Skip to main content

Emotion Regulation Intensive Outpatient Programming: Development, Feasibility, and Acceptability

Abstract

Individuals with Autism Spectrum Disorder (ASD) and/or intellectual and developmental disabilities (DD) often struggle with behavior management and emotion-regulation (ER). In this manuscript, we describe the results of a chart review examining a group treatment program designed to address ER deficits in youth with ASD and/or DD. The intensive 5 week program utilizes cognitive behavior, applied behavior analysis, and mindfulness techniques and includes biweekly child and parent groups. Results indicate that this program is feasible and associated with high caregiver satisfaction. Pre-and-post outcome results indicate statistically significant improvement on behavioral measures, but did not demonstrate significant improvment on the Pediatric Quality of Life Family Impact Module. Based on overall positive outcomes, a randomized controlled trial of the program is indicated.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  • Achenbach, T. M., & Rescorla, L. (2001). ASEBA school-age forms & profiles. Burlington: ASEBA.

    Google Scholar 

  • Aldao, A., & Nolen-Hoeksema, S. (2013). One versus many: Capturing the use of multiple emotion regulation strategies in response to an emotion-eliciting stimulus. Cognition & Emotion, 27(4), 753–760. https://doi.org/10.1080/02699931.2012.739998.

    Article  Google Scholar 

  • Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237. https://doi.org/10.1016/j.cpr.2009.11.004.

    Article  Google Scholar 

  • Ali, A., Hall, I., Blickwedel, J., & Hassiotis, A. (2015). Behavioural and cognitive-behavioural interventions for outwardly-directed aggressive behaviour in people with intellectual disabilities. Cochrane Database System Reviews. https://doi.org/10.1002/14651858.CD003406.pub4.

    Article  Google Scholar 

  • Aman, M. G., McDougle, C. J., Scahill, L., Handen, B. L., Arnold, L. E., Johnson, C. R., et al. (2009). Medication and parent training in children with pervasive developmental disorders and serious behavior problems: Results from a randomized clinical trial. Journal of American Academy of Child and Adolescent Psychiatry, 48(12), 1143–1154. https://doi.org/10.1097/CHI.0b013e3181bfd669.

    Article  Google Scholar 

  • Aman, M. G., & Singh, N. N. (1986). Aberrant behavior checklists: Manual. East Aurora: Slosson Educational Publications.

    Google Scholar 

  • Bandura, A. (1989). Regulation of cogntivie processes through perceived self-efficacy. Developmental Psychology, 25, 729–735.

    Article  Google Scholar 

  • Bearss, K., Johnson, C., Smith, T., Lecavalier, L., Swiezy, N., Aman, M., et al. (2015). Effect of parent training vs parent education on behavioral problems in children with autism spectrum disorder: A randomized clinical trial. JAMA, 313(15), 1524–1533. https://doi.org/10.1001/jama.2015.3150.

    Article  PubMed  Google Scholar 

  • Blackledge, J. T., & Hayes, S. C. (2001). Emotion regulation in acceptance and commitment therapy. Journal of Clinical Psychology, 57(2), 243–255.

    Article  Google Scholar 

  • Blake, M. J., Sheeber, L. B., Youssef, G. J., Raniti, M. B., & Allen, N. B. (2017). Systematic review and meta-analysis of adolescent cognitive-behavioral sleep interventions. Clinical Child and Family Psychology Review, 20(3), 227–249. https://doi.org/10.1007/s10567-017-0234-5.

    Article  PubMed  Google Scholar 

  • Burckhardt, R., Manicavasagar, V., Batterham, P. J., Hadzi-Pavlovic, D., & Shand, F. (2017). Acceptance and commitment therapy universal prevention program for adolescents: A feasibility study. Child and Adolescent Psychiatry and Mental Health, 11, 27. https://doi.org/10.1186/s13034-017-0164-5.

    Article  PubMed  PubMed Central  Google Scholar 

  • Buron, K., & Curtis, M. (2003). The incredible 5-point scale: Assisting students with autism spectrum disorders in understanding social interactions and controlling their emotional responses. Shawnee Mission: Autism Asperger Publishing Company.

    Google Scholar 

  • Campos, J. J., Frankel, C. B., & Camras, L. (2004). On the nature of emotion regulation. Child Development, 75(2), 377–394. https://doi.org/10.1111/j.1467-8624.2004.00681.x.

