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In: Autism Spectrum Disorders ISBN: 978-1-62081-786-5
Editors: Chaz E. Richardson and Reece A. Wood © 2012 Nova Science Publishers, Inc.
Chapter I
Emotion Regulation, Social Cognition and Social Adjustment: Specificities
in Children with Autism
Spectrum Disorder
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone Catholic University of Louvain, Belgium
1. Introduction
Several theories and hypotheses have been developed about specificities of emotional
regulation and social cognition, including the Theory of Mind (ToM), in children and
adolescents with autism spectrum disorders (ASD). These give some explanation of their
deficits in social adjustment. Recent empirical studies have tested this set of hypotheses. This
chapter will summarize briefly how emotional regulation and theory of mind develop in
typically developing preschoolers (TD), and will focus on how these processes are
compromised in ASD children and adolescents presenting an intellectual disability. The links
between these processes and their impact on social maladjustment will be also explored.
Some behavior disorders in ASD children and adolescents could be better understood through
their deficits in emotional regulation or in social cognition.
2. Emotional Regulation
2.1. Emotional Regulation: Definition and Strategies
Emotional regulation corresponds to a set of processes by which an individual assesses,
controls and modifies his/her spontaneous emotional responses, by using various strategies, in
order to accomplish his/her goals or in order to express socially adequate emotional behavior
in social relationships (Eisenberg & Fabes, 1992; Eisenberg, Fabes, Guthrie & Reiser, 2000;
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Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 2
Eisenberg, Hofer & Vaughan, 2007; Eisenberg, Zhou, Liew, Pidada & Champion, 2006;
Gross & Thompson, 2007; Thompson, 1994, 2011). Eisenberg and Spinrad (2004, p. 338)
defined “emotion-related self-regulation as the process of initiating, avoiding, inhibiting,
maintaining, or modulating the occurrence, form, intensity, or duration of internal feeling
states, emotion-related physiological, attentional processes, motivational states, and/or the
behavioral concomitants of emotion in the service of accomplishing affect-related biological
or social adaptation or achieving individual goals”. This definition distinguishes between the
regulation of emotion and by emotion; it includes both the modulation of “emotion-related
behaviour” and the regulation of internal states, including sensations, physiological,
perceptive and cognitive processes.
2.2. Development of Emotional Regulation in TD Preschoolers and Impact on Social Abilities
From the age of two or three years to six years, the development of symbolism,
representations and language and the beginning of autonomy help children to acquire self-
regulated, anticipated and proactive strategies of emotion regulation that can be observed
throughout their socio-emotional behaviors (Holodynski & Friedlmeier, 2006; Kalpidou,
Power, Cherry & Gottfried, 2004; Macklem, 2008; Perron & Gosselin, 2009). This
corresponds to a developmental phase designated by an “intra-personal level of regulation”
or “symbolically mediated strategies of regulation” (Holodinsky & Friedlmeier, 2006, p. 8),
sustained by self-awareness and self-other differentiation (Cicchetti, Ganiban & Barnett,
1991).
Preschoolers develop awareness of their own emotions and those of others and they learn
to control the expression of their emotions (Holodinsky & Friedlmeier, 2006; Macklem,
2008), and to modify the intensity of emotional expression according to the situation and the
social rules (Blurton-Jones, 1967; Cole, Dennis, Smith-Simon & Cohen, 2008; Baurain &
Nader-Grosbois, 2011; Saarni, 1999), for the benefit of their social interactions with peers and
adults (Macklem, 2008; Perron & Gosselin, 2004, 2009).
Preschoolers intentionally control their emotional expression in order to avoid hurting
others’ sensibilities, to protect their own feelings (Saarni, 1999) or to induce a false belief in
their partner (Perron & Gosselin, 2004).
They share positive emotions in diversified social contexts and they become able to
express complex emotions such as shame, embarrassment and pride (Cole, 1986; Joseph,
1994; Saarni, 1999; Snow, Hertzig & Shapiro, 1987); this evolves depending on their
understanding of their own mental states. In addition, they are able to express “social
emotions” such as empathy towards others in distress (Lewis Sullivan, Stanger & Weiss,
1989).
At preschool age, children can express their emotional states verbally and they are able to
inhibit a behavior by means of language (Holodinsky & Friedlmeier, 2006, p.142), because
language has an impact on their own actions and verbal instructions incite them to regulate
their emotions and behavior.
Although children develop skills in expressing their emotions, the imperatives of social
life imply that they learn to dissimulate, control their own emotional states and regulate their
expressive behavior in particular contexts; children begin to distinguish between real and
Emotion Regulation, Social Cognition and Social Adjustment 3
apparent emotions at three to four years old (Banerjee, 1997; Gosselin, 2005; Harris, Johnson,
Hutton, Andrews & Cooke, 1989; Perron & Gosselin, 2004; Sissons Joshi & McLean, 1994;
Zeman, Cassano, Perry-Parrish & Stegall, 2006). For example, three- to four-year-old
children hid their disappointment by a smile even if they have received an unwanted gift
(Cole, 1986; Joseph, 1994). The dissimulation of emotions develops particularly from six to
ten years old.
In empirical studies, emotion regulation in preschoolers is assessed by other-reported
questionnaires completed by familiar adults1 or is observed and analyzed during behaviors
displayed in situations that often elicit negative emotions, such as:
persistence in challenges (Goldsmith & Rothbart, 1996);
management or tolerance of frustration, of disappointment (Cole et al., 2008; Dennis,
2006; Dennis & Kelemen, 2009; Eisenberg et al., 2001; Feng, Shaw, Kovacs, Lane,
O’Rourke & Alarcon, 2008; Hill, Degman, Calkins & Keane, 2006; Kalpidou et al.,
2004);
modulation of non-verbal and verbal emotional expression, of its intensity,
adaptation of emotion according to the situation, or the use of strategies of emotion
regulation, and their variability according to the persons involved (peers or adults), in
social interactions in cooperative or competitive play situations (Baurain & Nader-
Grosbois, 2011; Campos, Walle, Dahl & Main, 2011; Galyer & Evans, 2001;
Gulsrud, Jahromi & Kasari, 2010; Herbé, Tremblay & Mallet, 2007; Hubbard, 2001;
Hughes, White, Sharpen & Dunn, 2000; Mirabile, Scaramella, Sohr-Preston &
Robison, 2009; Thompson, 2011);
self-control and effortful control, sustained by inhibition or activation of behavior
(Derryberry & Rothbart, 1988; Rothbart & Bates, 1998; Eisenberg, Fabes, Murphy,
Karbon, Smith & Maszk, 1996b, Eisenberg et al., 1997a-b, 2001; Spinrad et al.,
2009);
By the end of the preschool period, when children feel negative emotions, they use
diverse anticipated strategies of emotion regulation: regulating the expression of emotions,
comforting themselves, self-distracting by redirecting their attention away from whatever is
causing them stress or engaging in some other activity, managing their frustration, inhibiting
emotional behaviors which are socially inappropriate, postponing or waiting, approaching or
withdrawing from situations, staying organized when they face powerful emotional events, or
negotiating with others (Denham et al., 2003; Dennis & Kelemen, 2009; Kalpidou et al.,
2004; Macklem, 2008; Scharfe, 2000; Stansbury & Sigman, 2000).
The development of emotion regulation has a potential role in social interactions between
preschoolers and in the evolution of their social competence (Cole, Martin & Dennis, 2004;
Dennis, 2006; Dennis & Kelemen, 2009; Dennis, Malone & Chen, 2009; Eisenberg, Fabes,
Murphy, Maszk, Smith & Karbon, 1995; Eisenberg et al., 1997a-b, 2006; Eisenberg &
Spinrad, 2004; Fabes et al., 1999; Rieder, Perrez, Reicherts & Horn, 2007; Spinrad et al.,
2006). In other words, children’s abilities to regulate and control their emotional and
1 Such as the Emotion Regulation Checklist (ERC, Shields & Cicchetti, 1997), the Emotional Regulation Rating
Scale (ERRS, Carlson & Wang, 2007) or the Emotion Regulation Subscale of the Social Competence Scale
(Conduct Problems Prevention Research Group, 1999).
