EDUCATIONAL CAREGIVERS PAIN PERCEPTION 1 Understanding Educational Caregivers Accuracy in Detecting Facial Expressions of Pain in Children: An Eye-Tracking Study

Facial expressions of pain are important indicators that an individual needs attention from others. Previous studies have found that different caregiver groups have had difficulty in distinguishing genuine, suppressed and fake pain in children. The current study examines education professionals and their ability to recognize pain expressions in children while their eye-movements were tracked. Eye-tracking was used to understand their accuracy in detecting pain expressions, as well as identifying strategies to improve recognition. Results indicated that participants were more accurate for suppressed than fake expressions, and more for fake than genuine expressions. Results from eye movement patterns offer information on how to improve accuracy upon recognition. For genuine and suppressed expressions, participants must attend to the eye zone longer than the mouth zone. For fake expressions, the mouth zone needs more attention to increase accuracy. Also, when participants spent more time in the eye zone than the mouth zone, their levels of accuracy decreased. EDUCATIONAL CAREGIVERS PAIN PERCEPTION 3 Understanding Educational Caregivers Accuracy in Detecting Facial Expressions of Pain in Children: An Eye-Tracking Study The ability for individuals to read non-verbal behavior, such as facial expressions, is an important social skill that allows humans to identify what others need as well as their emotions and, allows us to react accordingly (Matsumoto & Hwang, 2011). For example, while in pain our expressions signify to others that we need help. Thus, in order to respond appropriately to a given situation, it is an important skill to be able to recognize the sincerity of pain expressions. The current study analyzed educational professional’s ability to accurately recognize genuine, suppressed, and faked facial expressions of pain in children. To the best of our knowledge, no research has examined how well educators perform at this task. Furthermore, by tracking the eye-movements of each participant, this study provided data on the perceptual-attentional processes that are involved in discriminating between pain expressions. More precisely, eye-tracking allowed the observation of differences between where the educational professionals focused their attention in relation to their accuracy in determining the correct facial pain expression. Production of Facial Pain Expressions Various studies that have induced pain in participants for the purpose of recording their facial expressions to then analyze muscle activations in pain expressions that occur naturally (Birnie et al., 2012; Boerner et al., 2013; von Baeyer et al., 2005; Wolf & Hardy, 1941). One method to analyzing the expressions is through the use of the Facial Action Coding System (FACS) (Ekman & Friesen, 1978). FACS describes each facial action unit that is displayed as result of facial muscle contractions. For example, with a EDUCATIONAL CAREGIVERS PAIN PERCEPTION 4 genuine expression of pain, research has shown more frequent and intense activations of the lip corner puller, the cheek raiser, the opening of the mouth or a raised upper lip, the eyelids become tighter or the eyes are closed, and nose wrinkling (Hill & Craig, 2002; Larochette et al., 2006). These findings are consistent across adults and children (Bennett & Montgomery, 1999; Breau et al., 2001). Although these types of expressions have been identified and coded, differences in how pain expressions are displayed individually does occur, as well as by the level of their intensity displayed (Craig & Hill, 2002). The way genuine facial expressions occur has been considered universal (Ekman, 2003). However, along with presenting our expressions naturally, humans are also capable of, suppressing them (Porter & ten Brinke, 2008). Humans may suppress their facial expressions of pain for multiple reasons, and one possible reason for children to suppress their pain expressions is due to fear of negative consequences from their caregivers (Craig & Hill, 2002; Larochette et al., 2006). Suppressed pain expressions are similar to the way genuine facial expressions are displayed, however they are less frequent and intense than when displayed genuinely (Larochette et al., 2006). Seeing as individuals have the ability to control their expressions, they are also capable of faking their pain (Larochette et al., 2006). Faked pain expressions can occur due to various reasons; some people will fake their pain for a personal benefit or gain, such as in legal matters (Craig & Hill, 2002). Genuine facial expressions and faked facial expressions differ in relation to the frequency and intensity of the facial actions or facial muscle movements (Craig & Hill, 2002). Faked pain expressions are more vigorous, and they usually have a longer duration in comparison to a genuine facial expression (Craig & Hill, 2002). Faked pain expression also result in a decreased rate of eye blinking (Craig & EDUCATIONAL CAREGIVERS PAIN PERCEPTION 5 Hill, 2002), as well as faked pain expressions show the same facial cues as a genuine pain expression, just with a higher intensity (Larochette et al., 2006). Furthermore, research has indicated that faked pain expressions’ muscle activation may appear gradually and separately rather than all at once, which is how genuine facial pain expressions occur (Craig & Hill, 2002). Finally, unlike genuine and suppressed facial expressions, faked facial expressions may contain activations associated to other emotional expressions such as shame, guilt or a smile (Hager & Ekman, 1985). This could indicate that although people can recreate different facial expressions, there can be an underlying difficulty in accurately reconstructing the facial expression they are trying to produce.