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Applying a Self-Regulation and Communication Framework to Autism Intervention 943
Self-regulation is widely recognized as a critical capacity for children to develp, as it is a strong and positive predictor of both academic [7; 24] and social wellbeing [6; 29]. Self-regulation involves recognizing, monitoring, and managing internal states such as stress, energy, and emotions with the goal of attaining and maintain optimal levels of arousal [15; 16; 26]. It is a capacity that develops over time, beginning in infancy and continuing through to adulthood . In its simplest form, an infant who reflexively turns his head away from an over stimulating noise, or averts his gaze from over stimulating visual information is thought to be self-regulating his behavior. His actions help him to maintain an optimal level of arousal and avoid becoming overwhelmed by sensory information [11; 19; 28]. The more cognitive and deliberate component of self-regulation relies on children’s development of executive functioning and metacognitive skills. These skills help children to problem solve, plan, set goals, self-monitor, and reflect. They develop slowly and gradually, within the context of co-regulating interactions with others .
In a recent publication, Binns, Hutchinson, and Oram Cardy (2019) discussed the important role that speech-language pathologists can play in supporting children’s development of self-regulation capacities. We examined the role that stress can have on children’s ability to engage in self-regulation and shared a clinical framework intended to guide clinicians’ consideration of stress and self-regulation in speech and language intervention. Throughout this article, I will refer to this framework as the Stress, Self-Regulation and Communication (SSC) framework. Within the framework, there are four overarching phases. The first phase involves identifying stressors that might be contributing to a child’s state of dysregulation, and then co-regulating the child to reduce stress and support her readiness for learning. The second phase focuses on providing scaffolding strategies intended to enhance children’s development of the skills needed to self-regulate (e.g., executive functioning skills, comprehension of vocabulary). The third phase provides suggestions that clinicians can use to scaffold children’s autonomy in the self-regulation process, and the final phase occurs when the individual is self-regulating. The SSC framework was designed to be used with a variety of children who experience a range of speech, language, and communication challenges (e.g., developmental language disorder, fluency disorders, attention-deficit/hyperactivity disorder, motor speech disorders, autism spectrum disorder). See Figure 1 for a visual representation of the four phases in the SSC framework. The present article is intended to be an extension of the original tutorial and considers how clinicians can use the SSC framework in autism intervention. First, I will briefly discuss self-regulation capacities in children with autism spectrum disorder (ASD). Then I will share how this information may be used to inform our application of the SSC framework in autism intervention. [Insert Figure 1 about here.]
Self-Regulation and Autism
It is well documented that children with ASD experience challenges in the domain of self-regulation. In studies comparing the self-regulation capacities of children with ASD to their non-ASD peers, parents rated autistic children as slower to adapt, less persistent, less able to focus and shift attention, more easily distracted, and more temperamentally challenging [10; 22]. Autistic children also scored more deviant ratings in the domains of self-regulation compared to children with Down Syndrome . Regulating emotions can be particularly challenging for autistic individuals. They are more likely than their peers to have poorly differentiated emotional responses, display less positive affect and more flat or negative affect, and have limited cognitive insight about their emotions and emotional experiences . Self-reports from individuals from autism have echoed challenges in emotional and overall self-regulation domains [17; 21].
Because a child’s ability to engage in the process of self-regulating involves using executive functioning and metacognitive skills (i.e., problem solving, planning, reflecting), it is important to have an understanding of how autistic children use these skills. A recent meta-analysis concluded that children diagnosed with ASD consistently demonstrated evidence of overall executive dysfunction . On average they performed significantly worse than their non-asd peers. However, no consistent pattern of relative strengths or challenges were found when examining individual subdomains of executive functioning (i.e., concept formation, mental flexibility, fluency, planning, response inhibition, working memory) .
