Pilot Study of Mind Reading and in-Vivo Rehearsal for Children with HFASDs

Background: Research suggests that individuals with high-functioning ASDs (HFASDs) can exhibit a range of facial- and vocal-emotion decoding difficulties (Golan et al., 2006; Lindner & Rosén, 2006). Computer software interventions have been proposed to address this deficit, including Mind Reading (MR; Baron-Cohen et al., 2004). LaCava et al. (2007) evaluated MR’s effectiveness with 8 children with HFASDs (M=10.5 hours per person). Pre-post comparisons indicated significant improvements in emotion recognition; however facial improvements were limited to tasks from MR. Although promising, LaCava et al. noted the need for studies that include measures of broader social performance. Additional limitations included no reporting of effect sizes, IQ, or language data, and lack of diagnostic confirmation using a diagnostic instrument.

Objectives: This pilot evaluated a manualized administration of Mind Reading (MR) and in-vivo rehearsal for its: (1) effect on emotion recognition and social behaviors of children with HFASDs; and (2) overall feasibility.

Methods: Participants. Eleven participants, ages 7-12 with HFASDs were screened using a multiple-gate procedure. Inclusion criteria included a short-form IQ composite > 70; receptive or expressive language score ≥ 80; and score meeting ASD criteria on the ADI-R. 

Outcome measures. Social Responsiveness Scale (SRS; 65-item rating scale assessing ASD features and social behaviors); Emotion Recognition and Display Survey (ERDS; 54-item researcher-developed rating scale assessing decoding and encoding of 27 MR emotions). Participant and parent satisfaction was assessed via eight-item satisfaction surveys. Feasibility was evaluated using the MR chronometer that tracked MR time and satisfaction surveys.

Procedures. The manualized MR and in-vivo rehearsal protocol was administered during 12 staff-supervised 90-minute sessions. Children completed MR exercises (Emotions Library, Learning Center, etc.) and in-vivo rehearsal according to a pre-established schedule and protocol. Children earned MR generated computer-based rewards and earned points for following rules, identifying and displaying emotions, and exhibiting pro-social behaviors. 

Results: Parent ratings indicated a significant pre-post decrease in SRS scores (t(10)=4.073, p<.0167, d=.65) and significant increases on the ERDS emotion recognition (t(10)=3.004, p<.0167, d=.95) and display of emotions scores (t(10)=5.185, p<.0167, d=1.70). Exploratory comparisons on the SRS indicated significant decreases for 3 of 5 subscales (Social Awareness (t(10)=2.970, p<.01, d=.58); Social Communication (t(10)=2.972, p<.01, d=.70); and Social Motivation (t(10)=2.861, p<.01, d=.77). Effect sizes (SRS and ERDS) were medium-to-large. MR usage time approximated the 16-hour projected time (M=15.87 hours). Average parent satisfaction rating was 55.33 out of 56 and child satisfaction was 43.89 out of 56.

Conclusions: Results indicated that completion of the manualized MR and in-vivo rehearsal protocol was associated with significantly higher post-intervention ratings of emotion decoding and encoding, and lower ratings of ASD-related social problems particularly in the areas of social awareness, communication, and motivation. The findings also suggest the children’s newly-learned skills generalized to some extent and may have affected other social behaviors (collateral improvements as captured by the SRS). Support for feasibility was reflected in high satisfaction ratings and participant usage of MR. Limitations and implications will be described.