RESEARCH ARTICLE

Emotion Regulation in Children and Adolescents With Autism

Spectrum Disorder
Andrea C. Samson, Antonio Y. Hardan, Rebecca W. Podell, Jennifer M. Phillips, and James J. Gross
Emotion dysregulation is not a formal criterion for the diagnosis of autism spectrum disorder (ASD). However, parents
and clinicians have long noted the importance of emotional problems in individuals with ASD (e.g. tantrums and
meltdowns). In this study, 21 high-functioning children and adolescents with ASD and 22 age and gender groupmatched typically developing (TD) controls completed a Reactivity and Regulation Situation Task. This task assesses
emotional reactivity and spontaneous use of emotion regulation strategies (problem solving, cognitive reappraisal,
avoidance, distraction, venting, suppression, and relaxation) in the context of age-appropriate ambiguous and potentially threatening negative scenarios. After the concept of cognitive reappraisal was explained, the scenarios were
presented again to participants, and they were prompted to use this strategy. Results indicated that individuals with ASD
exhibited the same level of reactivity to negative stimuli as TD participants. Furthermore, youth with ASD had a different
emotion regulation profile than TD individuals, characterized by a less frequent use of cognitive reappraisal and more
frequent use of suppression. When prompted to use cognitive reappraisal, participants with ASD were less able to
implement reappraisal, but benefitted from this strategy when they were able to generate a reappraisal. Findings from this
study suggest that cognitive reappraisal strategies may be useful to children and adolescents with ASD. Therefore, the
development of treatment programs that focus on enhancing the use of adaptive forms of emotion regulation might
decrease emotional
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with ASD.
Res 2014,
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Wiley Periodicals,
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Keywords: autism spectrum disorder; emotional reactivity; emotion regulation; cognitive reappraisal; suppression

dren and adolescents with ASD, compared with a group

of typically developing (TD) participants.

Introduction
Problematic emotional responses, such as tantrums and
anger outbursts, are surprisingly common in individuals
with autism spectrum disorder (ASD). Indeed, clinical
reports and a few initial empirical studies provide evidence of severe impairments in emotional functioning
among individuals with ASD [e.g. Laurent & Rubin, 2004;
Mazefsky, Pelphrey, & Dahl, 2012; Mazefsky et al., 2013;
Myles, 2003]. Interestingly, such dysfunctional emotional
responses are not part of the formal definition or core
features of ASD, which include deficits in social communication and interaction, as well as restricted and repetitive behaviors [American Psychiatric Association, 2013].
To better understand emotional problems in ASD, the
present study was designed to examine the use and
effectiveness of cognitive reappraisal, a generally adaptive
emotion regulation strategy, in high-functioning chil-

Research on Emotion Regulation

When individuals regulate their emotions, they are
attempting to influence how they experience and/or
express emotions [e.g. Gross, 1998; Gross & Thompson,
2007]. Emotion regulation abilities are crucial for optimal
functioning and adaptive long-term outcomes because
they enable appropriate responses in social interactions
and facilitate the ability to cope with novel or changing
situations and stimuli [Gross, 1998, 2007; Silk, Steinberg,
& Morris, 2003].
Over the past decade, researchers have begun to characterize a number of emotion regulation strategies. These
strategies differ in important ways, such as whether they
influence the unfolding emotional response relatively

From the Department of Psychology, Stanford University, Stanford, California (A.C.S., R.W.P., J.J.G.); Department of Psychiatry and Behavioral Sciences,
Stanford University, Stanford, California (A.Y.H., J.M.P.)
Received April 01, 2013; accepted for publication March 27, 2014
Address for correspondence and reprints: Andrea Samson, Department of Psychology, Stanford University, 450 Serra Mall, Bldg 420, Stanford, CA
94305. E-mail: [email protected]
Authors Notes: Grant sponsor Swiss National Science Foundation; Grant number: PA00P1_136380 (to A.S.) and Mosbacher Family Fund for Autism
Research.
Conflict of interest: None.
Ethics: The work with human subjects complies with the guiding policies and principles for experimental procedures endorsed by the NIH.
23 Wiley
May 2014
in Wiley
Library (wileyonlinelibrary.com)
Published online in
Online
LibraryOnline
(wileyonlinelibrary.com)
DOI: 10.1002/aur.1387
2014 International Society for Autism Research, Wiley Periodicals, Inc.

