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EMOTIONAL REGULATION FOR CHILDREN WITH ASD

Inside Out Command Center: Emotional Regulation for Children with Autism Spectrum
Disorder 

Kaitlin Brown and Katelyn Hennis

University of Utah Occupational Therapy

OCTH 6020: Groups and Communication

Lynn Farley

March 4, 2020
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD
PART I

Title 

Inside Out Command Center (Emotional Regulation for Autism) 

Rationale

Autism is a developmental disorder, which has an effect on the way a child with this

diagnosis responds to stress (Reaven et al., 2019). We developed this group to teach and create

behaviors that will help children identify and cope with stress-inducing situations. Children with

autism spectrum disorders (ASD) tend to possess greater negative emotionality, which leads

them to have more irritability and aggressive behavior (Reaven et al., 2019). Children with ASD

lack all the necessary skills to emotionally regulate including identifying emotions (Reaven et

al., 2019). We feel that a group focused on teaching children with ASD how to be self-aware of

their emotions and how to effectively use coping mechanisms will be beneficial in avoiding or

handling crisis situations. Coping strategies such as meditation and mindful breathing have been

shown to be helpful in children with ASD, which is why we have incorporated both of these

mechanisms into our group layout (Sequeria & Ahmed, 2012).

Population

The target population and selection criteria is children ages 8-10 with autism spectrum

disorder. Each participant will be assessed using the CERQ-k tool to measure their cognitive

emotional regulation abilities (Garnefski et al., 2007). The measurement must show an impaired

ability to cope effectively. The minimum skills required include the ability to communicate

verbally and comprehend instructions either verbally or with physical prompts. Behaviors needed
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD
to participate successfully include an absence of severe behaviors directed at other people

(hitting, spitting, kicking). Special considerations will include being aware of the amount of

sensory input from the environment we create. Additionally, we format our group sessions to fit

the cognitive abilities of our participants; meaning language and activity difficulty will be

considered. The group sessions will also be mindful of transition periods and sticking to a

schedule. The only contraindication for this group will be avoiding over stimulating situations. 

Format

Our group sessions will have two facilitators; one will lead the activities and guide the

group sessions. The other facilitator will assist the participants and will observe the group for any

signs of overstimulation or anxiety. The group will consist of six participants; this will allow for

a 2:1 ratio to maintain safety. The group size will also be large enough to enhance social

participation. Our group will take place in an outpatient pediatric clinic setting in a room with

limited distractions. There will be chairs for each participant set up in a circle formation. There

will be limited harsh lighting and a sensory area close by in case a participant experiences

overstimulation. The group will be closed, which will allow each group to build off of the last

and will enhance group cohesiveness. 

Leadership

A directive approach will be used considering the age of the population and their need for

structure. This will help to ensure the productive flow of the group as well as aiding transitions. 

As the group cohesiveness progresses, a more facilitative leadership style will be incorporated.

Allowing the participants to learn from both the facilitators and their peers.  
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD

Methods 

The group sessions will incorporate role play, journaling, and interactive activities.  

Goals

1. Group members will build an awareness of intrinsic emotions. Displayed by accurately

identifying emotions 70% of the time. 

2. Group members will identify emotions in others 70% of the time. 

3. Group members will identify when a coping strategy is needed for emotional regulation

60% of the time. 

4. Group members will implement a coping strategy and effectively emotionally regulate

60% of the time.  

Session Plans 

Our group will include ten sessions over a five-week period. They will be held twice a

week to provide one day to teach new skills and one day to reinforce the skills and behaviors.

There should be one to two days in between sessions for practice and implementation at home.

The duration will be forty-five minutes to keep attention and avoid overstimulation while

allowing enough time to implement the concepts and skills. The time frame will also hold the

attention of the group without allowing excessive inattention. 

Session Outlines
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD

Session 1: It’s an Ocean of Emotions

Objective

Session one will address the different types of emotions and will teach the participants

how to identify emotions through visual aids and activities. 

Goal

Addresses long term goal number 1. The progress of the participants will be measured by

showing them photos or scenarios where various emotions are being displayed. Group members

will be asked to identify which emotion is being visually portrayed and demonstrate accurate

identification three out of five times. 

Session 2: Reflections

Objective

Session two will address intrinsic emotions and how we identify our feelings. 

Goal

Addresses long term goal number 1.  The progress of the participants will be measured by

providing them with scenarios and having them identify with a visual-aid how that would make

them feel. Group members should accurately identify emotions three out of five times. 

Session 3: Practice Makes Perfect

Objective

Session three will reinforce the previous two sessions on identifying intrinsic emotions. 

Goal
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD
Addresses long term goal number 1. We will check in on progress by measuring how

confidently they are able to match and identify emotions. For practice, we will have them journal

once a day about a situation and how it made them feel. Group members should accurately

identify emotions four out of five times. 

Session 4: What do you see?

