Proneness to guilt, shame, and pride in children with Autism Spectrum Disorders and neurotypical children

Co-production of the 'EPIC' multidimensional tool-kit to support neurodivergent children and young people at home and school: a feasibility and pilot study

BACKGROUND

Interventions focused on cognitive function in neurodivergent children typically focus on single functions, e.g. working memory training. They are often focused on 'deficit' models and lack an emphasis on understanding areas of individual strengths and difficulties as a prerequisite to appropriate support. The multidimensional nature and phenotypic variability of cognitive profiles in these children indicate a need for a multicomponent-tailored intervention programme focused on understanding and supporting an individual child's cognitive functioning.

AIMS

The 'EPIC' intervention (Edinburgh Psychoeducation Intervention for Children and Young People) is focused on improving cognition, learning and behaviour in neurodivergent children such as those with attention deficit hyperactivity disorder (ADHD) or who are autistic. Building on our previous co-production work, this study aimed to use a participatory methods approach to develop EPIC practices and materials in relation to our key principles which include psychoeducation, multicomponent, individualised approach, strengths and difficulties profiling and pairing of a child's individual strengths and difficulties with internal and external strategies. We also set out to assess the feasibility and acceptability of EPIC, and pilot this novel tool-kit intervention with neurodivergent children and their parents and teachers.

METHODS

The intervention practices, materials and strategies of EPIC were co-produced with neurodivergent children, their parents, teachers and clinicians taking a strengths and difficulties approach. Identification of psychoeducation activities and strategy practices (e.g. mind-maps, chunking), testing of feasibility and collection of pilot data were conducted over a bi-weekly 8-week programme. Eleven neurodivergent children aged 7 to 12 completed the 16-session individualised programme. Acceptability and feasibility were ascertained via qualitative reports elicited within child and teacher interviews and child ratings of enjoyment. Pilot evaluation data was collected pre- and post-intervention participation, and across cognitive assessments (CANTAB, BRIEF), educational attainment (WIAT) and parent and teacher questionnaires measuring clinical symptoms and behaviour (Conners, AQ, SDQ, self-perception). Data was compared with a matched neurodivergent treatment-as-usual control group (N = 9).

RESULTS

The co-produced EPIC intervention was both feasible to deliver and acceptable to children, parents and their teachers. Pilot data identified that the 8-week intervention improved cognition (short-term and working memory) and literacy (receptive vocabulary, oral word fluency, listening comprehension). Improvements in the intervention group were also found for parent-reported child behavioural difficulties and aggression, and teacher-reported scholastic competence. Effect sizes generated (Cohen's d) ranged from 0.65 to 2.83. Parents reported continuing to use EPIC strategies when interviewed over a year after participating in the programme.

CONCLUSION

The current study met our objectives fully. 'EPIC' (Edinburgh Psychoeducation Intervention for Children and Young People) is feasible in home and school contexts and improves a range of aspects of cognition, learning and behaviour in neurodivergent children. Our findings show EPIC is suitable to be assessed within a full-scale trial.

Increased risk of acute stress disorder and post-traumatic stress disorder in children and adolescents with autism spectrum disorder: a nation-wide cohort study in Taiwan

Introduction

Children and adolescents with autism spectrum disorder (ASD) may be particularly vulnerable to the impact of traumatic events, yet the association between ASD and the risk of developing acute stress disorder and post-traumatic stress disorder (PTSD) remains uncertain. This study aims to investigate this association, addressing the gap in large-scale evidence on the subject.

Methods

Conducted as a retrospective and matched cohort study, data was sourced from the National Health Insurance Research Database (NHIRD) in Taiwan, spanning from January 1, 2000, to December 31, 2015. The study included patients aged 18 years or under newly diagnosed with ASD (n=15,200) and compared them with a matched control group (n=45,600). The Cox proportional regression model was employed to assess the risk of acute stress disorder and PTSD.

Results

Over the 15-year follow-up period, a total of 132 participants developed either acute stress disorder or PTSD. Among them, 105 cases (0.691% or 64.90 per 100,000 person-years) were in the ASD group, while 27 cases (0.059% or 5.38 per 100,000 person-years) were in the control group. The adjusted hazard ratio for the ASD group was significantly higher compared to the control group (25.661 with 95% CI = 15.913-41.232; P < .001).

Discussion

This study provides compelling evidence that individuals with ASD face an elevated risk of developing acute stress disorder and PTSD. The findings underscore the importance of clinicians recognizing and addressing this vulnerability in ASD individuals exposed to traumatic events. This emphasizes the need for heightened attention to the risk of PTSD and acute stress disorder in the ASD population.

