Emotion Regulation, Social Cognition and Social Adjustment ...€¦ · states, emotion-related...

In: Autism Spectrum Disorders ISBN: 978-1-62081-786-5

Editors: Chaz E. Richardson and Reece A. Wood © 2012 Nova Science Publishers, Inc.

Chapter I

Emotion Regulation, Social Cognition and Social Adjustment: Specificities

in Children with Autism

Spectrum Disorder

Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone Catholic University of Louvain, Belgium

1. Introduction

Several theories and hypotheses have been developed about specificities of emotional

regulation and social cognition, including the Theory of Mind (ToM), in children and

adolescents with autism spectrum disorders (ASD). These give some explanation of their

deficits in social adjustment. Recent empirical studies have tested this set of hypotheses. This

chapter will summarize briefly how emotional regulation and theory of mind develop in

typically developing preschoolers (TD), and will focus on how these processes are

compromised in ASD children and adolescents presenting an intellectual disability. The links

between these processes and their impact on social maladjustment will be also explored.

Some behavior disorders in ASD children and adolescents could be better understood through

their deficits in emotional regulation or in social cognition.

2. Emotional Regulation

2.1. Emotional Regulation: Definition and Strategies

Emotional regulation corresponds to a set of processes by which an individual assesses,

controls and modifies his/her spontaneous emotional responses, by using various strategies, in

order to accomplish his/her goals or in order to express socially adequate emotional behavior

in social relationships (Eisenberg & Fabes, 1992; Eisenberg, Fabes, Guthrie & Reiser, 2000;

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Nathalie Nader-Grosbois, Céline Baurain, and Stéphanie Mazzone 2

Eisenberg, Hofer & Vaughan, 2007; Eisenberg, Zhou, Liew, Pidada & Champion, 2006;

Gross & Thompson, 2007; Thompson, 1994, 2011). Eisenberg and Spinrad (2004, p. 338)

defined “emotion-related self-regulation as the process of initiating, avoiding, inhibiting,

maintaining, or modulating the occurrence, form, intensity, or duration of internal feeling

states, emotion-related physiological, attentional processes, motivational states, and/or the

behavioral concomitants of emotion in the service of accomplishing affect-related biological

or social adaptation or achieving individual goals”. This definition distinguishes between the

regulation of emotion and by emotion; it includes both the modulation of “emotion-related

behaviour” and the regulation of internal states, including sensations, physiological,

perceptive and cognitive processes.

2.2. Development of Emotional Regulation in TD Preschoolers and Impact on Social Abilities

From the age of two or three years to six years, the development of symbolism,

representations and language and the beginning of autonomy help children to acquire self-

regulated, anticipated and proactive strategies of emotion regulation that can be observed

throughout their socio-emotional behaviors (Holodynski & Friedlmeier, 2006; Kalpidou,

Power, Cherry & Gottfried, 2004; Macklem, 2008; Perron & Gosselin, 2009). This

corresponds to a developmental phase designated by an “intra-personal level of regulation”

or “symbolically mediated strategies of regulation” (Holodinsky & Friedlmeier, 2006, p. 8),

sustained by self-awareness and self-other differentiation (Cicchetti, Ganiban & Barnett,

1991).

Preschoolers develop awareness of their own emotions and those of others and they learn

to control the expression of their emotions (Holodinsky & Friedlmeier, 2006; Macklem,

2008), and to modify the intensity of emotional expression according to the situation and the

social rules (Blurton-Jones, 1967; Cole, Dennis, Smith-Simon & Cohen, 2008; Baurain &

Nader-Grosbois, 2011; Saarni, 1999), for the benefit of their social interactions with peers and

adults (Macklem, 2008; Perron & Gosselin, 2004, 2009).

Preschoolers intentionally control their emotional expression in order to avoid hurting

others’ sensibilities, to protect their own feelings (Saarni, 1999) or to induce a false belief in

their partner (Perron & Gosselin, 2004).

They share positive emotions in diversified social contexts and they become able to

express complex emotions such as shame, embarrassment and pride (Cole, 1986; Joseph,

1994; Saarni, 1999; Snow, Hertzig & Shapiro, 1987); this evolves depending on their

understanding of their own mental states. In addition, they are able to express “social

emotions” such as empathy towards others in distress (Lewis Sullivan, Stanger & Weiss,

1989).

At preschool age, children can express their emotional states verbally and they are able to

inhibit a behavior by means of language (Holodinsky & Friedlmeier, 2006, p.142), because

language has an impact on their own actions and verbal instructions incite them to regulate

their emotions and behavior.

Although children develop skills in expressing their emotions, the imperatives of social

life imply that they learn to dissimulate, control their own emotional states and regulate their

expressive behavior in particular contexts; children begin to distinguish between real and

Emotion Regulation, Social Cognition and Social Adjustment 3

apparent emotions at three to four years old (Banerjee, 1997; Gosselin, 2005; Harris, Johnson,

Hutton, Andrews & Cooke, 1989; Perron & Gosselin, 2004; Sissons Joshi & McLean, 1994;

Zeman, Cassano, Perry-Parrish & Stegall, 2006). For example, three- to four-year-old

children hid their disappointment by a smile even if they have received an unwanted gift

(Cole, 1986; Joseph, 1994). The dissimulation of emotions develops particularly from six to

ten years old.

In empirical studies, emotion regulation in preschoolers is assessed by other-reported

questionnaires completed by familiar adults1 or is observed and analyzed during behaviors

displayed in situations that often elicit negative emotions, such as:

persistence in challenges (Goldsmith & Rothbart, 1996);

management or tolerance of frustration, of disappointment (Cole et al., 2008; Dennis,

2006; Dennis & Kelemen, 2009; Eisenberg et al., 2001; Feng, Shaw, Kovacs, Lane,

O’Rourke & Alarcon, 2008; Hill, Degman, Calkins & Keane, 2006; Kalpidou et al.,

2004);

modulation of non-verbal and verbal emotional expression, of its intensity,

adaptation of emotion according to the situation, or the use of strategies of emotion

regulation, and their variability according to the persons involved (peers or adults), in

social interactions in cooperative or competitive play situations (Baurain & Nader-

Grosbois, 2011; Campos, Walle, Dahl & Main, 2011; Galyer & Evans, 2001;

Gulsrud, Jahromi & Kasari, 2010; Herbé, Tremblay & Mallet, 2007; Hubbard, 2001;

Hughes, White, Sharpen & Dunn, 2000; Mirabile, Scaramella, Sohr-Preston &

Robison, 2009; Thompson, 2011);

self-control and effortful control, sustained by inhibition or activation of behavior

(Derryberry & Rothbart, 1988; Rothbart & Bates, 1998; Eisenberg, Fabes, Murphy,

Karbon, Smith & Maszk, 1996b, Eisenberg et al., 1997a-b, 2001; Spinrad et al.,

2009);

By the end of the preschool period, when children feel negative emotions, they use

diverse anticipated strategies of emotion regulation: regulating the expression of emotions,

comforting themselves, self-distracting by redirecting their attention away from whatever is

causing them stress or engaging in some other activity, managing their frustration, inhibiting

emotional behaviors which are socially inappropriate, postponing or waiting, approaching or

withdrawing from situations, staying organized when they face powerful emotional events, or

negotiating with others (Denham et al., 2003; Dennis & Kelemen, 2009; Kalpidou et al.,

2004; Macklem, 2008; Scharfe, 2000; Stansbury & Sigman, 2000).

The development of emotion regulation has a potential role in social interactions between

preschoolers and in the evolution of their social competence (Cole, Martin & Dennis, 2004;

Dennis, 2006; Dennis & Kelemen, 2009; Dennis, Malone & Chen, 2009; Eisenberg, Fabes,

Murphy, Maszk, Smith & Karbon, 1995; Eisenberg et al., 1997a-b, 2006; Eisenberg &

Spinrad, 2004; Fabes et al., 1999; Rieder, Perrez, Reicherts & Horn, 2007; Spinrad et al.,

2006). In other words, children’s abilities to regulate and control their emotional and

1 Such as the Emotion Regulation Checklist (ERC, Shields & Cicchetti, 1997), the Emotional Regulation Rating

Scale (ERRS, Carlson & Wang, 2007) or the Emotion Regulation Subscale of the Social Competence Scale

(Conduct Problems Prevention Research Group, 1999).


behavioral responses could help them to have good interactions with peers, and could

contribute to social adjustment, including in school (Eisenberg et al., 1995, 1997a-b; Fabes et

al., 1999). Moreover, social interactions with peers offer them opportunities to exercise their

emotional regulation; emotional and behavioral responses from peers provide them feedback

on their own abilities (Bronson, 2000; Dunn, 1996; Parker & Asher, 1987). Depending on

interactive contexts, emotional regulation in preschoolers varies as the situation requires.

