F
ACULTEIT DERM
AATSCHAPPIJ-
ENG
EDRAGSWETENSCHAPPENGraduate School of Child Development and Education
Orthopedagogiek Masterthesis
Name student: Shanna van Trigt Address: Bilderdijkkade 638a City: Amsterdam
Phone number: 06 37401506 Student number: 10365664
E-mail: shannavantrigt@hotmail.com Supervisor: Dr. Milica Nikolić
Second reviewer: Dr. Cristina Colonnesi
Subject: Autistic traits and guilt in young children: A mediation by social cognition? Date of submission: 26-08-2018
Abstract
Children with high levels of autistic traits, characterized by deficits in social interaction and communication, usually experience a lack of guilt, yet guilt is an important emotion to develop, since it functions as a motivator for prosocial behaviors. This study examined the relation between autistic traits and guilt in early childhood and mechanisms influencing this relation. Two- to five-year-old children (N = 65) were presented a rigged toy that broke once played with, to elicit feelings of guilt. Also, two tasks to measure Theory of Mind (ToM), representing the ability to understand other people’s mental states, and emotion recognition were conducted. Additionally, parents reported about children’s levels of autistic traits, using the Social Responsiveness Scale. Higher levels of autistic traits were related to less guilt and lower ToM. Moreover, higher levels of ToM were related to more guilt. No relations with emotion recognition were found. Finally, ToM and emotion recognition did not mediate the relation between autistic traits and guilt. As guilt facilitates us in our social interactions, future studies could assess causing mechanisms of low guilt and how less guilt influences social interactions in children with high levels of autistic traits in order to adjust interventions improving these interactions.
Autistic Traits and Guilt in Young Children: A Mediation by Social Cognition? According to Freud (1930), a sense of guilt is necessary for the regulation and accommodation of relationships and social bonds between individuals. For example, if someone breaks something that belongs to someone else or hurts a friend’s feelings, that person tries to make amends by fixing what is broken or by apologizing. Guilt rises from the reflection of one’s behavior in aspects of social conventions and contributes positively to humans’ navigation through the social environment (Davidson, Vanegas, & Hilvert, 2017; Estrada-Hollenbeck & Heatherton, 1998; Muris et al., 2016) by functioning as a motivator for prosocial behavior (Davidson, Hilvert, Misiunaite, & Giordano, 2018; Drummond,
Hammond, Satlof-Bedrick, Waugh, & Brownell, 2017). Guilt is a self-conscious emotion, which means that it arises in relation to social rules and is reflective of one’s behavior in context of these social rules (Davidson et al., 2017). To be reflective of one’s behavior, self-conscious emotions also require an understanding of the self in relation to these social rules and to others’ evaluation of one’s behavior (Davidson et al., 2018; Davidson et al., 2017). Self-conscious emotions drive individuals to show socially appreciated behaviors and, thus, dysregulations in self-conscious emotions could lead to problems in social interactions and intimate relationships (Muris & Meesters, 2014).When experiencing self-conscious emotions to a severe extent, these emotions could become the prevailing emotional response, which could lead to maladaptive behaviors, such as internalizing problems and depression (Muris & Meesters, 2014). But when self-conscious emotions are mostly missing, their adaptive role is also absent, resulting in less socially adequate behaviors. Dysregulations in self-conscious emotions are related to psychopathology and experiencing social difficulties (Muris & Meesters, 2014; Muris et al., 2016). These dysregulations may play a role in individuals with autism, which is characterized by difficulties in social interactions and relations.
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder and is associated with severe and pervasive deficits in social interaction and communication (Schaller & Rauh, 2017). Individuals with high levels of autistic traits tend to have deficits in the understanding of thoughts and intentions of others (Davidson et al., 2018; Davidson et al., 2017; Schaller & Rauh, 2017), which may lead to impairments in self-conscious emotions (Davidson et al., 2018). For example, individuals with high levels of autistic traits have been shown to be less prone to report on feelings of guilt than typically developing individuals (Davidson et al., 2018; Davidson et al., 2017; Mazza et al., 2016).
in young children (Drummond et al., 2017). Especially research regarding guilt in relation to autism in young children is lacking. According to the Dutch Central Statistics Office, it is estimated that 2.5% of all 4-12 year old children in the Netherlands are diagnosed with ASD (CBS, 2018). Since guilt is an important emotion to display in social interactions in which a violation of a norm or rule appears, knowing why it is impaired in children with higher levels of autistic traits can help us develop interventions, such as interventions focused on displaying adaptive self-conscious emotions and improving social interactions. Therefore, in this study the association between autistic traits and guilt and possible mechanisms influencing this association in children aged two to five years old will be examined.
Autism and Guilt
Guilt is a self-conscious emotion that usually arises when an individual does
something that is conflicting with social norms or values, causing the belief that others will disapprove this behavior resulting in negative evaluations by others (Estrada-Hollenbeck & Heatherton, 1998; Lewis, 2007; Muris & Meesters, 2014). When feeling guilty, one evaluates their own behavior—a specific action—as bad, but it does not inflict a negative evaluation of the whole self (Drummond et al., 2017; Lewis, 2007; Muris, 2015; Muris & Meesters, 2014). One regrets the action or behavior and wishes they behaved differently, so feelings of guilt motivate individuals to repair the negative consequences of the action that caused these feelings, by engaging in reparative behavior such as apologizing and repairing (Davidson et al., 2018; Drummond et al., 2017; Muris, 2015; Muris & Meesters, 2014; Muris et al., 2016).
