Potential Applications of Social Robots in Robot-Assisted Interventions for Social Anxiety.

Social anxiety disorder or social phobia is a condition characterized by debilitating fear and avoidance of different social situations. We provide an overview of social anxiety and evidence-based behavioural and cognitive treatment approaches for this condition. However, treatment avoidance and attrition are high in this clinical population, which calls for innovative approaches, including computer-based interventions, that could minimize barriers to treatment and enhance treatment effectiveness. After reviewing existing assistive technologies for mental health interventions, we provide an overview of how social robots have been used in many clinical interventions. We then propose to integrate social robots in conventional behavioural and cognitive therapies for both children and adults who struggle with social anxiety. We categorize the different therapeutic roles that social robots can potentially play in activities rooted in conventional therapies for social anxiety and oriented towards symptom reduction, social skills development, and improvement in overall quality of life. We discuss possible applications of robots in this context through four scenarios. These scenarios are meant as 'food for thought' for the research community which we hope will inspire future research. We discuss risks and concerns for using social robots in clinical practice. This article concludes by highlighting the potential advantages as well as limitations of integrating social robots in conventional interventions to improve accessibility and standard of care as well as outlining future steps in relation to this research direction. Clearly recognizing the need for future empirical work in this area, we propose that social robots may be an effective component in robot-assisted interventions for social anxiety, not replacing, but complementing the work of clinicians. We hope that this article will spark new research, and research collaborations in the highly interdisciplinary field of robot-assisted interventions for social anxiety.

Creating an operational definition for prolonged postoperative opioid use through the use of concept analysis.

AIM: To develop an evidence-based operational definition for Prolonged Postoperative Opioid Use (PPOU). BACKGROUND: In the United States, opioids are a mainstay of postoperative pain management, and are prescribed to over 90% of patients following surgery. Recent literature has highlighted the risk for prolonged postoperative opioid use (PPOU) after many surgical procedures. However, reported rates of PPOU vary greatly across studies, due in part to inconsistent operational definitions. Recent literature identified 29 distinct definitions for PPOU, which resulted in incidence ranging from 0.01% to 14.7% when applied to the same cohort of opioid naïve patients. METHODS: We followed the eight-step method described by Walker & Avant, using an iterative literature search process with the following databases: PubMed, CINAHL, Google Scholar. English-language peer-reviewed publications through August 2020 were included in the analysis. RESULTS: The four defining attributes of PPOU are (1) use of opioids greater than 90 days following surgery, (2) treatment of postoperative (non-cancer) pain, (3) in opioid-naïve patients, (4) with legal prescription use. We identified four antecedents and four consequences to PPOU. CONCLUSION: The definition of PPOU in current literature varies greatly and has had significant impact on the interpretation and reliability of research findings. We propose the following working definition: PPOU is the legal prescription use of any opioid for greater than 90 days following surgery, for the purposes of treating post-operative pain, by a patient who opioid naïve in the year prior to surgery.

The other side of the screen: The impact of perspective-taking on adolescents' online communication.

INTRODUCTION: In recent decades, adolescents' interactions with peers have increasingly transitioned online. While socially interactive technologies provide multiple avenues for positive communication between peers, adolescents may experience harmful online peer interactions, with such interactions negatively impacting their well-being. A paucity of work exists investigating how adolescents' characteristics are related to their communicative choices on social media and if such choices can be influenced by cues to consider a recipient. Addressing this gap, this work examines experimental manipulations of perspective-taking and individual differences in socio-cognitive skills as they relate to adolescents' communicative choices online. METHOD: Within individual sessions, 12- to 15-year-old Canadian participants (N = 72, 36 girls) viewed pictures of other adolescents on a simulated social media app similar to Snapchat and chose between pre-written aggressive or prosocial comments to send to a recipient under three conditions: a perspective-taking cue, a time-delay, no delay. Participants also completed self-report questionnaires assessing emotion regulation and empathy. RESULTS: Following perspective-taking cues, participants chose more prosocial comments to send compared to when participants were permitted to choose a comment immediately after viewing another adolescent's picture, while controlling for a brief time-delay. Adolescents' individual characteristics (i.e., Social Media Use, State Mood, Affective Empathy, Gender) were associated with their communicative choices online. CONCLUSIONS: Findings from this work provide new insight into the ways adolescents navigate their complex and increasingly online peer interactions. Further, the results suggest that adolescents' social media communication is malleable with a brief perspective-taking cue to consider a recipient.

