Families' Neighborhood Resources Predict Treatment Response for Regulating Together, a Group Therapy for Emotion...

Autistic youth often face difficulties with emotion dysregulation (ED) and associated challenging behaviors. The Regulating Together (RT) group therapy was developed to treat ED in autistic youth ages 8-18 years and has been shown to be feasible, acceptable, and efficacious at reducing ED. Results from other clinical trials suggest the efficacy of behavioral therapies may vary based on family- or neighborhood-level social determinants of health (SDOH: "the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks"; U.S. Department of Health and Human Services). The extent to which these factors modify treatment response for RT is not known. This knowledge may help identify characteristics of treatment responders, inform implementation strategies to maximize real-world effectiveness, and guide decisions around treatment assignment and dosing.

This is an exploratory, secondary analysis of our previously reported in-person (N = 37) and telehealth (N = 26) nonrandomized trials of RT. Participants included 63 autistic youth (79.3% male; mean age = 12.8 years, SD = 2.9, range = 8-18) and caregivers. ED and related constructs (e.g., cognitive inflexibility) were assessed at baseline, post-treatment, and 5- and 10-week follow-up visits. Neighborhood-level SDOH were indexed using the Child Opportunity Index based on participants' home addresses. Linear mixed-effects models tested whether neighborhood opportunity moderated treatment response.

Neighborhood opportunity was unrelated to baseline clinical characteristics. However, neighborhood opportunity moderated treatment outcomes: reductions in irritability and emotional reactivity were greatest among families in neighborhoods with fewer opportunities.

Our finding of an amplified treatment response among families living in neighborhoods with fewer resources aligns with results from clinical trials for disruptive behaviors and internalizing disorders in typically developing youth. Possible explanations for this include families' limited prior access to behavioral health services, secondary reductions in caregiver stress, or high satisfaction with RT. These results challenge assumptions about diminished efficacy in low-resource settings and underscore the importance of considering contextual factors in future trials to enhance real-world impact.