Emotions

Emotions

It has been postulated that persons with autism have blunted or inappropriate emotions and that they are unable to understand mental states and the causes of mental states as experienced by themselves and others. In short, it has been proposed that persons with autism lack 'Theory of Mind' (see Frith, 1989). Like the areas of intellectual functioning and language, the emotional domain of persons with autism has been viewed by many as damaged beyond repair. The reader, however, must not be misled by such speculations. Most students who receive intensive early behavioural intervention develop richer and more varied emotional lives than individuals who do not receive such intervention.

The program in this chapter, which describes how to teach students to identify feelings and the diverse causes of feelings, should pose no particular problem for many of the students taught. Complete mastery of the current program, however, requires considerable mastery of expressive language, including the labels of various facial expressions, such as smiling and crying. In addition, the student's ability to use pronouns in sentences such as 'He is angry' and 'We are happy' is essential for full mastery of the Emotions Program. It is possible, however, to help the student make a start at identifying certain feelings both interpersonally and interpersonally without elaborate expressive language provided the student has achieved some mastery of receptive identification of the visual stimuli commonly used to signal basic emotions, such as a smile (see Chapter 18). It is also possible to aid the student who has limited expressive language by teaching him to use written language (see Chapter 29) to label certain emotions.

Before we present the beginning steps of the Emotions Program, it may be helpful to comment briefly on how people often approach the subjects of emotions and emotional development. Let us begin by stating that how one feels about oneself, one's family, one's work, and so forth, is often used as the criterion for whether or not that person has made a successful adjustment. A supportive family life, good friends, and a good job are often cited as causes for feeling happy. When favourable situations are lost or absent, people may describe themselves as unhappy, depressed, or lonely. Further, we often judge other people in terms of whether they make us happy or sad as reflected in such statements as, 'You make me so happy; I could not ask for more,' in contrast to, 'You hurt me; I feel angry and depressed.' Parents are often asked how they feel about their children and may describe that their children give rise to all kinds of feelings, ranging anywhere from extreme love to hurt to anger, depending on how their children behave.

Clinical psychologists and psychiatrists have placed a major emphasis on trying to understand the feelings of their clients, and they guide much of their therapeutic work toward achieving this goal. One often hears of therapies that aim to alleviate feelings of depression, anger, and fear, with the goal often being described as an attempt to help the client reach a feeling of satisfaction and competence. A great deal of effort in clinical training institutions is also placed on helping incoming individuals develop the ability to identify the feelings of others and themselves. It may be said that when one understands how a person really feels, then one can be in a better position to help that person.

Anyone familiar with persons with developmental delays inevitably observes a delay in the growth of many emotions. Some kinds of emotions, such as angry outbursts, may be quite evident, whereas other emotions, such as joy, affectionate attachment, sadness, and grief, may occur relatively rarely. However, the more one learns about individuals with developmental delays, the more one comes to realize that the delay in emotional development is one that can best be described as different in degree and frequency of expression rather than in quality of expression.

Developing Feelings

Given the importance people assign to emotions and the delay in emotional development of the students we serve, it may seem surprising that of the many programs introduced in this manual only one explicitly addresses the student's emotions. There are two reasons for such a brief account. First, for many years we had assumed that emotional development could be taught or shaped up in a way similar to the way we shape up language and other behaviours. In one of the first programs we developed, children were taught to hug each other and the adults who took care of them. After mastering this program, the children demonstrated they had learned to hug others. We had hoped that when the children learned to accept and return hugs, these skills would open up an avenue for more elaborate emotional expressions. In other words, we had hoped that the hug would generalize to other emotional expressions of affection. This was not the case when we began in 1963 and it appears not to be the case now either. We were pleased to be hugged, and the children sometimes seemed pleased as well. But many times the embraces seemed more like the children were merely going through the motions without 'real feelings.' We referred to these hugs as operant hugs. At the same time, it became apparent that it was impossible to teach the children to laugh or cry when it was appropriate to express such feelings. It was as if we had reached a standstill.

The problems involved in teaching genuine and varied emotions solved themselves, however, without the need for specific teaching programs. It took some time before we realized that the development of such emotional behaviours came as a result of progressing through the teaching programs detailed in this manual. In other words, the development of emotional behaviours occurred spontaneously as a consequence of the children's successes and failures in acquiring new and varied behaviours and reinforcers. The emotional development of the children we worked with became more and more like that of typical children, which was one of the strongest signs that we were on the right track.

