Emotional competence in children with autism: Diagnostic criteria and empirical evidence

Do you feel me? Autism, empathic accuracy and the double empathy problem

LAY ABSTRACT

The assumption that autistic people lack empathy, particularly imagining how others feel, has been much debated and is now being challenged by an alternative view: the 'double empathy problem'. This suggests that non-autistic people may find it equally difficult to imagine how autistic people feel. Although this perspective is gaining popularity, research testing whether non-autistic people can accurately imagine and feel an autistic person's emotions is still limited. Our study used video clips of autistic and non-autistic people recounting emotional events to test if participants from the general population could: track the intensity of the narrators' emotions; name and feel the same emotion; match where the narrator felt the emotion and indicate how intensely they felt the emotion using a body map. Our results show that participants found it significantly harder to track autistic narrators' emotions compared to non-autistic narrator's emotions, especially when viewing clips of narrators feeling happy and sad. We also found that participants felt emotions more intensely in the body when viewing clips of autistic narrators compared to non-autistic narrators, especially when describing anger and fear. These findings support the double empathy problem and have strong implications for therapeutic and interpersonal relationships with autistic people.

Development of emotion comprehension in children with autism spectrum disorder and Williams syndrome

Although research has shed light on the development of emotion comprehension in typically developing children, little is known about emotion comprehension in children who are developing atypically. Thus, this study examined the developmental trajectory of emotion understanding in non-clinical (NC) children and children with autism spectrum disorder (ASD) and Williams syndrome (WS) using a Test of Emotion Comprehension. In the test, we measured children's understanding of (I) recognition of emotions based on facial expressions, (II) external causes of emotions, (III) desire-based emotions, (IV) belief-based emotions, (V) the influence of a reminder on a present emotional state, (VI) regulating an experienced emotion, (VII) hiding an emotional state, (VIII) mixed emotions, and (IX) moral emotions. A Bayesian modeling approach was applied to compare the developmental trajectories of emotion understanding across the syndrome groups. The results revealed that NC children and children with WS followed significantly different developmental trajectories in specific aspects of emotion understanding, while children with ASD followed a very similar path to NC children. Children with ASD and NC children gradually developed an understanding of each component of emotion comprehension as they matured. However, the understanding of some components, such as desire-based emotions, hiding an emotional state, and moral emotions, in children with WS was affected by their Autism Spectrum Quotient scores. This is one of the first cross-syndrome studies to assess the development of emotion comprehension in children with ASD and WS, providing important insights for understanding the nature of disability and advancing the development of intervention programs.

Emotional and behavioral alterations and their relationship with executive functioning in the pediatric population with autism spectrum disorder and epilepsy: a comparative study

Introduction

The pediatric population with Autism Spectrum Disorder (ASD) and epilepsy presents behavioral and emotional alterations that hinder their correct developmental maturation as well as their integration in different contexts such as school, family or social. This population shows atypical behavioral and emotional patterns, with difficulties in emotional regulation, understanding of emotions, aggressiveness, or low frustration tolerance. They also present alterations in executive functions, which significantly influence the emotional and behavioral characteristics of this population. Research suggests that epilepsy worsens the emotional, behavioral, and executive functioning status.

Objective

To explore differences in behavioral, emotional, and executive functioning profile in individuals with a diagnosis of ASD, epilepsy, and ASD with epilepsy.

Method

In this quasi-experimental and cross-sectional study, a total of 170 participants were selected and distributed into three groups: a group of participants with ASD, a group with epilepsy, and a group of participants with ASD and epilepsy. The SENA, BASC-3, and ENFEN tests were administered to verify the behavioral, emotional, and executive functioning profile in the three groups.

Results

The results indicate that individuals diagnosed with ASD and epilepsy present greater emotional, behavioral, and executive functioning alterations compared to those who only present ASD or epilepsy.

Conclusion

Individuals with ASD and epilepsy present significant alterations in emotional, behavioral, and executive functioning processes, which hinder their adaptation to different contexts, as well as decreasing their quality of life and that of their family.

Toward the detection of reduced emotion expression intensity: an autism sibling study

INTRODUCTION

Expressing emotions through spontaneous facial expression is an important nonverbal social communication skill. In our study, we aimed to demonstrate that both children with autism spectrum disorder (ASD) and the non-ASD siblings of children with ASD have deficits in this skill.

METHOD

In this study, we analyzed the six core facial emotion expressions of three distinct groups of children - those diagnosed with ASD (n = 60), non-ASD siblings (n = 60), and typically developed children (n = 60). To analyze facial expressions, we employed a computer vision program that uses machine learning algorithms to detect facial features and conducted an evidence-based task that involved assessing participants' ability to recognize facial emotion expressions.

RESULTS

Deficits in spontaneous emotion expression were shown in the children with ASD and in non-ASD siblings when compared with typically developed children. Interestingly, it was determined that these deficits were not related to the severity of the autism symptoms in the ASD group.

CONCLUSIONS

The results of the study suggest that computer-based automated analysis of facial expressions with contextual social scenes task holds potential for measuring limitations in the ability to express emotions, and they supplement the traditional clinical assessment of social phenotypical behavior deficits. This applies both to children with ASD and especially, to the non-ASD siblings of children with ASD. This study adds a novel approach to previous literature examining the emotion expression skills.

The relationship between autistic traits and empathy in adolescents: An ERP study

Based on the mind-blindness hypothesis, a large number of studies have shown that individuals with autism-spectrum disorder (ASD) and autistic traits have empathy deficits. However, the recent double empathy theory contradicts the mind-blindness hypothesis and suggests that individuals with ASD and autistic traits do not necessarily lack empathy. Thus, the presence of empathy deficits in individuals with ASD and autistic traits is still controversial. We recruited 56 adolescents (28 high autistic traits, 28 low autistic traits, 14-17 years old) in this study to explore the relationship between empathy and autistic traits. The study participants were required to undertake the pain empathy task, during which the electroencephalograph (EEG) activities were recorded. Our results show that empathy was negatively associated with autistic traits at the questionnaire, behavioral, and EEG levels. Our results also suggested that empathy deficits in adolescents with autistic traits may be manifested mainly in the late stages of cognitive control processing.