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 4
behavioral responses could help them to have good interactions with peers, and could
contribute to social adjustment, including in school (Eisenberg et al., 1995, 1997a-b; Fabes et
al., 1999). Moreover, social interactions with peers offer them opportunities to exercise their
emotional regulation; emotional and behavioral responses from peers provide them feedback
on their own abilities (Bronson, 2000; Dunn, 1996; Parker & Asher, 1987). Depending on
interactive contexts, emotional regulation in preschoolers varies as the situation requires.
During cooperative play between peers, children display exchanges, express joy easily and
engage with their partner (Herbé et al., 2007; Nader-Grosbois, 2011a).
Emotion regulation includes intra-individual processes related to cognitive and control
processes (Dumas & Lebeau, 1998; Harris et al., 1989; Stein, Trabasso & Liwag, 1993) and
inter-individual social processes (Campos, Campos & Barret, 1989; Eisenberg & Fabes,
1992; Eisenberg et al., 1997a-b, 2000; Walden & Smith, 1997), both of which play a basic
role in the stable development of social competence at preschool and school age (Sallquist et
al., 2009).
2.3. Specificities of Emotional Regulation and Impact on Social Abilities in ASD Children
Trevarthen (1989) suggests that autism is due to an early basic deficit in the production of
emotions and of emotion regulation in reaction to environmental stimulations. He
hypothesizes a biological origin for this impairment: a dysfunction of central regulator
systems.
Moreover, where emotional expression in ASD children is either inadequate or
unexpectedly excessive, such expression does not play its usual role of regulator, as a means
of seeking, producing, maintaining, inhibiting, and interrupting behaviors with respect to
others or to objects (Tanguay, 1987).
Poor emotional regulation is frequently associated with autistic profiles (Southam-Gerow
& Kendall, 2002; Tardif, Lainé, Rodriguez & Gepner, 2007; Vermeulen, 2009; Whitman,
2004). Several studies have emphasized a deficit in expression, in modulation, in internal and
external regulation of emotions (Tardif et al., 2007). Such children are easily stressed,
anxious and fearful. They have difficulty in self-regulating their emotions when their feelings
become excessive.
How do such children develop their emotional expression and emotion regulation?
Some studies have reported similarities between ASD and other children in this respect;
however, other studies have identified specific deficits in ASD children, in comparison with
TD children and/or children with intellectual disabilities (ID).
ASD infants show similar expressions of emotions, but they are less attentive to faces and
their affective behavior is less oriented towards others, than is the case with TD or ID infants
matched for IQ or mental age (Baranek, 1999; Maestro et al., 2002, 2005; Osterling, Dawson
& Munson, 2002; Palomo, Belinchon & Ozonoff, 2006; Werner, Dawson, Osterling & Dinno,
2000). Although ASD children are sensitive to emotional cues emitted by others, such as
distress (Nadel et al., 2000; Sigman, Kasari, Kwon & Yirmiya, 1992), they do not easily
express their own emotions appropriately (Brun, Nadel & Mattlinger, 1998; Loveland,
Tunali-kotoski, Pearson, Brelsford, Ortegon & Chen, 1994; Snow et al., 1987; Yirmiya,
Sigman, Kasari & Mundy, 1992).
Emotion Regulation, Social Cognition and Social Adjustment 5
ASD preschoolers, compared with MA-matched children, display similar emotional
expressiveness in social interactions or when they are watching video sequences illustrating
others’ emotional expressions (Capps Kasari, Yirmiya & Sigman, 1993). Although ASD
children express a similar quantity of positive and negative emotions to TD children, their
facial movements often incongruously express more than one emotion (for example, joy and
sadness) (Yirmiya, Kasari, Sigman & Mundy, 1989).
By contrast, other authors have reported fewer expressions of positive emotions and
poorer emotional expressiveness in young ASD children than in TD and ID children (Kasari
& Sigman, 1996; Loveland et al., 1994; Snow et al., 1987).
During social exchanges, ASD preschoolers barely modify their emotional reactions in
response to others (Konstantareas & Stewart, 2006), they show poor emotional coordination
and timing of affect (Scambler, Hepburn, Rutherford, Wehner & Rogers, 2007) and they
rarely initiate shared attention with others (Mundy, Sigman & Kasari, 1990; Travis, Sigman
& Ruskin, 2001; Warreyn, Roeyers & De Groote, 2005). Because of the cognitive
specificities in the way they interpret their own emotional experiences and those felt by
others, ASD children are unlikely to convey their emotions conventionally, according to
Saarni (1999).
Compared with TD or ID children, ASD children at school age share their emotional
expressions with others in social interactions less spontaneously (Attwood, Frith & Hermelin,
1988; Bieberich & Morgan, 2004; Snow et al., 1987), notably in unstructured situations in
which the caregiver does not initiate the interaction (Kasari, Sigman & Yirmiya, 1993b).
They combine emotional expression and eye contact less in response to their caregiver’s
expressions than control groups (Dawson, Spencer, Galpert & Watson, 1990). They have
neutral, flat or idiosyncratic expressions more frequently than MA controls (Czapinski &
Bryson, 2003; Hobson & Lee, 1998; Kasari, Sigman, Mundy & Yirmiya, 1990; Loveland et
al., 1994; Yirmiya et al., 1989). For example, these children display less attention and fewer
smiles than children with Down syndrome when other children are laughing in play situations
(Reddy, Williams & Vaughan, 2002). They also display happy expressions in solitary or
unpleasant situations more often than in social situations (Whitman, 2004). At school age,
they are less likely to respond with comforting or empathic behaviors to others’ emotional
expressions; they do not easily share their emotional states with a partner (Bacon, Fein,
Morris, Waterhouse & Allen, 1998; Corona, Dissanayake, Arbelle, Wellington & Sigman,
1998; Dawson, Webb, Carver, Panagiotides & McPartland, 2004; Kasari et al., 1990; Sigman
et al., 1992). This weak responsiveness to others’ emotions remains stable over a five-year
period (Dissanayake, Sigman & Kasari, 1996). In order to decrease this lack of empathy,
specific training helps them to show empathic responses in social scenarios (Argott,
Buffington Townsend, Sturmey & Poulson, 2008; Charman, Swettenham, Baron-Cohen, Cox,
Baird & Drew, 1997, 1998; Dyck, Ferguson & Shochet, 2001; Gena, Krantz, McClannahan &
Poulson, 1996; Hudry & Slaughter, 2009; Sigman et al., 1992; Travis et al., 2001; Yirmiya et
al., 1992). However, empathic behavior may vary according to the individual (McGovern &
Sigman, 2005) and according to specific emotional context, or familiarity with people (Hudry
& Slaughter, 2009). In addition, complex emotions, such as embarrassment, pride and guilt
are not experienced in the same way by ASD individuals as by TD people (Grandin, 1995).
According to Begeer, Koot, Rieffe, Meerum Terwogt and Stegge (2008), ASD children
differ in the inter- and intra-personal integration of their emotions. However, they specify that
“empirical evidence found for the influence of age, intelligence and context factors on the
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 6
level of emotional expressiveness in ASD children and adolescents refines the marked
impairments of emotional expressive behavior that are suggested in the diagnostic manuals”
(Begeer et al., 2008, p.346).
Some authors postulate that impaired emotion regulation could explain a set of ASD
children’s inabilities in their social interactions (Gulsrud, Jahromi & Kasari, 2010;
Konstantareas & Stewart, 2006). According to Geller (2005)2, ASD children face additional
challenges in the development of their emotion regulation, because they have sensory and
processing differences, they experience fewer opportunities to engage in social interactions
day-to-day, and often have negative experiences from continual teasing or rejection that could
alter their emotional equilibrium. ASD individuals use internal effort to suppress negative
emotions in order to appear more socially acceptable or because they fear losing control. In
ASD individuals, the feeling of friendlessness, pain, anxiety, and stress due to being avoided
by others and increasing social isolation impede the development of emotional regulation and
hinder socially privileged relationships.
2.4. Specificities of Co-Regulation between ASD Children and Their Parents
Environmental conditions, including parents’ strategies of social regulation or of
socialization of emotions3 toward their ASD children could help support their emotion
regulation, or conversely could lead to emotional dysregulation. As ASD children display
maladaptive behaviors that predict maternal stress (Tomanik, Harris & Hawkins, 2004), this
could interfere with the maternal support of emotion regulation in their children (Belsky,
1984). As their mothers do not easily interpret and react to the ambiguous emotional signals
expressed by their ASD children, they may offer less support for new skills, including
regulatory skills (Stansbury & Zimmermann, 1999). Improving maternal or parental
strategies, by means of specific intervention focused on joint attention and engagement, can
contribute to improved emotion regulation in ASD children and co-regulation of emotions
between the two partners (Gulsrud et al., 2010)4 and facilitate the parents’ understanding of
2 http://aspergercenter.com/articles/Emotional-Regulation-and-Autism-Spectrum.pdf (Geller, 2005).
