Measuring change in facial emotion recognition in individuals with autism spectrum disorder: A systematic review.

LAY ABSTRACT: Children and adults with autism spectrum disorder show difficulty recognizing facial emotions in others, which makes social interaction challenging. While there are many treatments developed to improve facial emotion recognition, there is no agreement on the best way to measure such abilities in individuals with autism spectrum disorder. The purpose of this review is to examine studies that were published between January 1998 and November 2019 and have measured change in facial emotion recognition to evaluate the effectiveness of different treatments. Our search yielded 65 studies, and within these studies, 36 different measures were used to evaluate facial emotion recognition in individuals with autism spectrum disorder. Only six of these measures, however, were used in different studies and by different investigators. In this review, we summarize the different measures and outcomes of the studies, in order to identify promising assessment tools and inform future research.

Attentional control mediates fearful responding to an ecologically valid stressor.

BACKGROUND AND OBJECTIVES: Attentional control (AC) is defined as the ability to voluntarily shift and disengage attention and is thought to moderate the relationship between preexisting risk factors for fear and the actual experience of fear. DESIGN: This longitudinal study elaborates on current models of AC by examining whether AC moderates or mediates effects of an ecologically valid stressor (a college examination) and also whether AC is predictive of state-like fear over longer timescales than previously reported. METHODS: Based on previous findings, we hypothesized that AC would moderate the relationship between trait anxiety and affective distress in response to the examination stressor. We also tested a competing mediational model based on AC theory. These models were tested in two separate samples (sample 1, N = 219; sample 2, N = 129; Total N = 348) at two time points, at the beginning of a college semester in a large undergraduate class and 5 minutes prior to a college examination. RESULTS: Mediation but not moderation of anxiety by AC was supported in both samples using multiple dependent measures. CONCLUSIONS: We conclude that AC may be useful in predicting affective distress in naturalistic settings, particularly in cases where anxiety is anticipatory.

The Role of Perspective-Taking on Ability to Recognize Fear.

Impairment in the ability to detect certain emotions, such as fear, is linked to multiple disorders and follows a pattern of inter-individual variability and intra-individual stability over time. Deficits in fear recognition are often related to social and interpersonal difficulties but the mechanisms by which this processing deficit might occur are not well understood. One potential mechanism through which impaired fear detection may influence social competency is through diminished perspective-taking, the ability to perceive and consider the point of view of another individual. In the current study, we hypothesized that intra-individual variability in the accuracy of facial emotion recognition is linked to perspective-taking abilities in a well-characterized, non-clinical adult sample. Results indicated that the ability to accurately detect fear in the faces of others was positively correlated with perspective-taking, consistent with initial hypotheses. This relationship appeared to be unique to recognition of fear, as perspective-taking was not significantly associated with recognition of the other basic emotions. Results from this study represent an initial step towards establishing a potential mechanism between some processes of FER and perspective-taking difficulties. It is important to establish the relationship between these processes in a non-clinical adult sample so that we can consider the possibility of a developmental or pathological influence of impoverished perspective-taking on fear perception.

Validation of the NIMH-ChEFS adolescent face stimulus set in an adolescent, parent, and health professional sample.

Attention to faces is a fundamental psychological process in humans, with atypical attention to faces noted across several clinical disorders. Although many clinical disorders onset in adolescence, there is a lack of well-validated stimulus sets containing adolescent faces available for experimental use. Further, the images comprising most available sets are not controlled for high- and low-level visual properties. Here, we present a cross-site validation of the National Institute of Mental Health Child Emotional Faces Picture Set (NIMH-ChEFS), comprised of 257 photographs of adolescent faces displaying angry, fearful, happy, sad, and neutral expressions. All of the direct facial images from the NIMH-ChEFS set were adjusted in terms of location of facial features and standardized for luminance, size, and smoothness. Although overall agreement between raters in this study and the original development-site raters was high (89.52%), this differed by group such that agreement was lower for adolescents relative to mental health professionals in the current study. These results suggest that future research using this face set or others of adolescent/child faces should base comparisons on similarly-aged validation data. Copyright © 2015 John Wiley & Sons, Ltd.

