The early development of emotion recognition in autistic children: Decoding basic emotions from facial expressions and from emotion-provoking situations.

Autism is associated with challenges in emotion recognition. Yet, little is known about how emotion recognition develops over time in autistic children. This four-wave longitudinal study followed the development of three emotion-recognition abilities regarding four basic emotions in children with and without autism aged 2.5 to 6 years over three years. Behavioral tasks were used to examine whether children could differentiate facial expressions (emotion differentiation), identify facial expressions with verbal labels (emotion identification), and attribute emotions to emotion-provoking situations (emotion attribution). We confirmed previous findings that autistic children experienced more difficulties in emotion recognition than non-autistic children and the group differences were present already from the preschool age. However, the group differences were observed only when children processed emotional information from facial expressions. When emotional information could be deduced from situational cues, most group differences disappeared. Furthermore, this study provided novel longitudinal evidence that emotion recognition improved with age in autistic children: compared to non-autistic children, autistic children showed similar learning curves in emotion discrimination and emotion attribution, and they showed greater improvements in emotion identification. We suggest that inclusion and respect in an environment free of stereotyping are likely to foster the development of emotion recognition among autistic children.

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.

Toward feeling, understanding, and caring: The development of empathy in young autistic children.

LAY ABSTRACT: Empathy is a highly valued human capacity. Yet, autistic people are often portrayed as lacking in empathy. Recent research, which views empathy as a complex construct emerging from multiple interrelated emotional and cognitive processes, argues that, although many autistic people do have difficulty understanding others' emotions, and this may hinder them from responding to others in a prosocial manner, they are not indifferent to other people's feelings. Hoping to contribute to a better understanding of the unique challenges that autistic children face in their empathy development, we followed the development of four empathy abilities: emotion contagion, attention to others, emotion acknowledgment, and prosocial actions, in 1- to 6-year-old autistic children, in comparison with non-autistic children. Once a year, for 4 consecutive years, children's empathy abilities were evaluated by experimenters who acted out emotional episodes to provoke empathy in children, and by parents who filled out empathy questionnaires. We found that autistic children experienced indeed more difficulty attending to others, acknowledging others' emotions, and initiating prosocial actions toward others. However, according to parents, they did not differ from their non-autistic peers in feeling along with others' negative emotions. This indicates that it might not be the case that autistic children did not want to act empathetically toward others. Rather, they might not know how to do so. Notably, despite these difficulties, when looking at children's developmental trajectories, autistic children showed similar improvements over time as non-autistic children. This provides evidence that autistic children have the potential to learn and to improve their empathy skills.

Friendship quality among autistic and non-autistic (pre-) adolescents: Protective or risk factor for mental health?

LAY ABSTRACT: Autistic young people are often misunderstood by non-autistic young people, and this can lead to difficulties in their friendships. We know that friendship is very important for our mental health. For non-autistic young people, having good friendships is linked to better mental health and having problems in friendship can cause mental health problems. This study aimed to compare the positive and negative features of friendship that autistic non-autistic young people experience. The study also aimed to understand if having positive or negative friendship features is related to signs of mental health problems (anxiety and depression). 306 young people aged 9-16 took part in this study. These were 86 autistic boys, 18 autistic girls, 91 non-autistic boys and 111 non-autistic girls. The findings of this study showed that autistic young people have less positive friendship features than non-autistic young people. For all young people in the study, having more positive friendship features was related to fewer signs of depression, while having more negative friendship features was related to more signs of depression. Just for autistic girls, having more positive friendship features was related to more signs of anxiety. These findings show that support is needed to help autistic young people have more positive friendships. For example, by teaching non-autistic young people how to be supportive friends to their autistic peers.

Quantity and quality of empathic responding by autistic and non-autistic adolescent girls and boys.

LAY ABSTRACT: Empathy is an important feature to feel for another person, evoking social support for the person in distress, and thus strengthening social cohesion. The question is to what extent empathic reactions can also be observed in autistic adolescents and autistic girls in particular, since their often mentioned good social skills might prevent their direct social environment from recognizing their autism. We examined 194 adolescents (autistic and non-autistic boys and girls) during an in vivo task in which the experimenter pretended to hurt herself while closing a binder. All responses by the participants were videotaped and coded by two independent coders. In line with our predictions, no group or gender differences appeared related to their attention for the event; yet autistic girls and boys showed less visible emotional arousal, which could indicate less affective empathy (feeling for someone), or which could indicate that autistic adolescents know less well how to show empathy. Autistic girls and boys reacted by comforting the experimenter equally often as their non-autistic peers, but autistic boys addressed the problem more often than any other group, while girls (autistic and non-autistic) more often addressed the emotion of the person in need. Our findings highlight that empathic behaviour is remarkably similar between autistic and non-autistic boys and girls. Indeed, only subtle differences exist, in terms of expressed emotional arousal and gender-specific comforting styles. Autistic girls' higher levels of emotion-focused comforting could be explained by well-developed social skills, camouflaging, or emotional investment in relationships with others.