    Article  PubMed  Google Scholar 

  • Chang, Y. C., Laugeson, E. A., Gantman, A., Ellingsen, R., Frankel, F., & Dillon, A. R. (2014). Predicting treatment success in social skills training for adolescents with autism spectrum disorders: The UCLA Program for the Education and Enrichment of Relational Skills. Autism, 18(4), 467–470. https://doi.org/10.1177/1362361313478995.

    Article  PubMed  Google Scholar 

  • Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion regulation and the anxiety disorders: An integrative review. Journal of Psychopathology and Behavioral Assessment, 32(1), 68–82. https://doi.org/10.1007/s10862-009-9161-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Coleman, P. K., & Karraker, K. H. (1998). Self-efficacy and parenting quality: Findings and future applications. Developmental Review, 18, 47–85.

    Article  Google Scholar 

  • Cotton, S., Luberto, C. M., Sears, R. W., Strawn, J. R., Stahl, L., Wasson, R. S., et al. (2016). Mindfulness-based cognitive therapy for youth with anxiety disorders at risk for bipolar disorder: A pilot trial. Early Intervention in Psychiatry, 10(5), 426–434. https://doi.org/10.1111/eip.12216.

    Article  PubMed  Google Scholar 

  • de Bruin, E. I., Blom, R., Smit, F. M., van Steensel, F. J., & Bogels, S. M. (2015). MYmind: Mindfulness training for Youngsters with autism spectrum disorders and their parents. Autism, 19(8), 906–914. https://doi.org/10.1177/1362361314553279.

    Article  PubMed  Google Scholar 

  • Eisenberg, N., & Spinrad, T. L. (2004). Emotion-related regulation: Sharpening the definition. Child Development, 75(2), 334–339. https://doi.org/10.1111/j.1467-8624.2004.00674.x.

    Article  PubMed  Google Scholar 

  • Frankel, F., Myatt, R., Sugar, C., Whitham, C., Gorospe, C. M., & Laugeson, E. (2010). A randomized controlled study of parent-assisted children’s friendship training with children having autism spectrum disorders. [Randomized Controlled Trial Research Support, N. I. H., & Extramural]. Journal of Autism and Developmental Disorders. 40(7), 827–842, https://doi.org/10.1007/s10803-009-0932-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gowen, J. W., Johnson-Martin, N., Goldman, B. D., & Applebaum, M. (1989). Feelings of depression and parenting competence of mothers of handicapped and nonhandicapped infants: A longitudinal study. American Journal on Mental Retardation, 94, 259–271.

    PubMed  Google Scholar 

  • Granpeesheh, D., Tarbox, J., & Dixon, D. R. (2009). Applied behavior analytic interventions for children with autism: A description and review of treatment research. Annals of Clinical Psychiatry, 21(3), 162–173.

    PubMed  Google Scholar 

  • Guy, W. (1976). ECDEU assessment manual for psychopharmacology, publication No. 76–338. Washington, DC: U.S. DHEW, NIMH.

  • Hastings, R. P., & Brown, T. (2002). Behavior problems of children with autism, parental self-efficacy, and mental health. American Journal on Mental Retardation, 107(3), 222–232, https://doi.org/10.1352/0895-8017(2002)107%3C0222:bpocwa%3E2.0.co;2.

    Article  PubMed  Google Scholar 

  • Hesse, T., Holmes, L. G., Kennedy-Overfelt, V., Kerr, L. M., & Giles, L. L. (2015). Mindfulness-based intervention for adolescents with recurrent headaches: A pilot feasibility study. Evidence-Based Complementary and Alternative Medicine, 2015, 508958, https://doi.org/10.1155/2015/508958.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hill, A. L., Degnan, K. A., Calkins, S. D., & Keane, S. P. (2006). Profiles of externalizing behavior problems for boys and girls across preschool: The roles of emotion regulation and inattention. Developmental Psychology, 42(5), 913–928. https://doi.org/10.1037/0012-1649.42.5.913.

    Article  PubMed  Google Scholar 

  • Hwang, Y. S., & Kearney, P. (2013). A systematic review of mindfulness intervention for individuals with developmental disabilities: Long-term practice and long lasting effects. Research in Developmental Disabilities, 34(1), 314–326. https://doi.org/10.1016/j.ridd.2012.08.008.

    Article  PubMed  Google Scholar 

  • 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. https://doi.org/10.1111/j.1469-7610.2012.02560.x.