3 We refer here to the “Heuristic model of the socialization of emotion” (Eisenberg, Spinrad & Cumberland, 1998)
or the “Tripartite model of the impact of the family on children’s emotion regulation and adjustment” (Morris,
Silk, Steinberg, Myers & Robinson, 2007). 4 In the study by Gulsrud et al. (2010), mother-child dyads attended twenty-four ten-minute sessions, organized in
ten modules, targeting early joint attention, language and joint engagement with the mother, three days a week
for eight weeks. The children’s behaviour was coded in the following categories: “negativity” in facial and
body expressions; regulation strategies including symbolic self-soothing, physical self-soothing, repetitive or
idiosyncratic behaviours, tension release, avoidance, distraction, maternal orientation, other-directed comfort
seeking and other-directed assistance seeking. Maternal regulation strategies were coded in the following
categories: prompting/helping, following the child’s lead, redirection of attention, active ignoring, reassurance,
emotional following, physical comfort, vocal comfort. Behavioural strategy combinations were applied to
classify the two partners’ regulatory behaviours as follows: (a) maternal vocal strategies consisting of a
combination of maternal vocal comfort and reassurance; (b) maternal active strategies consisting of a
combination of prompting/helping, redirection of attention and physical comfort; (c) children’s comfort
strategies consisting of physical self-comfort and comfort-seeking; (d) children’s physical strategies consisting
of tension release, avoidance, and distraction; and (e) children’s verbal strategies consisting of cognitive/verbal
self-soothing and assistance seeking. The results showed variability in the intensity of negative expressions
and in the number of distress episodes in ASD toddlers, but almost all ASD toddlers showed more frequent
negative arousal during play interactions with their mothers (interpreted as profiles of dysregulation).
However, these children engaged in a range of emotion regulation strategies, characterized as appropriate
Emotion Regulation, Social Cognition and Social Adjustment 7
their children during emotional events (Aldred, Green & Adams, 2004; Drew et al., 2002).
Empirical studies have emphasized the importance of assessing and training co-regulation
between ASD children and those around them.
3. Theory of Mind
3.1. Theory of Mind: Definition and Components
Theory of Mind (ToM) refers to abilities to understand others’ mental states, perceptive
states (visual perception, attention), volitional and motivational states (desire, intention),
epistemic states (beliefs and false beliefs), pretences, thinking and emotions (Emery, 2005;
Flavell, 1999; Wellman, 1990, 1991). ToM constitutes both a corpus of knowledge about the
human mind and abilities to infer mental states in other people through behavior and
multimodal expressions in social situations (Abbeduto & Murphy, 2004; Wellman, 1990,
2000). ToM is considered as “perspective-taking” or as a component of “social cognition”.
Taking other people’s perspective and identifying their mental states help with the
development of empathy towards others increase harmonious social interactions between
individuals and potentially contribute to social adjustment (Deneault & Morin, 2007; Nader-
Grosbois, 2011a).
3.2. Development of Theory of Mind in TD Children
3.2.1. Conceptions of Theory of Mind Several conceptions have been developed in order to explain ToM development.
The “theory theory approach” (Wellman, 1990), inspired by Piagetian constructivism,
postulates the progressive construction of successive theories adjusted by the child according
to information from diverse social contexts.
The “simulation theory” (Gordon, 1992; Harris, 2000, 2005) postulates an empirical
understanding by the child who experiences mental states in several situations; according to
what he or she feels, thinks or believes, he or she attributes to others similar mental states in
analogous situations.
A “modular approach” was conceived by Baron-Cohen and his colleagues, as an innate
conception of ToM acquisition. At birth, the children have specialized modules of
information processing at their disposal; in the course of neurological maturation they become
active strategies (distraction, avoidance and tension release) and constructive strategies (orienting to mum and
seeking assistance). Like TD toddlers, they requested maternal support and assistance, but they made less
frequent use of sophisticated verbal strategies such as symbolic/verbal self-soothing. Emotion regulation
strategies were used significantly more by ASD toddlers during episodes of negativity than non-negativity.
When their ASD child was in distress, the mothers engaged in active strategies (redirection, prompting, and
physical behaviours) or vocal comforting strategies (vocal soothing and reassurance). Some characteristics in
the ASD child and the mother were associated with emotion regulation outcomes. When the mothers
interacted with their toddlers with behaviour problems, they were more stressed and they used more active
strategies and fewer vocal strategies. These mothers’ ability to redirect attention away from a source of distress
for their children and reengage them in an ongoing play activity is an important regulatory strategy. This study
provides evidence for the effectiveness of an early mother-driven social-communication intervention in
supporting emotion regulation abilities in ASD children.
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 8
progressively able to understand the human world (Baron-Cohen, Leslie & Frith, 1985;
Baron-Cohen, 1991a-b-c, 1995; Deneault & Morin, 2007; Leslie, 2000). Four innate
mechanisms make “mindreading” possible: the “Intentionality Detector” (ID), the “Eye
Direction Detector” (EDD), the “Shared Attention Mechanism” (SAM) and the “Theory of
Mind Mechanism” (ToMM). The “ID” corresponds to a perceptual mechanism that interprets
“primitive volitional”, basic mental states (such as goal and desire) required to make sense of
movements of organisms in the environment. The “EDD” has three functions: the detection of
the presence of eye-like stimuli; the evaluation of whether eyes are oriented towards the
subject or in another direction; and the interpretation of a person’s gaze as “seeing” by
inferring from the observation that the person’s eyes are directed at something else that he or
she actually sees something. This last function helps the mind-reading process because it
allows the infant to attribute a specific perceptual state to the person. The “ID” and the
“EDD” allow the infant to interpret behavior in terms of certain mental states and to interpret
behavior on a dyadic level (between the agent and the infant, between the agent and the object
he sees). The “SAM” is a more complex skill that allows the child to conceptualize “triadic
representations”, establishing relations between an agent, the self, and an object or another
agent. The child is able to perceive the perceptual state of another agent and to compute
shared attention, by comparing that agent’s perceptual state with the self’s current perceptual
state. The “ToMM” makes it possible to infer all mental states (believing, feeling, knowing,
deceiving, imagining, dreaming, etc.) from the observation of behavior, and to elaborate an
understanding of how people’s mental states are linked with their actions and relate to each
other.
“Executive function/ToM” theories focus on interdependent links between these
processes, particularly in the case of links between executive functioning and ToM beliefs
(Carlson & Moses, 2001; Hughes, Adlam, Happé, Jackson, Taylor & Caspi, 2000; Kloo &
Perner, 2003). A certain level of ToM is needed to attain a certain degree of executive control
(including inhibition) and executive functioning is needed to master a certain level of ToM.
The “socio-constructivist Vygotskian approach” is centered on inter-individual social
processes in ToM development. The child elaborates a ToM, by means of repeated social
interactions, of sharing of social knowledge and explanations about mental states, and of
language used in social exchanges, with members of his or her culture (Astington, 1996;
Deneault & Morin, 2007; Dunn, 1995; Symons, 2004). If social interactions give
opportunities to evoke mental states, the child should easily develop ToM abilities.
In addition, two levels of ToM ability are distinguished in the literature (Baron-Cohen,
1995): the first-order level refers to inferring the thoughts of another person; the second-order
level refers to the children’s reasoning about what another person thinks about the thoughts of
a third person.
3.2.2. Development of Theory of Mind Related to Emotions in TD Children With specific reference to the ToM “emotions”, we can distinguish between the
understanding of causes of emotions (or prediction of emotions depending on the situation)
and the understanding of consequences of emotions (or prediction of appropriate behavior
depending on the felt emotions), concerning the four primary emotions (joy, sadness, anger
and fear) (Nader-Grosbois, 2011a; Nader-Grosbois & Thirion-Marissiaux, 2011).
