(PS4-28) Cognitive Reappraisal as a Strategy to Regulate Neural Responses to Sensory Over-responsivity in Autistic Youth

Introduction
Autism spectrum disorder (ASD) is characterized by social communication challenges, repetitive behaviors, and sensory processing differences (Pitskel et al., 2014). Specifically, sensory over-responsivity (SOR), an extreme negative response to sensory stimuli, is present in over half of autistic children (Baranek et al., 2006). However, interventions for SOR are limited. Cognitive reappraisal, a strategy rooted in cognitive behavioral therapy, helps change emotional responses to stimuli by reinterpreting their meaning. In both typically developing (TD) and autistic children, reappraisal can reduce negative feelings during negative scenarios (Samson et al., 2014), and is thought to do so through activation of frontal brain regions associated with executive functioning and emotion regulation (Buhle et al., 2014; Silvers et al., 2017). Preliminary research suggests that, in autistic children, frontal brain regions may also help regulate sensory responses (Pitskel et al., 2014), making reappraisal a promising potential intervention for treating SOR. Here, we examined whether reappraisal reduces neural reactivity to aversive sensory stimulation in autistic children.

Methods
Participants were 43 children aged 8-15 years who had ASD (n=22) or were TD (n=21). Participants were first trained in a reappraisal task adapted from emotion regulation literature in which children are taught to view visual stimuli as near (i.e., without regulating emotions) or distant (i.e., reappraisal) (Silvers et al., 2017). Here, they were trained to either focus on how an aversive tactile stimulus makes them feel (“Feel” condition), or report on the stimuli and think about how they would describe it to someone else (“Report” condition). Participants then underwent fMRI while mildly aversive tactile stimuli (i.e., scratchy sweater, fake grass) were administered to their arm for 20 seconds at a time, with each block indicating “Feel” or “Report”. Participants experienced 6 blocks of each condition, with the order counterbalanced across participants. FMRI analyses were performed at a threshold of Z=2.3, p< .05.

Results
For all participants, the Report condition resulted in significantly more activation in frontal brain regions associated with executive functioning and higher-order sensory processing (i.e., superior frontal gyrus, paracingulate gyrus, supplementary motor area) than in the Feel condition. For autistic children only, the Report condition resulted in significantly less activation in sensory and visual cortical regions (i.e., operculum, planum temporale, lateral occipital cortex) compared to the Feel condition.

Conclusion
Across groups, reappraisal led to upregulation of executive functioning and emotion regulation regions, suggesting that both groups effectively engaged in reappraisal to process their sensory experiences differently. Furthermore, for autistic youth, reappraisal reduced activation in sensory and visual brain regions where overactivity has been previously shown to be associated with SOR in ASD (Green et al., 2015; 2019). Results suggest that cognitive reappraisal may be an effective way to help ASD children regulate the overwhelming sensory experiences associated with SOR.