Evaluation of an emotion training programme for young children with autism

The main aim of this thesis was to evaluate the efficacy of an emotion training intervention for young children with autism. Further aims were to investigate the relationship between emotion recognition ability, autism symptom severity and social skills in young children with autism. The first chapter of this thesis provides a review of the literature on emotion recognition skills of children with autism. It has been suggested that difficulties in recognising and responding to emotions may underlie the social deficits that are a core feature of autism (Baron-Cohen, Golan, & Ashwin, 2009). However research varies regarding the exact nature of emotion recognition skills of children with autism. Review of the literature suggests that children with autism and comorbid ID have some difficulty matching and labelling basic facial expressions of emotion, for both human and non-human faces, across static and dynamic conditions, when compared with typically developing children and those with other clinical disorders matched for mental age, VIQ or PIQ. For children with high-functioning Autism Spectrum Disorders (ASD), results vary due to large differences between studies. In general, research suggests that children with high-functioning autism have emotion recognition difficulties relative to typically developing children matched for chronological age and cognitive ability, and that these difficulties may be specific to the recognition of complex, but not basic, emotional expressions. These findings highlight the importance of emotion training programmes for young children with autism. Chapter 1 also discusses research in to the relationship between emotion recognition ability and social skills for individuals with autism. Some research has reported a specific association between reduced accuracy in the recognition of expressions of sadness and reduced social skills for adolescents and adults with ASD (Boraston, Blakemore, Chilvers & Skuse, 2007; Wallace et al., 2011) but no research has investigated this association for children with autism. It was suggested that future research might benefit from the investigation of the relationship between emotion recognition skills and social skills in young children with autism. Chapter 2 of this thesis provides a review of research evaluating emotion recognition interventions for children with autism, with the aim of identifying areas of research requiring further investigation. Review of the literature suggested that most emotion training programmes designed for children with autism have been evaluated with older, high-functioning children. Few of these programmes have been evaluated with young children with autism and none have been trialled with young children with autism and comorbid intellectual disability. One of the intervention programmes reviewed in Chapter 2 (the Transporters; Changing Media Development, 2006) was designed for use with young children with autism but had only been evaluated with high-functioning children with ASD. Further research was needed to evaluate its efficacy with young children with autism with a lower range of cognitive ability. The main focus of the current study was to investigate the efficacy of an emotion training programme (the Transporters) for use with a group of 55 young children with autism of a lower range of intellectual ability. To address limitations in previous research the current study also investigated the relationship between emotion recognition ability, autism symptom severity and social skills for young children with autism, with analyses based on the intervention study’s baseline assessment data. Three research papers were developed from this data and are presented in Chapters 4 to 6 as submitted journal articles. Paper 1 was a randomised controlled trial evaluating the efficacy of the Transporters emotion recognition training programme for use with a group of 55 young children with autism, aged four to seven years (FSIQ 42-107). Previous research evaluating the use of the Transporters programme suggested that it was effective in teaching emotion recognition skills to high-functioning children with ASD (e.g., Golan et al., 2010). However in the current study the Transporters programme showed limited efficacy in teaching basic emotion recognition skills to young children with autism of a lower range of cognitive ability. Improvements were limited to the recognition of expressions of anger, with poor maintenance of these skills at follow-up, and with no generalisation of skills to Theory of Mind or social skills. These findings provide limited support for the efficacy of the Transporters programme for young children with autism of a lower cognitive ability, with results suggesting that the Transporters may be more efficacious for older, higher-functioning children with autism. Paper 2 assessed the relationship between degree of autism symptom severity and emotion recognition ability for 55 young children with autism. Only two previous studies had been published on this topic, with findings suggesting that increased autism symptom severity was related to reduced accuracy in emotion recognition in older children and adolescents with ASD. More research was needed to investigate the relationship between autism symptom severity and emotion recognition skills in young children with autism. In support of previous findings, the current study showed that higher autism severity scores were associated with reduced accuracy in the recognition of facial expressions of fear and anger, as well as decreased accuracy in the identification of desire-based but not situation-based emotions. These findings suggest that emotion recognition difficulties may be more pronounced for children with more severe levels of autism symtomatology. Paper 3 investigated the relationship between emotion recognition ability and social skills for a sub-group of 42 young children with autism. Three previous studies had been published on this topic, but further research was needed into the association between accuracy in the recognition of specific emotions (happiness, sadness, anger and fear) and social skills in young children with autism. In the current study, analyses indicated that accuracy in the recognition of expressions of sadness (but not happiness, anger or fear) was associated with better social skills. These findings extend previous research with adults with ASD, suggesting that accuracy in the recognition of sadness is also related to better social skills in children with autism. The discussion chapter comments on the limitations of the current study, as well as the clinical implications and future research directions generated by this research. The main limitation of the current study was that outcome measures were limited the use of four basic facial expressions of emotion. This was due to the young developmental age of the participants, the cognitive demands of the emotion recognition tasks, and difficulty obtaining standardised measures of emotion recognition ability that could be reliably used with children with autism of a young developmental age. As a result, it is unknown whether children improved in their recognition of the more complex emotions that were also targeted in the Transporters programme. Further research is needed to develop and evaluate emotion recognition stimuli for use with young children with autism of a young developmental age. These materials would assist in the evaluation of emotion training programmes for young children with autism. The main conclusion of the current study was that the Transporters emotion training programme showed limited efficacy for use with young children with autism of a lower range of cognitive ability. The Transporters programme may instead be more efficacious for older, higher-functioning, children with autism. Collectively the current findings suggest that there is a need to identify more effective interventions to help teach emotion recognition skills to children with autism of a young developmental age, including those with comorbid ID.