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.

The Adaptive Test of Emotion Knowledge for 3-to 9-Year-Olds: Psychometric Properties and Validity

Children with an advanced knowledge of emotions are generally more socially competent, less likely to suffer from psychopathology, and more likely to succeed in school, both socially and academically. The assessment of children's emotion knowledge has thus gained importance in recent decades - both in psychiatric practice and in developmental and educational psychology. However, there is still a lack of appropriate instruments for assessing children's emotion knowledge in a performance test reliably, and for a broad age range. The Adaptive Test of Emotion Knowledge (ATEM 3-9) is a newly developed measure which encompasses seven components of emotion knowledge in 3-9-year-olds. The ATEM 3-9 is an adaptive test which uses skip and dropout rules to adjust for children's varying levels of knowledge. In addition to German, the ATEM has been translated into English and Hebrew. The German norming sample of the ATEM 3-9 comprises N = 882 (54% female, 21% bilingual) children between the ages of 3 and 9 years, who were divided into seven age groups. Test items, which are ordered according to the item response theory, showed a good fit to a seven-dimensional model reflecting the seven components. The internal consistencies of the dimensions are acceptable to good. Construct validity was examined by means of correlations with other measures of emotion knowledge, as well as measures on language skills and executive functions in a subsample. This resulted in medium size correlations in the expected directions. In addition, children with externalizing and internalizing disorders who were recruited in psychiatric in- and outpatient clinics showed deficits in various components of emotion knowledge when compared to their agemates in the norming sample. Overall, the ATEM 3-9 is well suited to measure individual components of emotion knowledge in children and to obtain a differentiated picture of the various aspects of emotion knowledge. The ATEM 3-9 thus supports the investigation of the development of social-emotional competencies in normative development (e.g., school readiness) and in social-emotional-learning interventions. Furthermore, it is suitable as an instrument for the differentiated assessment of (progress of) children's emotion knowledge in clinical child psychology and psychiatry.

Review: Posed vs. Genuine Facial Emotion Recognition and Expression in Autism and Implications for Intervention

Different styles of social interaction are one of the core characteristics of autism spectrum disorder (ASD). Social differences among individuals with ASD often include difficulty in discerning the emotions of neurotypical people based on their facial expressions. This review first covers the rich body of literature studying differences in facial emotion recognition (FER) in those with ASD, including behavioral studies and neurological findings. In particular, we highlight subtle emotion recognition and various factors related to inconsistent findings in behavioral studies of FER in ASD. Then, we discuss the dual problem of FER – namely facial emotion expression (FEE) or the production of facial expressions of emotion. Despite being less studied, social interaction involves both the ability to recognize emotions and to produce appropriate facial expressions. How others perceive facial expressions of emotion in those with ASD has remained an under-researched area. Finally, we propose a method for teaching FER [FER teaching hierarchy (FERTH)] based on recent research investigating FER in ASD, considering the use of posed vs. genuine emotions and static vs. dynamic stimuli. We also propose two possible teaching approaches: (1) a standard method of teaching progressively from simple drawings and cartoon characters to more complex audio-visual video clips of genuine human expressions of emotion with context clues or (2) teaching in a field of images that includes posed and genuine emotions to improve generalizability before progressing to more complex audio-visual stimuli. Lastly, we advocate for autism interventionists to use FER stimuli developed primarily for research purposes to facilitate the incorporation of well-controlled stimuli to teach FER and bridge the gap between intervention and research in this area.

Explaining Variance in Social Symptoms of Children with Autism Spectrum Disorder

The social symptoms of autism spectrum disorder are likely influenced by multiple psychological processes, yet most previous studies have focused on a single social domain. In school-aged autistic children (n = 49), we compared the amount of variance in social symptoms uniquely explained by theory of mind (ToM), biological motion perception, empathy, social reward, and social anxiety. Parent-reported emotional contagion-the aspect of empathy in which one shares another's emotion-emerged as the most important predictor, explaining 11-14% of the variance in social symptoms, with higher levels of emotional contagion predicting lower social symptom severity. Our findings highlight the role of mutual emotional experiences in social-interactive success, as well as the limitations of standard measures of ToM and social processing in general.

Predictors in ASD: The Importance of Parents' Perception

Several predictors may influence children's developmental trajectories with Autism Spectrum Disorder (ASD), and parents' concerns may play an important role. This study aimed to investigate developmental trajectories of two groups of children with ASD to understand predictive factors, including parental perception. We examined the clinical features of a sample of 55 children with ASD at 3 and 6 years of age in two moments of evaluation to understand this process. We used the Autism Diagnostic Observation Schedule, (ADOS) in both moments. We selected two groups based on ADOS results at moment two: one group with a worse outcome (ADOS results above 8) and one group with a better outcome (ADOS results below 8 in the second moment). We also selected questions from a questionnaire (elaborated by the authors and used in clinical practice) applied to parents to understand if early parents' concerns may help to predict ASD prognosis. We found a significant association between imitation and playability and the child's prognostic. Also, Interactive Gestures, Beginning of Joint Attention, Reciprocity, and Pleasure in Interaction might help identify positive case evolution. Our findings are significant in early intervention program development, not only with direct intervention with the child but also including the parents' involvement in the intervention.

