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Although there are several examples of educational software aimed at teaching FER such as Gaining Face (www.ccoder.com/GainingFace/) and Fun with Feelings (www.ultimatelearning.net) there are relatively few empirically reviewed interventions currently available.

“Emotion Trainer”, a multimedia software programme, includes photographs of real people and animated emotional expressions and aims to improve basic FER and a number of ToM principles (Silver & Oakes, 2001). The FER component of the programme presents photographs of facial expressions one at a time and requires participants to choose which of four emotion labels accurately describe the portrayed emotion. The ToM training component teaches participants how to anticipate emotional states in others from situational events and mental states. Emotion Trainer provides the participant with consistent feedback, reinforcements and prompts. For correct answers, participants are rewarded with a congratulatory message incorporating a short, fun animation. For incorrectly answered questions, they receive a message prompting them to try again along with cues to the correct answer provided on subsequent incorrect attempts. ASC individuals (aged ten-eighteen) participated in an evaluation study; half of whom received ten sessions of training over a period of two-three weeks and the remaining half, matched on gender, age and school class, receiving no intervention. Results demonstrated an improvement in the intervention group in all taught areas, however, the intervention had no effect on FER since the control group also demonstrated

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similar gains indicative of any FER performance gains being attributable to the passage of time or practice effects (Silver & Oakes, 2001). However, ToM abilities did improve in the intervention group relative to controls offering support for the CAL approach. Silver and Oakes (2001) ascribed the failure of the intervention to significantly improve FER to potential issues with the validity of both the facial training stimuli and the facial stimuli used in the measures of FER ability (for example, the angry face did not present the typical facial behaviour associated with this emotion), rather than the CAL approach and stressed the need for valid and representative facial stimuli in future interventions and evaluative research. Positive feedback from school staff and the children who participated in the training was received post-intervention demonstrating that the children enjoyed the programme and were engaged, focussed and enthusiastic.

Traditionally, ASC research has focussed on a deficit model of autism, with cognitive theories attempting to describe and explain the difficulties and impairments experienced by those on the spectrum and interventions attempting to rectify them. However, more recently, theorists have begun to turn their attention towards a more positive model of autism, one which focuses on describing and explaining the strengths and islets of ability commonly identified within this population. This new way of thinking opens doors to revolutionary interventions which capitalise on these strengths in order to compensate for impaired social behaviours (Golan & Baron- Cohen, 2007). One such intervention, Mindreading: the interactive guide to emotions (Baron- Cohen et al., 2004) draws on the ES theory of autism (Baron-Cohen, 2005), and aims to remediate the affective deficit in ASC by capitalising on their superior systemising abilities (Golan & Baron-Cohen, 2006)

Mindreading is an interactive and comprehensive multimedia resource which combines text, video and audio to systematically teach emotions to ASC individuals. Information is presented in a taxonomic system of 412 basic and complex emotions and mental states systematically organised into thematic emotion groups and different difficulty levels corresponding to typical developmental ages. The software includes a library resource to learn about each emotion in addition to offering lessons and quizzes and includes reward and feedback systems to motivate learners (Golan & Baron-Cohen, 2006). Although evaluation studies of the Mindreading software (Baron-Cohen et al., 2004; Golan & Baron-Cohen, 2006), which assessed the efficacy of the intervention as a standalone intervention and in conjunction with social skills group training sessions, have reported significant improvements in adult user’s FER abilities relative to

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ASC matched controls who did not receive training, gains have been limited to improved recognition of emotions from variations of taught stimuli (faces and voices used in the software). The intervention, whether used alone or supported by group social skills sessions, failed to enable distant generalisation (transference of acquired skills to real life situations) in adult HFA ASC users.

La Cava et al. (2007) evaluated Mindreading with a group of children (aged eight to eleven) over a ten-week period. In contrast to the adult evaluation studies, children did demonstrate some generalisation of learning, although this was only apparent for emotive voices and not for FER. Results however must be interpreted with caution since this study employed neither an ASC or non-ASC control group. As such, the reported gains may have been due to practice effects or the passing of time. However, La Cava et al. (2007) observed different patterns of usage within the software, with some children primarily accessing the library section, others accessing quizzes but all children accessing the games section of the software. Post- intervention feedback demonstrated that Mind reader was fun and motivating for the children, they enjoyed interacting with the software and found it interesting, which provides support for the assertion that CAL technologies may be particularly beneficial for delivering training to ASC children.

