How do Children with Intellectual Disabilities Empathize in Comparison to Typically Developing Children?

OBJECTIVES: Two studies were conducted to better understand how children with intellectual disabilities (ID) empathize with the feelings of others during social interactions. The first study tested hypotheses of developmental delay or difference regarding empathy in 79 children with ID by comparing them with typically developing (TD) children, matched for developmental age or chronological age. The second study examined specific aspects of empathy in 23 children with Down syndrome (DS), compared with 23 nonspecific ID children, matched for developmental age, and TD children, matched for developmental age or chronological age. METHOD: An empathy task was administered to the children while their parents completed the French versions of the Empathy Questionnaire and the Griffith Empathy Measure. RESULTS: The first study showed that ID children showed delayed empathy development but were perceived by their parents as deficient in cognitive empathy. The second study showed that DS children were perceived as being more attentive to the feelings of others than TD children and non-specific ID children, matched for developmental age, and as having affective empathy that was similar to that of TD children matched for chronological age. CONCLUSION: These studies have drawn attention to delays or differences in different dimensions of empathy in children with ID and DS, which need to be taken into account in interventions.

Psychometric Properties of the Theory of Mind Task Battery (French Version) in Neurotypical Children and Intellectually Disabled Children.

These studies tested the psychometric properties of the French version of the Theory of Mind (ToM) Task Battery (vf) in typically developing (TD) children and intellectually disabled (ID) children. The Battery was administered to 649 TD children (2 ½ to 12 years old) in Study 1 and 155 ID (4 ½ to 14 ½ years old) in Study 2. Their mothers completed questionnaires: in both studies, the Theory of Mind Inventory (ToMI-1-vf); in Study 1, the Griffith Empathy Measure (GEM-vf) and the Emotion Regulation Checklist (ERC-vf); and in Study 2, the Social Competence and Behavior Evaluation (SCBE-vf). The Battery showed good internal consistency in both groups. Positive links with age and differences between age groups were identified in their performances. Convergent validity was confirmed by positive correlations between TD children's scores in the Battery and in ToMI1-vf, in empathy, in emotion regulation, and by a negative correlation with emotion dysregulation. In ID children, their scores in the Battery were positively linked with those in ToMI-1-vf, in some scales of SCEB-vf, and had a low level of internalizing problems. This Battery presents good psychometric qualities and could be useful for explicit assessment of ToM in TD and ID children in future research and intervention.

Empathy in Preschoolers: Exploring Profiles and Age- and Gender-Related Differences.

Empathy is a key skill in the daily life of preschoolers, and it is important to understand how it evolves during this crucial period of development. This paper includes two studies. The first study, which had a cross-sectional design, examined affective, cognitive, and behavioral empathy in 354 children (aged from 3 to 6 years) through a performance-based measure and questionnaires completed by their mothers. Although girls tended to have better affective empathy than boys on the performance-based task, no difference was noted in the mothers' perceptions of their children's empathy. Empathy dimensions varied depending on the age of the children. The hierarchical cluster analyses of the cases identified differentiated subgroups of children, according to their empathic skills in the three dimensions. The second study, which was longitudinal, used the same measures and investigated the developmental trajectory of empathy in 69 preschoolers over one year. The results showed that each empathic dimension predicted itself one year later, but did not predict the two others. The implications for potential interventions are emphasized in this study.

Relationships Between Mother-Child Conversations About Emotion and Socioemotional Development of Children with Autism Spectrum Disorder.

Mother-child emotion-related conversations, as a practice of parental socialization of emotion, can help children with autism spectrum disorder (ASD) develop socio-emotional skills. This study intends to explore relationships between mother-child conversations about emotions and socio-emotional skills of children with ASD by accounting for the moderating role of children personality traits and mothers' emotional openness. Mothers of children with ASD (n = 49) responded to five questionnaires describing their conversations about emotions, emotional openness as well as their child's socio-emotional skills and personality. We conducted hierarchical regression and moderation analyses. Our findings indicate that frequent mother-child conversations about emotions significantly predict higher emotional regulation and Theory of Mind (ToM) abilities in children with ASD (p < 0.05). Moreover, children's consciousness and openness to experience, along with mothers' emotional openness significantly moderate the relation between mother-child conversations about emotions and children's ToM skills (p < 0.05). Mother-child conversations about emotions, as a practice of parental socialization of emotion, could be beneficial for children with ASD. Children's personality traits and mothers' openness to emotion may act as a protective factor of ToM skills in children with ASD.

