Expression and co-regulation of negative emotion in 18-month-olds at increased likelihood for autism with diverse developmental outcomes

Abstract

Emotion dysregulation is a common challenge for autistic individuals, yet research examining early emotion regulation processes in autism is lacking. The present study examined negative emotion expression and parent-child co-regulatory processes in 18-month-old younger siblings of autistic children (children with an “elevated likelihood” (EL) of autism) with diverse outcomes: autism, language delay without autism (EL-LD), and no delay/diagnosis (EL-ND). Thirty-nine toddlers were videotaped at home with a parent. Negative emotion and parent co-regulatory responses were coded from the video. Results indicated that autistic toddlers exhibited more high-intensity negative emotion than EL-ND toddlers. The likelihood of negative emotion continuing once initiated was higher for autistic and EL-LD toddlers. Parental co-regulation strategy use was similar across groups. Parental co-regulation reduced the likelihood of continued negative emotion, although the effect appeared somewhat weaker for autistic toddlers. This research corroborates evidence that increased risk for heightened and prolonged negative emotion starts early in autistic children and, to a lesser extent, in EL-LD children. Parents of all children were highly responsive, but coregulatory responses may be less effective at reducing negative emotions for autistic children. While more research is needed, the present study contributes to our understanding of the unique emotional experiences of autistic toddlers.

Lay Abstract

Managing negative emotion can be challenging for autistic individuals and their families from a young age. Parents help young children manage negative emotions by responding in comforting or supportive ways. Not much research has examined how negative emotions and parent responses to negative emotions are different in very young autistic children. This study used videotapes of 18-month-old toddlers and parents at home. We examined how much and how intensely toddlers expressed negative emotion in everyday situations, and how parents responded. Participants were younger siblings of autistic children, and we compared three groups—children that (1) later received an autism diagnosis; (2) had language delays but not autism; and (3) had no delays or autism. We found that autistic toddlers’ negative emotion was more likely to be intense and to continue once it started compared with children without delays or autism. Language-delayed toddlers also showed some, but not all these differences. Parents responded similarly to negative emotions in all groups. When parents used strategies to help, it reduced the chances of the negative emotions continuing, although it may have been less helpful for autistic toddlers. This study shows that autistic children may express more intense and long-lasting negative emotions from an early age. It also shows that parents of autistic children are very responsive to their children’s negative emotions, but these responses may not be as helpful to autistic children. While more research is needed, this study helps us understand how autistic toddlers may express and experience emotions differently.

Keywords

autism co-regulation emotion expression emotion regulation negative emotion

Introduction

Learning to modulate the intensity and duration of one’s emotional responses to achieve one’s goals—often called emotion regulation—is a critical developmental task of childhood. Beginning in infancy, caregivers play an essential role in children’s emotion regulation development through numerous mechanisms, including modeling, sensitive responding, emotional talk, and the development of the attachment relationship (Morris et al., 2017). Core to this development is a dyadic process called co-regulation, whereby close adults (typically parents) help infants and young children to manage their big emotions through sensitive responding and strategies such as physical or verbal comfort, problem-solving, scaffolding, and redirection (Grolnick, 1998). Infants are born with little ability to self-regulate and are therefore extremely dependent on adults. Over the course of the first years of life, children begin to internalize these co-regulatory processes and develop independent self-regulation skills (Eisenberg et al., 2009). Research on typical development has established a link between parent-child co-regulation and child emotional reactivity and emotion regulation development in the short and long term (Morris et al., 2011; Putnam et al., 2002; Spinrad et al., 2006).

Autism is a neurodevelopmental condition characterized by differences and challenges in the areas of social interaction and communication as well as preferences for repetition and routine, intense and nonconventional interests, and sensory differences. In addition, intense emotional reactions and challenges with emotion regulation are increasingly recognized as common in autism (Cibralic et al., 2019; Conner et al., 2021; Mazefsky et al., 2013). Challenges with emotion regulation in autism have been linked to mental health challenges, psychiatric hospitalizations, aggressive and self-injurious behaviors, and suicidality later in life (Conner et al., 2020, 2021). Understanding differences in emotional reactivity and regulation early in life is an essential first step toward identifying intervention targets that might improve outcomes for autistic individuals.

Negative emotion expression in young autistic children

Studies of early parent-reported temperament suggest that by around 12 months and into toddlerhood, infants who go on to have autism tend to display more negative affects than their peers without autism (Mallise et al., 2020). In addition, several studies have examined emotion expression during emotion elicitation tasks in young autistic children, with mixed findings. For example, Jahromi et al. (2012) did not find differences between autistic and nonautistic 3- to 6-year-old children in intensity of facial or bodily negativity during tasks designed to elicit frustration. A more recent study by Macari et al. (2018) found a more intense negative affect in response to frustration tasks in younger autistic children (mean age 21 months) but reduced expressions of fear in response to fear-eliciting tasks. Similarly, Day et al. (2022) found that the overall effect was more negative in response to frustration tasks in autistic toddlers (mean age 25 months) compared to nonautistic peers, but there were no differences in effect during fear-eliciting tasks. In contrast, Hirschler-Guttenberg et al. (2015) found that preschool-aged autistic children displayed more negative emotionality during a fear task, but only when they were with their fathers (not with their mothers). Notably, most research to date has relied either on parent-report measures or elicitation of negative emotions in a laboratory setting. We are unaware of any studies that have observed negative emotion in everyday contexts in young autistic children.

