Flat Affect and Reading Facial Expressions: Help for Kids on the Autism Spectrum

"How can I help my daughter (high functioning autistic) to better understand non-verbal cues such as facial expressions and body language?"

“Flat affect” is a term used to describe a lack of emotional reactivity. It is manifest as a failure to express feelings – either verbally or non-verbally – especially regarding issues that would normally be expected to engage the emotions.

With a flat affect, expressive gestures are rare, and there is little animation in facial expression or vocal inflection. A person with flat affect has no – or nearly no – emotional expression. He or she may not react at all to circumstances that usually evoke strong emotions in others.

Many kids with Aspergers and High-Functioning Autism (HFA) have a flat affect. Their facial expressions are fixed or “artificial” in appearance instead of naturally animated. The youngster may not laugh or smile unless cued to do so in an appropriate situation, or he may appear to have a collection of rehearsed or “canned” reactions to match certain circumstances (which, by the way, is actually a real strength).

The youngster’s way of talking may also seem “flat” and monotone. In other words, his words may sound robotic and carefully measured, or there may be a lilting tone to his voice (described by some as “sing-song”) in which his speech sounds as if it's bouncing up and down when he talks.

==> How To Prevent Meltdowns and Tantrums In Children With High-Functioning Autism and Asperger's


Many young people on the autism spectrum have internal feelings that may or may not be reflected on their face. But it's important that they provide natural, spontaneous expressiveness – and recognize facial expressions in others – because facial expressions are a form of non-verbal communication essential to interpersonal relationships.

Reading facial expressions is important for social success. An inability to read facial and social cues makes “connecting” to others very difficult. Learning to translate and digest the meanings of different facial expressions can help determine other people's needs and foster true communication.





Parents can teach their special needs children how to be more expressive, and they can teach the meaning of facial expressions in others.

In teaching the child how to express himself “facially,” parents can model different emotions and the corresponding facial expression (e.g., how being “surprised” may look with raised eyebrows and eyes wide opened). Then, parents can have the child practice such facial expressions while she looks at herself in the mirror.

One method to teach the meaning of facial expressions in others is to use photographs that depict different facial expressions. Here are some other ways to teach your child to “read” facial expressions:

1. Teach your child the different modes of facial expression. Start with the building block basics (e.g., what does anger, disgust or surprise look like?). Realize that one building block of reading facial expressions is to discern that the words being spoken may not necessarily reflect the true inner emotions.

2. Teach your child to listen carefully to whatever words are said, but to examine the overall body and facial language (e.g., clenched teeth, angry piercing eyes, or a set, hard mouth). Some people have subtle tics that worsen under stress.

3. Teach your child to look for overly-intensive stares (e.g., overcompensation, rapid blinking, or small smirks in the face). Kids, especially, can’t help but smile a little when thinking that they are "getting away with it." Liars will either avoid direct eye contact or overcompensate by looking you right in the eyes to assure you of their "sincerity."

4. Reading fear in faces can be discerned, even on a subtle level. Pupils will dilate, the person's breathing will become deeper, the mouth will open wider to take in air, and the eyes will wander around much more than usual.

5. Teach that some people hide many of their true feelings under social discourse, from trying to protect others from negative emotions, to out-and-out deception. Often, the words do not match the emotions being conveyed.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

6. Review facial expressions that signify emotions of happiness, including people with a wide open stare, who move in closer, show an unaffected smile, or relax their eyebrows. Playing with hair is a positive sign for women. So is sitting up straight and extending a hand with an honest smile. This shows the person is receptive, not closing themselves away. Eye contact is increased and hands are open.

7. Teach how body language plays into facial expressions. Many body positions tell more than what the speaker is saying (e.g., folding the arms across the chest, even while smiling and saying nice words, is a known "on guard" position). The opposite posture, then, is someone sitting with legs spread out, slouched in a relaxed position.





