Enhancing Cognitive Processing of Complex Emotional Cues in Young Adults on the Autism Spectrum through an Online Intervention

Background: Individuals with autism spectrum disorder (ASD) exhibit differences in executive functioning compared to individuals without ASD, particularly with regard to selective visual attention and emotional identification. Little research has developed interventions aimed at young adult individuals with ASD, although this is a developmental period of critical transitions and important educational milestones.

Objectives: This study aimed to develop and evaluate a novel, short-term, online intervention to improve selective visual attention in young adults with ASD.

Methods: A total of 23 participants (13 males; age range: 18-24 years) completed the intervention. Seventeen individuals who were clinically diagnosed with ASD were recruited from the autism clinic at a local medical school. The remaining six were recruited from the undergraduate population at a small liberal arts university and reported autistic traits in the clinical range as assessed by the Autism Quotient (Baron-Cohen et al., 2001). The intervention included eight online sessions, to be completed over the course of three weeks. The first and last sessions constituted a pre- and post-test of performance on tasks designed to assess visual attention and emotion identification. The training sessions included six tasks designed to train participants in selective attention (e.g., Stroop task) and emotion identification (e.g., emotion identification of morphed faces). The pre- and post-training tasks consisted of 1) an emotional flanker task, in which participants identified whether a center face flanked by four other faces displayed a congruent or incongruent emotion, 2) a classic flanker task, in which participants identified whether a center arrow pointed in a congruent or incongruent direction as its flanking arrows, 3) a basic face emotion identification task, in which participants  identified basic emotional expressions (i.e., happy, angry), 4) a complex face emotion identification task, in which participants  identified complex emotions (i.e., shame, pride), 5) a basic eyes emotion identification task, in which face stimuli were cropped to only display the eyes, and participants identified basic emotional expressions, and 6) a complex eyes emotion identification task, in which participants identified complex emotions from the cropped face stimuli. 

Results: ASD individuals showed a significant improvement in the complex eyes emotion identification task after completion of the training modules (M₁ = 5.69, M₂ = 6.77), t = -2.59, p= .024. For the basic eyes emotion identification task, participants averaged a similar number of correct responses during both the pre-training and post-training tests. There were no other significant differences in pre- and post-task performance.

Conclusions: These data indicate that this training module might be useful for improving emotional identification skills in individuals with ASD, at least with those emotions that are less easily identifiable than basic emotions. These findings suggest that these online training modules, that could be accessible to a large number of affected individuals, might be effective in helping individuals with ASD to distinguish between subtly different emotional expressions. Larger scale studies are needed to further investigate the efficacy and ecological validity of this intervention.