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Desire for social interaction in children with autism spectrum disorders
Research in Autism Spectrum Disorders 8 (2014) 449–453
Contents lists available at ScienceDirect
Research in Autism Spectrum Disorders Journal homepage: http://ees.elsevier.com/RASD/default.asp
Desire for social interaction in children with autism spectrum disorders Anne Deckers a,*, Jeffrey Roelofs a, Peter Muris a, Mike Rinck b a
RIAGG Maastricht Child and Youth Care and Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands b Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
A R T I C L E I N F O
A B S T R A C T
Article history: Received 7 August 2013 Received in revised form 19 December 2013 Accepted 26 December 2013
In this experimental clinical study, a first attempt was made to examine the desire for social interaction in children with autism spectrum disorders (ASD). Children with ASD and typically developing (TD) children completed both an explicit measure (self-report) and an implicit measure (Face Turn Approach–Avoidance Task) of the desire for social interaction. On the explicit assessment, children with ASD clearly displayed lower scores reflecting less desire for social interaction than TD children. On the implicit assessment, children with ASD showed a stronger tendency to pull both social and non-social stimuli towards them, which indicates a general automatic tendency towards approach, as compared to the TD children. Possible reasons for this dissociation between the explicit and implicit desire for social interaction are discussed and directions for future research are provided. ß 2014 Elsevier Ltd. All rights reserved.
Keywords: Autism spectrum disorders Children Desire for social interaction Approach and avoidance tendencies
1. Introduction An extensive line of research indicates that positive interpersonal relationships are important for both physical and emotional well-being of individuals (Baumeister & Leary, 1995). Children with autism spectrum disorders (ASD) spend less time participating in social interactions (McConnell, 2002), and are less inclined to initiate social contact with peers (Bauminger, Shulman, & Agam, 2003) than children without ASD. As a result, many interventions aim at stimulating children with ASD to engage in social interactions (e.g., Rogers, 2000). The precise reason for the diminished social contact of children with ASD is unclear. On the one hand, it is possible that qualitative social impairments, such as limited social cognition and lack of social skills, may hinder these children in initiating and maintaining social interactions (e.g., Bauminger, 2002). On the other hand, it has been proposed that children with ASD lack the intrinsic desire to interact with others (Chevallier, Kohls, Troiani, Brodkin, & Schultz, 2012; social motivation theory). So far, it is largely unknown to what extent children with ASD have a desire for social interaction. Children with ASD constitute a heterogeneous group and the current literature indicates that their social behaviour is rather diverse. In general, children with ASD have fewer friends, display lower friendship quality, and take a less central role within social networks. A significant fraction, however, manages to form reciprocal friendships and is involved in social networks in regular schools (e.g., Kasari, Locke, Gulsrud, & Rotheram-Fuller, 2011). Several studies have found that children with ASD report elevated levels of loneliness (e.g., Bauminger et al., 2003), which indicates that they experience a discrepancy between the desired and perceived social functioning. The presence of loneliness implicates that these children want to be involved in interaction with other people, which seems to be in contrast
* Corresponding author at: Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Postbox 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 043 3299640. E-mail address: [email protected] (A. Deckers). 1750-9467/$ – see front matter ß 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.rasd.2013.12.019
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A. Deckers et al. / Research in Autism Spectrum Disorders 8 (2014) 449–453
to the argument that they are not motivated to engage in social contact. However, several studies have demonstrated that the understanding of friendship and loneliness is fundamentally different in children with ASD and that the relationship between loneliness and friendships is less coherent (Chamberlain, Kasari, & Rotheram-Fuller, 2007). The existing research does not differentiate between the two lines of reasoning just described. More insight into the desire for social interaction in ASD is needed as variations in social motivation might explain variations in social behaviour (Calder, Hill, & Pellicano, 2012). It is also of clinical importance as it may have implications for treatment. The desire for social interaction can be assessed by means of explicit and implicit measures. Explicit or direct measures consist of questionnaires, interviews, and behavioural observations, and have a long and fruitful history in psychopathology research. At the same time, they also have clear limitations as they rely on the introspective abilities of individuals (Nisbett & Wilson, 1977). Implicit or indirect measures intend to capture more automatic processes, and they produce knowledge about psychopathology beyond conscious introspection or behavioural observations (Wiers, Teachman, & de Houwer, 2007), and as such are complementary to explicit measures (Roefs et al., 2011). In the present study, the explicit assessment method was covered by the Wish for Social Interaction Scale (WSIS), a self-report questionnaire to measure children’s desire for social interactions. To assess the desire for social interaction at an implicit level, a modified version of the Approach–Avoidance Task (AAT) was employed. The basic idea behind an AAT is that positively valenced stimuli will elicit an automatic approach tendency, while negatively valenced stimuli will evoke an automatic avoidance tendency. To measure these tendencies, an