Neural Mechanisms of Emotion Regulation in Autism Spectrum Disorder.

Autism spectrum disorder (ASD) is characterized by high rates of comorbid internalizing and externalizing disorders. One mechanistic account of these comorbidities is that ASD is characterized by impaired emotion regulation (ER) that results in deficits modulating emotional responses. We assessed neural activation during cognitive reappraisal of faces in high functioning adults with ASD. Groups did not differ in looking time, pupilometry, or subjective ratings of faces during reappraisal. However, instructions to increase positive and negative emotional responses resulted in less increase in nucleus accumbens and amygdala activations (respectively) in the ASD group, and both regulation instructions resulted in less change in dorsolateral prefrontal cortex activation in the ASD group. Results suggest a potential mechanistic account of impaired ER in ASD.

Attentional control moderates fearful responding to a 35% CO(2) challenge.

Attentional control (AC) is an individual difference variable indexing the ability to voluntarily focus attention and shift attention when desired. AC is thought to impact the experience of fear by facilitating the disengagement of attention from threat and promoting the deployment of attentional resources toward regulatory or coping strategies. Whereas previous research has focused on visual threat cues, in the current study we examined whether this model also applies to interoceptive threat by evaluating the extent to which individual differences in AC moderated the relationship between trait anxiety and self-reported fear in response to a single vital capacity inhalation of a 35% CO(2), 65% balanced O(2) gas mixture. The sample comprised a large nonclinical group of young adults (N=128). Results indicated that AC moderated the relationship between trait anxiety and fearful responding to the challenge. Findings suggest that AC plays a significant and clinically important role in modulating self-reported fear.

Reward circuitry function in autism during face anticipation and outcomes.

The aim of this study was to investigate reward circuitry responses in autism during reward anticipation and outcomes for monetary and social rewards. During monetary anticipation, participants with autism spectrum disorders (ASDs) showed hypoactivation in right nucleus accumbens and hyperactivation in right hippocampus, whereas during monetary outcomes, participants with ASDs showed hyperactivation in left midfrontal and anterior cingulate gyrus. Groups did not differ in nucleus accumbens responses to faces. The ASD group demonstrated hyperactivation in bilateral amygdala during face anticipation that predicted social symptom severity and in bilateral insular cortex during face outcomes. These results add to the growing body of evidence that autism is characterized by altered functioning of reward circuitry. Additionally, atypical amygdala activation during the processing of social rewards may contribute to the development or expression of autistic features.

The latent structure of dietary restraint, body dissatisfaction, and drive for thinness: a series of taxometric analyses.

Although the latent structure of various eating disorders has been explored in previous studies, no published studies have examined the latent structure of theoretically relevant variables that have been shown to cut across eating disorder diagnoses. The current study examined 3 such variables (dietary restraint, body dissatisfaction, and drive for thinness) among undergraduate women using the taxometric method. The 5 items from the Eating Disorders Examination Questionnaire's Dietary Restraint subscale were used as dietary restraint indicators, whereas items from the Eating Disorders Inventory Body Dissatisfaction and Drive for Thinness subscales were used as indicators of body dissatisfaction and drive for thinness, respectively. As hypothesized, MAXCOV (maximum covariance) and MAMBAC (mean above minus below a cut) analyses suggested that all 3 variables are dimensional; therefore, individuals with high levels of reported dietary restraint, body dissatisfaction, and drive for thinness appear to differ in degree, but not in kind, from those with lower levels. Implications for prevention, assessment, classification, and treatment are discussed.

A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders.

