Follow up questions

It seems like there are no specific questions on my topic of Emotion and Facial Processing.  Thank you everyone for your input on my posts and if you have any more questions or comments, just let me know!

Question 5: Take Home Strategies

When working with children with ASD, keep in mind that children with ASD have a lack of understanding of emotion and decreased recognition of facial expressions.  Children with autism do not have a good ability of recognizing emotion, as discussed in my previous posts, therefore, when you use your facial expressions as rewards or praise they will not understand.  For example, when the therapist smiles when the child does a “good job” in OT, the child may not understand that this means they did a good job. This was discussed in my first post, how children with autism process emotion differently than typically developing children.  They also have difficulty reading emotion on faces and in general use a different scan pattern when looking at faces (Gautheir, Klaiman, Schultz, 2009).

As stated previously, children with autism have difficulty understanding emotion in facial expression. Teaching children to label faces of different emotion and practicing making those faces are shown to improve children’s understanding of different emotions on faces, as stated in Ryan and Charragian (2010) article.  Also, sorting different faces with different emotions on them are helpful in having the child understand emotional expression.

Having difficulty understanding emotion affects the child’s ability to make friends, sustain friendships and get a job, as stated in my first post.  Therapists need to address these needs.  If we are working on prevocational activities or socialization goals, part of what we should address should be the emotional and facial processing skills of these kids.  These skills are vital in interviewing, sustaining a job, and making and keeping friends. (http://www.emotionalprocessing.org.uk/Various%20articles/Autism.htm#Autism_and_Emotional_Processing)

Lastly, this is an area where family education is important. Parents need to understand that sometimes their child may not understand what emotion they are displaying on their face and not react appropriately. Giving the family a variety of ideas to teach these skills, as stated in my previous post, for home use, will aid greatly in helping them form relationships with their children.

This is my last question to answer on my blog. I hope everyone has learned something from reading this blog. Please post any questions that you have for me so I can address them all on my next posting…thanks!

Question 5: Home Program

Provide 2 family focused home programs which will help families either help their child compensate OR drive them to a higher level of ability and efficiency in emotion/face processing

      Ideas for home activities for families:

·         Have a poster of different faces all representing different emotions, along with pictures of family members and friends expressing different emotions. Review daily with child what each emotion is and what it means. 

·         Throughout the day when mom is upset, happy, frustrated, have the child “guess” the emotion and reward as appropriate.  If time allows, you can even have your other children join in the game to guess other emotion.

·         Have a game where you each try to make different faces and guess which emotion you are portraying; discuss how that emotion makes the child feel.

·         Have child point out on board of faces how they are feeling that day and see if they can identify why they feel that way.

·         Read stories, such as, Bernstein Bears and talk about how each person would feel in the story and how you can tell.

·         Parents can play this online “feelings” game with child: http://specialchildren.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=specialchildren&cdn=parenting&tm=6&gps=308_237_1362_521&f=10&tt=13&bt=1&bts=1&zu=http%3A//www.do2learn.com/games/feelingsgame/index.htm

·         A good idea on the website: http://www.parentingscience.com/facial-expressions-for-kids.html is to match pictures of situations with pictures of the emotion is would make you feel.

·         This website:

http://www.thomasandfriends.com/usa/Thomas.mvc/Games/Home  has two games: one choose the right emotion and one matching emotions.  It could be done at home and the family could talk about when you would feel each emotion.

Question 4: Intervention Strategies

    Provide 3 clear strategies to modify your activities to compensate for these challenges. Reference any research available to support these strategies.

    

Superflex: A Superhero Social Thinking Curriculum Package

                This is a program designed for children with Aspergers and high functioning autism to improve on social skills.  It is about a superhero Superflex and how he deals with different social situations.  The program also helps to understand different people’s emotions.  Below is the link for some information on Superflex.  This can be a great program to implement in school. I know they have used this program at different districts and the kids love it. It would primarily be taught by a teacher, but we could easily carry it over into our treatment sessions by if a situation of social thinking comes up, you can ask, what would Superflex do or,  if working on fine motor skills, you can color in Superflex and talk about social situations. 

http://www.socialthinking.com/index.php?page=shop.product_details&flypage=flypage.tpl&product_id=129&category_id=9&option=com_virtuemart&Itemid=102

Matching components and faces of different emotions

                A study by Ryan and Charragain (2010) taught children with high functioning autism emotional recognition through a variety of tasks within small groups, the children were taught to match faces with different emotions and sort different components of faces based on the emotions.  For example, they not only labeled happy faces, but also, happy eyes and mouths. This study found this technique to be effective in teaching recognition of emotions.  We could easily incorporate this into our treatment session if we are working on sorting, categorizing, or body awareness. 

