Emotion recognition training in autism spectrum disorder: A systematic review of challenges related to generalizability

ABSTRACT Purpose: To assess the generalizability of findings from randomized controlled trials (RCTs) evaluating emotion recognition (ER) training for children and adolescents with autism spectrum disorder (ASD). Methods: We present a systematic review and narrative synthesis of the determinants of external validity in RCTs on ER training. Generalizability of the findings across situations, populations, settings, treatment delivery, and intervention formats was considered. Results: We identified 13 eligible studies. Participants were predominantly boys with ASD in the normative IQ range (IQ > 70), with an age span from 4 to 18 years across studies. Interventions and outcome measures were highly variable. Several studies indicated that training may improve ER, but it is still largely unknown to what extent training effects are translated to daily social life. Conclusion: The generalizability of findings from currently available RCTs remains unclear. This underscores the importance of involving children with ASD and their caregivers in informed treatment decisions.

[1]  Glyn Elwyn,et al.  Implementing shared decision making in the NHS Creation of a platform of tools to provide information to doctors and patients should be the first step in giving patients choice about their treatment , say , 2010 .

[2]  S. Baron-Cohen,et al.  Is There a "Language of the Eyes"? Evidence from Normal Adults, and Adults with Autism or Asperger Syndrome , 1997 .

[3]  F. Volkmar,et al.  Verbal bias in recognition of facial emotions in children with Asperger syndrome. , 2000, Journal of child psychology and psychiatry, and allied disciplines.

[4]  P. Reed,et al.  Brief Report: Teaching Situation-Based Emotions to Children with Autistic Spectrum Disorder , 2011, Journal of autism and developmental disorders.

[5]  B. Chorpita,et al.  Empirically guided coordination of multiple evidence-based treatments: an illustration of relevance mapping in children's mental health services. , 2011, Journal of consulting and clinical psychology.

[6]  P. Rothwell,et al.  Factors That Can Affect the External Validity of Randomised Controlled Trials , 2006, PLoS clinical trials.

[7]  R. Plomin,et al.  Evidence for overlapping genetic influences on autistic and ADHD behaviours in a community twin sample. , 2008, Journal of child psychology and psychiatry, and allied disciplines.

[8]  Joe Reichle,et al.  Single-subject experimental design for evidence-based practice. , 2012, American journal of speech-language pathology.

[9]  M. Britto,et al.  Shared Decision Making in the Care of Children with Developmental and Behavioral Disorders , 2016, Maternal and Child Health Journal.

[10]  S. Baron-Cohen,et al.  The Cambridge Mindreading (CAM) Face-Voice Battery: Testing Complex Emotion Recognition in Adults with and without Asperger Syndrome , 2006, Journal of autism and developmental disorders.

[11]  Nicole Brown,et al.  Piloting the use of experience sampling method to investigate the everyday social experiences of children with Asperger syndrome/high functioning autism , 2014, Developmental neurorehabilitation.

[12]  S. Baron-Cohen,et al.  The ‘Reading the Mind in the Voice’ Test-Revised: A Study of Complex Emotion Recognition in Adults with and Without Autism Spectrum Conditions , 2007, Journal of autism and developmental disorders.

[13]  S. Bölte,et al.  Training-induced plasticity of the social brain in autism spectrum disorder , 2015, British Journal of Psychiatry.

[14]  Michele Tarsilla Cochrane Handbook for Systematic Reviews of Interventions , 2010, Journal of MultiDisciplinary Evaluation.

[15]  D. Moore,et al.  Computer-Aided Learning for People with Autism – a Framework for Research and Development , 2000 .

[16]  S. Bölte The good, the bad and systematic reviews , 2015, Autism : the international journal of research and practice.

[17]  S. Bölte,et al.  Can findings from randomized controlled trials of social skills training in autism spectrum disorder be generalized? The neglected dimension of external validity , 2016, Autism : the international journal of research and practice.

[18]  F. Amthor,et al.  Avatar Assistant: Improving Social Skills in Students with an ASD Through a Computer-Based Intervention , 2011, Journal of autism and developmental disorders.

[19]  S. Baron-Cohen,et al.  Enhancing Emotion Recognition in Children with Autism Spectrum Conditions: An Intervention Using Animated Vehicles with Real Emotional Faces , 2010, Journal of autism and developmental disorders.

[20]  M. Fortin,et al.  Randomized Controlled Trials: Do They Have External Validity for Patients With Multiple Comorbidities? , 2006, The Annals of Family Medicine.