Mother-child co-regulation in dyads with autistic children

Only a few studies have examined co-regulation of emotions in parent-child dyads with autistic children. Hirschler-Guttenberg et al. (2015) compared emotion co-regulation in 3- to 6-year-old children with and without autism during free play and emotion elicitation tasks. Parents of autistic children did not differ from parents of nonautistic children in how sensitive or responsive they were, nor in limit-setting behavior. Parents of autistic children used somewhat fewer complex strategies (e.g. cognitive reappraisal, reframing) and more simple/physical tactics (e.g. physical comfort) during fear elicitation tasks than parents of nonautistic children.

Gulsrud et al. (2010) examined 2- to 3-year-old children with autism during interactions with their mothers as part of an early intervention study. The study did not have a nonautistic comparison group. Mothers used a range of co-regulation strategies (i.e. solution-focused, physical, and vocal comfort) when their children were upset, although active strategies (e.g. physical comfort, redirection) were more common than passive strategies (e.g. verbal explanations). Overall, these two studies suggest that parents of autistic children are responsive to their children, use a variety of strategies, and meet their children where they are developmentally.

To our knowledge, only one study has examined how parent co-regulation strategies impact autistic children’s negative affects at the moment. Dimachkie Nunnally et al. (2021) observed parent co-regulation strategies and child negative affect during a short (3 min) frustration task with 2- to 3-year-old autistic children. They used time-series data to examine predictors of the likelihood of negative affect in the next time interval. They found that the presence of negative affect in the previous interval increased the likelihood of negative affect in the following interval but found no impact of parent co-regulation strategies on the likelihood of subsequent negative affect. This research did not include a comparison group. Thus, it is unclear whether the lack of effect for co-regulation strategies was specific to this particular task (and set of instructions) and/or this particular population.

Moreover, the study found an overall low incidence of parent co-regulation strategies within this short frustration task. There are a variety of reasons why this may have been. First, parents were instructed not to intervene to help their child unless the child asked for help, which may have inhibited parents’ use of coregulation. In addition, use of parent coregulation strategies decreases between early toddlerhood and the preschool years as children build self-regulation skills (Spinrad et al., 2004); thus, the age of the children may have played a role in the low incidence of co-regulation strategies.

The present study

As summarized earlier, research on negative emotion expression and parent-child co-regulation in autism in early childhood is only just emerging, with mixed findings and several notable gaps. In particular, research examining very early emotion regulation processes in autism is lacking. As mentioned earlier, prior research has shown that parent use of co-regulation strategies decreases between 18 and 30 months as children gain independence (Spinrad et al., 2004), thus examining coregulation at a timepoint when it remains a common source of regulation for young children is essential. One of the challenges to studying early development in autism is that it is not commonly diagnosed before age three (Maenner et al., 2020; van’t Hof et al., 2021). Thus, studying developmental processes prior to the preschool years can be challenging. Prospectively studying the younger siblings of autistic children, who have an elevated likelihood of developing autism themselves, provides researchers with the opportunity to examine autistic children’s development prior to receiving a diagnosis (Jones et al., 2014; Rogers, 2009).

The present study aims to fill an important gap in the literature by examining expressions of negative emotion and co-regulatory processes in 18-month-old younger siblings of autistic children (elevated likelihood; EL siblings) with diverse developmental outcomes: those who go on to be diagnosed with autism, those who have a language delay but no autism, and those with no delay or diagnosis. It is the first study to our knowledge to examine emotional expression and co-regulation in relatively naturalistic interactions (i.e. unstructured interactions without an emotion elicitation component) in family’s homes, providing insight into how these processes look in everyday life. In addition, autistic children often have language delays, and several studies link emotion dysregulation to language ability (Beck et al., 2012; Manning et al., 2019). Thus, the inclusion of a group of children with language delays but without autism will help to distinguish whether differences in negative emotional expression and parent co-regulation are related to autism specifically, or relevant to all children with language delays.

The study aimed to answer the following questions: (1) Are there differences between EL toddlers with different developmental outcomes in the amount or intensity of negative emotion expressed during everyday activities? (2) Are there differences between parents of EL children with different developmental outcomes in the amount or types of co-regulation strategies used in response to negative emotion? and (3) Do parent co-regulation strategies reduce the likelihood of child negative affect continuing, and does this differ for EL children with different developmental outcomes?

We hypothesized that EL children with a later autism diagnosis would display more and more intense negative affect than children without autism. Although we did not expect differences in how often parents of children in different outcome groups used a co-regulation strategy in response to a child negative emotion or in how many co-regulation strategies they used, we predicted that parents of children with language delays or autism would be more likely to use physical comfort strategies and less likely to use verbal or solution-focused strategies than parents of children without a delay or diagnosis. Finally, we expected that the use of a parent co-regulation strategy would reduce the likelihood of negative affect continuing, but that this effect would be lower (or possibly nonexistent) for children with a later autism diagnosis.

Methods

Participants

Data for this study were drawn from a larger longitudinal study of the development of 72 infants collected between 2006 and 2013. These infants and their families were recruited through a university-based Autism Research Program, parent support organizations, and local agencies serving families of children with autism. All infants had an older full biological sibling diagnosed with autism according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria (American Psychiatric Association, 2000) and were born at term from uncomplicated pregnancies. English was the primary language spoken in all homes. Prior to study enrollment, older siblings’ diagnoses were confirmed by a trained clinician using the Autism Diagnostic Observation Schedule (ADOS; Lord et al., 2000). At 36 months, all infant participants were seen for final outcome assessment and classification by an experienced clinician naive to all previous study data using the ADOS. Children were classified as either having autism (N = 11), having a language delay without autism (N = 22), or having no diagnosis or delay (N = 39). This research was reviewed and approved by the Institutional Review Board at the University of Pittsburgh; written informed consent was obtained from all participants prior to study enrollment.

