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S.I. : EMOTION REGULATION AND PSYCHIATRIC COMORBIDITY IN ASD
Maladaptive Behavior in Autism Spectrum Disorder: The Role
of Emotion Experience and Emotion Regulation
Andrea C. Samson •Antonio Y. Hardan •
Ihno A. Lee •Jennifer M. Phillips •James J. Gross
Published online: 25 February 2015
ÓSpringer Science+Business Media New York 2015
Abstract Maladaptive behavior is common in Autism
Spectrum Disorder (ASD). However, the factors that give
rise to maladaptive behavior in this context are not well
understood. The present study examined the role of emo-
tion experience and emotion regulation in maladaptive
behavior in individuals with ASD and typically developing
(TD) participants. Thirty-one individuals with ASD and 28
TD participants and their parents completed questionnaires
assessing emotion experience, regulation, and maladaptive
behavior. Compared to TD participants, individuals with
ASD used cognitive reappraisal less frequently, which was
associated with increased negative emotion experience,
which in turn was related to greater levels of maladaptive
behavior. By decreasing negative emotions, treatments
targeting adaptive emotion regulation may therefore reduce
maladaptive behaviors in individuals with ASD.
Keywords ASD Emotion regulation Maladaptive
behavior Emotion experience Mediation
Introduction
Maladaptive behavior such as temper tantrums, aggression,
sleeping problems, and disobedience are common in indi-
viduals with Autism Spectrum Disorder (ASD, Konst et al.
2013). Tantrum behaviors and general irritability are key
motivating factors for seeking treatment (Robb 2010).
Therefore, a better understanding of the mechanisms that
increase maladaptive behavior in ASD is required to im-
prove interventions and associated outcomes. As the
questions of whether and how different emotional compo-
nents are related to maladaptive behavior in this disorder
remain largely unanswered, the goal of the present study is
to examine whether components of emotions, such as
emotion experience and emotion dysregulation, might
serve as explanatory constructs for maladaptive behaviors
in ASD.
Emotion Experience and Emotion Regulation
Recent advances in affective science have suggested a
framework for conceptualizing and examining emotional
reactivity and emotion regulation. Emotional reactivity can
be seen as loosely coupled experiential, behavioral, and
physiological responses (Gross and Thompson 2007).
Emotions vary in their quality, duration, and intensity. One
way to categorize emotions is to distinguish between
positive emotional experiences on the one hand, and
negative emotional experiences on the other (Watson et al.
1988). Studying individual profiles in negative and positive
emotions is informative, especially in relation to
psychopathology.
Emotion regulation takes place when one activates a
goal to influence the emotion-generative process (Gross
et al. 2011). Depending on the context, the individual, and
the emotion, a specific emotion regulation strategy can be
considered as adaptive or maladaptive (Aldao and Nolen-
Hoeksema 2012). While there are many forms of emotion
regulation (Gross 2014), two prototypical examples of such
A. C. Samson (&)I. A. Lee J. J. Gross
Department of Psychology, Stanford University, 450 Serra Mall,
Bldg 420, Stanford, CA 94305, USA
e-mail: andrea.samson@stanford.edu;
andrea.c.samson@gmail.com
A. Y. Hardan J. M. Phillips
Department of Psychiatry and Behavioral Sciences, Stanford
University School of Medicine, 401 Quarry Road, Stanford,
CA 94305, USA
123
J Autism Dev Disord (2015) 45:3424–3432
DOI 10.1007/s10803-015-2388-7
adaptive and maladaptive strategies are widely studied in
the literature. Cognitive reappraisal, on the one hand, is a
strategy involving cognitive change and is generally seen
as adaptive. In the other hand, expressive suppression in-
volves modulating the outward expression of the emotional
response, and can be considered as a maladaptive strategy
if used on a typical basis.
Emotion Experience and Emotion Regulation in Autism
Spectrum Disorder
Traditionally, emotional problems have not been seen as a
defining feature of ASD. However, there is mounting evi-
dence that emotional components are affected in this dis-
order. Indeed, ASD is increasingly viewed as a disorder
that involves problematic emotion frequency and intensity.
