Social competence and behavioral problems in children with
Autism Spectrum Disorder and the relation with emotion
regulation and expression
Sigrid Kok Studentnumber: 044067 Orthopedagogiek July 2012 Supervisors: C. Colonnesi C. Rieffe F.C. Jellesma
INTRODUCTION ... 4
Emotion expression in children with ASD ... 4
Emotion regulation in children with ASD ... 6
The role of emotional expression and emotion regulation in social competence and
behavioral problems ... 8
The present study ... 9
METHOD ... 10
Participants ...10
Procedure ...11
Instruments ...12
Analyses ...14
Behavioral problems and social competence ...15
Emotional expression ...15
Emotion regulation tasks and coping strategies ...16
The relation between behavioral problems and social competence and emotion
expression and regulation measures. ...18
DISCUSSION ... 21
Social functioning ... Error! Bookmark not defined.
Emotion expression and regulation ... Error! Bookmark not defined.
Social functioning and the relation with emotion expression and regulation ... Error!
Bookmark not defined.
REFERENCES ... 25
ABSTRACT
The purpose of the current study was to investigate the relation between emotion regulation and expression with social competence and behavioural problems for children with autism spectrum disorder (ASD) compared to typically developing (TD) children. Participants were 71 children with ASD and 93 TD children, aged between 1.5 and 5 years old. Parents filled out questionnaires about their children’s emotion expression and social functioning. Children completed tasks to measure their emotion regulation abilities. Results showed that children with ASD have more behavioural problems and lower social competence than TD children. Also children with ASD express more negative and less positive emotions than TD children. For TD children, relations were found between emotion expression and regulation and social competence and behavioural problems. For the group of children with ASD these relations were not found. Although more research on
contributing factors for their problems is necessary, it is evident that children with ASD experience problems at a young age and early intervention seems feasible.
INTRODUCTION
Children with an Autism Spectrum Disorder (ASD) are often reported to have behavioral problems (e.g., Brereton, Tonge & Einfeld, 2006; Gadow, DeVincent & Drabick, 2008). These behavioral problems, such as tantrums, loudness, stubbornness and impatient behavior are disruptive for the children and for their families. Research has shown that these problems are associated with high levels of parental stress (Lecavalier, Leone & Wiltz, 2006). Moreover, early onset (i.e., in toddlerhood and preschool years) of behavioral problems is a risk factor for the development of more serious problems later in life, such as conduct disorder and delinquency, but also ADHD (see Campbell, Shaw & Gilliom, 2000, for a review). Therefore, the presence of behavioral problems in young children with ASD is an important topic that deserves specific attention.
The problems described above exist alongside the so-called “core” issues of ASD according to the DSM-IV-TR (APA, 2001): qualitative limitations in social interaction, problems in
communication, and stereotypical behaviors. Koegel, Koegel, Frea and Fredeen (2001) report that children with ASD rarely have social interactions with their peers, whereas their typically
developing peers often engage in interactions with other children. As a result, children with ASD often feel lonely, because they do feel the desire to be in social relationships (Bauminger & Kasari, 2000). In typically developing (TD) children behavioral problems and lower social competence have been linked to poor emotion regulation and expression (Eisenberg, Fabes, Guthrie & Reiser, 2000, Trentacosta & Shaw, 2009; Cole, Zahn-Waxler, Fox, Usher & Welsh, 1996). Whether these factors also influence social functioning of children with ASD is still unknown. In the present study the relation between behavioral problems and social competence and emotion expression and emotion regulation in young children with ASD will be explored.
Emotion expression in children with ASD
The expression of emotions is an important factor for success in the social world of preschoolers. Emotions are, in the broadest sense, useful social signals that facilitate interactions between
children (Denham, 1998). For example, the expression of anger by a toddler can be useful to communicate that he does not want his toy to be taken away. The display of emotions and their readability, influence the impression that others gain about children’s skills and attractiveness as play partners. In other words, children that evidence better emotion regulation, because they display more readable and appropriate emotions, are viewed as more socially competent. These children also show more attention to the emotions of their peers and their peers like them better.