During cooperative play between peers, children display exchanges, express joy easily and

engage with their partner (Herbé et al., 2007; Nader-Grosbois, 2011a).

Emotion regulation includes intra-individual processes related to cognitive and control

processes (Dumas & Lebeau, 1998; Harris et al., 1989; Stein, Trabasso & Liwag, 1993) and

inter-individual social processes (Campos, Campos & Barret, 1989; Eisenberg & Fabes,

1992; Eisenberg et al., 1997a-b, 2000; Walden & Smith, 1997), both of which play a basic

role in the stable development of social competence at preschool and school age (Sallquist et

al., 2009).

2.3. Specificities of Emotional Regulation and Impact on Social Abilities in ASD Children

Trevarthen (1989) suggests that autism is due to an early basic deficit in the production of

emotions and of emotion regulation in reaction to environmental stimulations. He

hypothesizes a biological origin for this impairment: a dysfunction of central regulator

systems.

Moreover, where emotional expression in ASD children is either inadequate or

unexpectedly excessive, such expression does not play its usual role of regulator, as a means

of seeking, producing, maintaining, inhibiting, and interrupting behaviors with respect to

others or to objects (Tanguay, 1987).

Poor emotional regulation is frequently associated with autistic profiles (Southam-Gerow

& Kendall, 2002; Tardif, Lainé, Rodriguez & Gepner, 2007; Vermeulen, 2009; Whitman,

2004). Several studies have emphasized a deficit in expression, in modulation, in internal and

external regulation of emotions (Tardif et al., 2007). Such children are easily stressed,

anxious and fearful. They have difficulty in self-regulating their emotions when their feelings

become excessive.

How do such children develop their emotional expression and emotion regulation?

Some studies have reported similarities between ASD and other children in this respect;

however, other studies have identified specific deficits in ASD children, in comparison with

TD children and/or children with intellectual disabilities (ID).

ASD infants show similar expressions of emotions, but they are less attentive to faces and

their affective behavior is less oriented towards others, than is the case with TD or ID infants

matched for IQ or mental age (Baranek, 1999; Maestro et al., 2002, 2005; Osterling, Dawson

& Munson, 2002; Palomo, Belinchon & Ozonoff, 2006; Werner, Dawson, Osterling & Dinno,

2000). Although ASD children are sensitive to emotional cues emitted by others, such as

distress (Nadel et al., 2000; Sigman, Kasari, Kwon & Yirmiya, 1992), they do not easily

express their own emotions appropriately (Brun, Nadel & Mattlinger, 1998; Loveland,

Tunali-kotoski, Pearson, Brelsford, Ortegon & Chen, 1994; Snow et al., 1987; Yirmiya,

Sigman, Kasari & Mundy, 1992).


ASD preschoolers, compared with MA-matched children, display similar emotional

expressiveness in social interactions or when they are watching video sequences illustrating

others’ emotional expressions (Capps Kasari, Yirmiya & Sigman, 1993). Although ASD

children express a similar quantity of positive and negative emotions to TD children, their

facial movements often incongruously express more than one emotion (for example, joy and

sadness) (Yirmiya, Kasari, Sigman & Mundy, 1989).

By contrast, other authors have reported fewer expressions of positive emotions and

poorer emotional expressiveness in young ASD children than in TD and ID children (Kasari

& Sigman, 1996; Loveland et al., 1994; Snow et al., 1987).

During social exchanges, ASD preschoolers barely modify their emotional reactions in

response to others (Konstantareas & Stewart, 2006), they show poor emotional coordination

and timing of affect (Scambler, Hepburn, Rutherford, Wehner & Rogers, 2007) and they

rarely initiate shared attention with others (Mundy, Sigman & Kasari, 1990; Travis, Sigman

& Ruskin, 2001; Warreyn, Roeyers & De Groote, 2005). Because of the cognitive

specificities in the way they interpret their own emotional experiences and those felt by

others, ASD children are unlikely to convey their emotions conventionally, according to

Saarni (1999).

Compared with TD or ID children, ASD children at school age share their emotional

expressions with others in social interactions less spontaneously (Attwood, Frith & Hermelin,

1988; Bieberich & Morgan, 2004; Snow et al., 1987), notably in unstructured situations in

which the caregiver does not initiate the interaction (Kasari, Sigman & Yirmiya, 1993b).

They combine emotional expression and eye contact less in response to their caregiver’s

expressions than control groups (Dawson, Spencer, Galpert & Watson, 1990). They have

neutral, flat or idiosyncratic expressions more frequently than MA controls (Czapinski &

Bryson, 2003; Hobson & Lee, 1998; Kasari, Sigman, Mundy & Yirmiya, 1990; Loveland et

al., 1994; Yirmiya et al., 1989). For example, these children display less attention and fewer

smiles than children with Down syndrome when other children are laughing in play situations

(Reddy, Williams & Vaughan, 2002). They also display happy expressions in solitary or

unpleasant situations more often than in social situations (Whitman, 2004). At school age,

they are less likely to respond with comforting or empathic behaviors to others’ emotional

expressions; they do not easily share their emotional states with a partner (Bacon, Fein,

Morris, Waterhouse & Allen, 1998; Corona, Dissanayake, Arbelle, Wellington & Sigman,

1998; Dawson, Webb, Carver, Panagiotides & McPartland, 2004; Kasari et al., 1990; Sigman

et al., 1992). This weak responsiveness to others’ emotions remains stable over a five-year

period (Dissanayake, Sigman & Kasari, 1996). In order to decrease this lack of empathy,

specific training helps them to show empathic responses in social scenarios (Argott,

Buffington Townsend, Sturmey & Poulson, 2008; Charman, Swettenham, Baron-Cohen, Cox,

Baird & Drew, 1997, 1998; Dyck, Ferguson & Shochet, 2001; Gena, Krantz, McClannahan &

Poulson, 1996; Hudry & Slaughter, 2009; Sigman et al., 1992; Travis et al., 2001; Yirmiya et

al., 1992). However, empathic behavior may vary according to the individual (McGovern &

Sigman, 2005) and according to specific emotional context, or familiarity with people (Hudry

& Slaughter, 2009). In addition, complex emotions, such as embarrassment, pride and guilt

are not experienced in the same way by ASD individuals as by TD people (Grandin, 1995).

According to Begeer, Koot, Rieffe, Meerum Terwogt and Stegge (2008), ASD children

differ in the inter- and intra-personal integration of their emotions. However, they specify that

“empirical evidence found for the influence of age, intelligence and context factors on the


level of emotional expressiveness in ASD children and adolescents refines the marked

impairments of emotional expressive behavior that are suggested in the diagnostic manuals”

(Begeer et al., 2008, p.346).

Some authors postulate that impaired emotion regulation could explain a set of ASD

children’s inabilities in their social interactions (Gulsrud, Jahromi & Kasari, 2010;

Konstantareas & Stewart, 2006). According to Geller (2005)2, ASD children face additional

challenges in the development of their emotion regulation, because they have sensory and

processing differences, they experience fewer opportunities to engage in social interactions

day-to-day, and often have negative experiences from continual teasing or rejection that could

alter their emotional equilibrium. ASD individuals use internal effort to suppress negative

emotions in order to appear more socially acceptable or because they fear losing control. In

ASD individuals, the feeling of friendlessness, pain, anxiety, and stress due to being avoided

by others and increasing social isolation impede the development of emotional regulation and

hinder socially privileged relationships.