In the first two years, some signs of understanding emotions emerge. Nine-month-old
infants relate other people’s emotional expressions and actions (Barna & Legerstee, 2005). At
Emotion Regulation, Social Cognition and Social Adjustment 9
around 18 months, they become able to connect emotions and desires (Lagattuta, 2005;
Repacholi & Gopnik, 1997; Wellman, Phillips & Rodriguez, 2000). From three years of age,
children distinguish emotions and they begin to connect emotions to external causes (Rieffe,
Meerum Terwogt & Cowan, 2005). Preschoolers begin to comment on their own and others’
emotions (Wellman, Harris, Banerjee & Sinclair, 1995) and they evoke emotions in pretend
play (Deneault & Morin, 2007; Gordon, 1992; Harris, 2000; Harris et al., 1989; Harris,
Brown, Marriott, Whittall & Harmer, 1991; Leslie, 1987). In their games of make-believe,
they show their ability to comprehend that others have wishes, beliefs and feelings much as
they have themselves (Harris et al., 1989). Preschoolers learn that emotions are related to a
person’s representations of situations (Cutting & Dunn, 1999; Wellman et al., 2000) and they
progressively understand the situational causes and the consequences of emotions. They
discover that it is not only objective situations that can induce emotions (for example,
receiving a present causes happiness, or falling over makes you cry) but also mental states
such as beliefs, or desires (feeling happy when a person has what he or she wants) (Baron-
Cohen, Tager-Flusberg & Cohen, 2000; Harris et al., 1989; Leslie, 1987; Rieffe et al., 2005).
ToM is particularly linked to the understanding of complex emotions, such as surprise,
embarrassment, shame, guilt and pride, which are not acquired before children are about four
years old. Around ten to twelve years, children easily use and understand various social
emotions (Draghi-Lorenz, Reddy & Costall, 2001; Frith, 2003; Gilbert, 2004; Mills, 2005;
Saarni, 1999; Tracy, Robins & Lagattuta, 2005).
3.3. Theory of Mind in ASD Children
In these children, there is a structural impairment of specialized processing of mental
states and of precursors of ToM, including specific information processing relating to faces,
to facial emotional expressions, and to gaze direction, reactivity or emotional and
motivational reciprocity, empathy, detection of intentional movements, imitation, coupling
action-perception between self and others, etc. (Nader-Grosbois, 2011a; Nader-Grosbois &
Day, 2011).
3.3.1. Specificities in Precursors of Tom in ASD Children
3.3.1.1. Deficits in Information Processing Relating to Faces and to Facial
Emotional Expressions Their inability to understand the expressive movements of a face and to interpret facial
cues of emotions and other emotional cues (vocal, gesture, postural) (Hobson, 1989, 1991,
1993) could impede ASD children’s understanding of emotions and of mental states. Some
cognitive conceptions of information processing explain this difficulty5.
5
According to the “Weak central coherence theory” (WCC, Frith, 2003; Frith & Happé, 1994; Happé, 1999), the
central coherence ability is deficient in ASD children, because they privilege local information processing and
have difficulty in shifting between local aspects and global approach. Their WCC disrupts the solving of
problems requiring the establishment of relationships between social cues (Happé, 2000). This theory explains
specificities of perceptual-cognitive style (toward both non-social and social aspects) that limit the
understanding of context in ASD people more than it explains emotional and social domains (Rajendran &
Mitchell, 2007). Inter- and intra-individual variability of WCC has been reported in ASD from childhood to
adult age (van Lang, Bouma, Sytema, Kraijer, & Minderaa, 2006; Noens & van Berckelaer-Onnes, 2008).
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 10
3.3.1.2. Deficits in Early Imitation Deficits have been observed in inter-personal motor resonance in some aspects of
imitation in young ASD children (Dawson & Adams, 1984; Heimann, 1998; Meltzoff &
Gopnik, 1993; Nadel, 1998) and in their sensory-motor representations of self and others
(Rogers & Pennington, 1991). Their sub-activation of the system of mirror neurones6 in the
reproduction or the observation of emotional expressions is linked with their ASD intensity
(Oberman, Hubbard, McCleery, Altschuler, Ramachandran & Pineda, 2005; Dapretto et al.,
2006).
According to the simulation approach to the development of ToM, their early deficits in
imitation could lead to difficulties in directing attention toward relevant cues displayed by
others and in considering reciprocal mental states. Their impairment in imitation and in ToM
jointly works to their disadvantage in comparison with TD or ID children (Perra, Williams,
Whiten, Fraser, Benzie & Perrett, 2008).
3.3.1.3. Deficits in the Detection of Biological Movements, Gaze Direction,
Joint Attention Varied results are reported regarding ASD children’s impaired or non-impaired detection,
depending on age (Blake, Turner, Smoski, Pozdol & Stone, 2003; Parron et al., 2008;
Webster & Potter, 2008).
Numerous studies have shown that early joint attention7 behaviors are impaired in ASD
children (Bono, Daley & Sigman, 2004; Loveland & Landry, 1986; Mundy & Crowson,
1997; Mundy & Gomes, 1998; Smith, Mirenda & Zaidman-Zait, 2007; Toth, Munson,
Meltzoff & Dawson, 2006; Vaughan et al., 2003); and are a subject of training (Hwang &
Hughes, 2000; Kasari, Freeman & Paparella, 2001b, 2006; Whalen & Schreibman, 2003;
Whalen, Schreibman & Ingersoll, 2006; Jones & Carr, 2004; Jones, Carr & Feeley, 2006;
Jones & Feeley, 2007; Jones, 2009).
Their joint attention skills are positively linked to or predictive of their ToM abilities
(Baron-Cohen, 1991c, 1995; Gattegno, Ionescu, Malvy & Adrien, 1999; Phillips, Baron-
Cohen & Rutter, 1992; Robertson, Tanguay, L’Ecuyer, Sims & Waltrip, 1999; Tourrette,
Recordon, Barbe & Soares-Boucaud, 2000; Yirmiya, Pilowsky, Solomonica-Levi &
Shulman, 1999).
3.3.2. Specificities of Executive Function Connected with Tom in ASD Children
The “executive control dysfunction” hypothesis suggests that the deficit in their executive
control system generates a set of problems in ASD people, including lack of flexibility in
Mottron and his colleagues (Mottron & Burack, 2001; Mottron, Dawson, Soulieres, Hubert & Burack, 2006)
suggest that ASD children present a deficit in the hierarchical organization of these processes: global
information processing does not precede local information processing. 6
The coupling of interpersonal perceptions and actions is based on a system of mirror neurones in the pre-motor
cortex, activated when a person makes an intentional action or observes the action produced by another, or
when a person evokes a mental simulation of the action. 7
Baron-Cohen (1991c) argues that attention towards others in seven- to nine-month-old infants constitutes a critical
precursor to ToM development. Decoding another’s gaze direction and their attention oriented to an object or
an event contributes to the understanding that the object or event is the other’s focus of interest. “Proto-
declarative pointing” induces the sharing of attention between two individuals or “joint attention” and implies
that they could be open to each other’s mental states. Baron-Cohen (1995) conceptualized this ability as a
“shared attention mechanism” (SAM), an essential component for ToM development.
Emotion Regulation, Social Cognition and Social Adjustment 11
behavior, disorders in inhibition of behavior, and deficits in planning, in strategy selection
and in shifting attention (Corbett, Constantine, Hendren, Rocke & Ozonoff, 2009; Mottron,
2004; Russell, 1997); and that it could create obstacles in the construction of social cognition.
There is a debate as to whether ToM tasks need the executive processes (e.g. Russell, 1997;
Russell, Mauthner, Sharpe & Tidswell, 1991; Russell & Hill, 2001; Russell, Hala & Hill,
2003; Pellicano, 2006; Pellicano, Maybery, Durkin & Maley, 2007) or whether a ToM is
required for executive control (e.g. Perner, Lang & Kloo, 2002). Russell (1997) suggests that
the early dysfunction of the action-monitoring system and of the developmental features of
executive functioning, and memory problems have an impact on ASD children’s self-
awareness, on the development of knowledge regarding their actions, on their regulation
through inner speech, on the imitation of others’ actions, as well as on their understanding of
others’ intentions and minds. Pellicano’s study (2007) obtained a significant correlation
between ToM and executive function components in the ASD group, independent of age.