When looking into the literature about children with ASD and their emotional functioning it becomes clear that a lot of research has focused on the recognition of emotions in others. One of the numerous papers on this topic is a study of Rump, Giovannelli, Minshew and Strauss (2009), which shows that recognizing emotions in others is problematic for children with ASD. However, in social interaction not only the ability to recognize the emotion in others is important, but also to have the capacity to appropriately express emotions. Yet, the topic of emotional expression is less well documented in children with ASD. The few studies on emotional expression suggest that children with ASD are not viewed as emotionally flat, but that they are able to express at least simple emotions such as happiness, anger and sadness. Capps, Kasari, Yirmiya and Sigman (1993) have investigated emotion expression with parental reports. Parents perceived their children with ASD to be highly expressive of negative emotions, and reported more frequent expressions of sadness, anger, shame and guilt than parents of TD children. For positive emotions, however, the parents of the TD children reported more frequent expression than the parents of the children with ASD. The authors assume this finding can be explained by the fact that children with a
developmental disorder such as ASD, experience more pain and frustration and therefore express more negative emotions. Kasari and Sigman (1996) compared emotion expression of children with ASD with TD children. Children with ASD demonstrated poorer emotion expressions than children from group of TD children. Their deficits are especially apparent in a social context in which children with ASD have difficulties expressing socially aimed emotions of positive affect. These studies seem to indicate problems with expressing appropriate emotions with a communicative purpose in a social context in children with ASD, but also higher expression of negative emotions
and lower expression of positive emotions. The fact that children with ASD also display less engaged behavior, such as looking, listening and facial expressions in the interaction with their mothers in another study (Doussard-Roosevelt, Joe, Bazhenova & Porges, 2003) indicates that children with ASD might not fully understand the communicative aspect of emotion expression.
In sum, children with ASD show differences in emotion expression compared to TD children. These differences might be accounted for by differences in emotion regulation, since emotional expression requires good skills for regulating the level of arousal (Denham, 1998; Gross & Thompson, 2007).
Emotion regulation in children with ASD
The duration, frequency and intensity of expressed emotions largely depend on the ability to regulate emotions. Lack of regulation skills is likely to result in inadequate emotional expression, such as displaying emotions that are inappropriate or expressed too strongly for a particular situation. Emotion regulation in this study is defined as “the ability to manage one’s subjective experience of emotion, especially its intensity and duration, and to manage strategically one’s expression of emotion in communicative contexts.” (Saarni, 1999, p.220).
In order to understand the role of emotion regulation it is important to have a basic
understanding of the emotion experience. A certain change in a person’s situation triggers the start of the emotion experience. This change in situation can occur in the environment, but also in a person’s mind, for example by a memory or thought. It is accompanied by arousal. In order to manage the intensity of the arousal coping strategies can be used. The used coping strategy influences the outcome in terms of emotional expression and tendencies to act (Denham, 1998). Thus, successful emotion regulation leads to optimal physical arousal evidenced by an
appropriately modulated emotional expression in terms of intensity, frequency and duration (Gross, 1998).
Since the expression of emotions in children with ASD seems to differ from TD children both in quality and quantity, these groups are likely to differ in the regulation of emotion. Looking
at the components of the emotion experience leading to the expression of emotions, there seem to be two factors that can cause difficulties in expressing emotions. The root of the problem for children could be initial over-arousal, but it could also be that the level of arousal is the same, but that children with ASD are unable to regulate the arousal in order to have an appropriate
expression of emotions.
Emotion regulation in children with ASD is an underinvestigated subject. Rogers and Ozonoff (2005) have highlighted both theories of under-arousal as well as over-arousal in children with ASD compared to their TD peers. Differences in intial arousal between children with ASD and TD children remain unclear. However, children with ASD do show increased rates of co-morbid anxiety, disruptive behavior disorders and problems with anger management. They seem to be less able to think of alternative strategies to respond in the situation when they are feeling angry. Instead there is a direct intense physical response with a higher intensity and duration than
appropriate. This seems to indicate problems in regulating stress and anger (De Bruin, Ferdinand, Meester, de Nijs & Verheij, 2007; Sofronoff, Attwoon, Hinton & Levin, 2007). In other words, an explanation for differences in emotional expression might be the fact that children with ASD use maladaptive coping strategies.
Coping is a developmental concept, because the environment and the demands of this environment change over time and require different coping mechanisms. Children might also be limited in their use of coping mechanisms because of delays in other areas of development (e.g. cognitive development) and lack of experience (Fields and Prinz,1997). During preschool years, strategies of avoidance, distraction and support-seeking are common in different situations. Trentacosta and Shaw (2009) have investigated the relation between emotional regulation, peer rejection and antisocial behavior. Their results indicate that less use of distraction (during a frustration task) by preschool children was related to more peer rejection during middle childhood. On top of this finding, they discovered an indirect effect of distraction on antisocial behavior through peer rejection.