For example, compared to TD individuals, those with ASD
infrequently display positive empathic responses (Maskey
et al. 2013) and report lower levels of amusement in the
context of social types of humor (Samson 2013), while
anger and anxiety tend to be more frequent and more in-
tense (Ho et al 2012; Quek et al. 2012; Samson et al.
2014c).
These problematic patterns of emotion intensity, dura-
tion, frequency, or type can result from difficulties
regulating emotions (Konstantareas and Stewart 2006;
Laurent and Rubin 2004; Mazefsky et al. 2013,2014;
Rieffe et al. 2011; Samson et al. 2012,2014a,b). It seems
that individuals with ASD suffer from emotion regulation
failure (i.e., not engaging in regulation, Gross 2013), and if
there is regulation, it is usually not as adaptive as in TD
individuals, resulting in less effective emotion regulation
patterns (Samson et al. 2014c). Several studies showed that
adaptive strategies—such as cognitive reappraisal, accep-
tance, and problem solving—were used less frequently and
less efficiently compared to TD controls (Samson et al.
2012,2014b,c). In addition, studies have shown that in-
dividuals with ASD use maladaptive ER strategies – such
as rumination or shutting down—more frequently (Kohr
et al. 2014; Mazefsky et al. 2014; Samson et al. 2012,
2014b). However, the less frequent use of adaptive emotion
regulation strategies and increased use of maladaptive
strategies are not evident in every study. For example, one
study showed similar levels of using adaptive strategies
(Mazefsky et al. 2014), and expressive suppression—as
one example of a generally maladaptive strategy—was
more frequently used in ASD compared to TD participants
in some studies (Samson et al. 2012,2014b), but not others
(Samson et al. 2014c).
Besides simply documenting differences in emotion
regulation profiles in ASD compared to TD participants,
some studies have examined how emotion dysregulation
may affect individuals with ASD. For example, it was
shown that emotion dysregulation in ASD was correlated
with internalizing and externalizing behavior (Mazefsky
et al. 2014; Rieffe et al. 2011), and, in a longitudinal study,
with prosocial peer-engagement in the school context
(Jahromi et al. 2012).
The Present Study
The goal of this study is to better understand the
mechanisms that lead to maladaptive behavior in indi-
viduals with ASD. We examined the sequential effects of
emotion experience and regulation to determine whether
emotional experiences (i.e., high levels of negative emo-
tion and low levels of positive emotion), use of emotion
regulation strategies (more maladaptive than adaptive), or
both emotional experiences and strategy use lead to
maladaptive behavior. Since these emotional components
(i.e., emotion experience and regulation) are intertwined
and influence each other, they should be differentiated as
well as examined in tandem to better understand how they
give rise to maladaptive behaviors. Gaining insight into
such processes will help to improve treatment for indi-
viduals with ASD. To measure maladaptive behaviors, we
used the maladaptive behavior index of the Vineland
Adaptive Behavior Scales (2nd Edition, VABS-2, Spar-
row et al. 2005), which includes externalizing, internal-
izing and other behaviors that are known to interfere with
adaptive behavior.
We hypothesized that individuals with ASD, com-
pared to TD participants, would experience less positive
and more negative emotions, and would use cognitive
reappraisal less frequently (Samson et al. 2012,2014b,c)
based on parent and self-reports. Given the mixed find-
ings on the use of expressive suppression, we did not
formulate a hypothesis for suppression (Samson et al.
2012,2014b,c). We expected that (parent-reported) de-
creased positive emotions, increased negative emotions,
and less frequent cognitive reappraisal would be associ-
ated with increased maladaptive behaviors in individuals
with ASD compared to TD participants. These asso-
ciations were tested via 2-path mediation designs. Based
on these 2-path model results, we then tested sequential
effects of emotion experience and regulation on mal-
adaptive behavior in 3-path mediation designs. Two
plausible models here are that emotion experience affects
emotion regulation and in turn is associated with mal-
adaptive behavior, or that emotion regulation impacts
emotion experience and in turn is associated with mal-
adaptive behavior.