Examination of the relational pattern of ToM-executive functioning impairments showed
dissociations in only one direction: impaired ToM with intact executive functioning. Pellicano
(2007; Pellicano et al., 2006) showed that there are specific links between particular
executive (dys)functions and particular (dis)abilities in ToM.
In the “Cognitive Complexity and Control theory” (CCC, Zelazo, Burack, Boseovski,
Jacques & Frye, 2001; Zelazo, Jacques, Burack & Frye, 2002), executive functioning is
related to ToM in ASD people because both ToM and measures of executive functions
include higher-order rule use (leading to a correct judgment in belief tasks, for example). The
advantage of the CCC theory lies in the interrelations between these two things: executive
abilities are required to perform ToM tasks, and conversely, ToM understanding helps the
mobilization of executive functions. Zelazo et al. (2001) argue that each developmental
disorder may have an impact on the consciousness, the control of behavior and rule
complexity, and that researchers should not overlook the fact that specifically in ASD people,
a large proportion are intellectually impaired; this intellectual deficit may interact with other
inabilities to explain various findings in studies relating to both executive functioning and
ToM development. They suggest that the CCC conception makes it possible to identify
specificities in particular components of executive functions and in ToM in people presenting
distinct disorders, including ASD. In their study of ASD children and children with Down
syndrome, Zelazo et al. (2002) reported that individual differences in ToM are correlated with
individual differences in performance in two tests of rule use, except in ASD children with
severe intellectual deficits.
3.3.3. The “Theory of Mind Hypothesis” or Modular Approach in ASD Children
ASD children present a specific triad of disorders: social impairment, reduced
communication and lack of imaginative play (Frith, 2000; Wing, 1986). Baron-Cohen et al.
(1985) suggested that these combined deficits could be explained by an inability to represent
mental states cognitively. This “theory of mind hypothesis” postulates a fundamental deficit
in ASD children in the ability to ascribe mental states to others, to understand others’
perspective, to predict their behavior in referring to these mental states; this is called “mind-
blindness” (Baron-Cohen, 1989a-b, 1991a-b, 1995; Baron-Cohen et al., 1985, 1986; Leslie &
Thaiss, 1992; Perner, Frith, Leslie & Leekam, 1989; Rieffe et al., 2000). Researchers suggest
that this mind-blindness in ASD children comes from the fact that they do not identify their
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 12
own mental states. Severe ToM deficits are linked to social and communicative abnormalities
(Baron-Cohen, 1988, 1991c; Eisenmajer & Prior, 1991; Frith, 2003) and they may influence
behavior in social interactions (Baron-Cohen et al., 2000; Dixon, Tarbox & Najdowski,
2009).
According to Leslie (1987, 1991, 2000; Leslie & Roth, 2000), ASD individuals present
an impaired cognitive mechanism of metarepresentation that leads to difficulty in
constructing mental representations about what is going on in others’ mental states and also in
their pretend play. The “ToM mechanism”, functioning jointly with a cognitive mechanism,
“the selection processor”, is activated deficiently by ASD children in solving ToM tasks
(Leslie, 2000).
In addition, Baron-Cohen (1995, 1999, 2000) led studies of ASD children to validate his
modular model of ToM, including four innate mechanisms that make “mindreading” possible.
In ASD children, these mechanisms could be damaged. According to Baron-Cohen (1989a),
the neurodevelopmental disorder in ASD children particularly restricts the maturation of the
“ToMM”. He argues that their social information processing is less efficient when adjustment
towards other people makes it necessary to consider their beliefs, intentions, or thinking as
different from their own. He suggests that the detection of emotions is not impaired when the
emotion fits with the context and the other person’s behavior (expressions of internal state).
However, ASD children have difficulties when emotions are not congruent with the context
or when complex emotions involve a representational interpretation (for example surprise,
Baron-Cohen, Spitz & Cross, 1993).
Numerous studies in developmental psychopathology have used this modular approach in
order to explain deficits in ASD people. However, the main criticism is the absence of
evidence of an exclusive deficit in ToMM in ASD people, and the fact that other cognitive
functions are also deficient, such as executive functions and language (Baron-Cohen, 1995).
Other researchers in developmental psychology postulate the progression of ToM conceived
as a multi-construct that could benefit from environmental and social interactions.
3.3.4. Socio-Affective Bases of Tom Development in ASD Children In the perspective developed by Hobson (1986a-b, 1993), it was postulated that deficits in
ToM development in ASD children result from a primary innate inability to interact in
emotional ways with other people. Their relative inability with respect to inter-subjective
contact and engagement in social interactions with others and their deficient emotional
connection with others have certain consequences in the cognitive, linguistic and social
domains and constrain the development of the sense of self, symbolization and the sense of
others’ attitudes and feelings (Hobson, 1993). In other words, ASD children’s lack of
understanding of others’ feelings affects their understanding of their own emotions and vice
versa; consequently, they find it difficult to respond to and empathize with emotions
expressed by others (Hobson, 1993). Their developmental delay in each stage of development
alters the progression of their joint attention, which induces difficulties in elaborating a ToM.
ASD children present a disharmonic pattern in their performance when confronted with
emotional versus non-emotional tasks, and this supports the hypothesis of a specific deficit in
emotional processing (notably identifying auditory and visual emotional stimuli and
designating emotions) (Hobson, 1986a-b, 1993; Hobson, Ouston & Lee, 1988, 1989).
Emotion Regulation, Social Cognition and Social Adjustment 13
3.3.5. Tom “Emotions” in ASD Children Few studies have specifically considered ToM “emotions” and the understanding of the
causes and consequences of emotions in ASD children.
Some authors have reported that when explicit questions about emotions were put to
ASD children around ten years old and MA-matched children, the participants showed a
similar understanding of simple emotions in prototypical situations, such as birthdays or
hurting yourself, or getting what you want (Baron-Cohen, 1991b; Baron-Cohen et al., 1993;
Fein, Lucci, Braverman & Waterhouse, 1992).
Deficits are reported in ASD children in the interpretation of drawings of facial
expressions or of emotional gestures according to contexts, in the association of facial
expressions with vocal information and in their understanding of internal causes of emotions
(Baron-Cohen, 1991b; Celani, Battacchi & Arcidiacono, 1999; Hadwin, Baron-Cohen,
Howlin & Hill, 1996, Hobson, 1986a-b; Loveland, Tunali-Kotoski, Chen, Brelsford, Ortegon
& Pearson, 1995; Southam-Gerow & Kendall, 2002). Sigman et al. (1992) observed that ASD
children do not recognize and are relatively unreceptive to negative emotions felt by adults. In
the same perspective, Vermeulen (2009) suggested that ASD children do not easily
understand other’s emotions because they do not know how to take account of others’
expectations and the context that provokes the emotions.
In addition, as they present deficits in ToM “beliefs” and “desires”, emotions caused by
these mental states are not easily understood by school-age ASD children (Baron-Cohen,
1991b; Buitelaar & van der Wees, 19978; Serra, Loth, van Geert, Hurkens & Minderaa,
2002). With regard to complex emotions, ASD preschoolers take little interest in others’
mental states: even if they display pride in similar situations as TD children, they pass over
the social function of pride because they do not monitor the audience’s reaction (Kasari et al.,
1993a).
ASD children differ from TD preschoolers matched for MA because they have difficulty
in improving their understanding of emotions through experience, including understanding
the causes and consequences of emotions in various situations (Begeer et al., 2008).
In addition, links between ToM and self-conscious emotions have been emphasized.
Heerey, Keltner and Capps (2003) observed that ASD children performed worse than TD
children at recognizing facial expressions of self-conscious emotions (such as embarrassment
and shame)9, though they did not differ in the recognition of non-self-conscious emotions
from photographs. When ToM ability was controlled for, there was no group difference in the
recognition of self-conscious emotions.
In ASD children, levels of understanding of emotions or performance in ToM emotion
tasks vary according to their IQ or their cognitive abilities (Happé, 1995; Kasari et al., 2001a;
Yirmiya et al., 1992) and their verbal or non-verbal competence (Buitelaar, van der Wees,
Swaab-Barneveld & van der Gaag, 1999; Happé, 1995).
3.3.6. “Enactive Mind” Conception in ASD Children Klin, Jones, Schultz and Volkmar (2003) postulate an early deviant “embodied” social
cognition in ASD children. In daily life, multiple relevant social cues occur rapidly and often
8 Significant correlations were found between ToM “beliefs” and emotion recognition measures in ASD children
(Buitelaar & van der Wees, 1997). 9
These self-conscious emotions are associated with ToM, through the ability to understand that behavior has social
consequences in the eyes of others and through an understanding of social norm violations.