Another example of a CAL FER intervention is the Frankfurt test and training of facial affect recognition (FEFA), developed and evaluated by Bolte et al. (2002). Comprising photographs of the basic emotions plus neutral expressions, the format is simplistic and involves participants viewing either whole expressive faces or the eye region of these faces only (to engender two levels of complexity) and choosing the label (from a list of seven possible answers) that corresponds to the facial affect displayed. Learning is bolstered by visual and acoustic feedback and in the case of incorrectly answered items, participants are able to view descriptions of the emotion in both text and comic strip format. Using a pre-post design, HF ASC adolescents and adults trained with the software for two hours per week over a five week period and FER gains between pre and post intervention were compared to an ASC control group who received no training. Significant FER performance gains were observed for the intervention group for both whole face and eye region only stimuli whereas no gains were observed in the control group, demonstrating the usefulness of the software, and this approach, to teach FER to HF ASC adults. However, there was no generalisation of learning to novel faces or contexts. Similar

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behavioural results were observed in a subsequent study (Bolte et al., 2006). Behavioural results were combined with a neuroimaging study which assessed the effect of FEFA use on FER processing. Bolte et al. (2006) found no evidence of increased activity in the fusiform gyrus. FER gains in the intervention group however did coincide with greater right medial occipital gyrus and right superior parietal lobule activation and since these neural regions are believed to be implicated in compensatory face processing, it is suggested that the ASC individuals improved their FER abilities using differential strategies to those typically adopted by non-ASC individuals.

Moore et al. (2005) developed and evaluated a CAL tool as a means of teaching FER and ToM to ASC children by presenting facially manifested displays of affect on humanoid animated 3D avatars. In this exploratory study, three stages of training were included which could be completed in any order. Stage one involved either selecting an emotion label that best represented the facial expression of the avatar or selecting a facially expressive avatar head (from a choice of four) that matched a description and label of an emotion. Stage two involved participants deciding which face was most appropriate to a given scenario (such as “how would you feel if your brother broke your toy car”?). Stage three required participants to choose a scenario or event that would bring about the emotion represented by a given avatar. The CAL captured and recorded data during use and results indicated that 90% of the participating ASC children (aged seven to sixteen) were able to identify and predict emotions from a 3D avatar and suggested that the facility for repetition and practice in addition to creating an environment whereby the child can express their own emotional responses to situations through an emotionally expressive avatar allows learning to take place. This study is offered as an example of a virtual reality which could be an appropriate environment for the delivery of ASC interventions. Since no control groups were included and no pre-intervention measures of FER were provided for comparison, the main results from this study pertain to the motivational value of the medium which was found to be positive.

The Transporters animation series (Golan et al., 2009, 2010) uses animated vehicle characters to teach FER and emotion comprehension to low and high-functioning ASC children. Like Mind reader, this intervention aims to capitalise on the systemising cognitive style of ASC children by superimposing real life faces onto the bodies of animated trains. Since the ASC child’s typical cognitive style is that of a systemiser, they should, according to the ES theory (Baron-Cohen,

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2005), be more likely to attend to these faces because of their preference for predictable rule- based systems (such as vehicles). Golan et al. (2009) proposed that were the faces attached to human bodies, whose actions are wholly unpredictable, the child would be less likely to be attracted to them and opportunities for face appraisal would be diminished. Golan et al.

hypothesised that because the faces were grafted onto characters that appeal to ASC children, they may appraise the faces (and implicitly learn the featural and configural clues associated with expressions of affect) without even being aware they are doing so. They capitalised on the preferences and superior abilities of ASC children to create a more ASC friendly context in which to learn. The intervention comprised fifteen five minute episodes, each one focussing on a particular emotional state. Basic and complex emotions and mental states deemed developmentally appropriate or useful to the child’s age (e.g. unfriendly, jealous, joking) are featured. Quizzes (easy and difficult), which include matching faces to faces, situations to faces and faces to emotions also feature and provide feedback and reinforcements. A degree of autonomy is provided whereby the children can choose which episode to watch and which quizzes to access. Parental involvement in order to consolidate learning was encouraged throughout the training phase in order to practice generalising acquired skills and knowledge to real life situations. In an evaluation of the intervention, HF ASC children undertook training and were matched on age, gender and verbal ability to ASC children who did not receive training and non-ASC children. A pre-post design demonstrated that following intervention, the ASC intervention group significantly improved their FER and comprehension abilities relative to their pre-intervention performance. Furthermore, whereas prior to intervention, their performance was significantly poorer than matched non-ASC controls, following training, their scores were comparable. The ASC intervention group were also able to generalise their learning to new contexts (situations and faces that were not included in training and faces that were not grafted onto the bodies of trains). A couple of unique features of this intervention may have accounted for the success of Transporters where others have only seen limited success. Rather than simply presenting and labelling facial expressions of affect, the DVD series provided an explanation of the emotion and embedded it within context, which may have allowed the child to generalise this knowledge to new contexts. Golan et al. (2009) proposed that empathy gains, indexed by enhanced FER ability following four weeks of training, could be due to the appeal of the characters used to deliver the training and the impact this has on the child’s intrinsic