Eye Movements and Behavioural Responses to Gaze-Contingent Expressive Faces in Typically Developing Infants and Infant Siblings

Studies with infant siblings of children with Autism Spectrum Disorder have attempted to identify early markers for the disorder and suggest that autistic symptoms emerge between 12 and 24 months of age. Yet, a reliable first-year marker remains elusive. We propose that in order to establish first-year manifestations of this inherently social disorder, we need to develop research methods that are sufficiently socially demanding and realistically interactive. Building on Keemink et al. [2019, Developmental Psychology, 55, 1362-1371], we employed a gaze-contingent eye-tracking paradigm in which infants could interact with face stimuli. Infants could elicit emotional expressions (happiness, sadness, surprise, fear, disgust, anger) from on-screen faces by engaging in eye contact. We collected eye-tracking data and video-recorded behavioural response data from 122 (64 male, 58 female) typically developing infants and 31 infant siblings (17 male, 14 female) aged 6-, 9- and 12-months old. All infants demonstrated a significant Expression by AOI interaction (F(10, 1470) = 10.003, P < 0.001, ŋ_p ²  = 0.064). Infants' eye movements were "expression-specific" with infants distributing their fixations to AOIs differently per expression. Whereas eye movements provide no evidence of deviancies, behavioural response data show significant aberrancies in reciprocity for infant siblings. Infant siblings show reduced social responsiveness at the group level (F(1, 147) = 4.10, P = 0.042, ŋ_p ²  = 0.028) and individual level (Fischer's Exact, P = 0.032). We conclude that the gaze-contingency paradigm provides a realistically interactive experience capable of detecting deviancies in social responsiveness early, and we discuss our results in relation to subsequent infant sibling development. LAY SUMMARY: We investigated how infant siblings of children with autism spectrum disorder respond to interactive faces presented on a computer screen. Our study demonstrates that infant siblings are less responsive when interacting with faces on a computer screen (e.g., they smile and imitate less) in comparison to infants without an older sibling with autism. Reduced responsiveness within social interaction could potentially have implications for how parents and carers interact with these infants. Autism Res 2021, 14: 973-983. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

Emotion regulation, emotionality, and expression of emotions: A link between social skills, behavior, and emotion problems in children with ASD and their peers

This study aimed to investigate differences between emotion regulation (ER), emotionality, and expression of emotions in children with Autism Spectrum Disorder (ASD) and their typically developing (TD) peers; and to examine the potential links between these areas of development with social skills in both groups, as well as with behavioral, emotional, and social problems in ASD. Forty-four children (40 males and 4 females, ages 3 to 7 years) with ASD (n = 22) and their TD peers (n = 22) were included in this study. Mothers reported about their children's ASD symptoms, social, emotional, and behavioral functioning. As predicted, children with ASD were described as showing decreased ER, increased emotionality, and decreased expression of emotions when compared to their TD peers. Moreover, in the ASD group, increased social skills were associated with enhanced ER and increased expression of emotions; and in the TD group, increased social skills were correlated with decreased emotionality. Finally, enhanced ER was linked to decreased peer problems, and increased prosocial behaviors; and decreased emotionality was linked to decreased behavior and emotional problems in the ASD group. Implications for further research are discussed.

Altered neuronal habituation to hearing others' pain in adults with autistic traits

This study tested the hypothesis that autistic traits influence the neuronal habituation that underlies the processing of others' pain. Based on their autism-spectrum quotient (AQ), two groups of participants were classified according to their autistic traits: High-AQ and Low-AQ groups. Their event-related potentials in response to trains of three identical audio recordings, exhibiting either painful or neutral feelings of others, were compared during three experimental tasks. (1) In a Pain Judgment Task, participants were instructed to focus on pain-related cues in the presented audio recordings. (2) In a Gender Judgment Task, participants were instructed to focus on non-pain-related cues in the presented audio recordings. (3) In a Passive Listening Task, participants were instructed to passively listen. In the High-AQ group, an altered empathic pattern of habituation, indexed by frontal-central P2 responses of the second repeated painful audio recordings, was found during the Passive Listening Task. Nevertheless, both High-AQ and Low-AQ groups exhibited similar patterns of habituation to hearing others' voices, both neutral and painful, in the Pain Judgment and Gender Judgment Tasks. These results suggest altered empathic neuronal habituation in the passive processing of others' vocal pain by individuals with autistic traits.

Automated recognition of spontaneous facial expression in individuals with autism spectrum disorder: parsing response variability

BACKGROUND

Reduction or differences in facial expression are a core diagnostic feature of autism spectrum disorder (ASD), yet evidence regarding the extent of this discrepancy is limited and inconsistent. Use of automated facial expression detection technology enables accurate and efficient tracking of facial expressions that has potential to identify individual response differences.

METHODS

Children and adults with ASD (N = 124) and typically developing (TD, N = 41) were shown short clips of "funny videos." Using automated facial analysis software, we investigated differences between ASD and TD groups and within the ASD group in evidence of facial action unit (AU) activation related to the expression of positive facial expression, in particular, a smile.

RESULTS

Individuals with ASD on average showed less evidence of facial AUs (AU12, AU6) relating to positive facial expression, compared to the TD group (p < .05, r = - 0.17). Using Gaussian mixture model for clustering, we identified two distinct distributions within the ASD group, which were then compared to the TD group. One subgroup (n = 35), termed "over-responsive," expressed more intense positive facial expressions in response to the videos than the TD group (p < .001, r = 0.31). The second subgroup (n = 89), ("under-responsive"), displayed fewer, less intense positive facial expressions in response to videos than the TD group (p < .001; r = - 0.36). The over-responsive subgroup differed from the under-responsive subgroup in age and caregiver-reported impulsivity (p < .05, r = 0.21). Reduced expression in the under-responsive, but not the over-responsive group, was related to caregiver-reported social withdrawal (p < .01, r = - 0.3).