Guilt, as a self-conscious emotion, requires more complex cognitive and emotional abilities than the basic emotions, such as happiness, sadness or anger, and therefore appears later in children’s development than basic emotions (Lightfoot, Cole, & Cole, 2013; Muris & Meesters, 2014). It has been discussed whether self-conscious emotions are already present in children aged two years old (Barrett, Zahn-Waxler, & Cole, 1993; Drummond et al., 2017), because children need to possess specific cognitive skills to enable them to experience self-conscious emotions (Muris & Meesters, 2014). The emergence of the awareness of self is an important condition for experiencing guilt and other self-conscious emotions (Davidson et al., 2018; Kochanska, Gross, Lin, & Nichols, 2002; Lewis, 2007; Muris & Meesters, 2014), which normally develops between 18 and 24 months of age (Barrett et al., 1993; Cole, Barrett, Zahn-Waxler, 1992; Drummond et al., 2017; Muris & Meesters, 2014; Shaffer, 2005). Also, before children are able to realise they did something wrong, they need to incorporate social rules and norms, and additionally need to be aware that they are responsible for their own
behavior (Davidson et al., 2018; Lewis, 2007; Muris & Meesters, 2014). Children are
normally capable of doing so around the age of two years (Lewis, 2007). Yet another skill that children need to possess for experiencing self-conscious emotions is the awareness of and reflection on how other people evaluate the child’s behavior (Muris & Meesters, 2014). This skill is part of the development of a Theory of Mind (ToM), which is the ability to understand others’ mental states and predict behaviors accordingly (Derksen, Hunsche, Giroux, Connolly, & Bernstein, 2018). It has been claimed that ToM develops around the age of four years, yet, recently, evidence suggesting an early, implicit form of ToM that is already present around the age of two years, has been found (Derksen et al., 2018; Grosse Wiesmann, Friederici, Singer, Steinbeis, 2017; Setoh, Scott, & Baillargeon, 2016). Also, precursors of ToM, such as emotion recognition, can already start to develop around the age of two years (Derksen et al., 2018), which may cause the ability to experience and express feelings of guilt at an earlier age (Zinck, 2008). That is why it may be possible that children younger than four years already experience and express feelings of guilt and other self-conscious emotions.
Individuals with higher levels of autistic traits are usually characterized by deficits in the understanding of, and coping or communicating with the social environment (Baron-Cohen, 1997; Baron-(Baron-Cohen, Leslie, & Frith, 1985; DSM-5, 2013). Other autism related characteristics are impaired social cognition, language impairment and repetitive behavioral patterns (Heerey, Keltner, & Capps, 2003; Mazza, Mariano, Peretti, Masedu, Pino, & Valenti, 2017). In addition, autism is often associated with deficits in self-conscious emotions, because these emotions require knowledge of the thoughts and intentions of others (Davidson et al., 2018; Davidson et al., 2017). Recent studies found that children diagnosed with ASD showed less proneness to report on feelings of guilt than children without this diagnosis (Davidson et al., 2018; Muris et al., 2016). Also, adults with high levels of autistic traits showed less proneness to report on feelings of guilt than adults with lower levels of autistic traits (Davidson et al., 2017). These findings correspond to the earlier descriptions of behaviors related to guilt; children with high levels of autistic traits usually have difficulties in recognizing social norms (Muris et al., 2016) and emotions of others (Harms, Martin, & Wallace, 2010; Schaller & Rauh, 2017), resulting in a lack of reparative behaviors (Muris et al., 2016), which indicate feelings of guilt (Davidson et al., 2018; Drummond et al., 2017; Muris, 2015; Muris & Meesters, 2014; Muris et al., 2016). It has been shown that children diagnosed with ASD may show self-conscious emotions in situations where there was explicitly explained that the child was violating norms (Kasari, Chamerlain, & Bauminger, 2001, as cited in Heerey et al., 2003). This suggests that children with ASD are able to
experience self-conscious emotions, but they have difficulties understanding when they violated a norm and how it may influence others. Hence, the lack of self-conscious emotions in children with high levels of autistic traits may be because of deficits in socio-cognitive abilities.
Social Cognition as a Mediator in the Relation between Autistic Traits and Guilt in Young Children
Social cognition concerns the cognitive mechanisms underlying our social behavior, that is, how individuals perceive, implement and evaluate information gathered in social situations (Schaller & Rauh, 2017; Senju, 2013). It emerges gradually during life (Sirois & Jackson, 2007). Social cognition may be an underlying cause for the behavioral peculiarities of autism, of which ToM and emotion recognition are the most influential aspects (Buitelaar, Van der Wees, Swaab–Barneveld, & Van der Gaag, 1999). ToM represents the ability to attribute mental states (feelings, thoughts and intentions) to one-self and others and the ability to understand and explain people’s behaviors based on their mental states (Mazza et al, 2017; Premack & Woodruff, 1978). False belief, which is the realization that others can have diverging beliefs and intentions, is an important aspect in the development of ToM and normally develops around the age of four years (Mazza et al., 2017; Poulin-Dubois & Yott, 2017). False belief can be measured with the false belief task, which assesses a child’s ability to recognize that others can have, and can act according to beliefs that are contrary to the facts in reality (Lightfoot, Cole, & Cole, 2013; Poulin-Dubois & Yott, 2017). However, numerous recent studies have claimed that children have already developed an implicit form of false belief around the age of two years (Derksen et al., 2018; Fizke, Butterfill, van de Loo, Reindl, & Rakoczy, 2017; Grosse Wiesmann et al., 2017; Happé & Frith, 2014; Kulke, von Duhn, Schneider, & Rakoczy, 2018; Mazza et al., 2017; Oktay-Gür, Schulz, & Rakoczy, 2018; Setoh et al., 2016).