8. Teach your child to look at people’s eyes. For many people, the eyes reveal the emotions behind the words. Even if a person is angry and hiding it with polite words, a wrinkling at the edges (with the eyes held at half mast) tells a different story. So does the smile on a sad person trying to hide their tears in public, but is looking away. Teach to read these cues.

9. Teach your child to be careful not to stare too intently while seeking to read someone's facial expressions.

10. There are many tests online in which you can teach and practice discernment of facial expressions.

11. To your child to watch for the “con man” who can be far more skilled at hiding true emotions and manipulating facial expressions. Often, this overcompensation translates into lack of affect (emotion).

12. Watch foreign movies with your child to teach “facial reading” skills. Study how the actors respond to different activities and situations. This is a way to "see" each emotion, because unless the movie is subtitled, you'll be concentrating on nonverbal signals instead of dialogue.


Resources for parents of children and teens on the autism spectrum:
 
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Aspergers in Girls

How the symptoms of Aspergers affect girls differently than boys: 



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What is the Best Treatment for High-Functioning Autism?

“What kind of treatment has had the best outcome for children with autism - high functioning? I’m new to the world of Autism Spectrum Disorders, and I want the best for my child.”

The type of treatment that will have the best outcome varies from child to child depending on his or her symptoms and level of functioning. The most important factor is early intervention. Research shows that early intervention treatment can greatly improve a youngster’s development. Early intervention services help kids from birth to 3-years-old learn important skills.  Services include therapy to help the youngster talk, walk, and interact with others.  Therefore, it is important for parents to talk to their youngster’s doctor as soon as possible if they think their son or daughter has Aspergers or High-Functioning Autism (HFA).



Even if the youngster has not been diagnosed with the disorder, he or she may be eligible for early intervention treatment services. The Individuals with Disabilities Education Act (IDEA) says that kids under the age of 36 months who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.

In addition, treatment for particular symptoms (e.g., speech therapy for language delays) often does not need to wait for a formal diagnosis. While early intervention is extremely important, intervention at any age can be helpful.

There are many different types of treatments available:
  • anti-yeast therapy
  • auditory training
  • discrete trial training
  • facilitated communication
  • music therapy
  • occupational therapy
  • physical therapy
  • sensory integration therapy
  • vitamin therapy

The different types of treatments can generally be broken down into the following categories:
  • Medication
  • Dietary Approaches 
  • Complementary and Alternative Medicine
  • Behavior and Communication Approaches
According to reports by the American Academy of Pediatrics and the National Research Council, behavior and communication approaches that help kids with ASD are those that provide structure, direction, and organization for the youngster in addition to family participation.

A notable treatment approach for children on the autism spectrum is called applied behavior analysis (ABA). ABA has become widely accepted among doctors and used in many schools and treatment clinics. ABA encourages positive behaviors and discourages negative behaviors in order to improve a variety of skills.  The youngster’s progress is tracked and measured.




There are different types of ABA.  Following are some examples:

1. Verbal Behavior Intervention (VBI): VBI is a type of ABA that focuses on teaching verbal skills.

2. Pivotal Response Training (PRT): PRT aims to increase a youngster’s motivation to learn, monitor his own behavior, and initiate communication with others. Positive changes in these behaviors should have widespread effects on other behaviors.

3. Early Intensive Behavioral Intervention (EIBI): This is a type of ABA for very young kids with HFA, usually younger than five, and often younger than three.

4. Discrete Trial Training (DTT): DTT is a style of teaching that uses a series of trials to teach each step of a desired behavior or response. Lessons are broken down into their simplest parts and positive reinforcement is used to reward correct answers and behaviors.  Incorrect answers are ignored.

==> Parenting System that Significantly Reduces Defiant Behavior in Teens with Aspergers and High-Functioning Autism

Other therapies that can be part of a complete treatment program for a youngster with HFA and Aspergers include:

1. Treatment and Education of Autistic and related Communication-handicapped Kids (TEACCH): TEAACH uses visual cues to teach skills. For example, picture cards can help teach a youngster how to get dressed by breaking information down into small steps.