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AutismResearch
Research:
8: ,
918, 2015
Autism
2014

19

early (i.e. antecedent-focused) or relatively late (i.e.

response-focused) in the emotion-generative process.
Cognitive reappraisal, an antecedent-focused regulation
strategy, has been identified as particularly important for
adaptive emotional functioning. It involves thinking
about an event that has the potential to elicit an emotional response in a way that alters the events emotional
impact. Previous studies suggest that cognitive reappraisal is a strategy that is highly effective in downregulating negative emotions in TD individuals and
predicts positive long-term outcomes [e.g. Bower et al.,
2005; Gross, 2002]. Cognitive reappraisal has been found
to be a key skill for optimizing emotional functioning
[e.g. Gross & Thompson, 2007; Moore, Zoellner, &
Mollenholt, 2008].
Emotion Dysregulation in ASD
Problematic emotional behaviors including irritability,
temper outbursts, aggression, and/or self-injurious behaviors are frequently observed in ASD [e.g. Geller, 2005;
Lecavalier, Leone, & Wiltz, 2006; Lerner, Haque,
Northrup, Lawer, & Bursztajn, 2012; Prizant & Laurent,
2011; Quek, Sofronoff, Sheffield, White, & Kelly, 2012].
Lecavalier et al. [2006] recently suggested that more than
60% of youth with ASD exhibit such behaviors. Additionally, individuals with ASD also experience elevated
levels of anxiety and increased negative emotions
[Capps, Kasari, Yirmiya, & Sigman, 1993; Joseph & TagerFlusberg, 1997; Kasari & Sigman, 1997; Laurent & Rubin,
2004; Volkmar & Klin, 2003] that can contribute to
intense feelings of distress. In combination with problematic emotional behaviors, elevated negative emotions
may adversely impact daily functioning, quality of life,
and long-term outcomes [see, for example, Cole &
Michel, 1994; McLaughlin, Hatzenbuehler, Mennin, &
Nolen-Hoeksema, 2011].
Relatively few studies have examined emotion
regulation in ASD, but available evidence suggests high
levels of disturbances in this domain [Jahromi, Meek, &
Ober-Reynolds, 2012; Konstantareas & Stewart, 2006;
Laurent & Rubin, 2004; Lecavalier et al., 2006; Lerner
et al., 2012; Quek et al., 2012; Rieffe et al., 2011]. For
example, studies have suggested that individuals with
ASD use adaptive emotion regulation strategies, such as
goal-directed behaviors or social support seeking, less
effectively compared with a control group [Jahromi et al.,
2012]. Instead, individuals with ASD rely on maladaptive
or idiosyncratic strategies [see also Laurent & Rubin,
2004], such as avoidance and venting [Jahromi et al.,
2012] or defense and crying [Konstantareas & Stewart,
2006]. In addition, eye contact avoidance in ASD has
been suggested to be a coping mechanism used to avoid
a heightened emotional response associated with eye
contact [Dalton et al., 2005]. This is consistent with

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Samson, Huber, and Grosss [2012] recent study suggesting that adults with ASD use cognitive reappraisal less
frequently than their TD counterparts, but use more
expressive suppression, which is considered maladaptive
in the long term if it is the only available regulatory
strategy. This pattern persisted even when controlling for
differences in emotional reactivity and labeling.
The Present Study
The goal of the present study was to gain a better understanding of emotion regulation in children and adolescents with ASD. While initial findings from a self-report
study provided evidence suggesting that adults with ASD
use cognitive reappraisal less frequently than TD adults
[Samson et al., 2012], little is known about the use and
efficacy of cognitive reappraisal in children and adolescents with ASD. Late childhood and adolescence are both
critical phases for the development of emotion regulation
skills. During these stages, individuals acquire a broad
repertoire of emotion regulation strategies, including
adaptive strategies such as problem solving and cognitive
reappraisal. As development continues through these
stages, the strategies acquired may be used more flexibly
and may be tailored to situational requirements [Compas,
Connor-Smith, Saltzman, Thomsen, & Wadsworth, 2001;
Gross, 1999; McRae et al., 2012; Silvers et al., 2012].
Using the Reactivity and Regulation Situation Task
[Carthy, Horesh, Apter, Edge, & Gross, 2010], we examined spontaneous and cued cognitive reappraisal in highfunctioning children and adolescents with ASD and TD
controls. We also measured the extent to which reappraising a potentially threatening situation yielded a
reduction in levels of experienced negative emotion
(reappraisal efficacy). By utilizing stimuli that resemble
real-life situations in childhood and adolescence, we were
able to elicit real-time emotional activation in order to
provide quantitative and qualitative assessments of individual differences in emotional reactivity and regulation.
We hypothesized that compared with TD participants, (a)
individuals with ASD would be equally affected by the
emotional stimuli. We also anticipated that participants
with ASD would exhibit a different emotion regulation
profile. Specifically, we predicted that relative to TD participants, individuals with ASD would (b) make less spontaneous use of cognitive reappraisal; (c) be less able to use
cognitive reappraisal when prompted; and (d) be less
effective at downregulating their negative emotions using
cognitive reappraisal.

