Browsing by Author "Conner, Caitlin M."
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Item Assessment and Treatment of Emotion Regulation Impairment in Autism Spectrum Disorder Across the Life Span Current State of the Science and Future Directions(WB Saunders, 2020) Beck, Kelly B.; Conner, Caitlin M.; Breitenfeldt, Kaitlyn E.; Northrup, Jessie B.; White, Susan W.; Mazefsky, Carla A.; University of Pittsburgh; University of Alabama TuscaloosaEmotion regulation (ER) is the ability to modify arousal and emotional reactivity to achieve goals and maintain adaptive behaviors. ER impairment in autism spectrum disorder (ASD) is thought to underlie many problem behaviors, co-occurring psychiatric symptoms, and social impairment, and yet is largely unaddressed both clinically and in research. There is a critical need to develop ER treatment and assessment options for individuals with ASD across the life span, given the multitude of downstream effects on functioning. This article summarizes the current state of science in ER assessment and treatment and identifies the most promising measurement options and treatments.Item Assessment and Treatment of Emotion Regulation Impairment in Autism Spectrum Disorder Across the Life Span: Current State of the Science and Future Directions(Elsevier, 2020) Beck, Kelly B.; Conner, Caitlin M.; Breitenfeldt, Kaitlyn E.; Northrup, Jessie B.; White, Susan W.; Mazefsky, Carla A.Emotion regulation (ER) is the ability to modify arousal and emotional reactivity to achieve goals and maintain adaptive behaviors. ER impairment in autism spectrum disorder (ASD) is thought to underlie many problem behaviors, co-occurring psychiatric symptoms, and social impairment, and yet is largely unaddressed both clinically and in research. There is a critical need to develop ER treatment and assessment options for individuals with ASD across the life span, given the multitude of downstream effects on functioning. This article summarizes the current state of science in ER assessment and treatment and identifies the most promising measurement options and treatments.Item Brief Report: Creation of a Transition Readiness Scale for Adolescents with ASD(Springer, 2023) Elias, Rebecca; Conner, Caitlin M.; White, Susan W.; University of Southern California; Children's Hospital Los Angeles; University of Pittsburgh; University of Alabama TuscaloosaThe transition to postsecondary education is characterized by many changes for adolescents with autism spectrum disorder (ASD). A data-based understanding of a student's readiness for postsecondary education could help students, and their parents, better prepare for this life transition. The Transition Readiness Scale (TRS) was created to address this need. The TRS is a self/other-report questionnaire used to assess postsecondary readiness across behavioral, cognitive, and emotional domains among adolescents 15-18 years of age. The present study details measure development and provides preliminary psychometric properties in a sample of transition-aged youth with ASD. Results indicate strong internal consistency, adequate item-level analyses, and discriminant and concurrent validity. Future validation of the TRS in large-scale field testing is merited to inform clinical interpretation.Item Development of a College Transition and Support Program for Students with Autism Spectrum Disorder(Springer, 2017) White, Susan W.; Elias, Rebecca; Capriola-Hall, Nicole N.; Smith, Isaac C.; Conner, Caitlin M.; Asselin, Susan B.; Howlin, Patricia; Getzel, Elizabeth E.; Mazefsky, Carla A.Empirically based, consumer-informed programming to support students with Autism Spectrum Disorder (ASD) transitioning to college is needed. Informed by theory and research, the Stepped Transition in Education Program for Students with ASD (STEPS) was developed to address this need. The first level (Step 1) supports high school students and the second level (Step 2) is for post-secondary students with ASD. Herein, we review the extant research on transition supports for emerging adults with ASD and describe the development of STEPS, including its theoretical basis and how it was informed by consumer input. The impact of STEPS on promotion of successful transition into college and positive outcomes for students during higher education is currently being evaluated in a randomized controlled trial.Item Efficacy of the Emotion Awareness and Skills Enhancement (EASE) Program in Autism: A Randomized Controlled Trial(Elsevier, 2025) White, Susan W.; Conner, Caitlin M.; Beck, Kelly; Mazefsky, Carla A.Autistic adolescents and adults often struggle with emotion dysregulation, and advocates consistently encourage more research on mental health. This study aimed to establish efficacy for psychotherapeutic intervention for emotion dysregulation for autistic adolescents and young adults. In this multisite randomized controlled trial, a primarily mindfulness-based intervention