Beyond social awkwardness: Problems with "reading" faces?
Janet Jankowiak, MD
Feelings of awkwardness at a party are not limited to the teenagescene. Remember the guy who won’t look at you when hetalks but mumbles as he gazes at his shoelace or the more unnervingfellow who gets too close and breathes into your face as hetalks? Many people suffer from problems interacting with others.At the extreme, these people may be labeled with autism, Aspergerdisorder, and socio-emotional processing disorders; see AboutSocial Developmental Disorders on the next page. What makessocial interactions so difficult for these people?
In a recent study, published in this issue of Neurology, RebeccaHefter et al.1 suggest that problems with social interactionsmay be related to problems learning how to interpret faces.One of the ways we judge a person’s emotional state isby "reading" his/her facial expression. During a conversation,"reading" your listener’s expression helps you judge whetherhe/she understands or is interested in what you are saying.Without this ongoing assessment and modification of what youare saying, a conversation may become awkward, ineffective orworse.
Hefter’s group suggests that people with social developmentaldisorders (SDD) have difficulties identifying faces and interpretingfacial expression. To test this idea, they studied 26 adultswith a number of different types of SDD. Information was obtainedfor each person regarding developmental history and emotionaladjustment. Special attention was given to their use of eyecontact, facial expression and gestures. Each person took astandardized intelligence test. Then, they took a special testto see if they recognized famous people. Pictures of 20 famousand 20 non-famous faces were shown to each subject. The taskwas to separate the pictures into groups of familiar and unfamiliarfaces, and to name the familiar faces, if possible. Their responseswere compared with those of 15 healthy people who served asa control group. To test the ability to recognize emotions,the study group was given other tests. In one test, they heardan audiotape of a woman’s voice and were asked to interprether tone of voice and emotional fluctuations of speech. In another,they were shown a videotape of a woman’s face or body(from shoulders to thighs), and were asked to interpret whatemotion she was showing. On a computer, the subjects were shownpictures of emotional faces and asked to describe them as happy,sad, angry or fearful. Another test was a type of "reading themind in the eyes." The subjects were shown only photographsof pairs of eyes. They were given a choice of four complex emotionalstates to interpret for each pair of eyes: reflective, aghast(shocked), irritated, or impatient.
Ten of the 26 people with SDD scored well within the normalrange on recognition of famous faces. However, within the wholegroup, there was a wide range of ability in interpreting facialexpressions. This study showed that the ability to recognizea face was not related to the ability to interpret facial expressions.The 10 people with SDD who had normal recognition of facialidentity had as much difficulty recognizing emotions as the16 who had poor recognition of facial identity. Previous studieshave also shown that people with autism or Asperger disorderhave difficulty recognizing emotions both visually (facial expressions,gestures and body postures) as well as interpreting tone ofvoice and emotional changes of speech. Interestingly, Hefter’sstudy showed that the ability to interpret a facial expressionwas correlated with the ability to interpret nonfacial emotionalcues (for example, by voice and gestures or "body language").
From this study, Hefter’s group suggested that the problemsof "reading" facial expression in SDD might be linked to problemswith interpreting emotions rather than problems with simplyassessing faces. Without the ability to interpret the emotionsof others normal social interactions are basically impossible.Further research is needed to better understand how and wherein the brain various types of emotional cues are processed.
Learning social skills and how to talk with others is somethingmost people take for granted. By the time a child enters kindergarten,many of these basic skills are well established. Yet, it isclear that there is a very wide range of ability in these skills.Children who seem to have a knack for chatting comfortably withothers become "popular" while those who are more awkward ingroups often find themselves alone. Those at the "awkward" endof the spectrum run into the zone of social developmental disorders(SDD). The most severely impaired are labeled autistic. It hasbecome clear that there are abnormalities in the brains of thesechildren that do no develop as expected. Three of the SDDs areautism, Asperger disorder and socio-emotional processing disorder.
Autism is a disorder of the nervous system that affects theway a person communicates with others. Autistic disorders areconsidered to cover a wide spectrum; each individual is affecteddifferently and to varying degrees. It is estimated that about1.5 million Americans have some form of autism, or 1 in 166births. Four times as many boys as girls are affected. It isgenerally apparent before the age of 3. Both verbal and nonverbal(facial expression, gestures, body language) communication areaffected. The severity of the disorder is quite variable, frommild social awkwardness to complete social isolation. Communicationskills may be delayed or may never develop. Early signs in asmall child may be minimal eye contact, a lack of social interest,and avoiding hugging and cuddling. These children may have difficultyinterpreting the meaning of facial expressions (such as smilingor frowning) and gestures (such as winking). About half of childrenwith autism may remain mute for their entire life. Others mayshow a great delay in learning to talk. These children oftenecho what people say to them without seeming to understand howto reply. Repetitive behaviors are common such as rocking, twirlingtheir hair or waving their hands. These children may also beunusually sensitive to sounds that most people can completelyignore. For example, they may be so distracted by the soundof another person chewing gum that they cannot function. Peoplewith autism may also be obsessed about keeping routines andhaving objects in specific places. If an object is out of itsexpected place, the person may become outraged and overwhelmedby the change. Fortunately, many of these problems may improvewith time, special education, and other therapies.
Asperger disorder is thought to be a milder form of autism.Generally, these people have normal intelligence or may evenbe intellectually gifted. However, as in autism, they are sociallyinept and lack insight. They are inflexible to changes in expectedroutines and have a narrow range of interests. Often they developin-depth knowledge about specific interests such as airplanes,trains, dinosaurs, etc. Repetitive behaviors, such as spinningobjects, are also common. They may also be physically clumsy.However, unlike autism, as children they begin to speak on time.That is, by 2 years old they use single words and by age 3 theyspeak in phrases. Their spoken language often lacks emotionalexpression.
What is socio-emotional processing disorder (SEPD)?
This is a third type of social developmental disorder. In SEPD,language is learned at a normal time and the development ofmany thinking skills is normal. However, some types of thinkingthat are believed to rely on the nondominant side of the brainare abnormal. In a right-handed person, the left side of thebrain governs verbal language and is called the dominant hemisphere.The right side of the brain is called the nondominant hemisphere.It has an important role in nonverbal communication, such as"reading" body language and interpreting emotions. In SEPD,testing on standardized intelligence tests (measures of IQ orintellectual quotient) shows a verbal IQ at least 10 pointshigher than nonverbal IQ. Normally, verbal and nonverbal IQsare about equal. This means that people with SEPD may have normalor even superior verbal skills, yet may still have a lot oftrouble with social communication. Conversations may often beone sided. The person with SEPD may carry on a monologue ona favorite subject and not be aware of attempts of his/her listenerto interject comments. At the same time, they most likely donot recognize the frustration or other emotional response theirlistener is showing. Consequently, it is difficult for themto develop emotional relationships, friendships, and even normalinteractions with coworkers.
Although children with these disorders do not "outgrow" them,an early diagnosis is very important because specialized programsthat can help are being developed.
Hefter RL, Manoach DS, Barton JJS. Perception of facial expression and facial identity in subjects with social developmental disorders. Neurology 2005;65:1620–1625.[Abstract/Free Full Text]
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