([<reflink idref="bib18" id="ref30">18</reflink>]; [<reflink idref="bib32" id="ref31">32</reflink>]). Children with ASD also use more maladaptive ER strategies overall ([<reflink idref="bib28" id="ref32">28</reflink>]; [<reflink idref="bib31" id="ref33">31</reflink>]; [<reflink idref="bib33" id="ref34">33</reflink>]; [<reflink idref="bib32" id="ref35">32</reflink>]; [<reflink idref="bib35" id="ref36">35</reflink>]), contrasting with TD children who use more adaptive strategies that are associated with positive future outcomes ([<reflink idref="bib6" id="ref37">6</reflink>]).</p> <p>Similar to what is seen among TD children, ER abilities in children with ASD are associated with a range of future outcomes including social functioning ([<reflink idref="bib7" id="ref38">7</reflink>]; [<reflink idref="bib8" id="ref39">8</reflink>]), mental health ([<reflink idref="bib28" id="ref40">28</reflink>]) and school readiness ([<reflink idref="bib2" id="ref41">2</reflink>]). These impairments in ER may be especially detrimental for children on the spectrum who experience core deficits in social communication that already predispose them to challenges in social functioning ([<reflink idref="bib4" id="ref42">4</reflink>]).</p> <hd id="AN0152489940-5">The role of the caregiver</hd> <p>Caregivers of children with and without developmental disabilities are instrumental in facilitating the development of ER during early childhood ([<reflink idref="bib21" id="ref43">21</reflink>]). Not only is the ability to regulate emotions developed through transactional interactions with caregivers over time, but caregivers also contribute to their children's in vivo regulation of negative emotions through co-regulation ([<reflink idref="bib16" id="ref44">16</reflink>]; [<reflink idref="bib21" id="ref45">21</reflink>]), where caregiver co-regulation refers to active emotional and motivational scaffolding strategies that are used with the explicit intent to assist the child in modulating their emotions ([<reflink idref="bib14" id="ref46">14</reflink>]). Caregivers of children with ASD have been found to use a wide range of strategies to help their child co-regulate their emotions ([<reflink idref="bib16" id="ref47">16</reflink>]; [<reflink idref="bib42" id="ref48">42</reflink>]), but appear to use comparatively more physical and active helping strategies ([<reflink idref="bib14" id="ref49">14</reflink>]; [<reflink idref="bib16" id="ref50">16</reflink>]; [<reflink idref="bib41" id="ref51">41</reflink>]) and less cognitively sophisticated strategies in comparison to typically developing peers (i.e. cognitive reframing; [<reflink idref="bib29" id="ref52">29</reflink>]). An association between caregiver co-regulation and decreased negativity has been found using a sample of toddlers with ASD ([<reflink idref="bib14" id="ref53">14</reflink>]), but little is known regarding how specific caregiver co-regulation strategies impact the likelihood of children's dysregulation from moment to moment.</p> <p>More broadly, caregivers' overall responsiveness during formative caregiver–child interactions may also impact their child's ER ([<reflink idref="bib21" id="ref54">21</reflink>]; [<reflink idref="bib26" id="ref55">26</reflink>]). Responsiveness refers to attending to verbal and nonverbal bids from children in a way that is timely, contingent, and appropriate. Examples of this could include responding to a child's question or offering assistance when requested. Caregiver responsiveness precludes behaviors that may be considered directive, such as commanding the child's attention toward the adult's interest or directing the child's actions according to the caregiver's agenda ([<reflink idref="bib5" id="ref56">5</reflink>]; [<reflink idref="bib36" id="ref57">36</reflink>]). Responsive parenting in the context of behavioral intervention has been linked to improvements in social behavior and language attainment among children with ASD ([<reflink idref="bib36" id="ref58">36</reflink>]; [<reflink idref="bib37" id="ref59">37</reflink>]); although little is known regarding the impact of caregiver responsiveness on ER in this population.</p> <hd id="AN0152489940-6">The current study</hd> <p>Children with ASD have difficulty maintaining reciprocal and high-quality social interactions with their caregivers ([<reflink idref="bib1" id="ref60">1</reflink>]). While social communication delays clearly contribute to this difficulty, poor ER and negativity can magnify these deficits and quickly derail positive caregiver–child interactions ([<reflink idref="bib16" id="ref61">16</reflink>]). Given that ER is largely formed through transactional caregiver–child interactions, mismatched caregiver–child interactions could in turn impact children's ER development ([<reflink idref="bib21" id="ref62">21</reflink>]). Thus, it is important to understand what caregiver and child behaviors may help reduce the frequency of negativity so that high-quality interactions can be maintained. Although correlates of ER and the role of the caregiver in co-regulating their child has been previously explored, no studies to date have attempted to explore how caregiver behaviors are predictive of the likelihood of children's expressed negativity over the course of a challenging task. The purpose of this study is two-fold: (<reflink idref="bib1" id="ref63">1</reflink>) to provide a fine-grained description of caregiver and child behaviors during a clinic-based caregiver–child interaction and (<reflink idref="bib2" id="ref64">2</reflink>) to evaluate the likelihood of an immediate negative episode following specific child ER strategies, caregiver co-regulation strategies and caregiver responsiveness will be evaluated. It is hypothesized that caregiver use of co-regulation strategies and caregiver responsiveness will contribute to a decreased likelihood of a child exhibiting a negative episode in the following interval, and that children's use of ER strategies will have limited success in decreasing negativity, based on previous findings showing that children with ASD have exhibit difficulties in regulating negative emotions ([<reflink idref="bib4" id="ref65">4</reflink>]; [<reflink idref="bib27" id="ref66">27</reflink>]; [<reflink idref="bib29" id="ref67">29</reflink>]; [<reflink idref="bib34" id="ref68">34</reflink>]).</p> <hd id="AN0152489940-7">Methods</hd> <p></p> <hd id="AN0152489940-8">Participants</hd> <p>This study includes a sample of toddlers with ASD and their caregivers who participated in a randomized controlled efficacy trial of a caregiver-mediated social communication intervention. Participants were originally recruited from a 10-week outpatient early intervention (EI) program, consisting of a combination of behavioral, speech, and occupational therapies for 30 hours a week. Children were included if they were younger than 36 months, had a clinical diagnosis of ASD confirmed by an independent assessment using the Autism Diagnostic Interview–Revised (ADI-R; [<reflink idref="bib24" id="ref69">24</reflink>]) and the Autism Diagnostic Observation Schedule (ADOS; [<reflink idref="bib23" id="ref70">23</reflink>]), had no significant physical disabilities, and both the caregiver and child were available for treatment and follow-up assessments. A total of 86 caregiver–child dyads enrolled in the study from January 2007 to September 2012, 71 of whom were included in this study. Table 1 presents the participants' demographics.</p> <p>Graph</p> <p>Table 1. Participants' demographics (n = 71).