Role playing emotion expressions

In the Ryan and Charragian  (2010) study, they also had the children practice role-playing different emotion expressions and drawing expressions to improve ability to recognize emotion.  These we could easily incorporate in our treatment sessions, if we are working on pencil skills, we could have children draw different expressions, or if we are working on any facial exercises we could incorporate naming emotions of the faces we are making.  This intervention was found to improve children’s recognition of emotion. 

Conclusion

Overall, I think we have to be aware of the fact that children with ASD do not understand emotion in the same way we do.  We have to be aware to not use our expressions to guide behavior and use our expressions as rewards.   Also, explaining how you feel to the child, for example, if you are disappointed they did not follow a direction, tell the child how you feel and ask them how they can tell that is how you feel.  We can use pictures of different facial expressions that show, happy , sad, and angry faces in treatment ,  to show how the therapist and/or child is feeling.

Reference

Ryan, C. & Charragain, C.N. (2010). Teaching Emotion Recognition Skills to Children with Autism.  J Autism Dev Disord 40: 1505-1511.

Question 3: Clinical examples

Provide 3 clear examples of clinical situations in which your treatment approach is challenged by a child’s reduced or inavailability to process emotion and facial features.

When working with a student on a task, for example handwriting, and they do not want to complete the task, I usually offer a reward or try to make it “fun”.  Sometimes, the student still becomes frustrated with the task and difficulty attending and therefore will run away or act out.  If this child could process emotion typically, I would show the child I am upset with my facial expression and tell them to sit down. However, this does not work with children who cannot understand what my expression means or why I am having an “angry” or “disappointed” emotion. I have to come up with a different way to control the behavior this child, which we have discussed throughout our modules.

When trying to get a student to try a new task that may be difficult for them, for example, use shaving cream to write letters.  Usually, I would act excited for the child to try the new sensory texture and smile and say how much “fun” it is going to be, but if the student does not process the smile and happiness, this is not a valid way to prep the activity. 

When on a swing if the child starts to tip the swing and do anything unsafe, I usually will say “stop!” with a little fear and some sternness in my voice, however, if the child does not understand my look of fear and the “fear” in my voice, they might stop the action as quickly. With my other students, they understand this and don’t do this again, but with these students, I have to come up with a different approach.

Working in groups is also more challenging.  Usually working in a group, I might have the children play a competitive fine motor game; this type of play means understanding when someone wins/loses to be kind to them and involves lots of social interaction. However, when working with two children and one does not understand emotion, I will start off with parallel play, then turn taking and then a competitive game

I often use my “happiness” as a reward for the student, for example, after they complete a task saying good job with a big smile can be a big enough reward, however, with a child who has difficulty understanding emotion, this would not be the best reward, a tangible item would have better results.

Question 2

What research tells us this is a problem? What are the specific neurological differences identified that researchers link to emotion and face processing challenges?

There is much research out there reporting that children with autism have difficulty with emotional understanding along with facial processing.  There is so much research in this area because a key behavior in people with autism is difficulty with socialization and emotional understanding. (Hill et al, 2004)

In Rump et al’s (2009) research,   she discusses the “Development of emotion: recognition in individuals with autism”.  This study explored how recognition of emotion developed from age 5 to adult in people with autism compared to controls.    This study found that adults with autism were not as good at identifying emotions on people’s faces as the control group of adults.  However, the children and adolescents with autism did not show a significant difference from controls on identifying emotion.   In the control groups,  children performed worse than adolescents, and both groups worse than the adults.  However, the group of adolescent participants with autism did not show this difference with adults with autism.  This demonstrates how people with autism may stop learning about emotion and maturing in this category as they age. (Rump et al, 2004)

A brief report on cognitive processing of own emotions of people with ASD was written by Hill, Verthoz, and Frith (2004).  This was a survey taken by people with ASD, as well as a control group, answering questions on how they felt they processed emotion and if they were depressed.  Relatives of the participants with autism also took these two surveys.  The results showed that in the group with ASD only 14.8% were not impaired in emotion processing abilities, but 78.7% of relatives and 82.9% were non impaired.  It was concluded that there was a significant difference between emotional processing of adults with autism compared to relatives of adults with autism and the control group.  Adults with ASD experience a significantly higher level of depression than the controls and their relatives (Hill et al, 2004).

