For Every Child – SEND Adaptations

Skylark’s books, toys and games can be adapted to special needs and learning difficulties. Learn how My First Emotions can help children with autism.

Autism and Emotions
by Dr John Lambie

Individuals diagnosed with autism spectrum disorder present with two types of symptoms: problems in social communication and interaction, and restricted, repetitive patterns of behaviour, interests or activities (Diagnostic and Statistical Manual-5). With regard to difficulties with social interaction, DSM-5 mentions “reduced sharing of emotions” and difficulties in back-and-forth conversation as typical features of autism. How might these features of autism affect a child’s engagement with My First Emotions, and conversely, how might My First Emotions help the emotional development of a child with autism? To answer these questions, we need to first summarize some of the research on autism and emotion.

• Children with autism are not necessarily “less emotional” than typically developing children, and in some cases may in fact be more emotional.
• Children with autism are more likely to find recognizing and labelling negative emotion faces harder than typically developing children.
• Children with autism will typically find it harder to explain the reasons and causes of other people’s emotions.
• Children with autism are often empathic in the sense of being affected by other people’s emotions—for example, feeling distressed by another person’s distress—and may sometimes in fact have a heightened sensitivity to other people’s emotions.
• The combination of being sensitive to others emotions (high emotional empathy) but not being able to easily label or explain them (low cognitive empathy), may lead children with autism to want to avoid other people’s emotions.

Autism and emotional recognition

It has been suggested that “emotion reading”, i.e. recognizing and understanding other people’s emotions might be a primary difficulty in autism (Hobson, 1986). However, the evidence is mixed. Some studies have indeed found that children with autism have problems in recognizing emotion faces (e.g. Corbett et al, 2009), while others have found no impairment in recognizing emotion faces when comparing children with autism and typically developing children (Jones et al 2011). In a meta-review of 48 high quality research studies, Uljarevic and Hamilton (2013), concluded that overall there was indeed evidence for emotion recognition difficulties in autism for the emotions of sadness, anger, fear, surprise, and disgust, but not for happiness. These findings are based on averages and do not mean that all children with autism were impaired on emotional recognition. But overall, children with autism as a group seem to have difficulties with recognizing negative emotions when compared to typically developing children.

Autism and empathy

Some researchers distinguish between “cognitive empathy” and “emotional empathy” (Smith, 2009). Cognitive empathy is the ability to predict and understand another’s person’s behaviour on the basis of their mental states. For example, knowing that someone feels sad because they believe they have lost their teddy. Emotional empathy is being emotionally affected by another person’s emotion, or sharing in their emotional state (Smith, 2009). For example, feeling sad because someone else is crying. To summarize this distinction: you might see a child crying and as a result feel sad or distressed (high emotional empathy), but find it hard to work out why the child is crying (low cognitive empathy).

While there is a consensus that individuals with autism are usually impaired in cognitive empathy, also known as “theory of mind” (Baron-Cohen, 1995), some research studies show that they are not impaired in emotional empathy (Newbigin et al, 2016; Scheeren et al, 2013), and some researchers argue they may in fact have heightened emotional empathy (Caldwell, 2006; Smith, 2009). The combination of high emotional empathy and low cognitive empathy may mean that people with autism are more likely to avoid other people’s negative emotions because they find them especially distressing and confusing (Smith, 2009). In this sense, children with autism may be oversensitive to other’s emotions while at the same time having less understanding of them.

Ways to use My First Emotions with a child with autism

The first thing to say is that all children are different and the best way to use My First Emotions for any child—whether they are typically developing or are on the autistic spectrum—is to respond to how your child wants to engage with the set.

Having said that, some things that may be of help to consider when using My First Emotions with a child with autism are listed below.

Extra help with emotion recognition may be needed

Being able to label angry, sad, and fearful faces may be harder for children with autism. More repetition with the emotion recognition activities in the Activity Book (labelled with an “eye” icon) may therefore be helpful. The following activities all deal with emotional recognition (page numbers refer to the Activity Book):

• Reading the stories (p. 7)
• Find it (p. 8)
• Talk about the story (p. 8)
• Matching the toys (p. 11)
• What am I feeling? (p. 11)
• Looking at emotion faces (p. 15)
• Labelling emotion faces (p. 16)
• Matching faces (p. 17)
• Emotional peek-a-boo (p. 23)
• A wall of faces (p. 26)
• Find the treat (p. 27)
• Look at my face (p. 31)
• Stones have feelings (p. 32)
• Make an emotion-meter (p. 35)
• Look at an emotion (p. 36)
• How strong is your emotion? (p. 37)
• Look at me! (p. 38)

For example, the activity “Labelling emotion faces” (p. 16) involves getting out all the emotion cards that show emotion faces (you can also use the emotion toys) and asking your child to point to, or to label, each one—e.g. “point to the angry face”. You can also make the faces yourself and ask your child to make the faces. A lot of repetition of this task over the weeks should be helpful in learning the differences between the faces.