To examine race-ethnic differences in the lifetime prevalence rates of common anxiety disorders, we examined data from the Collaborative Psychiatric Epidemiology Studies. The samples included 6870 White Americans, 4598 African Americans, 3615 Hispanic Americans, and 1628 Asian Americans. White Americans were more likely to be diagnosed with social anxiety disorder, generalized anxiety disorder, and panic disorder than African Americans, Hispanic Americans, and Asian Americans. African Americans more frequently met criteria for post-traumatic stress disorder (PTSD) than White Americans, Hispanic Americans, and Asian Americans. Asian Americans were also less likely to meet the diagnoses for generalized anxiety disorder and PTSD than Hispanic Americans, and were less likely to receive social anxiety disorder, generalized anxiety disorder, panic disorder, and PTSD diagnoses than White Americans. The results suggest that race and ethnicity need to be considered when assigning an anxiety disorder diagnosis. Possible reasons for the observed differences in prevalence rates between racial groups are discussed.

Temporal and structural dynamics of anxiety sensitivity in predicting fearful responding to a 35% CO2 challenge.

The current study assessed the incremental prediction of anxiety sensitivity (AS) in both taxonic (categorical) and dimensional representations at various time points before and after a single vital capacity inhalation of a 35% CO(2), 65% balanced O(2) gas mixture. Participants were 128 young adults screened for a history of panic attacks. By controlling for traitwise factors including state anxiety and testing both categorical and continuous conceptualizations of the AS construct at various timepoints, the present report was able to evaluate the temporal and structural dynamics of AS in relation to fearful responding to the challenge. Relevant variables were evaluated in a hierarchical linear regression framework, and it was found that a continuous conceptualization of AS provided incremental predictive validity above and beyond trait anxiety immediately post-challenge, while a categorical representation of AS was equivalent to a continuous model of AS at post-challenge but outperformed a continuous model at follow-up. These data provide basic but important evidence suggesting that AS is uniquely associated with anxious responding to a 35% CO(2) challenge, and that categorical representations of AS should be considered in biological challenge studies.

The latent structure of child depression: a taxometric analysis.

BACKGROUND: The current study examined the categorical versus continuous nature of child and adolescent depression among three samples of children and adolescents ranging from 5 to 19 years. METHODS: Depression was measured using the Children's Depression Inventory (CDI). Indicators derived from the CDI were based on factor analytic research on the CDI and included indices of: 1) social withdrawal, 2) anhedonia, 3) incompetence/maladjustment and 4) negative self-esteem. RESULTS: Taxometric procedures provided convergent support for the existence of a latent taxon across three independent samples. Internal and external consistency tests as well as Monte Carlo simulations supported the validity of the results. CONCLUSIONS: Multiple nonredundant procedures and samples were all consistently indicative of taxonicity in child depression.

When social anxiety disorder co-exists with risk-prone, approach behavior: investigating a neglected, meaningful subset of people in the National Comorbidity Survey-Replication.

Little is known about people with social anxiety disorder (SAD) who are not behaviorally inhibited. To advance knowledge on phenomenology, functional impairment, and treatment seeking, we investigated whether engaging in risk-prone behaviors accounts for heterogeneous outcomes in people with SAD. Using the National Comorbidity Survey-Replication (NCS-R) dataset, our analyses focused on people with current (N = 679) or lifetime (N = 1143) SAD diagnoses. Using latent class analysis on NCS-R risk-prone behavior items, results supported two SAD classes: (1) a pattern of behavioral inhibition and risk aversion and (2) an atypical pattern of high anger and aggression, and moderate/high sexual impulsivity and substance use problems. An atypical pattern of risk-prone behaviors was associated with greater functional impairment, less education and income, younger age, and particular psychiatric comorbidities. Results could not be subsumed by the severity, type, or number of social fears, or comorbid anxiety or mood disorders. Conclusions about the nature, course, and treatment of SAD may be compromised by not attending to heterogeneity in behavior patterns.

Attention training for generalized social anxiety disorder.