J Autism Dev Disord (2015) 45:3424–3432 3425
123
Methods
Participants
Thirty-one individuals with ASD (four female) and 28 TD
individuals (seven female) between the ages of 8 and
20 years participated in the study (see Table 1). The
sample consisted of 62.7 % Caucasians, 20.3 % Asians,
5.1 % Hispanics, 1.7 % African-Americans, and 10.2 %
other ethnicities. Participants with ASD were recruited
from a clinic specializing in ASD and developmental dis-
abilities as well as from a research registry. TD participants
were recruited in areas that were comparable to the socio-
economic status of the participants with ASD. Participants
were enrolled as part of a larger project.
Clinical Assessment
For participants with ASD, diagnosis was established
through expert clinical evaluation based on the DSM-IV-TR
(APA 2000) or, since May 2013, DSM-5 (APA 2013a,b)
and confirmed with the Autism Diagnostic Interview-Re-
vised (ADI-R) and Autism Diagnostic Observation Sched-
ule (ADOS; Lord et al. 1994,2000). Three individuals with
ASD did meet inclusion criteria on the ADI-R, but missed
inclusion criteria on the ADOS by one point. Since ex-
cluding these borderline cases did not affect any of the
group differences and indirect effects results reported in the
current paper, we decided to include all of the participants
for the analysis of the current study. Individuals with sec-
ondary autism related to a specific etiology (e.g., tuberous
sclerosis, Fragile X) and individuals with evidence of ge-
netic, metabolic, or infectious disorders were excluded.
TD participants were screened using face-to-face
evaluations (Kiddie-Schedule for Affective Disorders and
Schizophrenia for School-Aged Children, Kaufman et al.
1997), telephone interviews, and observation during psy-
chometric tests. Exclusion of TD participants was also
performed based on medical and psychiatric history.
Cognitive functioning (FSIQ) was assessed using the
Stanford Binet (5th Edition, SB5, Roid 2003). The ASD
core features were assessed with the Social Responsiveness
Scale (SRS, Constantino and Gruber 2005; Constantino
et al. 2000) and the Repetitive Behavior Scale-Revised
(RBS-R, Lam and Aman 2007). Externalizing and inter-
nalizing behavior was assessed with the Child Behavior
Checklist (Achenbach 1991).
This study was approved by the University’s Institu-
tional Review Board. Written informed consent was ob-
tained from parents and assent from all participants.
Self- and Parent-Report Questionnaires Assessing
Emotion Experience, Emotion Regulation,
and Maladaptive Behavior
As part of a larger study on emotional reactivity and
regulation, individuals with ASD and TD controls as well
as their parents were asked to fill out questionnaires online.
Each participant and his or her parents received links to
online surveys consisting of several questionnaires. While
participants were asked to report about their own emotion
experience and regulation, parents were asked to report
about their children’s emotion experience and regulation.
Emotion Experience
The Positive and Negative Affect Schedule (PANAS) is a
20-item self-report measure of positive and negative
Table 1 Sample characteristics
ASD TD Statistics
M (SD), N or frequency, range M (SD), N or frequency, range
N3128
Male/female 27/4 21/7 ns
a
Age 13.26 (3.35, 8–20) 12.43 (2.77, 8–20) t(57) =1.03, ns
FSIQ 100.94 (17.49, 64–129) 112.14 (12.01, 92–133) t(57) =-2.84, p\.01
SRS 97.20 (29.15, 40–149) 19.14 (14.48, 0–59) F(3,51) =51.12, p\.001
RBS-R 24.26 (21.63, 0–80) 2.15 (5.65, 0–28) F(3,52) =11.24, p\.001
Internalizing behavior (CBCL) 65.13 (8.56, 48–77) 45.46 (10.56, 33–68) F(3,57) =20.04, p\.001
Externalizing behavior (CBCL) 57.00 (11.32, 34–74) 44.14 (9.30, 33–65) F(3,57) =8.31, p\.001
ANCOVAS with FSIQ and age as covariates were used for group comparisons of SRS, RBS-R and CBCL
ASD Autism Spectrum Disorder, TD typically developing, FSIQ Full Scale IQ, RBS-R Repetitive Behavior Scale-Revised (total score),
SRS Social Responsiveness Scale (total score), CBCL Child Behavior Checklist
a
On the basis of a Fisher’s exact test, two-tailed
3426 J Autism Dev Disord (2015) 45:3424–3432
123
emotion experience developed by Watson et al. (1988).