Objective

Session four will address identifying emotions in other people. This could be through

their words, facial expressions or body language. 

Goal

 Addresses long term goal number 2. The progress of the participants will be measured by

their ability to identify the correct emotions within more complex scenarios found in movie clips.

Group members should accurately identify emotions three out of five times. 

Session 5: Inside Out 

Objective

Session five will address a combination of identifying both intrinsic and extrinsic

emotions. We will also start to introduce the concept that individuals react to situations

differently. 

Goal

Addresses long term goals numbers 1 and 2. This will be measured by their ability to

identify emotions both within themselves and others through role-playing scenarios. Group

members should accurately identify intrinsic and extrinsic emotions four out of five times. 
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD

Session 6: Don’t Lose Hope, Let’s Learn How to Cope! 

Objective

Session six will address using mindful breathing as a coping mechanism. There will be an

activity of making a sensory bottle to help them calm down. 

Goal

Address long term goal number 3. The progress will be measured through a take home

questionnaire for parents to complete. This will document their child’s ability to use breathing

strategies in difficult situations. Parents must identify if their child effectively used breathing as a

coping mechanism at least one time during the week. 

Session 7: Let it Go

Objective

Session seven will address using meditation as a coping mechanism. This session will

include a guided meditation specifically created for children. 

Goal

Address long term goal number 3. The progress will be measured through a take home

questionnaire, which we will ask the parents to complete. This will document how well

mindfulness was implemented at home with or without the use of prompts. Parents must identify

if their child effectively used meditation as a coping mechanism at least one time during the

week. 

Session 8: Sensory Fun

Session eight will address situations when coping strategies facilitate emotional

regulation. The session will start by introducing the participants to a “sensory box”, which will

provide them with a third coping option. The facilitators will then encourage the participants to

choose which coping option works best for them. 

Goal

Addresses long term goals 3 and 4. To measure progress during this session the

participants will have a scenario narrated to them and they will need to show they can implement

their selected coping strategy effectively. Group members must select a coping mechanism when

presented with a coping mechanism at least three out of five times. 

Session 9: Let’s Practice 

Objective

Session nine will reinforce coping strategies in difficult situations. The participants will

be provided with a group task that will challenge their emotions. 

Goal

Addresses long term goals 3 and 4. This will be measured by the participants ability to

choose and utilize an effective coping strategy. Group members either stay emotionally regulated

or choose and implement an effective coping strategy in at least three out of five of the

activities. 

Session 10: Make a Plan

Objective
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD
Session ten will ask each participant to identify a situation that makes them feel

overwhelmed. The participants will create a plan that they can implement. 

Goal

Addresses long term goals 3 and 4.  We will measure the participants progress by their

ability to implement their plan during role play scenarios. Group members either stay

emotionally regulated or choose and implement an effective coping strategy from their self-

designed plan in at least four out of five of the scenarios. 

PART II

Title

Session 1: It’s an Ocean of Emotions

Time Duration: 45 minutes 

Session Description

Objective

Session one will address the different types of emotions and will teach the participants

how to identify emotions through visual aids and activities. 

Goal

Addresses long term goal number 1. The progress of the participants will be measured by

showing them photos or scenarios where various emotions are being displayed. Group members
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD
will be asked to identify which emotion is being visually portrayed and demonstrate accuracy

three out of five times. 

Session Objective 

By the end of the session each group member will be able to recognize different emotions

as well as the visual cues that suggest which emotion is being portrayed. 

Evaluation 

In order to identify progress towards the overall goal of emotional regulation, the

participants will put stickers on visual representations after being prompted with which emotion

to identify by the facilitators. This will show us if they can correctly identify visual cues of

different emotions 3 out of 5 times. 

Materials/Preparation 

1. Plastic Eggs for decoration - $6.00

2. Premade plastic eggs with emotions already on them 

3. Sharpie 

4. Stickers - $10.00 

5. Whiteboard and markers 

6. Printed out facial expressions or characters that represent an emotion 

7. Paper

8. Crayons
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Session Outline 

Introductions: 3 minutes 

Introduce both therapists and the name of the group. Provide a brief synopsis of what our

time will look like together. 

Warm up: 5 minutes

The hobbies name game: Each participant will tell the group their name and their favorite

hobby followed by an action to describe that hobby. Example: My name is Kaitlin and I like to

dance. Then I would demonstrate my favorite dance move. The group will then repeat back the

name, the hobby and the move. 

Activity Part 1: 10 minutes 

We will have happy, sad, angry, excited, and content emotions displayed on the board

through representative pictures. We will go through each emotion describing when and why we

feel that way.  Example: With happiness, are we smiling? 

Activity Part 2: 5 minutes 

The participants will decorate their eggs with stickers to represent whatever emotion they

choose. 