Children with ASD seem to employ different coping strategies than their TD peers. Rieffe, Triantafyllakos and MeerumTerwogt, (2003), in: Rieffe et al. 2011) have investigated coping strategies of children with ASD. In their study emotion vignettes that described stressful daily events were presented to the children. They were asked how they would feel in the situation and what they would do in order to make themselves feel less sad or angry. The children with ASD reported fewer cognitive coping strategies than their TD peers to cope with negative daily life-events. Konstantareas and Stewart (2006) have studied strategies of emotion regulation in children with ASD by inducing mild frustration. The children were handed a highly attractive toy and after several seconds had to hand it back to the experimenter. The response of the children was observed in a 15-second period after handing back the toy. The reactions of the children to the situation were categorized from most adaptive (active engagement with a substitute toy) to least adaptive
(Focusing on the frustrating object). They found that children with ASD used less adaptive strategies than TD children and that they used a greater range of strategies than the TD children.
The role of emotional expression and emotion regulation in social competence and behavioral problems
Emotions and emotion regulation play an important role in developing adequate social behavior. Eisenberg et al. (2000) have reviewed some of the research on emotion and emotion regulation and their role in the prediction of the quality of (concurrent and future) social functioning, and have collected longitudinal data on this topic. In their study, children were on average seven years old during the first and nine years old during the second measurement. Emotion regulation was measured (on both T1 and T2) by parent reports, teacher reports and a behavioral measure in the form of a puzzle box task. Social competence was assessed with reports from teachers at T1 and T2 and from peers at T1. The authors conclude that emotion and the regulation of emotion play an important role in developing a high quality of social functioning. Negative emotionality and lack of regulatory control are indicated as risk factors for developing externalizing behavioral problems.
Blair, Denham, Kochanoff and Whipple (2004) have investigated coping strategies and temperament in preschoolers and the relationship with social behavior. Coping strategies were measured by means of a questionnaire for parents and teachers. The social behavior of the children was teacher-rated. Their findings showed that the use of passive coping strategies played a
significant role in maladaptive behaviors in young children.
In sum, the discussed research shows the importance of emotion regulation in developing adequate social behavior in TD children. It seems that behavioral problems are related to poorer emotion regulation, whereas good emotion regulation skills are related to higher levels of social competence. Since these areas of functioning are both problematic for children with ASD, and some evidence shows that they are experiencing problems regulating and expressing their emotions, this relationship needs investigating.
The present study
The aim of the present study is to examine the relation between behavioral problems and social competence and emotional expression and regulation in children with ASD. It is expected that (in line with Koegel et al. (2001); Brereton et al. (2006); Gadow et al. (2008)) children with ASD are less socially competent and experience more behavioral problems than TD children. Since behavioral problems and social competence are related to emotional expression and emotion regulation in TD children, this relation might exist for children with ASD. It seems plausible that more expression of positive emotions is linked to higher levels of social competence and less behavioral problems, since the expression of more positive emotions might make children more attractive as social interaction partners. Higher levels of negative emotions, however, could be related to lower levels of social competence and more behavioral problems. It is also possible that expressiveness in general, both positive and negative, is related to higher levels of social
competence. The explanation for this could be that expression of emotions serves a communicative purpose and therefore contributes to higher quality of social interactions.
In the current study, the focus will be on young children (ages between three and six) with ASD, because earlier findings suggest that development of problems starts at an early age.
(Campbell et al. 2000) The findings of this study can be useful for treatment of behavioral problems and social functioning of this group of young children with ASD. This is important to prevent serious behavioral problems in adulthood. If indeed there is a relation between emotion regulation and emotion expression on the one side and behavioral problems and social skills on the other, there might be possibilities to improve social functioning and prevent behavioral problems. Due to different factors (such as development of better diagnostic materials, public awareness and neonatal hearing screening, which helps filtering out hearing problems) the group of young
children with a diagnosis of ASD is a relatively new research group, because children are currently being diagnosed at a younger age.