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 14
simultaneously in social situations. Difficulties in identifying and interpreting them
experienced by ASD individuals may alter their interpretation of social meaning and lead to
their social maladjustment. Their selective attention is oriented less to social stimuli from
people than to physical stimuli from things in the environment. They develop poor tools for
interpreting and solving social situations.
To conclude, these diverse conceptions of deficits in precursors of ToM and in ToM in
ASD children help to explain their social maladjustment. However, complementary
explanations could come from specificities: the perception of subtlety of face, voice and body
movements, the processing of various sources of information simultaneously, the selection of
the most relevant information in social contexts, the inhibition of an inappropriate response
and the mobilization of another more appropriate response and the emotion regulation
processes.
4. Links between Emotional Regulation, ToM and Social Adjustment
4.1. Types of Links
Three distinct positions have been put forward about the links between these processes.
First, in their model of three levels of social skills, Yeates et al. (2007) postulated “bi-
directional” links between social information processing (including social cognition, ToM
and social problem-solving), social interactions (including emotional aspects) and social
adjustment. In other words, children who mobilize social information processing in an
appropriate way can interact easily, display adequate emotional regulation and prosocial
behavior, and establish and maintain positive relationships, and vice versa (Nader-Grosbois,
2011b). Similarly, in the model of effective social competence developed by Halberstadt,
Denham and Dunsmore (2001) and in the model of Leerkes et al. (2008), the emotional
processes, including understanding of emotions and socio-emotional regulation, are
conceived as interrelated skills.
Other positions postulate “predictive” links between these processes, but in two different
directions.
1) The understanding of emotion enables emotion regulation which in turn facilitates
cognitive and behavioral coping strategies; the understanding of emotion is therefore
considered as a mediator of relations of emotion regulation and social adjustment
(Izard, Schultz, Fine, Yougstrom & Ackerman, 2000). Through socio-cognitive
development, the child acquires an understanding of emotions (causes and
consequences), ToM “emotions”, and also a knowledge of social rules that allows
him or her to determine which emotion should be expressed when, towards whom
and in what circumstances. Social abilities in children are linked with their skills at
expressing and recognizing emotions and understanding others’ emotions and
intentions (Cassidy et al., 1998; Denham et al., 2003; Fabes et al., 1999).
2) The level of regulation in preschoolers predicts their emotional understanding two
years later (Schultz, Izard, Ackerman & Yougstrom, 2001).
Emotion Regulation, Social Cognition and Social Adjustment 15
More rarely, a lack of association between these two processes has been observed: TD
children with a high level of social information processing do not necessarily have good
socio-emotional regulation and vice versa (Lindsey & Colwell, 2003).
Few studies have examined specific links between emotion regulation during
interactions, ToM and social adjustment in ASD children who function at the symbolic
developmental level. Often these processes have been studied separately. Recently, some
authors have investigated the use of perspective taking and mental-state inference in
representing and taking part in dyadic interactions between ASD adolescents and adults and
TD children (Begeer, Malle, Nieuwland & Keysar, 2010).
4.2. A Comparative Exploratory Study of Emotion Regulation, Tom and
Social Adjustment
4.2.1. Objective Based on the integrative model proposed by Nader-Grosbois and Day (2011, p.144), a
recent exploratory study led by Nader-Grosbois, Baurain and Mazzone examined the links
between in ASD children’s socio-emotional regulation, observed in three dyadic contexts
(neutral with an adult and competitive and cooperative with a pair) and their ToM skills to do
with emotions and in social problem-solving, as well as their social adjustment.
4.2.2. Method
4.2.2.1. Participants
We compared these processes and the links between them in 12 ASD children with 12
children with intellectual disabilities (ID) and 12 TD preschoolers, matched for
developmental age.
Table 1. Means and standard deviations of chronological
and developmental ages for each group
Groups
TD children
(n= 12)
Girls (n= 6)
Boys (n = 6)
ID children
(n=12)
Girls (n= 8)
Boys (n = 4)
ASD children
(n=12)
Boys (n = 12)
M (SD) M (SD) M (SD)
Chronological age 57.33 (12.43) 111.92 (21.85) 117.58 (29.84)
Developmental age 60.24 (13.99) 60.25 (13.72) 60.08 (14.27)
Note. TD = Typically Developing; ID = Intellectual Disability; ASD = Autism Spectrum Disorders; n =
number of children; M = Mean; SD = Standard Deviation.
The Table 1 presents means and standard deviations of chronological and developmental
ages for each group.
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 16
4.2.2.2. Instruments and Procedure The ToM emotion tasks (Nader-Grosbois & Thirion-Marissiaux, 2011) assess the child’s
recognition and understanding of causes and consequences of emotions. A preliminary task of
facial emotional expression recognition for four basic emotions (joy, sadness, anger and fear)
was presented. Correct recognition was a necessary condition before administering the two
ToM emotion tasks. In the Causes of emotions task, the child has to understand the emotion
felt by the character of a story according to the situation with which he or she is confronted.
The Causes of emotions task included four similar beginnings of scripts illustrated by two
pictures. The end of each script required a choice from among four emotions: joy, sadness,
anger and fear (illustrated by pictures). The examiner read out each script and the child was
asked to make an emotion attribution to the main character by pointing to the most
appropriate of four facial emotional expressions. Finally, the examiner asked the child to
justify his or her answer. In the Consequences of emotions task, according the emotion felt by
the character in a story, the child has to predict his or her behavior. The consequences of
emotions task included four scripts (illustrated by two pictures) corresponding to four
situations in which the character felt joy, sadness, anger or fear. The end of each script
required a choice among three types of behavior (illustrated by three pictures): adjusted social
behavior, maladjusted social behavior, or neutral behavior. The examiner read out each script
and the child was asked to make a choice among the three pictures. Finally, the examiner
asked the child to justify his or her answer. The response to each emotional script was scored
between 0 and 1.5 points according to the participant’s justification. For each task, the
maximum score was 6 points and the two ToM emotion tasks were scored out of a total of 12
points.
The Social Solving task (RES, Barisnikov, Van der Linden & Hippolyte, 2005) is used to
estimate the capacity of the child to judge whether or not other people’s social behavior is
appropriate and to determine the extent to which their judgment is based on the knowledge of
conventional or moral rules. The 14 items, illustrated by 14 pictures, consist of appropriate
versus inappropriate social behavior displayed by a character in social situations. Three
questions are asked. The first question assesses the child’s judgment of adequate or
inadequate social behavior: “What happens in this picture? What do you think? Is he/she
doing something that is good or that is not good (or bad)?” (Maximum score = 2). The
second question assesses the identification of the target behavior of the situation: “Can you
show me what is good/not good in this picture?” (Maximum score = 1). The third question
estimates the level of justification, with reference to social rules, connected to the judgment:
“Why is it good/not good?” (Maximum score = 7). The maximum total score is 140.
The Dyadic Game of Socio-Emotional Problem-Solving (Baurain & Nader-Grosbois,
2011) aims to assess the child’s abilities to resolve several socio-emotional problems in
interactive contexts and to analyze his or her socio-emotional behavior. Concretely, the child
must solve these problems to reach the end of the course (represented by a star) in three types
of interactive contexts: neutral (playing only with an adult), competitive and cooperative
(playing with a child-partner). Two aspects are assessed: (1) performance in thirteen socio-
emotional problem-solving situations; (2) variation of socio-emotional regulation depending
on the interactive contexts and on three temporal sequences elicited by the design. In each
context, nine problem situations and four critical stories are presented and the child must
identify the character’s emotion among four basic emotions (joy, sadness, anger and fear),
and differentiate the inappropriate social behavior versus the appropriate social behavior, by
Emotion Regulation, Social Cognition and Social Adjustment 17
choosing among several possibilities illustrated by pictures. For the four critical stories
relating to four emotions (joy, sadness, anger, fear), we attribute 1 point per recognized
emotion. For the nine problem-situations, we attribute 3 points per situation (1 point if the
child recognizes what is socially acceptable or not in the behavior of one or more
protagonist(s); 1 point if the child is capable of justifying what he or she considers acceptable
or not; 1 point if the child is capable of choosing the socially acceptable behavior according to
the situation). The order of these nine problem-situations and the possible solution (illustrated
by acceptable social behavior) vary in order to limit inter-contextual learning biases. The
maximum score for the thirteen socio-emotional problem-solving situations per context is 31
points, for a total maximum score of 93 points for all contexts.