The strong correlation between the reinforcing properties of an event and the capacity for that event to concurrently elicit emotional behaviours relates back to the old hedonistic interpretation of rewards and punishment. A reward is something that makes you feel happy, and a punishment or loss of a reward is something that makes you feel sad or anxious. Positive feelings are elicited when one's behaviours gain positive reinforcers, such as love, food, and freedom. Positive feelings also arise when one reduces or eliminates negative events by escaping or avoiding unpleasant situations, such as fear, pain, and embarrassment. In contrast, feelings of unhappiness, such as depression and fear, seem elicited by the frustration involved in the loss of a positive reinforcer or the presentation of a negative event. The self-injurious and tantrumous behaviours reviewed in Chapter 5 are often triggered by just those kinds of consequences: Interruption of the student's self-stimulatory behaviour removes a positively reinforcing event, and, similarly, the presentation of an aversive event, such as an instruction the student fails to understand, often causes anger and discomfort.

Two important gains were made when we recognized these relationships. First, we did not have to separately teach emotional expressions because they occurred spontaneously as a consequence of the students' acquisition of more varied behavioural repertoires. Second, the emotions that emerged seemed genuine, sincere, and basic, and looked similar to those of typical individuals. Their genuine appearance most likely reflects that these emotions are inborn or reflexive expressions common to all human beings. A full explanation of these relationships would require an exposition of what has been called classical (respondent) conditioning, which is beyond the scope of this book. Perhaps all that is necessary to know at this point is that the presentation or removal of many or most reinforcers possesses unconditioned stimulus properties that elicit affective-emotional behaviours.

If we now attempt to explain why individuals with autism are delayed in emotional development, we can provide two observations. First, given the individuals' limited behavioural repertoires prior to treatment, in addition to the limited reinforcers available to those individuals, it is reasonable to expect a restriction and delay in expression of emotional behaviours. In contrast, as the student acquires an increasing range of behaviours, the stage is set for the student to come into contact with and acquire a growing range of reinforcing consequences. Second, there is always the possibility that, as reinforcers are gained, they can also be withdrawn or lost for the simple reason that many or most reinforcers are controlled by others. Given this scenario, all kinds of feelings ranging from happiness to sadness should emerge with the delivery or loss of external reinforcers. On the other hand, a student who is heavily involved in self-stimulatory behaviours has control over her own limited range of reinforcers (see Chapter 6). She has nothing or little to lose, for what is reinforcing to her is not controlled by others but rather by her. The less a person has to gain or lose, the less that person is likely to demonstrate emotional expressions of happiness, depression, sadness, and grief. If a person is not attached to others and is not reinforced by their presence, the departure of a person would not cause much anxiety and sadness. Perhaps this is the reason why many autistic persons do not seem upset when their parents leave them alone or when they are lost. One may compare such a person to a meditating guru, who may experience a continual state of peace and serenity provided that such a person is divorced from the everyday world and instead engaged in ritualistic behaviours. Indeed, individuals with developmental delays and autistic features historically have been acclaimed as saints or mystics.

It may help to illustrate the correlation between gaining and losing reinforcers on the one hand and the development of various emotional states on the other hand through examples of excerpts from two popular songs. The song called 'Only You' (Reed, 1955) is about acquisition: obtaining the positive reinforcers associated with love and losing the negative states associated with loneliness. These states are basic to being a happy individual. In contrast, many other songs illustrate the opposite, such as the song from the Beatles called 'Yesterday' (McCartney, 1965). This song is about depression and loneliness associated with extinction and the loss of reinforcers. Songs frequently illustrate feelings caused by the gaining and losing of all sorts of reinforcers.

Once emotional behaviours are triggered, they need to be modified in their expression so as to fit the cultural mode of acceptance. The modification of tantrumous behaviour (Chapter 5) is an example of altering an emotional expression. Tantrumous and angry behaviours have to be modified in typical children as well. Adults contribute in this effort, shaping emotional behaviours such as anger, affection, and sadness into acceptable expressions corresponding to the culture in which the children live. At this point into teaching, you are likely to know enough about reinforcement operations to shape appropriate expressions.

