The Association between Self-Regulation and Symptoms of Autism Spectrum Disorder in Preschoolers with Externalizing Behavior Problems

  • Rosmary Ros
  • Della Gregg
  • Katie C. Hart
  • Paulo A. Graziano


The purpose of the current study was to examine the role of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) symptoms in predicting deficits in self-regulation across the domains of executive functioning and emotion regulation. Parents of 40 preschoolers with externalizing behavior problems reported on children’s ADHD and ASD symptoms, and emotion regulation. Children completed a standardized executive functioning battery. Results indicated that 28% of parents and 53% of teachers rated children above the subclinical range on ASD symptoms. An interaction emerged such that higher ASD symptoms were only associated with poorer executive functioning for children with lower ADHD symptoms. However, ASD symptoms were predictive of poorer emotion regulation independent of ADHD symptoms. Findings revealed clinically significant ASD symptoms, which aided in explaining heterogeneity in self-regulation deficits.


Externalizing behavior problems Autism spectrum disorder Executive functioning Emotion regulation Attention-deficit/hyperactivity disorder 



The research reported here was supported by a local grant from The Children’s Trust (1329–7290) to the last author. The opinions expressed are those of the authors and do not represent views of The Children’s Trust.

Compliance with Ethical Standards

Conflict of Interest

Rosmary Ros, Della Gregg, Katie C. Hart, and Paulo A. Graziano declare that they have no conflicts of interest.

Ethical Approval

All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participant’s parents included in the study.