2.4. Specificities of Co-Regulation between ASD Children and Their Parents

Environmental conditions, including parents’ strategies of social regulation or of

socialization of emotions3 toward their ASD children could help support their emotion

regulation, or conversely could lead to emotional dysregulation. As ASD children display

maladaptive behaviors that predict maternal stress (Tomanik, Harris & Hawkins, 2004), this

could interfere with the maternal support of emotion regulation in their children (Belsky,

1984). As their mothers do not easily interpret and react to the ambiguous emotional signals

expressed by their ASD children, they may offer less support for new skills, including

regulatory skills (Stansbury & Zimmermann, 1999). Improving maternal or parental

strategies, by means of specific intervention focused on joint attention and engagement, can

contribute to improved emotion regulation in ASD children and co-regulation of emotions

between the two partners (Gulsrud et al., 2010)4 and facilitate the parents’ understanding of

2 http://aspergercenter.com/articles/Emotional-Regulation-and-Autism-Spectrum.pdf (Geller, 2005).

3 We refer here to the “Heuristic model of the socialization of emotion” (Eisenberg, Spinrad & Cumberland, 1998)

or the “Tripartite model of the impact of the family on children’s emotion regulation and adjustment” (Morris,

Silk, Steinberg, Myers & Robinson, 2007). 4 In the study by Gulsrud et al. (2010), mother-child dyads attended twenty-four ten-minute sessions, organized in

ten modules, targeting early joint attention, language and joint engagement with the mother, three days a week

for eight weeks. The children’s behaviour was coded in the following categories: “negativity” in facial and

body expressions; regulation strategies including symbolic self-soothing, physical self-soothing, repetitive or

idiosyncratic behaviours, tension release, avoidance, distraction, maternal orientation, other-directed comfort

seeking and other-directed assistance seeking. Maternal regulation strategies were coded in the following

categories: prompting/helping, following the child’s lead, redirection of attention, active ignoring, reassurance,

emotional following, physical comfort, vocal comfort. Behavioural strategy combinations were applied to

classify the two partners’ regulatory behaviours as follows: (a) maternal vocal strategies consisting of a

combination of maternal vocal comfort and reassurance; (b) maternal active strategies consisting of a

combination of prompting/helping, redirection of attention and physical comfort; (c) children’s comfort

strategies consisting of physical self-comfort and comfort-seeking; (d) children’s physical strategies consisting

of tension release, avoidance, and distraction; and (e) children’s verbal strategies consisting of cognitive/verbal

self-soothing and assistance seeking. The results showed variability in the intensity of negative expressions

and in the number of distress episodes in ASD toddlers, but almost all ASD toddlers showed more frequent

negative arousal during play interactions with their mothers (interpreted as profiles of dysregulation).

However, these children engaged in a range of emotion regulation strategies, characterized as appropriate

http://aspergercenter.com/articles/Emotional-Regulation-and-Autism-Spectrum.pdf


their children during emotional events (Aldred, Green & Adams, 2004; Drew et al., 2002).

Empirical studies have emphasized the importance of assessing and training co-regulation

between ASD children and those around them.

3. Theory of Mind

3.1. Theory of Mind: Definition and Components

Theory of Mind (ToM) refers to abilities to understand others’ mental states, perceptive

states (visual perception, attention), volitional and motivational states (desire, intention),

epistemic states (beliefs and false beliefs), pretences, thinking and emotions (Emery, 2005;

Flavell, 1999; Wellman, 1990, 1991). ToM constitutes both a corpus of knowledge about the

human mind and abilities to infer mental states in other people through behavior and

multimodal expressions in social situations (Abbeduto & Murphy, 2004; Wellman, 1990,

2000). ToM is considered as “perspective-taking” or as a component of “social cognition”.

Taking other people’s perspective and identifying their mental states help with the

development of empathy towards others increase harmonious social interactions between

individuals and potentially contribute to social adjustment (Deneault & Morin, 2007; Nader-

Grosbois, 2011a).

3.2. Development of Theory of Mind in TD Children

3.2.1. Conceptions of Theory of Mind Several conceptions have been developed in order to explain ToM development.

The “theory theory approach” (Wellman, 1990), inspired by Piagetian constructivism,

postulates the progressive construction of successive theories adjusted by the child according

to information from diverse social contexts.

The “simulation theory” (Gordon, 1992; Harris, 2000, 2005) postulates an empirical

understanding by the child who experiences mental states in several situations; according to

what he or she feels, thinks or believes, he or she attributes to others similar mental states in

analogous situations.

A “modular approach” was conceived by Baron-Cohen and his colleagues, as an innate

conception of ToM acquisition. At birth, the children have specialized modules of

information processing at their disposal; in the course of neurological maturation they become

active strategies (distraction, avoidance and tension release) and constructive strategies (orienting to mum and

seeking assistance). Like TD toddlers, they requested maternal support and assistance, but they made less

frequent use of sophisticated verbal strategies such as symbolic/verbal self-soothing. Emotion regulation

strategies were used significantly more by ASD toddlers during episodes of negativity than non-negativity.

When their ASD child was in distress, the mothers engaged in active strategies (redirection, prompting, and

physical behaviours) or vocal comforting strategies (vocal soothing and reassurance). Some characteristics in

the ASD child and the mother were associated with emotion regulation outcomes. When the mothers

interacted with their toddlers with behaviour problems, they were more stressed and they used more active

strategies and fewer vocal strategies. These mothers’ ability to redirect attention away from a source of distress

for their children and reengage them in an ongoing play activity is an important regulatory strategy. This study

provides evidence for the effectiveness of an early mother-driven social-communication intervention in

supporting emotion regulation abilities in ASD children.


progressively able to understand the human world (Baron-Cohen, Leslie & Frith, 1985;

Baron-Cohen, 1991a-b-c, 1995; Deneault & Morin, 2007; Leslie, 2000). Four innate

mechanisms make “mindreading” possible: the “Intentionality Detector” (ID), the “Eye

Direction Detector” (EDD), the “Shared Attention Mechanism” (SAM) and the “Theory of

Mind Mechanism” (ToMM). The “ID” corresponds to a perceptual mechanism that interprets

“primitive volitional”, basic mental states (such as goal and desire) required to make sense of

movements of organisms in the environment. The “EDD” has three functions: the detection of

the presence of eye-like stimuli; the evaluation of whether eyes are oriented towards the

subject or in another direction; and the interpretation of a person’s gaze as “seeing” by

inferring from the observation that the person’s eyes are directed at something else that he or

she actually sees something. This last function helps the mind-reading process because it

allows the infant to attribute a specific perceptual state to the person. The “ID” and the

“EDD” allow the infant to interpret behavior in terms of certain mental states and to interpret

behavior on a dyadic level (between the agent and the infant, between the agent and the object

he sees). The “SAM” is a more complex skill that allows the child to conceptualize “triadic

representations”, establishing relations between an agent, the self, and an object or another

agent. The child is able to perceive the perceptual state of another agent and to compute

shared attention, by comparing that agent’s perceptual state with the self’s current perceptual

state. The “ToMM” makes it possible to infer all mental states (believing, feeling, knowing,

deceiving, imagining, dreaming, etc.) from the observation of behavior, and to elaborate an

understanding of how people’s mental states are linked with their actions and relate to each

other.

“Executive function/ToM” theories focus on interdependent links between these

processes, particularly in the case of links between executive functioning and ToM beliefs

(Carlson & Moses, 2001; Hughes, Adlam, Happé, Jackson, Taylor & Caspi, 2000; Kloo &

Perner, 2003). A certain level of ToM is needed to attain a certain degree of executive control

(including inhibition) and executive functioning is needed to master a certain level of ToM.

The “socio-constructivist Vygotskian approach” is centered on inter-individual social

processes in ToM development. The child elaborates a ToM, by means of repeated social

interactions, of sharing of social knowledge and explanations about mental states, and of

language used in social exchanges, with members of his or her culture (Astington, 1996;

Deneault & Morin, 2007; Dunn, 1995; Symons, 2004). If social interactions give

opportunities to evoke mental states, the child should easily develop ToM abilities.

In addition, two levels of ToM ability are distinguished in the literature (Baron-Cohen,

1995): the first-order level refers to inferring the thoughts of another person; the second-order

level refers to the children’s reasoning about what another person thinks about the thoughts of

a third person.

