# Motivation and emotion/Book/2021/Autism and emotion perception through faces and biological motion

* Multimedia presentation (3 min)

## Overview

Autism is a developmental disorder which can impact a person's physical and mental functioning to differing degrees. A person diagnosed with autism can have varying degrees of atypical mannerisms, movements and impaired comprehension of social and emotional situations. This presents a challenge when the majority of the neurotypical population express and perceive emotions displayed through nonverbal communication such as facial expression and body language. As such, perceiving and relating to emotions presented through these physical cues can be challenging for individuals with autism in the neurotypical world. This chapter discusses the impact that autism has on the perception of emotions expressed through nonverbal communications by defining and discussing theories for both autism and emotional perception, explaining the interaction between the two and how emotional perception can be promoted within individuals with autism in day-to-day life.
* Focus questions:
* What is autism?
* What is emotional perception?
* How does autism affect emotional perception?
* How can emotional perception be encouraged?

## Autism

[Provide more detail]

### Definition

Autism is a neurodevelopmental disorder. It is estimated by the Centre for Disease Control and Prevention that 1 in 59 children globally have autism (Alpert, 2020). Autism can be diagnosed in children as young as two years, although many adults have varying degrees of undiagnosed autism. Autism is a spectrum disorder, meaning there are variances in the apparentness of individuals symptoms, such that some are moderately impacted whereas others require constant care (Trajkovski, 2020). There is currently no definitive answer to what causes autism; it is theorised to be the result of interactions between genetic and environmental factors; nor is there a definitive treatment.
As autism is a spectrum disorder, identification and diagnosis can be difficult. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines two core identifiers commonly present in individuals with autism (American Psychiatric Association, 2013):
* Persistent deficits in social communication and interaction across multiple contexts
* Restricted, repetitive patterns of behaviour, interests or activities
DSM-5 also has three subfactors which can aid in diagnosis:
* Symptoms present in the early developmental period
* Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
* Intellectual disability and autism spectrum disorder frequently co-occur
These identifiers are used in diagnosing individuals with autism, however, further identification processes are required to determine the severity of the diagnosis, as shown in Table 1 (Autism Speaks Inc, 2021).
Table 1: DSM-5 severity levels of autism :
| Severity level | Support required | Social communication | Restricted, repetitive behaviours |
| Level 1 | Requires support | -   Difficulty initiating social interactions -   Slight atypical social communications -   Decreased interest in social situations | -    Difficulty switching activities -   Issues with organisation and planning |
| Level 2 | Requires substantial support | -   Social impairments obvious even with support -   Abnormal responses to social situations and others -   Speaks only about specific interests | -   Frequent repetitive behaviours -   Distressed about change |
| Level 3 | Requires very substantial support | -   Difficulty with verbal and non-verbal social communication without support -   Minimal social interactions and rarely initiates interactions | -   Inflexible behaviour -   Struggles to cope with change -   Difficulty changing focus or tasks |

### Theories

Many theories try to explain aspects of autistic individuals actions, mental processes and emotion perception and expression. Two theories that provide an explanation for the atypical emotion expression and perception of autistic individuals is the amygdala theory and social motivation theory.

#### Amygdala theory

The amygdala theory was developed by Simon Baron-Cohen who proposed that individuals with Autism experience decreased amygdala functioning which alters their ability to attend, interpret and interaction with social information (Baron-Cohen et al., 2000). One of the proposed properties of the amygdala is to interpret the face to determine threatening attributes and allocate pleasant feelings to certain stimuli (Tyng et al., 2017). However, it is known that the amygdala isn't the only component of the brain associated with emotional perception, with the hippocampus having an influential role. As such researchers propose that an individual's inability to process faces and respond accordingly is a result of inefficient networks of the amygdala and other components of the brain (Tyng et al., 2017).