Sharing: 10 minutes 
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD
After the participants are done decorating their eggs, we will ask them individually about

the emotion their egg represents. For each egg they do, we can ask the group to raise their hand if

they have ever felt that emotion. We will provide them the opportunity to share a time they felt

that way. 

Measurable: 5 minutes 

At the end of the activities, the participants will be prompted to put a sticker on the visual

representation that matches the emotion identified out loud by the group facilitators. This will be

done in the format of a matching game, which will measure each group members ability to

accurately identify emotion three out of five times. 

Processing: 3 minutes 

We will discuss the activity with the participants by first asking if they enjoyed it. We

will follow up with asking them if it was difficult to decide on how to decorate their egg. 

Generalizing: 2 minutes 

The facilitators will reiterate the important components based on what we heard from the

processing step. Members will be asked when they feel specific emotions in various situations.

For example, the facilitators could ask about situations at home such as dinner time, or when

mom or dad asks them to turn off the T.V. 

Application: 3 minutes 
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD
We will discuss the learning objectives from the session and how these can be applied to

everyday life with examples like sitting down to eat or fighting with siblings. Talk about how we

experience emotions every day and why it is important to understand how we are feeling. 

Summarizing: 2 minutes 

We will ask the participants to tell us about the activity and what was learned. We will

confirm the goals of the group and will give verbal recognition of the overall group dynamic. 

Optional Activities

If our activity is not going as planned or we have extra time, we will have paper and

crayons to identify the zones of regulation. We can have them all start to color with red and then

describe how that is anger. And then we would move on to having them color with blue and talk

about how blue represents sadness and what that looks like. 

References

Garnefski N, Rieffe C, Jellesma F, Terwogt MM, & Kraaij V. (2007). Cognitive emotion

regulation strategies and emotional problems in 9-11-year-old children: the development

of an instrument. European Child & Adolescent Psychiatry, 16(1), 1–9.

How to Improve Emotional Self-Regulation Among Children with Autism and Attention

Disorders. (2018, December 3). Retrieved from

https://onlinepsych.pepperdine.edu/blog/emotional-self-regulation-children-autism/
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD
Reaven, J. M., Reyes, N., & Pickard, K. (2019). Emotion regulation: A treatment target for

autism spectrum disorder. Bulletin of the Menninger Clinic, 83(3), 205-234.

Sequeira, S., & Ahmed, M. (2012). Meditation as a Potential Therapy for Autism: A Review.

Autism Research and Treatment, 2012, 1–11. doi: 10.1155/2012/835847

Evidence

The article Emotion regulation: A treatment target for autism spectrum disorder,

discusses the importance of emotional regulation in children with ASD due to negative

emotionality (Reaven et al., 2019). The article describes that compared to typically developed

children, children with ASD not only have more aggression and irritability but they also have

difficulty with using and implementing emotional regulation strategies (Reaven et al., 2019).  

The article focuses on several different interventions aimed at teaching and recognizing emotions

(Reaven et al., 2019). These interventions include complex emotions, facial expressions, role-

play and body language as well as the development of problem-solving skills (Reaven et al.,

2019). The interventions saw improvements with peers and social skills, problem-solving skills

and an increase in understanding emotions and identifying skills to emotionally regulate (Reaven

et al., 2019). The article found that these interventions along with mindfulness increased

emotional regulation in individuals with ASD (Reaven et al., 2019). 

This article provided evidence for our group protocol as we developed our sessions to

include similar areas of intervention. Our session outlines focus on identifying basic emotion,

emotion in others through facial expression and body language. We also incorporated problem-

solving skills through identifying difficult situations and choosing coping strategies to use. We
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EMOTIONAL REGULATION FOR CHILDREN WITH ASD
took the areas that these interventions saw success and found creative ways to apply those

concepts in our groups to help facilitate emotional regulation in children with ASD. 

The article, Meditation as a potential therapy for autism: A review explored the use of

meditation as an intervention for children with autism (Sequeria & Ahmed, 2012). The review

looked at evidence from various studies, which suggests that interventions based on meditative

concepts are effective and worth implementing (Sequeria & Ahmed, 2012). According to the

article, meditation can often produce outcomes related to greater relaxation, expression of

feelings, and quality of life as it relates to family and friends (Sequeria & Ahmed, 2012). With

autism affecting how children respond to stress, meditation is an approach that should be

considered because it is one of the only interventions that can influence the ability for self-

control and character development (Sequeria & Ahmed, 2012). The review found that children

with autism will benefit from mantra meditation and could override some cognitive impairments

(Sequeria & Ahmed, 2012). Additionally, the review addressed yogic breathing as a productive

intervention method for children with autism (Sequeria & Ahmed, 2012). 

This article was beneficial to our group protocol development because it provided

evidence for breathing and meditative interventions. Breathing and meditation were both

included in our sessions as coping mechanisms, which will be taught to help our group members

emotionally regulate.  Having coping skills will allow the group members to use various

mechanisms when they are working to avoid a level of emotional crisis.