The present study included a subsample of 39 infants (23 boys, 16 girls) from the larger study. This sample was created by first selecting all infants who ultimately received an autism diagnosis (N = 11) and then using random selection to create roughly equivalently sized groups of infants with language delay (N = 12) and with no diagnosis or delay (N = 16). Demographic characteristics were similar across all outcome groups. Parents identified the infants’ race and ethnicity as White, non-Hispanic (31), Hispanic or Latino (5), Asian or Pacific Islander (1), Black (1), or Multiracial (1). No significant differences between outcome groups were apparent in demographic variables (ps > 0.05; see Table 1 for sample characteristics).

Table 1.

Demographic characteristics of sample.

	EL-ND (n = 16)	EL-LD (n = 12)	Autism (n = 11)
Mean infant age (SD)	18.09 (0.28)	18.12 (0.13)	18.17 (0.22)
Infant biological sex (M, F)	8, 8	7, 5	8, 3
Infant race/ethnicity
Asian or Pacific Islander	0	1	0
Black	0	0	1
Hispanic or Latino	0	4	1
White	16	7	8
Multiracial	0	0	1
Mean mother age (SD)	33.69 (2.96)	33.08 (5.30)	31.91 (4.32)
Mean father age (SD)	36.69 (5.20)	36.58 (6.40)	34.36 (4.72)
Mother education
Graduate degree (%)	6 (37.5%)	4 (33.3%)	3 (27.2%)
Some college/college degree (%)	10 (62.5%)	5 (41.7%)	4 (36.4%)
High school (%)	0 (0%)	3 (25%)	4 (36.4%)
Father education^a
Graduate degree (%)	5 (31.2%)	2 (16.7%)	5 (50%)
Some college/college degree (%)	11 (68.8%)	10 (83.3%)	4 (40%)
High school (%)	0 (0%)	0 (0%)	1 (10%)

EL-ND: no diagnosis or delay; EL-LD: language delay; SD: standard deviation.

Educational attainment was missing for one father.

Procedure

Within the larger longitudinal study, infants were observed during everyday activities and playing with a parent. These infants were followed monthly from 5 to 14 months of age, with follow-up visits at 18, 24, and 36 months. The current study focuses on data collected at the observation completed when infants were 18 months old (M = 18.12, SD = 0.22).

The general procedure was similar across all sessions. All children were seen in their home with a parent. In the current sample, 36 children (92%) were seen with their mothers, 2 were with their fathers, and one child was with their mother for half the visit and their father for the other half. At each visit, parent-child dyads were videorecorded by a researcher with a single camera for approximately 45 min (M = 44.03 min, range = 29–52.17), including transitions between activities. First, parents were instructed to continue what they were doing prior to the researchers’ arrival for 15 min to observe children in their naturalistic environment (“naturalistic”). Next, parents were instructed to play with their child and their own toys as they normally would for 15 min (“free play”). Finally, parents were given two standardized toy sets to play with (“structured play”). The first toy set was a bag containing a teddy bear, bowl, spoon, cup, brush, and blanket. Parents were instructed to play with these toys for 3 min and then clean up the toys with their child. The second toy set was a barn set, consisting of a toy barn and a variety of people and animals. Parents and their child played with the barn set for 10 min. Supplementary Table 1 displays means and standard deviations for total observation length and length of time spent by each group in the “naturalistic” and “free play” conditions (combined) and the “structured play” conditions. There were no differences between groups in observation or task durations (ps > 0.05). Information on how child affect and parent coregulation strategies differed across context can also be found in the supplementary materials (Supplementary Table 2).

Table 2.

Detailed descriptions of parent co-regulation strategies.

Behavior	Definition
Redirection	Parent distracts the child or directs the child’s attention to something new (e.g. pointing out other toys in the room, playing peek-a-boo, etc.)
Physical comfort	Parent initiates physical behaviors to comfort child (e.g. hugging, kissing, rocking, stroking hair or face)
Vocal comfort	Parent initiates vocalizations to comfort or support the child, including verbal reassurance (“it’s okay”, “we’re almost done”), encouragement (“you can do it!”), or emotional following (“I know you want the other toy”)
Solution-focused	Parent physically or vocally prompts, scaffolds, or helps child to solve the problem causing distress (e.g. opens a difficult box, gets something out of reach). Parent may also change the environment in a way that reduces distress (e.g. turns off a loud noise that is bothering child or moves a piece of furniture so child can access what they want)
Active ignoring	Parent actively ignores child during distress episode (e.g. may stop what they’re doing, purposely turn away from child, or walk away from child)
Negative/minimizing	Parent responds to child’s negative affect with minimization or negative affect (e.g. anger, frustration, personal sadness). Parent may tell child to “stop crying/whining” or may mock/mimic child’s distress

Measures

The following standardized measures were administered to all infants and were used for determining developmental outcomes at the 36-month timepoint (see details below).

Autism diagnostic observation schedule

The ADOS (Lord et al., 2000) was administered to all infants at 36 months by a research-reliable clinician naive to previously collected study data. The ADOS is a structured play schedule that systematically probes for features of autism in social interaction, communication, play, and repetitive behaviors and provides standard “cutoff” scores for the diagnosis of autism. All children received either a Module 1 or Module 2 assessment, depending on their language level.