experimental paradigm has been developed by Rinck and Becker (2007) during which a series of stimuli are presented one-by-one on a computer screen. Participants are given a joystick and instructed to respond to a certain (irrelevant) feature of each stimulus by either pulling (approach) or pushing (avoid) the joystick. The assumption is that if a participant’s attitude towards the stimulus matches the direction of the required response, the reaction will be faster. However, when the attitude does not match the required arm movement direction, the reaction will be slower. In the current study, we used a similar task, the Face Turn AAT (Voncken, Rinck, Deckers, & Lange, 2011), during which pictures of side-view faces were presented on a computer screen. By moving the joystick, participants were instructed to either turn the faces towards them (pullapproach) or turn the faces away (push-avoid), depending on an irrelevant feature of the stimulus (i.e., whether the target face looked to the left or to the right). The original Face Turn AAT (Voncken et al., 2011) was modified and adjusted to our child population by adding child faces and reducing the duration of the task. Our goal with this modified AAT was to test whether children with a stronger desire for social interaction will display shorter reaction times when they are prompted to turn the faces towards them (approach) and will exhibit longer reaction times when they are prompted to turn the faces away (avoidance). To summarize, this study investigated the desire for social interaction in children with ASD in more detail. For this purpose, we asked clinically referred children with ASD and typically developing (TD) children to complete a self-report instrument (the WSIS) to measure their desire for social interaction at an explicit level. We used the Face Turn AAT as an implicit measure of the desire to engage in social contact. Our expectations regarding the results of this study were ambivalent. Based on social motivation theory (Chevallier et al., 2012), children with ASD can be hypothesized to display lower levels of desire for social interaction than TD children. However, considering the ‘increased loneliness’ findings, children with ASD may display a similar or even stronger wish for social contacts than TD children. As children with ASD are also more prone to develop social phobia (e.g., Muris, Steerneman, Merckelbach, Holdrinet, & Meesters, 1998) and this type of anxiety problem is likely to guide children’s desire for social interaction (e.g., Voncken et al., 2011), we also included a measure of social anxiety as a control variable. 2. Methods 2.1. Participants The sample consisted of 63 children with ASD (autistic disorder: n = 5, Asperger’s disorder: n = 17, and pervasive developmental disorder-not otherwise specified: n = 41) and 69 TD children. The children participated after obtaining informed consent. The gender distribution differed between the two groups: there were more boys among the children with ASD (56 boys and 7 girls) than among the TD children (37 boys and 32 girls) [x2(1,132) = 19.68, p < .01]. The children with ASD (mean age = 9.9 years, SD = 1.26; range 8–12 years) were also significantly older than the TD children (mean age = 9.1 years, SD = 1.35; range 7–12 years) [t(130) = 3.19, p < .01]. Therefore, gender and age were included as covariates in all analyses. Children with ASD were recruited at a community mental health care centre (RIAGG Maastricht). A specialized, multidisciplinary team including licensed child psychologists and psychiatrists, with at least 5 years of experience with this type of psychopathology, determined the DSM-IV-TR diagnoses (American Psychiatric Association, 2000). For each child, the diagnosis was based on extensive assessments using multiple informants: a diagnostic interview carried out with parents (emphasizing the developmental history of the child), a teacher interview regarding the child and his/her interactions with peers, and behavioural observations of the child as documented by a psychologist or psychiatrist. In case of learning problems and/or concerns regarding the cognitive abilities of the child, an IQ test was administered. TD children were recruited via several primary schools. Although these children were not psychologically or psychiatrically examined, parents reported that they did not suffer from significant developmental problems or psychopathology. Results from a parental questionnaire measuring autistic behaviours (i.e., the Children’s Social Behaviour
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Questionnaire, which assesses symptoms such as not being socially tuned, tendency to withdraw, orientation problems, not understanding social cues, stereotyped behaviour, and fear of changes; Luteijn, Minderaa, & Jackson, 2002) confirmed that children with ASD indeed displayed significantly higher symptom levels (M = 42.24, SD = 14.41) than TD children (M = 13.86, SD = 12.45) [t(130) = 12.14, p < .01]. 2.2. Assessments 2.2.1. Explicit assessment The Wish for Social Interaction Scale (WSIS) intends to measure children’s desire for social interactions in a straightforward and explicit manner. This self-report scale consists of a series of yes/no questions regarding the desire to engage in social activities with unknown individuals. Eight side-view pictures of faces (2 boys, 2 girls, 2 males, and 2 females) were displayed one-by-one on a computer screen, and for each picture children had to respond to questions such as ‘‘Would you like to have a little chat with this person?’’ and ‘‘Would you like to play with this person?’’ A total score can be calculated by adding up the number of positive (i.e., ‘yes’) responses. The internal consistency of the WSIS appeared to be good (a = .93). 