</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">Mean/count</th></tr></thead><tbody><tr><td>Chronological age (months)</td><td>31.48 (3.20)</td></tr><tr><td>Gender (%)</td><td /></tr><tr><td><italic>Female</italic></td><td>12</td></tr><tr><td>Race/ethnicity (%)</td><td /></tr><tr><td><italic>African American</italic></td><td>2</td></tr><tr><td><italic>Caucasian</italic></td><td>46</td></tr><tr><td><italic>Hispanic</italic></td><td>6</td></tr><tr><td><italic>Asian/Pacific Islander</italic></td><td>6</td></tr><tr><td><italic>Other</italic></td><td>11</td></tr><tr><td>Mullen DQ</td><td>66.35 (18.78)</td></tr><tr><td>ADOS severity</td><td>6.45 (1.86)</td></tr><tr><td>Reynell receptive language</td><td>−1.94 (1.25)</td></tr><tr><td>Reynell expressive language</td><td>−2.35 (0.91)</td></tr><tr><td>Caregiver's age (years)</td><td>35.41 (6.55)</td></tr><tr><td>Caregiver education</td><td /></tr><tr><td><italic>High school graduate</italic></td><td>3</td></tr><tr><td><italic>Some college</italic></td><td>10</td></tr><tr><td><italic>Special training</italic></td><td>2</td></tr><tr><td><italic>College graduate</italic></td><td>30</td></tr><tr><td><italic>Graduate school</italic></td><td>26</td></tr></tbody></table> </ephtml> </p> <p>1 DQ: Developmental quotient; ADOS: Autism Diagnostic Observation Schedule.</p> <hd id="AN0152489940-9">Procedures</hd> <p>Of the 86 toddlers with ASD (mean age = 31.2 months), 71 completed a frustration task with their caregiver upon entry to the study. Participants were excluded from analysis if the task was not completed (i.e. missing). The task used was similar to the "Locked Box" task from laboratory temperament assessment battery (Lab-TAB), developed for use with typically developing preschoolers ([<reflink idref="bib13" id="ref71">13</reflink>]). During this task, toddlers were given a locked toy box and a ring of keys and encouraged by parents to open the box. In order to ensure that the task was developmentally appropriate for toddlers with developmental delays, a developmentally appropriate toy box was used. The box used for this task resembled a small house with four doors, each door having a keyhole of a different shape (square, circle, triangle, etc.). In order to open the box, children had to match the shapes and turn the key. Although caregivers were present during the task, they were asked not to assist their child in opening the box unless their child sought assistance. No instructions were given to caregivers regarding how to otherwise interact with their child. Interactions were videotaped and later coded in 10-s intervals for four factors related to the parent–child co-regulation process: child negativity, child ER strategies, caregiver co-regulation strategies, and parental responsiveness.</p> <hd id="AN0152489940-10">Coded measures</hd> <p>All child and caregiver variables were coded in 10-second intervals, culminating in a total of 18 intervals during the 3-minute task. For each interval, a primary code was given per variable in order to reflect the behavior represented in the majority of the interval. In the event of a tie, the latter behavior was chosen as the primary code. For child negativity, a binary variable, children were either designated as exhibiting or not exhibiting negativity during the given interval. In order to accurately capture dyadic behaviors, caregiver and child variables were coded independently of one another, such that no variable was reliant on the presence of another variable. Examples of this include coding children's and caregiver's use of regulation strategy regardless of whether negativity was coded in the same interval, and coding caregivers' use of physical comfort regardless of whether or not children exhibited comfort-seeking.</p> <hd id="AN0152489940-11">Child negativity</hd> <p>Child negativity was coded based on an existing protocol used in a study of toddlers with ASD and their mothers ([<reflink idref="bib14" id="ref72">14</reflink>]), using a binary variable indicating the presence of exhibited negativity. This code indicates whether or not children exhibited negative facial expression, such as furrowed brows and downturned mouths, or body negativity, such as foot stamping during a given interval.</p> <hd id="AN0152489940-12">Children's emotion regulation strategies</hd> <p>Children's emotional regulation strategies codes were from existing protocol to indicate the presence of the following strategies: symbolic self-soothing, physical self-soothing, repetitive or idiosyncratic behaviors, tension release, avoidance, distraction, caregiver orientation, other-directed comfort-seeking, and other-directed assistance-seeking (see Table 2 for definitions; [<reflink idref="bib14" id="ref73">14</reflink>]).</p> <p>Graph</p> <p>Table 2. Children's emotion regulation strategies.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th align="left">Behavior</th><th align="left">Definition</th></tr></thead><tbody><tr><td>Symbolic self-soothing</td><td>Self-directed behaviors that include statements or activities indicating the use of cognitive/symbolic strategies to deal with frustration. Examples include positive self-talk (It's okay, I can do it!) and reappraisal ("It's not that hard").</td></tr><tr><td>Physical self-soothing</td><td>Bodily directed behaviors such as thumb-sucking or playing with hair.</td></tr><tr><td>Repetitive/idiosyncratic behavior</td><td>Child engages in repetitive behavior with no apparent instrumental focus. Examples include hand-flapping or echolalic vocalizations.</td></tr><tr><td>Tension release</td><td>Child engages in high-energy behavior with no apparent instrumental focus. Examples include running, kicking legs, and screaming.</td></tr><tr><td>Avoidance</td><td>Child engages in behaviors with the intended goal of distancing themselves from the task. This could include turning one's body away from the task (without an alternative focus) or trying to leave the room.</td></tr><tr><td>Distraction</td><td>Child focuses attention away from task, and toward another focus. Can attend to himself or herself, another object in the room, or another place in the room. This can be distinguished from avoidance by the presence of an alternate focus of attention.</td></tr><tr><td>Caregiver orientation</td><td>Child looks to caregiver without making bid for comfort or assistance. If gaze is paired with a bid for comfort (e.g. reaching out to be held) or assistance (e.g. "open?"), this behavior would be coded as comfort-seeking or assistance-seeking, respectively.</td></tr><tr><td>Comfort-seeking</td><td>Comfort-seeking behavior such as wanting to be held, touching parent's hair or clothing, or reclining on parent's lap.</td></tr><tr><td>Assistance-seeking</td><td>Verbal or nonverbal behaviors meant to elicit help from another person. Examples to include asking for help ("I need help!") or nonverbally communicating the need for assistance (giving the keys to the parent while referencing the toy).</td></tr></tbody></table> </ephtml> </p> <hd id="AN0152489940-13">Caregiver co-regulation strategies</hd> <p>The presence of the following caregiver regulation strategies was coded: active game-like engagement, redirection of attention, reassurance, following, or physical comfort (see Table 3 for definitions; adapted from [<reflink idref="bib14" id="ref74">14</reflink>]). The choice was made to eliminate "prompting/helping" from the original coding protocol in order to parse the emotional and motivational types of co-regulation from task-related helping behaviors. Instead, caregiver prompting/helping behaviors were captured by the "caregiver responsiveness" codes described below.</p> <p>Graph</p> <p>Table 3. Caregiver co-regulation strategies.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th align="left">Behavior</th><th align="left">Definition</th></tr></thead><tbody><tr><td>Active game-like engagement</td><td>Caregiver actively plays with the child or engages in game-like activity (e.g. singing a song or tickling the child.)