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. Author manuscript; available in PMC: 2021 Jun 25.
Published in final edited form as: J Appl Dev Psychol. 2020 May 4;68:101139. doi: 10.1016/j.appdev.2020.101139

Self-Regulation is Bi-Directionally Associated with Cognitive Development in Children with Autism

Heather J Nuske 1, Melanie Pellecchia 1, Cary Kane 1, Max Seidman 1, Brenna B Maddox 1, Laura MacMullen Freeman 2, Keiran Rump 1, Erica M Reisinger 1, Ming Xie 1, David S Mandell 1
PMCID: PMC8232541  NIHMSID: NIHMS1703200  PMID: 34177028

Abstract

Children with autism are at high risk for self-regulation difficulties because of language delays and emotion-regulation difficulties. In typically-developing children, language development helps promote self-regulation, and in turn, cognitive development. Little research has examined the association between self-regulation and cognitive-skill development in children with autism. Children with autism (5–8 years), who were minimally-verbal (n=38) or typically-verbal (n=46) participated in a structured cognitive assessment and were observed for self-regulation difficulties during the cognitive assessment at the beginning and end of an academic year. Results showed that children with autism who were minimally- compared to typically-verbal had more self-regulation difficulties. Increase in self-regulation difficulties predicted less cognitive-skill gains, regardless of verbal ability, and cognitive skill gains also predicted changes in self-regulation difficulties. Interventions targeting self-regulation may be appropriate for all children with autism and should be adapted for minimally-verbal children.

Keywords: Self-regulation, Autism, Cognitive development

The ability to control one’s actions, cognitions and emotions – in other words, to self-regulate – is critical to success across the lifespan (Carver & Scheier, 2001; Mischel et al., 2010). In school-aged children, self-regulation skills promote persistence and resilience, predict positive social and mental health outcomes (Durlak et al., 2011; Eisenberg et al., 1995; Lengua, 2003), and are linked to higher academic achievement (Blair & Razza, 2007; Fuhs et al., 2013; Liew et al., 2008; McClelland et al., 2007; Ponitz et al., 2009). Language development is critical to developing self-regulation skills (Cole et al., 2010; Eisenberg et al., 2005; Fonagy & Target, 2002; Kopp, 1982; Vallotton & Ayoub, 2011). Teachers and parents explicitly teach self-regulation skills via instruction, reasoning, and reflection, processes mediated by children’s language comprehension and verbal expression (Berkman, 2016; Dignath et al., 2008). Seminal work by Lev Vygotsky highlighted that the language that teachers use to mediate learning becomes internalized, and in turn promotes children’s cognitive skill development via self-regulation (Camperell, 1981; Diaz & Berk, 2014; Vygotsky, 1962). Indeed, cross-sectional research on children with autism points to a relationship between communication skills and self-regulation skills (Park et al., 2012); greater vocabulary (rather than temperamental talkativeness) predicts children’s better self-regulation ability (Vallotton & Ayoub, 2011). Moreover, cognitive skill development is thought to promote self-regulation skills (Kopp, 1982). Thus, the development of self-regulation and cognitive skills may have a bi-directional, co-dependent relationship (Ursache et al., 2012; Zimmerman, 1990).

Children with autism, a disorder characterized by social communication difficulties and behavioral rigidity (American Psychiatric Association [APA], 2013), commonly have difficulty with many facets of self-regulation, including attentional, emotional and behavioral regulation (Jahromi et al., 2013; Loveland, 2005; Silva & Schalock, 2012). Many children with autism experience cognitive control difficulties, especially with regards to cognitive flexibility (adapting cognitions to environmental changes) and set shifting (switching between attentional foci) (Landry & Bryson, 2004). These difficulties are associated with sensory sensitivities and repetitive behaviors common in children with autism, such as the inability to block out distracting noise or to disengage from a special interest (Boyd et al., 2009; Chen et al., 2009). Children with autism also commonly have attention difficulties; 63% meet criteria for attention deficit hyperactivity disorder (Simonoff et al., 2008). Children with autism also exhibit more emotional lability (Samson et al., 2012), negative mood and irritability (Samson et al., 2014; Zwaigenbaum et al., 2005), anxiety and depression (Berthoz & Hill, 2005), aggression and hyperactivity (Ashburner et al., 2010; Bauminger et al., 2010), and fewer adaptive emotion regulation strategies (Jahromi et al., 2012; Konstantareas & Stewart, 2006; Mazefsky et al., 2014; Nuske et al., 2017; Zantinge et al., 2017).