Method
Participants
Only participants able to complete the experimental procedures were included (one ASD participant was not

Samson et al./Emotion regulation in autism spectrum disorder

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Table 1.

Sample Characteristics

N
Male/female
Age
FSIQ

ASD

TD

M (SD)

M (SD)

Statistics

21
18/3
12.71 (3.62)
103.33 (15.33)

22
16/6
13.00 (2.99)
112.59 (11.54)

ns.a
t(41) = 0.28, ns.
t(41) = 2.24, P < 0.05

Notes. FSIQ, full-scale intelligence quotient; ASD, participants with

autism spectrum disorder; SD, standard deviation; TD, typically developing
participants.
a
On the basis of a Fishers exact test, two-tailed.

included because he could not respond to any of the

questions). Twenty-one individuals with ASD and 22
individuals with TD participated in the study. Table 1
presents sample characteristics. The two groups did not
differ in gender and age (age range within each group:
820 years), but TD participants scored higher on fullscale intelligence quotient (FSIQ) (FSIQ range for individuals with ASD: 80129; FSIQ range for TD participants:
92133). The sample consisted of 68.3% Caucasian, 2.4%
Mexican, 9.8% Chinese, 4.9% Indian, 2.4% Southeast
Asian, 7.3% other, and 4.9% declined to answer. No
group difference was observed when comparing Caucasians with all other ethnicities (70% of individuals with
ASD and 66.7% of TD participants were Caucasian,
X2(1) = 0.05, P = 0.82). For ASD participants, the diagnosis of autism was established through expert clinical
evaluation (J.M.P. and A.Y.H.) based on the Diagnostic
and Statistical Manual of Mental Disorders-IV-TR (DSMIV-TR) and confirmed with the Autism Diagnostic
Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule [ADOS; Lord et al., 2000; Lord, Rutter, &
Le Couteur, 1994]. The ADI-R is administered to the
parent and consists of 88 items that are informed by the
International Classification of Diseases (ICD-10) and
Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV) diagnostic criteria for autistic disorder. The
ADOS is a semi-structured instrument that allows assessment of children through behavioral observations during
specific play, social, and language tasks [Lord et al., 2000].
Children with secondary autism related to a specific etiology (e.g. tuberous sclerosis, Fragile X) were excluded, as
were potential subjects with evidence of genetic, metabolic, or infectious disorders.
TD controls were recruited through advertisements in
areas that were comparable with the socioeconomic
status of the ASD participants. TD participants were
screened using face-to-face evaluations [Kiddie-Schedule
for Affective Disorders and Schizophrenia for SchoolAged Children-Present and Lifetime Version (K-SADS PL);
Kaufman et al., 1997], telephone interviews, and observation during psychometric tests. The Kiddie-Schedule