</td></tr><tr><td>Redirection of attention</td><td>Caregiver distracts the child or directs the child's attention away from negative stimulus (e.g. drawing the child's attention to an item of interest.)</td></tr><tr><td>Reassurance</td><td>Caregiver reassures or encourages child surrounding frustrating or negative activity (e.g. "You can do it!")</td></tr><tr><td>Following</td><td>Caregiver's reflection, extension, or elaboration upon child's distress or preoccupation (e.g. "I know you want to leave.")</td></tr><tr><td>Physical comfort</td><td>Caregiver initiates behaviors to physically comfort their child (e.g. hugging, stroking hair, and placing in lap).</td></tr></tbody></table> </ephtml> </p> <hd id="AN0152489940-14">Caregiver responsiveness</hd> <p>Caregivers' interactions with their children were coded based on the responsiveness items from the Maternal Behavior Rating Scale (MBRS: [<reflink idref="bib25" id="ref75">25</reflink>]) to indicate whether caregivers were: responsive, proactive, directive, or non-responsive to their child's bid (see Table 4 for definitions). This code is used to capture caregivers' helping behaviors and reflect how caregivers responded to children's bids for assistance during the task. Children's bids may include both verbal bids for their caregivers' attention (e.g. child asking their caregiver to "open") or nonverbal bids for their caregivers' attentions (e.g. reaching for caregiver or orienting to caregiver without vocalization).</p> <p>Graph</p> <p>Table 4. Caregiver responsiveness.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /></colgroup><thead><tr><th align="left">Behavior</th><th align="left">Definition</th></tr></thead><tbody><tr><td>Responsive</td><td>Caregiver makes a contingent response to the child's verbal or nonverbal bid, regardless of whether task-related or not. This code can be used whether or not the caregiver's response was successful in achieving resolution of the problem. Example: a child is having difficulty manipulating the toy keys and asks for help, caregiver responds by adjusting the child's grip.</td></tr><tr><td>Proactive</td><td>Caregiver responds to their child's behavioral indications of needing assistance without a verbal or nonverbal bid from the child—this does not include instances in which a caregiver attempts to redirect their child when fixated. Example: a child is having difficulty manipulating the toy keys and is becoming visibly upset, the caregiver responds by adjusting the child's grip.</td></tr><tr><td>Directive</td><td>Caregiver guides the child's actions unsolicited, not in response to social bids or behavioral indications of the need for assistance. This includes instances in which caregiver attempts to redirect the child within the task if the child is fixated on repetitive behaviors. Example: child is attending to the keys by visually inspecting and rotating them to view the shapes, and the caregiver attempts to redirect the child by reminding them of the task.</td></tr><tr><td>Non-responsive</td><td>Caregiver does not respond to the child's verbal or nonverbal bid. Example: a child is having difficulty manipulating the toy keys and verbally asks the caregiver for assistance, and the caregiver makes no response.</td></tr></tbody></table> </ephtml> </p> <hd id="AN0152489940-15">Coding procedures</hd> <p>A team of four undergraduate coders were trained to reliability (Cohen's kappa above 80% for all variables of interest) by the first author over a 1-month period using a set of practice videos. Reliability was re-assessed over the course of the coding period, culminating in a total of 24% of videos (17 videos out of 71) that were double coded. Reliability was calculated for each variable of interest using Cohen's <emph>k</emph> and are as follows: children's negativity (<emph>k</emph> = 0.70, 95% confidence interval (CI) [0.59, 0.81]), children's ER strategies (<emph>k</emph> = 0.75, 95% CI [0.69, 0.81]), caregiver responsiveness (<emph>k</emph> = 0.70, 95% CI [0.61, 0.80]), and caregiver's co-regulation strategies (<emph>k</emph> = 0.61, 95% CI [0.53, 0.69]).</p> <hd id="AN0152489940-16">Data analysis</hd> <p>This study reports on variables coded from videos collected at entry into the study. Descriptive information for each child and caregiver strategy was calculated as the percentage of total intervals in which the strategy was used as the primary strategy. A mixed-effect logistic regression was used to examine the effect of specific child regulation strategies, caregiver co-regulation strategies and parent responsiveness on the presence or absence of negativity in the subsequent interval; a binary dependent variable (coded as present = 1/not-present = 0). Given that developmental age has been found to contribute to children's development of self-regulation ([<reflink idref="bib21" id="ref76">21</reflink>]), the decision was made to control for children's developmental level by including Mullen Scales of Early Learning (MSEL) developmental quotient (DQ) in the model as a continuous covariate. The presence of negativity in the previous interval was included as a categorical covariate to control for the presence of sequential periods of negativity. The mixed-effect model allows for the inclusion of subject level intercepts to account for the nested structure of the data (intervals nested within children), the random intercept was the only random effect included. To address the primary aim, the three covariates, child regulation strategies, caregiver co-regulation strategies, and caregiver responsiveness were included as categorical variables with each level of the variable representing a specific strategy. The contrast (reference group) within each variable was always the absence of the strategy (i.e. 0). This allowed for the effect of specific strategies on children's likelihood of having a negative episode to be determined. For example, whether the presence of a strategy in interval two makes a negative episode in interval three more or less likely. The model was fit using the glmer function within the lme4 package ([<reflink idref="bib3" id="ref77">3</reflink>]) in <emph>R</emph> ([<reflink idref="bib9" id="ref78">9</reflink>]). All data are reported in odds ratios, the upper and lower bounds of the 95% confidence interval are reported. 95% CIs that do not cross a value of "1" are considered to be robust.</p> <hd id="AN0152489940-17">Community involvement statement</hd> <p>Given that the current study is a secondary data analysis of existing data collected as part of a larger randomized controlled efficacy trial of a parent-mediated social communication intervention, community members were not involved in the design and implementation of the current study.</p> <hd id="AN0152489940-18">Results</hd> <p></p> <hd id="AN0152489940-19">Descriptives and preliminary analyses</hd> <p>Descriptive statistics were run to ensure that the data met all the necessary assumptions for a mixed-effects binary logistic regression. Variance inflation factors for all variables were less than 1.75 indicating little to no multicollinearity. The child ER strategies of symbolic self-soothing and physical self-soothing were used by only 7% and 5.6% of children, respectively, and overall were not observed at a high enough frequency to accurately estimate the influence of these behaviors. To improve model convergence, they were excluded from the subsequent analysis. This led to seven child ER strategies: repetitive behaviors, tension release, avoidance, distraction, maternal orientation, comfort-seeking, and assistance-seeking.