A major cause of emotional dysregulation and associated challenging behavior in children with intellectual disabilities is the inability to verbally express one’s needs (Emerson et al., 2001; McClintock et al., 2003; Walker & Snell, 2013). About a third of children with autism are minimally verbal (e.g., have less than 20 functional words) past age 5, even after early intervention (Anderson et al., 2007; DiStefano et al., 2016; Hus et al., 2007; Kasari et al., 2013). Therefore, children with autism, especially those who are minimally verbal, may be at increased risk for self-regulation difficulties. Little is known, however, about minimally-verbal children with autism, as they often are excluded from research (Kasari et al., 2013).

While many studies have linked typically developing children’s self-regulation skills to a host of positive outcomes (e.g. Durlak et al., 2011), few studies have examined this link in children with autism. Initial findings suggest that self-regulation skills in children with autism predict later social adjustment (Berkovits et al., 2017; Jahromi et al., 2013) and cross-sectional research finds an association between self-regulation difficulties and poor academic performance in children (Ashburner et al., 2010), and quality of life in adults (Dijkhuis et al., 2017). Less research has examined the association between self-regulation in children with autism and cognitive development (Blacher & Kasari, 2016). It is critical to understand this relationship given that cognitive skill gains represent the most common outcome of autism interventions (Lord et al., 2005). Self-regulation skills allow a child to learn by keeping their emotional arousal in an optimal zone for learning and their attention on the learning material (Diamond et al., 2007; Yerkes & Dodson, 1908). Developing such skills may bolster cognitive skills in children with autism, as is the case in typically developing children (e.g. Durlak et al., 2011). To our knowledge, no study has examined whether self-regulation skills are associated with cognitive skill development in children with autism.

The current study examines in children with autism: 1) whether self-regulation difficulties differ in minimally-verbal vs. typically-verbal children and 2) the impact of self-regulation skill development on cognitive skill development, and vice versa. We hypothesized that:

  1. Minimally-verbal children with autism have more self-regulation difficulties than typically-verbal children with autism, and

  2. Self-regulation skill development is bi-directionally associated with cognitive skill development in both groups.

Methods

Participants

Participants were 84 children with autism (70 males [83%]; 25 white [30%]), aged 5–8 years, who participated in one of two school-intervention trial in the School District of Philadelphia, the eighth largest district in the USA (Mandell et al, 2013). Most students are ethnic minorities (69%), with 75% living below the federal poverty line. The first trial took place between 2008 and 2010 (Mandell et al., 2013) and the second took place between 2015 and 2017 ((Pellecchia et al., 2016, 2019)) intervention effects are reported in those articles, so are not repeated here. Children in both trials received the Strategies for Teaching based on Autism Research (STAR) program (Arick et al., 2004), a manualized and comprehensive program for children with autism that includes three interventions (discrete trial training, pivotal response training, teaching within functional routines) and six curriculum areas (expressive language, receptive language, spontaneous language, functional routines, pre-academic concepts, and play and social interaction skills). Self-regulation skills were not specifically targeted in this intervention.

Children were recruited from 58 classrooms. Inclusion criteria were that they were enrolled full-time in an autism-support classroom and were in kindergarten, first or second grade, so therefore all children had an educational classification of autism spectrum disorder. Diagnosis was confirmed on all children by a trained clinician for 80% of the sample (67 children), using the Autism Diagnostic Observation Schedule, Generic (Lord et al., 2000) or Second Edition (Lord et al., 2012), a semi-standardized play assessment of autism symptoms. Calibrated severity scores range from 1–10 with higher scores meaning higher autism symptomology. On average, children had moderate levels of autism symptoms (M= 6.72, SD= 1.23, Range= 3–10). The other 20% of children did not complete the ADOS, but all children in the sample had an educational classification of autism provided by a school psychologist within the school district and were enrolled in an autism support classroom.

Children were classified as minimally verbal (n=38) or typically verbal (n=46) based on assessment scores. Those in the minimally-verbal (MV) group met established criteria (DiStefano et al., 2016; Kasari et al., 2013) of < 20 words, operationalized as ‘is not able’ or ‘never (or almost never) when needed’ on the Communication item [“names 20 or more familiar objects”] of the Adaptive Behavior Assessment System-II or -III (Harrison & Oakland, 2003, 2015), completed by their parents. For the purposes of this study, children in the typically-verbal (TV) comparison group were classified as such by having a typical expressive vocabulary (t score 40–60) on the Differential Abilities Scales, Second Edition (DAS-II; Elliott, 2007) Picture Naming subtest. See Table 1 for participant characteristics.