I found the article “Eye contact detection in humans from birth” by Farroni, Csibra, Simion, and Johnson, 2002) very interesting.  This article explored newborn’s gaze and neural processing of faces in 4 month olds.  It was noted that newborns (first five days of life) look longer at a face that is looking directly at the infant compared to a face averting his gaze away from the infant.  They also found that in “four month olds infants, the presence of direct gaze facilitated the neural processes that are associated with the earliest steps of face encoding” (Farroni et al, 2002, pp9604) This study shows at what a young age typically developing children develop eye contact and their interest in others eyes, which I think is interesting to compare this to our kids with autism.  This is brought up because of the conclusion in Krichner, et al, (2011) that “there is an association between deviant eye gaze behavior in autistic individuals and face processing deficits and social impairment” (Krichner et al, 2011, pp166)

People with autism have difficulty interpreting and expressing emotion. This study explored the intonation and emotion in ASD (Hubbard & Trauner, 2006).   The study included nine children with Asperger’s Syndrome, nine with autism, and 10 controls. This was a two experiment study. In the first experiment, the participants were asked to repeat a phrase with happy, sad and angry intonation.  In the second experiment, the children were read a story and asked to complete the story with one sentence while pretending to be a character.  In experiment one, all three groups showed a correlation between pitch range and intended emotion. In the second experiment, only four of the nine children with autism could complete the task. There was no significant difference found in experiment 2 between the two groups.   The ASD group had a larger pitch range than the other two groups. The author commented that the autistic subjects outperformed controls on subjective ratings of emotion, but scored very low on spontaneous speech, the researcher raised the question, “...whether the high scoring subjects are truly processing the stimuli in Experiment 1 as speech or rather as sounds.” (Hubbard &Trauner, 2006, pp 171)

What are the specific neurological differences identified that researchers link to emotion and face processing challenges?

The one area of the brain that seems to resurface in relations to autism and social perception is the amygdala.  Another part of the brain involved in processing social stimuli is the ventromedial prefrontal cortex which has reciprocal connections with the amgydala (Monk etal, 2009).  The ventromedial  prefrontal coretex is involved in cognitive flexibility and dealing with social situations (Monk et al, 2009) The fusiform gyrus is involved in identifying faces,  the superior temporal sulcus processes changeable features of the face, which then activates the amygdala. (Schultz, 2005,  Monk et al, 2009) The fusiform face area (FFA) has been controversially known to activate strongly to faces as well as other stimuli (Schultz, 2005 ).  The FFA is within “the lateral aspect of the middle part of the fusiform gyrus” ( Schultz, 2005, pp130)  The FFA is thought to be involved with perceptual facial recognition. However, this area has been known to  activate when someone is looking at something they have high emotional attachment to, such as, a bird watcher looking at birds (Schultz, 2005) 

“The subcortical visual system passes information from retina to the superior colliculus to the pulvinar nucleus of the thalamus to the amgydala” ( Schultz, 2005, pp135) One hypotheses is that children with autism have an issue with the subcortical visual system at birth resulting in being less attentive to faces at birth  and thus affecting development of socialization as the child ages (Schultz, 2005).

Studies have shown a greater activation in the amygdala when shown faces in people with ASD than controls (Monk et al, 2009). Monk et al (2009) found that people with ASD had a greater right amygdala activation toward happy verse neutral faces and sad neutral faces than controls. There was no difference in angry to neutral neutral faces.   The ASD group had weaker connectivity between right amygdale and left middle temporal gyrus when shown happy faces.  The control group had more activation in the inferior frontal gyrus when shown sad-neutral pairs.  The ASD group had greater connectivity between right amygdale and ventro medial prefrontal cortex to happy faces (Monk et al, 2009).