This design is intended to elicit positive and negative emotions in children during distinct
sequences of the game: notably frustration when they fail or when their partner succeeds, and
joy when they succeed or when they progress more than their partner in the game; it creates a
situation where the children need to regulate their emotions, their emotional expressions and
their socio-emotional behaviors. These behaviors can be managed in different ways by the
children depending on the context and the sequence, and can be more or less adjusted
depending on these situational aspects. We code behavior by viewing videos of children
playing in the game and applying the following coding grid.
The Coding Grid of Socio-Emotional Regulation by sequences (Baurain & Nader-
Grosbois, 2011) was created with reference to behavioral categories in measurements
conducted by other parties, such as the Emotion Regulation Checklist (ERC, Shields &
Cicchetti, 1997), the Emotional Regulation Rating Scale (ERRS, Carlson & Wang, 2007), and
the Emotion Regulation Subscale of the Social Competence Scale (Conduct Problems
Prevention Research Group, 1999) and in direct measurements (Fabes et al., 1999; Flem,
Thygesen, Valas & Magnes, 1998; Rothbart & Bates, 1998). The objective of the coding grid
is to assess variability of socio-emotional regulation depending on three interactive contexts
and on three temporal sequences (three challenges per sequence). The grid includes 26 items
divided into categories: Emotional Expressions and Emotional Adaptation; Behavior towards
Social Rules (listening and follow an adult’s instructions, waiting one’s turn); Social
Behavior (pro-social behavior, empathic behavior and behavior towards the task such as self-
effort or self-control). Validation phases and statistical analyses were performed to verify
concordance between judges, the internal structure, the consistency of the coding grid, and the
relevance of the design (Baurain & Nader-Grosbois, 2011).
4.2.3. Results Table 2 presents the results of the ANOVA analyses for the between-groups comparison.
With regard to social cognition, the results showed that the three groups of children
differed significantly in the Social Solving task: the ASD children presented the lowest
performances in this task. However, no significant differences between groups were obtained
in ToM tasks, and in performances in socio-emotional problem-solving in the dyadic games.
With regard to socio-emotional regulation, these analyses emphasized significant
differences in social behaviors displayed during the dyadic interactive games (all contexts
together, and specifically in cooperative and competitive contexts with peers), to the
disadvantage of ASD children; however no significant differences were obtained in the
frequency or intensity of emotional expression, or in behavior towards social rules during the
dyadic interactive game, whatever the type of context.
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 18
With regard to the teacher’s perception of the children’s social adjustment in daily life,
there was no significant difference between the three groups. Table 3 presents the Spearman’s
coefficients of correlation calculated for each group, between the children’s developmental
age and their abilities in social cognition, socio-emotional regulation and social adjustment.
The significant positive correlations showed that as the developmental age increased, so ToM
abilities and performances in socio-emotional problem-solving in the dyadic games improved
in TD and ASD children. Developmental age was positively linked with performance in the
social problem-solving task for TD and ID children only. Except for social behavior in TD
children, no significant correlations were obtained between categories of socio-emotional
regulation and developmental age in the three groups. For ASD children only, the higher their
developmental age, the better their social adjustment.
Table 2. ANOVA analyses for the between-groups comparisons in social cognition,
in socio-emotional regulation and in social adjustment
Groups
TD children
(n= 12)
ID children
(n=12)
ASD children
(n=12)
M (SD) M (SD) M (SD) F
Social cognition
Theory of Mind (ToM) 8.62 (2.27) 8.25 (1.99) 7 (2.74) 1.56
Social Solving task 54.50 (19.04) 63.25 (20.10) 42.33 (12.87) 4.26*
Socio-emotional problem-
solving in the dyadic game 50.45 (5.03) 49.48 (7.95) 44.70 (7.70) 2.21
Socio-emotional regulation Contexts
Emotional expression All 128.58 (6.30) 127.50 (13.50)
127.25
(13.50) .03
Neutral 42.25 (4.09) 42.67 (7.77) 42.75 (4.82) .02
Cooperative 43.58 (1.83) 42.58 (5.90) 42.50 (5.14) .20
Competitive 42.75 (2.73) 42.25 (3.36) 42.00 (4.73) .12
Behavior towards social rules All 71.92 (10.67) 64.67 (8.81) 66.75 (10.93) 1.61
Neutral 17.83 (1.85) 18.08 (2.64) 18.67 (2.27) .42
Cooperative 28.42 (5.23) 24.17 (4.80) 24.75 (4.00) 2.87
Competitive 25.67 (5.69) 22.17 (3.83) 23.33 (6.49) 1.28
Social Behavior All 17.83 (6.33) 20.42 (10.88) 9.08 (7.56) 5.88*
Neutral 2.92 (2.96) 4.25 (4.24) 1.92 (3.17) 1.33
Cooperative 7.08 (3.17) 7.50 (4.10) 3.67 (2.77) 4.60*
Competitive 7.83 (3.35) 8.67 (4.94) 3.5 (3.39) 5.86*
Social adjustment 55.60 (8.52) 60.30 (13.61) 46.14 (15.08) 2.71
Note. * p < .05; TD = Typically Developing; ID = Intellectual Disability; ASD = Autism Spectrum
Disorders; n = number of children; M = Mean; SD = Standard Deviation.
Table 4 presents the Spearman’s coefficients of correlation calculated for each group,
between the children’s socio-emotional regulation by categories and their abilities in social
cognition and in social adjustment. In ASD children, only emotional expression in socio-
emotional regulation was linked positively and significantly with social adjustment. In ID
children, significant positive correlations were obtained between emotional expression and
performance in socio-emotional problem-solving in dyadic games and also between behavior
towards social rules and ToM abilities.
Emotion Regulation, Social Cognition and Social Adjustment 19
Table 3. Spearman’s coefficients of correlations between children’s developmental
age and their abilities in social cognition, socio-emotional regulation and social
adjustment in each group
Developmental age
Groups
TD children
(n= 12)
ID children
(n=12)
ASD children
(n=12)
Social cognition
Theory of Mind (ToM) .64* .55 .68*
Social Solving task .80** .64* .56
Socio-emotional problem solving in the dyadic
game .88** .67* .89**
Socio-emotional regulation
Emotional expression .43 .23 .50
Behavior towards social rules -.19 .36 -.09
Social Behavior .65* -.25 -.16
Social adjustment .14 .36 .75*
Note. ** p < .001 * p < .05; TD = Typically Developing; ID = Intellectual Disability; ASD = Autism
Spectrum Disorders; n = number of children.
Table 4. Spearman’s coefficients of correlations between children’s abilities in socio-
emotional regulation and their social cognition and social adjustment in each group
Socio-emotional regulation
Groups
Emotional
expression
Behavior towards
social rules
Social
Behavior
TD children (n = 12)
Social cognition
Theory of Mind (ToM) .08 -.02 .50
Social Solving task .44 -. 28 .32
Socio-emotional problem-
solving in the dyadic game .53 -.30 .25
Social adjustment -.37 .23 .22
ID children (n = 12)
Social cognition
Theory of Mind (ToM) .15 .59* -.10
Social Solving task .09 .22 -.16
Socio-emotional problem-
solving in the dyadic game .58* .40 -.38
Social adjustment .17 .12 .40
ASD children (n = 12) Social cognition
Theory of Mind (ToM) .07 -.16 .02
Social Solving task .37 .01 -.11
Socio-emotional problem-
solving in the dyadic game .20 -.12 .36
Social adjustment .78* .57 .14
Note. * p < .05; TD = Typically Developing; ID = Intellectual Disability; ASD = Autism Spectrum
Disorders; n = number of children.