Table 1.

Participant Characteristics

MV Group TV Group
Variable M (SD)/ Frequency (%) Comparison Statistics
Age (years) 6.4 (0.9) 6.6 (0.9) t(82)=−0.88
Sex
 Male 31 (36.9%) 37 (44.1%)
 Female 7 (8.3%) 7 (8.3%) X2(2,84)=1.78
 Missing 0 (0%) 2 (2.4%)
Race
 White 4 (4.8%) 17 (20.2%)
 Black 28 (33.3%) 25 (29.8%) X2(2,84)=7.93*
 Missing 6 (7.1%) 4 (4.8%)
Ethnicity
 Hispanic 12 (14.3%) 12 (14.3%)
 Non-Hispanic 26 (31.0%) 34 (40.5%) X2(1,84)=0.31
Income
 < $20,000 20 (23.8%) 25 (29.8%)
 $20,000 – $40,000 8 (9.5%) 8 (9.5%)
 $40,000 – $60,000 8 (9.5%) 5 (6.0%) X2(3,84)=0.25
 > $60,000 2 (2.4%) 8 (9.5%)
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#

p < .10

*

p < .05

**

p < .01

***

p < .001

Measures

Self-regulation difficulties

Self-regulation difficulties were measured using the Behavioral Interference Coding Scheme (BICS) ((Nuske, Pellecchia, et al., 2019); Nuske et al., in preparation). This scale measures behavioral manifestations of self-regulation difficulties that are observable during standardized testing. Self-regulation behaviors in the scale are based on those measured by similar parent-report scales (e.g. the Behavior Regulation scale of the Behavior Rating Inventory of Executive Function; Gioia, Isquith, Retzlaff, & Espy, 2002) or direct assessment of children’s self-regulation (Smith-Donald et al., 2007). The BICS includes ten items: 1) easily distractible, 2) impulsive, 3) noncompliant with task directions, 4) needs prompting and reminders for compliance, 5) difficulties with transitions between activities, 6) low frustration tolerance, 7) rigid/inflexible, 8) easily fatigued, 9) gives up easily and 10) aggressive. Our previous studies ((Nuske, Pellecchia, et al., 2019); Nuske et al., in preparation) have identified the scale as psychometrically robust (Cicchetti, 1994), with 1) high factor loadings (Range = .64–.90), 2) excellent internal consistency reliability across four samples of children with autism, ICC = .91, 95%CI = .75–.98, ICC = .86, 95%CI = .81–.90, ICC = .90, 95%CI = .88–.92 and ICC = .87, 95%CI = .84–.90 (n = 26, n = 78, n = 125 and n = 228, respectively), excellent inter-rater reliability for children with autism ICC = .95, 95%CI =.80–.99, and moderate convergent validity with the parent-report of the Emotional Control (r = .281, p = .028), Inhibit (r = .330, p = .012) and Inhibitory Self-Control (r = .331, p = .011) sub-scales of the BRIEF-Preschool version (Gioia et al., 1996). Researchers trained to reliability in the identification of these behaviors by a licensed clinical psychologist supervisor were asked to rate the occurrence or non-occurrence of each behavior during the testing session on the following Likert scale: 1 = never, 2 = sometimes, 3 = often, or 4 = constant. Since the first study did not include the tenth item, this item was excluded from the analysis for the purposes of this study. Mean of the nine items gave the total score, with higher scores indicating more frequent self-regulation difficulties. Internal consistency was high for both groups and for the groups combined (MV: ICC = .90, 95%CI = .85–.94, TV: ICC = .89, 95%CI = .83–.93, both groups: ICC = .91, 95%CI = .88–.94).

Cognitive skills

Cognitive skills were measured using the DAS-II, specifically the General Conceptual Ability standard score (M=100, SD=15). The Early Years core subtests of the DAS-II were used, which is designed for participants between 2 years 6 months to 8 years 11 months. The DAS-II is commonly used with children with autism (Ozonoff et al., 2005). A licensed clinical psychologist trained the research assistants in DAS-II administration and supervised them in administering the DAS-II. The testing team met weekly to maintain reliability in administration and scoring in consultation with the clinical psychologist, and ongoing in-vivo coaching was provided by licensed school and clinical psychologists.