  1. Alloway, T. P., Gathercole, S. E., & Pickering, S. J. (2004). The automated working memory assessment. Test battery available from authors.Google Scholar
  2. Alloway, T. P., Gathercole, S. E., & Pickering, S. J. (2006). Verbal and visuospatial short-term and working memory in children: Are they separable? Child Development, 77(6), 1698–1716.CrossRefPubMedGoogle Scholar
  3. Anastopoulos, A. D., Smith, T. F., Garrett, M. E., Morrissey-Kane, E., Schatz, N. K., Sommer, J. L., Kollins, S. H., & Ashley-Koch, A. (2011). Self-regulation of emotion, functional impairment, and comorbidity among childrenwith AD/HD. Journal of Attention Disorders, 15(7), 583–592.CrossRefPubMedGoogle Scholar
  4. Association, A. P. (2000). Diagnostic and statistical manual of mental disorders. 4th text revision (pp. 553–557). Washington, DC: American Psychiatric Association.Google Scholar
  5. Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65–94.CrossRefPubMedGoogle Scholar
  6. Blair, C., & Razza, R. P. (2007). Relating effortful control, executive function, and false belief understanding to emerging math and literacy ability in kindergarten. Child Development, 78(2), 647–663.CrossRefPubMedGoogle Scholar
  7. Campbell, S. B., Shaw, D. S., & Gilliom, M. (2000). Early externalizing behavior problems: Toddlers and preschoolers at risk for later maladjustment. Development and Psychopathology, 12(03), 467–488.CrossRefPubMedGoogle Scholar
  8. Carlson, S. M., Moses, L. J., & Claxton, L. J. (2004). Individual differences in executive functioning and theory of mind: An investigation of inhibitory control and planning ability. Journal of Experimental Child Psychology, 87(4), 299–319.CrossRefPubMedGoogle Scholar
  9. de Abreu, P. M. E., Conway, A. R., & Gathercole, S. E. (2010). Working memory and fluid intelligence in young children. Intelligence, 38(6), 552–561.CrossRefGoogle Scholar
  10. Downer, J. T., Booren, L. M., Lima, O. K., Luckner, A. E., & Pianta, R. C. (2010). The individualized classroom assessment scoring system (inCLASS): Preliminary reliability and validity of a system for observing preschoolers’ competence in classroom interactions. Early Childhood Research Quarterly, 25(1), 1–16.CrossRefPubMedGoogle Scholar
  11. Eisenberg, N., Fabes, R. A., Guthrie, I. K., Murphy, B. C., Maszk, P., Holmgren, R., & Suh, K. (1996). The relations of regulation and emotionality to problem behavior in elementary school children. Development and Psychopathology, 8(01), 141–162.CrossRefGoogle Scholar
  12. Eisenberg, N., Gershoff, E. T., Fabes, R. A., Shepard, S. A., Cumberland, A. J., Losoya, S. H., et al. (2001). Mother's emotional expressivity and children's behavior problems and social competence: Mediation through children's regulation. Developmental Psychology, 37(4), 475–490.CrossRefPubMedGoogle Scholar
  13. Eisenberg, N., Guthrie, I. K., Fabes, R. A., Shepard, S., Losoya, S., Murphy, B., Jones, S., Poulin, R., & Reiser, M. (2000). Prediction of elementary school children's externalizing problem behaviors from attentional and behavioral regulation and negative emotionality. Child Development, 71(5), 1367–1382.CrossRefPubMedGoogle Scholar
  14. Eisenberg, N., Spinrad, T. L., & Eggum, N. D. (2010). Emotion-related self-regulation and its relation to children’s maladjustment. Annual Review of Clinical Psychology, 6, 495–525.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Faja, S., Dawson, G., Sullivan, K., Meltzoff, A. N., Estes, A., & Bernier, R. (2016). Executive function predicts the development of play skills for verbal preschoolers with autism spectrum disorders. Autism Research.Google Scholar
  16. Gioia, G. A., Espy, K. A., & Isquith, P. K. (2003). BRIEF-P: Behavior Rating Inventory of Executive Function--Preschool Version: Professional Manual: Psychological assessment resources.Google Scholar
  17. Goldstein, S., & Naglieri, J. A. (2009). Autism Spectrum rating scales (ASRS™). Tonawanda, NY: Multi-Health Systems.Google Scholar
  18. Goldstein, S., Naglieri, J. A., Rzepa, S., & Williams, K. M. (2012). A National Study of autistic symptoms in the general population of school-age children and those diagnosed with autism Spectrum disorders. Psychology in the Schools, 49(10), 1001–1016.CrossRefGoogle Scholar
  19. Graziano, P. A., & Garcia, A. (2016). Attention-deficit hyperactivity disorder and children's emotion dysregulation: A meta-analysis. Clinical Psychology Review, 46, 106–123.CrossRefPubMedGoogle Scholar
  20. Graziano, P. A., Slavec, J., Hart, K, Garcia, A., & Pelham, W. E. (2014). Improving school readiness in preschoolers with behavior problems: Results from a summer treatment program. Journal of Psychopathology and Behavioral Assessment 36(4), 555–569CrossRefGoogle Scholar
  21. Graziano, P. A., & Hart, K. (2016). Beyond behavior modification: benefits of social–emotional/self-regulation training for preschoolers with behavior problems. Journal of school psychology, 58, 91–111.Google Scholar