Positive emotion experience reflects the extent to which a
person feels enthusiastic, active, and alert. Negative emo-
tion experience reflects the extent to which a person feels
negative emotional states such as nervous and upset. The
scale points are: 1 =‘‘very slightly or not at all’’ to
5=‘‘very much’’. A number of different time frames have
been used with the PANAS; in the current study the time
frame adopted was ‘during the past few weeks’. For the
parent reports, we asked the parents to report about their
child’s emotion experiences.
Emotion Regulation
The Emotion Regulation Questionnaire (ERQ, Gross and
John 2003) is a 10-item measure of two types of emotion
regulation in which six items assess frequency of reap-
praisal usage, i.e., the ability to modify or change emotions
and experiences (‘‘I control my emotions by changing the
way I think about the situation I’m in’’) and four items
assess the use of expressive suppression, i.e., the ability to
avoid or prevent the expression of emotions (‘‘I control my
emotions by not expressing them’’). Responses are scored
on a seven-point scale from 1 =‘‘totally disagree’’ to
7=‘‘totally agree’’. For the parent reports, we have re-
formulated the items, e.g., ‘‘My child controls his or her
emotions by changing the way he or she thinks about the
situation he or she is in’’.
Maladaptive Behavior
Maladaptive behavior was assessed with the Parent/
Caregiver Rating Form of the Vineland Adaptive Be-
havior Scales, 2nd Edition (VABS-2, Sparrow et al.
2005). The scale measures adaptive behavioral function-
ing in several domains (socialization, communication,
daily living skills, motor skills) and provides an overall
adaptive behavior composite score. For the purpose of the
present study, we focused on the maladaptive behavior
index of the VABS-2 which includes a composite of ex-
ternalizing (e.g., ‘‘Has temper tantrums,’’ ‘‘Is impulsive
(acts without thinking),’’), internalizing (e.g., ‘‘Is overly
anxious or nervous,’’ ‘‘Is sad for no clear reason’’), and
other undesirable behavior (e.g., ‘‘Swears,’’ ‘‘Is truant
from school or work’’) potentially interfering with one’s
adaptive behavior. Responses are scored on a three-point
scale from 0 =‘‘never’’, 1 =‘‘ s o m e t i m e s ’’ , t o 2 =
‘‘often’’, with scale scores indicating average (\18),
elevated (18–20), or clinically significant (21–24) levels
of maladaptive behavior.
Statistical Analyses
Group differences in emotion, emotion regulation, and
maladaptive behavior between ASD and TD were exam-
ined using ANCOVAs, in which FSIQ and age were in-
cluded as covariates.
The relationships among group, emotion experience, emo-
tion regulation, and maladaptive behavior were examined via
path analyses of 2- and 3-path mediation designs. Four 2-path
models were tested to examine whether group membership
was linked to maladaptive behaviors via positive emotion,
negative emotion, cognitive reappraisal, and expressive sup-
pression. In addition, two 3-path models were tested to ex-
amine the sequence of effects as indicated from the 2-path
model results: (1) Group membership as influencing cognitive
reappraisal, which then influences negative emotions, and in
turn, maladaptive behavior. (2) Group membership as influ-
encing negative emotions, which then influences cognitive
reappraisal, and in turn, maladaptive behavior. FSIQ and age
were included as covariates in all analyses. For consistency, we
used parent reports of emotion and emotion regulation.