Understanding how children with autism use executive functioning skills during tasks that require them to self-regulate their behaviors or emotions is also of interest. Behavioral coding of children’s responses to a mildly frustrating problem solving task revealed that autistic children displayed greater variability and inconsistency in their use of adaptive strategies, compared to non-ASD controls, and the adaptive strategies autistic children used were less likely to be successful [1; 2; 22]. Autistic children were also less likely to use ‘conventional’ strategies to regulate their behaviour during a problem solving task. Specifically, high rates of perseverative errors and difficulty in maintenance were observed [1; 2]. These challenges are not exclusive to children with autism. Adults with autism were also more likely than age matched peers to use less adaptive emotion regulation strategies (e.g., cognitive reappraisal) and more maladaptive strategies (e.g., suppression of emotions . Understanding the important role self-regulation plays in child development, and recognizing that autistic individuals consistently face a range of challenges in self-regulation that persist into adulthood, it is essential for clinicians to support autistic children’s development of self-regulation.
Special Considerations for Applying the SSC Framework in Autism Intervention
The SSC framework proposed by Binns et al. (2019) is not a prescriptive way to approach intervention, but rather designed to guide clinicians through the process of thinking about how to support self-regulation and communication development. How clinicians use the framework should depend on children’s individual differences. It can be used alongside children’s intervention programs and aligns particularly well with developmental social pragmatic models of intervention (i.e., DIR Floortime, Play Project, PACT) [5; 18; 20; 27]. In this section, I will highlight a few special considerations for applying the SSC framework to autism intervention.
Consideration 1: Collaboration
Phase 1 of the SSC framework suggests that clinicians consider collaborating with other professionals (e.g., occupational therapists, mental health professionals) when trying to understand what stressors might be underlying a child’s dysregulation. Because ASD is characterized by challenges in multiple domains, the benefit to collaborating with parents and other professionals is logically amplified.
Consideration 2: Parallel use of co-regulation and scaffolding strategies
Children with autism are also likely to experience more dysregulation than their peers when engaged in simple executive functioning tasks (i.e., object permanence task). Therefore, the parallel use of co-regulation and scaffolding strategies is recommended. The co-regulation strategies introduced in phase 1 of the SSC framework (designed to mitigate a child’s dysregulation) can be used alongside scaffolding children to develop executive functioning and metacognitive skills (phases 2 and 3). For example, a child engaged in a problem solving task (e.g., trying to find his missing shoe) may benefit from an adult using leading questions to scaffold him to make a plan for where to look, while simultaneously using co-regulation strategies such as selecting a quiet space with few visual distractions to make the plan, using simple language, and using visuals (e.g., writing down the plan). See Table 1 for examples of the strategies suggested within the SSC framework. [Insert Table 1 about here]
Consideration 3: Depth and Breadth
The higher rates of reduced cognitive insight about emotions in autistic individuals suggests that a therapeutic emphasis on developing autistic children’s understanding of emotions is warranted. Within phase 2 of the SSC framework, suggestions were provided for helping children develop a depth and breadth to their understanding and use of mental state vocabulary (e.g., emotions) often used in the self-regulation process. When autistic children are showing signs of readiness to learn mental state vocabulary (e.g., the ability to sustain attention during social interactions, using intentional communication reciprocally), intervention should focus on helping them to develop a comprehensive understanding of how emotions might be experienced personally and how others might experience emotions.
Consideration 4: Respect the unconventional use of self-regulation strategies
Respect that individuals with autism may use self-regulation strategies that are unconventional (e.g., flapping hands, rocking). The goal is to help them identify and use personal strategies that are effective – for them.
Conclusions and Summary
Development of self-regulation capacities are important for child development and children with ASD are more likely than their peers to experience challenges in the domain of self-regulation. The SSC framework proposed by Binns et al. (2019), which was designed to support development of both self-regulation and communication in children with a range of communication disorders, can also be applied to autism intervention. Taking into consideration the specific challenges that autistic individuals may experience in the domain of self-regulation, I have provided special considerations for applying the SSC framework to ASD. These included placing importance on collaborating with others (e.g., parents and professionals) to understand why children might be experiencing dysregulation, using co-regulation and scaffolding strategies in parallel, supporting comprehensive understanding of emotions, and respecting differences in how children might self-regulate.