3.2.2. Development of Theory of Mind Related to Emotions in TD Children With specific reference to the ToM “emotions”, we can distinguish between the

understanding of causes of emotions (or prediction of emotions depending on the situation)

and the understanding of consequences of emotions (or prediction of appropriate behavior

depending on the felt emotions), concerning the four primary emotions (joy, sadness, anger

and fear) (Nader-Grosbois, 2011a; Nader-Grosbois & Thirion-Marissiaux, 2011).

In the first two years, some signs of understanding emotions emerge. Nine-month-old

infants relate other people’s emotional expressions and actions (Barna & Legerstee, 2005). At


around 18 months, they become able to connect emotions and desires (Lagattuta, 2005;

Repacholi & Gopnik, 1997; Wellman, Phillips & Rodriguez, 2000). From three years of age,

children distinguish emotions and they begin to connect emotions to external causes (Rieffe,

Meerum Terwogt & Cowan, 2005). Preschoolers begin to comment on their own and others’

emotions (Wellman, Harris, Banerjee & Sinclair, 1995) and they evoke emotions in pretend

play (Deneault & Morin, 2007; Gordon, 1992; Harris, 2000; Harris et al., 1989; Harris,

Brown, Marriott, Whittall & Harmer, 1991; Leslie, 1987). In their games of make-believe,

they show their ability to comprehend that others have wishes, beliefs and feelings much as

they have themselves (Harris et al., 1989). Preschoolers learn that emotions are related to a

person’s representations of situations (Cutting & Dunn, 1999; Wellman et al., 2000) and they

progressively understand the situational causes and the consequences of emotions. They

discover that it is not only objective situations that can induce emotions (for example,

receiving a present causes happiness, or falling over makes you cry) but also mental states

such as beliefs, or desires (feeling happy when a person has what he or she wants) (Baron-

Cohen, Tager-Flusberg & Cohen, 2000; Harris et al., 1989; Leslie, 1987; Rieffe et al., 2005).

ToM is particularly linked to the understanding of complex emotions, such as surprise,

embarrassment, shame, guilt and pride, which are not acquired before children are about four

years old. Around ten to twelve years, children easily use and understand various social

emotions (Draghi-Lorenz, Reddy & Costall, 2001; Frith, 2003; Gilbert, 2004; Mills, 2005;

Saarni, 1999; Tracy, Robins & Lagattuta, 2005).

3.3. Theory of Mind in ASD Children

In these children, there is a structural impairment of specialized processing of mental

states and of precursors of ToM, including specific information processing relating to faces,

to facial emotional expressions, and to gaze direction, reactivity or emotional and

motivational reciprocity, empathy, detection of intentional movements, imitation, coupling

action-perception between self and others, etc. (Nader-Grosbois, 2011a; Nader-Grosbois &

Day, 2011).

3.3.1. Specificities in Precursors of Tom in ASD Children

3.3.1.1. Deficits in Information Processing Relating to Faces and to Facial

Emotional Expressions Their inability to understand the expressive movements of a face and to interpret facial

cues of emotions and other emotional cues (vocal, gesture, postural) (Hobson, 1989, 1991,

1993) could impede ASD children’s understanding of emotions and of mental states. Some

cognitive conceptions of information processing explain this difficulty5.

5

According to the “Weak central coherence theory” (WCC, Frith, 2003; Frith & Happé, 1994; Happé, 1999), the

central coherence ability is deficient in ASD children, because they privilege local information processing and

have difficulty in shifting between local aspects and global approach. Their WCC disrupts the solving of

problems requiring the establishment of relationships between social cues (Happé, 2000). This theory explains

specificities of perceptual-cognitive style (toward both non-social and social aspects) that limit the

understanding of context in ASD people more than it explains emotional and social domains (Rajendran &

Mitchell, 2007). Inter- and intra-individual variability of WCC has been reported in ASD from childhood to

adult age (van Lang, Bouma, Sytema, Kraijer, & Minderaa, 2006; Noens & van Berckelaer-Onnes, 2008).


3.3.1.2. Deficits in Early Imitation Deficits have been observed in inter-personal motor resonance in some aspects of

imitation in young ASD children (Dawson & Adams, 1984; Heimann, 1998; Meltzoff &

Gopnik, 1993; Nadel, 1998) and in their sensory-motor representations of self and others

(Rogers & Pennington, 1991). Their sub-activation of the system of mirror neurones6 in the

reproduction or the observation of emotional expressions is linked with their ASD intensity

(Oberman, Hubbard, McCleery, Altschuler, Ramachandran & Pineda, 2005; Dapretto et al.,

2006).

According to the simulation approach to the development of ToM, their early deficits in

imitation could lead to difficulties in directing attention toward relevant cues displayed by

others and in considering reciprocal mental states. Their impairment in imitation and in ToM

jointly works to their disadvantage in comparison with TD or ID children (Perra, Williams,

Whiten, Fraser, Benzie & Perrett, 2008).

3.3.1.3. Deficits in the Detection of Biological Movements, Gaze Direction,

Joint Attention Varied results are reported regarding ASD children’s impaired or non-impaired detection,

depending on age (Blake, Turner, Smoski, Pozdol & Stone, 2003; Parron et al., 2008;

Webster & Potter, 2008).

Numerous studies have shown that early joint attention7 behaviors are impaired in ASD

children (Bono, Daley & Sigman, 2004; Loveland & Landry, 1986; Mundy & Crowson,

1997; Mundy & Gomes, 1998; Smith, Mirenda & Zaidman-Zait, 2007; Toth, Munson,

Meltzoff & Dawson, 2006; Vaughan et al., 2003); and are a subject of training (Hwang &

Hughes, 2000; Kasari, Freeman & Paparella, 2001b, 2006; Whalen & Schreibman, 2003;

Whalen, Schreibman & Ingersoll, 2006; Jones & Carr, 2004; Jones, Carr & Feeley, 2006;

Jones & Feeley, 2007; Jones, 2009).

Their joint attention skills are positively linked to or predictive of their ToM abilities

(Baron-Cohen, 1991c, 1995; Gattegno, Ionescu, Malvy & Adrien, 1999; Phillips, Baron-

Cohen & Rutter, 1992; Robertson, Tanguay, L’Ecuyer, Sims & Waltrip, 1999; Tourrette,

Recordon, Barbe & Soares-Boucaud, 2000; Yirmiya, Pilowsky, Solomonica-Levi &

Shulman, 1999).

3.3.2. Specificities of Executive Function Connected with Tom in ASD Children

The “executive control dysfunction” hypothesis suggests that the deficit in their executive

control system generates a set of problems in ASD people, including lack of flexibility in

Mottron and his colleagues (Mottron & Burack, 2001; Mottron, Dawson, Soulieres, Hubert & Burack, 2006)

suggest that ASD children present a deficit in the hierarchical organization of these processes: global

information processing does not precede local information processing. 6

The coupling of interpersonal perceptions and actions is based on a system of mirror neurones in the pre-motor

cortex, activated when a person makes an intentional action or observes the action produced by another, or

when a person evokes a mental simulation of the action. 7

Baron-Cohen (1991c) argues that attention towards others in seven- to nine-month-old infants constitutes a critical

precursor to ToM development. Decoding another’s gaze direction and their attention oriented to an object or

an event contributes to the understanding that the object or event is the other’s focus of interest. “Proto-

declarative pointing” induces the sharing of attention between two individuals or “joint attention” and implies

that they could be open to each other’s mental states. Baron-Cohen (1995) conceptualized this ability as a

“shared attention mechanism” (SAM), an essential component for ToM development.


behavior, disorders in inhibition of behavior, and deficits in planning, in strategy selection

and in shifting attention (Corbett, Constantine, Hendren, Rocke & Ozonoff, 2009; Mottron,

2004; Russell, 1997); and that it could create obstacles in the construction of social cognition.

There is a debate as to whether ToM tasks need the executive processes (e.g. Russell, 1997;

Russell, Mauthner, Sharpe & Tidswell, 1991; Russell & Hill, 2001; Russell, Hala & Hill,

2003; Pellicano, 2006; Pellicano, Maybery, Durkin & Maley, 2007) or whether a ToM is

required for executive control (e.g. Perner, Lang & Kloo, 2002). Russell (1997) suggests that

the early dysfunction of the action-monitoring system and of the developmental features of

executive functioning, and memory problems have an impact on ASD children’s self-

awareness, on the development of knowledge regarding their actions, on their regulation

through inner speech, on the imitation of others’ actions, as well as on their understanding of

others’ intentions and minds. Pellicano’s study (2007) obtained a significant correlation

between ToM and executive function components in the ASD group, independent of age.