Preschoolers' Empathy Profiles and Their Social Adjustment.

Preschoolers face new challenges in their social life: the development of social and emotional abilities in order to have positive relationships with peers and adults. Empathy, the ability to share and understand the emotions of others, contributes to this socio-emotional adjustment. This exploratory study examines mothers and fathers' perceptions of their child's empathy and individual factors, such as age, gender, and personality, which are related to cognitive and affective empathy in 63 typically developing preschoolers. Links between children's individual characteristics (empathy and personality) and their social adjustment on the one hand and risk of developing internalized vs. externalized behaviors on the other were also investigated. Parents completed four questionnaires about their child's empathy, personality, and social (mal)adjustment. The results showed that mothers and fathers perceived their children's cognitive and affective empathy, attention to others' feelings, and social actions (such as helping), in the same way, except for emotion contagion. Gender differences appeared specifically for some components of empathy: girls were said to pay more attention to others' emotions while boys had better cognitive empathy. Moreover, children's empathy as perceived by mothers or fathers was positively linked with their age, and with personality factors (extraversion, emotional stability, agreeableness, and openness to experience). Cognitive empathy and personality were found to be partly related to higher social skills and lower externalized and internalized behaviors. The results nuanced specific links between cognitive and affective empathy and social adjustment as well as behavior problems at preschool age. These results may have some implications for future research and prevention in childhood.

Training Inhibition and Social Cognition in the Classrooms.

Executive functions and social cognition competences are associated with many important areas of life, such as school readiness, academic success or sociability. Numerous intervention programs aiming to improve these capacities have emerged and have been shown to be effective. As inhibition in particular, is closely related with social cognition competences, we developed a training program that targets both abilities and implemented it in kindergarten and lower primary school classes for 6 months. We evaluated its effectiveness at improving inhibition and social cognition as well as its possible impact on academic performance. The results showed that tackling inhibition and social cognition in the classroom at an early age improved inhibition, visual attention and flexibility as well as Theory of Mind and social information processing skills. However, the impact on academic learning was weak; a slight effect on a mathematical task was observed.

Social Cognition in Children With Non-specific Intellectual Disabilities: An Exploratory Study.

Social cognitive abilities - notably, Theory of Mind (ToM) and social information processing (SIP) - are key skills for the development of social competence and adjustment. By understanding affective and cognitive mental states and processing social information correctly, children will be able to enact prosocial behaviors, to interact with peers and adults adaptively, and to be socially included. As social adjustment and inclusion are major issues for children with intellectual disabilities (IDs), the present study aimed to explore their social cognitive profile by combining cluster analysis of both ToM and SIP competence, and to investigate the structure of relations between these skills in children with IDs. Seventy-eight elementary school children with non-specific IDs were recruited. They had a chronological age ranging from 4 years and 8 months to 12 years and 6 months and presented a preschool developmental age. Performance-based measures were administered to assess ToM and SIP abilities. Questionnaires were completed by the children's parents to evaluate the children's social competence and adjustment and their risk of developing externalizing or internalizing behaviors. Exploratory analysis highlighted strengths and weaknesses in the social cognitive profiles of these children with IDs. It also emphasized that the understanding of affective and cognitive mental states was used differently when facing appropriate vs. inappropriate social behaviors. The present study leads to a better understanding of the socio-emotional profile of children with IDs and offers some suggestions on how to implement effective interventions.

Self-perception, self-regulation and metacognition in adolescents with intellectual disability.

This study compares self-perception of competences in 28 typically developing children (TD) aged 7-9 years and 32 adolescents with intellectual disability (ID) aged 11-16 years in special school, matched for mental age (MA). The links between self-perception, self-regulation in problem-solving and metacognition are investigated. Overall self-perception and self-perception of competences by domain do not differ significantly between the two groups. Self-perception of competences in specific domains, self-regulation and metacognition vary depending on MA and verbal comprehension in the two groups. ID adolescents attribute more importance to social acceptance than TD children. In both groups, positive links are identified between self-perception and importance attributed to domains. Performance, self-regulation and metacognition are lower in ID adolescents than in TD children. Positive links are obtained between self-perception of competences in specific domains and certain self-regulatory and metacognitive strategies, although these links differ in the two groups.