Schultz(2005) discusses hypo activation in the FFA area of the brain in people with ASD.  There may be a relationship between social impairment and activation of the FFA area of the brain.  The right fusiform gyrus may be enlarged in people with ASD (Schultz, 2005). 

People with autism have shown less activation in the ventromedial prefrontal cortex compared to controls in response to facial displays(Monk et al, 2009).   In people with autism the “white matter tract between temporal lobe and amygdala is compromised” ( Monk et al,. 2009, pp106)

Another study explored “Resting cortical brain activity and social behavior in higher functioning children with autism.” (Sutton et al, 2004)  This study measured resting anterior cortical activity which may explain the social and emotional differences in children with autism.   They compared children with learning disabilities, typically developing children and children with autism.   The autism group had more left sided than right sided activity.   Children with HFA who showed an increase in right midfrontal asymmetry also had reports of more social impairments and social and emotional functioning difficulties.    In conclusion, there may be a correlation between social interaction and anterior cortical asymmetry  (Sutton et al, 2004).

             

As a side note, I know the question was brought up, I believe in module 2, do children with blindness have a decrease in attachment/socialization.  In the article I read by Schultz (2005), he mentioned that children with congenital blindness have social impairments. He was referring to a study by Hobson and Bishop, (2003)

References

Hill, E., Berthoz, S., & Frith, U. (2004). “Brief Report: Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives.” Journal of Autism and Developmental Disorders, 34 (2) 229-235.

Hubbard, K., Trauner, D. (2007). “Intonation and Emotion in Autistic Spectrum Disorders” J Psycholinguist Res 36:159-173.

Krichner, J., Hatri A., Heekreren, H.R., Dziobeck, I. (2011) “Autistic Symptomology, Face Processing Abilities, and Eye Fixation Patterns.” J Autism Dev Disord 41: 158-167.

Farroni, T, Csibra, G., Simion, F., Johnson, M. (2002). “Eye contact detection in humans from birth.” PNAS 99(14)9602-9605.

Monk, C., Weng, S., Wiggins, J., Kurapati, N, Louro, H., Carraso, M., Maslowsky, J., Risi, S., Lord, C. (2010) “Neural circuitry of emotional face processing in autism spectrum disorders.” J Psychiatry Neurosci 35 (2) 105-114.

Rump, K., Giovannelli, J., Minshew, N., Strauss, M. (2009). “The development of emotion recognition in individuals with autism.” Child Development, 80 (5), 1434-1447.

Schultz, R. (2005). “Development deficits in social perception in autism: the role of the amygdale and fusiform face area.” Int.J. Devl Neuroscience 23 125-141.

Sutton, S., Burnette, C., Mundy, P.C., Meyer, J., Vaughan, A., Sanders, C., & Yale, M. (2005). “Resting cortical brain activity and social behavior in higher functioning children with autism.”  Journal of Child Psychology and Psychiatry 46: 2, 211-222.

Question 1

a. What are the challenges our children with ASD face with respect to emotion understanding?

There are a variety of challenges children with ASD face in understanding and projecting emotion. Overall in the readings, it is understood that people with an ASD have difficulty processing and understanding emotion. Many authors/researchers have speculated and studied why children with autism have differences in understanding/displaying emotion compared to other people.  This posting will discuss some of these thoughts.

Children with ASD may have difficulty with the cognitive processing and understanding of emotions In other words, the way the brain processes the understanding of emotion. (Hill, E., Berthoz, S., & Frith, U,2004)

One theory of children with autism’s understanding of emotion is entitled “mind-blindness.” Baron Cohen developed the  mindblindness theory; he hypothesized that people with ASD have a delay in developing the understanding of what others are feeling. People with ASD have difficulty putting themselves in someone else’s place and understanding how that other person is feeling.  (http://en.wikipedia.org/wiki/Mind-blindness)

Another theory is that people with autism have difficulty controlling and understanding emotion because they have difficulties with socialization, communication, and flexibility; the combination of these deficits leads to difficulty understanding other’s emotions.