#### Social motivation theory

Social motivation theory explores the possibility that individuals with Autism have less interest in social situations and perceptions due to finding faces unrewarding. As such it is perceived that these individuals will fail to attend to social information such as facial expression due to being uncontent with previous rewards from these interactions in early life (Kleinhans et al., 2010). The behavioural response to social interaction are categories into three assets (Chevallier et al., 2012):
* Attention is prioritised to objects with social importance
* Social interactions are rewarding
* Interpersonal behaviours are influenced by a desire for and to maintain relationships
The importance of these categories appear to be diminished within individuals with autism. They have previously found social interactions unrewarding, as such the individuals lacks the desire and prioritisation to attend to social interactions. The diminished importance is believed to be correlated to alterations to the orbitofrontal-striatal-amygdala circuitry as well as dysregulation of certain neuropeptides and neurotransmitters (Chevallier et al., 2012).
* Example:
* When Jack was a toddler he didn't receive an adequate biological reward (processed by the amygdala) from his interactions with social information. As such, now 8 years old Jack doesn't interact with social information, as it provides him no reward.

## Emotional perception

Emotional perception is the ability to recognise and comprehend emotions displayed by an individual through verbal and non-verbal cues. Emotions can be expressed and experienced through three core elements of experimental, behavioural and physiological attributes (University of West Alabama, 2019). The expression of these emotion can be through various avenues beyond verbal articulation such as facial expressions and body language.

### Non-verbal cues

In the relation to emotion expression, non-verbal cues refer to the use of facial expression and body language (also known as biological motion) to portray an emotion felt. Facial expressions are the most common non-verbal cue, with our use of smiles to illicit happiness or the furrowing of our brow or forehead to express disapproval (Segal et al., 2020). These non-verbal cues can be extended further into the use of body language. Body language is seem as a nonverbal form of communication that utilises bodily posture, limb-to-trunk configuration and hand or whole body gesture (Peterson et al, 2015).
This is seen where the crossing of arms over chest general represents a guarded or disengage (see Figure 1) or when someone hold strong eye contact can demonstrate concentration and interest in conversation. Furthermore, the way in which we move our body can also express the emotions we feel. Such that an individual walking with a bowed head can demonstrate sadness or shame (Melzer et al, 2019) whereas the relaxation of an individual's posture can demonstrate approachability (Peterson et al, 2015)[grammar?]. Research by Flack in 1999 (as cited in Shafir et al, 2016) demonstrated that the combination of facial expressions and body language has a cumulative effect and elicits a strong expression of the emotion. The perception of these non-verbal cues allows for an individual to formulate an appropriate response to an emotion being expressed by others but also to convey their own emotions implicitly.
* Example:
* Olive broke her mum's favourite vase and when her mum found out she was angry. Olive could tell that her mum was upset because of the way she was frowning and her arms were crossed over her chest.

### Theories

Many theories have tried to explain the ability of expressing and interpreting emotions. The benchmark of these discoveries was largely set by Charles Darwin and his evolutionary theories. Over time this has been expanded and disproved by other theorists, however, a definitive theory of emotion perception is yet to be discovered.

#### Evolutionary theory

The evolutionary theory of emotional perception is largely associated with the findings of Charles Darwin. Darwin discussed the basic emotion approach which explains how movement in the face and body evolved through basic biology (Barrett, 2011). Initially the expression of emotion as defined by Darwin in The Expression of the Emotions in Man and Animals (1872), was that humans are born with the ability to perceive emotions expressed through facial expressions, see figure 2. The ability to express and perceive these facets of emotions is linked to natural selection and evolutionary psychology (Barrett, 2011). Darwin's ideas were later expanded by evolutionary theorists who proposed universal facial movements were manners of expressing information, generally of fear (Gendron et al., 2020).