METHOD
Participants
A total of 164 children were included in this study, 71 children with ASD and 93 TD children. The TD children were matched with the children with ASD on gender and age (see Table 1). The group of children with ASD consists of children with a diagnosis of autism, Asperger syndrome, or PDD-NOS. Children with additional disabilities were excluded from this study. All TD children attended regular primary schools and regular daycare settings. Thirty-four children with ASD attended regular primary schools, 11 attended regular daycare or preschool, 2 attended specialized primary schools, 14 specialized daycare, 2 children stayed at home, and for 8 children with ASD the setting was unknown. All ASD children had a cognitive development within two standard deviations of the average (between 70-130). Children with ASD and their parents were recruited via the Centre for Autism, in Leiden, the Netherlands. The recruitment took place during the diagnostic process in order to include children in the study as young as possible. Parents received information about the project from their practitioner and were asked to participate in the study. Children that did not
receive a diagnosis during the process were excluded from the study. The recruitment of TD children was done through primary schools and daycare centers.
Table 1 Participant Details by Diagnosis
ASD (n=71) TD (n=93)
Mean age in months (SD) 55 (12) 52 (10)
Sex (%) Male 63 (89) 80 (86) Female 8 (11) 13 (14) ASD diagnosis Autism 40 PDD-NOS 27 Asperger 2 Preliminary diagnosis 2 Procedure
A team of researchers from Leiden University and Centre for Autism, Leiden, the Netherlands, collected the data as a part of a larger project that focuses on the socio-emotional development of children with ASD as compared to TD children. After obtaining written informed consent from the parents, questionnaires were sent to the parents by mail or they received a link to our website by e-mail. The tasks with the children were administered in a quiet room at school, at the Centre for Autism, at a day care centre, or at home by a trained experimenter. A test session lasted approximately 45 to 60 minutes and consisted of several tasks, not all of them are part of the current study. The behaviors of the children were, as far as possible, coded during the session by the experimenter. The session was also video-taped in order to be able to check observations afterwards.
Instruments
In order to measure social skills, behavioral problems, emotional expression and emotion regulation, questionnaires and tasks were used. The questionnaires were filled out by one of the parents (either mother or father).
Table 2 Psychometric Properties of the Scales
Number of items Range (min-max) Chronbach’s alpha AS D TD Social functioning SDQ, Externalizing behavior (hyperactivity and conduct scale)
10 0-2 .64 .71
SDQ, Social competence
(prosocial and peer problems scale)
10 0-2 .74 .78
Emotion Expression
EEQ, Negative emotion expression 8 1-5 .64 .85
EEQ, Positive emotion expression 6 1-5 .66 .69
Emotion regulation
Avoidance/distraction bottle 5 0-2 .70 .62
Negative reaction bottle 4 0-2 .67 .71
Negative reaction car 4 0-2 .65 .57
Coping Task 6 0-1 .90 .89
Social functioning. The Strengths and Difficulties Questionnaire (SDQ, Goodman, 1997;
Dutch version) was used to measure social skills and behavioral problems. The SDQ consists of five scales of five items each: emotional symptoms scale (e.g. “Many worries, often seems
worried”), conduct problems scale (e.g. “often has temper tantrums of hot tempers”), hyperactivity scale (e.g. “constantly fidgeting or squirming”), peer problems scale (e.g. “picked on or bullied by other children”), prosocial scale (e.g. “kind to younger children”). Parents rated each item on a three points scale (0=not true, 1=somewhat true, 2=true). Following Wiefferink, Rieffe, Ketelaar & Frijns (2012) the conduct problems scale and the hyperactivity scale were taken together as a measure for externalizing behavior. The peer problems scale was recoded into a positive scale and was taken together with the prosocial scale. This new scale was used as a measure of social competence. The internal consistencies of the scales were moderate to good (Table 2).
Expression of emotions. The Emotion Expression Questionnaire (EEQ) was used to
measure emotion expression. This questionnaire consists of 35 items that measure intensity and frequency of positive and negative emotion expression and has been designed for this study (Rieffe, Ketelaar & Wiefferink, 2010). In this study, the scales for anger and sadness were taken together as a measure for negative emotion expression. An example item for this scale is “how often does your child show anger?”. The scales that measured the extent to which a child showed joy and happiness were used as a measure for positive emotion expression. An example item of the positive emotion expression scale is “how long does your child show joy?”.
