6.26 Lost in Translation: Expressed Emotion and Social Functioning in Youth With Autism Spectrum Disorder

Abstract

Existing studies substantiate a relationship between high familial expressed emotion (EE) and externalizing behaviors in children with autism spectrum disorder (ASD); however, little is known about the relationship between EE and the severity of core symptoms of ASD, specifically social communication and adaptive functioning. This study assesses the hypothesis that EE demonstrates significant relationships with measures of social cognition, perception of the quality of peer relationships, and adaptive functioning. A preliminary analysis includes 16 adolescents with ASD ages 13 to 17 years old, and 12.5% were female. The Social Responsiveness Scale, Second Edition (SRS-2) was administered to measure social interaction and communication deficits. The Child and Adult versions of the Reading the Mind in the Eyes Tests (RMET-C and RMET-A, respectively) were administered as measures of theory of the mind. The Adaptive Behavior Composite score from the Vineland-3 (VABS-3) assessed adaptive functioning. The NIH Patient-Reported Outcomes Measurement Information System (PROMIS) measure was used to evaluate the perception of quality of peer relationships. EE was determined using the Five-Minute Speech Sample. There was a nonsignificant difference in the hypothesized direction between SRS-2 total score (p = 0.34), Social Communication subscale score (p = 0.34), and Social Communication and Interaction DSM-5–compatible subscale score (p = 0.36) between the high and low EE groups. On the RMET-C and -A, subjects with high caregiver EE had similar error rates as those with low EE (p = 0.18 for RMET-C and p = 0.36 for RMET-A). There was no significant difference between the groups on the VABS-3 (p = 0.86). High EE youth rated the quality of their peer relationships lower by 4.9 points on the PROMIS Peer Relationship scale than individuals with low EE (p = 0.16). Although these preliminary results do not support our hypotheses, the nonsignificant differences were in the hypothesized direction. Our sample size was small (N = 16) and likely lacking the power needed to identify significant differences in the social communication of youth with ASD living with low vs high degrees of caregiver EE. Directions for future study include reexamining these hypotheses with a larger sample size and identifying directionality in the association between EE and core deficits.