Emotion recognition refers to the ability to accurately assess emotions based on
external cues, such as facial emotional expressions, and this is necessary to take the emotional perspective of one other (Buitelaar et al., 1999). By the age of three months, infants already discriminate their mothers’ happy, sad or angry expressions when accompanied by vocal expressions of these emotions and respond to these emotions by getting cheerful as reaction to happy emotions and distressed by their mothers’ anger or sadness (Shaffer, 2005). Social referencing, which is the use of others’ emotional expressions to gather information about uncertain situations and use this information to adjust their own behavior, begins to develop
around the age of seven to ten months (Shaffer, 2005). This social referencing will change in toddlers to a more active search for information after a new object or situation is approached or avoided. Between the ages of three to five years, children start to identify emotions of others more correctly and also label these emotions (Shaffer, 2005). Knowledge about others’ emotions is important to develop, because it enables us to deduce how someone is feeling and adjust our behavior accordingly (Buitelaar et al., 1999; Shaffer, 2005). Deficits in emotion recognition could result in impairments in social interactions and social relations (Buitelaar et al., 1999; Hobson, Ouston, & Lee, 1988).
Impaired socio-cognitive development is a common aspect of autism. Children with autism usually experience impairments in ToM (Baron-Cohen et al., 1985; Buitelaar et al., 1999; Burnside, Wright, & Poulin-Dubois, 2017; Heerey et al., 2003; Mazza et al., 2017; Misailidi, 2018; Muris & Meesters, 2014; Schaller & Rauh, 2017; Senju, 2013) and emotion recognition (Buitelaar et al., 1999; Harms et al., 2010; Schaller & Rauh, 2017). It has been shown that pre-schoolers diagnosed with ASD had lower levels of ToM than typically developing pre-schoolers (Burnside et al., 2017). Also, adolescents diagnosed with ASD seemed to score lower on emotion recognition and ToM tasks than their typically developing peers (Schaller & Rauh, 2017). A possible explanation for the deficits in socio-cognitive abilities may be that individuals with autism often experience reduced social input because of impairments in social communication and interaction, which may result in a deprived
development of socio-cognitive abilities (Burnside et al., 2017). In addition, less social input combined with a lack of orientation to faces, which is common in individuals with autism, causes less exposure to various facial expressions, which may lead to difficulties in emotion recognition (Harms et al., 2010).
Impaired socio-cognitive abilities could in turn cause impairments in self-conscious emotions. To experience self-conscious emotions, one must be able to form beliefs about the ways other people evaluate their behavior; individuals can only feel guilty when they believe that others believe their action was wrong (Davidson et al., 2018; Heerey et al., 2003;
Misailidi, 2018; Muris & Meesters, 2014). But when socio-cognitive abilities are impaired, the ability to take the perspective of someone else is decreased (Heerey et al., 2003). Impairments in socio-cognitive abilities could also cause failure to understand social transgressions, which in turn could lead to less feelings of guilt; when individuals are not aware of violating a norm or rule, they will not believe that others believe their action was wrong and thus, will not feel guilty (Heerey et al., 2003; Muris et al., 2016). When explicitly explained to a child with autism that a norm or rule is violated, which eliminates the need for
socio-cognitive abilities, children with autism show self-conscious emotions (Kasari, Chamerlain, & Bauminger, 2001, as cited in Heerey et al., 2003), which suggests that social cognition may be a mechanism causing lower levels of guilt in children with higher levels of autistic traits. It has been claimed that the role of social cognition is bigger in the experience of guilt than other self-conscious emotions, since brain regions indicative of mental state attribution and perspective-taking are more active when experiencing guilt than for instance shame or sadness (Jankowski & Takahashi, 2014). Children with ASD seemed to report less proneness to guilt compared to typically developing children (Davidson et al., 2018) and similar results have been found for adults with high levels of autistic traits compared to adults with low levels of autistic traits (Davidson et al., 2017). Additionally, higher levels of ToM have been found to be associated with more proneness to guilt (Davidson et al., 2018; Misailidi, 2018). Based on the past research, it may thus be concluded, that children with higher levels of autistic traits may experience a lack of guilt because of their impaired socio-cognitive abilities.
Present Study
This study investigated whether higher levels of autistic traits related to less guilt in children aged two to five years old, and whether this relation was mediated by two socio-cognitive skills, namely emotion recognition and ToM. Davidson et al. (2018) have examined the relation between children’s autism and guilt proneness, yet they used a self-report
questionnaire to assess proneness of guilt. However, this may be problematic, since children with autism tend to have difficulties in recognizing, describing and distinguishing emotions (Cook, Brewer, Shah, & Bird, 2013). Therefore, to contribute to the current knowledge, objective observations of expressions of guilt were used in the present study. It was expected that children with higher levels of autistic traits would show less guilt. Also, it was expected that levels of social cognition would be lower in children with higher levels of autistic traits. Furthermore, it was expected that lower levels of socio-cognitive abilities relate to less guilt. Finally, it was expected that socio-cognitive abilities mediate the relation between autistic traits and guilt in the way that higher levels of autistic traits are related to lower levels of socio-cognitive abilities, which, in turn, is related to lower levels of guilt.