One of the first steps in shaping emotional behaviours is teaching the student to recognize and identify expressions. We start by teaching the student to identify outside or external expressions of emotions. We then teach the student how such external expressions correspond to internal states or feelings. For example, we may teach the student to label external emotional expressions such as smiling and crying and then help the student label the underlying feelings of happiness and sadness. Finally, we teach the student to identify the causes of various feelings (e.g., 'She is happy because you are patting her' or 'He is sad because you are hitting him').

Receptive Identification of Emotional Expressions in a 2-D Format

Some students progress faster when the current program is initiated through the expressive labelling component instead of through the receptive identification component.

However, for most students, receptive identification of emotional expressions tends to be easier to acquire than expressive labelling of emotional expressions; therefore, we recommend that you begin the Emotions Program with receptive identification. In addition, some students progress faster when persons displaying expressions are used rather than pictures of facial expressions. For other students, however, the opposite occurs. Therefore, be flexible with what kinds of stimuli are used.

Prior to beginning this program, the student should have mastered the matching of facial expressions (e.g., smiling, crying, scowling) depicted on photographs as described in the Matching and Sorting Program (Chapter 12). Such matching will facilitate the student's discrimination of and attention to emotional expressions. When using 2-D stimuli, select one picture of a person expressing readily identifiable signs of happiness (e.g., smiling) and another picture of the same person expressing readily identifiable signs of sadness (e.g., crying). Note that the procedures for teaching the student to identify these expressions are identical to those employed in the receptive language programs and thus are outlined only briefly here.

Step 1

Present SD1, which consists of your saying, 'Point to smiling,' while presenting a picture of a person smiling. Prompt and reinforce. Over successive trials, fade the prompt. Place mastery at 5 out of 5 or 9 out of 10 unprompted correct responses.

Step 2

Present SD2, which consists of your saying, 'Point to crying,' while presenting a picture of a person crying. Prompt and reinforce. Over successive trials, fade the prompt. Place mastery at 5 out of 5 or 9 out of 10 unprompted correct responses.

Step 3

Intermix the two SDs according to discrimination learning procedures. Because the pictures of persons smiling and crying may differ in several stimulus dimensions not related to either expression, the student may learn to attend to these irrelevant stimuli instead of the emotional expressions. The identification of emotional expressions should therefore be generalized across different pictures of persons displaying the same expressions until the student is able to extract the expressions regardless of who exhibits them.

Once mastery is achieved in Step 3 (9 out of 10 or 19 out of 20 unprompted correct responses across novel stimuli), generalize from 2-D stimuli (pictures) to 3-D stimuli (in vivo) as described below.

Receptive Identification of Emotional Expressions In Vivo

When teaching this task, it is helpful to have two additional adults (Adult 1 and Adult 2) present to demonstrate emotional expressions. The student, the teacher, and the two extra adults should sit facing each other in a rectangular configuration with approximately a 2- to 3-foot space in the centre. The teacher should have previously instructed the adults to model exaggerated expressions on cue and to maintain a neutral expression between trials. In general, the more exaggerated the expressions, the easier it is for the student to discriminate between them. When exhibiting such expressions, it pays to think of oneself as a performer on stage.

Step 1

Present SD1, which consists of instructing Adult 1 to smile broadly and asking the student to 'Point to smiling' (or simply 'Smiling'). Prompt if necessary, reinforce, and fade the prompt over trials. If you experience problems fading the prompt, try prompting by presenting the 2-D stimulus card used in the previous section. Place the 2-D card on the adult (or have the adult hold it) to prompt the correct response. Fade the card by moving it in gradual steps under the adult's seat or underneath the adult's shirt. Place mastery at 5 out of 5 or 9 out of 10 unprompted correct responses. Generalize to Adult 2, placing mastery at 3 out of 3 or 4 out of 5 unprompted correct responses. Next, alternate between Adults 1 and 2, setting mastery at 5 out of 5 or 9 out of 10 unprompted correct responses.

Step 2

Present SD2, which consists of Adult 1 presenting an exaggerated expression of crying (a sad face and 'sobbing') and your asking, 'Point to crying.' Prompt, reinforce, and fade the prompt.

Generalize to Adult 2 so that the emotional expression is not associated with a particular adult.