</p> <p>Due to the low frequency of caregivers' use of co-regulation regulation strategies, occurring on average in 11.4% (standard deviation (SD) = 14.2%) of intervals across participants and only 33.8% of caregivers using any co-regulation strategy, the variable was collapsed into a binary variable representing either the presence or absence of a strategy in the interval. Caregivers were responsive on average in 17.2% (SD = 18.2%) of intervals, non-responsive in 7.7% (SD = 15.4%), and directive and proactive in 2.8% (SD = 6.9%) and 3.3% (SD = 8.6%) of intervals, respectively. 70.4% of caregivers were responsive at least once while only 40.8% were non-responsive at least once.</p> <p>On average, children experienced a negative episode in 22.1% of intervals (SD = 26.4%). The most common ER strategies used by the children were distraction, which children used on average in 20.4% of intervals (SD = 26.6%) with 61.9% of children exhibiting the strategy at least once, and tension release which children used on average in 11.6% of intervals (SD = 17.9) with 52.1% exhibiting the strategy at least once. Table 5 presents full details on children's ER strategies, caregiver's responsiveness, and use of co-regulation strategies.</p> <p>Graph</p> <p>Table 5. Percentage of intervals with behavior present.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left">Mean of percent of intervals with present (SD)</th><th align="left">Range of percent of intervals with present</th><th align="left">Percentage of children who exhibit</th></tr></thead><tbody><tr><td>Child negativity</td><td>22.1% (26.4%)</td><td>0%–94%</td><td>63.4%</td></tr><tr><td><italic>Child emotion regulation strategies</italic></td><td /><td /><td /></tr><tr><td>No strategy</td><td>27.7% (25.2%)</td><td>0%–83%</td><td>77.4%</td></tr><tr><td>Symbolic self-soothing</td><td>1.5% (7.5%)</td><td>0%–50%</td><td>7.0%</td></tr><tr><td>Physical self-soothing</td><td>1.3% (6.2%)</td><td>0%–38%</td><td>5.6%</td></tr><tr><td>Repetitive/idiosyncratic behavior</td><td>8.6% (16.7%)</td><td>0%–63%</td><td>32.4%</td></tr><tr><td>Tension release</td><td>11.6% (17.9%)</td><td>0%–78%</td><td>52.1%</td></tr><tr><td>Avoidance</td><td>6.0% (11.2%)</td><td>0%–64%</td><td>39.4%</td></tr><tr><td>Distraction</td><td>20.4% (26.6%)</td><td>0%–100%</td><td>61.9%</td></tr><tr><td>Maternal orientation</td><td>7.3% (11.8%)</td><td>0%–65%</td><td>52.1%</td></tr><tr><td>Other-directed comfort-seeking</td><td>6.4% (11.8%)</td><td>0%–67%</td><td>42.2%</td></tr><tr><td>Other-directed assistance-seeking</td><td>9.1% (13.5%)</td><td>0%–61%</td><td>48%</td></tr><tr><td><italic>Parental responsiveness</italic></td><td /><td /><td /></tr><tr><td>Responsive</td><td>17.2% (18.2%)</td><td>0%–72%</td><td>70.4%</td></tr><tr><td>Proactive</td><td>3.3% (8.6%)</td><td>0%–55%</td><td>22.5%</td></tr><tr><td>Directive</td><td>2.8% (6.9%)</td><td>0%–33%</td><td>21.1%</td></tr><tr><td>Non-responsive</td><td>7.7% (15.4%)</td><td>0%–83%</td><td>40.8%</td></tr></tbody></table> </ephtml> </p> <p>2 SD: standard deviation.</p> <hd id="AN0152489940-20">Primary analysis: predictors of child negative episode</hd> <p></p> <hd id="AN0152489940-21">Negativity</hd> <p>The presence of negativity in the previous interval was related to an increase in the likelihood of a subsequent negative episode (odds ratio (OR) = 1.82 [1.12, 2.95]).</p> <hd id="AN0152489940-22">Children's emotion regulation strategies</hd> <p>Tension release was a robust predictor of a subsequent negative episode, with the presence of tension release making a negative episode 2.28 times more likely, 95% CI [1.12, 4.65]. No other variables were related to increased or decreased likelihood of a subsequent negative episode. All estimates are reported in Table 6.</p> <p>Graph</p> <p>Table 6. Predictors of a negative episode.</p> <p> <ephtml> <table><colgroup><col align="left" /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /><col align="char" char="." /></colgroup><thead><tr><th /><th align="left"><italic>β</italic></th><th align="left">SE (β)</th><th align="left"><italic>p</italic></th><th align="left">OR</th><th align="left">Lower limit</th><th align="left">Upper limit</th></tr></thead><tbody><tr><td>Intercept</td><td>−1.75</td><td>0.62</td><td>0.005</td><td>0.17</td><td>0.05</td><td>0.59</td></tr><tr><td><italic>Child strategies</italic><xref ref-type="table-fn" rid="tfn4">a</xref></td><td /><td /><td /><td /><td /><td /></tr><tr><td>Repetitive behaviors</td><td>−0.96</td><td>0.60</td><td>0.11</td><td>0.38</td><td>0.12</td><td>1.25</td></tr><tr><td>Tension release</td><td>0.83</td><td>0.36</td><td>.02</td><td>2.28</td><td>1.12</td><td>4.65</td></tr><tr><td>Avoidance</td><td>−0.23</td><td>0.50</td><td>0.64</td><td>0.79</td><td>0.30</td><td>2.11</td></tr><tr><td>Distraction</td><td>−0.50</td><td>0.36</td><td>0.17</td><td>0.61</td><td>0.30</td><td>1.24</td></tr><tr><td>Maternal orientation</td><td>0.21</td><td>0.45</td><td>0.64</td><td>1.23</td><td>0.51</td><td>2.98</td></tr><tr><td>Comfort-seeking</td><td>−0.11</td><td>0.44</td><td>0.81</td><td>0.90</td><td>0.38</td><td>2.15</td></tr><tr><td>Assistance-seeking</td><td>0.21</td><td>0.38</td><td>0.57</td><td>1.23</td><td>0.59</td><td>2.57</td></tr><tr><td><italic>Parent responsiveness</italic><xref ref-type="table-fn" rid="tfn5">b</xref></td><td /><td /><td /><td /><td /><td /></tr><tr><td>Parental responsiveness</td><td>0.81</td><td>0.30</td><td>.007</td><td>2.25</td><td>1.24</td><td>4.08</td></tr><tr><td>Proactive behaviors</td><td>1.51</td><td>0.58</td><td>0.008</td><td>4.52</td><td>1.46</td><td>14.02</td></tr><tr><td>Directive behaviors</td><td>−0.03</td><td>0.68</td><td>0.96</td><td>0.96</td><td>0.26</td><td>3.63</td></tr><tr><td>Parental non-responsiveness</td><td>1.58</td><td>0.38</td><td><0.001</td><td>4.86</td><td>2.31</td><td>10.24</td></tr><tr><td><italic>Parent strategies</italic></td><td /><td /><td /><td /><td /><td /></tr><tr><td>Parent ER strategies</td><td>−0.61</td><td>0.35</td><td>0.08</td><td>0.54</td><td>0.27</td><td>1.09</td></tr><tr><td><italic>Control variables</italic></td><td /><td /><td /><td /><td /><td /></tr><tr><td>Mullen DQ</td><td>−0.01</td><td>0.01</td><td>0.41</td><td>0.99</td><td>0.97</td><td>1.01</td></tr><tr><td>Presence of negativity</td><td>0.60</td><td>0.25</td><td>0.02</td><td>1.82</td><td>1.12</td><td>2.95</td></tr></tbody></table> </ephtml> </p> <ulist> <item>3 SE: standard error; OR: odds ratio; ER: emotion regulation.</item> <item>4 Reference group is no child strategy present.</item> <item>5 Reference group is the absence of any child bids or indicators of need and absence of any caregiver assistance.</item> </ulist> <hd id="AN0152489940-23">Caregiver co-regulation strategies and responsiveness</hd> <p>Caregiver's unresponsiveness to their child's bid led to a 4.86 times increase in the likelihood of a negative episode 95% CI [2.31, 10.24]. In addition, the presence of proactive behaviors from the parent led to a 4.52 times increase, 95% CI [1.46, 14.02] and the presence of caregiver responsiveness led to a 2.25 times increase in the likelihood of a negative episode, 95% CI [1.24, 4.08]. The presence of caregiver co-regulation strategies (presence of any strategy) did not lead to either an increased or decreased likelihood of a subsequent negative episode (OR = 0.54, 95% CI [0.27, 1.09]).