Socio-emotional regulation in children with intellectual disability and typically developing children, and teachers' perceptions of their social adjustment.

This study examined the extent to which socio-emotional regulation displayed in three dyadic interactive play contexts (neutral, competitive or cooperative) by 45 children with intellectual disability compared with 45 typically developing children (matched on developmental age, ranging from 3 to 6 years) is linked with the teachers' perceptions of their social adjustment. A Coding Grid of Socio-Emotional Regulation by Sequences (Baurain & Nader-Grosbois, 2011b, 2011c) focusing on Emotional Expression, Social Behavior and Behavior toward Social Rules in children was applied. The Social Adjustment for Children Scale (EASE, Hugues, Soares-Boucaud, Hochman, & Frith, 1997) and the Assessment, Evaluation and Intervention Program System (AEPS, Bricker, 2002) were completed by teachers. Regression analyses emphasized, in children with intellectual disability only, a positive significant link between their Behavior toward Social Rules in interactive contexts and the teachers' perceptions of their social adjustment. Children with intellectual disabilities who listen to and follow instructions, who are patient in waiting for their turn, and who moderate their externalized behavior are perceived by their teachers as socially adapted in their daily social relationships. The between-groups dissimilarity in the relational patterns between abilities in socio-emotional regulation and social adjustment supports the "structural difference hypothesis" with regard to the group with intellectual disability, compared with the typically developing group. Hierarchical cluster cases analyses identified distinct subgroups showing variable structural patterns between the three specific categories of abilities in socio-emotional regulation and their levels of social adjustment perceived by teachers. In both groups, several abilities in socio-emotional regulation and teachers' perceptions of social adjustment vary depending on children's developmental age. Chronological age in children with intellectual disability had no impact on their socio-emotional regulation and social adjustment.

How could Theory of Mind contribute to the differentiation of social adjustment profiles of children with externalizing behavior disorders and children with intellectual disabilities?

This study compared Theory of Mind (ToM) emotion and belief abilities in 43 children with externalized behavior (EB) disorders presenting low intelligence, 40 children with intellectual disabilities (ID) and 33 typically developing (TD) preschoolers (as a control group), matched for developmental age. The links between their ToM abilities, their level in seven self-regulation strategies as displayed in social problem-solving tasks and their social adjustment profiles (assessed by the Social Competence and Behavior Evaluation, completed by their teachers) were examined. Children with EB presented lower comprehension of causes of emotions and lower self-regulation of joint attention and of attention than children with ID and TD children. In comparison with TD children, lower social adjustment was observed in nearly all dimensions of profiles in both atypical groups. Specifically, children with EB were significantly angrier than children with ID. Although variable patterns of positive correlations were obtained in atypical groups between self-regulation strategies and ToM abilities, the most numerous positive links were obtained in the group with EB. Regression analyses showed that developmental age predicted ToM abilities and certain dimensions of social adjustment profiles in atypical groups. In the ID group, ToM emotions predicted general adaptation, affective adaptation, interactions with peers and with adults and low internalizing problems. In the EB group, general adaptation was predicted by ToM emotions and self-regulation, interactions with peers by ToM beliefs, and a low level of externalizing problems by ToM emotions. Some implications for intervention and perspectives for research are suggested.

Theory of mind, socio-emotional problem-solving, socio-emotional regulation in children with intellectual disability and in typically developing children.

This study has examined the link between social information processing (SIP) and socio-emotional regulation (SER) in 45 children with intellectual disability (ID) and 45 typically developing (TD) children, matched on their developmental age. A Coding Grid of SER, focusing on Emotional Expression, Social Behaviour and Behaviours towards Social Rules displayed by children in three dyadic contexts (neutral, competitive or cooperative) was applied. Correlational analyses highlighted specific "bi-directional" links between some abilities in SIP and in SER, presenting between-groups partial similarities and dissimilarities that allowed discussing the developmental delay versus difference hypotheses in ID children. Cluster cases analyses identified subgroups with variable patterns of links. In both groups, the SIP and some categories of SER varied depending on developmental age.