► Step

Intermix SD1 and SD2 according to the discrimination learning paradigm, placing mastery at 5 out of 5 or 9 out of 10 unprompted correct responses. Remember to randomly rotate between adults at all stages during this step and, once the random rotation phase of discrimination procedures is reached, also randomly rotate presentations of SD1 and SD2. At this point, you may want to include yourself as well as other adults for generalization purposes.

Expressive Labelling of Emotional Expressions in a 2-D Format

Step 1

Present SD1, the initial picture of smiling used in the receptive identification component, while asking, 'What is he doing?' (or just 'Doing?'). Expressively prompt the response ('Smiling') or use receptive identification ('Point to smiling') as a prompt to help occasion the expressive label. Reinforce each correct response, and fade the prompt over the next several trials. Set mastery at 5 out of 5 or 9 out of 10 unprompted correct responses.

Step 2

Present SD2, which replaces smiling with crying.

Step 3

Intermix SD1 and SD2 according to the discrimination learning paradigm, setting mastery at 5 out of 5 or 9 out of 10 unprompted correct responses. Generalize across other pictures.

Expressive Labelling of Emotional Expressions In Vivo

Because verbally describing emotional expressions in vivo is basic to learning to label underlying feelings of emotional expressions, the current portion of the Emotions Program is presented in some detail. Retain the setting used in the previous section 'Receptive Identification of Emotional Expressions In Vivo.'

Step 1

Present SD1, which consists of cueing Adult 1 to smile and then ask the student, 'What is she doing?' Expressively prompt the answer 'Smiling' for the student to imitate or use receptive identification to help occasion the expressive label. The latter prompt may be arranged by your saying, 'Smile,' to Adult 1 and, once the adult smiles, asking the student 'What is she doing?' Make certain that both adults assume a neutral facial expression between the trials and that the onset of the smile is distinct and exaggerated and occurs concurrently with the instruction. Over successive trials, fade all prompts until the student independently responds by saying, 'Smiling.' A single-word response ('Smiling') is sufficient in the early parts of this program. In later steps, the student may be taught to respond in a complete sentence (e.g., 'She is smiling'). Place mastery at 5 out of 5 or 9 out of 10 unprompted correct responses, then generalize to Adult 2.

Step 2

Present SD2, in which Adult 1 presents an exaggerated expression of crying (a sad face and 'sobbing') and you ask, 'What is she doing?' Prompt the answer 'Crying,' following the same procedures used in Step 1. Set mastery at 5 out of 5 or 9 out of 10 unprompted correct responses, then generalize to Adult 2.

Step 3

Intermix SD1 and SD2 according to discrimination learning procedures. Set the criterion for mastery at 9 out of 10 or 19 out of 20 unprompted correct responses. To facilitate the student's acquisition of the initial discrimination, both adults should maintain a neutral facial expression between trials, and the onset of the adult's exaggerated expressions should occur concurrently with your SDs so as to facilitate the student's attending to (discriminating) what you want the student to respond to.

Generalize the first two emotional expressions across several adults in vivo as was done in the receptive component of this program. Although you could introduce more labels of emotional expressions at this point, we prefer to teach the underlying feelings that correspond to the first two expressions. Once this skill is mastered, additional expressions may be introduced. Be aware that not all students master this component of the Emotions Program. For those students who have difficulty with vocal expressions, the Reading and Writing Program may prove to be an effective format for teaching emotions.

Teaching the Underlying Feelings of Emotional Expressions

Teaching the student the underlying feelings of particular emotional expressions proceeds as follows:

► Step 1

Present SD1, which consists of asking, 'What is he doing?' as the adult smiles. The student should have previously mastered the answer, 'Smiling.' As soon as the student labels the facial expression and while the adult is still smiling, present the question 'How is he feeling?' and immediately prompt the response 'Happy.' Reinforce the student for imitating the prompt. To further facilitate the student's response, you should enunciate the words 'feeling' and 'happy' clearly and loudly to help the student discriminate (attend to) the relevant parts of the questions. Both prompts should be faded over subsequent trials. Consider the response mastered when the student responds correctly to the adult's smile and your question, 'How is he feeling?' in 5 out of 5 or 9 out of 10 unprompted trials.

