Unique emotion recognition treatment leads to significant improvement in children with high-functioning autism

Impairment in social-communicative functioning is a defining feature of HFASD and it is exacerbated by significant problems in reading emotions in the facial and vocal expressions of others. To date, attempts to improve the emotion recognition skills of children with HFASD and thus their social functioning and symptoms have been largely unsuccessful. This has led some researchers to use computer-based treatment as a way to increase the emotion recognition skills of these children. These efforts however have resulted in narrow and limited gains that have not translated to more significant improvements in skills and symptoms.

Given the narrow and limited gains reported by many investigators, researchers at the Institute for Autism Research set out to enhance a commonly used emotion-recognition software, Mind Reading (Jessica Kingsley Publishing, Inc.) for children with HFASD. According to Marcus L. Thomeer, PhD, co-director of the Institute for Autism Research and the study's lead author, "the Mind Reading software has produced some promising findings however the gains were not leading to broader improvements for children with HFASD. We developed and tested a treatment that included additional elements we thought would greatly improve the effectiveness of the Mind Reading software."

Findings from the clinical trial, just published in the Journal of Autism and Developmental Disorders, provide strong support for the effectiveness of the enhanced treatment.

Christopher Lopata, PsyD, co-director of the Institute for Autism Research and one of the study's lead authors, noted that prior studies of the Mind Reading software for children with HFASD have relied almost exclusively on having the children learn and practice emotion recognition using the computer program alone. "This approach left out an important element, the opportunity for the children to practice emotion recognition and expression skills with another person and receive feedback on the accuracy of their skills."

The research team developed a treatment that included Mind Reading computer instruction, repeated practice opportunities for emotion recognition and expression between the children and clinical staff, and reinforcement for accurately recognizing and expressing emotions in facial expressions. The unique treatment was administered during 24 sessions (two 90-minute sessions per week) over 12 weeks. A total of 43 children, ages 7-12 years with HFASD participated in the clinical trial, with 22 randomly assigned to receive the treatment and 21 to a wait-list control condition.

Following the 12 week treatment, children in the treatment group demonstrated significantly better emotion-recognition skills and were rated as significantly better at facial-emotion recognition and expression by their parents compared to children in the control group. Children in the treatment group also had significantly lower parent ratings of autism symptoms, including social impairments following treatment compared to the control children.

This suggested that the treatment had an effect on broader symptoms and impairments that were not directly targeted by the treatment. Follow-up ratings collected 2-3 months following the treatment indicated that the significant gains in emotion recognition and expression and the reduction in autism symptoms were maintained.

"These findings represent an important step as they suggest that emotion recognition and expression skills of children with HFASD can be significantly improved and autism symptoms and impairments reduced by providing direct instruction, real-life practice opportunities, and reinforcement for accuracy," said Thomeer. "But more importantly the improvements were maintained after the treatment ended; this is promising as children with HFASD often have difficulty maintaining skills after treatment ends."

This is the first randomized trial of the Mind Reading computer program for children with HFASD and results suggest that the software can be especially effective when additional treatment elements including repeated real-life practice opportunities and reinforcement are included. Computer-based treatments such as Mind Reading have been identified as particularly appealing for this population as children with HFASD reportedly have an affinity toward working on computers.