1. Emotion Regulation (ER) Emotion Regulation (ER)
A Combined Emotion Recognition and Emotion Regulation Intervention for Preschoolers with Autism Spectrum Disorder
Walker, B. L., Weber, S., Raval, V. V., Gibbons, C., Carlton, M., Weiskittel, K., and Kroeger, K. A.
Introduction
Individuals with Autism Spectrum Disorder (ASD) often have difficulties in emotion recognition and emotion regulation (ER).1-6
Emotion recognition and ER training programs have supportive evidence with school-aged children.2,7-18
Targeting these skills in the preschool years may reduce risk of the development of emotional and behavioral disorders.1,3,19
Previous studies have not evaluated interventions combining training in emotion recognition and ER for preschoolers with ASD.
This study tested an intervention that was designed to increase the emotion recognition and ER skills of preschool children with ASD.
(1) Emotion Recognition: Discrete Trial Training was used to teach children to recognize emotions.
(2) Emotion Regulation (ER): Video Modeling was used to teach children how to use adaptive calm down strategies, and Calm Down Coaching was used to support children in using those strategies.
Results
Discussion
Emotion Recognition
Preschool children with ASD, developmental delays, and some behavioral problems learned to identify emotions from pictures of facial expressions and from situational context.
This adds to a growing body of evidence7,9,11-13,16,24-26
Children did not learn to identify emotions from tone of voice.
Few intervention studies have targeted emotion recognition from tone of voice in children with ASD.2,11
Emotion Regulation (ER)
Video Modeling
Children appropriately imitated use of three adaptive ER strategies.
This suggests that preschool children with ASD are capable of learning adaptive ER strategies via video modeling when calm.
Calm Down Coaching
Children typically did not engage in adaptive ER behavior during the baseline period.
During the intervention period, Child 1 and Child 3 increased adaptive ER behavior when upset when receiving calm down coaching.
This suggests that preschool children with ASD are capable of engaging in adaptive ER behaviors when upset but that they may be unlikely to do so unless prompted by an adult.
Limitations
Small sample size  
Materials did not have established reliability and validity
Did not assess generalization of improvements in emotion recognition
Skill maintenance in emotion recognition and ER was not assessed
Future Directions
Effects of calm down coaching on the frequency, intensity, and duration of children’s emotional episodes
Maintenance of calm after calm down coaching vs. calming alone
Generalizability of calm down coaching to other settings and ER items
Conclusions
This brief intervention resulted in some improvements in emotion recognition and ER of preschool children with ASD.
A more intensive version of this intervention could be developed to reduce the risk of children with ASD developing comorbid emotional disorders.
Emotion Recognition
Child 3’s Results
Baseline Phase
Intervention Phase
Pictured (left) is an example of a facial expression stimulus used in this study. Children increased recognition of emotions via facial expression. Child 3’s results are shown on the right.
Pictured (right) is a visual support of a situational vignette used in this study: “Kyle does not want to go into the dark basement.” Children increased recognition of emotions via situational context.
Children listened to audio clips of statements read in different tones of voice. Children did not increase recognition of emotions via tone of voice.
Method
Participants
Participants were 3 males, ages 4 years 3 months to 5 years 1 month.
The study took place in the participants’ early intervention preschool classroom.
Parents completed the Child Behavior Checklist.23
One child had no behavior problems, one child had problems with withdrawal, and another child had problems with emotional reactivity and withdrawal. 
Information from children’s initial ASD diagnostic assessments on the Mullen Scales of Early Learning21 and Vineland Adaptive Behavior Scales 2nd Ed.22 indicated that all three children had some level of developmental delay at the time of diagnosis.
Procedures
Emotion Recognition
Discrete trial training: a brief, structured teaching method with corrective feedback.
Discrete trial training was used to teach children to recognize emotions from visual, situational, and auditory stimuli.
Visual: pictures of children making emotion faces
Situational: vignettes about children in situations that evoke emotions
Auditory: audio clips of an adult talking in different tones of voice
Emotion Regulation (ER)
Video modeling: children model behaviors they observe in videos.
When children were calm, they watched videos to learn how to use three adaptive calm down strategies.
Calm down coaching: adults support children’s calm down efforts.
When children were upset, classroom staff coached children’s use of the three adaptive calm down strategies they learned in video modeling.
Emotion Recognition Nonoverlap of All Pairs (NAP; effect size) and p-values
Visual
Situational
Auditory
 Child
NAP
Descriptor p 1
.46
Weak
.808
.78
Medium
.059 2
.92
.015
.80
.046
.85
.039 3
.83
.052
.93
Strong
.004
.71
.225
Emotion Regulation (ER)
Children participated in video modeling and received calm down coaching. Two children increased their use of adaptive calm down strategies in the intervention phase.
Shown on the right is a still frame of one of the videos children watched to learn how to use three adaptive calm down strategies.
Children’s Adaptive ER During Emotional Episodes in the Baseline and Intervention Phases
Baseline Phase
Intervention Phase
Child
Adaptive ER (#)
Total Episodes
Adaptive ER (%) 1 3
33.3% 4 5
80% 2 0%
--- 6 10 11
90.9%
Acknowledgements
We would like to thank the volunteers who helped us create and test the materials for this intervention, the children who participated in this study and their parents, and the Cincinnati Children’s Hospital Early Intensive Behavioral Intervention (EIBI) classroom team.