We recommend that the student respond with the two separate answers 'Smiling' and 'Happy' to the respective questions 'What is he doing?' and 'How is he feeling?' on the assumption that the student will learn to associate the words 'smiling' and 'happy.' However, if responding to two different questions proves too difficult, simply require the word 'happy' in response to the question 'How is he feeling' and the adult's smile (see Step 4 for more detail on implementing this format).

Step 2

Repeat the procedures described in Step 1 using crying rather than smiling as the visual component of the stimuli. In this step, the response to SD2 'How is he feeling?' should be 'Sad.' Place criterion at 5 out of 5 or 9 out of 10 unprompted correct responses.

Step 3

Teach the student to discriminate between the emotions happy and sad by intermixing SD1 and SD2 according to discrimination learning procedures. Both SD1 and SD2 are complex given that they each consist of three components: the adult's smiling or crying, the student's label 'smiling' or 'crying,' and the question 'How is he feeling?' It can be expected that the student will respond incorrectly upon transitions from SD1 to SD2, and vice versa, during the early stages of discrimination learning. The correct answers should therefore initially be prompted by using the least intrusive prompt that is effective. Place mastery at 9 out of 10 or 19 out of 20 unprompted correct responses. As mastery of the SD1-SD2 discrimination strengthens, you may want to extend the responses from 'Happy' and 'Sad' to 'He is happy' and 'He is sad.' Note that such responses require mastery of pronouns. To minimize confusion, you refrain from attempting to teach pronouns at the same time as emotions (i.e., do not try to teach two skills at the same time). An upcoming volume on advanced programs outlines procedures for teaching the student to use pronouns.

It may seem unduly elaborate to present such complex instructions in teaching the student to label the underlying feelings of the overt expressions smiling and crying as 'happy' and 'sad,' respectively. The reasoning behind using this procedure is that it often helps students associate the words 'crying' and 'sad' and the words 'smiling' and 'happy.' The verbal labels are likely to mediate generalization between different physical expressions of the corresponding emotions. Should this procedure be too difficult for a particular student, and to test whether the student acquired the appropriate discrimination through this procedure, go on to Step 4, which may serve to establish or test the correct discrimination between the two emotions.

Step 4

Through Steps 1 to 3, the student may have learned to associate the words 'happy' and 'sad' with the words 'smiling' and 'crying,' respectively, rather than with the expression on the adult's face and your question, 'How is he feeling?' Step 4 helps to correct this problem if it occurs. Begin by presenting SD1, which consists of having the adult smile without being verbally instructed to do so. While the adult is smiling, ask, 'How is he feeling?' The correct answer is 'Happy.' If the student responds incorrectly or fails to respond, repeat the question, prompt, and then fade the prompt over subsequent trials. Place mastery at 5 out of 5 or 9 out of 10 unprompted correct responses.

Step 5

Present SD2 by cueing (but not verbally instructing) the adult to cry and asking, 'How is he feeling?' If necessary, prompt the correct response, 'Sad.' Place mastery at 5 out of 5 or 9 out of 10 unprompted correct responses.

Step 6

Intermix SD1 and SD2 according to discrimination learning procedures. Mastery is reached when the student correctly responds to the SDs presented in random rotation in 9 out of 10 or 19 out of 20 unprompted responses.

Solidify this discrimination by generalizing it across different adults and environments over the next 1 to 2 weeks, extending it into everyday situations. Include in this generalization the student's parents and siblings, and involve the teaching of sentences as illustrated in answers such as 'Mommy is happy' and 'Baby is sad.'

The Causes of Feelings

Once a minimum of two different expressions of emotions and their respective underlying feelings are mastered, teach the student to label the causes of feelings.

Step 1

Present SD1 by cueing the second adult to smile and asking the student, 'What is she feeling?' Immediately after the student gives the correct response 'Happy,' affectionately pat the adult on the back; ask, 'Why is she happy?'; and then prompt, 'Patting.' The prompt should be faded until the student responds correctly without prompting in 5 out of 5 or 9 out of 10 responses.

Step 2

Present SD2 by cueing the second adult to look sad and asking, 'What is she feeling?' Immediately after the student gives the correct response, 'Sad,' look angry and mock slap one of the adult's arms; ask, 'Why is she sad?'; and then prompt, 'Hitting.' Fade the prompt and place mastery at 5 out of 5 or 9 out of 10 unprompted correct responses.