LIMITATIONS

This exploratory study does not account for multiple comparisons, and future work will have to ascertain the strength and reproducibility of all results. Reduced displays of positive facial expressions do not mean individuals with ASD do not experience positive emotions.

CONCLUSIONS

Individuals with ASD differed from the TD group in their facial expressions of positive emotion in response to "funny videos." Identification of subgroups based on response may help in parsing heterogeneity in ASD and enable targeting of treatment based on subtypes.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02299700. Registration date: November 24, 2014.

Emotion regulation: A treatment target for autism spectrum disorder

Individuals with autism spectrum disorder (ASD) tend to experience difficulties with emotion regulation (ER). Treatments designed to address ER difficulties in individuals with ASD are emerging. The authors review cognitive-behavioral therapy (CBT) and mindfulness-based treatments that have focused on ER difficulties in youth and young adults with ASD. In general, these treatments addressing ER skills have included awareness of emotions/psychoeducation about emotions, frustration tolerance, and ER skills, as well as practice and use of these skills during group therapy that sometimes includes caregivers. The results from these interventions are encouraging for individuals with high-functioning ASD because ER skills tend to improve following treatment. The inclusion of ER in other ASD treatments is discussed.

Peer's pragmatic language outcomes following a peer-mediated intervention for children with autism: A randomised controlled trial

BACKGROUND

Peer-mediated pragmatic language interventions can be of benefit to children with autism as they simultaneously target an individual child's pragmatic language skills and contextual factors related to social interactions. However, little is known about peer outcomes following peer-mediated interventions.

AIMS

This study evaluated the pragmatic language outcomes for typically-developing (TD) playmates who participated in a peer-mediated intervention for children with autism.

METHODS

Dyads (child with autism and TD-playmate; n = 71) were randomised to a treatment-first or waitlisted-first comparison group. Dyads attended 10 clinic play-sessions with a therapist and parents mediated home-practice. The Pragmatics Observational Measure 2nd edition (POM-2), and Social Emotional Evaluation (SEE) evaluated pragmatics before, after and 3-months following the intervention.

RESULTS

Changes in both outcomes measures were equivalent for intervention-first and waitlisted TD-playmates, but all TD-playmates made significant gains in pragmatics following the intervention. Treatment effects maintained for 3-months (p < 0.001-0.014, d = 0.22-0.63), were equivalent in different environments (clinic and home). Peer relationship type and therapist profession mediated POM-2 scores across the study, while expressive language ability moderated SEE scores.

CONCLUSIONS

This peer-mediated intervention had a positive impact on TD-playmate's pragmatic language capacity and performance.

Positive Aspects of Emotional Competence in Preventing Internalizing Symptoms in Children with and without Developmental Language Disorder: A Longitudinal Approach

In order to better understand protective factors for internalizing problems, this longitudinal study examined positive emotions, emotion awareness and (non-)emotional communication skills in relation to somatic complaints and social anxiety in children with (N = 104) and without (N = 183) Developmental Language Disorder (DLD) using self-reported measures twice with a 9-month interval. Additionally, parents reported on their child’s communication problems and emotion communication at Time 1. Most importantly, since we found that increasing levels of emotion awareness related to decreases in social anxiety and somatic complaints in children with and without DLD, we conclude that children with DLD are likely to benefit from interventions aimed at improving their emotion awareness in addition to language interventions.

Cross-modal emotion recognition and autism-like traits in typically developing children

The ability to explicitly recognize emotions develops gradually throughout childhood, and children usually have greater difficulty in recognizing emotions from the voice than from the face. However, little is known about how children integrate vocal and facial cues to recognize an emotion, particularly during mid to late childhood. Furthermore, children with an autism spectrum disorder often show a reduced ability to recognize emotions, especially when integrating emotion from multiple modalities. The current preliminary study explored the ability of typically developing children aged 7-9 years to match emotional tones of voice to facial expressions and whether this ability varies according to the level of autism-like traits. Overall, children were the least accurate when matching happy and fearful voices to faces, commonly pairing happy voices with angry faces and fearful voices with sad faces. However, the level of autism-like traits was not associated with matching accuracy. These results suggest that 7- to 9-year-old children have difficulty in integrating vocal and facial emotional expressions but that differences in cross-modal emotion matching in relation to the broader autism phenotype are not evident in this task for this age group with the current sample.

A Randomized Controlled Trial of a Play-Based, Peer-Mediated Pragmatic Language Intervention for Children With Autism

PURPOSE

This randomized controlled trial evaluated the effectiveness of a play-based pragmatic language intervention for children with autism.

METHODS

A sample of 71 children with autism were randomized to an intervention-first group (n = 28 analyzed) or waitlist-first (n = 34 analyzed) group. Children attended 10, weekly clinic play-sessions with a typically developing peer, and parents mediated practice components at home. The Pragmatics Observational Measure (POM-2) and the Social Emotional Evaluation (SEE) evaluated pragmatics before, after and 3-months following the intervention.

RESULTS

POM-2 gains were greatest for intervention-first participants (p = 0.031, d = 0.57). Treatment effects were maintained at 3-month follow-up (p < 0.001-0.05, d = 0.49-0.64). POM-2 scores were not significantly different in the clinic and home settings at follow-up.

CONCLUSION

Findings support the combination of play, peer-mediation, video-feedback and parent training to enhance pragmatic language in children with autism.

Effects of Prosodic and Semantic Cues on Facial Emotion Recognition in Relation to Autism-Like Traits

The current study investigated whether those with higher levels of autism-like traits process emotional information from speech differently to those with lower levels of autism-like traits. Neurotypical adults completed the autism-spectrum quotient and an emotional priming task. Vocal primes with varied emotional prosody, semantics, or a combination, preceded emotional target faces. Prime-target pairs were congruent or incongruent in their emotional content. Overall, congruency effects were found for combined prosody-semantic primes, however no congruency effects were found for semantic or prosodic primes alone. Further, those with higher levels of autism-like traits were not influenced by the prime stimuli. These results suggest that failure to integrate emotional information across modalities may be characteristic of the broader autism phenotype.