Perceived social acceptance, theory of mind and social adjustment in children with intellectual disabilities.

Perceived social acceptance, theory of mind (ToM) and social adjustment were investigated in 45 children with intellectual disabilities (ID) compared with 45 typically developing (TD) preschoolers, matched for developmental age assessed by means of the Differential Scales of Intellectual Efficiency-Revised edition (EDEI-R, Perron-Borelli, 1996). Children's understanding of beliefs and emotions was assessed by means of ToM belief tasks (Nader-Grosbois & Thirion-Marissiaux, 2011) and ToM emotion tasks (Nader-Grosbois & Thirion-Marissiaux, 2011). Seven items from the Pictorial Scale of Perceived Competence and Social Acceptance for children (PSPCSA, Harter & Pike, 1980) assessed children's perceived social acceptance. Their teachers completed the Social Adjustment for Children Scale (EASE, Hughes, Soares-Boucaud, Hochmann, & Frith, 1997). For both groups together, the results showed that perceived social acceptance mediates the relation between ToM skills and social adjustment. The presence or absence of intellectual disabilities does not moderate the relations either between ToM skills and perceived social acceptance, or between perceived social acceptance and social adjustment. The study did not confirm the difference hypothesis of structural and relational patterns between these three processes in children with ID, but instead supported the hypothesis of a similar structure that develops in a delayed manner.

Parents' regulation and self-regulation and performance in children with intellectual disability in problem-solving using physical materials or computers.

This study compared mothers and fathers' regulation with respect to 29 children with intellectual disability (ID) and 30 typically developing (TD) children, matched on their mental age (MA), as they solved eight tasks using physical materials and computers. Seven parents' regulatory strategies were coded as they supported their child's identification of the objective, planning, attention, motivation, joint attention, behaviour regulation and evaluation. Children's performance was scored. Regulation by the parents of the two groups did not differ significantly, regardless of the medium, except that the degree of parental regulation of the child's behaviour was greater in the ID group than in the TD group. In tasks involving the computer, we observed a higher degree of regulation of children's planning and a lower degree of regulation of their evaluation for the two groups. The parents displayed significantly less regulation with respect to the children with the highest MA than towards the children with the lowest MA, in each group. There was a significant interaction effect of medium and children's MA on overall parents' regulation and on their support of identification of objective and of planning. Most parental strategies were negatively linked with ID and TD children's performance in tasks. In both groups, with control for MA, parental support with the identification of the objective, with planning and with attention was negatively linked to the corresponding self-regulatory strategies of the children with each medium; however, parents' joint attention was positively linked with children's joint attention.

Self-regulation and performance in problem-solving using physical materials or computers in children with intellectual disability.

This study compares self-regulation in 29 children with intellectual disability and 30 typically developing children, who solved tasks using physical materials or computers. Their cognitive, linguistic levels were assessed in order to match the children of both groups. In the presence of their mothers and fathers, the children were asked to perform eight tasks presented using two types of medium (physical materials and computer). Performance and task completion time were recorded. Seven self-regulated strategies were analyzed: identification of objective, planning, self-attention, self-motivation, joint attention, behaviour regulation and self-evaluation. Children in the two groups did not differ in their self-regulation, and in each group, their chronological age had no significant effect on their self-regulation. However, whatever the medium used, their mental age had a significant effect on their overall self-regulation and on six self-regulated strategies: identification of objective, planning, self-attention, self-motivation, behaviour regulation, and self-evaluation. A positive link between overall self-regulation and language abilities was only obtained in the group of typical developers. In addition, although no significant effect of the medium on overall self-regulation was observed in each group, an effect of the type of medium was obtained concerning three specific self-regulated strategies, though not in the same direction: self-attention and self-evaluation are better with the computer than with physical materials, whereas joint attention is better with physical materials than with the computer. In both groups, overall self-regulation, whatever the medium, correlated positively and highly significantly with performance in different tasks (but not with completion time). In each group, variable correlational patterns were obtained between specific self-regulated strategies and performance in each task with each medium: inter-task variability of efficiency of distinct strategies was observed.

Self-regulation during pretend play in children with intellectual disability and in normally developing children.