MacArthur-Bates communicative development inventory

The MacArthur-Bates Communicative Development Inventory (CDI; Fenson et al., 1993) is a parent report measure of receptive and productive vocabulary and early nonverbal communication. The CDI Words and Sentences form (CDI-WS) and the CDI-III assess vocabulary production (i.e. “Words Produced”) and aspects of grammar. Parents completed the CDI-WS at the 18- and 24-month visits, and the CDI-III at 36 months. Both forms result in a “Words Produced” percentile score based on the normed sample, which was used in the present study as a part of the Outcome classification (described below). The CDI is a reliable and valid parent report measure of communication development in children with typical development and is a sensitive indicator of language delays in young children (Dale et al., 1989; Fenson et al., 1993, 1994; Heilmann et al., 2005; Miller et al., 1995; Thal et al., 1999).

Mullen scales of early learning

The Mullen scales of early learning (MSEL; Mullen, 1995) is a standardized assessment of cognitive, language, and motor abilities designed for infants and young children. The MSEL was selected because it was a core measure for the Baby Siblings Research Consortium (see, for example, Messinger et al., 2013; Ozonoff et al., 2011), of which our research group was a part. The MSEL was administered at 18, 24, and 36 months of age, and yield subscale scores for Gross Motor, Fine Motor, Visual Reception, Receptive Language, and Expressive Language. The Receptive Language and Expressive Language subscales were used for outcome classification.

Outcome classification

Outcome classification was completed at 36 months and used scores from the MSEL, CDI, and ADOS. Based on the standardized language assessments at 18, 24, and 36 months and ADOS scores at 36 months, infants were classified into one of the three mutually exclusive outcome groups: autism, language delay without autism (EL-LD), or no diagnosis or delay (EL-ND).

Infants were classified as having autism if they met or exceeded ADOS algorithm cutoffs for autism spectrum disorder and had a clinical best estimate diagnosis of Autistic Disorder or Pervasive Developmental Disorder-Not Otherwise Specified using DSM-IV-TR criteria.

Infants were classified as exhibiting language delay (EL-LD) if they did not receive an autism diagnosis and either had Words Produced percentile scores on the CDI-WS and/or CDI-III at or below the 10th percentile at more than one administration between 18 and 36 months (Heilmann et al., 2005); and/or had Words Produced percentile scores on the CDI-III at or below the 10th percentile and standardized scores on the Receptive and/or Expressive language subscales of the MSEL equal to or greater than 1.5 SDs below the mean at 36 months of age (e.g. Ozonoff et al., 2010).

Infants were classified as having no diagnosis or delay (EL-ND) if they did not meet any of the above criteria.

Data coding

Infants’ negative affect and parents’ co-regulation strategies were coded from video using ELAN software (https://tla.mpi.nl/tools/tla-tools/elan/elan-description/). A 10-s interval was selected for coding negative affect as it offered the best balance between efficiency (longest possible) and loss of information (likelihood of multiple intensity codes within the period; see Northrup et al., 2020). Thus, each 45-min observation was divided into approximately 270 ten-second intervals for coding (M = 264.18, range = 174–313).

A single coder coded 100% of the sample for negative affect intensity and a separate coder coded 100% of the sample for parent co-regulation strategies. Both primary coders were naïve to infant assessment results and outcome status. The first author, J.B.N., trained both coders and served as the reliability coder, independently coding a randomly selected sample of participants for reliability purposes (see below for details on training and reliability).

Negative affect

Coders first identified instances of negative affect in each interval using a three-point scale: (0) no detectable bodily or vocal frustration or sign of general negativity; (1) mild to moderate facial negativity or vocalizations of frustration or negativity; or (2) high intensity facial anger or distress, highly distressed vocalizations (e.g. crying, screaming, loud protests), or aggression toward objects, self, or others.

Parent co-regulation

A series of parent co-regulation strategies were adapted from a study of autistic toddlers and their mothers (Gulsrud et al., 2010). Co-regulation strategies included: redirection, physical comfort, vocal comfort, solution-focused responses, active ignoring, and negative/minimizing (see Table 2 for descriptions of all co-regulation strategies). Within each interval containing negative affect, all co-regulation strategies used by the parent during that interval were coded. If the next interval did not contain a negative affect, co-regulation strategies used in that interval were also considered a response to the previous negative affect and coded in association with that interval. Multiple types of co-regulation strategies could be coded within each interval. Coders also identified all instances where parents had no opportunity to respond to their child’s negative affect (e.g. the parent was not present in the room at the time of the negative affect) and removed those intervals from analysis (1.1% of all intervals). Active ignoring and negative/minimizing happened extremely infrequently (0.5% and 1% of all intervals, respectively), and therefore were not analyzed further.

Training and reliability

For coding of negative affect, the primary coder and reliability coder double-coded videos during a training period until Cohen’s kappas greater than 0.75 were achieved on three consecutive videos. Following this training period, the reliability coder coded one out of every five videos coded by the primary coder to check reliability and prevent coder drift. In all, 23% (N = 9) of the videos were double-coded for reliability. Interobserver reliability was high for identifying the presence of negative affect (% agreement = 97.19%; κ = 0.79) and for categorizing intensity of negative affect (% agreement = 96.9%, ICC = 0.805).

Because co-regulation was coded only in intervals when negative affect occurred, and there was wide variability in the number of intervals with negative affect across videos (ranging from 2 to 48) as well as in the variety of strategies used, it was not possible to calculate accurate interrater reliability on an individual video basis. It was therefore not possible to use a typical strategy of requiring achievement of a certain level of reliability on three consecutive videos during a training period. Instead, the primary coder and reliability coder double-coded all of the first 12 videos (meeting after every 2–3 videos to discuss discrepancies). Following this initial period, the two coders continued to double code every one in every five videos from the remaining videos. In all, 20 videos (51.3%) were double coded for parental co-regulation.