Method Design and Procedure
In this cross-sectional study, two- to five-year-old children and one of their parents were tested at the Family Lab at the University of Amsterdam. A measurement was held on one day and took about 90 minutes. The child and parent were welcomed in the Family Lab while receiving a short introduction about the study. During the measurement, different self-conscious emotions were measured, as well as the development of ToM and emotion recognition. The parent filled in several questionnaires, among others a questionnaire to measure autistic traits of the child, to gather information about the child’s and parent’s social development and psychopathology. The room where the measurements and questionnaires took place was equipped with four cameras and a one-way mirror. The children received a small gift and a ‘young researcher’ diploma after the measurement to thank them for
participating and the parent got debriefed about the different tasks and their purpose. For this study, only the parent-reported questionnaire about autistic traits and the tasks measuring children’s socio-cognitive abilities and guilt were used.
Participants
The participants of this study were two- to five-year-old children (N = 65) with a parent. The children had an average age of 49.94 months (SD = 13.51) of which 55.3 % were girls (n = 36) and 44.6 % were boys (n = 29). Most participants lived in or nearby
Amsterdam. Parents had an average age of 35.67 years (SD = 6.18) and 87.7% were female (n = 57) and 12.3% male (n = 8), mostly had a Dutch ethnicity (81.5%), were relatively high educated (M = 6.31, SD = 1.70 on the scale 1=primary education to 9=doctorate) and were, based on parental income, from middle-to-high socio-economic status.
The children and their parents were recruited by letters that were sent out via primary schools, day-care centres and pre-schools, by handing out information letters in front of crowded public areas in Amsterdam which are often visited by parents with children in this age-range, such as museums, swimming pools and parks and through online advertisement on social media. Parents filled in an informed consent form to register for this study, but were free to drop out anytime, without giving any reason. The study has been approved by the ethics committee of the Research Institute of Child Development and Education of the University of Amsterdam.
Children’s Levels of ASD Traits Reported by Parent
The Social Responsiveness scale (SRS) (Constantino & Gruber, 2005) was used to measure the level of ASD traits. The SRS is a parent report to measure children’s autistic
traits which consists of 65 items with a five point rating scale ranging from not true to always true, regarding a child’s ability to engage in an emotionally appropriate way in interactions with others (Constantino et al., 2003). An example item is: “My child is able to understand the meaning of other people’s tone of voice and facial expressions”. The SRS has five subscales: social awareness, social cognition, social communication, social motivation and autistic mannerisms (Constantino et al., 2003). Most items were indicative of behaviors regarding autistic traits, so higher scores represented higher levels of autistic traits, but some items were reversed and so, higher scores represented lower levels of autistic traits. Values for these items were reversed, so the higher the score, the higher the levels of autistic traits. The test-retest reliability of the SRS measured by Constantino et al. (2003) was 0.83. Internal consistency was excellent in previous studies, α = 0.93 (Constantino & Gruber, 2005), α = 0.97 (Bölte, Poustka, & Constantino, 2008),and internal consistency for the SRS found in the present study was also excellent, α = 0.91.
Measurement and Coding of Children’s Expressions of Guilt
The Broken Toy mishap (Barrett et al., 1993; Cole et al., 1992; Kochanska et al., 1995) was used to measure guilt; a standard task to evoke short-term guilt and shame in toddlers and young children adapted for the current study based on Drummond et al. (2017). During the Family lab visit, the parent received an instruction letter to inform them about the task, and the task was only performed with an additional permission from the parent. The test-leader presented a teddy bear, henceforth referred to as Teddy, to the child with emphasis on the emotional value of Teddy for the test-leader by mentioning it was the test-leader’s favorite childhood toy. Teddy was then attached to the wall with a Velcro patch and the child was told that he/she was allowed to play with Teddy while the test-leader was gone. Teddy was rigged, so the arm and/or leg fell off when the child started playing with it. Around two minutes after the child broke Teddy, the experimenter returned to the room following five cues with 15 seconds in between, in which the child got stimulated to respond to the situation. The first cue was loudly saying: “Alright, thanks a lot and see you soon!” just outside the room, so the child knew the test-leader was returning to the room. Second cue was looking at the broken bear with a neutral facial expression. Third cue was asking: “What happened to Teddy?”. The fourth cue was asking: “What happened so his arm/leg fell of?”. The fifth cue was saying: “Teddy was my favorite bear”. After the five cues the child got debriefed by saying: “Oops, I forgot that Teddy was already broken! I can fix him, I will be right back with a repaired Teddy.”. After leaving the room, the test-leader returned with an identical, not broken Teddy
and said: “See, he is as good as new. Now Teddy is happy again, I am happy again and you can be happy again as well!”. If the child showed severe signs of distress and started to cry at any point during the task, the test-leader immediately debriefed the child regardless of the other cues that had to come. The Broken Toy mishap had a mean duration of 153.96 seconds (SD = 46.47).
Afterwards, different behaviors were coded using the video records of the task and the coding programme ‘The Observer XT 13’ (Zimmerman, Bolhuis, Willemsen, Meyer, & Noldus, 2009). The expressions of guilt were coded based on the coding system of Drummond et al. (2017). According to the coding system of Drummond et al. (2017), behaviors that indicate feelings of guilt are repairing Teddy, confessing and explaining and showing that Teddy got broken. In this study the ‘guilt proneness’ group out of the research of Drummond et al. (2017), was used, which is characterized by the following coded behaviors: high levels of ‘Talking about or showing Teddy to the parent or test-leader’ and ‘Repairing Teddy’. Also verbal expressions were coded and verbalizations that are thought to reflect guilt, such as apologizing, taking responsibility, acknowledging feelings/taking perspective of test-leader and regretting what happened were coded as part of guilt (Barrett et al., 1993; Ioannou et al., 2013). Descriptions and examples of coded behaviors are reported in Table 1. Coded behaviors were not mutually exclusive, so different behaviors could happen at the same time. Repairing Teddy and Talking about or showing Teddy to the parent or test-leader were coded as state events, so durations of these behaviors were coded and could be
converted to percentages. For verbal behaviors, the frequencies of different verbal expressions were coded. The behaviors were coded by a trained master student and Inter-rater reliability was established by another trained master student on 12 observations (25.53%) for both Repairing Teddy and Talking about or showing Teddy to the parent or test-leader. Cohen’s kappa corrected for kappa max was κ = 0.64 for Repairing Teddy and κ = 0.72 for Talking about or showing Teddy to the parent or test-leader.