All indirect effects of group membership on maladaptive
behavior via emotion/emotion regulation were tested for
significance using bootstrapping methods. Bias-corrected
confidence intervals were generated from 10,000 resamples
using the SPSS PROCESS macro (Hayes 2013). If the re-
sulting 95 % confidence interval did not include zero, the
indirect effect was declared statistically significant at p\.05.
Results
Preliminary Analyses
The two groups did not differ in age or gender. Individuals
with ASD scored significantly lower on Full Scale IQ
(FSIQ), showed significantly more restricted and repetitive
behaviors (via RBS-R; Lam and Aman 2007), social and
communication deficits (via SRS, Constantino and Gruber
2005; Constantino et al. 2000), and externalizing and in-
ternalizing behavior (via CBCL; Achenbach 1991) com-
pared to TD participants (see Table 1).
Group Differences in Emotion Experience
Parent Reports
ANCOVA (with FSIQ and age as covariates) results indi-
cated that individuals with ASD experience less positive
emotion [F(3,56) =5.78, p\.01], and more negative
emotion [F(3,56) =7.31, p\.001] compared to TD
J Autism Dev Disord (2015) 45:3424–3432 3427
123
individuals (see Table 2). The covariate FSIQ was not as-
sociated with positive emotion experience
[F(1,56) =2.46, ns] or negative emotion experience in
ASD [F(1,56) =2.45, ns). Age had a significant effect on
experiencing positive emotions [F(1,56) =5.65, p\.05]
and on negative emotions [F(1,56) =3.73, p=.06,
trending effect].
1
Child Reports
ANCOVA results indicated that children and adolescents
with ASD did not differ in positive [F(3,55) =1.69, ns]or
negative emotion experience [F(3,55) =.99, ns] compared
to TD individuals.
2
Group Differences in Emotion Regulation
Parent Reports
ANCOVA results showed that individuals with ASD used
cognitive reappraisal less frequently [F(3,52) =12.78,
p\.001] but did not differ in their use of expressive
suppression [F(3,52) =1.50, ns, see Table 2]. Age
[F(1,52) =2.48, ns] and FSIQ [F(1,52) =.01, ns] had no
significant effect on cognitive reappraisal.
Child Reports
ANCOVA results indicated that individuals with ASD used
cognitive reappraisal [F(3,50) =3.97, p\.05] and ex-
pressive suppression [F(3,50) =2.81, p\.05] less
frequently. While the covariate FSIQ had no effect on
cognitive reappraisal [F(1,50) =.25, ns] or expressive
suppression [F(1,50) =.80, ns], age significantly affected
the use of cognitive reappraisal [F(1,50) =6.81, p\.05]
and suppression [F(1,50) =6.89, p\.05].
3,4
Group Differences in Maladaptive Behavior
ANCOVA results showed that individuals with ASD
(M=20.04, SD =2.14, range 17–23) had significantly
more maladaptive behavior (bordering on ‘‘clinically sig-
nificant’’) compared to TD participants with ‘‘average’’
levels of maladaptive behavior [M=14.74, SD =2.16,
range 12–18, F(3,45) =22.90, p\.001]. The covariates
age [F(1,45) =.03, ns] and FSIQ [F(1,45) =.71, ns] were
not associated with maladaptive behavior.
Sequential Effects of Emotion Experience
and Regulation on Maladaptive Behavior
The 2-path indirect effects of group membership on mal-
adaptive behavior via negative emotions and cognitive
reappraisal were significant (ps\.05; see Fig. 1). Com-
pared to TD participants, ASD reported higher levels of
negative emotion, which in turn resulted in increased
maladaptive behavior (ab =.97, 95 % CI [.30; 1.94]).