called the Emotion Awareness and Skills Enhancement (EASE) Program, developed to improve emotion dysregulation in autistic adolescents and young adults, was compared to a rigorous active control condition (ACC) that allowed for personalized and evidence-based intervention as long as it did not include EASE core elements. It was hypothesized that the EASE group would demonstrate a steeper decline in emotion dysregulation, as well as decreased mental health problems, compared to those in ACC. A total of 109 participants were randomized, 102 began treatment, 89 participants completed all treatment sessions. intent-to-treat (ITT; n = 109) analyses were conducted, with supplemental per protocol analyses (PP; n = 76). Primary outcomes included emotion dysregulation severity and its interference with daily functioning, whereas secondary outcomes assessed mental health symptoms. Condition-naive interviews, which gauged impairment related to dysregulation, showed that the EASE group had more treatment responders (63%) compared to ACC (44%) (p = .052, odds ratio = 2.85), but this difference was not statistically significant. EASE participants demonstrated greater declines in emotion dysregulation than those in ACC (Reactivity, b = − 0.168, p = .017; Dysphoria, b = − 0.182, p = .010) at endpoint. EASE participants demonstrated improvement in internalizing and externalizing symptoms, relative to baseline, based on self and caregiver-report, whereas ACC participants showed improvement only in caregiver-reported externalizing symptoms. All effects were stronger in PP analyses, suggesting the possible importance of treatment dosage. Findings suggest that EASE improves emotion dysregulation for autistic adolescents and young adults.Item Emotion Dysregulation is Substantially Elevated in Autism Compared to the General Population: Impact on Psychiatric Services(Wiley, 2021) Conner, Caitlin M.; Golt, Josh; Shaffer, Rebecca; Righi, Giulia; Siegel, Matthew; Mazefsky, Carla A.; University of Pittsburgh; University of Alabama Tuscaloosa; Cincinnati Children's Hospital Medical Center; University of Cincinnati; Brown University; Maine Medical Center; Tufts UniversityEmerging evidence suggests that emotion regulation (ER) impairment in those with ASD is associated with poor mental health. This study used the Emotion Dysregulation Inventory, a new norm-referenced ER measure with clinical cut-offs, developed and validated in ASD and non-ASD samples, to establish rates of ER impairment and understand its association with psychiatric service use in ASD. Parents of 6-17 year olds in three well-characterized samples (nationally representative US n = 1,000; community ASD n = 1,169; inpatient ASD n = 567) completed a battery of questionnaires about their child. The prevalence of ER impairment was significantly higher in the ASD groups compared to the nationally representative sample and highest in the psychiatric Inpatient ASD group. The community ASD and inpatient ASD samples were four and seven times more likely, respectively, to exceed clinical cutoffs for emotional reactivity than the general US sample. Similarly, history of psychiatric hospitalization, recent emergency services use (police contact, emergency room visits, or in-home crisis evaluations for emotional or behavioral concerns in the past 2 months), and psychotropic medication prescriptions were significantly higher in the ASD groups. ER impairment was significantly associated with all forms of psychiatric service use, after controlling for demographics (age, sex, race), co-occurring intellectual disability, and ADHD symptoms. This is the first large-scale study to document substantially higher rates of ER impairment in youth with ASD compared to the general population. The importance of ER impairment is underscored by its association with higher utilization of inpatient, emergency, and medication services in ASD, after accounting for demographics and ADHD-related symptoms. Lay Summary This study compared problems with emotion regulation in large samples of youth with and without ASD. An ASD community sample had two to four times more youth with clinically elevated regulation impairments compared to youth without ASD. Emotion regulation impairment was also related to using psychiatric hospitalizations, emergency services, and medications in the ASD group. This study suggests that screening for emotion regulation difficulties in ASD is important and treatment may have a wide ranging impact.Item Emotion Regulation and Executive Function: Associations with Depression and Anxiety in Autism(Elsevier, 2023) Conner, Caitlin M.; Elias, Rebecca; Smith, Isaac C.; White, Susan W.Adolescents and young adults with autism spectrum disorder (ASD) are prone to experience co-occurring mental health conditions such as mood or anxiety disorders, as well as impairments in emotion regulation and executive functioning. However, little research has examined inter-relationships