    Article  PubMed  Google Scholar 

  • King, B. H., Hollander, E., Sikich, L., McCracken, J. T., Scahill, L., Bregman, J. D., et al. (2009). Lack of efficacy of citalopram in children with autism spectrum disorders and high levels of repetitive behavior: Citalopram ineffective in children with autism. Archives of General Psychiatry, 66(6), 583–590. https://doi.org/10.1001/archgenpsychiatry.2009.30.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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. https://doi.org/10.1007/s10803-005-0051-4.

    Article  PubMed  Google Scholar 

  • Kumar, S., Feldman, G., & Hayes, A. (2008). Changes in mindfulness and emotion regulation in an exposure-based cognitive therapy for depression. Cognitive Therapy and Research, 32(6), 734. https://doi.org/10.1007/s10608-008-9190-1.

    Article  Google Scholar 

  • Kuypers, L. M. (2011). The zones of regulation. San Jose: Social Thinking Publishing.

    Google Scholar 

  • Laugeson, E. A., Frankel, F., Gantman, A., Dillon, A. R., & Mogil, C. (2012). Evidence-based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS program. Journal of Autism and Developmental Disorders, 42(6), 1025–1036. https://doi.org/10.1007/s10803-011-1339-1.

    Article  PubMed  Google Scholar 

  • Laugeson, E. A., Frankel, F., Mogil, C., & Dillon, A. R. (2009). Parent-assisted social skills training to improve friendships in teens with autism spectrum disorders. [Clinical Trial Comparative Study Research Support, N.I.H., Extramural]. Journal of Autism and Developmental Disorders, 39(4), 596–606. https://doi.org/10.1007/s10803-008-0664-5.

    Article  PubMed  Google Scholar 

  • Lovaas, O. I., Koegel, R., Simmons, J. Q., & Long, J. S. (1973). Some generalization and follow-up measures on autistic children in behavior therapy. Journal of Applied Behavior Analysis, 6, 131–166.

    Article  Google Scholar 

  • Madrigal, S., & Garcia Winner, M. (2008). Superflex… A superhero social thinking curriculum. San Jose: Social Thinking Publishing.

    Google Scholar 

  • Mandelberg, J., Frankel, F., Cunningham, T., Gorospe, C., & Laugeson, E. A. (2014). Long-term outcomes of parent-assisted social skills intervention for high-functioning children with autism spectrum disorders. Autism, 18(3), 255–263. https://doi.org/10.1177/1362361312472403.

    Article  PubMed  Google Scholar 

  • Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., et al. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679–688. https://doi.org/10.1016/j.jaac.2013.05.006.

    Article  Google Scholar 

  • Mazefsky, C. A., Pelphrey, K. A., & Dahl, R. E. (2012). The need for a broader approach to emotion regulation research in autism. Child Development Perspectives, 6(1), 92–97. https://doi.org/10.1111/j.1750-8606.2011.00229.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • 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. https://doi.org/10.1016/j.chc.2013.07.002.

    Article  PubMed  Google Scholar 

  • Mazefsky, C. A., Yu, L., White, S. W., Siegel, M., & Pilkonis, P. A. (2018). The emotion dysregulation inventory: Psychometric properties and item response theory calibration in an autism spectrum disorder sample. Autism Research, 11(6), 928–941. https://doi.org/10.1002/aur.1947.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mcclure, K. S., Halpern, J., Wolper, P. A., & Donahue, J. (2009). Emotion regulation and intellectual disability. Journal of Developmental Disabilities, 15(2), 38–44.

    Google Scholar 

  • McDougle, C. J., Scahill, L., Aman, M. G., McCracken, J. T., Tierney, E., Davies, M., et al. (2005). Risperidone for the core symptom domains of autism: Results from the study by the autism network of the research units on pediatric psychopharmacology. American Journal of Psychiatry, 162(6), 1142–1148. https://doi.org/10.1176/appi.ajp.162.6.1142.

    Article  PubMed  Google Scholar 

  • McGillivray, J. A., & Kershaw, M. (2015). Do we need both cognitive and behavioural components in interventions for depressed mood in people with mild intellectual disability? Journal of Intellectual Disability Research, 59(2), 105–115. https://doi.org/10.1111/jir.12110.

    Article  PubMed  Google Scholar 

  • Medrano, G. R., Berlin, K. S., & Hobart Davies, W. (2013). Utility of the PedsQL family impact module: Assessing the psychometric properties in a community sample. Quality of Life Research, 22(10), 2899–2907. https://doi.org/10.1007/s11136-013-0422-9.