Attentional bias toward negative social cues is thought to serve an etiological and/or maintaining role in social anxiety disorder (SAD). The current study tested whether training patients to disengage from negative social cues may ameliorate social anxiety in patients (N = 36) with a primary diagnosis of generalized SAD. Patients were randomly assigned to either an attention training condition (n = 18), in which patients completed a modified dot-probe task designed to facilitate attentional disengagement from disgusted faces, or a control dot-probe task condition (n = 18). As predicted, patients in the attention training condition exhibited significantly greater reductions in social anxiety and trait anxiety, compared with patients in the control condition. At termination, 72% of patients in the active treatment condition, relative to 11% of patients in the control condition, no longer met Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for SAD. At 4-month follow-up, patients in the attention training condition continued to maintain their clinical improvement, and diagnostic differences across conditions were also maintained. Results support attention-based models of anxiety and suggest that attention training is a promising alternative or complementary intervention.

Exploration of anxiety sensitivity and distress tolerance as vulnerability factors for hoarding behaviors.

BACKGROUND: The phenomenon of compulsive hoarding, characterized by the acquisition of and failure to discard a large number of possessions, is increasingly recognized as a significant public health burden. Despite the magnitude of the impairment associated with this condition, empirical research is still in the nascent stages and many facets of the phenomenology, underlying vulnerability and risk factors for hoarding, are as of yet unknown. METHOD: The overall aim of the current investigation was to examine the association between hoarding behaviors and two potential vulnerability factors-anxiety sensitivity (AS) and distress tolerance (DT). In addition, we investigated the robustness of these associations as well as the interaction between the two hypothesized risk factors. Three studies (total N=745) involving independent nonclinical samples assessed hoarding, AS, DT, and relevant covariates using a range of measures. Resutlts: Findings revealed that AS and hoarding are significantly and robustly associated with one another beyond general depressive, anxiety, and nonhoarding obsessive-compulsive symptoms. Hoarding was also found to be associated with low DT. Consistent with prediction, AS and DT interacted such that DT may play a less important role among individuals with low AS. By contrast, low DT appears to increase vulnerability to hoarding symptoms among individuals high in AS. Results are discussed with regard to future research and treatment implications. Depression and Anxiety, 2009. Published 2009 Wiley-Liss, Inc.

Anxiety disorders moderate the association between externalizing problems and substance use disorders: data from the National Comorbidity Survey-Revised.

Anxiety disorders and externalizing problems are both associated with substance use disorders. However, the nature of this relationship remains unclear. To examine whether presence of an anxiety disorder changes the association between externalizing problems (conduct disorder, oppositional defiant disorder, and attention deficit hyperactivity disorder) and substance use disorders, we analyzed data from the National Comorbidity Survey-Replication, which is based on a nationally representative sample of 9282 English-speaking adults. Presence of externalizing problems was associated with an increased odds for alcohol abuse (OR: 6.7, CI: 5.6-8.1), alcohol dependence (OR: 7.6, CI: 5.9-9.6), substance abuse (OR: 9.9, CI: 8.1-12.2), and substance dependence (OR: 13.1, CI: 9.6-17.8). Similarly, anxiety disorders were associated with increased odds for substance use disorders. The highest association was found between post-traumatic stress disorder and substance use disorder (OR: 9.2, CI: 5.4-15.5). Individuals who met diagnostic criteria for an anxiety disorder and externalizing problems showed consistently and significantly lower odds for substance use problems than subjects with externalizing problems without a comorbid anxiety disorder. The results suggest that presence of any anxiety disorder reduces the association between externalizing problems and substance use disorders, possibly because the fear of bodily symptoms prevents individuals with externalizing problems from engaging in drug-seeking behaviors.

Anxiety sensitivity as an incremental predictor of later anxiety symptoms and syndromes.

Although anxiety sensitivity (AS) has been shown to predict anxiety symptoms and panic, this literature is limited in regard to evaluating AS as an incremental predictor of anxiety psychopathology relative to other established risk factors including sex and negative affect. The present report prospectively evaluated whether AS was predictive of later changes in anxiety symptoms after controlling for potential confounding factors. Consistent with hypothesis, AS was found to be a significant, incremental predictor of anxiety symptoms over time, even after controlling for sex and negative affectivity. These data provide novel evidence for the unique association between AS of the development of anxiety symptoms.

