Attend Less, Fear More: Elevated Distress to Social Threat in Toddlers With Autism Spectrum Disorder

Abstract

Differential emotional reactivity to social and nonsocial stimuli has been hypothesized but rarely examined empirically in ASD despite its potential importance for development of social motivation, cognition, and comorbid psychopathology. This study examined emotional reactivity, regulation, and attention to social and nonsocial threat in toddlers with ASD (n = 42, Mage: 22 months) and typically developing (TD) toddlers (n = 22, Mage: 23 months), and their mutual associations with autism symptom severity. Participants were exposed to social (stranger), nonsocial (mechanical objects), and ambiguous (masks) threats, and their intensity of distress (iDistress), attention to threat (Attention), and presence of emotion regulation (ER) strategies were measured. Autism symptom severity was quantified using the Autism Diagnostic Observation Schedule‐2. In response to social threat, toddlers with ASD exhibited elevated iDistress (P < 0.038) but lower Attention (P < 0.002) and a wider variety of ER strategies (P < 0.040) compared to TD controls, though their ER strategies were less likely to be social. However, nonsocial and ambiguous threat elicited lower iDistress in ASD than in TD toddlers (P = 0.012 and P = 0.034, respectively), but comparable Attention and ER strategy use. Autism severity was not associated with iDistress. The study demonstrates elevated emotional salience but diminished attentional salience of social threat in ASD. A failure to attend adequately to social threats may restrict opportunities to appraise their threat value and engender often observed in ASD negative emotional responses to novel social situations. Early atypical emotional reactivity may independently contribute to the shaping of complex autism phenotypes and may be linked with later emerging affective and behavioral symptoms. Lay Summary Compared to typically developing toddlers, toddlers with ASD show diminished attention yet enhanced distress in response to social threat. Poor attention to potential social threat may limit opportunities to assess its threat value and thus contribute to often observed negative emotional responses to novel social situations. Identifying the precursors of atypical emotional reactivity in infancy and its links with later psychopathology will inform about novel treatment targets and mechanisms of change in the early stages of ASD. Autism Res 2021, 14: 1025–1036. © 2020 International Society for Autism Research, Wiley Periodicals, LLC

Behavioral and physiological differences during an emotion-evoking task in children at increased likelihood for autism spectrum disorder

“…For example, Macari et al (2018) also did not find group differences during bubbles and reported increased levels of negative affect in toddlers with ASD during tasks that included masks as a part of the testing protocol (fear protocol). In addition, children with ASD in the Macari et al (2021) study spent less time looking at distressing stimuli and displayed increased levels of distress compared to their neurotypical peers. Increases in displayed negative affect and reduced gaze during distressing stimuli may reflect atypical regulation and/or expression of negative emotions, potentially affecting early social interactions and contributing to the early presentation of ASD.…”

Early Learning in Autism as an Atypical Balance between Assimilation and Accommodation Processes

“…People, particularly unfamiliar people, could also have the potential to be over-arousing and anxiety-producing in autism. Recent research by Macari et al (2020) suggests that autistic children display diminished attention and enhanced distress toward a novel, or unfamiliar person from toddlerhood on, in contrast to other studies documenting normative arousal in response to eye contact with familiar people (Nuske et al, 2014(Nuske et al, , 2015Vivanti & Nuske, 2017). This suggests that emotional responses to social stimuli are mediated by the familiarity of the situation in the autistic population.…”

Opportunities and Limitations in the Analysis of Autistic Phenotypes - A Conceptual Review

“…Some researchers create and use their databases despite the comprehensive databases, which are sometimes too small to reach high statistical power. That fact might limit the conclusions drawn from the results (Norcia et al, 2021) (Macari et al, 2021).…”

“…Sometimes, they also consider the ASD group as homogeneous concerning the chosen aspect of their research (Macari et al, 2021). In reality, some characteristics of TD individuals and ASD subgroups might overlap (Kim et al, 2018), different causes might lead to the same symptoms (Constantino & Charman, 2016), and the combination of ASD symptoms that occur in one individual may be caused by several different mechanisms (Katuwal et al, 2016).…”