among these constructs, despite evidence of additional stressors and increased risk of internalizing disorders at this age, relative to non-autistic individuals. If either emotion regulation or executive functioning are shown to have patterns of association with mental health, this can inform mechanism-based intervention. Fifty-seven autistic adolescents and adults (16–25 years) with ASD in a transition intervention completed questionnaires and clinician-administered measures at baseline. Analyses assessed whether executive functioning impairment, above and beyond emotion regulation impairment, were associated with depression and anxiety symptoms. ASD characteristics, emotion regulation, anxiety, and depression were significantly correlated. ASD characteristics was a significant contributor to depression and emotion regulation impairments were significant contributors to anxiety and depression. Findings indicated that inhibition difficulties did not uniquely contribute to depression or anxiety above emotion regulation impairment. Difficulties in cognitive flexibility were associated with depression above and beyond ASD characteristics, IQ, and emotion regulation, but not associated with anxiety. Although preliminary, findings suggest that inflexibility and regulatory impairment should be considered in depression remediation approaches. Improving ER, on the other hand, may have broader transdiagnostic impact across both mood and anxiety symptoms in ASD.Item Improving Transition to Adulthood for Students with Autism: A Randomized Controlled Trial of STEPS(Routledge, 2021) White, Susan W.; Smith, Isaac C.; Miyazaki, Yasuo; Conner, Caitlin M.; Elias, Rebecca; Capriola-Hall, Nicole N.; University of Alabama Tuscaloosa; Virginia Polytechnic Institute & State University; University of PittsburghEmerging adulthood is a period of heightened risk for young people with autism spectrum disorder (ASD). Due in part to a lack of evidence-based services and supports during the transition to adulthood, many emerging adults fail to matriculate into postsecondary education or thrive in productive employment. The Stepped Transition in Education Program for Students with ASD (STEPS) was developed to address the psychosocial, transition-related needs of emerging adults with ASD. Adolescents and emerging adults (n =?59) with ASD were randomly assigned to either STEPS or transition as usual (TAU). Results indicate that STEPS is acceptable to young people with ASD and their parents and that it can be implemented with high fidelity. Among secondary school students, those who completed STEPS exhibited significantly greater gains in transition readiness from high school, and these gains were largely sustained after program completion. Among students enrolled in postsecondary education, STEPS resulted in increased levels of student adaptation to college relative to those in TAU. Programming to address ASD-related challenges can promote successful educational transitions.Item Parents’ State and Trait Anxiety: Relationships with Anxiety Severity and Treatment Response in Adolescents with Autism Spectrum Disorders(Springer, 2013) Conner, Caitlin M.; Maddox, Brenna B.; White, Susan W.Comorbid anxiety is common among children with Autism Spectrum Disorder (ASD), and parents of children with ASD are more likely to have anxiety disorders. This study investigated the relationship between parents’ state and trait anxiety and parent-reported internalizing and externalizing symptoms among adolescents (n = 30) with ASD, as well as the relationship of parents’ anxiety symptoms and adolescent treatment response in the context of a randomized controlled trial. Parental state anxiety correlated with severity of adolescent anxiety, and trait anxiety in parents correlated with parent-reported adolescent internalizing and externalizing symptoms. Also, parents of adolescent treatment responders experienced a decrease in their own trait anxiety. Findings highlight the importance of considering parental anxiety when targeting anxiety among youth with ASD.Item Psychosocial Treatments Targeting Anxiety and Depression in Adolescents and Adults with Autism Spectrum Disorder: Review of the Latest Research and Recommended Future Directions(Springer, 2018) White, Susan W.; Simmons, Grace Lee; O'Gotham, Katherine; Conner, Caitlin M.; Smith, Isaac C.; Beck, Kelly B.; Mazefsky, Carla A.This synthesis of treatment research related to anxiety and depression in adolescents and adults with autism spectrum disorder (ASD) focuses on the scientific support for various forms of psychosocial interventions, useful adaptations to standard interventions, and engagement of candidate therapeutic mechanisms. There is considerable evidence for the efficacy of cognitive-behavioral therapy (CBT) to treat co-occurring problems with anxiety, but there has been relatively little research on treatment of co-occurring depression. Multiple mechanisms