Table 1
Coded Behaviours with Description and Example
Behaviour Description Example Situation
Teddy breaks Teddy breaks and the child realises. Not coded yet when Teddy breaks but the child doesn’t realise yet.
Coded when the child notices that Teddy is broken.
Test-leader comes in Test-leader comes in when the child is done playing with Teddy.
Coded when the test-leader opens the door.
Repairing Repairing Teddy or not repairing Teddy
Coded when the child is trying to put the arm or leg back
Talking Talking about/showing Teddy or not talking about/showing Teddy
Coded when the child is talking about and/or showing Teddy to parent and/or test-leader
Verbal expressions Apologizing
Taking responsibility
Acknowledging feelings/taking perspective of test-leader Regretting what happened
“I’m sorry”
“I made the arm/leg fall of”
“She (test-leader) is going to be sad” Verbalizations indicating regret, for example: “Ahhh”
Measurement of Socio-Cognitive Abilities
For the measurement of social cognition both ToM and emotion recognition were measured. A shortened version of the Theory of Mind-test-Revised (ToM-test-R) (Steerneman & Meesters, 2009) was used; a structured interview with 14 short stories about which the child had to answer 36 questions for measuring ToM in children. The ToM-test-R has three subscales: ToM 1, which measured precursors of ToM such as emotion recognition and pretense, ToM 2, which measured the first manifestations of true ToM such as false belief and ToM 3, which measured more advanced ToM aspects (Ahmadi, Jalaie, & Ashayeri, 2015). The ToM-test-R is normally used for children aged 4-12 years old. In this study only items 1, 3, 4 and 5 were used, representing only ToM 1 and 2, because the following tasks were too advanced for children aged two to five years old. These items measured four different
milestones in the development of ToM; item 1 measures pretense, item 3 emotion recognition and first order belief and item 4 and 5 measure false belief. Pretense is the ability to pretend,
whereas first order belief refers to the understanding of someone’s actions and false belief to the understanding that someone can have different beliefs than reality and act accordingly (Leslie, 1987). Each ToM test item was scored as either ‘good’ or ‘false’ and got a score of respectively 1 or 0, where a higher score reflected more developed ToM. Pretense and emotion recognition represented ToM 1 and first order belief and false belief represented ToM 2. Internal consistency of the complete ToM-test-R in a previous study was excellent, α = 0.92 (Ahmadi et al., 2015), internal consistency in the present study was excellent for ToM 1, α = 0.90, and good for ToM 2, α = 0.86.
The emotion understanding task (Denham, 1986) as used in Pears and Fisher (2005) was used to measure emotion recognition; a task using four pictures of a boy or girl, matched to the gender of the child, showing happy, sad, scared and angry emotions. The task was divided into two subscales: expressive emotion recognition and receptive emotion recognition (Pears & Fisher, 2005). While expressive emotion recognition was measured by presenting the pictures one-by-one and asking which picture represents which emotion, receptive
emotion recognition was measured by presenting all four pictures at the same time and asking the child to point to the requested emotion (Pears & Fisher, 2005). A correct answer was scored as 1 and a wrong answer as 0, resulting in a sum score for emotion recognition based on both receptive and expressive emotion recognition tasks, where a higher score represented higher levels of emotion recognition. Internal consistency for the emotion understanding task found in earlier studies was good, α = 0.84 (Pears & Fisher, 2005), internal consistency for the emotion understanding task in the present study was acceptable, α = 0.76.
Data Analyses
Standardized mean scores of the SRS questionnaire were used in the analyses. For the non-verbal behaviors indicating feelings of guilt (repairing Teddy and talking about/showing Teddy) percentages were calculated to account for the total duration of the task, which
differed among children. The percentages of the two guilt behaviors were standardized as well as the summed up verbal behaviors and then the standardized variables were averaged to compute the composite ‘guilt’ variable. The total scores of ToM 1, ToM 2 and emotion recognition represented different socio-cognitive abilities and were, thus, used separately in analyses. In the analyses, mean scores of social cognition subscales were used. The data was checked for outliers (± 3 SD), skewness and kurtosis. Two outliers were detected; one in the verbal behavior variable of the Broken toy mishap and one in the total score of the SRS questionnaire. These outliers were winsorized by changing their value to the closest
up-following value that was not an outlier (Wilcox, 2005). The assumption of normal distribution was checked by inspecting histograms and evaluating standardized skewness. All variables were normally distributed.
The question whether there is a relation between levels of autistic traits and guilt, as well as between autistic traits and socio-cognitive skills and between socio-cognitive skills and guilt, was answered by means of Pearson’s correlations and partial correlations to control for the effect of age. To assess the extent to which autistic traits predict guilt with socio-cognitive abilities as mediating variables, three mediation regression models were tested, where ToM 1, ToM 2 and emotion recognition (representing social cognition) were the mediating variables in the relation between autistic traits on guilt. To control for children’s age, all mediation regression models used age as a covariate variable.