Top-down Effects on Empathy for Pain in Adults with Autistic Traits

While empathic responses of individuals with autism-spectrum disorder have been reported to be modulated by top-down attention, it remains unclear whether empathy for pain in typically developing individuals with autistic traits also involves such top-down modulation mechanisms. This study employed the autism-spectrum quotient (AQ) to quantify autistic traits in a group of 1,231 healthy adults. Two subset groups (High-AQ and Low-AQ groups) were randomly selected from the highest and lowest 10% AQ scores respectively. We explored whether participants in both groups would differ in their response to others’ pain when their attention was directed toward (A-P tasks) or away (A-N tasks) from pain cues in auditory and visual experimental modalities. Compared to Low-AQ individuals, High-AQ individuals exhibited more suppressed N1 and P2 amplitudes in response to painful vocal cues in auditory A-N tasks. This suggests suppressed attentional and emotional processes of empathy for pain when High-AQ individuals have their attention directed away from others’ pain cues. No significant difference was found between both groups in the auditory A-P task, nor in the visual A-P and A-N tasks. These results suggest that top-down attention modulation of cortical empathic responses to others’ vocal pain is influenced by autistic traits.

Automatic Recognition of Posed Facial Expression of Emotion in Individuals with Autism Spectrum Disorder

Facial expression is impaired in autism spectrum disorder (ASD), but rarely systematically studied. We focus on the ability of individuals with ASD to produce facial expressions of emotions in response to a verbal prompt. We used the Janssen Autism Knowledge Engine (JAKE^®), including automated facial expression analysis software (FACET) to measure facial expressions in individuals with ASD (n = 144) and a typically developing (TD) comparison group (n = 41). Differences in ability to produce facial expressions were observed between ASD and TD groups, demonstrated by activation of facial action units (happy, scared, surprised, disgusted, but not angry or sad). Activation of facial action units correlated with parent-reported social communication skills. This approach has potential for diagnostic and response to intervention measures.Trial Registration NCT02299700.

Investigating alexithymia in autism: A systematic review and meta-analysis

BACKGROUND

New research suggests that, rather than representing a core feature of autism spectrum disorder (ASD), emotional processing difficulties reflect co-occurring alexithymia. Autistic individuals with alexithymia could therefore represent a specific subgroup of autism who may benefit from tailored interventions. The aim of this systematic review and meta-analysis was to explore the nature and prevalence of alexithymia in autism using the Toronto Alexithymia Scale (TAS).

METHODS

Online scientific databases were searched systematically for studies on ASD popu lations using the TAS. Meta-analyses were performed to evaluate differences in scores between the ASD and neurotypical groups, and to determine the prevalence of alexithymia in these populations.

RESULTS

15 articles comparing autistic and neurotypical (NT) groups were identified. Autistic people scored significantly higher on all scores compared to the NT group. There was also a higher prevalence of alexithymia in the ASD group (49.93% compared to 4.89%), with a significantly increased risk of alexithymia in autistic participants.

CONCLUSIONS

This review highlights that alexithymia is common, rather than universal, in ASD, supporting a growing body of evidence that co-occurring autism and alexithymia represents a specific subgroup in the ASD population that may have specific clinical needs. More research is needed to understand the nature and implications of co-occurring ASD and alexithymia.

Intact counterfactual emotion processing in autism spectrum disorder: Evidence from eye-tracking

Counterfactual emotions, such as regret and relief, require an awareness of how things could have been different. We report a preregistered experiment that examines how adults with and without ASD process counterfactual emotions in real-time, based on research showing that the developmental trajectory of counterfactual thinking may be disrupted in people with ASD. Participants were eye-tracked as they read narratives in which a character made an explicit decision then subsequently experienced either a mildly negative or positive outcome. The final sentence in each story included an explicit remark about the character's mood that was either consistent or inconsistent with the character's expected feelings of regret or relief (e.g., "… she feels happy/annoyed about her decision."). Results showed that adults with ASD are unimpaired in processing emotions based on counterfactual reasoning, and in fact showed earlier sensitivity to inconsistencies within relief contexts compared to TD participants. This finding highlights a previously unknown strength in empathy and emotion processing in adults with ASD, which may have been masked in previous research that has typically relied on explicit, response-based measures to record emotional inferences, which are likely to be susceptible to demand characteristics and response biases. Therefore, this study highlights the value of employing implicit measures that provide insights on peoples' immediate responses to emotional content without disrupting ongoing processing. Autism Res 2019, 12: 422-444 © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Despite known difficulties with empathy and perspective-taking, we found that adults with autism are unimpaired at inferring complex emotions (regret and relief) in others. This finding extends existing evidence showing dysfunctional counterfactual thinking in children with autism. We highlight the value of using implicit measures to identify strengths and abilities in ASD that may be masked by explicit tasks that require participants to interact socially or report their own thoughts.

The games they play: Observations of children with autism spectrum disorder on the school playground

The playground may be an important context to examine the social functioning of children with autism spectrum disorder. Previous literature on playground peer engagement has used quantitative methods, but there is limited research using qualitative observations to understand the nuances of playground behavior. Using a mixed-methods approach, 55 elementary school-aged children with autism spectrum disorder who are primarily included in general education settings were observed on the school playground using the Playground Observation of Peer Engagement. Quantitative and qualitative data were examined using a mixed-methods approach. The results showed that children with autism spectrum disorder: engage in solitary and peripheral activities; demonstrate appropriate initiations and responses to peers; display self-stimulatory, motoric behaviors most frequently during solitary activities; and often have neutral affect on the playground. These findings suggest that intervention and supports for children with autism spectrum disorder may be important to deliver at recess to address peer engagement.

