Difficulties recognising emotions: Initial insights into similarities and treatment for people with Autism Spectrum Disorder and Traumatic Brain Injury.
27th June 2023
Written by Caitlin Thompson, Assistant Psychologist.
Autism spectrum disorder (ASD) and acquired brain injury (ABI) are two distinct conditions that affect individuals cognitive, social and emotional functioning in unique ways. However, a closer look reveals surprising (or to some clinicians, unsurprising) similarities in cognitive functioning. Exploring the common deficit of facial affect recognition in both of these conditions can provide some helpful insights into ASD treatment methods that may benefit ABI individuals.
Facial affect recognition or emotion recognition is the ability to ‘read’ and interpret non-verbal emotional facial expressions, which is a large part of how we communicate. However, the ability to recognise these non-verbal cues is significantly impacted by both traumatic brain injuries and autism spectrum disorders, this is because changes to the brain increase cognitive difficulties. Impairments in emotion recognition limits the ability to interpret and understand how others are feeling, undoubtedly affecting individuals’ aptitude to maintain and form new relationships, which in turn can potentially increase feelings of isolation and depression.
An acquired brain injury is defined as any type of injury or damage to the brain that occurs after birth, including traumatic brain injuries, stroke and diseases that affect the brain. The symptoms of an acquired brain injury can be wide-ranging and depend on the mechanism, location, and severity of the injury. Severe symptoms can include changes in cognition, behaviour, communication, and social functioning which can have adverse effects on the individual, their support system, and the economy. Impairments in emotion recognition can be particularly prominent after an ABI and therefore, perhaps unsurprisingly, individuals who have experienced brain injury are impacted by these deficits as areas of the brain involved in emotional processing are vulnerable. These areas include the prefrontal, temporal and parietal lobes, the amygdala and other structures and connections to and within the limbic system. Some researchers and clinicians have concluded the complexity of these areas working together indicates there is not one singular area of the brain that is involved in emotion recognition, rather emotion is ‘comprised of intricate neuroanatomical circuitry’, where different areas work together (1).
Autism spectrum disorder has been used since 2013 as an ‘umbrella’ term for several disorders such as autistic syndrome, Asperger’s disorder, and pervasive developmental disorder (2). In this blog, the term ASD is used to refer to autistic syndrome, which is a neurodevelopmental disorder characterised by deficits in social interaction, communication, repetitive behaviours, and limited interests (3). The cause of ASD is unknown but most research supports genetic and environmental causal factors (4). Similar to ABI, one common characteristic of ASD is a deficit in emotion recognition, an aspect of social cognition which is often evident developmentally. The ability to recognise emotions is thus an obstacle to the effective development of social competence in both ASD and ABI patients.
Researchers have investigated autistic individuals and brain injured patients’ ability to recognise different facial emotions, many of which suggest both groups of individuals experience more difficulty identifying negative emotions such as fear and disgust, compared to identifying happiness and surprise. Metanalyses found that individuals with ASD had significant difficulty recognising all basic emotions except happiness, yet other studies have found impairments in recognising happiness, anger, fear, and surprised expressions but not sad or disgusted expressions (5). Therefore, differing patterns of facial affect recognition in ASD appears to be likely. Similarly, participants with a traumatic brain injury were found to experience more difficulty accurately identifying fear and anger, followed by disgust, neutrality and sadness but less difficulty when identifying happiness and surprise (6).
More recently there has been an emphasis in the literature on understanding social interactions between ‘neurotypical’ and autistic individuals, focusing on the differences in interaction abilities. For example, when an autistic person is feeling sad, they may not make facial expressions such as a downturned mouth, that most neurotypical people would express. Therefore, neurotypical people may not recognise the expression because it is different from the norm and what they would anticipate from another neurotypical person, implying that neurotypical and autistic faces are essentially “speaking a different language” (7). If this is indeed the case, caregivers and clinicians could be trained to ‘read’ typical autistic facial expressions, treating it as a different non-verbal communicative style rather than a ‘deficit’, and in turn, potentially reducing social-communication difficulties.
As autism syndrome and acquired brain injuries such as traumatic brain injuries often share deficits in facial affect recognition, the interventions used for one may also benefit the other. However, there has been more research in the development of treatment programmes for affect recognition in ASD. Such programmes aim to teach people with autism and social perception difficulties to recognise emotions to improve social skills. Therapies such as applied behavioural therapy, cognitive behavioural therapy and insight-oriented therapy focus on minimising the impact of autism symptoms and can also be applied to ABI patients to improve their social and emotional skills.
It is worth noting that careful consideration should be made when applying treatment and training methods to ABI individuals as it should follow adequate assessment, be tailored to the person’s level of functioning, and address other related difficulties. However, supporting improvements in emotional recognition following ABI may be an important step towards improving the social outcomes of people with a brain injury.
References:
- Radice-Neumann, D., Zupan, B., Babbage, D. R., & Willer, B. (2007). Overview of impaired facial affect recognition in persons with traumatic brain injury. Brain injury, 21(8), 807-816.
- Garcia-Garcia, J. M., Penichet, V. M., Lozano, M. D., & Fernando, A. (2022). Using emotion recognition technologies to teach children with autism spectrum disorder how to identify and express emotions. Universal Access in the Information Society, 21(4), 809-825.
- American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub, Washington, DC (2013)
- Happé, F., Ronald, A., & Plomin, R. (2006). Time to give up on a single explanation for autism. Nature neuroscience, 9(10), 1218-1220.
- Yeung, M. K. (2022). A systematic review and meta-analysis of facial emotion recognition in autism spectrum disorder: The specificity of deficits and the role of task characteristics. Neuroscience & Biobehavioral Reviews, 133, 104518.
- Murphy, J. M., Bennett, J. M., de la Piedad Garcia, X., & Willis, M. L. (2022). Emotion recognition and traumatic brain injury: A systematic review and meta-analysis. Neuropsychology review, 32(3), 520-536.
- Keating, C. T., & Cook, J. L. (2020). Facial expression production and recognition in autism spectrum disorders: A shifting landscape. Child and Adolescent Psychiatric Clinics, 29(3), 557-571.
Image sourced from: https://kids.frontiersin.org/articles/10.3389/frym.2016.00015