  22. Grzadzinski, R., Di Martino, A., Brady, E., Mairena, M. A., O’Neale, M., Petkova, E., et al. (2011). Examining autistic traits in children with ADHD: Does the autism spectrum extend to ADHD? Journal of Autism and Developmental Disorders, 41(9), 1178–1191.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Happé, F., Booth, R., Charlton, R., & Hughes, C. (2006). Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: Examining profiles across domains and ages. Brain and Cognition, 61(1), 25–39.CrossRefPubMedGoogle Scholar
  24. Hill, E. L. (2004). Executive dysfunction in autism. Trends in Cognitive Sciences, 8(1), 26–32.CrossRefPubMedGoogle Scholar
  25. Hinshaw, S. P. (1992). Academic underachievement, attention deficits, and aggression: Comorbidity and implications for intervention. Journal of Consulting and Clinical Psychology, 60(6), 893–903.CrossRefPubMedGoogle Scholar
  26. Isquith, P. K., Gioia, G. A., & Espy, K. A. (2004). Executive function in preschool children: Examination through everyday behavior. Developmental Neuropsychology, 26(1), 403–422.CrossRefPubMedGoogle Scholar
  27. Jahromi, L. B., Bryce, C. I., & Swanson, J. (2013). The importance of self-regulation for the school and peer engagement of children with high-functioning autism. Research in Autism Spectrum Disorders, 7(2), 235–246.CrossRefGoogle Scholar
  28. Keenan, K., & Wakschlag, L. S. (2000). More than the terrible twos: The nature and severity of behavior problems in clinic-referred preschool children. Journal of Abnormal Child Psychology, 28(1), 33–46.CrossRefPubMedGoogle Scholar
  29. Koblinsky, S. A., Kuvalanka, K. A., & Randolph, S. M. (2006). Social skills and behavior problems of urban, African American preschoolers: Role of parenting practices, family conflict, and maternal depression. American Journal of Orthopsychiatry, 76(4), 554–563.CrossRefPubMedGoogle Scholar
  30. La Greca, A. M., Silverman, W. K., & Lochman, J. E. (2009). Moving beyond efficacy and effectiveness in child and adolescent intervention research. Journal of Consulting and Clinical Psychology, 77(3), 373–382.CrossRefPubMedGoogle Scholar
  31. Laurent, A. C., & Rubin, E. (2004). Challenges in emotional regulation in Asperger syndrome and high-functioning autism. Topics in Language Disorders, 24(4), 286–297.CrossRefGoogle Scholar
  32. Leung, R. C., Vogan, V. M., Powell, T. L., Anagnostou, E., & Taylor, M. J. (2016). The role of executive functions in social impairment in autism Spectrum disorder. Child Neuropsychology, 22(3), 336–344.CrossRefPubMedGoogle Scholar
  33. Martel, M. M., Nigg, J. T., & Von Eye, A. (2009). How do trait dimensions map onto ADHD symptom domains? Journal of Abnormal Child Psychology, 37(3), 337–348.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Mazefsky, C. A., Herrington, J., Siegel, M., Scarpa, A., Maddox, B. B., Scahill, L., & White, S. W. (2013). The role of emotion regulation in autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(7), 679–688.CrossRefGoogle Scholar
  35. Mazefsky, C. A., Pelphrey, K. A., & Dahl, R. E. (2012). The need for a broader approach to emotion regulation research in autism. Child Development Perspectives, 6(1), 92–97.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Melnick, S. M., & Hinshaw, S. P. (2000). Emotion regulation and parenting in AD/HD and comparison boys: Linkages with social behaviors and peer preference. Journal of Abnormal Child Psychology, 28(1), 73–86.CrossRefPubMedGoogle Scholar
  37. Mitsis, E. M., McKAY, K. E., Schulz, K. P., Newcorn, J. H., & Halperin, J. M. (2000). Parent–teacher concordance for DSM-IV attention-deficit/hyperactivity disorder in a clinic-referred sample. Journal of the American Academy of Child & Adolescent Psychiatry, 39(3), 308–313.Google Scholar
  38. Mulligan, A., Anney, R. J., O’Regan, M., Chen, W., Butler, L., Fitzgerald, M., et al. (2009). Autism symptoms in attention-deficit/hyperactivity disorder: A familial trait which correlates with conduct, oppositional defiant, language and motor disorders. Journal of Autism and Developmental Disorders, 39(2), 197–209.CrossRefPubMedGoogle Scholar
  39. Nigg, J. T., & Barkley, R. A. (2014). Attention deficit/hyperactivity disorder. In E. Mash & R. Barkley (Eds.), Child Psychopathology (Vol. 3rd ed., pp. 75–144). New York: Guilford Press.Google Scholar
  40. Nigg, J. T., Blaskey, L. G., Huang-Pollock, C. L., & Rappley, M. D. (2002). Neuropsychological executive functions and DSM-IV ADHD subtypes. Journal of the American Academy of Child & Adolescent Psychiatry, 41(1), 59–66.CrossRefGoogle Scholar
  41. Nigg, J. T., & Casey, B. (2005). An integrative theory of attention-deficit/hyperactivity disorder based on the cognitive and affective neurosciences. Development and Psychopathology, 17(03), 785–806.CrossRefPubMedGoogle Scholar
  42. Nigg, J. T., Stavro, G., Ettenhofer, M., Hambrick, D. Z., Miller, T., & Henderson, J. M. (2005). Executive functions and ADHD in adults: Evidence for selective effects on ADHD symptom domains. Journal of Abnormal Psychology, 114(4), 706–717.CrossRefPubMedGoogle Scholar
