(R.- 265905) Estados Unidos Mexicanos

A number of limitations in this thesis need to be discussed. Firstly, whilst this thesis has shown that the CERT improves emotion recognition, we have not addressed the next step, that is, whether an improvement in emotion recognition is related to an improvement in behaviour. We are currently in the process of following up the same participants six-months later and are collecting repeat behavioural data from the child’s schoolteacher. Importantly, the schoolteachers were not aware of who was taking part in the CERT, as it was completed during times when the child would have normally been with the Police Community Support Officer (PCSO) or Family Support Worker. However, because the teachers were aware that children were participating in a study, there are potential issues surrounding objectivity. Because of

this, we are also collecting objective data, such as the number of parental meetings about problematic school behaviours and exclusion rates, to find out whether a change in behaviour has occurred subsequent to the improvement in emotion recognition. Previous studies have shown that improving emotion recognition is associated with reduced aggressive behaviours and a reduction in the severity of crimes (Hubble et al., 2015; Penton-Voak et al., 2013) so it seems plausible that similar improvements in behaviour may be observed in the current sample. We have shown in section 2.2 that the children featured in this thesis are typically not liked by other children, they would not share with others and are not considerate of other’s feelings and would not help others. Emotion recognition is thought to be related to social skills (Vachon et al., 2014) and Hubble et al. (2015) showed that an

improvement in emotion recognition was related to a reduction in the severity of crimes committed in the 6 months following the intervention. High severity crimes generally involve more physically aggressive behaviour and more interpersonal violence and so these authors rationalised that the improvement in emotion

recognition may have resulted in a better understanding of the emotions of potential victims. Indeed, emotion recognition is predictive of positive social adjustment and prosocial behaviour (Belacchi & Farina, 2012; Leppänen & Hietanen, 2001). It could be likely that in our sample we would see an improvement in social skills and better friendships with others, which is a protective factor in preventing further behavioural issues and future criminal behaviours (Hodges, Boivin, Vitaro, & Bukowski, 1999).

Secondly, whilst we obtained informal feedback from both the children

participating in the CERT and the individuals who delivered it, we currently do not have any formal feedback. Again, this is currently being addressed as we are in the process of collecting qualitative data from the individuals who provided the CERT. Informal feedback does appear positive though; the children appear to enjoy the

activities, specifically the interactive nature of them, and they enjoyed the fact that it was on a computer. Individuals delivering the CERT have commented on the usefulness of it being a short intervention. A more in-depth evaluation of the CERT, including a cost-benefit analysis, however, needs to be conducted.

Another issue is that we lacked a suitable control group within Chapter 4. The current research was an exploratory and preliminary study into changes in emotion recognition and empathy impairments after completing the CERT. However, our two participant groups differed on emotion recognition at baseline and, therefore, are not suitable to compare at post-test. The next step in this research would be a study design higher on the Maryland Scientific Scale (Farrington et al., 2002) whereby the DB+ group are randomly allocated to receive the CERT or not. This would provide two groups who were similar at pre-test and then could be directly compared again at post-test. However, the sample size of the DB+ group prevented us adopting this approach in this thesis.

To be included in the DB group, they only had to reach the threshold for one of three of the SDQ subscales. Because they were recruited from the Early Intervention Hub, this group were also exposed to a range of different risk factors (e.g. domestic abuse and mentally ill parents). It is possible that these differences in behaviour and risk factor exposure could have influenced their emotion recognition and empathy abilities. For example, Pollak and Sinha (2002) showed that physically abused children require less sensory input to identify facial displays of anger than controls. Future research should aim to examine the influence of these risk factors on emotion recognition and empathy ability.

This study did not consider the influence of CU traits despite their hypothesised importance in emotion recognition and empathy (Dadds et al., 2006; Pasalich et al.,

2014). Future research should investigate the role of CU traits in the emotion recognition and empathy abilities of children with disordered behaviour.

Finally, we did not correct for IQ when analysing emotion recognition scores. This is because in Chapter 3, our DB groups differed in emotion recognition but not IQ, ruling out a key role for IQ in emotion recognition abilities. Additionally, we did not find a significant correlation between negative emotion recognition and IQ in Chapter 4. Some research does suggest that IQ plays a role in emotion recognition (Lawrence et al., 2015); however, other research has questioned this (Airdrie et al., 2018; van Zonneveld et al., 2018). Therefore, future research should aim to further investigate the role of IQ in emotion recognition.

Additionally, we do not know how long the duration of emotion recognition improvement lasts. Previous studies have tested emotion recognition immediately after training and have not investigated the duration of improvement over time. Additionally, it would be interesting to see if emotion recognition abilities continued to improve once a sufficient amount of time after training has elapsed to allow more (good quality) interactions with others (Rawdon et al., 2018). Perhaps we would see a further improvement in emotion recognition once the children had more time to

practice and consolidate their emotion recognition skills, which may then influence other social skills. We have already shown that the positive effects of the training transfer to the recognition of novel faces and the effect of training may thus go on to influence participants’ real-world social interactions.

Regarding our empathy measure, relying solely on participants to report their own emotional states can be problematic because antisocial children may have difficulties verbalising their thoughts and feelings (Quiggle et al., 1992). Since estimates of IQ were not related to measures of empathy, we believe this particular issue was not a problem with using self-report empathy in this thesis. Nevertheless, self-reported

emotional states are vulnerable to demand characteristics and social desirability (Eisenberg-berg & Hand, 1979; Eisenberg et al., 1989). Consequently, self-reports might not necessarily reflect how one has actually felt, but rather indicate one's

knowledge of how other people expect one to feel. Physiological measures have been employed to assess affective empathy such as heart rate or skin conductance (van Zonneveld et al., 2017). Nonetheless, these measures are also open to some criticism. For example, skin conductance measures general arousal and is not sensitive to discrete emotions (Mauss & Robinson, 2009). Since we considered discrete emotions, this would not have been suitable. Furthermore, it is currently uncertain whether empathy, sympathy and distress can be reliably distinguished by using these physiological measures (Zhou, Valiente, & Eisenberg, 2003); self-report measures can attempt to disentangle these different concepts even though the reliability and validity of these measures in samples of young children and/or those with limited verbal ability remains a doubt. Additionally, we did not include a measure of motor empathy, although it has also been implicated in emotion recognition (Blair, 2005b). To date there is little research on motor empathy within antisocial populations (Bons et al., 2013) so future research should determine the nature of motor empathy impairments and therefore whether interventions would also be required to improve motor empathy and its relationship to emotion recognition.

Another issue is that we did not consider gender differences throughout the thesis. We know that there are sex differences in emotion recognition (Wingenbach, Ashwin, & Brosnan, 2018) and empathy (Decety & Ickes, 2009), typically showing that females outperform males (Baron-Cohen & Wheelwright, 2004). CD also presents differently in males and females (Euler et al., 2015). Conversely, there is also evidence for no gender difference in emotion processing (Fairchild et al., 2010) and brain structure abnormalities (Fairchild, Hagan, et al., 2013). Additionally, the gender ratio was

similar in both groups and we found no evidence for a gender difference in either emotion recognition or empathy. Further, given that participants were referred to the study, we could not specifically recruit participants on their gender. Our sample with a higher percentage of males also corresponds to the literature showing that a higher number of males are involved in the Criminal Justice system (Ford, Goodman, & Meltzer, 2003). Future research should aim to understand the similarities and differences in affective processing in both male and female children with disordered behaviour and to understand whether the sexes respond differently to emotion recognition training.