2.2.2. Implicit assessment A modified version of the Face Turn AAT (Voncken et al., 2011) was administered to implicitly assess the desire for social interaction in children. During this computerized task, profile pictures of faces of boys and girls, men and women were used as the social target stimuli, while pictures of computer screens showing photographs of landscapes were employed as control stimuli. Pictures were presented one by one to the children, with the instruction to respond to the direction (left or right) of the stimulus with a joystick (push or pull) as accurately and quickly as possible. Every time children pushed the joystick, the stimulus turned away from them (i.e., avoidance), and every time they pulled the joystick, the stimulus turned towards them (i.e., approach). When the joystick was correctly and completely pushed or pulled, the stimulus disappeared. To create the turning effect, a series of 7 photographs of each stimulus was used that showed the transition of a frontal view to a dorsal view in fixed steps of 30 degrees (for an example, see Appendix 1). The children had 16 practice trials which were excluded from the data analyses. In total, the task consisted of 140 trials: 14 trials per experimental condition (combinations of 5 stimuli and 2 response directions). Two versions were used to counterbalance the combinations of picture direction, picture category, and response direction. The computer recorded children’s reaction times and accuracy of their responses. Reaction times were recorded following completion of the correct pull or push movements. 2.2.3. Social anxiety The social anxiety subscale of the Screen for Child Anxiety and Related Emotional Disorders (SCARED-71; Bodden, Bo¨gels, & Muris, 2009) was used to assess children’s level of social anxiety. Parents had to indicate how often their child experiences each of nine social anxiety symptoms using a 3-point Likert scale (ranging from 0 = almost never to 2 = often). 3. Results 3.1. Explicit assessment To examine whether children with ASD and TD children differ in terms of their explicit desire for social interaction, an analysis of covariance (ANCOVA) was carried out with the total score on the WSIS as dependent variable, group as betweensubjects factor, and age, gender, and social anxiety as covariates. The results revealed that children with ASD had significantly lower scores on the WSIS than TD children, with means being 18.94 (SD = 13.81) and 28.30 (SD = 11.15), respectively [F(1,126) = 4.52, p < .05, h2 = .03]. Additionally, social anxiety was also significantly associated with WSIS scores: the higher the level of social anxiety, the lower children’s explicit desire for social interaction [F(1,126) = 4.76, p < .05, h2 = .04]. 3.2. Implicit assessment Differences between children with ASD and TD children with regard to their implicit desire for social interaction were explored by performing a 2 (group) 2 (stimulus: social target vs. control) 2 (direction: push vs. pull) repeated-measures ANCOVA on the reaction times as measured during the Face Turn AAT. Again, we included age, sex, and social anxiety as covariates. The results indicated that on average, children with ASD responded slower than TD children [F(1,126) = 7.94, p < .01, h2 = .06]. Moreover, both groups responded more quickly by pulling than by pushing, implying that both groups displayed an overall approach tendency [F(1,126) = 12.18, p = .001, h2 = .09]. Further, a significant interaction effect of group and direction [F(1,126) = 13.88, p < .001, h2 = .10] indicated that this overall approach tendency was significantly stronger among children with ASD (see Fig. 1). The expected three-way interaction of group, direction, and stimulus was not found [F(1,126) < 1], which implies that children with ASD did not exhibit a specific automatic approach/avoidance tendency for social stimuli as compared to TD children. Finally, a main effect of age [F(1,126) = 35.64, p < .001, h2 = .22] and an interaction effect of direction and age [F(1,126) = 6.60, p = .01, h2 = .05] indicated that older children responded faster, and that this age effect was larger for the pull trials. The covariates gender and social anxiety were not significantly associated with reaction times [F(1,126) < 1 and F(1,126) = 2.55, p = .11, respectively].
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Fig. 1. Mean difference in reaction times (in ms) to social stimuli and control stimuli of the Face Turn AAT (push minus pull, thus reflecting an approach tendency) for children with an autism spectrum disorder (ASD) and typically developing children (TD).
Since the reaction times were recorded following completion of the correct pull or push movements, it may well be that errors (i.e., initial pulling instead of pushing and vice versa) had a significant impact on children’s reaction times. To investigate this possibility, an additional 2 (group) 2 (stimulus) 2 (direction) ANCOVA was performed on the error rates, again with age, gender, and social anxiety as covariates. Children demonstrated more errors during push trials (mean = 7.79% and SD = 8.41) than during pull trials (mean = 4.21%, SD = 4.71) [F(1,126) = 22.22, p < .001, h2 = .15], and children with ASD made relatively more of such errors than TD children [F(1,126) = 17.30, p < .001, h2 = .12]. Younger participants displayed more errors, especially during the push trials [F(1,126) = 14.88, p < .001, h2 = .11]. This pattern of findings is similar to that observed for the reaction times, and thus makes it plausible to assume that errors mediated the effects found for the reaction times. Children with ASD had more difficulty pushing the stimuli away than TD children, and this was demonstrated both by slower movements and by more incorrect movements (pulling instead of pushing). 