Assessment & Research

A systematic review of emotion regulation in parent-mediated interventions for autism spectrum disorder

Hendrix et al. (2022) · Frontiers in Psychiatry 2022
★ The Verdict

Parent-mediated autism studies chase problem behavior and ignore emotion regulation—so slip ER goals and quick measures into your next parent plan.

✓ Read this if BCBAs running parent-training programs for toddlers and preschoolers with ASD.
✗ Skip if Clinicians who only work with school-age fluency or vocational goals.

01Research in Context

01

What this study did

The team hunted for parent-mediated autism studies that measured emotion regulation. They screened every paper published up to 2021. Twenty studies made the cut. All twenty taught parents ways to lower tantrums or aggression. None listed emotion regulation as the main goal.

The reviewers double-checked each outcome list. They looked for words like “coping,” “calm,” or “emotion.” Those words were missing. Instead, the papers tracked “problem behavior” or “compliance.”

02

What they found

Challenging behavior stole the spotlight. Emotion regulation stayed backstage. Tools for meltdowns, breath counting, or labeling feelings were rarely taught. Parents learned to reward quiet hands, not to coach “I feel mad.”

03

How this fits with other research

Bassett-Gunter et al. (2017) warned the field years ago: “Stop counting only child words—count parent stress too.” Hendrix et al. echo that call, but for feelings. Both reviews say parent programs need broader yardsticks.

Schmitt et al. (2021) give a ready ruler. They showed the Probabilistic Reversal Learning task picks up flexibility gains after an ER intervention. The task is short, game-like, and sensitive. Use it and you close the measurement gap Hendrix found.

Verschuur et al. (2019) and Whiteside et al. (2022) prove parents can master new targets. Group PRT lifted parent stress and toddler initiations. Mediated-learning coaching lifted joint attention. If parents can hit those marks, they can hit emotion-regulation targets too—once we write them into the protocol.

04

Why it matters

Your parent coaching probably tracks tantrum minutes. Add one ER probe: ask the parent to note times the child names a feeling or uses a calm-down kit. Slip the PRL task in pre- and post-test. In one extra sheet you turn “behavior plan” into “feelings plan,” filling the blind spot this review exposes.

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Add one ER column to your parent data sheet—track if the child labels a feeling or uses a coping tool during daily routines.

02At a glance

Intervention
not applicable
Design
systematic review
Population
autism spectrum disorder
Finding
not reported

03Original abstract

Autistic individuals are at elevated risk for difficulties with emotion regulation (ER) that emerge early in life and are associated with a range of internalizing and externalizing disorders. Existing interventions that support ER have focused on school-age autistic children and adolescents as well as adults. Proactive approaches to improving ER in early childhood are thus needed, as is understanding the approaches by which ER skills can be feasibly supported in this young population. This review summarizes how ER has been measured within parent-mediated interventions for children at or under the age of 6 years and the extent to which ER is measured concurrently with or distinctly from observable behaviors that have been referenced in existing literature as externalizing or challenging behavior. Using PsycInfo, EBSCOhost, and PubMed databases, we searched for peer-reviewed journal articles published through August 2021, that focused on the use of parent-mediated interventions targeting ER and/or challenging behavior. The systematic search resulted in 4,738 publications; following multi-stage screening, the search yielded 20 studies. Eighteen of 20 studies were designed to target challenging behavior using manualized curricula or behavior analytic methodologies and assessed child outcomes through validated caregiver rating scales and/or direct behavioral observation. One study measured changes in ER as secondary to the social communication skills that were targeted in the intervention. Only one study specifically supported ER skill development and measured changes in ER as the primary intervention outcome. Findings highlight the need for better assessment of ER outcomes within the context of parent-mediated interventions for toddlers and young autistic children.

Frontiers in Psychiatry, 2022 · doi:10.3389/fpsyt.2022.846286