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 20
Table 5. Linear regression analyses: predictors of social adjustment for each group
Groups Predictors of social adjustment B
SD/
B BETA R2aju. F
TD children
(n=12)
Developmental age .17 .19 .30 -.02 .39
Social cognition
Theory of Mind (ToM) 1.11 1.50 .25 -.05 .55
Social Solving task .12 .15 .28 -.04 .62
Socio-emotional regulation
Emotional expression -.33 .43 -.26 -.04 .58
Behavior towards social rules .05 .26 .07 -.11 .04
Social Behavior .33 .46 .25 -.05 .52
ID children
(n=12)
Developmental age .53 .31 .53 .20 3.25
Social cognition
Theory of Mind (ToM) 1.73 2.11 .27 -.03 .67
Social Solving task .45 .16 .70 .43 7.64*
Socio-emotional regulation
Emotional expression .31 .25 .40 .06 1.57
Behavior towards social rules .38 .54 .24 -.06 .49
Social Behavior .34 .43 .26 -.04 .61
ASD children
(n=12)
Developmental age .87 .31 .78 .53 7.79*
Social cognition
Theory of Mind (ToM) 3.42 2.14 .58 .20 .17
Social Solving task .87 .37 .71 .41 5.33
Socio-emotional regulation
Emotional expression .74 .21 .84 .65 12.42*
Behavior towards social rules 1.07 .63 .60 .24 2.89
Social Behavior -.62 .85 -.31 -.08 .53
Note. * p< .05 ; TD = Typically Developing; ID = Intellectual Disability; ASD = Autism Spectrum
Disorders; n = number of children.
Table 5 presents the results of linear regression analyses which were performed in order
to identify the predictors of social adjustment. In ASD children, social adjustment was
predicted by developmental age and emotional expression in socio-emotional regulation. In
ID children, social adjustment was predicted only by abilities in the Social Solving task.
This exploratory study showed that when ASD children are matched for developmental
age with TD or ID children, they have a deficit in Social Solving tasks and display less social
behavior during the dyadic interactive games, particularly in cooperative and competitive
contexts with peers. It also emphasized some specific characteristics of links between target
processes in ASD children: both their developmental age and their emotional expression
included in socio-emotional regulation during dyadic games predicted their social adjustment.
The higher their developmental age, the better their abilities were in ToM and in socio-
emotional problem-solving in the dyadic games. The various methodologies used in this
Emotion Regulation, Social Cognition and Social Adjustment 21
exploratory study made a nuanced approach possible, not only to delay and deficits, but also
to strengths, in ASD and ID children; moreover, the study showed that relational patterns
between the various socio-emotional processes could be organized differently according to
the group of children. Similar studies involving larger samples and clinical subgroups should
be conducted.
5. Perspectives for Research and Implications for Assessment and for Intervention
In order to take account of the heterogeneity in ASD children and of multiple-deficit
accounts (as proposed by researchers such as Baron-Cohen & Swettenham, 1997; Bishop,
1993; Happé, Ronald & Plomin, 2006; Joseph, Tager-Flusberg & Lord, 2002; Rajendran &
Mitchell, 2007), future research should investigate specificities in subgroups of children and
adolescents with distinct profiles of ASD and different disorders, including genetic
syndromes, intellectual disabilities and behavior disorders.
The study of specificities of emotion regulation in ASD children should be conducted
using a dynamic and integrative approach that takes account of different levels of cognitive
and socio-emotional competences or deficits (as suggested by Yeates et al. 2007, Nader-
Grosbois, 2011b; Nader-Grosbois & Day, 2011): perceptual information-processing10
,
executive and cognitive abilities (attention, inhibition, etc.), social information-processing
(including ToM, understanding of one’s own and others’ emotions, social problem-solving
abilities), social interactions and social adjustment. To infer what other people think or feel
and to regulate one’s emotions in social interactions requires the perception of subtle face,
voice and body movements, the processing of various sources of information simultaneously
and in an integrated way, the selection of the most important and relevant information in the
context and the inhibition of an already given response in a similar situation to find a more
appropriate one. Emotion regulation in social situations could therefore depend on such
factors, with respect to which ASD children present deficits. In inter-disability comparative
studies, specific bidirectional or predictive links should be investigated between socio-
emotional regulation, social information-processing, including ToM, and social (mal)
adjustment in ASD children and ID children with a similar developmental age. With regard to
the need for additional research looking at the relation between theory of mind and social
behavior, recently, Lerner, Hutchins and Prelock (2011) examined the relationship between
parental responses in the Theory of Mind Inventory (ToMI)11
about their ASD adolescents
and measures of their autistic symptoms and social skills. Their results supported the use of
the ToMI with ASD adolescents and the link between ASD and social impairments. In
experimental studies, researchers should test the extent to which the training in social
information-processing or ToM could bring about improvements in socio-emotional
regulation and social adjustment in ASD children, compared with ID children and children
with externalized disorders.
We have also emphasized the importance of conducting longitudinal studies in order to
gain a better understanding of ToM in ASD children at different stages of development; such
10
As suggested by Mottron (2004). 11
A parental report measure of ToM, formerly called the Perception of Children’s Theory of Mind Measure
(Hutchins, Bonazinga, Prelock & Taylor, 2008) renamed the Theory of Mind Inventory (ToMI).
Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 22
studies could help to establish whether there is a delay, a deficit or a combination of the two
(as suggested by Serra et al., 2002).
Moreover, it would be relevant to examine parental socialization of emotions towards
their ASD children: how parents react to their own emotions, how they converse about
emotions and mental states, how they express their emotions; and also to study the impact of
these things on their children’s abilities in ToM, their socio-emotional regulation and their
social adjustment.
Socio-emotional co-regulation between both parents and ASD children and also between
these children and their peers also needs to be investigated in connection with the
development of ToM.
Future research should use recent assessment measures of ToM components, of
emotional abilities, of socio-emotional regulation, and of social skills, involving ecological
tasks (see the suggestions made by Nader-Grosbois, 2011a, and Nader-Grosbois and Day,
2011).
These research perspectives could yield specific guidelines on improving the effective-
ness of intervention toward subgroups of children more or less impaired in one domain or
another (Teunisse, Cools, van Spaendonck, Aerts & Berger, 2001).
In order to improve the social inclusion and the quality of life of ASD children, there is a
need for integrated assessment and intervention from infancy and childhood. We suggest the
following guidelines (see the detailed suggestions made by Geller, 2005; Nader-Grosbois,
2011a; Nader-Grosbois and Day, 2011). We propose to assess by means of various
methodologies (testing, relevant questionnaires, observations) and to provide training in12
:
a) ToM precursors: recognition of emotional stimuli (facial, vocal, gestural, body
movements) using various media (photographs, videos, computer software); face
processing, early imitation; joint attention;
b) socio-perceptive processing of social cues and perceptive integration;
c) executive functions and self-regulation strategies13
;
d) social knowledge and skills in socio-emotional problem-solving and in social scripts;
e) ToM abilities14
, including the understanding of causes and consequences of
emotions;
f) identification of one’s own positive and negative feelings;
g) modalities of emotional expression, emotional regulation strategies and conventional
responses towards others’ emotions, empathic behaviors;
h) social adaptive abilities;
i) self-perception of social self, of the quality of social relationships.
12
Several programs have been developed: “Mind Reading: the interactive guide to emotions- Learning Centre &
Games Zone” (Baron-Cohen, 2004), “Social Communication, Emotional Regulation and Transactional
Support” (SCERTS, 2005), “Teaching Children with Autism to Mind-Read: A Practical Guide” (Howlin,
Baron-Cohen & Hadwin, 1999), “Emotion Trainer” (Silver, 2000; Silver & Oakes, 2001), “Promoting
Alternative Thinking Strategies” (PATHS, Kusché & Greenberg, 1994), “Comic Strip Conversations” and
“Social Stories” (Gray, 1994, 2004; Gray & Garand, 1993), “Navigating the Social World” (McAfee, 2001),
“Solving the relationship puzzle”(Gutstein, 2000). 13
See the discussion of literature about the impact of self-regulation processes on development in atypical children
in Nader-Grosbois (2011c). 14
For example, showing video models for perspective-taking tasks could improve ASD children’s understanding of
another person’s mental states (Charlop-Christy & Daneshvar, 2003).
Emotion Regulation, Social Cognition and Social Adjustment 23
To gain a better understanding of ToM concepts, to mobilize a higher level of social
cognition, and to regulate their emotional expression and social behaviors better, ASD
children need specific adults’ scaffolding and various opportunities to practice these
processes in distinct contexts with different materials.
It is also necessary to assess and work on ASD children’s perceptions and behaviors of
peers, surroundings, parents or teachers, related to their socio-emotional (in)abilities.
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