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for Affective Disorders and Schizophrenia for SchoolAged Children (K-SADS) is a semi-structured diagnostic
interview designed to assess current and past episodes of
psychopathology in adolescents according to Diagnostic
and Statistical Manual of Mental Disorders-III-R (DSMIII-R) and DSM-IV criteria. Exclusion of control subjects
was also based on medical and psychiatric history.
Participants with a FSIQ < 70 were excluded from the
study. Cognitive functioning was assessed using the
StanfordBinet, 5th edition [SB5; Roid, 2003]. This study
was approved by Stanford Universitys Institutional
Review Board. Written informed consent was obtained
from parents, and assent was obtained from all participants.
Reactivity and Regulation Situation Task
To assess emotional reactivity and regulation in children
and adolescents with and without ASD, we adapted the
Reactivity and Regulation Situation Task [Carthy et al.,
2010]. In this task, participants are asked to consider 16
ambiguous scenarios designed to elicit negative emotional reactions experienced in daily life. Scenarios are
presented on the computer, and each scenario is one or
two sentences long and written in the second person
singular (you). Topics include family situations (e.g.
Your parents tell you they want to talk to you about
something important), social relationships and interactions (e.g. You see a bunch of your classmates hanging
out and you want to join them; when you come closer
you hear them laughing), academic performance (e.g.
Your teacher asks to see you after class), or feeling
physically uncomfortable (e.g. You are walking down
the street and a stranger approaches you). We adapted
the original taskwhich was developed under the
supervision of one of the co-authorsin two ways. First,
the task was translated from Hebrew to English by a
PhD level experimenter who was bilingual and fully
familiar with details of the procedures. Second, because
the task was originally designed for children, a small
number of scenarios were adapted for adolescents (see
Appendix). This adaptation was made after some adolescents received the child version of the task (see limitation section).
The task consisted of two blocks. The first block began
with two practice trials, followed by 16 real trials. For
each trial, participants were instructed to read out loud a
sentence and to think about the situation as though it
were happening at that very moment. They were then
instructed to [d]escribe the first thought that comes into
your mind. The experimenter recorded participants
initial responses. Participants were then asked to rate [t]o
what extent to you feel tense/worried? A 1 = not at all to
5 = very much scale was used, with circles of increasing
size and redness, such that 5 was represented as a large,

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bright red unhappy face. Subsequently, participants were

then presented with the question, What would you do to
calm yourself down?; and again their responses were
recorded verbatim.
The second block began with an explanation and
examples of cognitive reappraisal. Cognitive reappraisal
was introduced as an emotion regulation strategy by
describing in very simple language how people are able
to change their emotions by changing the way they
think about what is happening or has happened to
them. The words think differently were used instead
of cognitive reappraisal to facilitate participants
understanding. Then, a few example scenarios were presented (e.g. Today you are sick but that means you can
stay home and do things you dont usually have time
for.). The participants had the opportunity to practice
thinking differently to decrease their anxiety and
fears. Once the participant was able to verbalize his/her
understanding of this process and was able to provide
an example for cognitive reappraisal, he/she was
instructed to implement this new strategy for each of
the scenarios he/she was affected by (rating >1) during
the first exposure, and in the same order as in Block
One (Can you think about this situation in a different way
so that it appears less worrisome/scary?). After each reappraisal, the participant was asked again how negative
he/she felt (from 1 = not at all to 5 = very much) and
the same 15 rating scale of red circles of increasing size
was presented. Participants rated their negativity following their cognitive reappraisals and not on their initial
reaction to the situation. For those scenarios that were
rated as not at all worrisome (i.e. rating of 1) in the
first exposure, the participant was not asked to reappraise. All reappraisals and ratings were documented by
the experimenter. There were two different versions of
each, the child and adolescent versions, with two different randomizations of the orders in which the stimuli
were presented to the participants. The duration of the
task varied between 30 and 45 min.
Data Reduction and Analysis
The Reactivity and Regulation Situation Task provides
indices for emotional reactivity (average ratings, as well
as percentage of how often individuals were affected by
the scenarios, i.e. ratings >1), percentage of spontaneous
use of different emotion regulation strategies (see categories below), percentage of using cognitive reappraisal after
having been prompted (in scenarios they were affected at
first exposure, i.e. rating >1), and efficacy of cognitive
reappraisal (percent reduction of negative emotions after
participants were able to use cued reappraisal compared
with the reactivity rating of the scenarios in block 1, i.e.
rating >1, this controlled for emotional reactivity during
first exposure).