Similarly, ASD participants reported less use of cognitive
Table 2 Means and standard
deviations of emotion
experience and emotion
regulation for individuals with
autism spectrum disorder (ASD)
and typically developing (TD)
participants in parent-reported
and self-reported questionnaires
PANAS positive and negative
affect schedule, ERQ emotion
regulation questionnaire
Observer Subscale ASD TD p
N M (SD) N M (SD)
Emotion experience (PANAS)
Parent-report Positive 30 3.18 (0.77) 27 3.69 (0.48) p\.01
Negative 30 2.25 (0.76) 27 1.59 (0.48) p\.001
Self-report Positive 30 3.03 (0.80) 26 3.41 (0.72) ns
Negative 30 2.01 (0.76) 26 1.81 (0.52) ns
Emotion regulation (ERQ)
Parent-report Reappraisal 27 3.10 (1.27) 26 4.98 (0.96) p\.001
Suppression 27 2.99 (1.23) 26 2.46 (0.95) ns
Self-report Reappraisal 26 4.04 (1.07) 25 4.67 (1.05) p\.05
Suppression 26 3.25 (1.44) 25 3.43 (1.35) p\.05
1
Partial correlations controlling for group revealed less positive
emotion with increasing age [r(56) =-.31, p\.05], but no
significant association between age and negative emotions
[r(56) =-.22, ns].
2
Even after excluding the two participants that had lower FSIQ than
70, these findings remained consistent for positive emotions
[F(3,53) =2.16, ns] and for negative emotions [F(3,53) =.97, ns].
3
Partial correlations controlling for group revealed increased use of
cognitive reappraisal [r(48) =.35, p\.05] and suppression
[r(48) =.37, p\.01], with increasing age.
4
Even after excluding participants with FSIQ scores below 70, these
findings remained consistent. ANCOVA results indicated that indi-
viduals with ASD used cognitive reappraisal [F(3,48) =4.45,
p\.01] and expressive suppression [F(3,48) =2.73, p=.06, trend-
ing effect] less frequently. While the covariate FSIQ had no effect on
cognitive reappraisal [F(1,48) =1.05, ns] or expressive suppression
(F(1,48) =.02, ns), age significantly affected the use of cognitive
reappraisal [F(1,48) =7.41, p\.01] and suppression
[F(1,48) =7.35, p\.01].
3428 J Autism Dev Disord (2015) 45:3424–3432
123
reappraisal, which resulted in increased maladaptive be-
havior (ab =1.84, 95 % CI [.70; 3.18]). Group member-
ship did not indirectly affect maladaptive behavior via
positive emotions (ab =.23, 95 % CI [-.41; 1.04]) and
expressive suppression (ab =-.05, 95 % CI [-.89; .32]).
Given the 2-path model results, we examined the se-
quence of effects involving group, negative emotion, cog-
nitive reappraisal, and maladaptive behavior. A significant
3-path indirect effect of group on maladaptive behavior via
cognitive reappraisal and negative emotions in sequence
was observed (see Fig. 2); ASD participants used less
reappraisal (than TD), which resulted in greater negative
emotions experienced, and in turn, increased maladaptive
behavior (a
1
d
21
b
2
=.92, 95 % CI [.36; 2.06]). However,
when reversing the order of reappraisal and negative emo-
tion variables, no 3-path indirect effect of group on mal-
adaptive behavior was observed (a
1
d
21
b
2
=.23, 95 % CI
[-.02; 1.04]). No significant covariate effects of FSIQ and
age were observed on emotion, emotion regulation, and
maladaptive behavior in any of the 2- and 3-path models.
Discussion
The present study aimed to better understand group dif-
ferences in emotion experience and regulation, as well as
the underlying mechanisms that lead to increased mal-
adaptive behaviors in individuals with ASD. This is the
first study to examine the sequential effects of emotion
experience and regulation on maladaptive behavior in
children and adolescents with ASD. More specifically, we
wanted to better understand whether patterns in positive
and negative emotion experience as well as adaptive and
maladaptive emotion regulation function as a link between
group (ASD vs. TD) and maladaptive behavior. The find-
ings suggest that individuals with ASD use cognitive
reappraisal less frequently, which is an adaptive emotion
regulation strategy, resulting in increased negative emo-
tions, and in turn leading to elevated levels of maladaptive
behavior. As our data are cross-sectional, we are not in-
ferring causality but exploring the potential directionality
of effects.