Emotional functioning and the development of internalizing and externalizing problems in young boys with and without autism spectrum disorder.

Children with autism spectrum disorder are at risk of developing internalizing and externalizing problems. However, information on early development of behavior problems and the contributing role of emotional functioning in preschool children with autism spectrum disorder is scarce. This study collected data of boys with and without autism spectrum disorder (N = 156; age: 2-6 years) over three consecutive years (three waves), about their internalizing and externalizing symptoms and emotional functioning (i.e. emotion control, recognition, and vocabulary), using parent-report questionnaires. No age effect was found on internalizing or externalizing problems for boys with and without autism spectrum disorder. Boys with autism spectrum disorder displayed more behavior problems than their typically developing peers and showed lower levels of emotional functioning. Better emotion control and improved emotion recognition were associated with a decrease in problem behaviors for boys with and without autism spectrum disorder, whereas improved emotion vocabulary was uniquely related to a decrease in externalizing problems in boys with autism spectrum disorder. Our findings suggest that boys with and without autism spectrum disorder showed similar developmental courses of internalizing and externalizing problems. However, lower levels of emotional functioning were already more pronounced in boys with autism spectrum disorder at a young age. This contributes to higher levels of behavior problems.

Spontaneous helping behavior of autistic and non-autistic (Pre-)adolescents: A matter of motivation?

Young autistic people have a range of social difficulties, but it is not yet clear how these difficulties can be explained. In addition, emerging research is suggesting that autistic girls may differ from boys in terms of their social behaviors, but yet unknown is if they differ in terms of their pro-social behavior, such as helping. The present study investigated spontaneous helping behavior using an in vivo paradigm and related this to participants' levels of social motivation (based on parent reports). Participants were 233 autistic and non-autistic (pre-)adolescents (M = 12.46 years, SD = 15.54 months). Our results demonstrated that autistic girls and boys have lower levels of social motivation compared to their non-autistic peers, but social motivation was unrelated to helping behavior in both groups. Furthermore, when the experimenter needed help, the autistic boys and girls looked and smiled to the same extent as their peers of the same gender, but they actually helped significantly less than their non-autistic peers. However, most autistic youngsters did help, highlighting the great individual differences in autistic individuals. We discuss the possibility that lower levels of helping behavior are due to difficulty initiating action in a social context, rather than lower social motivation. Autism Res 2019, 12: 1796-1804. © 2019 The Authors. Autism Research published by International Society for Autism Research published by Wiley Periodicals, Inc. LAY SUMMARY: This study examined the helping behavior of autistic boys and girls (aged 9-16). Many autistic young people did help, but compared to non-autistic individuals, autistic people did not help as much. This study also showed that when people did/did not help, it was not related to their interest in social relationships. It is important to teach young autistic people when and how to help others, to support them making friends.

Concordance between physiological arousal and emotion expression during fear in young children with autism spectrum disorders.

This study aimed to measure emotional expression and physiological arousal in response to fear in 21 children with autism spectrum disorders (43-75 months) and 45 typically developing children (41-81 months). Expressions of facial and bodily fear and heart rate arousal were simultaneously measured in response to a remote controlled robot (Laboratory Temperament Assessment Battery). Heart rate analyses revealed a main effect of task from baseline to fear ( p < 0.001, ηp2 ), no interaction effect and no effect for group. In addition, children with autism spectrum disorder showed intact facial and bodily expressions of fearful affect compared to typically developing children. With regard to the relationship between expression and arousal, the results provided evidence for concordance between expression and arousal in typically developing children ( r = 0.45, n = 45, p < 0.01). For children with autism spectrum disorder, no significant correlation was found ( r = 0.20, n = 21, p = 0.38). A moderation analysis revealed no significant interaction between expression and arousal for children with and without autism spectrum disorder ( F(1, 62) = 1.23, p = 0.27, ηp2 ), which might be the result of limited power. The current results give reason to further study concordance between expression and arousal in early autism spectrum disorder. Discordance might significantly impact social functioning and is an important topic in light of both early identification and treatment.

Emotion Control Predicts Internalizing and Externalizing Behavior Problems in Boys With and Without an Autism Spectrum Disorder.

Children and adolescents with Autism Spectrum Disorder (ASD) often show comorbid emotional and behavior problems. The aim of this longitudinal study is to examine the relation between emotion control (i.e., negative emotionality, emotion awareness, and worry/rumination) and the development of internalizing and externalizing problems. Boys with and without ASD (N = 157; age 9-15) were followed over a period of 1.5 years (3 waves). We found that baseline levels of worry/rumination was a specific predictor of later externalizing problems for boys with ASD. Furthermore, the developmental trajectory of worry/rumination predicted the development of internalizing and externalizing problems in both groups. Our findings suggest that worry/rumination may constitute a transdiagnostic factor underlying both internalizing and externalizing problems in boys with and without ASD.