Procedure

The study was carried out in accordance with the Declaration of Helsinki as revised in 2000. Informed consent was obtained for each participant. Testing took place at their school, in the quietest, least distracting room available. Children were tested at the beginning (Time 1) and end (Time 2) of the school year by trained researchers unaware of the study hypotheses, supervised, as mentioned above, by a licensed clinical psychologist. For each child, the researcher administered the DAS-II to assess cognitive ability and immediately after the DAS-II they completed the BICS self-regulation scale, based on the child’s behavior during the DAS-II.

Data Analysis

To test the hypothesis that MV children have more self-regulation difficulties than TV children with autism, we compared groups on a composite (M) of Time 1 and Time 2 self-regulation difficulties using independent samples t tests. We used within-group paired t tests to compare each groups’ Time 1 and Time 2 self-regulation scores. We also examined individual trajectories in self-regulation difficulties for each of the participants. To test the hypothesis that self-regulation skill development would be associated with cognitive skill development in children with autism, we conducted two sets of regression models, in the first, we regressed DAS-II standard score at Time 2 onto change in self-regulation score from Time 1 to Time 2, controlling for group (MV, TV), DAS-II standard score at Time 1 and other child characteristics (age, sex, race, ethnicity, and family income). In the second, we regressed BICS Total score at Time 2 onto change in cognitive skills from Time 1 to Time 2, again controlling for group (MV, TV) and the same set of other child characteristics, as well as BICS Total score at Time 1. Following recommendations of Hosmer and Lemeshow (2000), the criterion set for entering of covariates into the adjusted regression models was that bivariate associations of the with the outcome variables (unadjusted models) would be significant at p < .2. Based on this criterion, group, age and cognitive ability at Time 1 were entered into the first adjusted regression model, and group, sex, race, ethnicity and self-regulation difficulties at Time 1, were entered into the second adjusted regression model. Bivariate associations between all variables of interest are also provided in the Supplementary Material. We included random effects for classroom to account for potential clustering of child outcomes.

Results

Self-Regulation Difficulties in Minimally-Verbal vs. Typically-Verbal Children

Self-regulation score means (and cognitive score means) in the minimally- and typically-verbal group at each time point are presented in Table 2, showing that minimally verbal children had higher self-regulation difficulties (and lower cognitive skills) at each time point, relative to the typically developing group. As can be seen in Figure 1, no statistically significant changes from T1 to T2 in average self-regulation difficulties were found for either group. However, self-regulation difficulties had a large range; changes from Time 1 to Time 2 for the MV group ranged from −1.7 to +2.1 (SD = 0.93), and for the TV group ranged from −1.5 to +1.0 (SD = 0.58). Individual differences in the trajectories in self-regulation difficulties between the time points are shown in Figure 2, showing substantial change on an individual level despite no differences in group means.

Table 2.

Cognitive Skill and Self-Regulation Scores at the Start and End of the School Year

Start of School Year (Time 1) End of School Year (Time 2)
MV Group TV Group MV Group TV Group
Variable M (SD)/ Frequency (%) Comparison Statistics M (SD) Comparison Statistics
DAS-II Standard Scorea 38.00 (11.4) 66.54 (16.3) t(79.97)=−9.40*** 41.00 (12.5) 71.85 (15.9) t(82)=−9.73***
BICS Self-Regulationb 2.51 (0.8) 1.81 (0.6) t(82)=4.66*** 2.47 (0.6) 1.69 (0.5) t(82)=6.39***
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a

Differential Abilities Scale, Second Edition: General Conceptual Ability (Standard Score)

b

Behavioral Interference Coding Scheme (Self-Regulation)

#

p < .10

*

p < .05

**

p < .01

***

p < .001

Figure 1.

Figure 1.

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Frequency of self-regulation difficulties in children with autism who are minimally compared to typically verbal, at the start and end of the school year (Time 1 [T1] and Time 2 [T2], respectively).

Figure 2.

Figure 2.

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Individual differences in the trajectories of self-regulation difficulties (Behavior Interference Coding Scheme [BICS] Total score) from Time 1 to Time 2 for each of the participants in the study (n = 84). Line color represents group, with minimally verbal (n = 38) in black and typically verbal (n = 46) in light gray. Data show substantial movement in level of self-regulation difficulties between the time points.