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In order to analyze the emotion regulation strategies,

qualitative analyses were conducted. These included the
first thoughts and the spontaneous use of emotion regulation strategies. The statements were categorized into
the following categories based on the process model of
emotion regulation [Gross, 1998, 2007], the paper by
Carthy et al. [2010], and initial attempts to categorize the
types of spontaneous emotion regulation strategies: (a)
avoidance (e.g. I will run away, I will not go there);
(b) problem solving (e.g. I will call my mom and tell her
Im not well); (c) distraction (e.g. I distract my mind
with animals and books); (d) cognitive reappraisal (e.g.
I convince myself that she is fine, I think differently
about it); (e) suppression (e.g. I hold it in); (f) venting
(e.g. I will cry); (g) relaxation (e.g. I am taking a deep
breath); (h) no regulation (I just wait, I dont know
what to do); and (i) not codeable (if the participants
response was unclear or unrelated to the question or
situation). In the rare situations a participant mentioning
two different strategies, the first one was taken into
account for the coding.
Scoring was done by two raters who were blind to the
participants diagnosis, age, and gender. One rater coded
all the participants comments, while the second rater
coded those of 20 participants that were randomly
chosen to compute inter-rater reliability. Disagreements
were resolved by discussion, which resulted in a final
score used for analyses. The average inter-rater reliability
for all categories was satisfactory (Cohens Kappa,
= 0.83, ranging from 0.69 to 1.00).
Given differences in FSIQ between groups, we used
analysis of covariances (ANCOVAs) with FSIQ as a
covariate to test for group differences in emotional reactivity (average ratings, average frequency of being
affected by the scenarios), as well as in the use and efficacy of cued cognitive reappraisal. A repeated measures
ANCOVA with FSIQ as a covariate was used to test for
group differences in the spontaneous use of different
strategies between ASD and TD participants (i.e. emotion
regulation profile). Finally, all the analyses were conducted with emotional reactivity as an additional
covariate to control for uninstructed emotional reactivity
at first exposure (except of the efficacy of cued reappraisal
because this index already controlled for reactivity).

Results
Preliminary Analyses
Analyses of gender, age, and FSIQ revealed that these
factors did not interact with group, except for a
group gender effect for not codeable (F(1, 40) = 5.77,
P < 0.05), and a group FSIQ effect on the use of spontaneous reappraisal (F(1, 40) = 6.42, P < 0.05). Because we
found few effects for gender and age, only FSIQ was
included as a covariate in primary analyses given the

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Figure 1. Intensity of emotional reactivity and frequency of scenarios with >1 intensity ratings in autism spectrum disorder (ASD) and
typically developing (TD) participants. Average emotional reactivity based on negativity ratings (from 1 = not at all to 5 = very much).
Average frequency in percent of being affected = ratings >1 out of 16 scenarios.
observed group effect for this variable. The two orders
and versions of the task did not have an effect on the
reactivity and regulation variables. The age of the children that were presented the child version (n = 30) was
on average 11.87 (standard deviations (SD) = 2.98). The
age of participants that were presented the the adolescent
version (n = 13) was on average 15.15 (SD = 2.82). None
of the variables (except age: F(1, 42) = 11.38, P < 0.01)
differed across the two versions.
In order to assess whether the use of language was
different in the two groups, verbosity was analyzed. Word
frequency for the first and second block of the experiment was taken into account for group comparisons. In
the first block, individuals with ASD used 176.48
(SD = 67.05) words on average, while TD participants
used 189.90 (SD = 40.00) words. The groups did not differ
significantly (F(1,42) = .64, P = 0.43). In the second block,
individuals with ASD used significantly less words (M =
89.62, SD = 46.68) than TD participants (M = 126.91,
SD = 49.60, F(1,42) = 6.41, P = 0.015). However, after correcting for the number of scenarios in which the participants were affected, the groups did not differ anymore
because the participants were instructed to reappraise
only when he or she was affected at the first exposure to
the scenario (MASD = 10.21, SD = 5.92, MTD = 9.98, SD =
2.70, F(1,42) = .03, P = 0.87).
Group Differences in Emotional Reactivity
Average ratings over the 16 scenarios were computed, as
well as how frequently the participants indicated that
they were affected by rating the scenarios higher than
1. Using FSIQ as a covariate, individuals with ASD
(M = 2.38, SD = 0.79) did not differ in the average nega-

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tive emotional reactivity compared with TD participants