    Article  PubMed  Google Scholar 

  • Minshawi, N. F., Wink, L. K., Shaffer, R., Plawecki, M. H., Posey, D. J., Liu, H., et al. (2016). A randomized, placebo-controlled trial of D-cycloserine for the enhancement of social skills training in autism spectrum disorders. Molecular Autism, 7, 2. https://doi.org/10.1186/s13229-015-0062-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Noguchi, R., Sekizawa, Y., So, M., Yamaguchi, S., & Shimizu, E. (2017). Effects of five-minute internet-based cognitive behavioral therapy and simplified emotion-focused mindfulness on depressive symptoms: A randomized controlled trial. BMC Psychiatry, 17(1), 85. https://doi.org/10.1186/s12888-017-1248-8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Olatunji, B. O., Cisler, J. M., & Deacon, B. J. (2010). Efficacy of cognitive behavioral therapy for anxiety disorders: A review of meta-analytic findings. Psychiatric Clinics North America, 33(3), 557–577. https://doi.org/10.1016/j.psc.2010.04.002.

    Article  Google Scholar 

  • Reaven, J., Blakeley-Smith, A., Culhane-Shelburne, K., & Hepburn, S. (2012). Group cognitive behavior therapy for children with high-functioning autism spectrum disorders and anxiety: A randomized trial. Journal of Child Psychology and Psychiatry, 53(4), 410–419.

    Article  Google Scholar 

  • 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. https://doi.org/10.1177/1362361310366571.

    Article  PubMed  Google Scholar 

  • Samson, A. C., Huber, O., & Gross, J. J. (2012). Emotion regulation in Asperger’s syndrome and high-functioning autism. Emotion, 12(4), 659–665. https://doi.org/10.1037/a0027975.

    Article  PubMed  Google Scholar 

  • Scahill, L., Bearss, K., Lecavalier, L., Smith, T., Swiezy, N., Aman, M. G., et al. (2016). Effect of parent training on adaptive behavior in children with autism spectrum disorder and disruptive behavior: Results of a randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry, 55(7), 602–609.e603. https://doi.org/10.1016/j.jaac.2016.05.001.

    Article  Google Scholar 

  • Scarpa, A., & Reyes, N. M. (2011). Improving emotion regulation with CBT in young children with high functioning autism spectrum disorders: A pilot study. Behavioural and Cognitive Psychotherapy, 39(4), 495–500. https://doi.org/10.1017/s1352465811000063.

    Article  PubMed  Google Scholar 

  • Schneider, R. L., Arch, J. J., Landy, L. N., & Hankin, B. L. (2016). The longitudinal effect of emotion regulation strategies on anxiety levels in children and adolescents. Journal of Clinical Child & Adolescent Psychology. https://doi.org/10.1080/15374416.2016.1157757.

    Article  Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford.

    Google Scholar 

  • Shaffer, R. C., & Minshawi, N. F. (2014). Training and supporting caregivers in evidence-based practices. In P. Sturmey, J. Tarbox, D. Dixon & J. L. Matson (Eds.), International handbook of autism and pervasive developmental disorders. New York: Springer Publishing.

    Google Scholar 

  • Siener, S., & Kerns, K. A. (2012). Emotion regulation and depressive symptoms in preadolescence. Child Psychiatry & Human Development, 43(3), 414–430. https://doi.org/10.1007/s10578-011-0274-x.

    Article  Google Scholar 

  • Sofronoff, K., Attwood, T., & Hinton, S. (2005). A randomised controlled trial of a CBT intervention for anxiety in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 46(11), 1152–1160. https://doi.org/10.1111/j.1469-7610.2005.00411.x.

    Article  PubMed  Google Scholar 

  • Sofronoff, K., Attwood, T., Hinton, S., & Levin, I. (2007). A randomized controlled trial of a cognitive behavioural intervention for anger management in children diagnosed with Asperger syndrome. Journal of Autism and Developmental Disorders, 37(7), 1203–1214. https://doi.org/10.1007/s10803-006-0262-3.

    Article  PubMed  Google Scholar 

  • Sofronoff, K., & Farbotko, M. (2002). The effectiveness of parent management training to increase self-efficacy in parents of children with Asperger syndrome. Autism, 6(3), 271–286. https://doi.org/10.1177/1362361302006003005.

    Article  PubMed  Google Scholar 

  • Stoneman, Z., & Crapps, J. M. (1988). Correlates of stress, perceived competence, and depression among family care providers. American Journal on Mental Retardation, 93, 166–173.