Interobserver reliability was high for identifying whether or not a co-regulation strategy of any type occurred in an interval (agreement on 98.5% of intervals, κ = 0.74) and for identifying the presence of redirection (agreement on 88.4% of intervals, κ = 0.72) and physical comfort (agreement on 93.8% of intervals, κ = 0.77). Interobserver reliability was moderate for identifying solution-focused responses (agreement on 94.3% of intervals, κ = 0.63). Finally, interrater reliability was low for identifying vocal comfort (agreement on 88.7% of intervals, κ = 0.52) primarily due to low audio quality on some videos that made it difficult for coders to agree on what had been said.

Community involvement statement

Community members were not directly involved in the study design or implementation of this research.

Data analysis

Due to significant positive skew in most of the observed variables, nonparametric Kruskal–Wallis tests were used to determine whether the three outcome groups differed in variables of interest. Significant results were followed up with Dunn’s test with Bonferroni adjustment. Effect sizes are reported using eta-squared.

A generalized linear mixed-effects logistic regression was run using the glmer function within the lmer4 package (Bates et al., 2015) in R (R Core Team, 2023). The dependent variable was the likelihood of negative affect in the next interval, and the model included the following predictors as fixed effects: presence of negative affect in the current interval, presence of parent co-regulation strategy in the current interval, outcome group, the interaction between outcome group and presence of negative affect, and the interaction between outcome group and co-regulation strategy. A random intercept for participants was included in the model to account for individual variability in levels of negative affect. We used the DHARMa package in R to test model assumptions, including tests of normality, dispersion, outliers, within-group deviation, and homogeneity. Tests and visual inspection of residuals indicated no concerns with violation of assumptions in our model.

Results

Preliminary analyses

Given expected differences in cognitive, language, and developmental ability between groups, we first ran a series of ANOVAs to examine group differences in MSEL and CDI scores between our three outcome groups. Table 3 displays descriptive statistics and statistical results for these analyses. As expected, results revealed significant differences between groups in all scores except MSEL Fine Motor t-scores. Post hoc comparisons with Bonferroni corrections revealed significant differences between the EL-ND group and the Autism group in Gross Motor, Visual Reception, Receptive Language, Expressive Language, and CDI Words Produced. The EL-LD group did not differ significantly from either the EL-ND or autism groups in Gross Motor, Expressive Language, or Receptive Language scores. The EL-LD group had significantly lower CDI Words Produced percentile scores than the EL-ND group, but did not differ from the ASD group in this (or any other) measure.

Table 3.

Developmental assessment scores by outcome group.

	EL-ND (n = 15)	EL-LD (n = 12)	Autism (n = 11)
Mullen scales of early learning
Gross Motor t-score	52.87 (6.44)	47.45 (9.65)	40.36 (9.30)	F = 7.1, p = 0.003
Visual Reception t-score	53.27 (9.48)	45.42 (9.11)	34.82 (12.12)	F = 10.39, p ⩽ 0.001
Fine Motor t-score	53.47 (4.50)	52.5 (6.11)	47.73 (10.09)	F = 2.32, p = 0.114
Receptive Language t-score	46.73 (16.45)	39.25 (11.35)	28 (15.28)	F = 5.17, p = 0.011
Expressive Language t-score	47.27 (8.06)	38.58 (7.14)	34.64 (13.61)	F = 5.82, p = 0.007
CDI words produced percentile	30.67 (19.44)	9.58 (14.69)	11.82 (15.70)	F = 6.33, p = 0.004

EL-ND: no diagnosis or delay; EL-LD: language delay; CDI: communication development inventory.

Mullen scores were missing for one EL-ND toddler at 18 months.

We also examined correlations between MSEL and CDI scores and our primary variables of interest (proportion negative affect, proportion high-intensity negative affect, proportion with coregulatory response, proportion solution-focused response, proportion physical comfort responses, proportion redirection responses, and proportion vocal comfort responses) using Spearman’s rho (rank order correlations). These bivariate correlations are shown in Supplementary Table 3. Only a few statistically significant associations emerged. MSEL and CDI scores were not related to the overall level of negative affect or proportion of negative affect that received a coregulation response. MSEL visual reception scores were positively associated with proportion of solution-focused responses (r_s = 0.44, p = 0.006) and negatively associated with proportion of redirection responses (r_s = −0.37, p = 0.02). CDI words produced scores were negatively associated with proportion of high intensity affect (r_s = −0.46, p = 0.004). No other correlations were significant. It is worth noting that none of these significant correlations would be strong enough to hold up to a correction for multiple comparison (which would set the alpha level to 0.001 given 48 correlations).

Primary analyses

Table 4 displays descriptive statistics and results of the Kruskal–Wallis Tests for all variables of interest.

Table 4.

Descriptive statistics and group comparisons for all variables of interest.