Association between Self-regulation and Cognitive Skill Development

In the regression analyses examining predictors of cognitive skill development, after controlling for both cognitive abilities at Time 1, group, and age, children with fewer self-regulation difficulties at Time 2, relative to Time 1, made greater gains in cognitive ability (Table 3). Each unit decrease in self-regulation difficulties was associated with a gain of 2.73 cognitive ability (IQ) points. Age was marginally negatively related to cognitive gains (B = −1.95, p = .06). The self-regulation development × group (MV, TV) interaction effect was not statistically significant (B = −3.2, p = .21). Improvement in self-regulation was associated with cognitive gains in both groups (Figure 3). We also ran regression analyses examining predictors of self-regulation development. After controlling for both self-regulation difficulties at Time 1, group, and other significant child characteristics (race, ethnicity, sex), children with higher cognitive skills at Time 2, relative to Time 1, had decreased self-regulation difficulties at follow-up (Table 4). Sex was negatively related to changes in self-regulation difficulties, such that girls had less difficulties over time (B = −0.43, p = .009). Race and ethnicity were not related to changes in self-regulation difficulties in the adjusted analyses. The cognitive skill gains × group (MV, TV) interaction effect was not statistically significant (B = 0.007, p = .62).

Table 3.

Linear Regression Predicting Change in Cognitive Ability

Unadjusted* Adjusted**
B p B p
Predictor
 BICS self-regulation development (negative = less difficulties) −3.35 .008 −2.73 .023
Covariates
 Typically-verbal group (reference = minimally-verbal group) 6.79 .012 6.81 .010
 Age −1.84 .084 −1.95 .055
 Sex: male (reference = female) −1.77 .477
 Race: black (reference = white) −0.56 .795
 Ethnicity: hispanic (reference = non-hispanic) 1.94 .345
 Income (reference = > $60,000):
  < $20,000 −1.11 .710
  $20,000 – $40,000 0.93 .784
  $40,000 – $60,000 −2.77 .446
 DAS-II General Conceptual Ability (standard score): Time 1 0.96 < .001 0.85 < .001
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All analyses included random effects for classroom.

*

Controlling only for DAS-II Time 1 score.

**

Criterion for entering covariates into adjusted model was a bivariate association (unadjusted model) of p < .2 (Hosmer and Lemeshow, 2000).

Figure 3.

Figure 3.

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Correlation between change in cognitive skills (Time 2 –Time 1, with higher scores = higher cognitive abilities over time) and changes in self-regulation difficulties (Time 2 – Time 1, with higher scores = higher self-regulation difficulties over time), within a school year. Negative correlation in both groups indicates that children who have less self-regulation difficulties have better cognitive abilities scores at Time 2; both groups combined: r= −0.31, p= .01 (solid black line), typically-verbal group: r= −.38; p= .01 (dashed line) and minimally-verbal group: r= −.28; p= .09 (dotted line).

Table 4.

Linear Regression Predicting Self-Regulation Development

Unadjusted* Adjusted
B p B p
Predictor
 DAS-II cognitive skill development (positive = cognitive gains) −0.02 .004 −0.02 .010
Covariates
 Typically-verbal group (reference = minimally-verbal group) −0.63 <.001 −0.53 <.001
 Age 0.05 .535
 Sex: male (reference = female) −0.36 .048 −0.43 .009
 Race: black (reference = white) 0.27 .084 0.07 .598
 Ethnicity: hispanic (reference = non-hispanic) −0.21 .172 −0.20 .121
 Income (reference = > $60,000):
  < $20,000 0.14 .519
  $20,000 – $40,000 0.30 .229
  $40,000 – $60,000 0.27 .304
 BICS self-regulation: Time 1 0.41 <.001 0.27 .005
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All analyses included random effects for classroom.

*

Controlling only for BICS Time 1 score.

**

Criterion for entering covariates into adjusted model was a bivariate association (unadjusted model) of p < .2 (Hosmer and Lemeshow, 2000).

