Do you tend to react or anticipate? Proactive emotion regulation involves the prevention of challenging behaviors. The proactive approach consists of anticipating the disruptive behaviors of individuals with autism spectrum disorder (ASD) with the aim of preventing them and promoting alternative behaviors that are more adaptive to the context.

But, what is it that makes autistic people behave like this? Why do they do it? What enhancers or triggers have been identified? The proactive approach delves into these questions. Its aim is to prevent challenging behaviors based on the information available about behaviors that have occurred in the past.

“Proactive intervention in ASD does not consist in what to do when the behavior has already occurred or in how to act when it has occurred, but in inquiring, searching, and finding the reason.”

-Cristina Tinaquero-

An approach to the definition of ASD

Before beginning to talk about proactive emotional regulation in ASD, we’re going to explain some of the characteristics of this clinical condition. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5 ) published by The American Psychiatric Association (APA) defines the following symptoms:

Problems in communication and social interaction

These problems appear as deficits. In other words, they occur below the expected level. They refer to multiple domains (APA, 2015):

• Alterations in socio-emotional reciprocity. For instance, inappropriate social exchanges when it comes to expressing emotions or sharing interests.
• Changes in communication involving non-verbal communication. For example, inappropriate eye contact or body language.
• Disturbances in developing, maintaining, and understanding relationships with other people. For instance, a lack of interest in interpersonal relationships.

For ASD to be diagnosed, these alterations have to manifest themselves in various contexts. Moreover, they must occur in the early stages of the child’s development.

Restrictive and repetitive behaviors

These behaviors translate into highly repetitive behavior patterns. In addition, the individual has a poor selection of interests or activities. Among its manifestations are (APA, 2015):

• Stereotyped speech, such as echolalia.
• Environmental invariance. This is manifested by immense discomfort when small changes occur in the environment. It’s closely related to rigid thought patterns.
• Extremely restrictive interests. This can lead to intense attachment behaviors toward unusual objects.
• Hyper or hyporeactivity to different stimuli. For example, an apparent indifference to pain or temperature.

“Extreme reactions and rituals related to the taste, smell, texture, and appearance of food are frequent.”

-American Psychiatric Association-

Proactive emotional regulation

Recently, the Quinta Foundation published a guide. It states that investing time in analyzing the causes of the disruptive behaviors of children with ASD can be enormously beneficial when it comes to preventing them.

Previous steps

Before any intervention, the therapist must reflect on the child with ASD. They should address the following:

• What do they know about the child? What are their interests? And, what motivates them? Also, what about their strengths? How do they communicate and what sensory difficulties do they have? These are just some of the questions they should ask.
• How about their environment? What routines do they have? What visual cues do they use? And, what adaptations have been taken into account by their environment?
• How’s communication within the family? The therapist must understand the structure and situation of the family, as well as its needs. Therefore, they should find out if there are any disruptive behaviors in the family environment.
• What are the problem behaviors? Before intervening, the therapist must know what they intend to do. So, they should order the behaviors according to their topographic parameters (intensity, frequency, and duration).
• Carry out a functional behavioral assessment. This is extremely important because it allows the therapist to see what function a behavior plays in a given context.
• What are they trying to achieve through their behaviors? The therapist must respond to the objectives of each disruptive behavior in a specific way. Furthermore, they must establish why it manifests and what the child needs.
• How can they minimize their disruptive behaviors? They must be adjusted and adapted in accordance with the child’s capabilities.

In the functional analysis, the therapist makes use of the classic ABC model.  It allows them to establish relationships between the form of the behavior that’s occurring and the function it performs. In other words, what’s the child trying to achieve with their behavior?  Are they trying to communicate? Are they in pain? Which of their behaviors is the most striking?

Some strategies

Cristina Tinaquero, one of the creators of the aforementioned guide, states that there are some guidelines for the therapist to take into account. They need to link up with the way in which the child plays so they can understand what their interests are. The ultimate goal is to help them enhance the skills they have.

The establishment of the new routines must have the starting point of the child’s interests. The goal is for the routines to be predictable. However, at the same time, they should allow the child to explore and understand their environment.

Occasionally, despite having obtained all the available knowledge about the child and their family, disruptive behaviors continue to occur. In this case, the therapist will establish crisis plans in order to safeguard the physical health of the child with ASD.

Psychological Treatment for Autism