Variable	No diagnosis (n = 16)			Language delay (n = 12)			Autism (n = 11)			Kruskal-Wallis test
Variable	Mean (SD)	Mdn	Range	Mean (SD)	Mdn	Range	Mean (SD)	Mdn	Range	H	p	η²
Proportion negative	0.06 (0.04)	0.05	0.01–0.14	0.07 (0.04)	0.06	0.01–0.13	0.08 (0.05)	0.07	0.01–0.17	1.22	0.54	−0.02
Proportion high intensity	0.05 (0.09)	0.00	0.00–0.26	0.11 (0.15)	0.03	0.00–0.41	0.24 (0.25)	0.18	0.00–0.82	5.98*	0.05	0.11
Proportion coregulation	0.64 (0.19)	0.67	0.28–1.00	0.56 (0.25)	0.62	0.20–1.00	0.62 (0.25)	0.67	0.14–1.00	0.87	0.64	−0.03
Mean # Coreg strategies	1.32 (0.32)	1.18	1.00–2.25	1.36 (0.41)	1.31	1.00–2.43	1.27 (0.27)	1.23	1.00–2.00	0.21	0.90	−0.05
Solution focused	0.32 (0.26)	0.26	0.00–1.00	0.06 (0.13)	0.00	0.00–0.40	0.13 (0.16)	0.09	0.00–0.55	10.24**	0.00	0.23
Physical comfort	0.17 (0.16)	0.14	0.00–0.50	0.29 (0.31)	0.25	0.00–0.86	0.19 (0.17)	0.18	0.00–0.50	0.79	0.60	−0.03
Redirection	0.53 (0.31)	0.56	0.00–1.00	0.60 (0.26)	0.66	0.00–1.00	0.65 (0.29)	0.67	0.00–1.00	1.08	0.58	−0.03
Vocal comfort	0.30 (0.21)	0.25	0.00–0.75	0.40 (0.29)	0.36	0.00–1.00	0.30 (0.37)	0.17	0.00–1.00	2.13	0.34	0.003

SD: standard deviation. *p < .05; **p < .01

Negative affect

Figure 1 displays the proportion of intervals containing negative affect as well as the proportion of negative affect intervals categorized as low/moderate versus high intensity. Every toddler in the study had at least one time interval containing negative affect. As can be seen in the figure, negative affect was relatively rare, occurring in only about 6%–7% of intervals on average for the EL-ND and EL-LD toddlers and 8% of intervals on average for the autistic toddlers. No significant difference emerged between groups for the proportion of intervals that contained any negative affect. However, there was a significant difference between groups in the proportion of negative affect intervals that were categorized as high intensity. Specifically, the autism group had a higher proportion of high-intensity negative affect than the EL-ND group. The EL-LD group did not differ significantly from either the EL-ND or autism group.

Figure 1.

Proportion of intervals containing negative affect and proportion of negative affect intervals rated as high versus low/moderate in three outcome groups.

Parental co-regulation strategies

Parents used some form of co-regulation strategy (i.e. solution-focused response, physical comfort, redirection, or vocal comfort) in about 61% of intervals containing negative affect on average, and more than one co-regulation strategy in 17.9% of intervals on average. There were no significant differences between groups in the proportion of negative affect intervals that contained a co-regulation response, nor in the mean number of co-regulation responses used (given that any co-regulation response was used).

We next examined the proportion of co-regulation intervals (i.e. intervals containing a co-regulation response) that contained each of the co-regulation response types: solution-focused response, physical comfort, redirection, and vocal comfort (see Table 4 and Figure 2). Redirection was the most used co-regulation strategy overall by parents in all three groups. There was a significant difference between groups in the proportion of co-regulation intervals containing a solution-focused response, with a large effect size. Specifically, parents in the EL-ND group were more likely to use solution-focused responses than parents in the EL-LD group. While parents in the EL-ND group were also more likely to use solution-focused responses than parents in the autism group, this difference did not reach significance. Mothers in the autism and EL-LD groups did not differ from one another in use of solution-focused responses. There were no other group differences in the type of co-regulation responses used.

Figure 2.

Mean proportion of negative affect intervals containing various forms of coregulation strategies across different outcome groups.

Predicting the likelihood of continued negative affect

Our next analysis focused on predicting the likelihood of negative affect in the subsequent interval depending on the presence of negative affect and presence of a co-regulation strategy in the prior interval. Results are presented in Table 5. In line with our hypothesis, negative affect in the current interval was a significant predictor of negative affect in the next interval. Specifically, negative affect was 28 times more likely if there had been negative affect in the previous interval.

Table 5.

Results of binomial generalized linear mixed-effect model predicting the likelihood of negative affect in the next interval.

Predictors	Dependent Variable: Negative Affect in the Next Interval
Predictors	Odds ratios	CI	p
(Intercept)	0.04	0.03–0.05	<0.001
Negative affect present in current interval	28.41	18.57–43.46	<0.001
Coregulation strategy present in current interval	0.40	0.24–0.68	0.001
Outcome: language delay	0.97	0.65–1.44	0.867
Outcome: autism	0.98	0.65–1.49	0.938
Negative affect × outcome: language delay	2.01	1.04–3.88	0.038
Negative affect × outcome: autism	2.24	1.15–4.35	0.017
Coregulation × outcome: language delay	0.60	0.27–1.33	0.207
Coregulation × outcome: autism	1.10	0.50–2.40	0.810
Observations	10,264
Marginal R²/conditional R²	0.168/0.207

CI: confidence interval.

Furthermore, the interaction between outcome and negative affect was significant. For both the EL-LD and autism group, the influence of negative affect in the current interval on the likelihood of negative affect in the following interval was stronger than in the EL-ND group. In other words, children in the autism and EL-LD groups were more likely to continue to exhibit negative affect once it began than children in the EL-ND group. The presence of a parental co-regulation strategy in the current interval reduced the likelihood of negative affect in the following interval. Specifically, negative affect was more than two times less likely to continue if a co-regulation strategy was present. While we did not find an interaction between outcome and co-regulation strategy predicting the likelihood of negative affect in the subsequent interval, visual inspection of the results (see Figure 3) suggests that the effect of co-regulation strategy on reducing the likelihood of subsequent negative affect was somewhat less strong in the autism group.