Facial Expression Production in Autism: A Meta-Analysis

This meta-analysis summarized studies that examined group differences on the production of facial expressions in participants with ASD compared to typically developing or nonautistic clinical comparison groups. The overall summary effect from 67 effect sizes representing the average ASD-comparison group differences in facial expressions was -0.481, indicating a moderate effect size. We conducted subgroup analyses to group effect sizes according to separate facial expression abilities identified in the literature. These analyses revealed that participants with ASD display facial expressions less frequently and for less amount of time, and they are less likely to share facial expressions with others or automatically mimic the expressions of real faces or face stimuli. Their facial expressions are also judged to be lower in quality and are expressed less accurately. However, participants with ASD do not express emotions less intensely, nor is their reaction time of expression onset slower in response to odors, startling sensations, or in response to face stimuli in mimicry studies. ASD-comparison group differences were moderated by matching procedures, age, and intellectual functioning of the ASD participants suggesting that persons with higher IQ and larger number of accumulated life experiences are better able to produce facial expressions that are more consistent with "neurotypical" norms. Group differences were also stronger for "covertly elicited" than "explicitly elicited" facial expressions suggesting individuals with ASD may naturally produce facial expressions differently from other populations, but are less impaired in expressing emotions typically when prompted to do so in a laboratory setting. Autism Research 2018, 11: 1586-1601. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We reviewed studies that compared facial expressions in people with and without autism. Results revealed that facial expressions of people with autism are atypical in appearance and quality and are used atypically to regulate social interactions. The magnitude of these differences was influenced by participant characteristics (e.g. age and intellectual functioning), and by how facial expressions were measured and analyzed in various studies.

I Think We're Alone Now: Solitary Social Behaviors in Adolescents with Autism Spectrum Disorder

Research into emotional responsiveness in Autism Spectrum Disorder (ASD) has yielded mixed findings. Some studies report uniform, flat and emotionless expressions in ASD; others describe highly variable expressions that are as or even more intense than those of typically developing (TD) individuals. Variability in findings is likely due to differences in study design: some studies have examined posed (i.e., not spontaneous expressions) and others have examined spontaneous expressions in social contexts, during which individuals with ASD-by nature of the disorder-are likely to behave differently than their TD peers. To determine whether (and how) spontaneous facial expressions and other emotional responses are different from TD individuals, we video-recorded the spontaneous responses of children and adolescents with and without ASD (between the ages of 10 and 17 years) as they watched emotionally evocative videos in a non-social context. Researchers coded facial expressions for intensity, and noted the presence of laughter and other responsive vocalizations. Adolescents with ASD displayed more intense, frequent and varied spontaneous facial expressions than their TD peers. They also produced significantly more emotional vocalizations, including laughter. Individuals with ASD may display their emotions more frequently and more intensely than TD individuals when they are unencumbered by social pressure. Differences in the interpretation of the social setting and/or understanding of emotional display rules may also contribute to differences in emotional behaviors between groups.

Children with autism can express social emotions in their drawings

OBJECTIVES

The study aimed to examine the ability of children with an Autism Spectrum Condition (ASC) to depict social (pride and shame) vs. basic (happiness and sadness) emotions in their human figure drawings.

METHODS

Eleven children with a formal diagnosis of an ASC matched on gender and verbal mental age with 11 children with typical development (TD) participated in a series of tasks examining their emotional understanding, as well as their ability to depict a person experiencing the emotions under investigation and a person with no emotions. Drawings were assessed for their overall emotional expressiveness and the types of graphic cues employed to express emotions.

RESULTS

Results showed that children with ASC produced less expressive drawings of basic emotions than their controls. However, they did not differ from the control group in their overall expressiveness in drawing social emotions, despite their reduced performance in tasks assessing understanding of social emotions. Additionally, children with ASC used significantly less graphic cues to depict emotions than children with TD, while some qualitative differences between the two groups were observed.

CONCLUSION

The study underlines the value of drawing as a tool to investigate emotion understanding in children with ASC.

Production and perception of emotional prosody by adults with autism spectrum disorder

This study examined production and perception of affective prosody by adults with autism spectrum disorder (ASD). Previous research has reported increased pitch variability in talkers with ASD compared to typically developing (TD) controls in grammatical speaking tasks (e.g., comparing interrogative vs. declarative sentences), but it is unclear whether this pattern extends to emotional speech. In this study, speech recordings in five emotion contexts (angry, happy, interested, sad, and neutral) were obtained from 15 adult males with ASD and 15 controls (Experiment 1), and were later presented to 52 listeners (22 with ASD) who were asked to identify the emotion expressed and rate the level of naturalness of the emotion in each recording (Experiment 2). Compared to the TD group, talkers with ASD produced phrases with greater intensity, longer durations, and increased pitch range for all emotions except neutral, suggesting that their greater pitch variability was specific to emotional contexts. When asked to identify emotion from speech, both groups of listeners were more accurate at identifying the emotion context from speech produced by ASD speakers compared to TD speakers, but rated ASD emotional speech as sounding less natural. Collectively, these results reveal differences in emotional speech production in talkers with ASD that provide an acoustic basis for reported perceptions of oddness in the speech presentation of adults with ASD. Autism Res 2017, 10: 1991-2001. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

This study examined emotional speech communication produced and perceived by adults with autism spectrum disorder (ASD) and typically-developing (TD) controls. Compared to the TD group, talkers with ASD produced emotional phrases that were louder, longer, and more variable in pitch. Both ASD and TD listeners were more accurate at identifying emotion in speech produced by ASD speakers compared to TD speakers, but rated ASD emotional speech as sounding less natural.