  43. Nixon, E. (2001). The social competence of children with attention deficit hyperactivity disorder: A review of the literature. Child Psychology & Psychiatry Review, 6(04), 172–180.CrossRefGoogle Scholar
  44. Nolan, E. E., Gadow, K. D., & Sprafkin, J. (2001). Teacher reports of DSM-IV ADHD, ODD, and CD symptoms in schoolchildren. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 241–249.CrossRefGoogle Scholar
  45. Ozonoff, S., Goodlin-Jones, B., & Solomon, M. (2007). Autism Spectrum disorders Assessment of Childhood Disorders (pp. 487–525). New York: Guilford.Google Scholar
  46. Pelham, W. E., Evans, S. W., Gnagy, E. M., & Greenslade, K. E. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders: Prevalence, factor analyses, and conditional probabilities in a special education sample. School Psychology Review, 21(2), 285–299.Google Scholar
  47. Polanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., & Rohde, L. A. (2014). ADHD prevalence estimates across three decades: An updated systematic review and meta-regression analysis. International Journal of Epidemiology, 43(2), 434–442.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Posserud, M. B., Lundervold, A. J., & Gillberg, C. (2006). Autistic features in a total population of 7–9-year-old children assessed by the ASSQ (autism Spectrum screening questionnaire). Journal of Child Psychology and Psychiatry, 47(2), 167–175.CrossRefPubMedGoogle Scholar
  49. Reiersen, A. M., Constantino, J. N., & Todd, R. D. (2008). Co-occurrence of motor problems and autistic symptoms in attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 47(6), 662–672.CrossRefGoogle Scholar
  50. Reynolds, C. R., & Kamphaus, R. W. (2004). BASC-2: Behavior assessment system for children.Google Scholar
  51. Ros, R., & Graziano, P. A. (2017). Social functioning in children with or at risk for attention deficit/hyperactivity disorder: a meta-analytic review. Journal of Clinical Child & Adolescent Psychology, 1–23.Google Scholar
  52. Rosenberg, R. E., Kaufmann, W. E., Law, J. K., & Law, P. A. (2011). Parent report of community psychiatric comorbid diagnoses in autism spectrum disorders. Autism Research and Treatment, 2011, 1–10.Google Scholar
  53. Samson, A. C., Huber, O., & Gross, J. J. (2012). Emotion regulation in Asperger's syndrome and high-functioning autism. Emotion, 12(4), 659–665.CrossRefPubMedGoogle Scholar
  54. Sergeant, J. A., Geurts, H., & Oosterlaan, J. (2002). How specific is a deficit of executive functioning for attention-deficit/hyperactivity disorder? Behavioural Brain Research, 130(1), 3–28.CrossRefPubMedGoogle Scholar
  55. Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Developmental Psychology, 33(6), 906–916.CrossRefPubMedGoogle Scholar
  56. South, M., Ozonoff, S., & Mcmahon, W. M. (2007). The relationship between executive functioning, central coherence, and repetitive behaviors in the high-functioning autism spectrum. Autism, 11(5), 437–451.CrossRefPubMedGoogle Scholar
  57. Thorell, L. B., & Wåhlstedt, C. (2006). Executive functioning deficits in relation to symptoms of ADHD and/or ODD in preschool children. Infant and Child Development, 15(5), 503–518.CrossRefGoogle Scholar
  58. Upshur, C., Wenz-Gross, M., & Reed, G. (2009). A pilot study of early childhood mental health consultation for children with behavioral problems in preschool. Early Childhood Research Quarterly, 24(1), 29–45.CrossRefGoogle Scholar
  59. Valicenti-McDermott, M., Hottinger, K., Seijo, R., & Shulman, L. (2012). Age at diagnosis of autism spectrum disorders. The Journal of Pediatrics, 161(3), 554–556.CrossRefPubMedGoogle Scholar
  60. Vohs, K. D., & Baumeister, R. F. (2004). Understanding self-regulation: An introduction. Handbook of self-regulation: Research, theory, and applications, 1–9.Google Scholar
  61. Wechsler, D. (2012). Wechsler preschool and primary scale of intelligence (4th ed.). San Antonio: NCS Pearson.Google Scholar
  62. Welsh, J. A., Nix, R. L., Blair, C., Bierman, K. L., & Nelson, K. E. (2010). The development of cognitive skills and gains in academic school readiness for children from low-income families. Journal of Educational Psychology, 102(1), 43–53.CrossRefPubMedPubMedCentralGoogle Scholar
  63. West, J., Denton, K., & Reaney, L. (2001). The kindergarten year. Washington, DC: US Department of Education.Google Scholar
  64. Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of the executive function theory of attention-deficit/hyperactivity disorder: A meta-analytic review. Biological Psychiatry, 57(11), 1336–1346.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Rosmary Ros
    • 1
  • Della Gregg
    • 1
  • Katie C. Hart
    • 1
  • Paulo A. Graziano
    • 1
  1. 1.Department of PsychologyFlorida International UniversityMiamiUSA

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