Compassion-focused therapy with autistic adults

Some autistic adults experience repeated adverse events, including rejection, victimization and stigmatization. They also describe others being critical and negatively judging them, such as for how they socially interact or for expressing passion for particular interests. The impact of these adverse events can be substantial, including increasing vulnerability for poorer mental health, and contributing to development of negative self beliefs (such as "I am different" or "I do not fit in") and shame-based difficulties. Not all evidence-based psychological therapies are well-received by autistic people, or effective. Given high rates of self-harm and suicidality, finding acceptable and effective therapies for autistic adults is paramount. Here, writing as autistic and non-autistic clinicians and researchers, we outline the theoretical principles of compassion-focused theory and therapy (CFT). We propose that: (1) compassion-focused theory can provide a useful framework for conceptualizing shame-based difficulties some autistic adults experience; (2) CFT can be appropriate for addressing these; and (3) there is an impetus for practitioners to adopt compassion-focused approaches when supporting autistic adults.

See the self through others' eyes: The development of moral emotions in young children with autism spectrum disorder

Despite the important social functions of moral emotions, they are understudied in the autism spectrum disorder (ASD) population. This three-wave longitudinal study is among the first to examine the development of moral emotions and their associations with theory of mind in 3- to 7-year-old children with ASD, using observational tasks. One hundred and forty-two children (52 with ASD) were followed over a period of 2 years. We found that while the expressions of shame and guilt remained stable in non-ASD children, they decreased with age in children with ASD. No group differences were found in the levels or the developmental trajectories of pride. Besides, better false-belief understanding was uniquely related to the expressions of pride in children with ASD. Our findings highlight the importance of enhancing understanding of moral emotion development and related factors in children with ASD.

Pride: The Emotional Foundation of Social Rank Attainment

Pride is a self-conscious emotion, comprised of two distinct facets known as authentic and hubristic pride, and associated with a cross-culturally recognized nonverbal expression. Authentic pride involves feelings of accomplishment and confidence and promotes prosocial behaviors, whereas hubristic pride involves feelings of arrogance and conceit and promotes antisociality. Each facet of pride, we argue, contributes to a distinct means of attaining social rank: Authentic pride seems to promote prestige-a rank based on earned respect-whereas hubristic pride seems to promote dominance-a rank based on aggression and coercion. Both prestige and dominance are effective routes to power and influence in human groups, so both facets of pride are likely to be functional adaptations. Overall, the reviewed research suggests that pride is likely to be a human universal, critical for social relationships and rank attainment across human societies.

Successful emotion regulation via cognitive reappraisal in authentic pride: Behavioral and event-related potential evidence

The present study explored whether authentic pride (AP) and hubristic pride (HP) were differently associated with cognitive reappraisal strategy. In study 1, undergraduates (n = 235) completed a battery of self-report questionnaires, including the Authentic and Hubristic Pride-Proneness Scale (AHPPS), Emotion Regulation Questionnaire (ERQ), and emotion regulation questionnaire (ERP-R). The results showed that AP significantly predicted successful down-regulation of negative emotions via a spontaneous cognitive reappraisal strategy. However, hubristic pride (HP) was negatively associated with spontaneous cognitive reappraisal. In study 2, participants with trait AP (n = 31) and trait HP (n = 29) undergoing continuous electroencephalogram (EEG) recording were required to reinterpret emotional pictures to down-regulate/up-regulate their negative/positive emotional reactions. The results showed that individuals with AP reported lower levels of emotional arousal and lower amplitudes of late positive potentials (LPPs) than did individuals with HP in response to negative pictures during the down-regulation of negative emotions, but not during passive viewing or up-regulation of positive emotions. Across two studies, these findings showed that individuals with AP could utilize the cognitive reappraisal strategy (spontaneously in daily life and under experimental instructions) to down-regulate negative emotions more successfully relative to individuals with HP.

Recognition of Emotions from Situational Contexts and the Impact of a Mind Reading Intervention in Children with Autism Spectrum Disorder

The present research examined recognition of basic (happy, fear, sad) and self-conscious (pride, embarrassment, guilt) emotions from situational contexts in children with Autism Spectrum Disorder (ASD) and neurotypical children (Study 1). Results showed that children with ASD were less accurate in recognizing fear, embarrassment, and guilt situations than neurotypical children. Additionally, the research explored whether recognition of these emotions from situational contexts could be improved in children with ASD after a 4-week computerized emotion intervention (Study 2). Following the intervention, children showed better recognition of embarrassment and guilt, but no improvement in recognizing fear. In children with ASD, significant negative relations were found between ASD symptomatology and recognition of guilt (Study 1), although ASD symptomatology did not impact the intervention's efficacy (Study 2). Additional explanations for these findings are provided.