of treatment effect have been proposed, but there has been little demonstration of target engagement via experimental therapeutics. Comorbidity between ASD and anxiety and/or mood problems is common. Although there is evidence for the use of CBT for anxiety, little work has addressed how to effectively treat depression. There is emerging support for alternative treatment approaches, such as mindfulness-based interventions. We encourage rigorous, collaborative approaches to identify and manipulate putative mechanisms of change.Item Students with Autism Spectrum Disorder in College: Results from a Preliminary Mixed Methods Needs Analysis(Elsevier, 2016) White, Susan W.; Elias, Rebecca; Salinas, Carlos E.; Capriola, Nicole; Conner, Caitlin M.; Asselin, Susan B.; Miyazaki, Yasuo; Mazefsky, Carla A.; Howlin, Patricia; Getzel, Elizabeth E.Background—There is a growing call for empirically based programming to support the success of students with autism spectrum disorder (ASD) as they transition to college. Aims—The purpose of this study was to identify the needs and challenges faced by adolescents and young adults with ASD in postsecondary education. Methods—A mixed methods approach was taken to explore the needs of college-bound and college-enrolled students with ASD. Primary stakeholders (i.e., parents, educators/support staff from secondary and postsecondary institutions, and students) participated in an online survey (n = 67) and focus groups (n = 15). Results—Across the stakeholder groups, commonly identified areas of difficulty included limited interpersonal competence, managing competing demands in postsecondary education, and poor emotional regulation. There was a high degree of agreement across stakeholders in the identified needs and challenges. Implications—Findings from this preliminary needs analysis will inform the development of programming to support students with ASD.Item The Role of Emotion Regulation and Core Autism Symptoms in the Experience of Anxiety in Autism(Sage, 2020) Conner, Caitlin M.; White, Susan W.; Scahill, Lawrence; Mazefsky, Carla A.Youth with autism spectrum disorder (ASD) are at elevated risk for impaired emotion regulation (ER) and clinically impairing anxiety. A prior developmental framework posited that impaired ER leads to co-occurring psychiatric conditions such as anxiety, with outcome determined in part by ASD-specific moderating factors. Using measures developed and validated in ASD, this study evaluated: 1) the association between ER and anxiety in a large, community-based sample of youth with ASD and a wide range of intellectual and verbal abilities; and 2) whether greater core ASD symptoms strengthened the association between impaired ER and anxiety. Parents of 1,107 children with a community diagnosis of ASD (881 boys; age 6–17 years) participated in an online survey assessing their child’s ER, anxiety, and ASD symptoms. ER impairment significantly predicted whether participants had elevated levels of anxiety, after controlling for demographic variables and ASD symptoms; however, there was no interaction of ER and ASD symptoms. This study is the first to support the anxiety-ER association with measures developed and validated specifically for ASD, in a large sample with co-occurring ID and minimally verbal youth with ASD.Item Trial by trial EEG based BCI for distress versus non distress classification in individuals with ASD(Nature Portfolio, 2021) Eldeeb, Safaa; Susam, Busra T.; Akcakaya, Murat; Conner, Caitlin M.; White, Susan W.; Mazefsky, Carla A.; University of Pittsburgh; University of Alabama TuscaloosaAutism spectrum disorder (ASD) is a neurodevelopmental disorder that is often accompanied by impaired emotion regulation (ER). There has been increasing emphasis on developing evidence-based approaches to improve ER in ASD. Electroencephalography (EEG) has shown success in reducing ASD symptoms when used in neurofeedback-based interventions. Also, certain EEG components are associated with ER. Our overarching goal is to develop a technology that will use EEG to monitor real-time changes in ER and perform intervention based on these changes. As a first step, an EEG-based brain computer interface that is based on an Affective Posner task was developed to identify patterns associated with ER on a single trial basis, and EEG data collected from 21 individuals with ASD. Accordingly, our aim in this study is to investigate EEG features that could differentiate between distress and non-distress conditions. Specifically, we investigate if the EEG time-locked to the visual feedback presentation could be used to classify between WIN (non-distress) and LOSE (distress) conditions in a game with deception. Results showed that the extracted EEG features could differentiate between WIN and LOSE conditions (average accuracy of 81%), LOSE and rest-EEG conditions (average accuracy 94.8%), and WIN and rest-EEG conditions (average accuracy 94.9%).