#### Theory of affective pragmatics

The theory of affective pragmatics (TAP) was developed by Andrea Scarantino with the intention of exploring the belief that emotions are expressed in four aspects of communication (Keltner et al., 2019):
* the expressive function of expression
* the declarative function of expression
* the imperative function of expression
* the commissive function of expression
As such Scarantino (2017) theorises that emotion expression is a means of managing others[grammar?] behaviours, a method of depicting the world and committing to future plans as well as expression one's own emotions. TAP conveys that emotional expression is more a method of conveying emotions but also method of communicating an individual's intentions without the use of language (Scaratino, 2017).

## Effect of autism on emotional perception

Individuals with autism tend to struggle in comprehending emotions displays by others but also in understanding and expressing their own emotions. Affiliated with the impairment of emotion expression and perception is an individual's reduced empathy capabilities. However, it is important to note that not all neurodiverse individuals have decreased emotional perception or expression as it's a spectrum of severity. As such it is important to view the relationships and conditions discussed below as co-occurring with autism rather than an attribute of autism itself (Bird & Cook, 2013).

### Relationship between emotional perception and autism

Research has largely concluded that autistic adults and children both experience defects in their interpretation of facial expressions. Despite this conclusion, research is yet to determine a definitive position on why individuals with autism sometimes possess poorer emotional perception skills. Early works by from Hobson (as cited by Uljarevic & Hamilton, 2012) suggest that some individuals with autism struggle matching facial expressions to emotional body actions. Whereas others concluded that the relationship between an individual's lack of social interest and defects in facial processing (Jemel et al., 2006) are associated with lower levels of emotional perception[grammar?]. Alternatively, Baron-Cohen and colleagues (as cited in Uljarevic & Hamilton, 2012) proposed that individual[grammar?] with autism may have trouble recognising a select few of the basic six emotions. As such, studies over the years have demonstrated a number of possible reasons for the relationship between poor emotional perception and autism. Irrespective of this, research demonstrates that some neurodivergent individuals experience slower [missing something?] or difficulty perceiving emotions expressed nonverbally.

### Empathy

Empathy has two distinct aspects, cognitive and affective. Cognitive empathy refers to the individual's capability to comprehend the thoughts and feelings of other, whereas affective empathy is an individual's ability to resonate with emotions expressed by others and comprehend that they are different from their own emotions (Mazza et al., 2014). Literature has demonstrated that some individuals with autism do have ability to be empathetic, however, these individuals tend to have difficulty with cognitive empathy rather than affective (Mazza et al., 2014). Meaning these individuals are affected by emotions expressed by others but tend not to be able to understand the emotion[grammar?].

### Alexithymia

The term alexithymia was developed by psychiatrist Peter Sifneos in the 1970s, as a categorisation for individuals who lacked the ability to express emotions. More specifically the inability of the individual to verbally express their emotions, either due to their unawareness or confusion of the emotion they are feeling. For example, an individual may be aware that they are experiencing an emotion, however, they are unable to differentiate what type of emotion they are experiencing. There is growing research to suggest an association between individuals that experience alexithymia and those with autism, with approximately half of the individuals diagnosed with autism also having alexithymia (Poquérusse et al., 2018).

### Implications

For individuals with autism the comprehension and expression of emotions can be difficult. The relationship between poor emotional regulation in selective autistic individuals is inconclusive. With some research demonstrating [grammar?] the interconnection of emotional and social development are correlated to experiences poor emotional perception and social development (Lartseva et al., 2015). These poor social developments are largely depicted in autistic individuals experiencing poor social skills in the form of perception, interpretation and response (Manhattan Psychology Group, 2021). On a general level poor emotional perception skills impact an individual's ability to engaging in conversations, due to difficulty in comprehending non-verbal cue and confusion regarding responding to emotions, which can create one-sided conversations (Better Health Channel, 2019). This can impact the individual's[grammar?] ability to establish and maintain friendships and have also shown to be correlated with issues of social adjustment in school aged children (Bornhofen et al., 2008). Overall, individuals with poor emotional competence tend to experience low levels of mental health due to an inability to attend to their own emotion but also as they are sometimes unable to build strong friendships.
* Case study:
* Tom was diagnosed with autism as a child and has always found making friends difficult as he didn't know how to interact with the other kids. Tom didn’t understand why he needed to take turns when playing with the toys or why the other kids were upset when he didn’t share with them (figure 3). As Tom got older he found having conversations that included small talk or emotion very challenging as he didn’t understand what his friends were talking about.