4. Discussion In this experimental clinical study, a first attempt was made to examine the desire for social contact in children with ASD. Explicit and implicit measures of the desire to engage in social interaction were available for both children with ASD and a control group of TD children. On the explicit assessment, children with ASD clearly displayed lower scores, reflecting less desire for social interaction than TD children. This finding is in line with social motivation theory (Chevallier et al., 2012). The results obtained using the implicit measure suggested the opposite. Children with ASD showed a stronger tendency to pull both social and non-social stimuli towards them, thereby exhibiting a greater inclination towards approach than TD children. It is important to realize that the results on the explicit and implicit measures are not mutually exclusive, but provide complementary information (Roefs et al., 2011). It is unclear why this implicit general approach tendency of children with ASD does not manifest itself as an explicit desire for social contact. A possible explanation might be that social interactions are too complex and therefore too demanding for many of these children. It may well be that children with ASD do experience a wish for social interaction at an implicit level but that this is only expressed in specific situations (Hauck, Fein, Waterhouse, & Feinstein, 1995) or with familiar people (Hintzen, Delespaul, Van Os, & Myin-Germeys, 2010). A number of additional results of the Face Turn AAT deserve some comment. First, children with ASD demonstrated a stronger approach tendency for both social and control stimuli than TD children. Both groups did not differ in their responses to social versus control stimuli, and this might be due to the fact that only non-aversive stimuli were used. Second, no link was found between social anxiety and children’s approach–avoidance tendencies in the Face Turn AAT. This result contradicts findings of Voncken et al. (2011) and could be explained in terms of sample differences. That is, the Voncken et al. study included participants who were specifically selected according to their level of social anxiety (low versus high), while in the current investigation, social anxiety was no selection criterion but only included as a covariate. In passing, it should be noted that social anxiety was negatively associated with the explicit desire for social interaction (as indexed by the WSIS). This makes sense as individuals with this type of anxiety typically fear being exposed to unfamiliar people or possible scrutiny by others (American Psychiatric Association, 2000). It should be noted that the current study suffers from various limitations. A thorough clinical procedure was followed by a specialized team of professionals to classify children’s ASD diagnoses, and it has been demonstrated that the CSBQ discriminates groups of children with PDD-NOS and high functioning autism from control groups (Hartman, Luteijn, Serra, & Minderaa, 2006). However, no standardized instruments such as the Autism Diagnostic Interview-Revised (Lord, Rutter, & Le Couteur, 1994) or the Autism Diagnostic Observation Schedule (Lord, Rutter, Dilavore, & Risi, 2008) were applied to confirm the ASD diagnoses. Further, all participants showed age-appropriate levels of verbal communication and were able to properly answer the questions. However, we did not administer formal tests of intellectual abilities. While TD children were employed as the control group, it would be of interest to compare the explicit and implicit desire for social contact of children with ASD to that of children suffering from other clinical disorders. Finally, the WSIS and the modified Face Turn AAT were developed for the purpose of the present study, and more research is needed to examine the reliability and validity of these instruments.
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Despite these limitations, the current study is the first to systematically explore the implicit and explicit desire for social interaction in children with ASD. Our findings can be seen as a starting point for further research on this topic. More insight into the desire for social interaction in children with ASD might have important treatment implications as well as theoretical implications with regard to the causality of social impairments (Chevallier et al., 2012). It would be interesting to further investigate the contrasting findings with regard to the desire for social interaction at implicit versus explicit levels, and to explore how the desire for social interaction at both levels is related to actual social behaviour and experienced loneliness. Appendix 1 Example of pictures used in the modified Face Turn AAT (Voncken et al., 2011). See Fig. A1.
Fig. A1. (a) Sequence of the pull response for a male face and (b) sequence of the push response for a male face.
References American Psychiatric Association. (2000). DSM-IV-TR: Diagnostic and statistical manual of mental disorders (4th ed., Rev.). Washington, DC: APA. Baumeister, R. F., & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497–529. Bauminger, N. (2002). The facilitation of social-emotional understanding and social interaction in high-functioning children with autism: Intervention outcomes. Journal of Autism and Developmental Disorders, 32, 283–298. Bauminger, N., Shulman, C., & Agam, G. (2003). Peer interaction and loneliness in high-functioning children with autism. Journal of Autism and Developmental Disorders, 33, 489–507. Bodden, D. H. M., Bo¨gels, S. M., & Muris, P. (2009). The diagnostic utility of the screen for child anxiety related emotional disorders-71 (SCARED-71). Behaviour Research and Therapy, 47, 418–425. Calder, L., Hill, V., & Pellicano, E. (2012). ‘Sometimes I want to play by myself’: Understanding what friendship means to children with autism in mainstream primary schools. Autism http://dx.doi.org/10.1177/1362361312467866 Chamberlain, B., Kasari, C., & Rotheram-Fuller, E. (2007). Involvement or isolation? The social networks of children with autism in regular classrooms. Journal of Autism and Developmental Disorders, 37, 230–242. Chevallier, C., Kohls, G., Troiani, V., Brodkin, E. S., & Schultz, R. T. (2012). The social motivation theory of autism. Trends in Cognitive Science, 16, 231–239. Hartman, C. A., Luteijn, E., Serra, M., & Minderaa, R. B. (2006). Refinement of the children’s social behaviour questionnaire (CSBQ): An instrument that describes the diverse problems seen in milder forms of PDD. Journal of Autism Developmental Disorders, 36, 325–342. Hauck, M., Fein, D., Waterhouse, L., & Feinstein, C. (1995). Social initiations by autistic children to adults and other children. Journal of Autism and Developmental Disorders, 25, 