Examination of the relational pattern of ToM-executive functioning impairments showed

dissociations in only one direction: impaired ToM with intact executive functioning. Pellicano

(2007; Pellicano et al., 2006) showed that there are specific links between particular

executive (dys)functions and particular (dis)abilities in ToM.

In the “Cognitive Complexity and Control theory” (CCC, Zelazo, Burack, Boseovski,

Jacques & Frye, 2001; Zelazo, Jacques, Burack & Frye, 2002), executive functioning is

related to ToM in ASD people because both ToM and measures of executive functions

include higher-order rule use (leading to a correct judgment in belief tasks, for example). The

advantage of the CCC theory lies in the interrelations between these two things: executive

abilities are required to perform ToM tasks, and conversely, ToM understanding helps the

mobilization of executive functions. Zelazo et al. (2001) argue that each developmental

disorder may have an impact on the consciousness, the control of behavior and rule

complexity, and that researchers should not overlook the fact that specifically in ASD people,

a large proportion are intellectually impaired; this intellectual deficit may interact with other

inabilities to explain various findings in studies relating to both executive functioning and

ToM development. They suggest that the CCC conception makes it possible to identify

specificities in particular components of executive functions and in ToM in people presenting

distinct disorders, including ASD. In their study of ASD children and children with Down

syndrome, Zelazo et al. (2002) reported that individual differences in ToM are correlated with

individual differences in performance in two tests of rule use, except in ASD children with

severe intellectual deficits.

3.3.3. The “Theory of Mind Hypothesis” or Modular Approach in ASD Children

ASD children present a specific triad of disorders: social impairment, reduced

communication and lack of imaginative play (Frith, 2000; Wing, 1986). Baron-Cohen et al.

(1985) suggested that these combined deficits could be explained by an inability to represent

mental states cognitively. This “theory of mind hypothesis” postulates a fundamental deficit

in ASD children in the ability to ascribe mental states to others, to understand others’

perspective, to predict their behavior in referring to these mental states; this is called “mind-

blindness” (Baron-Cohen, 1989a-b, 1991a-b, 1995; Baron-Cohen et al., 1985, 1986; Leslie &

Thaiss, 1992; Perner, Frith, Leslie & Leekam, 1989; Rieffe et al., 2000). Researchers suggest

that this mind-blindness in ASD children comes from the fact that they do not identify their


own mental states. Severe ToM deficits are linked to social and communicative abnormalities

(Baron-Cohen, 1988, 1991c; Eisenmajer & Prior, 1991; Frith, 2003) and they may influence

behavior in social interactions (Baron-Cohen et al., 2000; Dixon, Tarbox & Najdowski,

2009).

According to Leslie (1987, 1991, 2000; Leslie & Roth, 2000), ASD individuals present

an impaired cognitive mechanism of metarepresentation that leads to difficulty in

constructing mental representations about what is going on in others’ mental states and also in

their pretend play. The “ToM mechanism”, functioning jointly with a cognitive mechanism,

“the selection processor”, is activated deficiently by ASD children in solving ToM tasks

(Leslie, 2000).

In addition, Baron-Cohen (1995, 1999, 2000) led studies of ASD children to validate his

modular model of ToM, including four innate mechanisms that make “mindreading” possible.

In ASD children, these mechanisms could be damaged. According to Baron-Cohen (1989a),

the neurodevelopmental disorder in ASD children particularly restricts the maturation of the

“ToMM”. He argues that their social information processing is less efficient when adjustment

towards other people makes it necessary to consider their beliefs, intentions, or thinking as

different from their own. He suggests that the detection of emotions is not impaired when the

emotion fits with the context and the other person’s behavior (expressions of internal state).

However, ASD children have difficulties when emotions are not congruent with the context

or when complex emotions involve a representational interpretation (for example surprise,

Baron-Cohen, Spitz & Cross, 1993).

Numerous studies in developmental psychopathology have used this modular approach in

order to explain deficits in ASD people. However, the main criticism is the absence of

evidence of an exclusive deficit in ToMM in ASD people, and the fact that other cognitive

functions are also deficient, such as executive functions and language (Baron-Cohen, 1995).

Other researchers in developmental psychology postulate the progression of ToM conceived

as a multi-construct that could benefit from environmental and social interactions.

3.3.4. Socio-Affective Bases of Tom Development in ASD Children In the perspective developed by Hobson (1986a-b, 1993), it was postulated that deficits in

ToM development in ASD children result from a primary innate inability to interact in

emotional ways with other people. Their relative inability with respect to inter-subjective

contact and engagement in social interactions with others and their deficient emotional

connection with others have certain consequences in the cognitive, linguistic and social

domains and constrain the development of the sense of self, symbolization and the sense of

others’ attitudes and feelings (Hobson, 1993). In other words, ASD children’s lack of

understanding of others’ feelings affects their understanding of their own emotions and vice

versa; consequently, they find it difficult to respond to and empathize with emotions

expressed by others (Hobson, 1993). Their developmental delay in each stage of development

alters the progression of their joint attention, which induces difficulties in elaborating a ToM.

ASD children present a disharmonic pattern in their performance when confronted with

emotional versus non-emotional tasks, and this supports the hypothesis of a specific deficit in

emotional processing (notably identifying auditory and visual emotional stimuli and

designating emotions) (Hobson, 1986a-b, 1993; Hobson, Ouston & Lee, 1988, 1989).


3.3.5. Tom “Emotions” in ASD Children Few studies have specifically considered ToM “emotions” and the understanding of the

causes and consequences of emotions in ASD children.

Some authors have reported that when explicit questions about emotions were put to

ASD children around ten years old and MA-matched children, the participants showed a

similar understanding of simple emotions in prototypical situations, such as birthdays or

hurting yourself, or getting what you want (Baron-Cohen, 1991b; Baron-Cohen et al., 1993;

Fein, Lucci, Braverman & Waterhouse, 1992).

Deficits are reported in ASD children in the interpretation of drawings of facial

expressions or of emotional gestures according to contexts, in the association of facial

expressions with vocal information and in their understanding of internal causes of emotions

(Baron-Cohen, 1991b; Celani, Battacchi & Arcidiacono, 1999; Hadwin, Baron-Cohen,

Howlin & Hill, 1996, Hobson, 1986a-b; Loveland, Tunali-Kotoski, Chen, Brelsford, Ortegon

& Pearson, 1995; Southam-Gerow & Kendall, 2002). Sigman et al. (1992) observed that ASD

children do not recognize and are relatively unreceptive to negative emotions felt by adults. In

the same perspective, Vermeulen (2009) suggested that ASD children do not easily

understand other’s emotions because they do not know how to take account of others’

expectations and the context that provokes the emotions.

In addition, as they present deficits in ToM “beliefs” and “desires”, emotions caused by

these mental states are not easily understood by school-age ASD children (Baron-Cohen,

1991b; Buitelaar & van der Wees, 19978; Serra, Loth, van Geert, Hurkens & Minderaa,

2002). With regard to complex emotions, ASD preschoolers take little interest in others’

mental states: even if they display pride in similar situations as TD children, they pass over

the social function of pride because they do not monitor the audience’s reaction (Kasari et al.,

1993a).

ASD children differ from TD preschoolers matched for MA because they have difficulty

in improving their understanding of emotions through experience, including understanding

the causes and consequences of emotions in various situations (Begeer et al., 2008).

In addition, links between ToM and self-conscious emotions have been emphasized.

Heerey, Keltner and Capps (2003) observed that ASD children performed worse than TD

children at recognizing facial expressions of self-conscious emotions (such as embarrassment

and shame)9, though they did not differ in the recognition of non-self-conscious emotions

from photographs. When ToM ability was controlled for, there was no group difference in the

recognition of self-conscious emotions.

In ASD children, levels of understanding of emotions or performance in ToM emotion

tasks vary according to their IQ or their cognitive abilities (Happé, 1995; Kasari et al., 2001a;

Yirmiya et al., 1992) and their verbal or non-verbal competence (Buitelaar, van der Wees,

Swaab-Barneveld & van der Gaag, 1999; Happé, 1995).