Social Anxiety and Shame Among Young Adults with Autism Spectrum Disorder Compared to Typical Adults

Social anxiety (SA) is common among young adults with autism spectrum disorder (ASD). While shame feelings predict SA among typical adults, the relationship between shame and SA in ASD remains unclear. The current study compared the relationship between SA and shame in ASD. SA, shame, and autistic self-assessment questionnaires were administered to 33 young adults with ASD (28 M/5F) and 38 typical young adults (32 M/6F, Mage = 24 years, range = 20-28 in both groups). Results showed higher SA levels in ASD than typical adults, but lower levels of shame characteristics in the former than in the latter group. Moreover, a significant moderation model showed that some aspects of shame were related to SA only in the typical group but not in ASD.

The impact of emotional development in people with autism spectrum disorder and intellectual developmental disability

BACKGROUND

Intellectual developmental disabilities (IDDs) and autism spectrum disorders (ASDs) are developmental conditions, which may also be associated with impairments in emotional development (ED). ED can be assessed using the Scale of Emotional Development - Short (SED-S), a five-stage model consisting of eight domains, which allows to study the relationship between ASD and ED in people with IDD.

METHODS

In this retrospective study, the level of ED was compared in 327 adults with IDD with [n = 83; mean age 38.3 years; level of IDD: mild (6), moderate (21), severe (45) and profound (11)] and without [n = 244, mean age 36.9 years; level of IDD: mild (67), moderate (73), severe (68) and profound (36)] ASD. The discriminative ability of the SED-S was determined by a regression in a training and a validation sample.

RESULTS

The level of ED correlated with the severity of IDD (r_s  = -.654) and the presence of ASD (r_s  = -.316). People with additional ASD showed lower levels of ED compared with those with IDD only (mean reference ages 7-18 vs 19-36 months). The developmental profiles were equally balanced in ASD and IDD-only. A regression analysis revealed three domains ('Relating-to-Peers', 'Differentiating-Emotions', and 'Regulating-Affect') to be useful for ASD assignment (AUC > 0.70, sensitivity 0.76-0.80, specificity 0.62-0.63).

CONCLUSIONS

In people with IDD, additional ASD was associated with delays in ED, which may be considered in diagnostics, treatment and care.

Links Between Autistic Traits, Feelings of Gender Dysphoria, and Mentalising Ability: Replication and Extension of Previous Findings from the General Population

Gender nonconformity is substantially elevated in the autistic population, but the reasons for this are currently unclear. In a recent study, Kallitsounaki and Williams (Kallitsounaki and Williams, Journal of Autism and Developmental Disorders, 2020; authors 1 and 2 of the current paper) found significant relations between autistic traits and both gender dysphoric feelings and recalled cross-gender behaviour, and between mentalising ability and gender dysphoric feelings. The current study successfully replicated these findings (results were supplemented with Bayesian analyses), in sample of 126 adults. Furthermore, it extended the previous finding of the role of mentalising in the relation between autistic traits and gender dysphoric feelings, by showing that mentalising fully mediated this link. Results provide a potential partial explanation for the increased rate of gender nonconformity in the autistic population.

Children's theory of mind as a mechanism linking parents' mind-mindedness in infancy with children's conscience

Growing research on parental mind-mindedness has revealed significant positive associations between parents' appropriate mind-minded (MM) comments to their infants and children's future theory of mind (ToM). In turn, ToM has been broadly linked with a range of social-moral competencies. However, few (if any) studies have examined long-term paths from mothers' and fathers' mind-mindedness in infancy to conscience at early school age, with ToM serving as a mediator of those links. We tested such a model in a prospective longitudinal study of 102 community infants, mothers, and fathers. Parents' MM comments to their infants were coded in naturalistic interactions in snack and play contexts at 7 months. Children's ToM was assessed in false-belief tasks at 4.5 and 5.5 years, and two aspects of their conscience were assessed at 6.5 years: discomfort following transgressions and prosocial judgments in hypothetical moral dilemmas. We tested our model in a comprehensive path analysis that accounted for developmental continuity of both aspects of conscience. Children's ToM was positively associated with both measures of future conscience. The long-term paths from parental mind-mindedness in infancy to conscience were found for mother-child relationships only. For mothers and children, we supported the paths from maternal appropriate MM comments during a snack context in infancy to both aspects of children's conscience mediated by children's ToM. The findings extend earlier evidence suggesting the potentially important role of the parent-child interactive context for long-term effects of early parental mind-mindedness and highlight differences in the roles MM comments may play in mother-child and father-child relationships.