[21]  Sven Bölte,et al.  Brief Report: Emotional Processing in High-Functioning Autism—Physiological Reactivity and Affective Report , 2008, Journal of autism and developmental disorders.

[22]  F. Shic,et al.  Computer-Assisted Face Processing Instruction Improves Emotion Recognition, Mentalizing, and Social Skills in Students with ASD , 2015, Journal of Autism and Developmental Disorders.

[23]  C. Lopata,et al.  RCT of a Psychosocial Treatment for Children with High-Functioning ASD: Supplemental Analyses of Treatment Effects on Facial Emotion Encoding , 2015 .

[24]  P. Ekman Pictures of Facial Affect , 1976 .

[25]  Katherine E Henson,et al.  Risk of Suicide After Cancer Diagnosis in England , 2018, JAMA psychiatry.

[26]  R. Nida,et al.  RCT of a Manualized Social Treatment for High-Functioning Autism Spectrum Disorders , 2010, Journal of autism and developmental disorders.

[27]  P. Bolton,et al.  Prevalence of autism-spectrum conditions: UK school-based population study , 2009, British Journal of Psychiatry.

[28]  C. Lopata,et al.  Randomized Clinical Trial Replication of a Psychosocial Treatment for Children with High‐Functioning Autism Spectrum Disorders , 2012 .

[29]  Sven Bölte,et al.  Is autism curable? , 2014, Developmental medicine and child neurology.

[30]  D. Povinelli,et al.  Mindblindness. An Essay on Autism and Theory of Mind Simon Baron-Cohen 1995 , 1996, Trends in Neurosciences.

[31]  Sven Bölte,et al.  Facial affect recognition in autism, ADHD and typical development , 2016, Cognitive neuropsychiatry.

[32]  S. Bölte,et al.  A Systematic Review of Social Communication and Interaction Interventions for Patients with Autism Spectrum Disorder , 2014 .

[33]  S. Bölte,et al.  Emotion Recognition in Children and Adolescents with Autism Spectrum Disorders , 2009, Journal of autism and developmental disorders.

[34]  Catherine Lord,et al.  Diagnosing autism in neurobiological research studies , 2013, Behavioural Brain Research.

[35]  Thomas Dierks,et al.  Facial affect recognition training in autism: can we animate the fusiform gyrus? , 2006, Behavioral neuroscience.

[36]  Cecil R. Reynolds,et al.  Behavior Assessment System for Children , 2010 .

[37]  Jason K. Johnson,et al.  A Pilot Study Assessing the Feasibility of a Facial Emotion Training Paradigm for School-Age Children With Autism Spectrum Disorders , 2014 .

[38]  Roxane J. Itier,et al.  Neural bases of eye and gaze processing: The core of social cognition , 2009, Neuroscience & Biobehavioral Reviews.

[39]  H. Roeyers,et al.  Effect of community interventions on social-communicative abilities of preschoolers with autism spectrum disorder , 2014, Developmental neurorehabilitation.

[40]  K. Sofronoff,et al.  A multi-component social skills intervention for children with Asperger syndrome: the Junior Detective Training Program. , 2008, Journal of child psychology and psychiatry, and allied disciplines.

[41]  R. Schultz,et al.  The perception and identification of facial emotions in individuals with autism spectrum disorders using the Let's Face It! Emotion Skills Battery. , 2012, Journal of child psychology and psychiatry, and allied disciplines.

[42]  B. de Gelder,et al.  Impaired Categorical Perception of Facial Expressions in High-Functioning Adolescents with Autism , 2001, Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence.

[43]  Marjorie Solomon,et al.  A Social Adjustment Enhancement Intervention for High Functioning Autism, Asperger’s Syndrome, and Pervasive Developmental Disorder NOS , 2004, Journal of autism and developmental disorders.

[44]  A. Young,et al.  Deficits in facial, body movement and vocal emotional processing in autism spectrum disorders , 2010, Psychological Medicine.

[45]  G. Andersson The promise and pitfalls of the internet for cognitive behavioral therapy , 2010, BMC medicine.

[46]  K. Wells,et al.  Treatment research at the crossroads: the scientific interface of clinical trials and effectiveness research. , 1999, The American journal of psychiatry.

[47]  R. Cordier,et al.  A preliminary study on the reliability and validity of using experience sampling method in children with autism spectrum disorders , 2015, Developmental neurorehabilitation.