Emotional regulation. Children’s emotion regulation was measured by bringing the child
in a situation that evokes frustration. The researcher opens a bottle which unknowingly to the child, was equipped with a safety cap in front of the child. Then the bottle is handed to the child and the child is asked to open the bottle. During 30 to 60 seconds the reaction of the child is scored on a three point scale (0= no, 1= a little, 2= a lot). Since research on this topic has been limited, the scoring was done in a more global fashion to explore the possible behaviors associated with this type of task.
For the bottle task two items were taken out, because almost all children scored the lowest score of zero, and therefore the items were not discriminative. A factor analysis was done to discover the different factors in the observations during the bottle task. Two factors were discovered. The first factor, “Avoidance/distraction” measures the extent to which the child can distract him/herself from the negative stimulus. An example item is “looks away from bottle”. The second scale, “Negative reaction”, measures the extent to which the child shows a negative reaction to the stimulus. An example item is “negative facial expression (getting angry, pouting, mouth corners down)”.
Another task used to measure emotion regulation was the car task. This too was designed to bring the children into a situation in which emotion regulation is required. The experimenter handed the child a car and tells the child he/she can play with it. As soon as the child starts driving the car around the wheels fall of. The response of the child was coded in similar fashion as during the bottle task.
Coping with difficult social situations. A second task was used to measure coping in
situations that evoke specific emotional responses. During this task six situations are presented to the child that evoke a negative emotion in the protagonist. Children were shown a drawing and told a short story about this drawing. An example of a situation is “Boy sees crocodile”. First the child is asked “How does the boy feel?” and the second question is “How can the boy be happy again?” The answers of the children were coded as adequate or inadequate based on a fixed coding scheme.
Analyses
To examine group differences as well as possible interaction effects on behavioral problems, social competence and emotion expression Repeated Measures ANOVAs (RM-ANOVAs) were used. The group differences in emotion regulation (as measured by tasks) were examined by means of t-tests. To examine the relations between the dependent (social competence and behavioral
problems) and the independent variables (emotion expression and emotion regulation), correlations and a regression analyses were conducted.
RESULTS
Behavioral problems and social competence
Behavioral problems and social competence in children with ASD and TD children were examined by means of an RM-ANOVA with the scales of the SDQ (behavioral problems and social
competence) as within factor and diagnosis (ASD or TD) as between factor. Table 3 shows the results of the RM-ANOVA with F-values for simple and interaction effects and the SIDAK comparisons. Significant main effects were found for diagnosis and SDQ scale and these effects were qualified by an interaction effect. Using SIDAK’s comparisons a significant difference was found between the scores of the groups on the externalizing behavior scale, with the ASD children scoring higher. On the social competence scale children with ASD had significantly lower scores than the TD children.
Emotional expression
Positive and negative emotion expression in children with ASD and TD children, as measured by the EEQ, were examined by means of a RM-ANOVA with the scales of the EEQ (positive and negative emotion expression) as within factor and diagnosis (ASD or TD) as between factor. Table 3 shows the results of the RM-ANOVA with F-values for simple and interaction effects and the SIDAK comparisons. A significant main effect for Emotion expression was found; children scored higher on positive emotion expression. No main effect was found for diagnosis, which indicates that children with ASD do not express more or less emotion in general. A significant interaction effect was found. Using SIDAK’s comparisons, a significant difference was found between the scores on the negative emotion expression scale, with the ASD children scoring higher. On the positive emotion expression scale children with ASD had a significantly lower score.
Emotion regulation tasks and coping strategies
Mean scores and standard deviations on the bottle and car task are shown in Table 4. Group differences were examined by means of an independent sample t-test (two-tailed). No group differences were found on the bottle task, but TD children scored higher on the negative reaction scale than children with ASD for the car task (t (151) = 3.03 p=.003). The correlation between the negative scale for the car and bottle task was .35 (p < .001), which is not very high considering that both tasks are designed to measure the same concept of negative reaction to a negative situation. A significant difference was found in the amount of appropriate coping strategies. The children with ASD scored significantly lower than the TD children.