The Role of Emotion Regulation in Maladaptive
Behavior in ASD
Psychopathology, and in a narrower sense maladaptive
behavior, is often conceptualized as resulting from, or
maintained by deficits in the ability to regulate one’s own
emotions appropriately and effectively (Gross and Jazaieri
2014). Emotion dysregulation in ASD, and especially the
lack of successful implementation of cognitive reappraisal
seems to increase negative emotional experiences, which
were associated with maladaptive behavior. While a pre-
vious study showed that anxiety and depression were
strongly correlated with aggression and tantrums in chil-
dren with ASD (Quek et al. 2012), the present study sug-
gests that less use of adaptive emotion regulation strategies
is crucial for increased negative emotions, and in turn, is
associated with increased maladaptive behavior in ASD.
Interestingly, two previous studies reported that the use of
Fig. 1 Regression coefficients (bs) from 2-path models depicting
aan indirect effect of group on maladaptive behavior via negative
emotional experiences and ban indirect effect of group on
maladaptive behavior via cognitive reappraisal. Group is coded as
1=ASD, 0 =TD. Covariate effects of FSIQ (bs from -.02 to 0)
and age (bs from -.10 to .04) were non-significant. Bold lines
indicate significant indirect effects. Unstandardized estimates are
displayed. *p \.05, **p\.01, ***p\.001
Fig. 2 Regression coefficients (bs) from one 3-path model depicting
an indirect effect of group on maladaptive behavior via cognitive
reappraisal and negative emotional experiences. Group is coded as
1=ASD, 0 =TD. Covariate effects of FSIQ (bs from -.01 to 0)
and age (bs from -.11 to .03) were non-significant. Bold lines
indicate significant indirect effects. Unstandardized estimates are
displayed. *p \.05, **p\.01, ***p\.001
J Autism Dev Disord (2015) 45:3424–3432 3429
123
maladaptive emotion regulation strategies only were asso-
ciated with internalizing behaviors (Rieffe et al. 2011) and
with emotional and behavioral problems (Kohr et al. 2014),
but not the use of adaptive strategies. However, another
study found that both adaptive and maladaptive emotion
regulation strategies were associated with internalizing and
externalizing behavior (Mazefsky et al. 2014). These
mixed findings may be related to various factors such as
using different emotion regulation measures or focusing on
different outcome measures. The advantage of the present
study is to examine sequential, combined effects of emo-
tion experience and regulation to better understand under-
lying mechanisms that are associated with maladaptive
behaviors in ASD.
While the present study provides further evidence of
decreased use of adaptive emotion regulation strategies in
individuals with ASD compared to TD individuals, also in
line with previous studies (Mazefsky et al. 2014; Samson
et al. 2012,2014b,c), we did not find conclusive evidence
that individuals with ASD use expressive suppression more
frequently as previously documented in adult, child, and
adolescent samples (Samson et al. 2012,2014b). Interest-
ingly, we did not observe group differences in parent-re-
ported use of expressive suppression, and moreover, ASD
participants reported even less use of expressive suppres-
sion. In one prior study that used parent interviews and
child daily diaries, group differences in using expressive
suppression were not evident either (Samson et al. 2014c).
At this point, the role of expressive suppression in indi-
viduals with ASD (vs. TD) participants still appears to be
inconclusive. Differences between studies may be due to
the difficulty to report about other people’s use of sup-
pression (and distinguishing it from not experiencing
emotions or blunted affect, see also Samson et al. 2014c)
when considering parent reports. Another possibility is that
controlling emotion expressions is generally more difficult
for children and adolescents compared to adults which may
partly explain that we cannot replicate the findings of
Samson et al. (2012). In general, differences between
studies may be related to the methods used to assess these
strategies but it also shows that more research is needed to
clarify the use of expressive suppression in ASD.