How to turn that frown upside down: Children make use of a listener's facial cues to detect and (attempt to) repair miscommunication.

Communication involves the integration of verbal and nonverbal cues. This study assessed preschool-age children's ability to use their conversational partner's facial expression to determine whether the partner required additional information or not. Children (aged 4;0-5;11 [years;months]; N = 101) played a game with a virtual child partner where they attempted to tell the virtual child in which box a prize was hidden. Children needed to provide several features of pictures on each box to uniquely identify the correct box. After providing their instructions, children viewed a video of the virtual child's emotional reaction (prize found = happy, not found = sad). We assessed children's recognition that miscommunication had occurred, their decision of whether or not to repair their message, and the content of their repairs. We found that children were able to determine whether or not the listener found the prize, and gauge their own skill at providing instructions, based on the listener's facial expression. Furthermore, children were more likely to attempt to repair messages when the listener appeared to be sad, although their actual success in repairing the message was minimal. With respect to individual differences, children with higher executive functioning and higher emotion knowledge skills were more accurate in their perceptions of communicative success. Children with higher emotion knowledge skills were more likely to attempt to repair their messages when the listener appeared to be sad. Overall, this study demonstrates that children are able to make inferences about communication using a listener's facial expression and that emotion recognition and executive functioning support this ability.

Theory of mind ability in high socially anxious individuals.

BACKGROUND/OBJECTIVES: Research has demonstrated an association between social anxiety and impaired Theory of Mind (ToM). We assess whether ToM deficits occur even at a subclinical level of social anxiety and whether group differences in ToM performance are consistent with interpretation bias. We also explore potential reasons as to why socially anxious individuals may perform differently on ToM tasks. METHODS/DESIGN: Undergraduate participants high (HSA; n = 78) and low (LSA; n = 35) in social anxiety completed a task of ToM decoding, the Reading the Mind in the Eyes (MIE), a task of ToM reasoning, the Movie for the Assessment of Social Cognition (MASC), and a post-task questionnaire about their experience completing the MASC. RESULTS: HSAs performed marginally worse than LSAs on the MIE on neutrally valenced trials, and their pattern of errors may be consistent with a negative interpretation bias. HSAs and LSAs did not differ overall in performance on the MASC, though HSAs reported experiencing more confusion and distress than LSAs during the task, and this distress was associated with more MASC errors for HSA participants only. These results provide insight into the nature of ToM ability in socially anxious individuals and highlight important avenues for future research.

Cognitive and behavioural predictors of adolescents' communicative perspective-taking and social relationships.

Given the pivotal role that social interactions play for adolescents' well-being, understanding the factors that influence communication is key. The present study examined relations between adolescents' communicative perspective-taking, executive function skills, and ADHD traits and explored the role communicative perspective-taking plays in peer relations. Data was collected from a community sample of 15 to 19-years-olds (N = 46) in Waterloo, Canada. Two communicative perspective-taking tasks required participants to infer speakers' communicative intentions. A battery of tasks assessed adolescents' working memory and inhibitory control. Elevated ADHD traits were associated with weaker working memory, inhibitory control, and communicative perspective-taking. Working memory was the strongest predictor of communicative perspective-taking. Highlighting the importance of communicative perspective-taking for social interactions, adolescents with weaker skills in this area reported worse peer relations. Findings underscore the importance of communicative perspective-taking for adolescents' social relations and have relevance for understanding the social difficulties faced by adolescents with elevated ADHD traits.

Consistency between verbal and non-verbal affective cues: a clue to speaker credibility.

Listeners are exposed to inconsistencies in communication; for example, when speakers' words (i.e. verbal) are discrepant with their demonstrated emotions (i.e. non-verbal). Such inconsistencies introduce ambiguity, which may render a speaker to be a less credible source of information. Two experiments examined whether children make credibility discriminations based on the consistency of speakers' affect cues. In Experiment 1, school-age children (7- to 8-year-olds) preferred to solicit information from consistent speakers (e.g. those who provided a negative statement with negative affect), over novel speakers, to a greater extent than they preferred to solicit information from inconsistent speakers (e.g. those who provided a negative statement with positive affect) over novel speakers. Preschoolers (4- to 5-year-olds) did not demonstrate this preference. Experiment 2 showed that school-age children's ratings of speakers were influenced by speakers' affect consistency when the attribute being judged was related to information acquisition (speakers' believability, "weird" speech), but not general characteristics (speakers' friendliness, likeability). Together, findings suggest that school-age children are sensitive to, and use, the congruency of affect cues to determine whether individuals are credible sources of information.