Figure 3.

Probability of negative affect in next interval as predicted by the presence of negative affect in current interval, coregulation in current interval, and outcome group.

Discussion

The present research made use of a prospective, longitudinal study with rich observational data to examine negative emotion expression and parental co-regulation in 18-month-old younger siblings of children with autism who had diverse developmental outcomes. This is the first study, to our knowledge, to examine these features observationally in children with autism before age two. The study was also unique in examining relatively unstructured parent-child interactions that occurred in children’s own homes, thus providing a more realistic window into what daily life looks like for these families.

We found that EL children with a later autism diagnosis differed from EL children with no delays or diagnosis in the intensity of negative affect and in the likelihood of staying negative once negative affect began. There were few differences in parents’ co-regulatory responding between groups, although our findings did corroborate prior reports that parents of autistic children and children with language delays were less likely to use more “advanced” co-regulatory strategies, such as solution-focused strategies, for reducing distress. The presence of a parental co-regulatory strategy reduced the likelihood that child negative affect continued, and while there were no significant differences between outcome groups, the strength of this effect appeared weaker for autistic toddlers. These findings are discussed in more detail later.

Expression of negative affect

Prior research on differences in expression of negative affect in young autistic children has been somewhat mixed, likely in part due to differences in how negative affect expression has been measured (e.g. parent report vs observation). Even within observational studies, there have been differences in the variables used to represent negative emotion expression that likely impact results. For example, Hirschler-Guttenberg et al. (2015) examined amount of time displaying negative emotionality, Macari et al. (2018) reported on peak emotional intensity of negative affect, and Day et al. (2022) reported on mean affect (from negative to positive). Each of these variables captures only one specific aspect of negative emotion expression but misses other important features. For example, examining only peak emotion or average emotion may miss differences in amount of time spent in negative affect, while examining only duration of affect might miss important differences in intensity. A strength of the present study is the examination of total amount and intensity of negative affect, as well as examination of the “stickiness” of negative affect (i.e. the likelihood of negative affect continuing once it has begun). By examining several features of negative affect expression, we were able to provide a clearer picture of how young autistic children may and may not differ from non-autistic peers.

Our findings suggest that differences emerge more in the intensity of negative affect than in the total amount. Young autistic children’s negative affect was more likely to be rated as “high intensity” when it occurred than the negative affect of toddlers who did not later end up with language delays or an autism diagnosis (i.e. EL-ND toddlers). All three groups were very similar in the amount of low/moderate intensity negative affect they displayed, but the EL-ND group had almost no high-intensity negative affect, whereas about a quarter of the negative affect in the autism group was rated as high intensity. Children with language delays fell somewhere in between the autistic toddlers and EL-ND toddlers, suggesting that differences in negative affect may be partially, but not fully explained by communication differences. This is further bolstered by the finding in our preliminary analyses that parent-reported expressive vocabulary (CDI Words produced scores) was modestly negatively associated with proportion of high-intensity affect (although other measures of language ability, like MSEL scores, were not).

In interpreting this finding and considering steps for future research, it is important to note that we cannot say whether these differences in observed intensity represent differences in emotional experience or differences in emotional communication (or both). It may be that autistic toddlers in fact experience more intense emotional distress, perhaps due to increased vulnerability to upsetting experiences (e.g. sensory overload, experiences of unpredictability in the environment), or it may be that some of the ways that autistic toddlers communicate negative affect are simply perceived by adults as more intense. For example, a study by Zantinge et al. (2018) found that while neurotypical children showed a strong correlation between physiological response to fear and outward emotional expression of fear, no such correlation was found in autistic children, suggesting a potential mismatch between internal experiences of emotion and outward displays of emotion in autistic children. Further research that incorporates both observational and physiological measurements of emotional arousal may provide more clarity on the source of differences in emotional intensity.

This was the first study, to our knowledge, to compare the “stickiness” of negative affect (i.e. likelihood of negative affect continuing) between autistic and nonautistic toddlers. Dimachkie Nunnally et al. (2021) examined time-series predictors of the likelihood of negative affect in autistic toddlers but did not have a comparison group of nonautistic peers. In the present study, we found that the likelihood of staying in negative affect once it began was higher for both autistic and language-delayed toddlers than for toddlers with no delay or diagnosis. This finding is consistent with amassing evidence of emotion regulation challenges in autistic individuals across the lifespan (Cibralic et al., 2019; Conner et al., 2021; Mazefsky et al., 2013) and suggests that these challenges start at an early age, even prior to the typical age of diagnosis.

The finding that language-delayed toddlers displayed a similar “stickiness” in negative affect suggests that communication abilities may play a role in emotion regulation at this age. Indeed, language ability has been linked to emotion regulation in typical development both conceptually (Cole et al., 2010) and empirically (Dixon & Smith, 2000; Stansbury & Zimmermann, 1999). Findings have been more mixed in the autism literature with one study finding that receptive language was associated with emotion regulation abilities (Zantinge et al., 2017), one finding that expressive language (but not receptive language) was related to measures of negative emotion expression in a frustration task (Jahromi et al., 2012), and another finding no relation between expressive language and emotion regulation (Berkovits et al., 2017). Children with more advanced language skills may have access to coping mechanisms that less verbal children do not, including the ability to communicate needs and desires to supportive adults. In addition, difficulty regulating emotions may interfere with language development. More research is needed, particularly in young children, to understand the connection between language and communication skills and emotion regulation.