## Encouraging emotional perception

Encouraging emotion perception in children with autism can be vital in improving their experiences in school and social development in later life. Encouraging the uptake and comprehension of emotional perception can be challenging, however, for many children learning and practicing the interpretation of emotions has proved effective. Along with theories of promoting emotion recognition and uptake there are a number of daily interactions that can be used to build these skills. Raising children network Australia (2020) outlines ideas for building these skills with an autistic child in day-to-day life.

###### Labelling emotions

This [what?] involves explaining and pointing out others[grammar?] emotions to the child. This can be through various forms of literature and in the child's friends and family. It is important when doing this to point out the components of the expression that demonstrate the emotion (Conallen & Reed, 2016). For example, when looking an image of someone frowning you can say to the child 'this person is frowning they must be sad.'

###### Responding to emotions

This involves labelling the emotion that the child is expressing through their facial expression or body language. As such saying to the child 'I can see that you are frustrated' when showing annoyance and upset when struggling to completing a task. This provides the child with the ability to learn the name for emotion they are feeling (Raising children network Australia, 2020) and assist in labeling and empathising these emotions in others.

### Emotional-based social skills training

Emotional-based social skills training (EBSST) is a practice that involves group-based social-emotional intervention that aims at improving autistic children's emotional competency and has also shown benefits in improving mental health (Ratcliffe et al., 2019). EBSST incorporates theories of emotional development and emotional intelligence to guide autistic children to comprehend their own and other's emotions as well as developing emotion problem solving and regulation skills (Ratcliffe et al., 2014). EBSST is practiced by some school counsellors in mainstream primary schools in Australia and has demonstrated significant results of its efficiency in improving children's emotional competence within the school environment (Ratcliffe et al., 2014). In later studies of EBSST application in schools, parents of the children reported seeing higher levels of emotional competence in their children both at home and in school ((Ratcliffe et al., 2019). While this practice is yet to be rigorously evaluated numerous pilot studies show promising effects when implemented into schools and home environments, providing valuable future research. Other areas such as discrete trial training (DTT) have shown promising effects in improving emotional competency especially when in combinations with other practices. Overall, the development of theoretical and home practices that assist in encouraging autistic individuals to maturing components of their emotional competency can assist in combating social development issues in later life.

## Conclusion

This chapter explored the relation between autism and emotion perception through nonverbal cues. Poor emotional perception, while not prevalent in all individuals with autism, can impact the individual's [grammar?] abilities of develop friendships, issues adjusting to school and can be correlated with lower levels of mental health (Bornhofen et al., 2008; Lartseva et al., 2015). While research is yet to conclude the definitive cause of autism, current theories agree that some individuals with autism have decreased ability to interpret, attend and process emotions expressed through nonverbal cues (Baron-Cohen et al., 2000; Kleinhans et al., 2010). Although a universal theory to explain our ability to express and comprehend emotions nonverbally is also yet to be determined, the evolutionary theory and theory of affective pragmatics demonstrate some possible explanations. Again the cause of relationship between autism and poor emotional perception is unclear but its prevalence and detrimental impacts, including difficulty engaging in conversation, attain friendships, struggles with social adjustments and mental health implications, is agreed. These implications highlight the importance of studies that explore daily tasks and practices that are possible methods of encouraging emotional perception among autistic individuals. This demonstrates that further research is needed [grammar?] in determining ways to encourage the uptake of emotional perspective in both children and adults with autism and hopefully assist in providing insight in other grey areas of autism research.