3.3.6. “Enactive Mind” Conception in ASD Children Klin, Jones, Schultz and Volkmar (2003) postulate an early deviant “embodied” social

cognition in ASD children. In daily life, multiple relevant social cues occur rapidly and often

8 Significant correlations were found between ToM “beliefs” and emotion recognition measures in ASD children

(Buitelaar & van der Wees, 1997). 9

These self-conscious emotions are associated with ToM, through the ability to understand that behavior has social

consequences in the eyes of others and through an understanding of social norm violations.


simultaneously in social situations. Difficulties in identifying and interpreting them

experienced by ASD individuals may alter their interpretation of social meaning and lead to

their social maladjustment. Their selective attention is oriented less to social stimuli from

people than to physical stimuli from things in the environment. They develop poor tools for

interpreting and solving social situations.

To conclude, these diverse conceptions of deficits in precursors of ToM and in ToM in

ASD children help to explain their social maladjustment. However, complementary

explanations could come from specificities: the perception of subtlety of face, voice and body

movements, the processing of various sources of information simultaneously, the selection of

the most relevant information in social contexts, the inhibition of an inappropriate response

and the mobilization of another more appropriate response and the emotion regulation

processes.

4. Links between Emotional Regulation, ToM and Social Adjustment

4.1. Types of Links

Three distinct positions have been put forward about the links between these processes.

First, in their model of three levels of social skills, Yeates et al. (2007) postulated “bi-

directional” links between social information processing (including social cognition, ToM

and social problem-solving), social interactions (including emotional aspects) and social

adjustment. In other words, children who mobilize social information processing in an

appropriate way can interact easily, display adequate emotional regulation and prosocial

behavior, and establish and maintain positive relationships, and vice versa (Nader-Grosbois,

2011b). Similarly, in the model of effective social competence developed by Halberstadt,

Denham and Dunsmore (2001) and in the model of Leerkes et al. (2008), the emotional

processes, including understanding of emotions and socio-emotional regulation, are

conceived as interrelated skills.

Other positions postulate “predictive” links between these processes, but in two different

directions.

1) The understanding of emotion enables emotion regulation which in turn facilitates

cognitive and behavioral coping strategies; the understanding of emotion is therefore

considered as a mediator of relations of emotion regulation and social adjustment

(Izard, Schultz, Fine, Yougstrom & Ackerman, 2000). Through socio-cognitive

development, the child acquires an understanding of emotions (causes and

consequences), ToM “emotions”, and also a knowledge of social rules that allows

him or her to determine which emotion should be expressed when, towards whom

and in what circumstances. Social abilities in children are linked with their skills at

expressing and recognizing emotions and understanding others’ emotions and

intentions (Cassidy et al., 1998; Denham et al., 2003; Fabes et al., 1999).

2) The level of regulation in preschoolers predicts their emotional understanding two

years later (Schultz, Izard, Ackerman & Yougstrom, 2001).


More rarely, a lack of association between these two processes has been observed: TD

children with a high level of social information processing do not necessarily have good

socio-emotional regulation and vice versa (Lindsey & Colwell, 2003).

Few studies have examined specific links between emotion regulation during

interactions, ToM and social adjustment in ASD children who function at the symbolic

developmental level. Often these processes have been studied separately. Recently, some

authors have investigated the use of perspective taking and mental-state inference in

representing and taking part in dyadic interactions between ASD adolescents and adults and

TD children (Begeer, Malle, Nieuwland & Keysar, 2010).

4.2. A Comparative Exploratory Study of Emotion Regulation, Tom and

Social Adjustment

4.2.1. Objective Based on the integrative model proposed by Nader-Grosbois and Day (2011, p.144), a

recent exploratory study led by Nader-Grosbois, Baurain and Mazzone examined the links

between in ASD children’s socio-emotional regulation, observed in three dyadic contexts

(neutral with an adult and competitive and cooperative with a pair) and their ToM skills to do

with emotions and in social problem-solving, as well as their social adjustment.

4.2.2. Method

4.2.2.1. Participants

We compared these processes and the links between them in 12 ASD children with 12

children with intellectual disabilities (ID) and 12 TD preschoolers, matched for

developmental age.

Table 1. Means and standard deviations of chronological

and developmental ages for each group

Groups

TD children

(n= 12)

Girls (n= 6)

Boys (n = 6)

ID children

(n=12)

Girls (n= 8)

Boys (n = 4)

ASD children

(n=12)

Boys (n = 12)

M (SD) M (SD) M (SD)

Chronological age 57.33 (12.43) 111.92 (21.85) 117.58 (29.84)

Developmental age 60.24 (13.99) 60.25 (13.72) 60.08 (14.27)

Note. TD = Typically Developing; ID = Intellectual Disability; ASD = Autism Spectrum Disorders; n =

number of children; M = Mean; SD = Standard Deviation.

The Table 1 presents means and standard deviations of chronological and developmental

ages for each group.


4.2.2.2. Instruments and Procedure The ToM emotion tasks (Nader-Grosbois & Thirion-Marissiaux, 2011) assess the child’s

recognition and understanding of causes and consequences of emotions. A preliminary task of

facial emotional expression recognition for four basic emotions (joy, sadness, anger and fear)

was presented. Correct recognition was a necessary condition before administering the two

ToM emotion tasks. In the Causes of emotions task, the child has to understand the emotion

felt by the character of a story according to the situation with which he or she is confronted.

The Causes of emotions task included four similar beginnings of scripts illustrated by two

pictures. The end of each script required a choice from among four emotions: joy, sadness,

anger and fear (illustrated by pictures). The examiner read out each script and the child was

asked to make an emotion attribution to the main character by pointing to the most

appropriate of four facial emotional expressions. Finally, the examiner asked the child to

justify his or her answer. In the Consequences of emotions task, according the emotion felt by

the character in a story, the child has to predict his or her behavior. The consequences of

emotions task included four scripts (illustrated by two pictures) corresponding to four

situations in which the character felt joy, sadness, anger or fear. The end of each script

required a choice among three types of behavior (illustrated by three pictures): adjusted social

behavior, maladjusted social behavior, or neutral behavior. The examiner read out each script

and the child was asked to make a choice among the three pictures. Finally, the examiner

asked the child to justify his or her answer. The response to each emotional script was scored

between 0 and 1.5 points according to the participant’s justification. For each task, the

maximum score was 6 points and the two ToM emotion tasks were scored out of a total of 12

points.

The Social Solving task (RES, Barisnikov, Van der Linden & Hippolyte, 2005) is used to

estimate the capacity of the child to judge whether or not other people’s social behavior is

appropriate and to determine the extent to which their judgment is based on the knowledge of

conventional or moral rules. The 14 items, illustrated by 14 pictures, consist of appropriate

versus inappropriate social behavior displayed by a character in social situations. Three

questions are asked. The first question assesses the child’s judgment of adequate or

inadequate social behavior: “What happens in this picture? What do you think? Is he/she

doing something that is good or that is not good (or bad)?” (Maximum score = 2). The

second question assesses the identification of the target behavior of the situation: “Can you

show me what is good/not good in this picture?” (Maximum score = 1). The third question

estimates the level of justification, with reference to social rules, connected to the judgment:

“Why is it good/not good?” (Maximum score = 7). The maximum total score is 140.

The Dyadic Game of Socio-Emotional Problem-Solving (Baurain & Nader-Grosbois,

2011) aims to assess the child’s abilities to resolve several socio-emotional problems in

interactive contexts and to analyze his or her socio-emotional behavior. Concretely, the child

must solve these problems to reach the end of the course (represented by a star) in three types

of interactive contexts: neutral (playing only with an adult), competitive and cooperative

(playing with a child-partner). Two aspects are assessed: (1) performance in thirteen socio-

emotional problem-solving situations; (2) variation of socio-emotional regulation depending

on the interactive contexts and on three temporal sequences elicited by the design. In each

context, nine problem situations and four critical stories are presented and the child must

identify the character’s emotion among four basic emotions (joy, sadness, anger and fear),

and differentiate the inappropriate social behavior versus the appropriate social behavior, by


choosing among several possibilities illustrated by pictures. For the four critical stories

relating to four emotions (joy, sadness, anger, fear), we attribute 1 point per recognized

emotion. For the nine problem-situations, we attribute 3 points per situation (1 point if the

child recognizes what is socially acceptable or not in the behavior of one or more

protagonist(s); 1 point if the child is capable of justifying what he or she considers acceptable

or not; 1 point if the child is capable of choosing the socially acceptable behavior according to

the situation). The order of these nine problem-situations and the possible solution (illustrated

by acceptable social behavior) vary in order to limit inter-contextual learning biases. The

maximum score for the thirteen socio-emotional problem-solving situations per context is 31

points, for a total maximum score of 93 points for all contexts.