</p> <hd id="AN0152489940-24">Discussion</hd> <p>This study offers further insight into the ways that caregivers and their toddlers with ASD navigate ER during a challenging task, as well as the way that caregiver and child behaviors are related to the likelihood of dysregulation during caregiver–child interactions in this population. First, children in this sample used a range of strategies during the task in an attempt to regulate their emotions, with only tension release predicting change in the likelihood of a subsequent negative episode. Second, findings of this study underscore the importance of <emph>how</emph> caregivers respond to children's bids for assistance during challenging interactions. Although no significant findings emerged regarding the impact of caregivers' use of co-regulation strategies on children's subsequent expression of negativity, significant findings emerged regarding caregivers' responsiveness to children's bids as a significant predictor of change in the likelihood of subsequent dysregulation.</p> <p>Children's use of tension release (high-energy behaviors such as running back and forth) was the only strategy that predicted a change in likelihood of a negative episode, with tension release predicting an increased likelihood that children would display negativity in the subsequent interval. Although the role of high-energy behaviors has not been established in the literature, this finding may be interpreted in several ways. For example, the presence of tension release itself may be an expression of children's dysregulation, or it may signal upcoming child dysregulation. Further exploration into the function of high-energy and repetitive behavior is needed to understand the function of this behavior in children with ASD.</p> <p>Also highlighted is the importance of how caregivers interact with their children in the context of challenging tasks. Surprisingly, caregivers' use of emotional co-regulation strategies was not found to significantly predict the likelihood of toddlers' upcoming negativity in this sample. It is unclear as to whether this finding is a result of the low incidence of caregivers' use of co-regulation strategies during this task. This finding may also be explained by the nature of the task, for which caregivers were given instruction to abstain from offering assistance to their children unless specifically requested by the child. These instructions may have affected caregivers' use of co-regulation strategies, accounting for the lack of a significant finding for caregivers' use of co-regulation strategies. In order to further parse how caregivers' co-regulatory behaviors predict the likelihood of subsequent negativity, further exploration of these constructs during naturalistic interactions is needed.</p> <p>Conversely, the way that caregivers responded to bids from their child did emerge as a significant predictor of subsequent negative episodes. Three of the four categories of caregiver responsiveness (caregiver responsiveness, caregiver proactiveness, and caregiver unresponsiveness) emerged as significant predictors of an <emph>increase</emph> in children's subsequent negativity. When interpreting these seemingly contradictory findings, it is essential to consider that caregivers' responsiveness is wholly contingent on whether or not children made a bid. As such, there exists a confound between children's bids and caregiver responsiveness, which should be considered in the interpretation of the findings regarding caregivers' responsiveness. That said, one possible explanation for this phenomenon is that caregivers are responding to perceived negativity from their child, which is maintained through to the following interval. In addition, given the confound between children's bids and caregiver responsiveness, it is possible that it is the act of the child making a bid toward their caregiver that may be partially responsible for the relationship seen between different types of caregivers' responsiveness and children's negativity. Finally, it is also important to note that the finding regarding caregiver responsiveness behaviors are based on comparison with a reference group of the absence of caregiver assistance, as well as the absence of child indicators for need for assistance (i.e. behavioral indicators, verbal bids, and nonverbal bids).</p> <p>With this in mind, perhaps the most important findings to emerge from the analysis of caregivers' responsiveness is that two caregiver behaviors, caregivers' unresponsiveness to children's bids and caregiver proactiveness, emerged as a robust predictors of a greater likelihood of an upcoming negative episode. The finding that caregivers' unresponsiveness to children's bids predicts a higher likelihood of a negative episode is not surprising, given the breadth of literature supporting the importance of caregiver responsiveness to facilitating children's ER. Caregiver proactiveness, or caregivers' responding to behavioral indicators of children's need for assistance, was also a significant predictor of the likelihood of children's upcoming negativity. Since this code captures caregivers' response to a perceived need for assistance from their child, it is possible that the finding that this finding can be attributed to caregivers detecting early indicators of dysregulation, which then predicted continued dysregulation. These results may suggest that caregivers are effective at detecting their children's need for assistance and are making active attempts to assist their children and deescalate children's emotional dysregulation. These findings are commensurate with previous literature identifying caregiver responsiveness as an important contributor to children's ER ([<reflink idref="bib21" id="ref79">21</reflink>]; [<reflink idref="bib26" id="ref80">26</reflink>]), and indicate a need for a more thorough exploration of the way caregiver behaviors impact children's likelihood of dysregulation in real time.</p> <hd id="AN0152489940-25">Limitations</hd> <p>Findings should be interpreted with caution due to several limitations. First, data were collected using a contrived task designed to elicit frustration from children. Prior to beginning the task, caregivers were instructed by researchers to not intervene to help their child unless their child requests their help, whether verbally or nonverbally. The unfamiliar setting, and circumstances and instructions given to caregivers may have affected the way that they interacted with their children. This may explain the low incidence of co-regulation strategies used by caregivers in this sample. The interpretation of these findings is also complicated by the fact that caregiver and child behaviors were coded as mutually exclusive variables which, although necessitated by the limitations of the data, does not allow for a transactional understanding of how caregivers and their children with ASD negotiate the process of emotion co-regulation. Although these findings shed light on the nature of caregiver and children's co-regulatory behaviors during a contrived laboratory-based task, further work is needed to understand the transactional nature of caregiver–child co-regulation during naturalistic interactions.</p> <p>This study is also limited by the size of the sample. Although 71 participants were included in this analysis, with a total of 1278 intervals across children, the nested structure of the data limited analytical power. Given the nature of the data, the choice was made to assign a predominant code per interval for each caregiver and child variable, which does not account for the intricate ways in which ER strategies interact nor does it fully capture the transactional nature of caregiver–child co-regulation. This indicates a need for a study of caregiver–child co-regulation using a larger sample, as well as using a task that provides more intervals per participant. This would build upon this study by allowing for more detailed analysis of how strategies are used and combined by caregivers and children and how strategy use predicts the likelihood of subsequent negativity and changes in the intensity of negativity. Finally, the lack of a TD comparison group makes it difficult to make claims regarding whether the behaviors seen among participants of this study are typical for the population, and how these behaviors compare to those seen in TD children.