Brief Report: Empathic Responsiveness of High Functioning Children with Autism to Expressed and Anticipated Distress

The majority of studies that have investigated empathic responsiveness of individuals with Autism spectrum disorder (ASD) have used heterogeneous groups in terms of age, cognitive level and gender which significantly impact the results. Our aim in this study was to explore responsiveness of a more homogenous sample of 21 children with ASD and 17 typically developing controls, aged 8-12 years to both overt (or expressed) and anticipated distress. In the anticipated distress task, groups were not differentiated in their response towards the experimenter who had her drawing torn. In the expressed distress task, groups were again similar in expressing concern and acting prosocially towards an experimenter who pretended to lose her watch. The theoretical and clinical implications of these findings are discussed.

Discrepancies between self- and adult-perceptions of social competence in children with neuropsychiatric disorders

BACKGROUND

The present study examines discrepancies between self- and adult-perceptions of social competence in children with attention deficit-hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and possible co-morbid disruptive behaviour disorders (DBD).

METHOD

Self-reported questionnaires were collected from multiple informants at the baseline of a multi-systemic family intervention programme for children (aged 5-12) with ADHD, ASD and possible co-morbid DBD. In total, out of the 154 families eligible for the study, information was received concerning children from 124 families (children n = 121; mothers n = 117; fathers n = 86; teachers n = 97). In addition to this, a comparison community sample of 318 school-aged children (approximately 10 years old) was utilized to examine the perceptions of children's social competence across intervention and population groups in more detail.

RESULTS

Children's self-perceptions in the prosocial dimension of social competence (i.e. cooperating skills, empathy) did not differ between the intervention and comparison groups. Interestingly, the children in the intervention sample expressed more impulsivity and disruptiveness - the antisocial dimension of social competence - when compared with the children in the comparison sample. Adult ratings demonstrated that mothers, fathers and teachers reported decreased prosocial behaviour and increased antisocial behaviour across overall dimensions and sub-dimensions when compared with adults' ratings of elementary school children. Informant discrepancies between self-ratings and adult ratings across intervention groups yielded significant effect sizes (eta-squared) across all domains of social competence ranging from .09 to .25.

CONCLUSION

Children's positive self-ratings of social competence relative to adult ratings increased within intervention sample when compared with population sample. The intervention sample children appeared to acknowledge their social competence deficits, yet self-perceptions were inflated relative to adult ratings when focusing on peer relationship difficulties, particularly, aggression to peers.

Neural mechanisms underlying valence inferences to sound: The role of the right angular gyrus

We frequently infer others' intentions based on non-verbal auditory cues. Although the brain underpinnings of social cognition have been extensively studied, no empirical work has yet examined the impact of musical structure manipulation on the neural processing of emotional valence during mental state inferences. We used a novel sound-based theory-of-mind paradigm in which participants categorized stimuli of different sensory dissonance level in terms of positive/negative valence. Whilst consistent with previous studies which propose facilitated encoding of consonances, our results demonstrated that distinct levels of consonance/dissonance elicited differential influences on the right angular gyrus, an area implicated in mental state attribution and attention reorienting processes. Functional and effective connectivity analyses further showed that consonances modulated a specific inhibitory interaction from associative memory to mental state attribution substrates. Following evidence suggesting that individuals with autism may process social affective cues differently, we assessed the relationship between participants' task performance and self-reported autistic traits in clinically typical adults. Higher scores on the social cognition scales of the AQ were associated with deficits in recognising positive valence in consonant sound cues. These findings are discussed with respect to Bayesian perspectives on autistic perception, which highlight a functional failure to optimize precision in relation to prior beliefs.

Autism in Action: Reduced Bodily Connectedness during Social Interactions?

Autism is a lifelong disorder, defined by deficits in social interactions and flexibility. To date, diagnostic markers for autism primarily include limitations in social behavior and cognition. However, such tests have often shown to be inadequate for individuals with autism who are either more cognitively able or intellectually disabled. The assessment of the social limitations of autism would benefit from new tests that capture the dynamics of social initiative and reciprocity in interaction processes, and that are not dependent on intellectual or verbal skills. New entry points for the development of such assessments may be found in ‘bodily connectedness’, the attunement of bodily movement between two individuals. In typical development, bodily connectedness is related to psychological connectedness, including social skills and relation quality. Limitations in bodily connectedness could be a central mechanism underlying the social impairment in autism. While bodily connectedness can be minutely assessed with advanced techniques, our understanding of these skills in autism is limited. This Perspective provides examples of how the potential relation between bodily connectedness and specific characteristics of autism can be examined using methods from the coordination dynamics approach. Uncovering this relation is particularly important for developing sensitive tools to assess the tendency to initiate social interactions and the dynamics of mutual adjustments during social interactions, as current assessments are not suited to grasp ongoing dynamics and reciprocity in behavior. The outcomes of such research may yield valuable openings for the development of diagnostic markers for autism that can be applied across the lifespan.

Autism, attachment, and social learning: Three challenges and a way forward

We explore three challenges that Autism Spectrum Disorder (ASD) poses to our understanding of the processes underlying early attachment. First, while caregiver-infant attachment and later social-affiliative behavior share common biobehavioral mechanisms, individuals with ASD are able to form secure attachment relationships, despite reduced social-emotional reciprocity and motivation for social interaction. Therefore, disruptions in social affiliation mechanisms can co-exist with secure caregiver-infant bonding. Second, while early attachment quality is associated with later social outcomes in typical development, interventions targeting caregiver-child interaction in ASD often show positive effects on parental responsivity and attachment quality, but not on child social behavior. Therefore, improvements in parent-child bonding do not necessarily result in improvements in social functioning in ASD. Third, individuals with ASD show normative brain activity and selective social affiliative behaviors in response to people that they know but not to unfamiliar people. We propose a conceptual framework to reformulate and address these three theoretical impasses posed by ASD, arguing that the dissociable pathways of child-parent bonding and social development in ASD are shaped by (1) a dissociation between externally-driven and internally-driven attachment responses and (2) atypical learning dynamics occurring during child-caregiver bonding episodes, which are governed by and influence social-affiliation motives and other operant contingencies.