Physiological Arousal and Emotion Regulation Strategies in Young Children with Autism Spectrum Disorders.

This study aimed to assess physiological arousal and behavioral regulation of emotion in the context of frustration in 29 children with Autism Spectrum Disorders (ASD) and 45 typically developing children (41-81 months). Heart rate was continuously measured and emotion strategies were coded, during a locked-box task. Results revealed increases in arousal followed by a decline during recovery, significant for both groups indicating that heart rate patterns between groups were identical. The ASD group deployed less constructive and more venting and avoidance strategies, which was related to language impairments. We conclude that rather than abnormal levels of emotional arousal, a key impairment in young children with ASD may be difficulties in behaviorally regulating and expressing experienced emotions to others.

Peers Influence Prosocial Behavior in Adolescent Males with Autism Spectrum Disorders.

Peer influence has a profound impact on decision-making in typically developing adolescents. In this study, we examined to what extent adolescent males (age 11-17 years; N = 144) with and without autism (ASD) were influenced by peer feedback on prosocial behavior, and which factors were related to individual differences in peer feedback sensitivity. In a public goods game, participants made decisions about the allocation of tokens between themselves and their group-in absence or presence of peer feedback. Adolescents with and without ASD were sensitive to peer feedback on prosocial behavior. More autism traits and social interest were associated with less sensitivity to antisocial feedback, suggesting that peer feedback creates opportunities for social adjustment in those with and without ASD.

Psychophysiological responses to emotions of others in young children with autism spectrum disorders: Correlates of social functioning.

Studying cognitive and affective mechanisms of social behavior could lead to identifying early indicators of derailing social behavior in young children with Autism Spectrum Disorders (ASD). The present study combined sensitive and objective techniques, such as eyetracking and psychophysiology, to provide insight into early neurodevelopmental mechanisms that are more difficult to uncover when relying on behavioral measures. Social attention towards faces and changes in affective arousal were investigated together in 28 young children with ASD (42-75 months) and 45 nonclinical controls (41-81 months). Children were shown a social-emotional video clip while eyetracking and heart rate were measured. Children with ASD fixated less on key social-emotional features within the clip as compared to controls, even though both groups attended equally toward the screen. In contrast to the control group, children with ASD did not show an increase or modulation in affective arousal in response to the social-emotional scenes. Severity of ASD symptoms, specifically social problems, was associated with arousal modulation and social attention within the ASD group. Early ASD symptoms are associated with impairments in fundamental building blocks of social behavior as expressed in a lack in spontaneous social attention and affective arousal. Such sensitive and objective measures of underlying mechanisms might serve as indicators for tailored approaches in treatment and may help in evaluating effectiveness of early interventions aimed at positively influencing social development and related quality of life in individuals with ASD. Autism Res 2017, 10: 1499-1509. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

The Understanding of Intentions, Desires and Beliefs in Young Children with Autism Spectrum Disorder.

This study provides a comprehensive picture of three core elements (Intentions, Desires, Beliefs) of Theory of Mind (ToM) in young children with autism spectrum disorder (ASD, n = 63, Mage = 55 months) and typically developing children (TD, n = 69, Mage = 54 months). Outcomes showed that ASD and TD children understood intentional actions equally well. Yet, children with ASD lacked the social interest to share intentions. Additionally, children with ASD had more difficulties in understanding others' desires and beliefs compared to their TD peers. It is discussed whether the ToM delay seen in children with ASD is a motivational or a conceptual problem.

Better to be equal? Challenges to equality for cognitively able children with autism spectrum disorders in a social decision game.

Much controversy surrounds questions about whether humans have an aversion to inequity and how a commitment to equality might play a role in cooperation and other aspects of social interactions. Examining the social decisions of children with autism spectrum disorders provides a fascinating opportunity to explore these issues. Specifically, we evaluated the possibility that children with autism spectrum disorders may be less likely than typically developing children to show a prioritisation of equality. A total of 69 typically developing (mean age 11;6 years) and 57 cognitively able children with autism spectrum disorders (mean age 11;7 years) played a social decision game in which the equality option was pitted against alternatives that varied in instrumental outcomes. Results showed that both groups were more likely to choose the equality option when there was no cost to the self. However, even though children with autism spectrum disorders appeared to view equality as preferable to causing explicit harm to others, they departed from an equality stance when there was an opportunity to increase instrumental gain without any obvious harm to the self or the other. Typically developing children, in contrast, showed similar prioritisation of equality across these contexts. Future research needs to address the question of how differences in the commitment to equality affect children's social behaviour and relationships in daily life.