[48]  S. Bölte,et al.  The recognition of facial affect in autistic and schizophrenic subjects and their first-degree relatives , 2003, Psychological Medicine.

[49]  J. Higgins,et al.  Cochrane Handbook for Systematic Reviews of Interventions , 2010, International Coaching Psychology Review.

[50]  Jonathan D Rodgers,et al.  Randomized Controlled Trial of Mind Reading and In Vivo Rehearsal for High-Functioning Children with ASD , 2015, Journal of Autism and Developmental Disorders.

[51]  Miriam Posselt,et al.  Using The Transporters DVD as a Learning Tool for Children with Autism Spectrum Disorders (ASD) , 2012, Journal of autism and developmental disorders.

[52]  Helen McConachie,et al.  Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD). , 2014, The Cochrane database of systematic reviews.

[53]  S. Baron-Cohen,et al.  Does Teaching Theory of Mind Have an Effect on the Ability to Develop Conversation in Children with Autism? , 1997, Journal of autism and developmental disorders.

[54]  I. Alaie,et al.  Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: a review of current practice. , 2014, Contemporary clinical trials.

[55]  Thomas Dierks,et al.  The development and evaluation of a computer-based program to test and to teach the recognition of facial affect , 2002, International journal of circumpolar health.

[56]  Alex Martin,et al.  Facial Emotion Recognition in Autism Spectrum Disorders: A Review of Behavioral and Neuroimaging Studies , 2010, Neuropsychology Review.

[57]  James W Tanaka,et al.  Using computerized games to teach face recognition skills to children with autism spectrum disorder: the Let's Face It! program. , 2010, Journal of child psychology and psychiatry, and allied disciplines.

[58]  R. Simpson,et al.  A single case design evaluation of a software and tutor intervention addressing emotion recognition and social interaction in four boys with ASD , 2010, Autism : the international journal of research and practice.

[59]  P. Scal,et al.  Shared decision making: improving care for children with autism. , 2012, Intellectual and developmental disabilities.

[60]  S. Baron-Cohen,et al.  Systemizing empathy: Teaching adults with Asperger syndrome or high-functioning autism to recognize complex emotions using interactive multimedia , 2006, Development and Psychopathology.

[61]  M. Silver,et al.  Evaluation of a New Computer Intervention to Teach People with Autism or Asperger Syndrome to Recognize and Predict Emotions in Others , 2001, Autism : the international journal of research and practice.

[62]  John O. Willis,et al.  Behavior Assessment System for Children–2 , 2008 .

[63]  J. Higgins,et al.  Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration , 2013 .

[64]  Christian Ryan,et al.  Teaching Emotion Recognition Skills to Children with Autism , 2010, Journal of autism and developmental disorders.

[65]  P. Curatolo,et al.  Effectiveness of community-based treatment on clinical outcome in children with autism spectrum disorders: An Italian prospective study , 2016, Developmental neurorehabilitation.

[66]  Elisabeth L Hill,et al.  Understanding autism: insights from mind and brain. , 2003, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[67]  Sven Bölte,et al.  Assessing autistic traits: cross‐cultural validation of the social responsiveness scale (SRS) , 2008, Autism research : official journal of the International Society for Autism Research.

[68]  S. Baron-Cohen,et al.  Using Assistive Technology to Teach Emotion Recognition to Students With Asperger Syndrome , 2007 .

[69]  S. Levy,et al.  Shared Decision Making and Treatment Decisions for Young Children With Autism Spectrum Disorder. , 2016, Academic pediatrics.

[70]  G. Waller Evidence-based treatment and therapist drift. , 2009, Behaviour research and therapy.

[71]  Y. S. Kim,et al.  Prevalence of autism spectrum disorders in a total population sample. , 2011, The American journal of psychiatry.

[72]  P. Howlin Interventions and outcome in Autism , 2002 .

[73]  Simon Baron-Cohen,et al.  Can we teach children with autism to understand emotions, belief, or pretence? , 1996, Development and Psychopathology.

[74]  S. Wass,et al.  The uses of cognitive training technologies in the treatment of autism spectrum disorders , 2014, Autism : the international journal of research and practice.

[75]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[76]  Ofer Golan,et al.  The ‘Reading the Mind in Films’ Task [Child Version]: Complex Emotion and Mental State Recognition in Children with and without Autism Spectrum Conditions , 2008, Journal of autism and developmental disorders.