Autistic individuals often face challenges in emotion regulation and stress management due to differences in cognitive processing, sensory sensitivities, and social communication. These difficulties can lead to increased anxiety, depression, and other mental health issues.
Investigating these challenges is crucial because it can inform the development of targeted interventions and support strategies.
Understanding how autistic people experience and respond to stress in daily life can help improve their overall well-being, enhance their ability to cope with challenges, and potentially reduce the risk of co-occurring mental health conditions.
This research is essential for creating more effective support systems and improving quality of life for autistic individuals.
Ilen, L., Feller, C., & Schneider, M. (2023). Cognitive emotion regulation difficulties increase affective reactivity to daily-life stress in autistic adolescents and young adults. Autism, 28(7), 1703-1718.. https://doi.org/10.1177/13623613231204829
Key Points
- Autistic adolescents and young adults report higher levels of perceived stress related to daily social context and activities compared to non-autistic peers.
- Autistic youth show increased affective reactivity to activity-related stressors in daily life.
- Youth with autism use less adaptive and more non-adaptive cognitive emotion regulation strategies than non-autistic youth.
- Non-adaptive emotion regulation strategies increase negative affect in response to daily stressors and may contribute to the severity of co-occurring mental health symptoms in autistic individuals.
- There is significant inter-individual variability in affective reactivity to stress within the autistic group.
- The study highlights the importance of effective stress management and emotion regulation strategies for autistic youth to minimize the negative impact of stress and prevent the development of mental health symptoms.
- This research contributes to understanding the complex relationship between autism, stress reactivity, emotion regulation, and mental health outcomes.
Rationale
Previous research has shown that autistic individuals report higher levels of perceived stress compared to non-autistic individuals (Bishop-Fitzpatrick et al., 2017; Hirvikoski & Blomqvist, 2015; McGillivray & Evert, 2018; van der Linden et al., 2021).
Autistic individuals may also be more likely to be exposed to adverse experiences, including traumatic and stressful life events, such as bullying (Haruvi-Lamdan et al., 2018; Hoover & Kaufman, 2018).
These experiences may contribute to the high rates of co-occurring psychiatric conditions reported in autistic individuals (Kirsch et al., 2020; Lai et al., 2019).
A potential mechanism linking stress exposure to mental health difficulties is increased stress reactivity. However, there is limited research on affective reactivity to stress in autism.
Additionally, difficulties in emotion regulation may increase vulnerability to negative outcomes of stress (Nolen-Hoeksema & Watkins, 2011).
Previous studies have reported emotion regulation difficulties in autistic individuals from childhood to adulthood (Jahromi et al., 2012; Samson et al., 2015; Samson et al., 2012).
The next step in this research area is to investigate affective reactivity to daily stress, cognitive emotion regulation, and their relationship with mental health difficulties in autistic adolescents and young adults.
This study aims to fill this gap by using ecological momentary assessment (EMA) to examine these factors in daily life.
Method
The study employed a mixed-methods approach, combining ecological momentary assessment (EMA) with questionnaires and clinical evaluations.
EMA was used to assess perceived daily-life stress and negative affects in participants’ natural environments.
Questionnaires and clinical evaluations were used to assess co-occurring mental health difficulties, social functioning, and cognitive emotion regulation.
Procedure
Participants completed a 6-day EMA protocol using a smartphone application. They received eight notifications per day between 7:30 am and 10:30 pm, resulting in a maximum of 48 assessments per person.
Participants had 15 minutes to complete each questionnaire. The EMA assessed negative affects, event-related stress, activity-related stress, and social stress.
Participants also completed questionnaires measuring cognitive emotion regulation and mental health symptoms.
A clinical assessment was conducted with autistic participants to examine the presence of DSM-5 diagnoses.
Sample
The final sample consisted of 39 autistic participants (mean age = 18.4 years) and 55 non-autistic participants (mean age = 18.1 years).
All participants were verbally fluent and had reading comprehension skills at least equal to the level of 11-12-year-old children. The groups did not significantly differ in terms of age, sex, or IQ.
Measures
- Ecological Momentary Assessment (EMA): Assessed negative affects, event-related stress, activity-related stress, and social stress.
- Cognitive Emotion Regulation Questionnaire (CERQ): Measured the use of adaptive and non-adaptive emotion regulation strategies.
- Child Behavior Checklist (CBCL) or Adult Behavior Checklist (ABCL): Assessed co-occurring mental health symptoms.
- Global Functioning Social scale: Evaluated social functioning.
- Autism Diagnostic Observation Schedule, second version (ADOS-2) and Autism Diagnostic Interview-Revised (ADI-R) or Social Communication Questionnaire (SCQ): Used for autism diagnosis confirmation.
Statistical measures
The study used multilevel regression models to analyze the hierarchical structure of the EMA data. Multiple linear regression models were used for group comparisons of non-EMA variables.
Ordinal logistic regression models were used for some clinical variables. The analyses controlled for age, gender, IQ, and EMA period (school/work, holidays, or lockdown due to COVID-19).