Ratings of Everyday Executive Functioning (REEF): A parent-report measure of preschoolers' executive functioning skills.

Executive functioning (EF) facilitates the development of academic, cognitive, and social-emotional skills and deficits in EF are implicated in a broad range of child psychopathologies. Although EF has clear implications for early development, the few questionnaires that assess EF in preschoolers tend to ask parents for global judgments of executive dysfunction and thus do not cover the full range of EF within the preschool age group. Here we present a new measure of preschoolers' EF-the Ratings of Everyday Executive Functioning (REEF)-that capitalizes on parents' observations of their preschoolers' (i.e., 3- to 5-year-olds) behavior in specific, everyday contexts. Over 4 studies, items comprising the REEF were refined and the measure's reliability and validity were evaluated. Factor analysis of the REEF yielded 1 factor, with items showing strong internal reliability. More important, children's scores on the REEF related to both laboratory measures of EF and another parent-report EF questionnaire. Moreover, reflecting divergent validity, the REEF was more strongly related to measures of EF as opposed to measures of affective styles. The REEF also captured differences in children's executive skills across the preschool years, and norms at 6-month intervals are reported. In summary, the REEF is a new parent-report measure that provides researchers with an efficient, valid, and reliable means of assessing preschoolers' executive functioning. (PsycINFO Database Record

Mother-Child Communication: The Influence of ADHD Symptomatology and Executive Functioning on Paralinguistic Style.

Paralinguistic style, involving features of speech such as pitch and volume, is an important aspect of one's communicative competence. However, little is known about the behavioral traits and cognitive skills that relate to these aspects of speech. This study examined the extent to which ADHD traits and executive functioning (EF) related to the paralinguistic styles of 8- to 12-year-old children and their mothers. Data was collected via parent report (ADHD traits), independent laboratory tasks of EF (working memory, inhibitory control, and cognitive flexibility), and an interactive problem-solving task (completed by mothers and children jointly) which was coded for paralinguistic speech elements (i.e., pitch level/variability; volume level/variability). Dyadic data analyses revealed that elevated ADHD traits in children were associated with a more exaggerated paralinguistic style (i.e., elevated and more variable pitch/volume) for both mothers and children. Mothers' paralinguistic style was additionally predicted by an interaction of mothers' and children's ADHD traits, such that mothers with elevated ADHD traits showed exaggerated paralinguistic styles particularly when their children also had elevated ADHD traits. Highlighting a cognitive mechanism, children with weaker inhibitory control showed more exaggerated paralinguistic styles.

Guess who? Children use prosody to infer intended listeners.

This study examined the relative influence of prosody and semantic content in children's inferences about intended listeners. Children (n = 72), who ranged in age from 5 to 10 years, heard greetings with prosody and content that was either infant or adult directed and chose the intended listener from amongst an infant or an adult. While content affected all children's choices, the effect of prosody was stronger (at least, for children aged 7-10 years). For conditions in which prosodic cues were suggestive of one listener, and content cues, another, children aged 7-10 years chose the listener according to prosody. In contrast, the youngest age group (5- to 6-year-olds) chose listeners at chance levels in these incongruent conditions. While prosodic cues were most influential in determining children's choices, their ratings of how certain they felt about their choices indicated that content nonetheless influenced their thinking about the intended listener. Results are the first to show the unique influence of prosody in children's thinking about appropriate speech styles. Findings add to work showing children's ability to use prosody to make inferences about speakers' communicative intentions.

Social Communication is Predicted by Inhibitory Ability and ADHD Traits in Preschool-Aged Children: A Mediation Model.