While there was correspondence between parent and
child reports regarding the use of cognitive reappraisal in
the present study, children and adolescents with ASD did
not report decreased positive and increased negative emo-
tions, as reported by the parents. Previous studies using
both, parent and child reports, found good correspondence
between parent and self-report (Kohr et al. 2014) and at
times even more robust effects in the self-report data
(Mazefsky et al. 2014). Rieffe et al. (2011) emphasized the
importance of letting children report about their emotional
experiences. We suggest that it is most informative to
include both parent and child reports in order to get a better
picture about several emotional components, since some
components might be more easily reported by children
(e.g., internalizing symptoms, see Achenbach et al. 1987),
while other components might be more easily reported by
their parents (e.g., maladaptive behavior).
Limitations and Future Directions
While this study provides insight into how different emo-
tional components contribute to maladaptive behavior in
ASD, there are a few limitations to be addressed.
First, the present study is cross-sectional; this design is
useful for exploring potential directional relationships
among emotion experience, regulation, and maladaptive
behavior, but does not allow for drawing conclusions about
causality. Longitudinal designs could provide stronger
evidence of directional relationships (with the potential to
infer causality) between emotional components and mal-
adaptive behavior. In addition, the current study relied
mainly on observational data. However, experimental in
contrast to observational study designs would help to fur-
ther examine the underlying mechanisms that lead to
maladaptive behavior.
Second, our study used a relatively small sample of
individuals with ASD. Although an advantage of the cur-
rent study is that we included a few individuals with
FSIQ \70 resulting in a broader range of individuals with
ASD, this was nonetheless a higher functioning sample on
average. Future studies should include larger samples with
a broader range of cognitive functioning. This would allow
a deeper understanding of emotion experience and
regulation in relation to maladaptive behavior in the ASD
population. In addition, future research could look at how
associations among emotion experience, regulation, and
maladaptive behavior may be conditional on higher and
lower functioning individuals using moderation analyses.
Third, while the present study examined individuals
with ASD compared to age and gender group matched TD
participants, we did not include a psychiatric control group.
Future studies need to include psychiatric controls to get a
better idea about the specificity of the effects for the ASD
population and to learn more about possible effects of ASD
core features on emotional problems and resulting mal-
adaptive behavior.
Fourth, the present study focused on positive versus
negative emotional experiences only and included a narrow
range of emotion regulation strategies. Especially regarding
negative emotions, it is possible that experiencing anger and
experiencing sadness, for example, are differentially related
to maladaptive behaviors. Moreover, expressive suppression
is one form of generally maladaptive emotion regulation, but
3430 J Autism Dev Disord (2015) 45:3424–3432
123
other maladaptive emotion regulation strategies may be
more strongly associated with maladaptive behavior. Future
studies should examine more closely a variety of different
types of emotions, as well as include a broader range of
emotion regulation strategies to gain further insight into
mechanisms that lead to maladaptive behavior in ASD. Fi-
nally, the present study used the maladaptive behavior index
of the VABS-2 (Sparrow et al. 2005) to assess maladaptive
behavior, which includes internalizing, externalizing, and
other behavior. Future studies are warranted that distinguish
between specific effects of emotion regulation and experi-
ence on internalizing and externalizing behavior separately
in larger sample sizes.
The current study suggests that interventions targeting
the ability to use cognitive reappraisal may improve
emotion experience as well as decrease maladaptive be-
havior in individuals with ASD. These interventions may
further elucidate the underlying mechanisms of successful
treatments in ASD (e.g., cognitive behavioral therapy to
ease anxiety; Sofronoff et al. 2005).
Acknowledgments The study was supported by the Swiss National
Science Foundation PA00P1_136380 (A.S.) and Mosbacher Family
Fund for Autism Research. We thank Yael Enav, Amrita Sharma,
Mirit Kopelman, and Robin Libove for their help with this study.
Conflict of interest The work with human subjects complies with
the guiding policies and principles for experimental procedures en-
dorsed by the NIH.
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