Discussion

Regardless of children’s verbal abilities, self-regulation skill development was associated with increased cognitive ability in our sample of children with autism. This finding extends previous work in typically developing children (e.g. Durlak et al., 2011; Pintrich & De Groot, 1990), and highlights the importance of self-regulation skills for improvements in cognitive functioning, and vice versa, in children with autism. Children with autism who develop skills in controlling their emotions, cognitions and attention may be better able to take advantage of classroom learning opportunities, and children’s cognitive skills may support their emerging self-regulation (Blair & Diamond, 2008). This finding is consistent with those documenting a relationship between emotion regulation of children with autism and their productivity, independence, flexible behavior and flexible attention in class (Sparapani et al., 2016). The effect of self-regulation development on change in cognitive ability did not differ between the two verbal ability groups, suggesting that for all children with autism, self-regulation is an area of development that is important to foster. Both regression models (i.e. self-regulation development predicting cognitive skill gains and cognitive skill gains predicting self-regulation development) showed a significant association between these two facets of development, hence indicating a bidirectional relationship. These results fit with the assumed codependency of development of these skills in typical populations (Ursache et al., 2012; Zimmerman, 1990).

As expected, children with autism who are minimally verbal also present with more self-regulation difficulties than those who are typically verbal, which fits the hypothesis that the development of self-regulation abilities is mediated through verbal development (Berkman, 2016; Dignath et al., 2008). Fewer opportunities may be available for self-regulation development for individuals who are not able to verbally express their cognitions and emotions. In a related study, children with autism who had difficulty identifying and verbally expressing their emotions had less parental involvement during a low-level stressor task, because they were less able to signal to their parents that they needed assistance (Costa et al., 2017). Minimally-verbal children commonly present with challenging behaviors (Hattier et al., 2011; Hill et al., 2014), which may occur due to regulatory difficulties. Indeed, findings from our group and others suggest that regulatory difficulties in minimally-verbal children with autism predict challenging behavior, both over time and in the moment (Cumpanasoiu et al., 2017; Korbut et al., submitted; Nuske, Finkel, et al., 2019).

On a group level, no significant changes were seen for either group in their self-regulation difficulties between the start and end of the school year. One possible reason for this is that the behavioral coding captured information on self-regulation at the trait level (i.e. as it relates to temperament; Rothbart, Ellis, et al., 2011; Rothbart, Sheese, et al., 2011), and accordingly would not be expected to change in one school year. However, as shown in Figure 2, there was substantial individual variation in self-regulation difficulty trajectories and the intervention children were involved in was not designed to target self-regulation (the six curriculum areas were expressive language, receptive language, spontaneous language, functional routines, pre-academic concepts, and play and social interaction skills). Though preliminary, these results validate the recent push to teach self-regulation skills to children through school-wide approaches to social and emotional learning (Cohen, 2006; Elias et al., 2003; Greenberg et al., 2003; Zins, 2004). Two recent meta-analyses found that supports for social and emotional learning skills led to improvements in academic skills and positive social behaviors and attitudes, and decreases in conduct problems and emotional distress (Durlak et al., 2011; Taylor et al., 2017). Our findings are consistent with these meta-analyses and suggest that children with autism may also benefit from interventions that target self-regulation, and that developing self-regulation skills may promote cognitive development. Current approaches to supporting self-regulation in children are not tailored towards children with significant language delays, so adaptations of these programs are needed. We also need to incorporate self-regulation as a target in autism interventions. Many behavioral interventions for children with autism focus on external methods of regulation (i.e., antecedent strategies or co-regulation by a familiar adult). However, our findings highlight the need for teaching self-regulation strategies, giving the child the strategies to regulate him/herself, and thereby supporting independence. In support of this argument, typically developing children who are given more autonomy support from their parents were later found to have higher impulse control and set shifting abilities (Bernier et al., 2010), and we have found that parents’ facilitation of self-regulation later predicts school engagement and self-development in children with autism (Nelson, Korbut, Hedley, Dissanayake & Nuske, submitted).

Given that fundamental tasks related to self-development are disrupted in young children with autism, such as visual self-recognition, use of self-evaluation statements (e.g., “mine”, “good vs. bad”) and asserting autonomy (Ferrari & Matthews, 1983; Neuman & Hill, 1978; Nuske et al., 2017), it may be fruitful for self-regulation interventions to include components on healthy self-concept and on self-efficacy. Initial findings suggest lower perceived self-efficacy in autism (Feldhaus et al., 2015). For typically developing children, a solid body of work supports the use of self-regulation strategies in classrooms to promote learning (e.g., Dignath et al., 2008; Durlak et al., 2011). However, rigorous testing of self-regulation interventions for children with autism, particularly those who are minimally-verbal, is limited. Single case studies of self-management interventions (including self-monitoring, self-recording, self-reinforcement and self–goal setting) in children with autism across ability levels shown effectiveness for improving social, academic and daily living skills (Carr et al., 2014).