579–595. Hintzen, A., Delespaul, P., Van Os, J., & Myin-Germeys, I. (2010). Social needs in daily life in adults with pervasive developmental disorders. Psychiatry Research, 179, 75–80. Kasari, C., Locke, J., Gulsrud, A., & Rotheram-Fuller, E. (2011). Social networks and friendships at school: Comparing children with and without ASD. Journal of Autism and Developmental Disorders, 41, 533–544. Lord, C., Rutter, M., Dilavore, P., & Risi, S. (2008). Autism diagnostic observation schedule manual. Los Angeles, CA: Western Psychological Services. Lord, C., Rutter, M., & Le Couteur, A. (1994). Autism Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism Developmental Disorders, 24, 659–685. Luteijn, E., Minderaa, R., & Jackson, S. (2002). Vragenlijst voor inventarisatie van sociaal gedrag bij kinderen, handleiding. Lisse, The Netherlands: Swets and Zeitlinger. McConnell, S. R. (2002). Interventions to facilitate social interaction for young children with autism: Review of available research and recommendations for educational intervention and future research. Journal of Autism and Developmental Disorders, 32, 351–372. Muris, P., Steerneman, P., Merckelbach, H., Holdrinet, I., & Meesters, C. (1998). Comorbid anxiety symptoms in children with pervasive developmental disorders. Journal of Anxiety Disorders, 12, 387–393. Nisbett, R. E., & Wilson, T. D. (1977). Telling more than we know: Verbal reports of mental processes. Psychological Review, 84, 231–259. Rinck, M., & Becker, E. S. (2007). Approach and avoidance in fear of spiders. Journal of Behavior Therapy and Experimental Psychiatry, 38, 105–120. Roefs, A., Huijding, J., Smulders, F. T. Y., MacLeod, C. M., de Jong, P. J., Wiers, R. W., et al. (2011). Implicit measures of association in psychopathology research. Psychological Bulletin, 137, 149–193. Rogers, S. J. (2000). Interventions that facilitate socialization in children with autism. Journal of Autism and Developmental Disorders, 30, 399–409. Voncken, M. J., Rinck, M., Deckers, A., & Lange, W. G. (2011). Anticipation of social interaction changes implicit approach–avoidance behavior of socially anxious individuals. Cognitive Therapy and Research http://dx.doi.org/10.1007/s10608-011-9408-5 Wiers, R. W., Teachman, B. A., & de Houwer, J. (2007). Implicit cognitive processes in psychopathology: An introduction. Journal of Behavior Therapy and Experimental Psychiatry, 38, 95–104.
Contents lists available at ScienceDirect
Research in Autism Spectrum Disorders Journal homepage: http://ees.elsevier.com/RASD/default.asp
Desire for social interaction in children with autism spectrum disorders Anne Deckers a,*, Jeffrey Roelofs a, Peter Muris a, Mike Rinck b a
RIAGG Maastricht Child and Youth Care and Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, The Netherlands b Behavioural Science Institute, Radboud University Nijmegen, The Netherlands
A R T I C L E I N F O
A B S T R A C T
Article history: Received 7 August 2013 Received in revised form 19 December 2013 Accepted 26 December 2013
In this experimental clinical study, a first attempt was made to examine the desire for social interaction in children with autism spectrum disorders (ASD). Children with ASD and typically developing (TD) children completed both an explicit measure (self-report) and an implicit measure (Face Turn Approach–Avoidance Task) of the desire for social interaction. On the explicit assessment, children with ASD clearly displayed lower scores reflecting less desire for social interaction than TD children. On the implicit assessment, children with ASD showed a stronger tendency to pull both social and non-social stimuli towards them, which indicates a general automatic tendency towards approach, as compared to the TD children. Possible reasons for this dissociation between the explicit and implicit desire for social interaction are discussed and directions for future research are provided. ß 2014 Elsevier Ltd. All rights reserved.
Keywords: Autism spectrum disorders Children Desire for social interaction Approach and avoidance tendencies
1. Introduction An extensive line of research indicates that positive interpersonal relationships are important for both physical and emotional well-being of individuals (Baumeister & Leary, 1995). Children with autism spectrum disorders (ASD) spend less time participating in social interactions (McConnell, 2002), and are less inclined to initiate social contact with peers (Bauminger, Shulman, & Agam, 2003) than children without ASD. As a result, many interventions aim at stimulating children with ASD to engage in social interactions (e.g., Rogers, 2000). The precise reason for the diminished social contact of children with ASD is unclear. On the one hand, it is possible that qualitative social impairments, such as limited social cognition and lack of social skills, may hinder these children in initiating and maintaining social interactions (e.g., Bauminger, 2002). On the other hand, it has been proposed that children with ASD lack the intrinsic desire to interact with others (Chevallier, Kohls, Troiani, Brodkin, & Schultz, 2012; social motivation theory). So far, it is largely unknown to what extent children with ASD have a desire for social interaction. Children with ASD constitute a heterogeneous group and the current literature indicates that their social behaviour is rather diverse. In general, children with ASD have fewer friends, display lower friendship quality, and take a less central role within social networks. A significant fraction, however, manages to form reciprocal friendships and is involved in social networks in regular schools (e.g., Kasari, Locke, Gulsrud, & Rotheram-Fuller, 2011). Several studies have found that children with ASD report elevated levels of loneliness (e.g., Bauminger et al., 2003), which indicates that they experience a discrepancy between the desired and perceived social functioning. The presence of loneliness implicates that these children want to be involved in interaction with other people, which seems to be in contrast