    PubMed  Google Scholar 

  • Tarrasch, R., Margalit-Shalom, L., & Berger, R. (2017). Enhancing visual perception and motor accuracy among school children through a mindfulness and compassion program. Frontiers in Psychology, 8, 281. https://doi.org/10.3389/fpsyg.2017.00281.

    Article  PubMed  PubMed Central  Google Scholar 

  • Unwin, G., Tsimopoulou, I., Kroese, B. S., & Azmi, S. (2016). Effectiveness of cognitive behavioural therapy (CBT) programmes for anxiety or depression in adults with intellectual disabilities: A review of the literature. Research in Developmental Disabilities, 51–52, 60–75. https://doi.org/10.1016/j.ridd.2015.12.010.

    Article  PubMed  Google Scholar 

  • Varni, J. W., Sherman, S. A., Burwinkle, T. M., Dickinson, P. E., & Dixon, P. (2004). The PedsQL Family Impact Module: Preliminary reliability and validity. Health and Quality of Life Outcomes, 2, 55. https://doi.org/10.1186/1477-7525-2-55.

    Article  PubMed  PubMed Central  Google Scholar 

  • Virues-Ortega, J. (2010). Applied behavior analytic intervention for autism in early childhood: Meta-analysis, meta-regression and dose-response meta-analysis of multiple outcomes. Clinical Psychology Review, 30(4), 387–399. https://doi.org/10.1016/j.cpr.2010.01.008.

    Article  PubMed  Google Scholar 

  • Vollestad, J., Nielsen, M. B., & Nielsen, G. H. (2012). Mindfulness- and acceptance-based interventions for anxiety disorders: A systematic review and meta-analysis. British Journal of Clinical Psychology, 51(3), 239–260. https://doi.org/10.1111/j.2044-8260.2011.02024.x.

    Article  PubMed  Google Scholar 

  • Weiss, J. A., Thomson, K., Burnham Riosa, P., Albaum, C., Chan, V., Maughan, A., et al. (2018). A randomized waitlist-controlled trial of cognitive behavior therapy to improve emotion regulation in children with autism. Journal of Child Psychology and Psychiatry. https://doi.org/10.1111/jcpp.12915.

    Article  PubMed  Google Scholar 

  • Wink, L. K., Minshawi, N. F., Shaffer, R. C., Plawecki, M. H., Posey, D. J., Horn, P. S., et al. (2017). d-Cycloserine enhances durability of social skills training in autism spectrum disorder. Molecular Autism, 8, 2. https://doi.org/10.1186/s13229-017-0116-1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wood, J. J., Drahota, A., Sze, K., Har, K., Chiu, A., & Langer, D. A. (2009). Cognitive behavioral therapy for anxiety in children with autism spectrum disorders: A randomized, controlled trial. Journal of Child Psychology and Psychiatry, 50(3), 224–234. https://doi.org/10.1111/j.1469-7610.2008.01948.x.

    Article  PubMed  Google Scholar 

  • Yang, L., Zhou, X., Zhou, C., Zhang, Y., Pu, J., Liu, L., et al. (2017). Efficacy and acceptability of cognitive behavioral therapy for depression in children: A systematic review and meta-analysis. Academic Pediatrics, 17(1), 9–16. https://doi.org/10.1016/j.acap.2016.08.002.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank all of the staff at Cincinnati Children’s Hospital Medical Center who assisted with ER-IOP, particularly our behavior assistant Jennifer Harms and additional group leaders Allison Blackburn, Nicole Klein, and Lauren Schmitt. This program would not be possible without their expertise and hard work.

Author information

Authors and Affiliations

Authors

Contributions

RCS developed and led the program, analyzed chart review data, and crafted the manuscript, LKW assisted with manuscript development, JR assisted with program development and group implementation, AP assisted with group implementation and manuscript development, RA assisted with data analysis, PCM supported the program implementation, MS supported the program implementation, CAE assisted with program development and manuscript development.

Corresponding author

Correspondence to Rebecca C. Shaffer.

Ethics declarations

Conflict of interest

All authors declare declare that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shaffer, R.C., Wink, L.K., Ruberg, J. et al. Emotion Regulation Intensive Outpatient Programming: Development, Feasibility, and Acceptability. J Autism Dev Disord 49, 495–508 (2019). https://doi.org/10.1007/s10803-018-3727-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10803-018-3727-2

Keywords

  • Autism Spectrum Disorder
  • Emotion regulation
  • Group treatment
  • Intensive outpatient programming
  • Cognitive behavioral therapy
  • Parent training