We included race and ethnicity as covariates in the analyses given some findings showing lower rated frustration tolerance (a key aspect of self-regulation) in minority children (Pigott & Cowen, 2000), and lower cognitive and language skills in minority children with autism (Chaidez et al., 2012). Correlations in the current study showed that race was marginally related to cognitive ability in the children with autism at both time points, and ethnicity was related to self-regulation difficulties at Time 1, with the groups combined. However, when they were entered into the main regression analyses, neither emerged as a predictor of cognitive development or self-regulation development. Therefore, despite our finding of a significant difference in diversity (race) between the minimally and typically developing groups, race did not account for the findings of longitudinal associations between self-regulation and cognitive development. Age was marginally related to cognitive and language development, such that younger children with autism had more gains, consistent with previous research (e.g. MacDonald, Parry-Cruwys, Dupere, & Ahearn, 2014; Vivanti, Dissanayake, & The Victorian ASELCC Team, 2016). Girls were found to have less self-regulation difficulties over time, which aligns with findings of a female advantage on self-regulation (e.g. Hosseini-Kamkar & Morton, 2014; Matthews, Ponitz, & Morrison, 2009).

Limitations

Several study limitations should be noted. First, given the lack of middle time points for the assessment of self-regulation skills, we are not able to definitively determine the direction of causation, i.e., whether changes in self-regulation impact cognitive skill development, or vice versa, however, in both regression models, one predicted the other. Future research should incorporate three or more time points in order to assess directionality between self-regulation and cognitive skill development, to further unpack the nature of these complex transactional processes. Another approach would be to test the developmental sequalae experimentally, through intervention outcome data on interventions designed to target self-regulation vs. cognitive skills. Second, the self-regulation measure was administered by an unfamiliar adult based on their behavior during the cognitive assessment period, which may not reflect their behavior with familiar others and at a less stressful/structured situation. However, given that ensuring consistent administration is important for research, this may also be seen as a methodological strength, paralleling experimental paradigms designed to measure emotion regulation during low-level stress tasks (e.g., Goldsmith, Reilly, Lemery, Longley, & Prescott, 2012; Nuske et al., 2017). Third, our characterization of the typically-verbal group pertained only to expressive vocabulary as measured on the DAS, and did not rely on a full language characterization. Future research comparing minimally- and typically-verbal children with autism should include more comprehensive language assessments.

Conclusions

Despite these limitations, several important implications related to these findings warrant attention. Minimally-verbal children with autism experience more frequent self-regulation difficulties than typically-verbal children with autism, indicating a need for interventions to support both the language and self-regulation skills of this group of children. Further, difficulties with self-regulation were associated with poorer cognitive changes regardless of children’s verbal level, and cognitive skill development was in turn associated with development in self-regulation. These findings suggest that interventions targeting self-regulation may be appropriate for all children with autism and should be adapted for the needs of minimally-verbal children.

Supplementary Material

Supplementary Table 1
Supplementary Table 2

Highlights.

  • Children with autism are at high risk for self-regulation difficulties

  • Children with autism who were minimally- compared to typically-verbal were found to have more self-regulation difficulties

  • Reduction in self-regulation difficulties over an academic year predicted higher cognitive-skill gains

  • Self-regulation interventions are recommended for children with autism and need adaptation for minimally-verbal children

Acknowledgments

The research team would like to thank all of the children, parents and teachers who graciously gave their time to the study and the team of dedicated Clinical Research Coordinators who contributed to the success of both school intervention trials, including but not limited to Max Seidman, Christine Spaulding and Rachel Ouellette, as well as all the wonderful student interns that worked tirelessly on the project. We thank also the funders, without which the research would not have been possible: National Institute of Mental Health (R01MH106175, PI: Mandell; R01MH083717, PI: Mandell; P50MH113840, PIs: Rinad Beidas, David Mandell, and Kevin Volpp; K01MH120509, PI: Nuske) and the Institute of Education Sciences (R324A080195, PI: Mandell).

Footnotes

Declarations of interest: None

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Supplementary Table 1
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Supplementary Table 2
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