Basis of Inability to Regulate Emotions in Autism Identified

While impaired social skills, communication difficulties, and repetitive behaviors are the core features used to diagnose someone as having an autism spectrum disorder (ASD), many parents and clinicians would say that emotional deficits such as irritability, tantrums, and aggressive behavior are also real elements of concern.

Emotional outbursts like tantrums are the leading contributors to stress among parents of ASD children and are the most common reason parents seek professional treatment. The only two Food and Drug Administration–approved drugs for autism—risperidone and aripiprazole—are prescribed to treat irritability.

The question at large is how two areas of deficiency—sociocommunication and emotion—overlap. Do children with ASD throw a tantrum as a result of frustrations at being unable to adequately express themselves?

New findings using functional magnetic resonance imaging (fMRI) suggest that the problems with emotional regulation in ASD lie deeper. When comparing fMRI scans of 15 young adults with ASD and 15 matched controls, the study found that the brain activity of the ASD subjects was different when trying to change their emotional perception of an image.

The tests carried out are known as cognitive reappraisals; after seeing an image of a face, the participants were given instructions to either “think positive” or “think negative,” which may or may not be in tune with the facial expression.

As lead author Gabriel Dichter, Ph.D., an associate professor of psychiatry and psychology at the University of North Carolina School of Medicine, told Psychiatric News, “Cognitive reappraisal measures one’s ability to take a deep breath following an emotional stimulus, as it were, and refrain from reacting inappropriately.

“With fMRI, we’ve now seen that the difficulties in emotion regulation observed in people with autism have a biological basis.”

Specifically, the images revealed that subjects in the ASD group had a decreased capacity to upregulate activity in the nucleus accumbens brain region when instructed to think more positively and had a decreased ability to downregulate activity in the amygdala when asked to think negatively. There were also deficits in activity in the prefrontal cortex during both regulatory conditions.

Moreover, the degree to which brain activity was deficient correlated with the severity of the individual’s autism, Dichter noted.

These differences were evident only in the imaging data. The ASD participants had the same subjective ratings of the faces as controls did—they could distinguish “happy,” and both groups spent the same amount of time looking at and thinking about the faces, as measured by eye trackers and pupil dilation.

“This is a very good pilot study that arrives at an opportune time as clinicians have become more cognizant of how strongly emotional regulation can determine long-term independence and well-being in people with ASD,” said Antonio Hardan, M.D., a professor of psychiatry and behavioral sciences at Stanford University Medical Center and director of the center’s Autism and Developmental Disorders Clinic. “The participants were all high-functioning adults with ASD, though, and it is important to test if these results are generalizable to the larger spectrum, especially those who have more severe autism.”

As for the possibility that emotional regulation problems might be a core deficiency in ASD, Hardan noted these findings were intriguing. Nonetheless, “we need to determine if the same pathophysiology that leads to the social and communication deficits also leads to the emotional deficits, and the science is not there yet.”

On a practical level, identifiable brain changes do provide a target for examining the emotional state of someone with ASD, which could be very useful in future clinical work.

“A big issue in autism clinical studies is obtaining personal insight,” Dichter explained. “Unlike a depression study, where you can ask people about their mood, people with autism often have difficulty reporting how they feel. Now with fMRI we have a way to bypass those communication difficulties and look at emotional activity right at the source.”

This study was published online in the Journal of Autism and Developmental Disorders as part of a special issue on emotion regulation. Funding was provided by grants from the National Institute of Mental Health and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. ■