Results Preliminary Analysis
Due to the need of parental consent for the Broken Toy mishap or the child not breaking Teddy, 18 measurements did not contain this task and, thus, could not be coded. Thus, data for 47 participants (72.31%) to assess guilt were available. Due to the loss of sound of the recording, the child not speaking and/or understanding Dutch adequately enough or the child not willing to fulfil the ToM task and emotion understanding task, six measurements did not contain these tasks and thus, could not be coded. Thus, data of ToM and emotion
recognition for 59 participants (90.80%) were available. For children’s age and autistic traits, information of one participant was missing, because answers were not (correctly) filled in by parents. Thus, data of children’s age and autistic traits for 64 participants (98.46%) were available. Analysis of missing data showed a total of 16.35% missing values, the Little’s MCAR test was used to check if these missing values were distributed randomly in the database and was not significant, χ2(67) = 78.32, p = 0.162, which indicated that data is
missing completely at random. Missing values were imputed using the expectation
maximization method and the imputed dataset was used in analyses. Descriptive statistics of all variables are reported in Table 2.
Table 2
Descriptive Statistics of Children’s Age, Levels of Guilt, Autistic Traits, ToM 1, ToM 2 and
Emotion Recognition N Mean (SD) Range Age a 65 49.94 (13.51) 24-27 Guilt 65 0.00 (0.64) -1.02-1.77 Autistic traits 65 1.32 (0.26) 0.58-2.03 ToM 1 65 7.25 (3.06) 0-10 ToM 2 65 2.53 (2.40) 0-8 Emotion recognition 65 4.95 (2.05) 0-8
Note. a Age in months
Correlations between Autistic Traits, Guilt and Socio-Cognitive Abilities
Table 3 displays zero-order and partial correlations. No significant differences were found between boys and girls, except for autistic traits, t(62) = -2.21, p = 0.030, 95% CI [-0.27,-0.01], therefore it was not used as a controlling variable since it did not influence the outcome variable, guilt. Children’s age was strongly positively correlated with all variables (except with autistic traits), so it was included as a controlling variable in following analyses. By means of Pearson’s correlations using bootstrapping based on 1000 samples to overcome the limitations of a small sample size, a significant negative relation between autistic traits and guilt has been found; higher levels of autistic traits were associated with lower levels of displaying guilt. Both autistic traits and guilt were associated with ToM1 and ToM 2; higher levels of autistic traits were associated to lower levels of ToM and higher levels of guilt were associated to higher levels of ToM1 and ToM2. Autistic traits and guilt were not associated with emotion recognition. Using partial correlations, also with bootstrapping on a 1000 samples, taking the effect of children’s age into account, autistic traits were still negatively associated with guilt. Thus the relation between autistic traits and guilt could not be explained by the age. Guilt was still positively associated with ToM 1 and autistic traits negatively with ToM 2. The significance of the positive association between guilt and ToM 2 and the negative association between autistic traits and ToM 1 were no longer found when controlling for children’s age.
Table 3
Pearson’s and Partial Correlations
Guilt Autistic traits ToM 1 ToM 2 Emotion rec.
r p r p r p r p r p Age 0.264* 0.033 -0.189 0.131 0.722** 0.000 0.626** 0.000 0.791** 0.000 Guilt -0.348** 0.005 0.359** 0.003 0.334** 0.007 0.133 0.290 Autistic traits -0.314* 0.011 -0.302* 0.015 -0.386** 0.001 -0.204 0.103 ToM 1 0.252* 0.044 -0.243 0.053 0.533** 0.000 0.626** 0.000 ToM 2 0.223 0.076 -0.349** 0.005 0.150 0.236 0.466** 0.000 Emotion rec. -0.129 0.311 -0.090 0.479 0.130 0.306 -0.060 0.639
Note. Significant correlations are highlighted with asterisks representing significance levels: *p<0.05, **p<0.01
Above diagonal are Pearson’s correlation coefficients for children’s sex and age in months, guilt, autistic traits, ToM 1, ToM 2 and emotion recognition; below diagonal are partial correlation coefficients controlled for children’s age.
Mediation Models: Socio-Cognitive Abilities as Mediators in the Relation between Autistic Traits and Guilt
Mediation Regression analyses using mediation model 4 of PROCESS v3.1 (Hayes & Rockwood, 2017) with 1000 bootstrap samples were used to investigate the hypothesis that socio-cognitive abilities mediate the relation between autistic traits and guilt. For all three mediation models, see Figure 1 and all mediation regression analyses results are reported in Table 4. In all the mediation models, children’s age was used as a covariate variable. The analyses showed that autistic traits did not significantly predict ToM 1 and emotion recognition, but they were a significant predictor of ToM 2. Higher levels of autistic traits were predictive of lower levels of ToM 2. Furthermore, ToM 1, ToM 2 and emotion
recognition did not predict guilt. Children’s age seemed to positively predict socio-cognitive abilities; ToM 1, ToM 2 and emotion recognition were significantly predicted by children’s age in the way that a higher age was predictive of higher socio-cognitive abilities.
Furthermore, children’s age was only predictive of guilt in the mediation model of emotion recognition, where a higher age was predictive of higher levels of guilt proneness. The results indicated that the indirect effects were not significant for ToM 1, ToM 2 and emotion
recognition; thus, socio-cognitive skills did not mediate the effect of autistic traits on guilt. In all three mediation models, however, the direct effect from autistic traits to guilt, in the way that higher levels of autistic traits predicted lower levels of guilt, were significant. In sum, higher levels of autistic traits predicted less guilt, but not via socio-cognitive abilities.
