تنظیم احساسات و توسعه در کودکان مبتلا به اوتیسم و سندرم حذف 22q13: مدارک و شواهد برای تفاوت گروهی

Emotion regulation (ER) abilities and developmental differences were investigated among 19 children with autism and 18 children with 22q13 Deletion Syndrome (a rare chromosomal disorder with certain autistic symptoms). The purpose of this study was to examine the phenotypic similarities between the two disorders. ER was measured by the Temperament and Atypical Behavior Scale (TABS) and development was measured by the Developmental Profile – Third Edition (DP-3). It was hypothesized that children with autism would score higher on the Detached domain of the TABS because the domain is associated with autism spectrum disorders. It was also hypothesized that because of similarly well established cognitive and communicative deficits between the two populations, no significant differences in development would be found. Results indicated that the autism group was significantly more impaired on the Detached domain of the TABS and scored higher on every domain of the DP-3 except in social–emotional skills. These findings differentiate the phenotypes of the two disorders and suggest that detached emotional behavior is more salient among children with autism. Early intervention programs that target the improvement of ER and social skills may ensure healthier behavioral outcomes for these individuals.

Emotion regulation (ER) involves the regulation of emotions by monitoring expressive behavior in order to achieve one's goals (Carlson and Wang, 2007 and Thompson, 1991). In addition, ER refers to the behaviors involved in coping emotionally with both positive and negative feelings, such as pleasure, fear, and anxiety (Kopp, 1989). ER is a crucial developmental task for children (Stifter, Spinrad, & Braungart-Rieker, 1999), and the acquisition of effective regulatory strategies plays an important role in many aspects of behavior, such as in guiding early social relationships (Butler et al., 2007 and Dennis et al., 2009). Not all children learn effective methods of ER. Some children become emotionally dysregulated, a pattern of unhealthy regulatory skills that results in an inability to be soothed, difficulties returning to homeostasis, and problems maintaining positive affect (Keenan, 2000). According to the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), emotion dysregulation is implicated in over half of all psychiatric disorders (American Psychiatric Association, 2000 and Gross, 1998). Identifying unhealthy patterns of ER can provide information regarding risk factors for later psychopathology, as well as aid in the creation of specialized interventions for emotion dysregulation.

The current study found that children with autism were more impaired in the Detached domain of the TABS as compared to children with 22q13 Deletion Syndrome. In addition, children with autism scored significantly higher on all domains of development on the DP-3 except for social–emotional skills. Social–emotional deficits may be more salient among children with autism. The findings also provide evidence for phenotypic differences between autism and 22q13 Deletion Syndrome. ER abilities were shown to be severely compromised in both the autism and the 22q13 Deletion Syndrome groups, with the autism group having the greatest impairments. Specialized early interventions for these populations may be beneficial in teaching effective ER skills. Interventions that target children's development of effective coping strategies, including the Promoting Alternative Thinking Strategies (PATHS) program (Greenberg & Kusche, 1993), the Social Emotional Intervention (Denham & Burton, 1996), and the Social Communication, Emotion Regulation, and Transactional Supports (SCERTS) program (Prizant, Wetherby, Rubin, & Laurent, 2003) could be effective in teaching ER skills for these children (Jahromi et al., 2008). The benefit of these programs is that they provide a more diverse (i.e., drawing from different disciplines), less fragmented (i.e., using parts of different approaches with little integration), and more flexible (i.e., family centered) approach as compared to traditional ABA therapies (Prizant et al., 2003). Most of these programs are implemented at the school level and represent only a few of dozens of interventions aimed at improving social–emotional functioning in children with autism. In addition to these treatments, intervention at home can also be beneficial. For example, some research has shown that parent intervention among children with Down syndrome can be effective in teaching emotion regulatory skills (Sorce & Emde, 1982). This intervention involves responsive caregiving and practice, during which parents present mildly frustrating situations involving everyday failure to their children in order for them to practice effective ER skills (Jahromi et al., 2008). A similar intervention may be effective for children with autism and 22q13 Deletion Syndrome, though there is no research to support this possibility. What is most important about these and other interventions for social–emotional skills is that they are implemented early. Research has indicated that children with autism (mean age 25.9 months) experience significant cognitive improvements after one year of an intensive early intervention program (Ben-Itzchak, Lahat, Burgin, & Zachor, 2008). The study also found that IQ improvements were highly correlated with a reduction in certain symptoms of autism, including stereotyped behaviors and social-communicative impairments (Ben-Itzchak et al., 2008). This research suggests that intensive early intervention can lead to marked improvements in behavior in a relatively short period of time, before the child enters school and during the period at which language and other skills may be more easily taught. In addition, ineffective ER abilities in infancy and childhood can have negative behavioral implications for individuals with autism. Infants who are frustrated easily but struggle with modulating their emotions exhibit increased noncompliance to requests from caregivers, placing them at risk for behavioral problems that persist throughout childhood (Stifter et al., 1999). According to Loveland (2005), children with autism also lack effective coping mechanisms for dealing with emotionally stressful situations, a deficit that may manifest later as clinically significant anxiety symptoms. These symptoms are sometimes so severe that they elicit maladaptive behaviors such as aggression and self-injury. Because these and other behavioral problems appear to persist throughout childhood, identifying ER deficits as early as possible can reduce negative mental health outcomes (Stifter et al., 1999). Future studies can focus on trends in gender and age between these two populations. In addition, longitudinal designs would allow for a more in depth examination of the development of ER in these groups. Research that further investigates the phenotypic overlaps between autism and 22q13 Deletion Syndrome is necessary and can aid in a better understanding of the genetic correlates among these populations. From this information, more specialized and appropriate special services can be allocated.