</p> <hd id="AN0152489940-26">Conclusion</hd> <p>This study contributes to the literature on caregiver–child co-regulation in young children with ASD by exploring how caregiver and child behaviors impact the likelihood of changes in children's expressed negativity over the course of a challenging task. The findings of this study align with previous work that shows that toddlers with ASD use other-directed and avoidance type strategies most often ([<reflink idref="bib18" id="ref81">18</reflink>]; [<reflink idref="bib20" id="ref82">20</reflink>]) and expands upon this work by exploring the relationship between strategy use and the likelihood of subsequent negativity. These findings emphasize that toddlers with ASD are capable of employing ER strategies and begin to shed light on how certain behaviors may be predictive of changes in children's emotional states. In addition, these findings underscore the important role played by caregivers in helping manage dysregulation in their child with ASD. Although caregivers' use of emotional co-regulation strategies did not predict a decrease in children's likelihood of negativity, the way that caregivers responded to their children during the task was a salient predictor of children's likelihood of negativity. Specifically, caregivers' unresponsiveness to their children and caregivers' proactiveness predicted increases in the likelihood of upcoming negative episodes, which indicates the importance of caregivers' responsive behaviors not only for future outcomes ([<reflink idref="bib36" id="ref83">36</reflink>]) but also during moment-to-moment caregiver interactions. These findings are promising given the move toward caregiver-mediated interventions that incorporate caregiver responsiveness as an element of fostering social communication in this population (i.e. JASPER; [<reflink idref="bib19" id="ref84">19</reflink>]), which appear to have a positive impact on children's ER over time ([<reflink idref="bib14" id="ref85">14</reflink>]). Future research is needed to understand how caregiver and child behaviors interact to modulate children's negative emotions in real time, as well as to understand the effect of caregiver-mediated intervention on caregiver–child co-regulation, both in real time and longitudinally.</p> <ref id="AN0152489940-27"> <title> References </title> <blist> <bibl id="bib1" idref="ref60" type="bt">1</bibl> <bibtext> Adamson L. B., Bakeman R., Deckner D. F., Romski M. (2009). Joint engagement and the emergence of language in children with autism and Down syndrome. Journal of Autism and Developmental Disorders, 39(1), 84.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref41" type="bt">2</bibl> <bibtext> Ashburner J., Ziviani J., Rodger S. (2008). Sensory processing and classroom emotional, behavioral, and educational outcomes in children with autism spectrum disorder. American Journal of Occupational Therapy, 62(5), 564–573.</bibtext> </blist> <blist> <bibl id="bib3" idref="ref77" type="bt">3</bibl> <bibtext> Bates D., Maechler M., Bolker B., Walker S., Christensen R. H. B., Singmann H.,...Bolker M. B. (2015). Package "lme4." Convergence, 12(1), 2.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref1" type="bt">4</bibl> <bibtext> Berkovits L., Eisenhower A., Blacher J. (2017). Emotion regulation in young children with autism spectrum disorders. Journal of Autism and Developmental Disorders, 47(1), 68–79.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref56" type="bt">5</bibl> <bibtext> Bornstein M. H., Tamis-LeMonda C. S., Hahn C. S., Haynes O. M. (2008). Maternal responsiveness to young children at three ages: Longitudinal analysis of a multidimensional, modular, and specific parenting construct. Developmental Psychology, 44(3), 867.</bibtext> </blist> <blist> <bibl id="bib6" idref="ref37" type="bt">6</bibl> <bibtext> Cai R. Y., Richdale A. L., Uljarević M., Dissanayake C., Samson A. C. (2018). Emotion regulation in autism spectrum disorder: Where we are and where we need to go. Autism Research, 11(7), 962–978.</bibtext> </blist> <blist> <bibl id="bib7" idref="ref38" type="bt">7</bibl> <bibtext> Cappadocia M. C., Weiss J. A., Pepler D. (2012). Bullying experiences among children and youth with autism spectrum disorders. Journal of Autism and Developmental Disorders, 42(2), 266–277.</bibtext> </blist> <blist> <bibl id="bib8" idref="ref39" type="bt">8</bibl> <bibtext> Chamberlain B., Kasari C., Rotheram-Fuller E. (2007). Involvement or isolation? The social networks of children with autism in regular classrooms. Journal of Autism and Developmental Disorders, 37(2), 230–242.</bibtext> </blist> <blist> <bibl id="bib9" idref="ref78" type="bt">9</bibl> <bibtext> Core Team. (2019). R: A language and environment for statistical computing (Version 3.0.2). R Foundation for Statistical Computing.</bibtext> </blist> <blist> <bibtext> Denham S. A. (2006). Social-emotional competence as support for school readiness: What is it and how do we assess it? Early Education and Development, 17(1), 57–89.</bibtext> </blist> <blist> <bibtext> Eisenberg N., Spinrad T. L. (2004). Emotion-related regulation: Sharpening the definition. Child Development, 75(2), 334–339.</bibtext> </blist> <blist> <bibtext> Fredricks J. A., Blumenfeld P. C., Paris A. H. (2004). School engagement: Potential of the concept, state of the evidence. Review of Educational Research, 74(1), 59–109.</bibtext> </blist> <blist> <bibtext> Goldsmith H. H., Reilly J., Lemery K. S., Longley S., Prescott A. (1999). The Laboratory Assessment Battery: Preschool Version (LAB-TAB). University of Wisconsin.</bibtext> </blist> <blist> <bibtext> Gulsrud A. C., Jahromi L. B., Kasari C. (2010). The co-regulation of emotions between mothers and their children with autism. Journal of Autism and Developmental Disorders, 40(2), 227–237.</bibtext> </blist> <blist> <bibtext> Hamre B. K., Pianta R. C. (2005). Can instructional and emotional support in the first-grade classroom make a difference for children at risk of school failure? Child Development, 76(5), 949–967.</bibtext> </blist> <blist> <bibtext> Hirschler-Guttenberg Y., Golan O., Ostfeld-Etzion S., Feldman R. (2015). Mothering, fathering, and the regulation of negative and positive emotions in high-functioning preschoolers with autism spectrum disorder. Journal of Child Psychology and Psychiatry, 56(5), 530–539.</bibtext> </blist> <blist> <bibtext> Jahromi L. B., Bryce C. I., Swanson J. (2013). The importance of self-regulation for the school and peer engagement of children with high-functioning autism. Research in Autism Spectrum Disorders, 7(2), 235–246.</bibtext> </blist> <blist> <bibtext> Jahromi L. B., Meek S. E., Ober-Reynolds S. (2012). Emotion regulation in the context of frustration in children with high functioning autism and their typical peers. Journal of Child Psychology and Psychiatry, 53(12), 1250–1258.</bibtext> </blist> <blist> <bibtext> Kasari C., Gulsrud A., Paparella T., Hellemann G., Berry K. (2015). Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism. Journal of consulting and clinical psychology, 83(3), 554.</bibtext> </blist> <blist> <bibtext> Konstantareas M. M., Stewart K. (2006). Affect regulation and temperament in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 36(2), 143–154.</bibtext> </blist> <blist> <bibtext> Kopp C. B. (1982). Antecedents of self-regulation: A developmental perspective. Developmental Psychology, 18(2), 199.