My interest stems from both personal interaction with affected family and friends, and working with autistic clients, early on in my training. I was most intrigued by the range of mental health and behavioral problems I was seeing clinically, that seemed to be rooted in trying to manage intense emotions. 

Anxiety in autism is multiply determined, meaning there are several causes. The most likely explanations include heightened biological risk for anxiety, atypical information and sensory processing, and difficulty in processing social information efficiently.

Many scientists are trying to answer these questions. To the best of my knowledge, it’s not clear that females are universally better at it, though they do seem to engage in more camouflaging. This is probably due to the fact that females are often diagnosed later in life (so have more time to develop masking skills) and the differing social milieu in which young girls and boys are raised, with greater expectations for females to be socially inclined and interpersonally sensitive.

I think both are correct. Emotional dysregulation is common among adolescents, regardless of the ASD diagnosis. But we know that autistic teens tend to have more difficulty with managing intense, negative emotion. This is not a formal diagnosable mental health problem, although it can be effectively targeted in treatment.

Yes, in fact my colleagues and I just finished a clinical trial testing the effectiveness of a mindfulness program for emotion regulation in teens and adults on the spectrum. Although we are now working on the data analyses, mindfulness-based approaches do have a growing research base to support their impact clinically.

I have seen some clients on the spectrum do wonderfully with the use of metaphors, and others not so much. It really depends on the client, and how they process information, moreso that the ASD per se. Sometimes a metaphor that ‘sticks’ can be turned into a mantra, that the person can use to remember what to do in a stressful situation. Helping the person create some space from their thoughts, through strategies like diffusion, have been found effective.

Sometimes we have to ‘let go’ of the focus on verbal labelling upon which most non-ASD people rely. We can be creative to find what the autistic client might prefer, such as using colors (e.g., color coding different emotions), numbers (e.g., to indicate severity or valence), or even entirely nonverbal approaches to convey their emotional experience. When a person is experiencing distress, sometimes they might not be able to talk about it right then, and asking them to do so can exacerbate the situation. Rather than asking questions or putting additional demands on, you might consider simply acknowledging the distress (e.g., I see this is really hard for you right now). Telling the person to calm down will rarely work; if they could, they’d be doing it already. Rather, modelling self-soothing can help. For instance, you might sit quietly with the person in a quiet room and take some slow breaths. After the distress (anger, etc.) has subsided, then processing and learning can occur. 

Research suggests that there is a neurobiological lag in the way that the emotion processing brain matures during childhood and into adolescence. Some, more adaptive strategies (e.g., like intentional reframing or perspective-taking) call on higher-order skills that many kids have not yet mastered. See Mazefsky and White (2014): https://pubmed.ncbi.nlm.nih.gov/24231164/ 

Intolerance of uncertainty has historically been under-studied, but we are now learning much more about IU and its role in the development of anxiety and other problems in autism. There is some indication that we can approach it in a fashion similar to that used in established approaches to fear reduction. Using gradual exposure with psychoeducation, a person can learn to tolerate increased uncertainty over time, as they learn that things tend to work out even when they don’t necessarily go ‘according to plan’.

I don’t know that we have a single approach that universally works best. Like most mental health strategies, we need to work to personalize approaches. Emotion regulation problems might manifest in a lot of different ways (e.g., aggression, self-harm, depression). For many people, improving awareness of emotional experiences ‘in the moment’ can be very helpful, along with making space for emotions, without trying to avoid them. Most people don’t want to let their emotions be in the driver’s seat. I have found that sometimes it can help increase motivation when the person realizes their actions are driven by emotions outside of their control, and that they have the power to exert control and be in charge.

Sometimes offering options rather than relying on "free text" responding can help. Also, for some people, picking the one “correct” emotion can be really hard, in part because humans are messy when it comes to emotions. They are not pure states, but rather often like a recipe: half sad, a quarter mad, and a quarter fearful. For a child like this, sometimes recreating the situation as much as possible and instilling "pause moments" in which he can stop to think about his thoughts and emotions can help.