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motivation to attend. This argument appears plausible given that children chose to watch between 49 and 382 episodes whereas they were only required to watch fifteen episodes per week. Although exciting, the study suffered from a number of weaknesses. No measure assessed whether performance gains translated to improved real life social functioning, although parental anecdotal reports suggested this may be the case with parents stating that the children were more interested in faces following intervention. However, the integrated approach adopted in this study (intervention plus parental support and consolidation of learning), whilst positive in terms of promoting discussions and interest in the topic area of emotions could have confounded results as to the efficacy of the intervention as a stand- alone remediation tool. Parental involvement was not controlled for and therefore the gains achieved in the evaluation study could have been due to parental tutoring, the DVD or a combination of both. This intervention however is one of the first to embrace and capitalise on the learning and cognitive styles and superiorities of ASC in order to address affective deficits.

In light of these criticisms, Young and Posselt (2012) conducted a study which compared the efficacy of the Transporters DVD series with an alternative DVD series “Thomas Discovers Emotions” (TDE) and assessed whether either or both series led to improved FER and social functioning. This study was designed to clarify which elements of the Transporters DVD led to FER gains. ASC children (aged four to eight) participated, thirteen of whom were randomly allocated to the Transporters condition and the other twelve to the TDE condition. The TDE DVD comprised episodes from the popular Thomas the Tank Engine series. Fifteen episodes were selected based on their focus on emotional content and included characters from the animated series displaying expressions of facial affect and typically (but not always) these expressions were supplemented by a narrative describing the emotion felt. Whereas the Transporters DVD used human faces grafted into to the animated trains’ bodies, the TDE DVD presented facial affect on animated synthetic faces. Furthermore, whereas the Transporters DVD was specifically designed to focus the child on emotions and kept the background bland to avoid distracting features, the TDE merely included emotional content and the background was attention grabbing to children, as would be expected in a child’s animated series. TDE and Transporter episodes’ length were comparable. Results revealed that post intervention, FER gains were only achieved in the Transporters condition suggesting that the content of the DVD, rather than mere exposure to emotional information in a cartoon series was the causal factor of

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remediation. However, interestingly, social behaviour (including increased use of eye contact) following intervention was significantly improved in both conditions, indicating that exposure to an ASC child friendly series featuring emotional content can positively impact social development regardless of the ability to pass FER tests in an empirical setting. Although it could be argued that possibly the fact that emotions were conveyed on synthetic rather than human faces could have attributed to the failure of TDE bringing about FER improvements, since the children may struggle to generalise skills from a cartoon face to a real human face, failures could also have been due to a combination of the lack of focus on teaching FER in the TDE series and on the failure to minimise distracting competing background visual stimuli. It has long been established that stimulus over-selectivity during learning tasks (the individual responds only to a part of the relevant stimulus or attends to irrelevant stimuli) is problematic in ASC (Lovaas et al., 1979). To overcome this barrier to learning, especially in the case of teaching FER which requires focus on facial features, tasks should be explicitly taught through repetition, tasks should be broken down into small, manageable steps, presented information should be simplified and distracting features in the learning environment should be minimised, in order to promote focus on the “to be learned” materials (Lovaas et al., 1979). The TDE intervention did not explicitly teach FER skills, it did not promote focus on the faces of the characters and it provided a highly distracting learning environment. It is not surprising therefore that the children failed to improve their FER abilities.

Given the finding that social behaviours can benefit from a cartoon series incorporating animated emotional faces however, it could be the case that, if integrated into a carefully and theoretically designed intervention, following the principles outlined above, similar or even better (discussed in the Chapter Six) gains could be achieved in FER.

Also found to be both appealing to children and effective in remediating social skill deficits is FaceSay (Hopkins et al., 2011), a social skills intervention aimed at ASC children which embeds training in a colourful and fun game in a bid to motivate children. Designed for both low and high functioning children, FaceSay comprises three games, each of which is dedicated to remediating a different ASC impairment and includes a virtual avatar to guide the children through activities. Games target eye gaze attendance and the recognition and discrimination of faces and facially expressed emotion and include a range of activities including completing face puzzles and manipulating and matching faces and expressions. In an evaluation study, children

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(aged six to sixteen) engaged in training over a six week period and whilst all children demonstrated improvements in FER and enhanced social interaction behaviours in natural environments such as the playground, relative to matched controls, the HF ASC group also improved their face recognition abilities. The researchers attributed the success of the intervention, in part, to its ability to engage the ASC children. Children showed an enthusiasm for starting training sessions and most continued playing until they had finished an activity. A more recent evaluation of FaceSay has reaffirmed the efficacy of this CAL technology (Rice et al., 2015).