* Corresponding author at: Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Postbox 616, 6200 MD Maastricht, The Netherlands. Tel.: +31 043 3299640. E-mail address: [email protected] (A. Deckers). 1750-9467/$ – see front matter ß 2014 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.rasd.2013.12.019
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to the argument that they are not motivated to engage in social contact. However, several studies have demonstrated that the understanding of friendship and loneliness is fundamentally different in children with ASD and that the relationship between loneliness and friendships is less coherent (Chamberlain, Kasari, & Rotheram-Fuller, 2007). The existing research does not differentiate between the two lines of reasoning just described. More insight into the desire for social interaction in ASD is needed as variations in social motivation might explain variations in social behaviour (Calder, Hill, & Pellicano, 2012). It is also of clinical importance as it may have implications for treatment. The desire for social interaction can be assessed by means of explicit and implicit measures. Explicit or direct measures consist of questionnaires, interviews, and behavioural observations, and have a long and fruitful history in psychopathology research. At the same time, they also have clear limitations as they rely on the introspective abilities of individuals (Nisbett & Wilson, 1977). Implicit or indirect measures intend to capture more automatic processes, and they produce knowledge about psychopathology beyond conscious introspection or behavioural observations (Wiers, Teachman, & de Houwer, 2007), and as such are complementary to explicit measures (Roefs et al., 2011). In the present study, the explicit assessment method was covered by the Wish for Social Interaction Scale (WSIS), a self-report questionnaire to measure children’s desire for social interactions. To assess the desire for social interaction at an implicit level, a modified version of the Approach–Avoidance Task (AAT) was employed. The basic idea behind an AAT is that positively valenced stimuli will elicit an automatic approach tendency, while negatively valenced stimuli will evoke an automatic avoidance tendency. To measure these tendencies, an experimental paradigm has been developed by Rinck and Becker (2007) during which a series of stimuli are presented one-by-one on a computer screen. Participants are given a joystick and instructed to respond to a certain (irrelevant) feature of each stimulus by either pulling (approach) or pushing (avoid) the joystick. The assumption is that if a participant’s attitude towards the stimulus matches the direction of the required response, the reaction will be faster. However, when the attitude does not match the required arm movement direction, the reaction will be slower. In the current study, we used a similar task, the Face Turn AAT (Voncken, Rinck, Deckers, & Lange, 2011), during which pictures of side-view faces were presented on a computer screen. By moving the joystick, participants were instructed to either turn the faces towards them (pullapproach) or turn the faces away (push-avoid), depending on an irrelevant feature of the stimulus (i.e., whether the target face looked to the left or to the right). The original Face Turn AAT (Voncken et al., 2011) was modified and adjusted to our child population by adding child faces and reducing the duration of the task. Our goal with this modified AAT was to test whether children with a stronger desire for social interaction will display shorter reaction times when they are prompted to turn the faces towards them (approach) and will exhibit longer reaction times when they are prompted to turn the faces away (avoidance). To summarize, this study investigated the desire for social interaction in children with ASD in more detail. For this purpose, we asked clinically referred children with ASD and typically developing (TD) children to complete a self-report instrument (the WSIS) to measure their desire for social interaction at an explicit level. We used the Face Turn AAT as an implicit measure of the desire to engage in social contact. Our expectations regarding the results of this study were ambivalent. Based on social motivation theory (Chevallier et al., 2012), children with ASD can be hypothesized to display lower levels of desire for social interaction than TD children. However, considering the ‘increased loneliness’ findings, children with ASD may display a similar or even stronger wish for social contacts than TD children. As children with ASD are also more prone to develop social phobia (e.g., Muris, Steerneman, Merckelbach, Holdrinet, & Meesters, 1998) and this type of anxiety problem is likely to guide children’s desire for social interaction (e.g., Voncken et al., 2011), we also included a measure of social anxiety as a control variable. 2. Methods 2.1. Participants The sample consisted of 63 children with ASD (autistic disorder: n = 5, Asperger’s disorder: n = 17, and pervasive developmental disorder-not otherwise specified: n = 41) and 69 TD children. The children participated after obtaining informed consent. The gender distribution differed between the two groups: there were more boys among the children with ASD (56 boys and 7 girls) than among the TD children (37 boys and 32 girls) [x2(1,132) = 19.68, p < .01]. The children with ASD (mean age = 9.9 years, SD = 1.26; range 8–12 years) were also significantly older than the TD children (mean age = 9.1 years, SD = 1.35; range 7–12 years) [t(130) = 3.19, p < .01]. Therefore, gender and age were included as covariates in all analyses. Children with ASD were recruited at a community mental health care centre (RIAGG Maastricht). A specialized, multidisciplinary team including licensed child psychologists and psychiatrists, with at least 5 years of experience with this type of psychopathology, determined the DSM-IV-TR diagnoses (American Psychiatric Association, 2000). For each child, the diagnosis was based on extensive assessments using multiple informants: a diagnostic interview carried out with parents (emphasizing the developmental history of the child), a teacher interview regarding the child and his/her interactions with peers, and behavioural observations of the child as documented by a psychologist or psychiatrist. In case of learning problems and/or concerns regarding the cognitive abilities of the child, an IQ test was administered. TD children were recruited via several primary schools. Although these children were not psychologically or psychiatrically examined, parents reported that they did not suffer from significant developmental problems or psychopathology. Results from a parental questionnaire measuring autistic behaviours (i.e., the Children’s Social Behaviour