Table 3 Results for The RMA; Mean Scores and F-values
Range (min-max) Mean scores (SD) ASD TD Between subject F-value Within subject F-value Inter-action F-value SIDAK Compar isons Social functioning SDQ, Externalizing behavior 0-2 0.98 (0.40) a,c 0.60 (0.39) a,d 16,50*** 72,27*** 110*** a***, b***, c***, d*** SDQ, Social competence 0-2 0.88 (0.35) b,c 1.56 (0.32) b,d Emotion expression
16
EEQ, Negative emotion expression 1-5 2.81 (0.50) a,c 2,35 (0.61) a,d 0.156 139.85*** 38.43*** a***, b***, c***, d*** EEQ, Positive emotion expression 1-5 3.20 (0.52) b,c 3.61 (0.58) b,d ***p<.001
Table 4 Mean Scores on the Scales of the Bottle Task, Car Task and Coping task Compared by Means of a T-test
Range (min-max) Mean scores (SD)
ASD TD
Emotion regulation
Avoidance/distraction bottle task
0-2 0.22 (0.34) 0.21 (0.30)
Negative reaction bottle task 0-2 0.32 (0.43) 0.39 (0.43) Negative reaction car task
***
0-2 0.15 (0.30) 0.33 (0.36)
Coping Task** 0-1 0.17 (0.30) 0.31 (0.36)
**, p<.01, ***p<.001
The relation between behavioral problems and social competence and emotion expression and regulation measures.
Correlation analyses were computed to explore the relation between emotion expression and emotion regulation with behavioral problems and social competence. Results are shown in Table 5, and it is clear that most associations are not significant. Negative emotion expression (as reported by the parents) is positively correlated with behavioral problems for both ASD and TD children; and negatively with social competence for TD children only. Also positive emotion expression was correlated for TD only with social competence. No other correlations were significant.
Table 5 Correlations between emotion expression and regulation measures with social competence and behavioral problems Behavioral problems Social competence ASD TD ASD TD Negative emotion expression .45 *** .45 *** -.12 -.37 ** Positive emotion expression -.04 -.12 -.03 .36 ** Avoidance bottle -.04 .18 -.28 -.16 Negative reaction Bottle .13 .06 .18 .22 Negative reaction car .04 -.04 .20 .02 Coping strategies .02 -.22 .20 .15 *** p <.001, ** p<.01
18
A regression analysis was done in order to discover predictors for social competence and behavioral problems in both the groups (TD and ASD). Negative emotion expression, positive emotion expression, the two scales of the bottle task, negative reaction in the car task and coping strategies were entered as predictors. The results for the regression analyses for social competence are shown in Table 6. For the ASD group the model was not significant. For the TD group the model was significant, and negative emotion expression (as reported by parents) contributed negatively to social competence whereas negative emotion expression in the bottle task contributed positively. Positive emotion expression in the TD group contributed positively.
Table 6 Regression analyses with emotion regulation measures as predictors for behavioral problems
Social competence ASD (n=42) TD (n=60) Regression Coefficients F adjR ² β t F adjR ² β t Model 1,62 .08 4.0 .23**
Negative emotion expression -.30 -1.71 -.36 3.12**
Positive emotion expression -.01 -.07 .24 1.98* a
Avoidance bottle -.10 -.56 -.10 -.86
Negative reaction Bottle .11 .64 .29 2.3*
Negative reaction Car .28 1.60 -.12 -.94
Coping strategies .14 .85 .13 1.08
*** p <.001, ** p<.01, *p<.05, a One-sided p-value is presented, because of the one-directional hypothesis.
Table 7 Regression analyses with emotion regulation measures as predictors for behavioral problems Behavioral problems ASD (n=42) TD (n=60) Regression Coefficients F adjR ² β t F adjR ² β T Model 1.80 .10 3.72 .21**
Negative emotion expression .41 2.41
*
.46 3.86***a
Positive emotion expression -.021 -.12 .01 .07
Avoidance bottle -.20
-1.19
.11 .94
Negative reaction Bottle -.20
-1.18
-.02 -.17
Negative reaction Car -.30 1.7 -.02 -.19
Coping strategies -.11 -.70
-.243
2.04*
*** p <.001, ** p<.01, *p<.05, a One-sided p-value is presented, because of the one-directional hypothesis.
The results for the regression analysis for behavioral problems are shown in table 7. For the ASD group the model was not significant. For the TD group the model was significant and negative emotion expression contributed to behavioral problems, whereas coping strategies contributed negatively to behavioral problems.
DISCUSSION
Since high levels of behavioral problems and low social competence have been reported for children with ASD, the aim of the current study was to identify possible factors that could explain the existence of these problems. Since for typically developing children a relation with emotion regulation and expression was found (Eisenberg et al, 2000, Trentacosta & Shaw, 2009; Cole et al., 1996), these are possible contributing factors for children with ASD.