OBJECTIVE: Given the role inhibitory control plays in both ADHD and communication, this study examined whether inattentive and hyperactive-impulsive traits mediate the impact of weak inhibitory ability upon the knowledge and application of pragmatic rules early in development. METHOD: Participants were 36 typically developing preschoolers and their caregivers. ADHD traits were assessed per caregiver report. Inhibition was assessed in children using a distraction task. Pragmatic language was assessed by asking children about hypothetical social situations (knowledge) and by asking caregivers to report on children's actual communicative behaviors (application). RESULTS: Individual differences in inhibition predicted both facets of pragmatic language development. Hyperactive-impulsive behaviors were a significant mediator of this relationship-but only with regard to children's ability to effectively apply pragmatic rules in everyday life. CONCLUSION: Our findings suggest that social communication difficulties in some young children are a downstream consequence of hyperactive-impulsive behaviors that arise from poorly developed inhibitory control.

Intonation influences how children and adults interpret sarcasm.

Adults distinguish sarcasm from literal language according to intonation involving a reduction in fundamental frequency (F0). We examined whether children's and adults' interpretation of a sarcastic speaker's belief, attitude, and humor was affected by degree of F0 reduction by presenting five- to six-year-olds and adults with sarcastic and literal criticisms with a small, medium, or large mean F0 reduction. Children and adults were more accurate in attributing the speaker's belief and intent for sarcastic criticisms for large F0 reductions compared to small reductions. These results show that F0 reduction is a helpful cue to sarcasm interpretation for both children and adults.

Attention orienting by gaze and facial expressions across development.

Processing of facial expressions has been shown to potentiate orienting of attention toward the direction signaled by gaze in adults, an important social-cognitive function. However, little is known about how this social attention skill develops. This study is the first to examine the developmental trajectory of the gaze orienting effect (GOE), its modulations by facial expressions, and its links with theory of mind (ToM) abilities. Dynamic emotional stimuli were presented to 222 participants (7-25 years old) with normal trait anxiety using a gaze-cuing paradigm. The GOE was found as early as 7 years of age and decreased linearly until 12-13 years, at which point adult levels were reached. Both fearful and surprised expressions enhanced the GOE compared with neutral expressions. The GOE for fearful faces was also larger than for joyful and angry expressions. These effects did not interact with age and were not driven by intertrial variance. Importantly, the GOE did not correlate with ToM abilities as assessed by the "Reading the Mind in the Eyes" test. The implication of these findings for clinical and typically developing populations is discussed.

Communicative perspective-taking performance of adults with ADHD symptoms.

OBJECTIVE: The ability to take the perspective of one's conversational partner is essential for successful communication. Given the significant cognitive and attention resources required to use another's perspective, the authors assessed whether adults who report symptoms of ADHD would have difficulty using their conversational partner's visual perspective to guide their interpretations. METHOD: Adults with high (clinical range) or low (nonclinical range) self-reported ADHD symptoms participated in a communication task that required perspective-taking. RESULTS: Eye movement measures revealed that individuals with high ADHD symptoms fixated on objects obscured from their partners' view more often than did those participants with low ADHD symptoms, and the degree to which this "egocentric" object was considered correlated with the degree of inattention symptoms. However, overt behavior (object choice) was not impacted by ADHD symptomatology. CONCLUSION: Individuals with high levels of ADHD symptoms, especially inattention, are less efficient in their ability to use another's perspective during conversation.

Children's use of information quality to establish speaker preferences.

Knowledge transfer is most effective when speakers provide good quality (in addition to accurate) information. Two studies investigated whether preschool- (4-5 years old) and school-age (6-7 years old) children prefer speakers who provide sufficient information over those who provide insufficient (yet accurate) information. Children were provided clues to the location of hidden dots by speakers who varied in quality and accuracy. Subsequently, children decided from whom they would like to receive additional information. In Study 1, when the outcome of the clue was clear, preschool- (n = 40) and school-age (n = 42) children chose to solicit information from sufficient rather than from insufficient speakers. In Study 2, when not provided with information about the outcome of the speakers' clues, school-age (n = 22), but not preschool-age (n = 19), children preferred sufficient relative to insufficient speakers. Results highlight a developmental progression in children's use of information quality as a cue to determining that individuals are preferable informants.

Depressive symptoms and use of perspective taking within a communicative context.