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Questionnaire, which assesses symptoms such as not being socially tuned, tendency to withdraw, orientation problems, not understanding social cues, stereotyped behaviour, and fear of changes; Luteijn, Minderaa, & Jackson, 2002) confirmed that children with ASD indeed displayed significantly higher symptom levels (M = 42.24, SD = 14.41) than TD children (M = 13.86, SD = 12.45) [t(130) = 12.14, p < .01]. 2.2. Assessments 2.2.1. Explicit assessment The Wish for Social Interaction Scale (WSIS) intends to measure children’s desire for social interactions in a straightforward and explicit manner. This self-report scale consists of a series of yes/no questions regarding the desire to engage in social activities with unknown individuals. Eight side-view pictures of faces (2 boys, 2 girls, 2 males, and 2 females) were displayed one-by-one on a computer screen, and for each picture children had to respond to questions such as ‘‘Would you like to have a little chat with this person?’’ and ‘‘Would you like to play with this person?’’ A total score can be calculated by adding up the number of positive (i.e., ‘yes’) responses. The internal consistency of the WSIS appeared to be good (a = .93). 2.2.2. Implicit assessment A modified version of the Face Turn AAT (Voncken et al., 2011) was administered to implicitly assess the desire for social interaction in children. During this computerized task, profile pictures of faces of boys and girls, men and women were used as the social target stimuli, while pictures of computer screens showing photographs of landscapes were employed as control stimuli. Pictures were presented one by one to the children, with the instruction to respond to the direction (left or right) of the stimulus with a joystick (push or pull) as accurately and quickly as possible. Every time children pushed the joystick, the stimulus turned away from them (i.e., avoidance), and every time they pulled the joystick, the stimulus turned towards them (i.e., approach). When the joystick was correctly and completely pushed or pulled, the stimulus disappeared. To create the turning effect, a series of 7 photographs of each stimulus was used that showed the transition of a frontal view to a dorsal view in fixed steps of 30 degrees (for an example, see Appendix 1). The children had 16 practice trials which were excluded from the data analyses. In total, the task consisted of 140 trials: 14 trials per experimental condition (combinations of 5 stimuli and 2 response directions). Two versions were used to counterbalance the combinations of picture direction, picture category, and response direction. The computer recorded children’s reaction times and accuracy of their responses. Reaction times were recorded following completion of the correct pull or push movements. 2.2.3. Social anxiety The social anxiety subscale of the Screen for Child Anxiety and Related Emotional Disorders (SCARED-71; Bodden, Bo¨gels, & Muris, 2009) was used to assess children’s level of social anxiety. Parents had to indicate how often their child experiences each of nine social anxiety symptoms using a 3-point Likert scale (ranging from 0 = almost never to 2 = often). 3. Results 3.1. Explicit assessment To examine whether children with ASD and TD children differ in terms of their explicit desire for social interaction, an analysis of covariance (ANCOVA) was carried out with the total score on the WSIS as dependent variable, group as betweensubjects factor, and age, gender, and social anxiety as covariates. The results revealed that children with ASD had significantly lower scores on the WSIS than TD children, with means being 18.94 (SD = 13.81) and 28.30 (SD = 11.15), respectively [F(1,126) = 4.52, p < .05, h2 = .03]. Additionally, social anxiety was also significantly associated with WSIS scores: the higher the level of social anxiety, the lower children’s explicit desire for social interaction [F(1,126) = 4.76, p < .05, h2 = .04]. 3.2. Implicit assessment Differences between children with ASD and TD children with regard to their implicit desire for social interaction were explored by performing a 2 (group) 2 (stimulus: social target vs. control) 2 (direction: push vs. pull) repeated-measures ANCOVA on the reaction times as measured during the Face Turn AAT. Again, we included age, sex, and social anxiety as covariates. The results indicated that on average, children with ASD responded slower than TD children [F(1,126) = 7.94, p < .01, h2 = .06]. Moreover, both groups responded more quickly by pulling than by pushing, implying that both groups displayed an overall approach tendency [F(1,126) = 12.18, p = .001, h2 = .09]. Further, a significant interaction effect of group and direction [F(1,126) = 13.88, p < .001, h2 = .10] indicated that this overall approach tendency was significantly stronger among children with ASD (see Fig. 1). The expected three-way interaction of group, direction, and stimulus was not found [F(1,126) < 1], which implies that children with ASD did not exhibit a specific automatic approach/avoidance tendency for social stimuli as compared to TD children. Finally, a main effect of age [F(1,126) = 35.64, p < .001, h2 = .22] and an interaction effect of direction and age [F(1,126) = 6.60, p = .01, h2 = .05] indicated that older children responded faster, and that this age effect was larger for the pull trials. The covariates gender and social anxiety were not significantly associated with reaction times [F(1,126) < 1 and F(1,126) = 2.55, p = .11, respectively].