</bibtext> </blist> <blist> <bibtext> Ladd G. W., Herald S. L., Kochel K. P. (2006). School readiness: Are there social prerequisites? Early Education and Development, 17(1), 115–150.</bibtext> </blist> <blist> <bibtext> Lord C., Risi S., Lambrecht L., Cook E. H. Jr Leventhal B. L., DiLavore P. C.,...Rutter M. (2000). The Autism Diagnostic Observation Schedule–Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30(3), 205–223.</bibtext> </blist> <blist> <bibtext> Lord C., Storoschuk S., Rutter M., Pickles A. (1993). Using the ADI-R to diagnose autism in preschool children. Infant Mental Health Journal, 14(3), 234–252.</bibtext> </blist> <blist> <bibtext> Mahoney G., Powell A., Finger I. (1986). The maternal behavior rating scale. Topics in Early Childhood Special Education, 6(2), 44–56.</bibtext> </blist> <blist> <bibtext> Mahoney G., Perales F. (2003). Using relationship-focused intervention to enhance the social—Emotional functioning of young children with autism spectrum disorders. Topics in Early Childhood Special Education, 23(2), 74–86.</bibtext> </blist> <blist> <bibtext> Mazefsky C. A., Herrington J., Siegel M., Scarpa A., Maddox B. B., Scahill L., White S. W. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679–688.</bibtext> </blist> <blist> <bibtext> Mazefsky C. A., White S. W. (2014). Emotion regulation: Concepts & practice in autism spectrum disorder. Child and Adolescent Psychiatric Clinics of North America, 23(1), 15–24.</bibtext> </blist> <blist> <bibtext> Nuske H. J., Hedley D., Woollacott A., Thomson P., Macari S., Dissanayake C. (2017). Developmental delays in emotion regulation strategies in preschoolers with autism. Autism Research, 10(11), 1808–1822.</bibtext> </blist> <blist> <bibtext> Prizant B. M., Laurent A. (2011). Behavior is not the issue: An emotional regulation perspective on problem behavior—Part one of a part-two article. Autism Spectrum Quarterly, 1, 29–30.</bibtext> </blist> <blist> <bibtext> Rieffe C., Oosterveld P., Terwogt M. M., Mootz S., Van Leeuwen E., Stockmann L. (2011). Emotion regulation and internalizing symptoms in children with autism spectrum disorders. Autism, 15(6), 655–670.</bibtext> </blist> <blist> <bibtext> Samson A. C., Hardan A. Y., Podell R. W., Phillips J. M., Gross J. J. (2015). Emotion regulation in children and adolescents with autism spectrum disorder. Autism Research, 8(1), 9–18.</bibtext> </blist> <blist> <bibtext> Samson A. C., Huber O., Gross J. J. (2012). Emotion regulation in Asperger's syndrome and high-functioning autism. Emotion, 12(4), 659.</bibtext> </blist> <blist> <bibtext> Samson A. C., Phillips J. M., Parker K. J., Shah S., Gross J. J., Hardan A. Y. (2014). Emotion dysregulation and the core features of autism spectrum disorder. Journal of Autism and Developmental Disorders, 44(7), 1766–1772.</bibtext> </blist> <blist> <bibtext> Samson A. C., Wells W. M., Phillips J. M., Hardan A. Y., Gross J. J. (2015). Emotion regulation in autism spectrum disorder: Evidence from parent interviews and children's daily diaries. Journal of Child Psychology and Psychiatry, 56(8), 903–913.</bibtext> </blist> <blist> <bibtext> Shire S. Y., Gulsrud A., Kasari C. (2016). Increasing responsive parent–child interactions and joint engagement: Comparing the influence of parent-mediated intervention and parent psychoeducation. Journal of Autism and Developmental Disorders, 46(5), 1737–1747.</bibtext> </blist> <blist> <bibtext> Siller M., Hutman T., Sigman M. (2013). A parent-mediated intervention to increase responsive parental behaviors and child communication in children with ASD: A randomized clinical trial. Journal of Autism and Developmental Disorders, 43(3), 540–555.</bibtext> </blist> <blist> <bibtext> Stifter C. A., Braungart J. M. (1995). The regulation of negative reactivity in infancy: Function and development. Developmental Psychology, 31(3), 448.</bibtext> </blist> <blist> <bibtext> Thompson J. N. (1994). The coevolutionary process. University of Chicago Press.</bibtext> </blist> <blist> <bibtext> Thompson R. A., Goodman M. (2010). Development of emotion regulation: More than meets the eye. In Kring A. M., Sloan D. M. (Eds.), Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment (pp. 38–58). Guilford Press.</bibtext> </blist> <blist> <bibtext> Ting V., Weiss J. A. (2017). Emotion regulation and parent co-regulation in children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(3), 680–689.</bibtext> </blist> <blist> <bibtext> Valentovich V., Goldberg W. A., Garfin D. R., Guo Y. (2018). Emotion coregulation processes between mothers and their children with and without autism spectrum disorder: Associations with children's maladaptive behaviors. Journal of Autism and Developmental Disorders, 48(4), 1235–1248.</bibtext> </blist> <blist> <bibtext> Zimmer-Gembeck M. J., Skinner E. A. (2011). The development of coping across childhood and adolescence: An integrative review and critique of research. International Journal of Behavioral Development, 35(1), 1–17.</bibtext> </blist> <blist> <bibtext> Zwaigenbaum L., Bauman M. L., Choueiri R., Kasari C., Carter A., Granpeesheh D.,...Pierce K. (2015). Early intervention for children with autism spectrum disorder under 3 years of age: Recommendations for practice and research. Pediatrics, 136(Suppl. 1), S60–S81.</bibtext> </blist> </ref> <ref id="AN0152489940-28"> <title> Footnotes </title> <blist> <bibtext> The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> The author(s) received no financial support for the research, authorship, and/or publication of this article.</bibtext> </blist> <blist> <bibtext> Amanda Dimachkie Nunnally</bibtext> </blist> <blist> <bibtext>Graph https://orcid.org/0000-0001-6272-9882</bibtext> </blist> </ref> <aug> <p>By Amanda Dimachkie Nunnally; Kyle Sterrett; Amanda Gulsrud and Connie Kasari</p> <p>Reported by Author; Author; Author; Author</p> </aug> <nolink nlid="nl1" bibid="bib27" firstref="ref2"></nolink> <nolink nlid="nl2" bibid="bib29" firstref="ref3"></nolink> <nolink nlid="nl3" bibid="bib34" firstref="ref4"></nolink> <nolink nlid="nl4" bibid="bib39" firstref="ref5"></nolink> <nolink nlid="nl5" bibid="bib11" firstref="ref6"></nolink> <nolink nlid="nl6" bibid="bib30" firstref="ref8"></nolink> <nolink nlid="nl7" bibid="bib17" firstref="ref10"></nolink> <nolink nlid="nl8" bibid="bib38" firstref="ref11"></nolink> <nolink nlid="nl9" bibid="bib21" firstref="ref12"></nolink> <nolink nlid="nl10" bibid="bib40" firstref="ref14"></nolink> <nolink nlid="nl11" bibid="bib43" firstref="ref15"></nolink> <nolink nlid="nl12" bibid="bib10" firstref="ref16"></nolink> <nolink nlid="nl13" bibid="bib12" firstref="ref17"></nolink> <nolink nlid="nl14" bibid="bib15" firstref="ref18"></nolink> <nolink nlid="nl15" bibid="bib22" firstref="ref19"></nolink> <nolink nlid="nl16" bibid="bib16" firstref="ref20"></nolink> <nolink nlid="nl17" bibid="bib20" firstref="ref27"></nolink> <nolink nlid="nl18" bibid="bib44" firstref="ref29"></nolink> <nolink nlid="nl19" bibid="bib18" firstref="ref30"></nolink> <nolink nlid="nl20" bibid="bib32" firstref="ref31"></nolink> <nolink nlid="nl21" bibid="bib28" firstref="ref32"></nolink> <nolink nlid="nl22" bibid="bib31" firstref="ref33"></nolink> <nolink nlid="nl23" bibid="bib33" firstref="ref34"></nolink> <nolink nlid="nl24" bibid="bib35" firstref="ref36"></nolink> <nolink nlid="nl25" bibid="bib14" firstref="ref46"></nolink> <nolink nlid="nl26" bibid="bib42" firstref="ref48"></nolink> <nolink nlid="nl27" bibid="bib41" firstref="ref51"></nolink> <nolink nlid="nl28" bibid="bib26" firstref="ref55"></nolink> <nolink nlid="nl29" bibid="bib36" firstref="ref57"></nolink> <nolink nlid="nl30" bibid="bib37" firstref="ref59"></nolink> <nolink nlid="nl31" bibid="bib24" firstref="ref69"></nolink> <nolink nlid="nl32" bibid="bib23" firstref="ref70"></nolink> <nolink nlid="nl33" bibid="bib13" firstref="ref71"></nolink> <nolink nlid="nl34" bibid="bib25" firstref="ref75"></nolink> <nolink nlid="nl35" bibid="bib19" firstref="ref84"></nolink>