(M = 2.57, SD = .55; F(2, 37) = 2.00, non significant, ns.).
In addition, individuals with ASD (M = 64.24, SD = 24.61)
did not differ on how frequently they were affected by the
scenarios (i.e. rated the scenario >1) compared with TD
participants (M = 78.41, SD = 16.33; F(2, 37) = 2.67, ns.,
see Fig. 1).
Group Differences in Spontaneous Emotion Regulation
To assess group differences in spontaneous emotion regulation, average percentages in the use of each regulation
strategy were calculated for scenarios in which the participants were emotionally affected. The 2 (group) 8 (strategy) repeated measures ANOVA with FSIQ as covariate
yielded a significant interaction effect (F (7,280) = 2.20, P <
0.05). As shown in Figure 2, follow-up ANCOVAs with
FSIQ as a covariate revealed that ASD participants used less
cognitive reappraisal (MASD = 17.14%, SD = 20.47; MTD =
37.10%, SD = 31.71; F(2,39) = 4.01, P < 0.05), but more
suppression (MASD = 6.24%, SD = 11.28; MTD = 2.39%,
SD = 4.76; F(2,39) = 3.78, P < 0.05) compared with TD participants. Furthermore, ASD participants displayed not
codeable responses more frequently than TD (MASD =
11.66%, SD = 11.11; MTD = 2.67%, SD = 4.75; F(2,37) =
7.03, P < 0.01). The other strategies yielded no significant
differences (avoidance (MASD = 9.04%, SD = 11.70; MTD =
6.43%, SD = 8.63); problem solving (MASD = 40.80%,
SD = 30.00; MTD = 50.72%, SD = 30.08); distraction (MASD =
7.69%, SD = 12.46; MTD = 3.38%, SD = 8.90); venting
(MASD = 0.62%, SD = 2.62; MTD = 0.38%, SD = 1.78); relaxation (MASD = 5.63%, SD = 16.16; MTD = 1.93%, SD = 4.58);
no regulation (MASD = 13.75%, SD = 11.09; MTD = 7.93%,
SD = 7.90).

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Figure 2. Spontaneous use of emotion regulation for autism spectrum disorder (ASD) and typically developing (TD) participants (in
percent). *P < 0.05.

Figure 3. Use and efficacy of cued cognitive reappraisal in autism spectrum disorder (ASD) and typically developing (TD) participants.
Use = percentage of times participants were able to generate cognitive reappraisals for scenarios that were rated >1 during first exposure.
Efficacy = percent reduction of negative emotions after participants were able to use cued reappraisal (difference scores between first and
second exposure for scenarios in which participants were affected, i.e. that were rated >1). **P < 0.01.
Additional analyses revealed that these effects were
evident even if emotional reactivity was included as an
additional covariate. The interaction of group strategy
(F(7,273) = 2.28, P < 0.05), and group differences in reappraisal (F(3,42) = 4.75, P < 0.01) suppression (F(3,42) =
3.37, P < 0.05) as well as the noncodeable responses
(F(3,42) = 6.04, P < 0.01) were still significant even controlling for emotional reactivity in block 1.
Group Differences in the Use and Efficacy of
Cued Reappraisal
ASD participants were able to come up with a reappraisal
strategy in fewer of the scenarios than TD participants,
as revealed by an ANCOVA with FSIQ as a covariate

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(MASD = 83.47%, SD = 21.48; MTD = 97.47%, SD = 4.89,

F(2,40) = 5.50, P < 0.01). However, if the participants
were able to generate a cognitive reappraisal, individuals
with ASD and TD equally benefitted from this strategy
(MASD = 36.99%, SD = 19.41; MTD = 36.84, SD = 17.76;
F(2,40) = .22, ns., see Fig. 3). Furthermore, when emotional reactivity was included as an additional covariate,
the two groups still differed significantly in cued reappraisal (F(3,39) = 3.85, P < 0.05).

Discussion
In this study, we found significant differences in the spontaneous emotion regulation profile of high-functioning

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children and adolescents with ASD, compared with TD