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Fig. 1. Mean difference in reaction times (in ms) to social stimuli and control stimuli of the Face Turn AAT (push minus pull, thus reflecting an approach tendency) for children with an autism spectrum disorder (ASD) and typically developing children (TD).
Since the reaction times were recorded following completion of the correct pull or push movements, it may well be that errors (i.e., initial pulling instead of pushing and vice versa) had a significant impact on children’s reaction times. To investigate this possibility, an additional 2 (group) 2 (stimulus) 2 (direction) ANCOVA was performed on the error rates, again with age, gender, and social anxiety as covariates. Children demonstrated more errors during push trials (mean = 7.79% and SD = 8.41) than during pull trials (mean = 4.21%, SD = 4.71) [F(1,126) = 22.22, p < .001, h2 = .15], and children with ASD made relatively more of such errors than TD children [F(1,126) = 17.30, p < .001, h2 = .12]. Younger participants displayed more errors, especially during the push trials [F(1,126) = 14.88, p < .001, h2 = .11]. This pattern of findings is similar to that observed for the reaction times, and thus makes it plausible to assume that errors mediated the effects found for the reaction times. Children with ASD had more difficulty pushing the stimuli away than TD children, and this was demonstrated both by slower movements and by more incorrect movements (pulling instead of pushing). 4. Discussion In this experimental clinical study, a first attempt was made to examine the desire for social contact in children with ASD. Explicit and implicit measures of the desire to engage in social interaction were available for both children with ASD and a control group of TD children. On the explicit assessment, children with ASD clearly displayed lower scores, reflecting less desire for social interaction than TD children. This finding is in line with social motivation theory (Chevallier et al., 2012). The results obtained using the implicit measure suggested the opposite. Children with ASD showed a stronger tendency to pull both social and non-social stimuli towards them, thereby exhibiting a greater inclination towards approach than TD children. It is important to realize that the results on the explicit and implicit measures are not mutually exclusive, but provide complementary information (Roefs et al., 2011). It is unclear why this implicit general approach tendency of children with ASD does not manifest itself as an explicit desire for social contact. A possible explanation might be that social interactions are too complex and therefore too demanding for many of these children. It may well be that children with ASD do experience a wish for social interaction at an implicit level but that this is only expressed in specific situations (Hauck, Fein, Waterhouse, & Feinstein, 1995) or with familiar people (Hintzen, Delespaul, Van Os, & Myin-Germeys, 2010). A number of additional results of the Face Turn AAT deserve some comment. First, children with ASD demonstrated a stronger approach tendency for both social and control stimuli than TD children. Both groups did not differ in their responses to social versus control stimuli, and this might be due to the fact that only non-aversive stimuli were used. Second, no link was found between social anxiety and children’s approach–avoidance tendencies in the Face Turn AAT. This result contradicts findings of Voncken et al. (2011) and could be explained in terms of sample differences. That is, the Voncken et al. study included participants who were specifically selected according to their level of social anxiety (low versus high), while in the current investigation, social anxiety was no selection criterion but only included as a covariate. In passing, it should be noted that social anxiety was negatively associated with the explicit desire for social interaction (as indexed by the WSIS). This makes sense as individuals with this type of anxiety typically fear being exposed to unfamiliar people or possible scrutiny by others (American Psychiatric Association, 2000). It should be noted that the current study suffers from various limitations. A thorough clinical procedure was followed by a specialized team of professionals to classify children’s ASD diagnoses, and it has been demonstrated that the CSBQ discriminates groups of children with PDD-NOS and high functioning autism from control groups (Hartman, Luteijn, Serra, & Minderaa, 2006). However, no standardized instruments such as the Autism Diagnostic Interview-Revised (Lord, Rutter, & Le Couteur, 1994) or the Autism Diagnostic Observation Schedule (Lord, Rutter, Dilavore, & Risi, 2008) were applied to confirm the ASD diagnoses. Further, all participants showed age-appropriate levels of verbal communication and were able to properly answer the questions. However, we did not administer formal tests of intellectual abilities. While TD children were employed as the control group, it would be of interest to compare the explicit and implicit desire for social contact of children with ASD to that of children suffering from other clinical disorders. Finally, the WSIS and the modified Face Turn AAT were developed for the purpose of the present study, and more research is needed to examine the reliability and validity of these instruments.
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Despite these limitations, the current study is the first to systematically explore the implicit and explicit desire for social interaction in children with ASD. Our findings can be seen as a starting point for further research on this topic. More insight into the desire for social interaction in children with ASD might have important treatment implications as well as theoretical implications with regard to the causality of social impairments (Chevallier et al., 2012). It would be interesting to further investigate the contrasting findings with regard to the desire for social interaction at implicit versus explicit levels, and to explore how the desire for social interaction at both levels is related to actual social behaviour and experienced loneliness. Appendix 1 Example of pictures used in the modified Face Turn AAT (Voncken et al., 2011). See Fig. A1.
Fig. A1. (a) Sequence of the pull response for a male face and (b) sequence of the push response for a male face.
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