Anxiety sensitivity profile: predictive and incremental validity.

Anxiety sensitivity (AS) is a well-researched risk factor for the development of anxiety psychopathology. AS is typically measured using the anxiety sensitivity index (ASI) but limitations have led to the creation of second generation measures of AS including the anxiety sensitivity profile (ASP). The ASP has not been used very extensively, however, and we believe this may be due to two important issues: (1) the ASP is lengthy, and (2) the predictive validity of the ASP is unexplored in relation to critical outcomes such as anxiety psychopathology. The purpose of the present report was to address these two issues. We evaluated whether an abbreviated form of the ASP was viable and also conducted tests of the scale's predictive validity. Findings suggest that a 22-item version of the ASP (i.e., ASP-22) is comparable to the original 60-item ASP. Moreover, the ASP-22 was predictive of anxious responding to a CO(2) challenge. In fact, the ASP-22 outperformed the ASI as a predictor of CO(2) reactivity. Also, the ASP-22 was a significant longitudinal predictor of incidence of Axis I diagnoses. In regard to predictive validity, the ASP-22 was comparable to the original ASP. In summary, the ASP-22 appears to represent a viable measure of AS that may complement the ASI.

Social anxiety symptoms uniquely predict fear responding to 35% CO(2) challenge.

The vast majority of biological challenge studies have focused on panic disorder though there is a small literature suggesting that patients with social anxiety disorder (SAD) show comparable responding. The SAD literature is potentially confounded, however, by the fact that many patients with SAD experience panic attacks. These patients also show elevated negative affect and anxiety sensitivity, factors that are also associated with increased fear responding to challenge. By controlling for these factors, the present report was able to evaluate whether social anxiety symptoms were uniquely associated with fearful responding to a 35% CO(2) challenge. A large nonclinical sample of young adults (N=120) screened for a history of panic attacks completed a 35% CO(2) challenge. Those high (versus low) in social anxiety showed approximately 2.5 times greater risk for experiencing substantial increases in anxiety in response to the challenge. This significant association was maintained after controlling for anxiety sensitivity and general negative affect. These data provide novel evidence suggesting that social anxiety symptoms are uniquely associated with anxious responding to 35% CO(2) challenge and this sensitivity appears to precede the development of panic attacks.

Exploring human freeze responses to a threat stressor.

Despite the fundamental nature of tonic immobility in anxiety responses, surprisingly little empirical research has focused on the "freeze" response in humans. The present report evaluated the frequency and predictors of a freeze response in the context of a biological challenge. A nonclinical sample (N=404) underwent a 20-s inhalation of 20% CO(2)/balance O(2). Perceptions of immobility in the context of the challenge were reported in 13% of the sample, compared with 20% reporting a significant desire to flee. Subjective anxiety and panic during the challenge were associated with the freeze response, as were a number of anxiety symptom dimensions.

Discomfort intolerance: evaluation of a potential risk factor for anxiety psychopathology.

Discomfort intolerance, defined as an individual difference in the capacity to tolerate unpleasant bodily sensations, is a construct recently posited as a risk factor for panic and anxiety psychopathology. The present report used a biological challenge procedure to evaluate whether discomfort intolerance predicts fearful responding beyond the effects of trait anxiety and a well-established psychological vulnerability factor (i.e., anxiety sensitivity). Nonclinical community participants (N=44) with no history of panic attacks or any Axis I condition completed a 35% CO(2) challenge. Results are consistent with our hypothesis suggesting that discomfort intolerance incrementally predicts increased subjective reactivity to the challenge. Moreover, there was some suggestion that discomfort intolerance interacted synergistically with anxiety sensitivity to increase anxiety-related symptoms. These findings add to a small but growing literature suggesting that discomfort intolerance may play a role in the development of anxiety problems.