Emotion regulation difficulties and differences in autism including demand-avoidant presentations—A clinical review of research and models, and a proposed conceptual formulation: Neural-preferencing locus of control (NP-LOC)

Emotion regulation (ER) difficulties and differences in autism are well documented in both research and clinical literature, negatively impacting well-being for autistic young people. Emotion dysregulation can significantly decrease access to opportunities to learn life skills and increase the risk of mental health problems in adulthood. This situation intensifies with more extreme demand avoidant presentations. Efforts to increase understanding in this area have therefore been the subject of much attention with conceptual models created to explore possible underlying mechanisms and guide interventions. This clinical review explores the ER literature and conceptual models in autism and offers a formulation—Neural Preferencing Locus of Control (NP-LOC). NP-LOC aims to build on existing theory, research and conceptual models by offering different perspectives in ER through a cognitive, developmental formulation related to the core features of autism—in particular, the impact of a strong need to follow preferred agendas and routines, differences in social understanding related to daily demands, and difficulties accessing social support systems—and how these factors relate to perceived safety and control needed for daily functioning. The role of social understanding as a mediating factor in ER and the implications for intervention in autism are discussed, especially for demand avoidant presentations.