Researchers offer new framework for defining self-regulation in neurodevelopmental conditions
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From left: PhD student Iciar Iturmendi-Sabater and professors Hsiang-Yuan Lin and Meng-Chuan Lai
By
Victoria Del Mastro Vicente
In a new review paper published in Nature Human Behaviour, researchers at the University of Toronto and the Centre for Addiction and Mental Health offer a map for aligning assessments, interventions and studies using a domain-general view of self-regulation for neurodevelopmental conditions.
Led by Iciar Iturmendi-Sabater, a PhD candidate at the Institute of Medical Science at U of T’s Temerty Faculty of Medicine, the study reviewed literature, finding inconsistencies in the field of psychology when measuring and defining the term self-regulation.
The review was coauthored by Iturmendi-Sabater’s two supervisors Meng-Chuan Lai and Hsiang-Yuan Lin, both clinician-scientists at CAMH and professors in the department of psychiatry at Temerty Medicine.
Writer Victoria Del Mastro Vicente sat down with Iturmendi-Sabater to discuss the concept of self-regulation and how a more consistent view can improve clinical care and patient outcomes.
What prompted you to explore the idea of self-regulation in neurodevelopmental conditions?
I was really interested in understanding developmental conditions — such as ADHD, intellectual disabilities, autism spectrum disorders — and I was also interested in this concept of emotion regulation across these conditions.
I decided to reach out to Dr. Meng-Chuan Lai, who is my current PhD supervisor, to see if he was accepting any students. He was, so I started my PhD with him. Then Dr. Hsiang-Yuan Lin joined as my co-supervisor.
As part of my PhD, I conducted three empirical studies, two of them using behavioural data, another one using neuroimaging. One problem that we had across all of these studies is that we had different measures to assess emotion regulation. Some studies were assessed by parents, others assessed by children, others were experimental designs.
So this problem emerged — we're seeing that emotion regulation is important to adaptive functioning [a person's ability to manage everyday tasks], but what actually is emotion regulation?
So that is why we conducted this review and it has been the final project of my thesis.
Is there a lot of inconsistency in the field about using the term self-regulation?
I think the problem comes from the fact that most studies actually use the emotion regulation terminology, but it was first coined in the adult/developing population.
When you take that concept and then apply it to a completely different population, which is made up of neurodiverse children, then there's a limitation in doing that.
What our review finds is that even when using the term emotion regulation, we're capturing things such as impulsivity, which is purely behavioral. Whereas attention is normally seen more as a cognitive faculty and not an emotional control faculty.
We do see that the field has preferred using emotion regulation in neurodivergent populations. But what we propose is that this term is actually inconsistent with what is being captured by it. That is why we propose self-regulation instead of using emotion regulation when it comes to neurodivergent children.
How can the inconsistencies around the term self-regulation affect care in real time?
As a mental health specialist, if you're focusing on emotion regulation and that's it, then you would create an intervention that perhaps only focuses on emotion recognition or relaxation strategies with children. But if we use a broader term, such as self-regulation, then there's also room for understanding that intervention when emotional factors are not enough.
Also, in the case of a child with autism, you need to consider the environment that they're in. Because they have different sensory profile sensitivities, if it's quite noisy or loud, then that may affect their self-regulation. And it has nothing to do with emotion.
What we suggest in this manuscript is that the term self-regulation leaves more room for intervention and also for deciding which way you want to approach the improvement of self-regulation in the children you're working with.
How can a consistent view of self-regulation enhance the way practitioners approach working with patients?
One has to do with neuropsychological evaluation. For instance, normally when a kid comes for a referral for ADHD, autism or a neurodevelopmental condition, you do a lot of assessments with a bunch of neuropsychological tests like attention tests, executive functioning, IQ, etc. The framework that we propose is a way to see all of this as integrated together to facilitate the self-regulation of these children. For clinicians, the framework can help them say “How do I interpret all of these different findings that we have?” That's for evaluation purposes.
Then for intervention purposes, it helps with the formulation in making the view of the case broader. So again, not just working with emotion to improve self-regulation, but working with all of these other executive functions and sensory processes, to see the child in a more holistic way — a way that takes into account the context that they're in throughout their daily lives.
What is next for this work?
The model that we propose is a starting point. It's not the final point.
The measures that we have right now, for whether you call it emotion regulation or self-regulation, are just assessing emotional aspects and not taking into account other things that are important, like sensory processing, language abilities, executive functioning and so on.
We are working to expand measurements, then also validate the use of those measures specifically in neurodevelopmental conditions. Most of the measures that we have currently are validated in [people who are] neurotypical, but the way that they work might just be completely different in a kid with a neurodevelopmental condition.
We are still missing the voice from people with neurodevelopmental conditions to actually speak to what self-regulation means to them. That subjective experience is going to be crucial in guiding future research as well as asking “what does being dysregulated mean to you and what does being regulated mean to you?”
Moving forward, I hope to keep combining my mix of clinical work with research and I want to move towards doing interventions that promote self-regulation in children who are neurodivergent.