Results
Hypothesis 1: Autistic youth would show higher levels of perceived stress and increased affective reactivity to daily stressors compared to non-autistic youth.
Results: Partially supported. Autistic participants reported higher levels of perceived social and activity-related stress, but not event-related stress. They showed increased affective reactivity only to activity-related stressors.
Hypothesis 2: Increased affective reactivity to stress would be associated with higher levels of co-occurring mental health symptoms and social isolation in youth with autism.
Results: Partially supported. Affective reactivity to event-related and activity-related stressors was associated with higher internalizing mental health symptoms, but these associations did not remain significant after correcting for multiple comparisons.
Hypothesis 3: Autistic participants would use less adaptive and more non-adaptive emotion regulation strategies than non-autistic participants.
Results: Supported. Autistic youth reported using significantly less adaptive and more non-adaptive cognitive emotion regulation strategies.
Hypothesis 4: Non-adaptive emotion regulation would be associated with clinical symptoms.
Results: Partially supported. More frequent use of non-adaptive cognitive emotion regulation was associated with higher levels of total and internalizing mental health symptoms, but these associations did not remain significant after correcting for multiple comparisons.
Hypothesis 5: The use of adaptive/non-adaptive emotion regulation would moderate the stress-negative affect association in daily life.
Results: Supported for non-adaptive strategies. More frequent use of non-adaptive emotion regulation increased the affective response to perceived daily-life stress, particularly in the autistic group.
Insight
This study provides valuable insights into the daily experiences of stress and emotion regulation in autistic adolescents and young adults.
The findings highlight that autistic youth perceive higher levels of stress related to their social context and daily activities compared to their non-autistic peers.
Importantly, they show increased emotional reactivity to activity-related stressors, suggesting that everyday tasks and responsibilities may be particularly challenging for this population.
The research extends previous work by using ecological momentary assessment to capture real-time experiences of stress and emotions in natural settings.
This method provides a more nuanced understanding of how stress affects autistic individuals in their daily lives, going beyond retrospective self-reports or laboratory studies.
The study also sheds light on the role of emotion regulation in stress reactivity and mental health outcomes for autistic youth.
The finding that autistic participants use fewer adaptive and more non-adaptive emotion regulation strategies is particularly informative.
It suggests that difficulties in regulating emotions may exacerbate the impact of daily stressors and potentially contribute to the development of mental health symptoms.
Further research could explore the specific types of daily activities that autistic youth find most stressful and investigate targeted interventions to help manage these stressors.
Additionally, longitudinal studies could examine how stress reactivity and emotion regulation strategies change over time and their long-term impact on mental health outcomes in autistic individuals.
Strengths
The study had many methodological strengths including:
- Use of ecological momentary assessment to capture real-time experiences in natural settings
- Inclusion of both autistic and non-autistic comparison groups
- Comprehensive assessment of multiple factors (stress, emotion regulation, mental health symptoms)
- Consideration of different types of daily stressors (event-related, activity-related, social)
- Control for potential confounding variables (age, gender, IQ, EMA period)
- Use of advanced statistical techniques (multilevel modeling) to account for the hierarchical structure of the data
Limitations
The study had several limitations:
- The sample was limited to verbally fluent autistic individuals with mostly average or above-average intellectual functioning, limiting generalizability to the broader autism spectrum.
- The reliance on self-report measures may be challenging for some autistic individuals who have difficulties with introspection or emotional awareness.
- The cross-sectional design limits causal inferences about the relationships between stress reactivity, emotion regulation, and mental health outcomes.
- The sample size was relatively small, potentially limiting statistical power, especially for subgroup analyses.
- The study did not include objective measures of stress (e.g., physiological indicators), relying solely on subjective reports.
- The emotion regulation measure focused only on cognitive strategies, not capturing other types of regulation (e.g., behavioral, interpersonal).
These limitations imply that the findings may not apply to all autistic individuals, particularly those with more significant communication or intellectual challenges.
The reliance on self-report and subjective measures may also introduce biases or inaccuracies in the data. Caution should be exercised in interpreting the results as definitive or applicable to all situations.
Implications
The results of this study have significant implications for understanding and supporting autistic adolescents and young adults:
Clinical Practice:
Mental health professionals working with autistic youth should be aware of the heightened stress reactivity, particularly to daily activities, and the potential impact on mental health.
Interventions focusing on stress management and adaptive emotion regulation strategies may be particularly beneficial.
Educational Settings:
Schools and universities should consider the finding that autistic youth experience more stress related to daily activities.
Providing additional support, structure, or accommodations for routine tasks may help reduce stress and improve overall well-being.
Emotion Regulation Training:
The study highlights the importance of developing and implementing emotion regulation interventions tailored to autistic individuals.
Teaching adaptive strategies and reducing reliance on non-adaptive approaches could have a positive impact on stress management and mental health.
Individualized Approaches:
The significant inter-individual variability in stress reactivity within the autistic group underscores the need for personalized assessments and interventions.
One-size-fits-all approaches may not be effective for all autistic individuals.