(http://www.emotionalprocessing.org.uk)

Another thought is that people with an ASD have difficulty interpreting emotion and understanding emotion including emotion noted by the intonation of speech; this will be further discussed on the next posting(Hubbard &Trauner, 2007).

    

b. Processing facial features?

People with autism are understood to have difficulty processing facial features as well as reading emotion on facial expressions.  One of the first indicators of abnormal brain development is decreased facial recognition by age one. By 12 months a typically developing child should use their mothers’ expression to guide their reactions; this is not always found in children with ASD. (Dawson, Webb, Carver, Panagiotides, McPartland , 2004)

Children with ASD may not process the face holistically and have been known to focus on the person’s mouth as opposed to eyes.  This results in difficulty with facial recognition.  If the child is cued to focus on certain parts of the face, he has a better chance of facial recognition.  Overall, Children with ASD’s brains show abnormal facial processing on fMRI and ERP which demonstrated different use of the brain to process faces as compared to typical children (Gauthier, Klaiman, Schultz, 2009.)

Different brain activity has been found in children with ASD opposed to typically developing children when looking at faces with different emotion. (Dawson et al, 2004)  This impairment in facial processing may be secondary to impairment in emotion, socialization or with joint attention. (Dawson et al, 2004)

c How are they inter-related?

It is very hard to distinguish between if children with ASD have difficulty with emotional processing, facial processing or a combination.  You must look at someone’s face, facial features, and expression to aid in understanding what emotion they are displaying or feeling.  “Given that emotion is often displayed in the face, separating a deficit in facial processing from a deficit in understanding and recognizing facial expression is difficult (343, dawson et al, 2004). However, there are also studies that oppose the idea that facial recognition and emotional recognition are separate (Dawson, 2004).

d How does it impact daily function? (ie: verbal communication, non-verbal communication, eye contact/social referencing/social skills, and overall participation in the community..) 

We use understanding of emotion and facial expression/recognition often.  In regards to verbal communication, not understanding intonation and the emotion of expression can affect how you react to a situation (http://www.emotionalprocessing.org.uk/Various%20articles/Autism.htm#Autism_and_Emotional_Processing).  For example if we see someone start to get teary when we are talking about someone who passed away, we may switch the subject.  Someone with an ASD may not recognize the sadness and switch the subject.

     Having impaired non verbal communication makes it difficult to make friends and interact in the community. For example, when a waitress asks for your order, sometimes they will just look at you and smile indicating you should order, but if you do not

understand what this means, then you will miss ordering. 

Social skills is greatly affected by difficulty understanding emotion.  The ability to make friends could be very difficult.  Many people rely on friends to cheer them up or understand what they are going through and that is difficult to do with lack of emotional understanding. You could also easily misunderstand many things that friends say.

     Working involves socialization.  Knowing when is a good time to speak with a supervisor about a day off or getting a raise or asking them a question about work, is integral in getting a good response.  For example, you are not going to ask your supervisor for a raise right after they finish yelling at you.

e. How could it impact behaviors across the lifespan and challenge things like getting and sustaining a job?

Reading people is important throughout life.  Being able to interview is vital in getting a job and having trouble responding to questions, such as, what would you do if you disliked a co-worker, may result in difficulty finding a job.  Being able to understand if a coworker is upset with you or happy for you can make for difficulty working together on projects which is very important with most jobs.

References

Dawson, G., Webb, S., Carver, L., Panagitotides, H., McPartland, J. (2004). Young children with autism show atypical brain responses to fearful versus neutral facial expressions of emotion. Developmental Science. 7:3 340-359.

Gauthier, I., Klaiman, C., Schultz, R. (2009)Face composite effects reveal abnormal face processing in Autism spectrum disorders. Vision Research. 49: 470-478.

Hill, E., Berthoz, S., & Frith, U. (2004). Brief report: Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34: 2.

Hubbard, K., Trauner, D. (2007). Intonation and Emotion in Autistic Spectrum Disorders. J Pyscholinguist Res. 36: 159-173.

http://en.wikipedia.org/wiki/Mind-blindness

http://www.spring.org.uk/2007/01/emotional-processing-in-autism-spectrum.php

http://www.emotionalprocessing.org.uk/Various%20articles/Autism.htm#Autism_and_Emotional_Processing_

MU Autism Emotion and Face Processing