First, our findings show that parents of children with ASD reported more behavioral problems than the parents of TD children, as was also reported in other studies (Brereton et al., 2006 and Gadow et al., 2008). Second, children with ASD were also reported by their parents to be less socially competent than TD children. These findings again stress the importance of studying this group of children at an early age, since the problems already exist between the ages of 1,5 and five.
Furthermore, in line with the findings of Capps et al.(1993), it was shown that children with ASD are not inexpressive of emotions. However, there is a difference in the type of expressed emotions between the children with ASD and the TD children. TD children express more positive emotions than children with ASD, whereas children with ASD express more negative emotions than the TD children.
In terms of negative reaction to the tasks presented to the children, the reactions do not seem to differ between the children with ASD and the TD children on the bottle task. However, children with ASD showed less negative reactions than the TD children in the car task. This pattern seems different from the pattern for the parent questionnaires, where children with ASD were reported to express more negative emotions than TD children. This difference could be due to the
fact that the questionnaire measures emotion expression in general, whereas the tasks are designed to measure emotion expression and regulation in a difficult situation. In this situation, the
expression serves a communicative purpose when it is directed towards the experimenter, because this might elicit help. Since children with ASD also display less engaged behavior in interaction (Doussard-Roosevelt et al., 2003), it is possible they express emotions less communicatively.
The different outcomes for the two tasks might be due to the fact that they do not seem to measure the exact same concept. This was reflected in the low correlation between the scores on the two tasks. Possibly the difference lies in the fact that children experience frustration when unable to open the bottle, whereas the car being broken could evoke more of a guilt response.
Additionally, a significant difference was found in the amount of adequate coping strategies between the two groups. Children with ASD used less adequate coping strategies than TD children. However since for both groups of children the amount of coping strategies was low, we could not differentiate between types of coping styles. Many children with ASD scored a zero on this task, because they were unable to answer the questions. This was often due to insufficient language abilities. Future research could look at coping strategies at a later age, where better language abilities could be expected and more children will be able to report coping strategies. This will make it possible to differentiate between the different styles.
With respect to the relation between emotion expression and emotion regulation and social competence the results for the group of TD children seem to be in accordance with previous findings. For this group the results show that higher levels of negative emotion expression as reported by the parents are predictive of lower levels of social competence. However, negative emotion expression in the bottle task is a positive contributor to social competence in TD children. This could be due to the fact that the expression of negative emotion during the bottle task can serve a communicative purpose. It could result, for example, in receiving help from the
experimenter with opening the bottle. More expression of positive emotions is predictive of higher social competence. This was expected, since expressing positive emotions in interaction can make you a more attractive interaction partner.
For children with ASD no relation between social competence and emotion expression was found. Since children with ASD show less engaged behaviors in social interactions (Doussard-Roosevelt et al. 2003), it is plausible that children with ASD do express emotions but do not do this directed towards another person. For example they do express happiness about playing with their favorite toy, but they do not smile at another person during a pleasant conversation. Therefore the expression of emotions does not contribute in social situations. This could explain why it is unrelated to social competence for children with ASD.
With respect to behavioral problems, these were related to negative emotion expression as reported by parents in both the group of children with ASD and the TD children. However, no relation was found between behavioral problems and negative emotion expression during the task. The relation between behavioral problems and negative emotion expression was to be expected, however it was not found for negative emotion expression during the tasks. This again could be explained by the communicative aspect of the negative emotion expression during the tasks. If negative emotions are expressed appropriately towards another person they might not cause behavioral problems. Future research could look closely at the directedness of emotions and whether this plays a role in the consequences of the emotion expression.
Furthermore, in the TD group higher use of appropriate coping strategies was related to less behavioral problems. Possibly using strategies to cope with difficult situations can result in less anger and sadness, which in turn could cause behavioral problems.
Future research should focus on the directedness of emotion expression at another person, since a lack of directedness in the group of children with ASD might explain why no relation has been found between emotion regulation and expression and social competence. If indeed the lack of directedness is found, it might be possible to design an intervention to improve this skill. Our findings might also indicate that for the ASD group social competence (or the lack of it) can be explained by other factors than for the TD children. Future research should also focus on identifying other contributing factors for children with ASD, since this study has replicated the existence of problems for this group of children. It seems too early to provide clear-cut
implications for clinical practice at this stage, but this study has shown that children with ASD already show problems at an early age. Therefore early intervention for children with ASD seems feasible.
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