This design is intended to elicit positive and negative emotions in children during distinct

sequences of the game: notably frustration when they fail or when their partner succeeds, and

joy when they succeed or when they progress more than their partner in the game; it creates a

situation where the children need to regulate their emotions, their emotional expressions and

their socio-emotional behaviors. These behaviors can be managed in different ways by the

children depending on the context and the sequence, and can be more or less adjusted

depending on these situational aspects. We code behavior by viewing videos of children

playing in the game and applying the following coding grid.

The Coding Grid of Socio-Emotional Regulation by sequences (Baurain & Nader-

Grosbois, 2011) was created with reference to behavioral categories in measurements

conducted by other parties, such as the Emotion Regulation Checklist (ERC, Shields &

Cicchetti, 1997), the Emotional Regulation Rating Scale (ERRS, Carlson & Wang, 2007), and

the Emotion Regulation Subscale of the Social Competence Scale (Conduct Problems

Prevention Research Group, 1999) and in direct measurements (Fabes et al., 1999; Flem,

Thygesen, Valas & Magnes, 1998; Rothbart & Bates, 1998). The objective of the coding grid

is to assess variability of socio-emotional regulation depending on three interactive contexts

and on three temporal sequences (three challenges per sequence). The grid includes 26 items

divided into categories: Emotional Expressions and Emotional Adaptation; Behavior towards

Social Rules (listening and follow an adult’s instructions, waiting one’s turn); Social

Behavior (pro-social behavior, empathic behavior and behavior towards the task such as self-

effort or self-control). Validation phases and statistical analyses were performed to verify

concordance between judges, the internal structure, the consistency of the coding grid, and the

relevance of the design (Baurain & Nader-Grosbois, 2011).

4.2.3. Results Table 2 presents the results of the ANOVA analyses for the between-groups comparison.

With regard to social cognition, the results showed that the three groups of children

differed significantly in the Social Solving task: the ASD children presented the lowest

performances in this task. However, no significant differences between groups were obtained

in ToM tasks, and in performances in socio-emotional problem-solving in the dyadic games.

With regard to socio-emotional regulation, these analyses emphasized significant

differences in social behaviors displayed during the dyadic interactive games (all contexts

together, and specifically in cooperative and competitive contexts with peers), to the

disadvantage of ASD children; however no significant differences were obtained in the

frequency or intensity of emotional expression, or in behavior towards social rules during the

dyadic interactive game, whatever the type of context.


With regard to the teacher’s perception of the children’s social adjustment in daily life,

there was no significant difference between the three groups. Table 3 presents the Spearman’s

coefficients of correlation calculated for each group, between the children’s developmental

age and their abilities in social cognition, socio-emotional regulation and social adjustment.

The significant positive correlations showed that as the developmental age increased, so ToM

abilities and performances in socio-emotional problem-solving in the dyadic games improved

in TD and ASD children. Developmental age was positively linked with performance in the

social problem-solving task for TD and ID children only. Except for social behavior in TD

children, no significant correlations were obtained between categories of socio-emotional

regulation and developmental age in the three groups. For ASD children only, the higher their

developmental age, the better their social adjustment.

Table 2. ANOVA analyses for the between-groups comparisons in social cognition,

in socio-emotional regulation and in social adjustment

Groups

TD children

(n= 12)

ID children

(n=12)

ASD children

(n=12)

M (SD) M (SD) M (SD) F

Social cognition

Theory of Mind (ToM) 8.62 (2.27) 8.25 (1.99) 7 (2.74) 1.56

Social Solving task 54.50 (19.04) 63.25 (20.10) 42.33 (12.87) 4.26*

Socio-emotional problem-

solving in the dyadic game 50.45 (5.03) 49.48 (7.95) 44.70 (7.70) 2.21

Socio-emotional regulation Contexts

Emotional expression All 128.58 (6.30) 127.50 (13.50)

127.25

(13.50) .03

Neutral 42.25 (4.09) 42.67 (7.77) 42.75 (4.82) .02

Cooperative 43.58 (1.83) 42.58 (5.90) 42.50 (5.14) .20

Competitive 42.75 (2.73) 42.25 (3.36) 42.00 (4.73) .12

Behavior towards social rules All 71.92 (10.67) 64.67 (8.81) 66.75 (10.93) 1.61

Neutral 17.83 (1.85) 18.08 (2.64) 18.67 (2.27) .42

Cooperative 28.42 (5.23) 24.17 (4.80) 24.75 (4.00) 2.87

Competitive 25.67 (5.69) 22.17 (3.83) 23.33 (6.49) 1.28

Social Behavior All 17.83 (6.33) 20.42 (10.88) 9.08 (7.56) 5.88*

Neutral 2.92 (2.96) 4.25 (4.24) 1.92 (3.17) 1.33

Cooperative 7.08 (3.17) 7.50 (4.10) 3.67 (2.77) 4.60*

Competitive 7.83 (3.35) 8.67 (4.94) 3.5 (3.39) 5.86*

Social adjustment 55.60 (8.52) 60.30 (13.61) 46.14 (15.08) 2.71

Note. * p < .05; TD = Typically Developing; ID = Intellectual Disability; ASD = Autism Spectrum

Disorders; n = number of children; M = Mean; SD = Standard Deviation.

Table 4 presents the Spearman’s coefficients of correlation calculated for each group,

between the children’s socio-emotional regulation by categories and their abilities in social

cognition and in social adjustment. In ASD children, only emotional expression in socio-

emotional regulation was linked positively and significantly with social adjustment. In ID

children, significant positive correlations were obtained between emotional expression and

performance in socio-emotional problem-solving in dyadic games and also between behavior

towards social rules and ToM abilities.


Table 3. Spearman’s coefficients of correlations between children’s developmental

age and their abilities in social cognition, socio-emotional regulation and social

adjustment in each group

Developmental age

Groups

TD children

(n= 12)

ID children

(n=12)

ASD children

(n=12)

Social cognition

Theory of Mind (ToM) .64* .55 .68*

Social Solving task .80** .64* .56

Socio-emotional problem solving in the dyadic

game .88** .67* .89**

Socio-emotional regulation

Emotional expression .43 .23 .50

Behavior towards social rules -.19 .36 -.09

Social Behavior .65* -.25 -.16

Social adjustment .14 .36 .75*

Note. ** p < .001 * p < .05; TD = Typically Developing; ID = Intellectual Disability; ASD = Autism

Spectrum Disorders; n = number of children.

Table 4. Spearman’s coefficients of correlations between children’s abilities in socio-

emotional regulation and their social cognition and social adjustment in each group


Groups

Emotional

expression

Behavior towards

social rules

Social

Behavior

TD children (n = 12)

Social cognition

Theory of Mind (ToM) .08 -.02 .50

Social Solving task .44 -. 28 .32


solving in the dyadic game .53 -.30 .25

Social adjustment -.37 .23 .22

ID children (n = 12)

Social cognition

Theory of Mind (ToM) .15 .59* -.10

Social Solving task .09 .22 -.16


solving in the dyadic game .58* .40 -.38

Social adjustment .17 .12 .40

ASD children (n = 12) Social cognition

Theory of Mind (ToM) .07 -.16 .02

Social Solving task .37 .01 -.11


solving in the dyadic game .20 -.12 .36

Social adjustment .78* .57 .14

Note. * p < .05; TD = Typically Developing; ID = Intellectual Disability; ASD = Autism Spectrum

Disorders; n = number of children.