participants, as reflected in the less frequent use of cognitive reappraisal, but more frequent use of suppression.
Moreover, individuals with ASD had greater difficulty generating cognitive reappraisals, even after being prompted
to use this strategy. We had expected individuals with ASD
to be less effective in downregulating their emotions when
implementing cognitive reappraisal. However, compared
with TD participants, they seemed to benefit from cognitive reappraisal to a similar extent when able to implement
this strategy. These findings underline crucial differences
in the cognitive reappraisal ability of ASD vs. TD participants, even when controlling for uninstructed emotional
reactivity, and dovetail nicely with previous self-report
findings in adults [Samson et al., 2012].
Explaining Differences in Emotional Reactivity
and Regulation
One noteworthy feature of our findings is that individuals with ASD were affected by the emotion-eliciting scenarios to the same degree as TD participants. This might
seem puzzling given that it is often reported that individuals with ASD have increased levels of negative effect
[Capps et al., 1993; Joseph & Tager-Flusberg, 1997;
Kasari & Sigman, 1997; Samson et al., 2012]. While the
scenarios implemented in the present study were previously used and validated [Carthy et al., 2010], it might
be possible to induce even stronger emotional reactions
in individuals with ASD if the stimulus materials were
tailored to the individuals specific negative emotional
triggers. Frequently, situations that are novel, difficult to
anticipate, and involving unexpected changes (e.g.
going to unfamiliar places, meeting unfamiliar people)
seem to induce strong negative emotions in individuals
with ASD.
Why might individuals with ASD have more difficulty
than TD in generating cognitive reappraisal strategies?
This might be related to a decreased ability to describe
and identify emotions and decreased insight into more
complex emotional processes [i.e. alexithymia; Capps,
Yirmiya, & Sigman, 1992; Losh & Capps, 2006], as well as
the tendency to perseverate, which was recently studied
in relation to emotion dysregulation [Mazefsky et al.,
2012]. Difficulty in interrupting or inhibiting maladaptive behaviors and negative emotions in ASD might also
increase the tendency to exhibit exaggerated negative
emotions and associated behaviors [Mazefsky et al.,
2012]. However, in prior work, differences in alexithymia
[i.e. difficulty to identify and describe own emotions, see
Berthoz & Hill, 2005] did not fully explain differences in
cognitive reappraisal [Samson et al., 2012]. Therefore,
other impaired processes in ASD, such as cognitive linguistic processes [e.g. Losh & Capps, 2006], executive
functions/cognitive flexibility/imagination ability [e.g.

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Jahromi, Bryce, & Swanson, 2013], or perspective taking/

theory of mind [Samson et al., 2012] might also hamper
the successful generation of cognitive reappraisals.
Treatment Implications
It is striking that individuals with ASD, similar to
neurotypicals, derive benefits when they are capable of
generating a cognitive reappraisal strategy. This finding
has important implications for the development of new
interventions for ASD. It can also be seen as a confirmation of several treatment programs that target metacognitive emotion regulation strategies [Social Communication, Emotional Regulation, and Transactional
Support, SCERTS model, Prizant, Wetherby, Rubin,
Laurent, & Rydell, 2006] or thinking tools that are
trained to improve modification of maladaptive thinking
[see Scarpa & Reyes, 2011; Sofronoff, Attwood, Hinton, &
Levin, 2007]. Although the participants with ASD demonstrated deficiencies in generating cognitive reappraisals, our results suggest that they are able to improve their
generation of adaptive emotion regulation strategies.
After being prompted to use cognitive reappraisals, ASD
participants were able to increase the number of reappraisals used in response to the emotion eliciting stimuli
(although to a limited extent, compared with TD participants). These observations are very informative because,
if replicated, they might be seen as a key component of
treatment programs that aim to improve emotion regulation in individuals with ASD [e.g. Scarpa & Reyes, 2011;
Sofronoff et al., 2007].
Interestingly, previous research has suggested that the
ability to generate cognitive reappraisal strategies may be
linked to perspective taking abilities, executive functioning, and cognitive linguistic abilities [e.g. Jahromi et al.,
2013; Losh & Capps, 2006; Samson et al., 2012]. This
association is critical because it means that interventions
that are developed to target cognitive reappraisal may
have the additional benefit of improving emotion regulation abilities among individuals with ASD as well as
providing potential benefits in other domains such as
social interaction and communications. This is particularly important in light of the limited availability of effective interventions to target emotional disturbances and
consequently core features of ASD because existing psychotropic medications, such as atypical antipsychotics,
lead to considerable side effects and have limited effects
on social and communication impairments [Doyle &
McDougle, 2012; Politte & McDougle, 2014].
Limitations and Future Directions
Our findings shed important new light on the ability of
individuals with ASD to use and benefit from cognitive
reappraisal. However, there were several limitations in
the current study that are important to note.