One issue that may hinder some of the above tasks is that some children with autism do not find emotional faces very rewarding to look at and often may prefer engaging with more mechanical games rather than character games (McClintock, Day, Leggett, & Baron-Cohen (2010). For example, children with autism often find trains to be interesting because they have a predictable mechanical motion over a set track, as opposed to people who are more unpredictable in their behaviour. One way to deal with this would be to put Robbie or some of the emotion toys into toy vehicles such as a cars, trucks or trains, and tell stories that involve a journey where set things happen at set times that lead to emotions, and then this story can be repeated over and over. For example here is a new game you could try:

Robbie’s train (or car) journey game

Put Robbie in a toy train or a toy car (anything with wheels!).

• Lay out in a room or on a table a journey that he makes, involving a starting place, a finishing place, a “fun” section, a “frustrating” obstacle, and a “scary” obstacle.
• For example: he starts at one corner of the room, and zooms very fast along a straight section (the “fun” part). He then has to go through a tunnel (the “scary” part). He then travels fast again (another “fun” part) but then has to stop at a red light (the “frustrating” part, where Robbie feels angry that he has to stop). After another zoomy, “fun” section he finally comes to the end of the journey (this is a “sad” part, because the journey is over).
• At each part of the journey, Robbie has a set emotion, which you can describe (e.g. “Robbie is scared being in the tunnel”; “Robbie is happy zooming along”; “Robbie is angry he has to stop”; “Robbie is sad the journey is over”). Each time he has the emotion, you could also put the one of the appropriate emotion face cards in his pouch. After you have done this a few times, you could ask your child to find the right face card to put in his pouch.
• Repeat the game in exactly the same way over several days or weeks. The repetition of a game like this involving mechanical motion may be appealing to a child with autism. So the journey could always be same, with the same emotions occurring at the same points. Repeated many times, this could help your child with emotion recognition.
• After many repetitions, if you think your child is ready for it, you could introduce variations, for example, Robbie drops his toy out of the train and feels sad when that happens

Emotional Validation with a child with autism

Emotional validation involves naming, accepting, and normalizing your child’s emotions (see pp. 37-45 of the Parent's Guide). There is really no difference in how to validate the emotions of a typically developing child or a child with autism. Some children may be more difficult to “read” than others, but knowing your child well, you will probably find that you are quite good at guessing what they are feeling (and your child can correct you if you are wrong). For example, if your child looks worried in a social group, you can say, “Oh dear, you look worried”, or “you look scared”. And normalize this with “I sometimes feel scared when I have to meet new people”. A strong climate of emotional validation within your family will be as relevant and as useful for a child with autism as with any other child. A child with autism may find it harder to engage with your emotions and their own emotions, but the reasons for this could be different for different children — for example, some children may find emotions unrewarding or less interesting, but others may actually be hypersensitive to other’s negative emotions and therefore find them more distressing to engage with. In any case, you can be sensitive to your child’s needs while knowing that helping them to engage with others emotions and to regulate their own emotions is always going to be helpful in the long run.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub.

Baron-Cohen, S. (1995). Mindblindness: An essay on autism and theory of mind. Boston: MIT Press/Bradford Books.

Caldwell, P. (2006). Finding you finding me: Using intensive interaction to get in touch with people whose severe learning disabilities are combined with autistic spectrum disorder. London: Jessica Kingsley

Corbett, B. A., Carmean, V., Ravizza, S., Wendelken, C., Henry, M. L., Carter, C., & Rivera, S. M. (2009). A functional and structural study of emotion and face processing in children with autism. Psychiatry Research: Neuroimaging, 173(3), 196-205.

Hobson, R. P. (1986). The autistic child's appraisal of expressions of emotion. Journal of Child Psychology and Psychiatry, 27(3), 321-342.

Jones, C. R., Pickles, A., Falcaro, M., Marsden, A. J., Happé, F., Scott, S. K., & Simonoff, E. (2011). A multimodal approach to emotion recognition ability in autism spectrum disorders. Journal of Child Psychology and Psychiatry, 52(3), 275-285.

McClintock, S., Day, K., Leggett, V., & Baron-Cohen, S. (2010). Enhancing emotion recognition in children with autism spectrum conditions: An intervention using animated vehicles with real emotional faces. Journal of autism and developmental disorders, 40(3), 269-279.

Newbigin, A., Uljarević, M., Vivanti, G., & Dissanayake, C. (2016). Brief report: Empathic responsiveness of high functioning children with autism to expressed and anticipated distress. Journal of autism and developmental disorders, 46(10), 3338-3343.

Scheeren, A. M., Koot, H. M., Mundy, P. C., Mous, L., & Begeer, S. (2013). Empathic responsiveness of children and adolescents with high‐functioning autism spectrum disorder. Autism Research, 6(5), 362-371.

Smith, A. (2009). The empathy imbalance hypothesis of autism: A theoretical approach to cognitive and emotional empathy in autistic development. The Psychological Record, 59, 489-510.

Uljarevic, M., & Hamilton, A. (2013). Recognition of emotions in autism: A formal meta-analysis. Journal of Autism and Developmental Disorders, 43(7), 1517-1526.

This is a report prepared by Dr John Lambie for Skylark Learning, 2018.