This study investigated the symbolic behavior and the self-regulation in dyads of children with intellectual disability and of normally developing children. Specifically, these processes were studied in link with the children's characteristics (mental age, linguistic level, individual pretend play level). The sample included 80 participants, 40 children with intellectual disability and 40 normally developing children, matched according to their mental age, ranged from 3 to 6 years old. First, a developmental assessment was performed (about cognitive, language and pretend play dimensions); then, in peers dyads, the children were elicited to pretend play by means of four kinds of material referring to four types of scripts (tea party, doctor, transportation, substitute objects eliciting creativity). The average symbolic behavior in individual and dyadic play contexts did not differ in both groups, but the average self-regulation in the group with intellectual disability was lower than in the normally developing group. Some positive partial correlations were obtained between mental age, language abilities, individual pretend play, dyadic pretend play and several self-regulatory strategies in both groups although they varied in importance between groups. Clusters analyses showed that individual and dyadic pretend play explained self-regulation in children of both groups. Specifically, in both groups, the higher was symbolic behavior in creativity context, the higher was self-regulation.

Theory of mind "beliefs", developmental characteristics and social understanding in children and adolescents with intellectual disabilities.

Patterns of development of ToM belief abilities in intellectually disabled (ID) children and typically developing (TD) children matched on their developmental age were investigated. The links between cognition, language, social understanding and ToM belief abilities were examined. EDEI-R [Perron-Borelli M. (1996). Echelles Différentielles d'Efficiences Intellectuelles. Forme Révisée (EDEI-R). Paris: Editions et Applications Psychologiques.] was used to match participants and to assess social understanding. ECOSSE [Lecocq P. (1996). L'E.CO.S.SE. Une épreuve de compréhension syntaxico-sémantique. Paris: Presses Universitaires du Septentrion.] assessed the level of syntactic and semantic comprehension of French speaking, to ensure a good comprehension of the questions in false belief tasks. Five tasks assessed the ability in visual perspective taking and in understanding of false belief. A difference in the global ToM ability was found between both groups (difference hypothesis in ID participants). Specific abilities in different ToM tasks showed developmental patterns partially different and partially similar, between ID and TD groups. The interest to assess the understanding of belief by means of several tasks is confirmed. Positive links between cognition, language and ToM abilities were found in both groups, but the impact of cognition and language on abilities in each ToM task is different in both groups. Finally, the specific impact of social understanding and of chronological age on abilities in false belief in ID group is discussed.

Theory of Mind "emotion", developmental characteristics and social understanding in children and adolescents with intellectual disabilities.

Patterns of development of ToM-emotion abilities in intellectually disabled (ID) children and typically developing (TD) children matched on their developmental age were investigated. The links between cognition, language, social understanding and ToM-emotion abilities were examined. EDEI-R (Perron-Borelli, M. (1996). Echelles Différentielles d'Efficiences Intellectuelles. Forme Révisée (EDEI-R). Paris: Editions et Applications Psychologiques) was used to match participants and to assess social understanding. ECOSSE (Lecocq, P. (1996). L'E.CO.S.SE. Une épreuve de compréhension syntaxico-sémantique. Paris: Presses Universitaires du Septentrion) assessed the level of syntactic and semantic comprehension of French speaking, to ensure a good comprehension of the questions in ToM-emotion tasks. Adapted tasks of the understanding of causes and consequences of emotions (Quintal, G. (2001). La compréhension des émotions chez les enfants d'âge préscolaire dans le cadre d'une théorie de l'esprit. Un-published master's thesis, University of Montreal, Québec) assessed ToM-emotion abilities (Nader-Grosbois, N., Thirion-Marissiaux, A.-F., & Grosbois, M. (2003). Adapted tests for assessment of the Theory of Mind of causes and consequences of emotions (unpublished documents). Louvain-la-Neuve, Belgium). Similarities in the development of ToM-emotion abilities and social understanding were found, respectively, in both groups (delay hypothesis in ID participants). Some differences between groups were observed in the links between social understanding and ToM-emotion abilities. Significant correlations between developmental characteristics (verbal and non-verbal cognition) and ToM-emotion abilities were obtained for both groups. Verbal cognition explained an important part of the variance of ToM results (understanding of causes and consequences of emotions). The impact of chronological age on ToM-emotion abilities was also examined and is discussed.