Samson et al./Emotion regulation in autism spectrum disorder

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15

First, the present study used written hypothetical scenarios to induce negative emotions. Although this is a
well validated set of stimuli previously used in clinical
contexts [Carthy et al., 2010], this task has certain limitations. Because this task involves reading and language,
as well as perspective taking abilities, it might be difficult
for some individuals with ASD to picture themselves in
the situations described in the scenarios. Additionally,
some reports suggest that individuals with ASD tend to
think in pictures rather than in words [e.g. Grandin,
1995], which may have impacted the accessibility of the
written scenarios. While verbosity did not differ by
group, future studies should use material that can be
processed via other sensory channels, such as visual
material. Additionally, future studies should focus on
emotion regulation strategies that require fewer language
abilities. Using language-independent stimuli and regulation strategies may also allow researchers to examine
emotion regulation in lower-functioning individuals
with ASD. In general, the conclusions drawn from this
study may not be generalizable to lower-functioning children and adolescents with ASD.
A second important limitation is that the dependent
measures were all self-report measures. It is true that these
measures were obtained in the content of an engaging
emotion-eliciting task. However, future studies on
emotion dysregulation should include more objective
measures, such as autonomic and brain measures. This
could be done using autonomic psychophysiology or
functional magnetic resonance imaging.
A third limitation is the absence of a control task. This
limits our ability to draw strong conclusions as to
whether the deficits we observed in ASD participants were
specific to emotion regulation per se. In future studies, it
might be helpful to include a control task that is comparable in difficulty with cognitive reappraisal, but not
related to emotions. A control condition also might help
assess effects of habituation (e.g. a condition in which
participants would not have been instructed to reappraise
but just rate emotional stimuli during a second exposure).
Because most of our participants were able to reappraise
during a second exposure to the stimulus, we were not
able to address the impactif anyof habituation.
A fourth limitation is that we introduced the adolescent version of the taskwhich differs from the child
version only in three scenariosonly after we had
already run some adolescents with the child version.
Although on average, the two groups differ in their age;
in both groups, the age range is 820 years.
A fifth limitation is that although we controlled for
cognitive functioning (FSIQ), the present study did not
link difficulties in emotion regulation to core features of
autism, such as social and communication difficulties,
repetitive behaviors, or sensory sensitivities. Previous
research has provided some evidence for a link between

8
16

emotion regulation difficulties and social competences

[i.e. prosocial peer engagement, see Jahromi et al., 2013].
In addition, other studies discuss possible associations
with perseveration [Mazefsky et al., 2012] or perspective
taking abilities and theory of mind [Samson et al., 2012].
Future studies with a larger sample size are required to
examine the associations between emotion dysregulation
and core features, as well as potential causal links.
These limitations, notwithstanding the present study,
help to clarify the emotion regulation profiles of individuals with ASD. Our focus here was primarily on cognitive reappraisal, and future tasks should broaden the
focus to other emotion regulation strategies that might be
beneficial for individuals with ASD. It is crucial to learn
more about how individuals with ASD implement and
benefit from other emotion regulation strategies, such as
problem solving or cognitive distraction. This has particular relevance for less cognitively challenging strategies that may be used by lower-functioning individuals
with ASD.

Acknowledgments
The authors would like to thank Meredith Harvey, Mona
Neysari, Samantha Ludin, and Shweta Shah for their help
conducting this study, and Gal Sheppes for his help in
translating the scenarios.

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Appendix
Scenarios
Items that were adapted for adolescents are in parentheses.
1. Your mom tells you that she needs to go to the doctor
for a checkup.
2. On the way to school, your stomach starts to feel
weird.
3. You are walking in the street and a car slows down
next to you.
4. Your parents are about to go out to an event in the
city. (You are about to go study abroad for 6 months).
5. You see a bunch of your classmates playing and you
want to join them. When you come closer, you hear
them laughing.
6. Your mom was supposed to be home, but she is late.
(Your boyfriend/girlfriend was supposed to call you
but he/she did not).
7. Your teacher asks to see you after class.
8. You enter a store and the employee stares at you.
9. Your father tells you unexpectedly that he has to
travel out of the country tomorrow.
10. You hear a knock on the door and when you open it,
you see a person you do not know.
11. You are in a group. People are introducing themselves, and now it is your turn to introduce yourself.
12. Your teacher returns a test and says that your score
was surprising.
13. Your parents tell you they want to talk to you about
something important.
14. You just got a test and you start reading the
questions.
15. You wake up at night and hear a noise in the hallway.
16. You are about to go out somewhere with a lot of
people. (You are about to go out somewhere with a
lot of people you just met).

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