Approach and avoidant emotion regulation prevent depressive symptoms in children with an Autism Spectrum Disorder.

The prevalence of depression is high in children with Autism Spectrum Disorders (ASDs), but its etiology has not yet been studied in this group. Emotion dysregulation is a well-known contributor to the development of depression in typically developing (TD) children, which might also apply to children with ASD. In this study, we examined the longitudinal relationship between three different ways of emotion regulation (approach, avoidance and worry/rumination) and depressive symptoms in children with ASD and a group of TD children which were compatible with the ASD group (age 9-15-years old). Children filled out self-report questionnaires at 3 time points (with a 9-month break between each session). To account for missing data multiple imputations were used. A regression model with clustered bootstrapping was used to establish which factors contributed to depression and to identify possible differences between the ASD and TD group. Approach and avoidant strategies prevented the development of depressive symptoms in both respective groups, whereas elevated levels of worry/rumination in turn increased children's depressive symptoms. Besides differences in absolute levels (children with ASD scored higher on symptoms of depression and lower on approach strategies than the TD group), no other differences between the groups emerged.

The social behavioral phenotype in boys and girls with an extra X chromosome (Klinefelter syndrome and Trisomy X): a comparison with autism spectrum disorder.

The present study aimed to gain more insight in the social behavioral phenotype, and related autistic symptomatology, of children with an extra X chromosome in comparison to children with ASD. Participants included 60 children with an extra X chromosome (34 boys with Klinefelter syndrome and 26 girls with Trisomy X), 58 children with ASD and 106 controls, aged 9 to 18 years. We used the Autism Diagnostic Interview, Social Responsiveness Scale, Social Anxiety Scale and Social Skills Rating System. In the extra X group, levels of social dysfunction and autism symptoms were increased, being in between controls and ASD. In contrast to the ASD group, the extra X group showed increased social anxiety. The effects were similar for boys and girls with an extra X chromosome.

Reactive/proactive aggression and affective/cognitive empathy in children with ASD.

The main aim of this study was to examine the extent to which affective and cognitive empathy were associated with reactive and proactive aggression, and whether these associations differed between children with an Autism Spectrum Disorder (ASD) and typically developing (TD) children. The study included 133 children (67 ASD, 66 TD, Mage=139 months), who filled out self-report questionnaires. The main findings showed that the association between reactive aggression and affective empathy was negative in TD children, but positive in children with ASD. The outcomes support the idea that a combination of poor emotion regulation and impaired understanding of others' emotions is associated with aggressive behavior in children with ASD.

Emotion regulation and internalizing symptoms in children with autism spectrum disorders.

The aim of this study was to examine the unique contribution of two aspects of emotion regulation (awareness and coping) to the development of internalizing problems in 11-year-old high-functioning children with an autism spectrum disorder (HFASD) and a control group, and the moderating effect of group membership on this. The results revealed overlap between the two groups, but also significant differences, suggesting a more fragmented emotion regulation pattern in children with HFASD, especially related to worry and rumination. Moreover, in children with HFASD, symptoms of depression were unrelated to positive mental coping strategies and the conviction that the emotion experience helps in dealing with the problem, suggesting that a positive approach to the problem and its subsequent emotion experience are less effective in the HFASD group.

Brief report: inhibitory control of socially relevant stimuli in children with high functioning autism.

The current study explored whether inhibitory control deficits in high functioning autism (HFA) emerged when socially relevant stimuli were used and whether arousal level affected the performance. A Go/NoGo paradigm, with socially relevant stimuli and varying presentation rates, was applied in 18 children with HFA (including children with autism or Asperger syndrome) and 22 typically developing children (aged 8-13 years). Children with HFA did not show inhibitory control deficits compared to the control group, but their performance deteriorated in the slow presentation rate condition. Findings were unrelated to children's abilities to recognize emotions. Hence, rather than a core deficit in inhibitory control, low arousal level in response to social stimuli might influence the responses given by children with HFA.

Attention to facial emotion expressions in children with autism.

High-functioning children in the autism spectrum are frequently noted for their impaired attention to facial expressions of emotions. In this study, we examined whether attention to emotion cues in others could be enhanced in children with autism, by varying the relevance of children's attention to emotion expressions. Twenty-eight high-functioning boys with autism and 31 boys from a control group were asked to sort photos depicting smiling or frowning faces of adults. As found in earlier studies, in neutral conditions children with autism were less attentive to emotion expressions than children from a control group. This difference disappeared when children were explicitly asked to make a socially relevant decision. These findings suggest that the attention of children with autism to emotion expressions in others is influenced by situational factors. Theoretical implications of these findings are discussed.