Co-regulation of emotion

Overall, parents of children in all outcome groups were very likely to provide a co-regulatory response when their child expressed negative affect, and the groups did not differ in the likelihood of providing a response or the number of responses used within a 10-second interval containing negative affect. Our results are in line with previous findings that parents of autistic children might be somewhat less likely to use more “complex” strategies with their child (Gulsrud et al., 2010; Hirschler-Guttenberg et al., 2015). Here, we found that parents of nonautistic, nondelayed children were somewhat more likely to use solution-focused responses than parents of children with a language delay especially. In preliminary analyses, we also found a positive correlation between MSEL visual reception scores (a measure of nonverbal cognitive ability) and use of solution-focused strategies. Taken together, these results may reflect parents meeting their child where they are developmentally. Note that our sample is younger than those included in previous research, so these children are only just starting to learn independent problem-solving and coping skills. Parents of nondelayed children might be more confident that their toddler will be able to understand and follow suggestions or instructions to solve their own problem when upset than parents of children with delays.

In our time-series analysis, we found that the presence of a co-regulatory response significantly decreased the likelihood of negative affect continuing in the next interval. While we did not detect a significant interaction between outcome group and co-regulatory response, it is worth mentioning that visual inspection of the effect in the three outcome groups suggests a smaller effect for young autistic children than for either of the other two groups. Notably, Dimachkie Nunnally et al. (2021), who looked only at autistic toddlers and did not have a comparison group, did not find a significant effect of co-regulatory responses reducing the likelihood of negative affect in their sample. Further research with a larger sample size is needed to probe whether there are differences in how effective parental co-regulatory responses are in reducing the likelihood of continued negative emotion for autistic children, and whether certain types of responses are more or less effective in this population. Autistic children have unique needs, strengths, and vulnerabilities that might change their experience of typical co-regulatory responses, and this is an important topic worth pursuing in future research.

Limitations and conclusions

The present study had a number of strengths, including prospective observation of toddlers prior to diagnosis, comparison of children with diverse developmental outcomes, detailed coding of negative affect and co-regulation, and relatively naturalistic observations occurring in children’s home environments. That said, results should also be considered in light of the study’s limitations. As mentioned previously, the small sample size is a primary limitation that may have limited our ability to detect more subtle differences between groups. Null findings reported here should be interpreted with caution and replication with larger sample sizes will be important. The sample was also homogeneous, representing a largely white and well-educated population, and was limited to families who had at least one child with autism (“EL” families)—generalization to the broader population is therefore unclear and further research with diverse samples is necessary. In addition, the present study focused solely on the expression of negative emotion. Emotion regulation involves the regulation and expression of both positive and negative emotions, and there is evidence for differences in positive emotional expression in autism (Garon et al., 2009; Hirschler-Guttenberg et al., 2015; Zwaigenbaum et al., 2005). Examining the full spectrum of emotional expression will be essential to fully understanding emotional development in young autistic children. Finally, it should be noted that the MSEL was developed in 1995 and has not been updated since that time. Future studies should use more up-to-date assessments to measure early cognition and development.

Despite these limitations, the present study represents a meaningful contribution to our understanding of negative emotion expression and parent co-regulation of emotion in young autistic children. Findings suggest that intensity and “stickiness” of negative emotion differentiate autistic children from non-autistic peers more than overall duration. In addition, we add to accumulating evidence that parents of autistic children are equally responsive to their children and, overall, use similar amounts and types of co-regulation strategies as parents of non-autistic peers. Presence of a co-regulation strategy reduced likelihood of continued negative affect for all groups, although the present study provides some suggestion that this might be reduced for autistic toddlers. Future research building on this work with larger and more diverse samples, considering both observational and physiological measures of the full emotional spectrum (positive to negative), would put us on a path to understanding the unique emotional experiences of autistic toddlers and ultimately developing early interventions that address those unique needs.

Supplemental Material

sj-docx-1-aut-10.1177_13623613241233664 – Supplemental material for Expression and co-regulation of negative emotion in 18-month-olds at increased likelihood for autism with diverse developmental outcomes

Supplemental material, sj-docx-1-aut-10.1177_13623613241233664 for Expression and co-regulation of negative emotion in 18-month-olds at increased likelihood for autism with diverse developmental outcomes by Jessie B Northrup, Kaitlyn B Cortez, Carla A Mazefsky and Jana M Iverson in Autism

Footnotes

Acknowledgements

We thank Joshua Wiener for help with video coding, Holly Gastgeb for assistance with clinical assessments, and the members of the Infant Communication Lab at the University of Pittsburgh for their support. Special thanks to the infants and families who made this research possible.

Authors’ note

Portions of these data were presented at the 2023 meeting of the Society for Research on Child Development. The coding materials associated with this study are available from the corresponding author upon request.

Declaration of conflicting interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by Autism Speaks and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01 HD54979 to J.M.I.). During preparation of this manuscript, Dr Northrup was supported by the National Institute of Mental Health under Award Number K23MH127420.

ORCID iDs

Jessie B Northrup

Kaitlyn B Cortez

Carla A Mazefsky

Supplemental material

Supplemental material for this article is available online.

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(2005). Behavioral manifestations of autism in the first year of life. International Journal of Developmental Neuroscience, 23(2–3), 143–152. https://doi.org/10.1016/j.ijdevneu.2004.05.001

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