Table 5. Linear regression analyses: predictors of social adjustment for each group

Groups Predictors of social adjustment B

SD/

B BETA R2aju. F

TD children

(n=12)

Developmental age .17 .19 .30 -.02 .39

Social cognition

Theory of Mind (ToM) 1.11 1.50 .25 -.05 .55

Social Solving task .12 .15 .28 -.04 .62


Emotional expression -.33 .43 -.26 -.04 .58

Behavior towards social rules .05 .26 .07 -.11 .04

Social Behavior .33 .46 .25 -.05 .52

ID children

(n=12)

Developmental age .53 .31 .53 .20 3.25

Social cognition

Theory of Mind (ToM) 1.73 2.11 .27 -.03 .67

Social Solving task .45 .16 .70 .43 7.64*


Emotional expression .31 .25 .40 .06 1.57

Behavior towards social rules .38 .54 .24 -.06 .49

Social Behavior .34 .43 .26 -.04 .61

ASD children

(n=12)

Developmental age .87 .31 .78 .53 7.79*

Social cognition

Theory of Mind (ToM) 3.42 2.14 .58 .20 .17

Social Solving task .87 .37 .71 .41 5.33


Emotional expression .74 .21 .84 .65 12.42*

Behavior towards social rules 1.07 .63 .60 .24 2.89

Social Behavior -.62 .85 -.31 -.08 .53

Note. * p< .05 ; TD = Typically Developing; ID = Intellectual Disability; ASD = Autism Spectrum

Disorders; n = number of children.

Table 5 presents the results of linear regression analyses which were performed in order

to identify the predictors of social adjustment. In ASD children, social adjustment was

predicted by developmental age and emotional expression in socio-emotional regulation. In

ID children, social adjustment was predicted only by abilities in the Social Solving task.

This exploratory study showed that when ASD children are matched for developmental

age with TD or ID children, they have a deficit in Social Solving tasks and display less social

behavior during the dyadic interactive games, particularly in cooperative and competitive

contexts with peers. It also emphasized some specific characteristics of links between target

processes in ASD children: both their developmental age and their emotional expression

included in socio-emotional regulation during dyadic games predicted their social adjustment.

The higher their developmental age, the better their abilities were in ToM and in socio-

emotional problem-solving in the dyadic games. The various methodologies used in this


exploratory study made a nuanced approach possible, not only to delay and deficits, but also

to strengths, in ASD and ID children; moreover, the study showed that relational patterns

between the various socio-emotional processes could be organized differently according to

the group of children. Similar studies involving larger samples and clinical subgroups should

be conducted.

5. Perspectives for Research and Implications for Assessment and for Intervention

In order to take account of the heterogeneity in ASD children and of multiple-deficit

accounts (as proposed by researchers such as Baron-Cohen & Swettenham, 1997; Bishop,

1993; Happé, Ronald & Plomin, 2006; Joseph, Tager-Flusberg & Lord, 2002; Rajendran &

Mitchell, 2007), future research should investigate specificities in subgroups of children and

adolescents with distinct profiles of ASD and different disorders, including genetic

syndromes, intellectual disabilities and behavior disorders.

The study of specificities of emotion regulation in ASD children should be conducted

using a dynamic and integrative approach that takes account of different levels of cognitive

and socio-emotional competences or deficits (as suggested by Yeates et al. 2007, Nader-

Grosbois, 2011b; Nader-Grosbois & Day, 2011): perceptual information-processing10

,

executive and cognitive abilities (attention, inhibition, etc.), social information-processing

(including ToM, understanding of one’s own and others’ emotions, social problem-solving

abilities), social interactions and social adjustment. To infer what other people think or feel

and to regulate one’s emotions in social interactions requires the perception of subtle face,

voice and body movements, the processing of various sources of information simultaneously

and in an integrated way, the selection of the most important and relevant information in the

context and the inhibition of an already given response in a similar situation to find a more

appropriate one. Emotion regulation in social situations could therefore depend on such

factors, with respect to which ASD children present deficits. In inter-disability comparative

studies, specific bidirectional or predictive links should be investigated between socio-

emotional regulation, social information-processing, including ToM, and social (mal)

adjustment in ASD children and ID children with a similar developmental age. With regard to

the need for additional research looking at the relation between theory of mind and social

behavior, recently, Lerner, Hutchins and Prelock (2011) examined the relationship between

parental responses in the Theory of Mind Inventory (ToMI)11

about their ASD adolescents

and measures of their autistic symptoms and social skills. Their results supported the use of

the ToMI with ASD adolescents and the link between ASD and social impairments. In

experimental studies, researchers should test the extent to which the training in social

information-processing or ToM could bring about improvements in socio-emotional

regulation and social adjustment in ASD children, compared with ID children and children

with externalized disorders.

We have also emphasized the importance of conducting longitudinal studies in order to

gain a better understanding of ToM in ASD children at different stages of development; such

10

As suggested by Mottron (2004). 11

A parental report measure of ToM, formerly called the Perception of Children’s Theory of Mind Measure

(Hutchins, Bonazinga, Prelock & Taylor, 2008) renamed the Theory of Mind Inventory (ToMI).


studies could help to establish whether there is a delay, a deficit or a combination of the two

(as suggested by Serra et al., 2002).

Moreover, it would be relevant to examine parental socialization of emotions towards

their ASD children: how parents react to their own emotions, how they converse about

emotions and mental states, how they express their emotions; and also to study the impact of

these things on their children’s abilities in ToM, their socio-emotional regulation and their

social adjustment.

Socio-emotional co-regulation between both parents and ASD children and also between

these children and their peers also needs to be investigated in connection with the

development of ToM.

Future research should use recent assessment measures of ToM components, of

emotional abilities, of socio-emotional regulation, and of social skills, involving ecological

tasks (see the suggestions made by Nader-Grosbois, 2011a, and Nader-Grosbois and Day,

2011).

These research perspectives could yield specific guidelines on improving the effective-

ness of intervention toward subgroups of children more or less impaired in one domain or

another (Teunisse, Cools, van Spaendonck, Aerts & Berger, 2001).

In order to improve the social inclusion and the quality of life of ASD children, there is a

need for integrated assessment and intervention from infancy and childhood. We suggest the

following guidelines (see the detailed suggestions made by Geller, 2005; Nader-Grosbois,

2011a; Nader-Grosbois and Day, 2011). We propose to assess by means of various

methodologies (testing, relevant questionnaires, observations) and to provide training in12

:

a) ToM precursors: recognition of emotional stimuli (facial, vocal, gestural, body

movements) using various media (photographs, videos, computer software); face

processing, early imitation; joint attention;

b) socio-perceptive processing of social cues and perceptive integration;

c) executive functions and self-regulation strategies13

;

d) social knowledge and skills in socio-emotional problem-solving and in social scripts;

e) ToM abilities14

, including the understanding of causes and consequences of

emotions;

f) identification of one’s own positive and negative feelings;

g) modalities of emotional expression, emotional regulation strategies and conventional

responses towards others’ emotions, empathic behaviors;

h) social adaptive abilities;

i) self-perception of social self, of the quality of social relationships.

12

Several programs have been developed: “Mind Reading: the interactive guide to emotions- Learning Centre &

Games Zone” (Baron-Cohen, 2004), “Social Communication, Emotional Regulation and Transactional

Support” (SCERTS, 2005), “Teaching Children with Autism to Mind-Read: A Practical Guide” (Howlin,

Baron-Cohen & Hadwin, 1999), “Emotion Trainer” (Silver, 2000; Silver & Oakes, 2001), “Promoting

Alternative Thinking Strategies” (PATHS, Kusché & Greenberg, 1994), “Comic Strip Conversations” and

“Social Stories” (Gray, 1994, 2004; Gray & Garand, 1993), “Navigating the Social World” (McAfee, 2001),

“Solving the relationship puzzle”(Gutstein, 2000). 13

See the discussion of literature about the impact of self-regulation processes on development in atypical children

in Nader-Grosbois (2011c). 14

For example, showing video models for perspective-taking tasks could improve ASD children’s understanding of

another person’s mental states (Charlop-Christy & Daneshvar, 2003).


To gain a better understanding of ToM concepts, to mobilize a higher level of social

cognition, and to regulate their emotional expression and social behaviors better, ASD

children need specific adults’ scaffolding and various opportunities to practice these

processes in distinct contexts with different materials.

It is also necessary to assess and work on ASD children’s perceptions and behaviors of

peers, surroundings, parents or teachers, related to their socio-emotional (in)abilities.

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