Key findings from recent research and implications for clinical practice

A review paper published in the Journal of the American Academy of Child and Adolescent Psychiatry (Northrup et al., 2026) proposes a developmental model for understanding emotion regulation in young autistic children. The model places parent-child co-regulation at the centre and offers a clinically useful framework for paediatric OTs working with autistic children and their families.

In this blog, we explore some of the key findings from the paper and consider the practical implications for paediatric OT practice.

Why Emotion Regulation Matters in Autism

Emotion dysregulation, including meltdowns, emotional outbursts, and self-injurious behaviours, is common in young autistic children.

The paper cites previous research showing that 58% of autistic children aged 2–5 years demonstrated dysregulation behaviours, compared to 15% of children without developmental concerns.

The authors note that:

“Emotion dysregulation is associated with lower adaptive functioning, poorer social outcomes, and increased mental health difficulties across the lifespan.”

Importantly, the paper identifies a significant gap in developmental models specifically addressing emotion regulation in autistic children under five years of age and proposes a framework to better guide early intervention.

The Co-Regulation Model

In typical development, emotion regulation develops through repeated parent-child co-regulatory interactions.

A child communicates distress through facial expression, vocalisation, behaviour, or gesture, and the caregiver responds through comfort, redirection, support, or problem-solving. Over time, the child begins to internalise both the feeling of safety and the regulation strategies themselves.

The authors describe this process as occurring on both:

• a micro level (moment-to-moment interactions), and
• a macro level (patterns that develop over weeks, months, and years).

The paper proposes that this co-regulatory process is disrupted in autism across several stages of development.

Three Key Disruptions in Autism

1. More frequent, idiosyncratic, and invisible triggers

Autistic children often experience a greater number of triggers to dysregulation.

These may include:

• sensory sensitivities,
• difficulty with transitions or change,
• sleep disturbance,
• gastrointestinal discomfort,
• social demands,
• cumulative sensory load across the day.

These triggers are highly individual and context dependent.

Families will often describe dysregulation as appearing “suddenly”, although clinically, the nervous system load has usually been building across the day.

2. Reduced or ambiguous emotional communication

Alexithymia is estimated to be present in approximately 50% of autistic individuals, compared to around 5% of the general population.

Differences in interoception are also well documented in autistic individuals.

Many autistic children struggle to recognise or interpret what is happening in their bodies early enough to communicate it clearly. For some children, those internal signals may feel vague, confusing, overwhelming, or difficult to describe.

As clinicians, this is important because the child may not yet have the awareness, language, or regulation capacity to communicate what their nervous system is experiencing internally.

3. Missed windows for early co-regulation

Because early signs of distress may not be clearly communicated or recognised, caregivers may only respond once the child is already significantly dysregulated.

At that point, co-regulatory strategies are often much harder to access successfully.

Over time, repeated experiences of unsuccessful co-regulation may lead the child towards avoidance, or families understandably adapting routines and environments in ways that reduce distress in the short term but also limit opportunities to build self-regulation skills over time.

Therapy Nugget

What you see is an external expression of the child’s internal world.

When dysregulation appears to arise suddenly, the internal load has often been building quietly across the day.

Our role is not simply to respond to behaviour, but to understand the nervous system underneath it.

Through a Neuro-affirming, Trauma-Informed Sensory Lens

This model aligns closely with the bottom-up sensory and nervous system work held within the SenseUp Model™ 360.

The research reinforces an important clinical principle we often discuss at SenseUp:

State first. Strategy second.

Regulation strategies need to match the child’s nervous system state in that moment.

Top-down approaches are unlikely to be effective once a child has moved into high levels of arousal or distress. The opportunity for successful co-regulation usually exists much earlier, when the child’s state first begins to shift.

Importantly, the paper also highlights that autistic children seek comfort and support from caregivers at rates comparable to neurotypical children.

This suggests that the challenge may not necessarily be the relationship itself, but rather whether the co-regulatory approach matches the child’s nervous system profile and sensory-emotional needs in that moment.

For many families, this is an incredibly important shift in understanding.

One of the most useful clinical takeaways from the paper is the reminder that children are often already showing us what their nervous system is seeking. Our role is not simply to reduce behaviours, but to understand the function underneath them and build from there.

Practical Implications for OT Practice

Assess cumulative load

When reviewing dysregulation episodes with families, explore the full context:

• sensory load,
• transitions,
• sleep quality,
• environmental demands,
• social expectations,
• regulation opportunities across the day.

Build individualised early-warning systems

Help caregivers identify their child’s subtle early signs of nervous system stress or dysregulation.

These signs are often highly individual and may appear long before overt behaviours emerge.

Support the development of self-regulation

Recognise that a child’s preferred sensory inputs are often regulatory in function.

A neuroaffirming approach requires us to work with the child’s sensory preferences while helping them access those inputs more functionally across environments.

This is where clinical reasoning becomes critical:

• identifying the type of input,
• the timing,
• the dosage,
• and how to support access across daily life settings.

Include caregiver wellbeing in the clinical picture

The paper reports that approximately one-third of parents of autistic children meet criteria for anxiety or depression.

Supporting the caregiver’s nervous system is not separate from intervention. It directly influences their capacity to co-regulate effectively with their child.

Explain the neuroscience to families

Understanding why dysregulation occurs can significantly shift how families interpret behaviour.

When families understand the nervous system processes underneath behaviour, it often reduces shame, blame, confusion, and frustration, while increasing compassion and clinical insight.

Bringing It Back to Clinical Reasoning

Within The SenseUp Approach Course Lite, these regulation, sensory-emotional, co-regulation, and clinical reasoning layers are explored together through the SenseUp Model™ 360 rather than in isolation.

Because in practice, children do not present in isolated systems.

And effective clinical reasoning rarely comes from looking at behaviour alone.

If this way of thinking already feels familiar to your clinical reasoning, TSAC Lite is where we explore these layers more deeply.

Across six months, therapists work through the SenseUp Model™ 360 with a focus on nervous system safety, sensory-emotional reasoning, co-regulation, and practical clinical decision-making in everyday paediatric OT practice.

Final enrolment for the 2026 cohort closes 31 May 2026 at midnight AEST.

Reference

Northrup JB, Nuske HJ, Hipwell AE, Mazefsky CA.
Review and Developmental Model: Early Childhood Emotion Regulation and Co-Regulation in Autism.
Journal of the American Academy of Child & Adolescent Psychiatry. 2026;65(4):527–538.

PubMed reference page:
PubMed – Early Childhood Emotion Regulation and Co-Regulation in Autism