Prevention of Mental Health Issues:
By identifying increased stress reactivity and emotion regulation difficulties as potential risk factors for mental health problems, this research points to possible targets for early intervention and prevention strategies.
Daily Life Support:
Families, caregivers, and support workers should be aware of the increased stress autistic youth may experience in relation to daily activities and social contexts.
Providing appropriate support and creating stress-reducing environments could be beneficial.
Research Directions:
The study opens up new avenues for research, including longitudinal studies to examine causal relationships, investigations into specific stressors for autistic individuals, and the development and testing of targeted interventions.
These implications underscore the importance of considering stress and emotion regulation in the overall care and support of autistic adolescents and young adults.
By addressing these factors, it may be possible to improve quality of life and reduce the risk of mental health difficulties in this population.
References
Primary reference
Ilen, L., Feller, C., & Schneider, M. (2023). Cognitive emotion regulation difficulties increase affective reactivity to daily-life stress in autistic adolescents and young adults. Autism, 28(7), 1703-1718. https://doi.org/10.1177/13623613231204829
Other references
Bishop-Fitzpatrick, L., Minshew, N. J., Mazefsky, C. A., & Eack, S. M. (2017). Perception of life as stressful, not biological response to stress, is associated with greater social disability in adults with autism spectrum disorder. Journal of autism and developmental disorders, 47, 1-16. https://doi.org/10.1007/s10803-016-2910-6
Haruvi-Lamdan, N., Horesh, D., & Golan, O. (2018). PTSD and autism spectrum disorder: Co-morbidity, gaps in research, and potential shared mechanisms. Psychological trauma: theory, research, practice, and policy, 10(3), 290. https://doi.org/10.1037/tra0000298
Hirvikoski, T., & Blomqvist, M. (2015). High self-perceived stress and poor coping in intellectually able adults with autism spectrum disorder. Autism, 19(6), 752-757. https://doi.org/10.1177/1362361314543530
Hoover, D. W., & Kaufman, J. (2018). Adverse childhood experiences in children with autism spectrum disorder. Current opinion in psychiatry, 31(2), 128-132.
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
Kirsch, A. C., Huebner, A. R., Mehta, S. Q., Howie, F. R., Weaver, A. L., Myers, S. M., … & Katusic, S. K. (2020). Association of comorbid mood and anxiety disorders with autism spectrum disorder. JAMA pediatrics, 174(1), 63-70.
Lai, M. C., Kassee, C., Besney, R., Bonato, S., Hull, L., Mandy, W., Szatmari, P., & Ameis, S. H. (2019). Prevalence of co-occurring mental health diagnoses in the autism population: A systematic review and meta-analysis. Lancet Psychiatry, 6(10), 819-829.
McGillivray, J. A., & Evert, H. T. (2018). Exploring the effect of gender and age on stress and emotional distress in adults with autism spectrum disorder. Focus on Autism and Other Developmental Disabilities, 33(1), 55-64. https://doi.org/10.1177/108835761454931
Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for developing transdiagnostic models of psychopathology: Explaining multifinality and divergent trajectories. Perspectives on psychological science, 6(6), 589-609. https://doi.org/10.1177/174569161141967
Samson, A. C., Hardan, A. Y., Podell, R. W., Phillips, J. M., & Gross, J. J. (2015). Emotion regulation in children and adolescents with autism spectrum disorder. Autism Research, 8(1), 9-18. https://doi.org/10.1002/aur.1387
Samson, A. C., Huber, O., & Gross, J. J. (2012). Emotion regulation in Asperger’s syndrome and high-functioning autism. Emotion, 12(4), 659.
van der Linden, K., Simons, C., Viechtbauer, W., Ottenheijm, E., van Amelsvoort, T., & Marcelis, M. (2021). A momentary assessment study on emotional and biological stress in adult males and females with autism spectrum disorder. Scientific reports, 11(1), 14160. https://doi.org/10.1038/s41598-021-93159-y
Keep Learning
Here are some Socratic questions for a college class to discuss this paper:
- How might the increased stress reactivity to daily activities in autistic individuals impact their long-term development and life outcomes?
- In what ways could society and institutions adapt to reduce the daily stress experienced by autistic individuals?
- How might the relationship between stress, emotion regulation, and mental health differ across the autism spectrum, particularly for those with more significant support needs?
- What ethical considerations should be taken into account when designing interventions to improve emotion regulation in autistic individuals?
- How might cultural factors influence the experience and expression of stress in autistic individuals from diverse backgrounds?
- In what ways could the findings of this study inform the development of more inclusive educational and work environments for autistic individuals?
- How might the use of technology, such as smartphone apps for ecological momentary assessment, change the way we study and understand autism in daily life?
- What are the potential long-term consequences of chronic stress and poor emotion regulation for autistic individuals, and how might these be mitigated?
- How could the insights from this study be applied to improve diagnostic and assessment processes for autism and co-occurring mental health conditions?
- In what ways might the experience of stress and emotion regulation in autistic individuals change across the lifespan, from childhood through adulthood?