Evaluating posed and evoked facial expressions of emotion from adults with autism spectrum disorder

Though many studies have examined facial affect perception by individuals with autism spectrum disorder (ASD), little research has investigated how facial expressivity in ASD is perceived by others. Here, naïve female observers (n = 38) judged the intensity, naturalness and emotional category of expressions produced by adults with ASD (n = 6) and typically developing (TD) adults (n = 6) in both a posed condition and an evoked condition in which emotions were naturalistically elicited and validated. ASD expressions were rated as more intense and less natural than TD expressions but contrary to prediction were identified with greater accuracy, an effect driven primarily by angry expressions. Naturalness ratings of evoked expressions were positively associated with identification accuracy for TD but not ASD individuals. Collectively, these findings highlight differences, but not a reduction, in facial expressivity in ASD that do not hinder emotion recognition accuracy but may affect social interaction quality.

Children with autism spectrum disorder are skilled at reading emotion body language

Autism is commonly believed to impair the ability to perceive emotions, yet empirical evidence is mixed. Because face processing may be difficult for those with autism spectrum disorder (ASD), we developed a novel test of recognizing emotion via static body postures (Body-Emotion test) and evaluated it with children aged 5 to 12 years in two studies. In Study 1, 34 children with ASD and 41 typically developing (TD) controls matched for age and verbal intelligence (VIQ [verbal IQ]) were tested on (a) our new Body-Emotion test, (b) a widely used test of emotion recognition using photos of eyes as stimuli (Baron-Cohen et al.'s "Reading Mind in the Eyes: Child" or RMEC [Journal of Developmental and Learning Disorders, 2001, Vol. 5, pp. 47-78]), (c) a well-validated theory of mind (ToM) battery, and (d) a teacher-rated empathy scale. In Study 2 (33 children with ASD and 31 TD controls), the RMEC test was simplified to the six basic human emotions. Results of both studies showed that children with ASD performed as well as their TD peers on the Body-Emotion test. Yet TD children outperformed the ASD group on ToM and on both the standard RMEC test and the simplified version. VIQ was not related to perceiving emotions via either body posture or eyes for either group. However, recognizing emotions from body posture was correlated with ToM, especially for children with ASD. Finally, reading emotions from body posture was easier than reading emotions from eyes for both groups.

Can Neurotypical Individuals Read Autistic Facial Expressions? Atypical Production of Emotional Facial Expressions in Autism Spectrum Disorders

The difficulties encountered by individuals with autism spectrum disorder (ASD) when interacting with neurotypical (NT, i.e. nonautistic) individuals are usually attributed to failure to recognize the emotions and mental states of their NT interaction partner. It is also possible, however, that at least some of the difficulty is due to a failure of NT individuals to read the mental and emotional states of ASD interaction partners. Previous research has frequently observed deficits of typical facial emotion recognition in individuals with ASD, suggesting atypical representations of emotional expressions. Relatively little research, however, has investigated the ability of individuals with ASD to produce recognizable emotional expressions, and thus, whether NT individuals can recognize autistic emotional expressions. The few studies which have investigated this have used only NT observers, making it impossible to determine whether atypical representations are shared among individuals with ASD, or idiosyncratic. This study investigated NT and ASD participants' ability to recognize emotional expressions produced by NT and ASD posers. Three posing conditions were included, to determine whether potential group differences are due to atypical cognitive representations of emotion, impaired understanding of the communicative value of expressions, or poor proprioceptive feedback. Results indicated that ASD expressions were recognized less well than NT expressions, and that this is likely due to a genuine deficit in the representation of typical emotional expressions in this population. Further, ASD expressions were equally poorly recognized by NT individuals and those with ASD, implicating idiosyncratic, rather than common, atypical representations of emotional expressions in ASD.

Mothering, fathering, and the regulation of negative and positive emotions in high-functioning preschoolers with autism spectrum disorder

BACKGROUND

Children with autism spectrum disorder (ASD) exhibit difficulties in regulating emotions and authors have called to study the specific processes underpinning emotion regulation (ER) in ASD. Yet, little observational research examined the strategies preschoolers with ASD use to regulate negative and positive emotions in the presence of their mothers and fathers.

METHODS

Forty preschoolers with ASD and 40 matched typically developing children and their mothers and fathers participated. Families were visited twice for identical battery of paradigms with mother or father. Parent-child interactions were coded for parent and child behaviors and children engaged in ER paradigms eliciting negative (fear) and positive (joy) emotions with each parent. ER paradigms were microcoded for negative and positive emotionality, ER strategies, and parent regulation facilitation.

RESULTS

During free play, mothers' and fathers' sensitivity and warm discipline were comparable across groups; however, children with ASD displayed lower positive engagement and higher withdrawal. During ER paradigms, children with ASD expressed less positive emotionality overall and more negative emotionality during fear with father. Children with ASD used more simple self-regulatory strategies, particularly during fear, but expressed comparable levels of assistance seeking behavior toward mother and father in negative and positive contexts. Parents of children with ASD used less complex regulation facilitation strategies, including cognitive reappraisal and emotional reframing, and employed simple tactics, such as physical comforting to manage fear and social gaze to maintain joy.

CONCLUSION

Findings describe general and parent- and emotion-specific processes of child ER and parent regulation facilitation in preschoolers with ASD. Results underscore the ability of such children to seek parental assistance during moments of high arousal and the parents' sensitive adaptation to their children's needs. Reduced positive emotionality, rather than increased negative reactivity and self-regulatory efforts, emerges as the consistent element associated with ER processes in this group.