OBJECTIVE: The ability to take the perspective of one's conversational partner is essential for successful communication. We assessed whether individuals who report high levels of depressive symptoms have more difficulty with navigating this interpersonal task. METHOD: Undergraduate students participated in a computerised communication task that, on some trials, required perspective taking (N=125). RESULTS: When participants were grouped according to their self-reported depressive symptoms, the "dysphoric group" (BDI ≥ 16, n=37) showed more errors than a "non-dysphoric group" (BDI ≤ 10, n=56) on trials requiring participants to use the perspective of the speaker, but not on control trials where perspective taking was not required. The dysphoric group demonstrated slower response times overall. CONCLUSIONS: Individuals with moderate to high levels of depressive symptoms are more challenged by using a speaker's perspective to interpret statements.

Referential communication in children with ADHD: challenges in the role of a listener.

PURPOSE: Successful communication requires that listeners accurately interpret the meaning of speakers' statements. The present work examined whether children with and without attention-deficit/hyperactivity disorder (ADHD) differ in their ability to interpret referential statements (i.e., phrases that denote objects or events) from speakers. METHOD: Children (6 to 9 years old), diagnosed with ADHD (n = 27) and typically developing (n = 26), took part in an interactive task in which they were asked by an adult speaker to retrieve objects from a display case. Children interpreted the referential statements in contexts that either did or did not require perspective-taking. Children's eye movements and object choices were recorded. Parents completed questionnaires assessing their child's frequency of ADHD symptoms and pragmatic communicative abilities. RESULTS: Behavioral and eye movement measures revealed that children with ADHD made more interpretive errors and were less likely to consider target referents across the 2 communicative conditions. Furthermore, ADHD symptoms related to children's performance on the communicative task and to parental report of the child's pragmatic skills. CONCLUSION: Children with ADHD are less accurate in their interpretations of referential statements. Such difficulties would lead to greater occurrences of miscommunication.

The development of preschoolers' appreciation of communicative ambiguity.

Using a longitudinal design, preschoolers' appreciation of a listener's knowledge of the location of a hidden sticker after the listener was provided with an ambiguous or unambiguous description was assessed. Preschoolers (N=34) were tested at 3 time points, each 6 months apart (4, 4½, and 5 years). Eye gaze measures demonstrated that preschoolers were sensitive to communicative ambiguity, even when the situation was unambiguous from their perspective. Preschoolers' explicit evaluations of ambiguity were characterized by an initial appreciation of message clarity followed by an appreciation of message ambiguity. Children's inhibitory control skills at 4 years old related to their explicit detection of ambiguity at later ages. Results are discussed in terms of the developmental progression of preschoolers' awareness of communicative ambiguity.

Which is important for preschoolers' production and repair of statements: what the listener knows or what the listener says?

Three- and four-year-olds participated in a referential communication task wherein they requested stickers from a knowledgeable or ignorant adult to complete a card. Following inadequate initial requests children were provided with three different feedback types: goal substitution (i.e. an incorrect sticker was provided), explicit statement of misunderstanding ('I don't know which one you mean'), and vague feedback ('Huh?'). Preschoolers' initial statements revealed sensitivity to the listener's perspective: more descriptors were provided when the listener did not have visual access to the card. Although listener's knowledge did not affect children's repair statements following feedback, the feedback type did: goal substitution elicited more repairs that included new descriptors, whereas vague responses elicited more repetition of initial requests than other feedback types. Children's age and verbal skills were related to the specific repair strategies used. Results demonstrate that preschoolers' use of cues from a conversational partner depends on the type of communicative task.

The role of gaze direction and mutual exclusivity in guiding 24-month-olds' word mappings.

In these studies, we examined how a default assumption about word meaning, the mutual exclusivity assumption and an intentional cue, gaze direction, interacted to guide 24-month-olds' object-word mappings. In Expt 1, when the experimenter's gaze was consistent with the mutual exclusivity assumption, novel word mappings were facilitated. When the experimenter's eye-gaze was in conflict with the mutual exclusivity cue, children demonstrated a tendency to rely on the mutual exclusivity assumption rather than follow the experimenter's gaze to map the label to the object. In Expt 2, children relied on the experimenter's gaze direction to successfully map both a first label to a novel object and a second label to a familiar object. Moreover, infants mapped second labels to familiar objects to the same degree that they mapped first labels to novel objects. These findings are discussed with regard to children's use of convergent and divergent cues in indirect word mapping contexts.