Table 4
Regression Analyses with Guilt as Dependent Variable, Autistic Traits as Predictor, ToM 1, ToM 2 and Emotion Recognition as Mediators and Children’s Age as Covariate
Regression model Mediator β (SE) t p 95% CI Autistic traits predicting
social cognition (a)
ToM 1 ToM 2 Emotion recognition -0.05 (0.03) -0.09** (0.03) -0.02 (0.02) -1.97 -2.94 -0.71 0.053 0.005 0.479 [-0.10,0.00] [-0.14,-0.03] [-0.06,0.03] Social cognition predicting guilt (b) ToM 1 ToM 2 Emotion recognition 0.55 (0.36) 0.33 (0.33) -0.58 (0.45) 1.52 1.01 -1.31 0.134 0.319 0.194 [-0.18,1.27] [-0.33,0.99] [-1.47,0.31] Covariate age predicting
social cognition ToM 1 ToM 2 Emotion recognition 0.02** (0.00) 0.01** (0.00) 0.02** (0.00) 7.94 6.07 9.89 0.000 0.000 0.000 [0.01,0.02] [0.01,0.02] [0.01,0.02] Covariate age predicting
guilt ToM 1 ToM 2 Emotion recognition 0.00 (0.01) 0.01 (0.01) 0.02* (0.01) 0.16 0.76 2.12 0.873 0.448 0.038 [-0.01,0.02] [-0.01,0.02] [0.00,0.04] Direct effect of autistic
traits on guilt (c) ToM 1 ToM 2 Emotion recognition -0.17* (0.08) -0.17* (0.08) -0.21** (0.08) -2.19 -2.09 -2.73 0.033 0.041 0.008 [-0.32,-0.01] [-0.33,-0.01] [-0.36,-0.06] Indirect effects: Autistic
traits predicting guilt via social cognition (mediation) ToM 1 ToM 2 Emotion recognition -0.03 (0.03) -0.03 (0.03) 0.01 (0.02) [-0.08,0.02] [-0.10,0.03] [-0.02,0.05]
Total effect autistic traits on guilt
-0.20* (0.08) -2.61 0.011 [-0.35,-0.05]
Note. Significant regression coefficients are highlighted with asterisks representing significance levels: *p<0.05,
**p<0.01
Discussion
This study investigated the relation between autistic traits and guilt in young children and socio-cognitive abilities as mediators of this relation. We found that higher levels of autistic traits were related to less displays of guilt. Also, when controlled for children’s age
this relation was still significant. Furthermore, higher levels of autistic traits were related to lower levels of ToM 1 and ToM 2. When controlled for children’s age, only the relation between autistic traits and ToM 2 was still significant, although the correlation between autistic traits and ToM 1 was a trend toward significance. So, children with higher levels of autistic traits showed greater impairments in first order belief and false belief understanding, even when accounting for age. There seemed to be a relation between socio-cognitive abilities and guilt as well. Higher levels of ToM 1 and ToM 2 were related to higher levels of guilt. An important note to these results is that age was highly related to socio-cognitive abilities and guilt and when age was taken into account, ToM 2 was no longer, although close to,
significantly related to guilt. Emotion recognition seemed unrelated to both autistic traits and guilt proneness. Also no mediating effect of socio-cognitive abilities on the relation between autistic traits and guilt was found.
The relation between autistic traits and guilt proneness is consistent with findings in previous studies; children diagnosed with ASD are assumed to show less proneness to guilt than typically developing children (Davidson et al., 2018; Muris et al., 2016). Similar results were found for levels of autistic traits and proneness to guilt in adults (Davidson et al., 2017). These results are noteworthy, since guilt is an important emotion to display in social situations and findings in the present and previous studies suggest that the deficits in guilt proneness in individuals with high levels of autistic traits are already present in toddlerhood and persist until adulthood. Furthermore, previous studies already suggested lower proneness to guilt in children diagnosed with ASD and in adults with higher levels of autistic traits, now there is also evidence suggesting lower levels of guilt in children with higher levels of autistic traits but with no ASD diagnosis. Moreover, in the present study, contrary to previous studies, objective observations of guilt expressions were used, which may be more representative of guilt proneness in children with higher levels of autistic traits then self-reported guilt proneness, since children with autism tend to have complications in recognizing, describing and distinguishing emotions (Cook et al., 2013).
It has been stated in numerous previous studies that children with higher levels of autistic traits experience impairments in socio-cognitive abilities (Baron-Cohen et al., 1985; Buitelaar et al., 1999; Burnside et al., 2017; Harms et al., 2010; Heerey et al., 2003; Mazza et al., 2017; Misailidi, 2018; Muris & Meesters, 2014; Schaller & Rauh, 2017; Senju, 2013). Lower levels of ToM 2 in children with higher levels of autistic traits were therefore expected. For children with high levels of autistic traits, development of ToM in terms of understanding beliefs could be impaired or delayed. But since pretense and emotion
recognition are early precursors of social cognition, these are the ones that develop earliest in life (Mazza et al., 2017). Therefore, even children with high levels of autistic traits, may have been able to catch up on these skills, causing little differences in ToM 1 and emotion
recognition for different levels of autistic traits. The development of first order belief and false belief are the next step in developing socio-cognitive skills and might therefore be less developed in children with higher levels of autistic traits.
In the current study, no relation was found between emotion recognition and autistic traits, as well as between emotion recognition and guilt proneness. The lack of relations with emotion recognition in the present study could be explained by findings of Heerey et al. (2003). They found that children with autism only experience difficulties in the recognition of self-conscious emotions but not in the basic emotions (happy, angry, sad and scared).