Header DbId: eric
DbLabel: ERIC
An: EJ1312128
AccessLevel: 3
PubType: Academic Journal
PubTypeId: academicJournal
PreciseRelevancyScore: 0
IllustrationInfo
Items – Name: Title
  Label: Title
  Group: Ti
  Data: What Are the Odds? Predicting the Likelihood of a Negative Episode in a Sample of Toddlers with Autism Spectrum Disorder
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Dimachkie+Nunnally%2C+Amanda%22">Dimachkie Nunnally, Amanda</searchLink> (ORCID <externalLink term="https://orcid.org/0000-0001-6272-9882">0000-0001-6272-9882</externalLink>)<br /><searchLink fieldCode="AR" term="%22Sterrett%2C+Kyle%22">Sterrett, Kyle</searchLink><br /><searchLink fieldCode="AR" term="%22Gulsrud%2C+Amanda%22">Gulsrud, Amanda</searchLink><br /><searchLink fieldCode="AR" term="%22Kasari%2C+Connie%22">Kasari, Connie</searchLink>
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Autism%3A+The+International+Journal+of+Research+and+Practice%22"><i>Autism: The International Journal of Research and Practice</i></searchLink>. Nov 2021 25(8):2254-2264.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: SAGE Publications. 2455 Teller Road, Thousand Oaks, CA 91320. Tel: 800-818-7243; Tel: 805-499-9774; Fax: 800-583-2665; e-mail: journals@sagepub.com; Web site: http://sagepub.com
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 11
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2021
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Autism%22">Autism</searchLink><br /><searchLink fieldCode="DE" term="%22Pervasive+Developmental+Disorders%22">Pervasive Developmental Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Toddlers%22">Toddlers</searchLink><br /><searchLink fieldCode="DE" term="%22Behavior+Problems%22">Behavior Problems</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Response%22">Emotional Response</searchLink><br /><searchLink fieldCode="DE" term="%22Self+Control%22">Self Control</searchLink><br /><searchLink fieldCode="DE" term="%22Intervention%22">Intervention</searchLink><br /><searchLink fieldCode="DE" term="%22Predictor+Variables%22">Predictor Variables</searchLink><br /><searchLink fieldCode="DE" term="%22Probability%22">Probability</searchLink><br /><searchLink fieldCode="DE" term="%22Negative+Attitudes%22">Negative Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Caregiver+Role%22">Caregiver Role</searchLink><br /><searchLink fieldCode="DE" term="%22Individual+Characteristics%22">Individual Characteristics</searchLink><br /><searchLink fieldCode="DE" term="%22Language+Skills%22">Language Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Severity+%28of+Disability%29%22">Severity (of Disability)</searchLink><br /><searchLink fieldCode="DE" term="%22Parent+Background%22">Parent Background</searchLink><br /><searchLink fieldCode="DE" term="%22Educational+Attainment%22">Educational Attainment</searchLink><br /><searchLink fieldCode="DE" term="%22Coping%22">Coping</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Autism+Diagnostic+Observation+Schedule%22">Autism Diagnostic Observation Schedule</searchLink><br /><searchLink fieldCode="SU" term="%22Mullen+Scales+of+Early+Learning%22">Mullen Scales of Early Learning</searchLink><br /><searchLink fieldCode="SU" term="%22Reynell+Developmental+Language+Scales%22">Reynell Developmental Language Scales</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1177/13623613211015001
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1362-3613
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Children with autism spectrum disorder exhibit challenges in regulating negativity and modifying emotional responses, a process known as emotion regulation. Such challenges affect social outcomes and response to intervention in children with autism spectrum disorder. Caregivers of children with autism spectrum disorder facilitate children's emotion regulation through a process known as co-regulation, but there have been no attempts to describe how dyadic use of strategies interact to impact the likelihood of negativity in real time. This study used video observations of 71 toddlers (mean age = 31.2 months) with autism spectrum disorder and their caregivers engaged in a frustrating, goal-oriented task. A mixed-effects logistic regression revealed that caregivers' use of co-regulation strategies was not a significant predictor of changes in the likelihood children's expressed negativity. Caregiver unresponsiveness and proactiveness, however, predicted increased likelihood of children's subsequent negativity. Children's use of high energy, non-instrumental behaviors (tension release), was also a robust predictor of increased likelihood of subsequent negativity. These findings shed a light on the effectiveness of child and caregiver strategies in facilitating emotion regulation in toddlers with autism spectrum disorder.
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2021
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1312128
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1312128
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1177/13623613211015001
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 11
        StartPage: 2254
    Subjects:
      – SubjectFull: Autism
        Type: general
      – SubjectFull: Pervasive Developmental Disorders
        Type: general
      – SubjectFull: Toddlers
        Type: general
      – SubjectFull: Behavior Problems
        Type: general
      – SubjectFull: Emotional Response
        Type: general
      – SubjectFull: Self Control
        Type: general
      – SubjectFull: Intervention
        Type: general
      – SubjectFull: Predictor Variables
        Type: general
      – SubjectFull: Probability
        Type: general
      – SubjectFull: Negative Attitudes
        Type: general
      – SubjectFull: Caregiver Role
        Type: general
      – SubjectFull: Individual Characteristics
        Type: general
      – SubjectFull: Language Skills
        Type: general
      – SubjectFull: Severity (of Disability)
        Type: general
      – SubjectFull: Parent Background
        Type: general
      – SubjectFull: Educational Attainment
        Type: general
      – SubjectFull: Coping
        Type: general
      – SubjectFull: Autism Diagnostic Observation Schedule
        Type: general
      – SubjectFull: Mullen Scales of Early Learning
        Type: general
      – SubjectFull: Reynell Developmental Language Scales
        Type: general
    Titles:
      – TitleFull: What Are the Odds? Predicting the Likelihood of a Negative Episode in a Sample of Toddlers with Autism Spectrum Disorder
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Dimachkie Nunnally, Amanda
      – PersonEntity:
          Name:
            NameFull: Sterrett, Kyle
      – PersonEntity:
          Name:
            NameFull: Gulsrud, Amanda
      – PersonEntity:
          Name:
            NameFull: Kasari, Connie
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 01
              M: 11
              Type: published
              Y: 2021
          Identifiers:
            – Type: issn-print
              Value: 1362-3613
          Numbering:
            – Type: volume
              Value: 25
            – Type: issue
              Value: 8
          Titles:
            – TitleFull: Autism: The International Journal of Research and Practice
              Type: main
ResultId 1