2. The Picture Exchange Communication System (PECS): PECS uses picture symbols to teach communication skills. The person is taught to use picture symbols to ask and answer questions and have a conversation.

3. Speech Therapy: Speech therapy helps to improve the person’s communication skills.  Some children are able to learn verbal communication skills.  For others, using gestures or picture boards is more realistic.

4. Sensory Integration Therapy: Sensory integration therapy helps the person deal with sensory information, like sights, sounds, and smells. Sensory integration therapy could help a youngster who is bothered by certain sounds or does not like to be touched.

5. Occupational Therapy: Occupational therapy teaches skills that help the person live as independently as possible.  Skills might include dressing, eating, bathing, and relating to children.

6. Developmental, Individual Differences, Relationship-Based Approach (DIR; also called "Floortime"): Floortime focuses on emotional and relational development (feelings, relationships with caregivers). It also focuses on how the youngster deals with sights, sounds, and smells.

==> Teaching Social Skills and Emotion Management to Children and Teens with Asperger's and High-Functioning Autism
 
Some dietary treatments have been developed by reliable therapists.  But many of these treatments do not have the scientific support needed for widespread recommendation. An unproven treatment might help one youngster, but may not help another.

Many biomedical interventions call for changes in diet. Such changes include removing certain types of foods from a youngster’s diet and using vitamin or mineral supplements. Dietary treatments are based on the idea that food allergies or lack of vitamins and minerals cause symptoms of HFA and Aspergers.  Some moms and dads feel that dietary changes make a difference in how their youngster acts or feels.

If you are thinking about changing your youngster’s diet, talk to the doctor first. Or talk with a nutritionist to be sure your youngster is getting important vitamins and minerals.

Although there are no medications that can cure Aspergers or High-Functioning Autism - or treat the core symptoms, there are some that can help children with the disorder to function better (e.g., help managing high energy levels, inability to focus, depression, seizures, etc.). Also, the U.S. Food and Drug Administration has approved the use of risperidone and aripiprazole (antipsychotic drugs) to treat kids on the spectrum who experience severe tantrums, aggression, and self-injurious behaviors.

Medications might not affect all kids in the same way. It is important to work with a doctor who has experience in treating kids with HFA and Aspergers. Moms and dads and doctors must closely monitor a youngster's progress and reactions while he or she is taking a medication to be sure that any negative side effects of the treatment do not outweigh the benefits.
It is also important to remember that kids on the spectrum can get sick or injured just like kids without the disorder. Regular medical and dental exams should be part of a youngster’s treatment plan. Often it is hard to tell if a youngster’s behavior is related to the disorder or is caused by a separate health condition. For example, head-banging could be a symptom of the HFA, or it could be a sign that the youngster is having headaches. In those cases, a thorough physical exam is needed. Monitoring healthy development includes paying attention to symptoms related to the disorder as well as the youngster’s physical and mental health.

To relieve the symptoms of HFA and Aspergers, some moms and dads and doctors use treatments that are outside of what is typically recommended by the doctor. These types of treatments are known as complementary and alternative treatments (CAM). They might include special diets, chelation (i.e., a treatment to remove heavy metals like lead from the body), biologicals (e.g., secretin), or body-based systems (e.g., deep pressure). These types of treatments are very controversial. Current research shows that as many as one third of moms and dads with autistic kids may have tried complementary or alternative medicine treatments, and up to 10% may be using a potentially dangerous treatment. Before starting such a treatment, check it out carefully, and talk to your youngster’s doctor.

More resources for parents of children and teens with High-Functioning Autism and Asperger's:
 
==> Launching Adult Children with Asperger's and High-Functioning Autism: Guide for Parents Who Want to Promote Self-Reliance

 ==> Unraveling The Mystery Behind Asperger's and High-Functioning Autism: Audio Book

 ==> Highly Effective Research-Based Parenting Strategies for Children with Asperger's and High-Functioning Autism

==> Parenting System that Reduces Problematic Behavior in Children with Asperger's and High-Functioning Autism
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