Step 3

Intermix SD1 and SD2 according to discrimination learning procedures. Place mastery at 9 out of 10 or 19 out of 20 unprompted correct responses.

Step 4

It is essential to generalize the student's achievements from the formal teaching setting to everyday life. To generalize SD1 and SD2, first replace the original adults with new persons (including family members and friends) who have somewhat different ways of expressing the facial manifestations of happy and sad emotions. Next, generalize the causes of feelings. For example, take food away from an adult or yell at an adult to cue crying and feelings of sadness. Tell another person how smart and pretty she is or give her a present to cue smiling and happiness. If the student has a baby brother or sister, opportunities for teaching about feelings are numerous (e.g., before and after the baby is given the bottle, before and after a nap).

Once begun, training should proceed with increasing ease and be extended to everyday life. At some point into generalization, the student should be able to master the causes of various emotions after having them pointed out just one time. This is called one-trial learning (sometimes referred to as incidental learning). Once the student masters basic actions or causes after one trial, gradually shape his responses into phrases (e.g., 'Because you are patting her' or 'Because you are hitting him').

There are no hard and fast rules established concerning when the next emotion should be introduced. We suggest that the student be taught additional emotions depending on how quickly he mastered the discrimination between the first and second emotions. If the student mastered the first discrimination quickly (i.e., the student acquired the first discrimination in both the receptive and expressive components of the Emotions Program in 1 week of teaching with a total of 2 hours per day focusing on this program), then additional emotions may be introduced at the rate of one every other week. If the student mastered receptively and expressively identifying the first two emotions with moderate difficulty (e.g., after 20 days of practice with a total of 2 hours per day focusing on this program), do not teach a third emotion right away, but rather place the original two emotions on a maintenance schedule and teach the third emotion a month or two later. If the student required more than 20 days (or 40 hours) achieving the receptive discrimination between the first two emotions, it may not be to the student's advantage to pursue the Emotions Program at the expense of teaching other skills at this point. Instead, we recommend introducing and expanding upon other programs, returning to the Emotions Program after a couple of months, or teaching emotions through the Reading and Writing Program (Chapter 29).

Teaching the Student to Label Her Own Feelings

It is of the utmost importance for the student to learn to generalize her understanding of others' feelings to her own feelings. Once the two basic feelings (i.e., happy and sad) are taught in reference to other persons, it is appropriate to teach the student to label her own emotional expressions and their underlying feelings.

This portion of the Emotions Program parallels the portion used to teach the student to label the emotions of others. Modify the present portion such that the student rather than the adult is prompted to smile (e.g., by being tickled or fed) and taught to answer the questions 'How do you feel?' and, later, 'Why are you happy?' After the student is taught to describe her happiness, she may be taught to describe her feelings of being sad. This may be done by frowning and mocking a spank to cue a crying response prompted through imitation of your wiping off pretend tears and moaning. Discrimination learning procedures should then be introduced. Once this initial discrimination is established in a controlled learning situation, the meaning of these feelings will be more fully acquired in the student's everyday environment as she encounters situations that naturally give rise to smiling and happiness or crying and sadness in other persons and her. The student's learning to describe her own feelings marks a giant step in her development.

Once the student learns to discriminate and generalize the associations between smiling and being happy and crying and being sad, a third basic emotion such as anger may be introduced. Anticipate difficulties when teaching more complex feelings in which the cues are subtle and thus hard to discriminate, such as the distinction between sadness and guilt. Keep in mind that feelings are complex, and even a typical individual can spend an entire lifetime learning about them without ever achieving mastery.

What to Expect

Students differ widely in their rates of mastery of the Emotions Program. Some students master the discrimination between smiling and crying, the underlying feelings of these expressions, and the causes of the underlying feelings in less than 1 hour of one-on-one teaching. Others master the receptive discrimination between smiling and crying but fail to progress beyond that stage. Some of these same students, however, demonstrate progress when emotions are taught through the Reading and Writing Program.

The Emotions Program is one of the most recently developed programs. There is obviously a great need for objective outcome data on this and similar programs, as well as a need for systematic research to help identify more effective teaching procedures. We hope that the presentation of this program will facilitate such research.