According to Schaller and Rauh (2017), this could be the result of learning compensatory strategies, causing the ability for children with autism to camouflage their deficits in emotion recognition by learning the expressions of the basic emotions, since they are less complicated than of self-conscious emotions. In the present study the basic emotions were used for the emotion recognition task, which could have led to the fact that no relations between autistic traits and emotion recognition were found. Another possible explanation may be that deficits in emotion recognition are not predicted by higher levels of autistic traits in general, but more specifically by higher levels of trait alexithymia, which is characterized by complications in recognizing, describing and distinguishing emotions (Cook et al., 2013).
The relation between socio-cognitive abilities and guilt was consistent with expectations based on previous studies. The positive relation between guilt and
socio-cognitive abilities may be explained by the great need for perspective taking, which demands socio-cognitive abilities, to experience feelings of guilt (Jankowski & Takahashi, 2014). Also, for experiencing guilt, the development of socio-cognitive abilities are of crucial importance, for example mentalizing skills and the understanding of social rules and norms are necessary for experiencing guilt (Davidson et al., 2017).
In previous literature it has been assumed that levels of autistic traits are related to the expression of guilt through deficits in social cognition. As social cognition is often impaired in children with higher levels of autistic traits (Baron-Cohen et al., 1985; Buitelaar et al., 1999; Burnside et al., 2017; Harms et al., 2010; Heerey et al., 2003; Mazza et al., 2017; Misailidi, 2018; Muris & Meesters, 2014; Schaller & Rauh, 2017; Senju, 2013), and impaired social cognition is related to less proneness to guilt (Davidson et al., 2018; Heerey et al., 2003; Misailidi, 2018; Muris & Meesters, 2014; Muris et al., 2016), deficits in social
cognition may cause lower levels of guilt in children with higher levels of autistic traits. But in the present study, no mediating effect of socio-cognitive abilities on the relation between autistic traits and guilt was found. This could be due to the limited sample size in the present study causing not enough power to establish the mediating effect. Also, autistic traits could be related to guilt through other mechanisms than socio-cognitive abilities. For example, it has been stated that deficits in empathic perspective taking in individuals with high levels of autistic traits, may be a mechanism causing the lack of proneness to guilt (Misailidi, 2018; Smith, 2009). Furthermore, eye contact may be a possible mechanism causing less proneness to guilt in individuals with autism. Individuals with autism tend to be less fixated on the eyes during interactions than neurotypical individuals (Baron-Cohen, Campbell, Karmiloff-Smith, Grant, & Walker, 1995; Madipakkam, Rothkirch, Dziobek, & Sterzer, 2017) and eye contact during interactions is found to elicit more experience of guilt than for example looking towards someone’s nose (Yu, Duan, & Zhou, 2017). These possible mechanisms causing less proneness to guilt in children with higher levels of autistic traits might be relevant directions for future research.
When looking at the influence of children’s age on the investigated relations, many of the significant relations did not seem to hold after accounting for the effect of age. Age was highly related to social cognition and guilt; older children showed more guilt-related
behaviors and had higher levels of social cognition. Thus, age may explain many of the relations found in this study. This might be because of the big differences in development between two- and five-year-olds. During this period, both socio-cognitive skills (Derksen et al., 2018; Fizke et al., 2017; Grosse Wiesmann et al., 2017; Happé & Frith, 2014; Kulke et al., 2018; Mazza et al., 2017; Oktay-Gür et al., 2018; Poulin-Dubois & Yott, 2017; Sirois & Jackson, 2007) and guilt-related behaviors (Barrett et al., 1993; Cole et al., 1992; Lewis, 20007; Muris & Meesters, 2014; Shaffer, 2005) are assumed to increase. Also, autistic traits show an increase with age (Mandell, Novak, & Zubritsky, 2005). Thus, the relation between some of them might be found because they all actually increase with age. This study was first in showing that when age is taken into account, autistic traits are still related to guilt as well as to ToM 2, and also ToM 1 is still related to guilt. However, age can explain the relation
between autistic traits and ToM 1, and between ToM 2 and guilt.
The present study has some limitations that should be taken into account when interpreting the results. First of all, the sample size of this study was small and although bootstrapping with 1000 samples was used, this could still have been causing less power to the analyses, resulting in not detecting some results. Also, children and parents in the current
sample mostly had a Dutch ethnicity and parents were relatively high educated, which makes the results found in the present study hard to generalize to other populations. Furthermore, it has been stated that children younger than four years already possess an implicit form of false belief, but it cannot be measured with the standard false belief task due to limitations in processing demands, such as less developed syntactic abilities and executive functions (Grosse Wiesmann et al., 2017; Oktay-Gür et al., 2018; Setoh et al., 2016). Nevertheless, in the present study a standard form of the false-belief task was used to measure ToM 2, which might not capture some of the younger children’s socio-cognitive abilities.
All things considered, higher levels of autistic traits were related to showing less guilt, and socio-cognitive abilities were not mediating this effect. The results of this study offer important information for future research, as a relation between guilt proneness and levels of autistic traits was found, and guilt facilitates us in our social interactions by decreasing our desire to harm others and to restore harm when done (Davidson et al., 2018). Therefore, it may be important for future studies to assess how less expression of guilt influences social interactions and social relationships in children with high levels of autistic traits. To adjust interventions focused on improving social interactions in children with autism, more research on the mechanism causing the deficits in self-conscious emotions is needed.
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