A Training to Develop Emotional Awareness in Children with ASD and Cognitive Delay: A Preliminary and Qualitative Study

Background:

Autism spectrum disorders (ASD) are complex phenomena, to which no suitable answers about the mechanisms underlying them have been found yet, involving poor abilities to establish and develop social relationships and understand emotional and mental states.

Objectives:

Our aim was the creation of an effective and specific training program for children with ASD and cognitive impairment to enable the rehabilitation of emotional skills (comprehension, expression and regulation). Specifically, the goals were the development of the ability to express and recognise emotions introspectively and with full awareness in complex social situation as well as the understanding of false beliefs.

Methods:

Five ASD teenagers (aged between 13 and 17; all males) with mild-moderate cognitive delay - were involved in the training on a weekly basis for 8 months.

The training consisted of three steps:

• Briefing (duration 10 minutes): the participants were asked to write down emotional relevant episodes on coloured cards (red for negative episodes and green for the positive ones), then the trainer read their stories aloud and all the children were invited to make and share their comments in the group, avoiding to take any judgmental attitude;
• Autogenic training (duration 30 minutes): the participants were presented with a new and very simple training created in a way to be suitable for their cognitive level: it was broken down in steps, which were repeated always in the same way, thus making their sequence predictable. Three types of exercises were included (relaxation and mindfulness, breathing, and guided imagery). During this phase, the participants were invited to tear off the red cards (filled-in previously) so to discard the negative emotions and keep instead the green cards (positive emotions) to share with the group.
• Free drawing (5 minutes): the participants were then asked, to make, in turn, graphic signs, or drawings (as they liked), on a large sheet so as to spontaneously expressing their internal states.

Results:

A change in the score at the TEC – Test of Emotion Comprehension – administrated to the participants before and after the training and video-recorded, was observed. Specifically, the results showed a qualitative and quantitative improvement in the ability to recognise their own emotions, as well as those of the others, and the mental states of others. Interestingly, a remarkable improvement in the participants’ performance was reported in the false belief tasks. Major changes were also found in the free drawing, used as a tool for encouraging the expression of emotions. A significant improvement was observed in self-reflection ability as evident from the participants’ performance in the choice of the emotional episodes to be shared with the group. Finally, a better regulation of the expression of anger, through the spontaneous use of the breathing techniques learnt during the training program, was also reported.

Conclusions:

The results show the importance of focusing on empathy skills – an element often neglected in the standard protocols applied to the rehabilitation of ASD individuals – for the development of a more effective and mindful emotional rehabilitation training.