Counterfactual Thinking in Children With Autism Spectrum Disorders

Abstract

Begeer, S., De Rosnay, M., Lunenburg, P., Stegge, H., & Terwogt, M. M. (2014). Understanding of emotions based on counterfactual reasoning in children with autism spectrum disorders. Autism, 18, 301–310.

Background

In this issue of Word of Mouth (WoM), I have discussed the nature and development of counterfactual reasoning. Positive associations between theory of mind (ToM) and counterfactual reasoning have also been documented in both typically developing children (Guajardo & Turley-Ames, 2004) and children with autism spectrum disorder (ASD; Grant, Riggs, & Boucher, 2004). Using counterfactual reasoning with one’s own experiences (“if the plane from Paris had been on time, I wouldn’t have missed my connection in New York”) requires intrapersonal cognitive and affective ToM—the ability to reflect on one’s own thoughts and emotions. Listening to others’ counterfactual statements requires cognitive and affective interpersonal ToM. Because persons with ASD exhibit deficits in ToM, one would anticipate that they would have difficulty comprehending and generating counterfactual statements. High-functioning children with ASD generally develop understanding of first-order (nonsocial) emotions such as happy, sad, mad, disgusted, afraid, disappointed, and contented; but typically have difficulty with second order (social/self-conscious emotions) such as embarrassment, pride, shame, jealousy, regret, relief, and guilt that involve appraising one’s self through the (imagined) evaluations of others.

Currently, however, it is not clear whether relations between ToM and understanding emotions based on counterfactual reasoning only entail for second-order emotions or whether such relations are also found with simple emotions. It is also unclear whether there is a systematic difference in children’s understanding of upward (imagining a better outcome) and downward (imagining a worse outcome) counterfactuals in the context of reasoning about emotional outcomes. Guttentag and Ferrell (2004) showed that 7-year-old children more readily recognized regret (upward) in a negative situation than relief (downward) in a positive or neutral situation. Furthermore, Guttentag and Ferrell (2008) reported that in the context of a negative outcome, 7- and 8-year-olds could express regret and disappointment (using upward counterfactuals), but there were few instances of downward counterfactual use (i.e., “things could have been worse”) until 9 years of age.

High-function children with ASDs (HFASD) can reason about counterfactual realities. When asked to generate an outcome based on an explicitly presented counterfactual statement (e.g., “I have a story where all cows go ‘Quack.’ Freda is a cow. In my story, does Freda say ‘Quack’?”), individuals with ASD were as able as controls to generate the correct consequence (i.e., “Yes, Freda says ‘Quack’”), despite its stark contrast with reality (Leevers & Harris, 2000). However, in these tasks, the correct answer could be inferred deductively from the premises. In contrast, when presented with stories and given open-ended questions, for which the correct answer cannot be deduced from the premises, children with ASD are less able to generate novel alternative resolutions (Grant et al., 2004). Children with autism may be capable with counterfactual reasoning as long as they do not have to speculate, imaginatively, on possible alternative outcomes that are not implied in a given scenario.

There is some evidence that children with HFASD can reason counterfactually, but there is no research showing if they are attuned to the affective consequences of counterfactual realities. (See the discussion of counterfactual emotions [CF-emotions] in the previous article in this issue of WoM). When reasoning about CF-emotions, there may be specific situational characteristics that differentiate HFASD and typically developing children, in particular when the domains of direction (upward vs. downward) and agency (high vs. low) are considered. Children with HFASD, who are able to understand the situational components of emotions (Begeer, Koot, Rieffe, Meerum Terwogt, & Stegge, 2008) and can generate counterfactual alternatives to reality (Begeer, Meerum Terwogt, Lunenburg, & Stegge, 2009), should be able to reflect on the counterfactual basis of simple emotions like disappointment and contentment. However, their limitations with ToM and second-order emotion attributions would hypothetically impair their understanding of the counterfactual basis of second-order emotions like regret and relief, which requires the child to conceptualize persons reflecting on the motivations and intentions that constituted their previous decisions (Zeelenberg, Van Dijk, Manstead, & van der Pligt, 1998). Furthermore, downward CF-emotions may be less compelling to children with HFASD when compared with typically developing children. Upward comparisons are generally more common than downward counterfactuals (White & Lehman, 2005). They are usually triggered by negative situations (“if only … ”), which directly entail the modification of one’s actions or circumstances in the future. This preparative function of upward counterfactual reasoning stands in contrast to the less pragmatic role of downward counterfactuals (“things could have been worse”), which primarily provide a mechanism for dealing with the current situation by modifying one’s emotional perspective. The motivation to modify a positive outcome is not as compelling as the motivation to modify a negative outcome, which is likely the main reason for the lower prevalence of downward counterfactuals (Harris, 2000). Children with HFASD, who are usually less focused on internal psychological processes, may be less appreciative of these internal psychological mechanisms that are not related to clear outcomes (Lombardo, Barnes, Wheelwright, & Baron-Cohen, 2007).

The Study

In this study, the researchers investigated the understanding of emotions based on counterfactual reasoning in children with typical development (TD) or ASDs, highlighting the functions of counterfactually based emotions (CF-emotions) and the capacities that are needed to appreciate these functions. The participants were 71 children with high-functioning autism (HFASD) or Asperger (AS) based on diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000) and 71 typically developing children, aged 6 to 12 years. Because this research involved a language-based task, groups were matched as closely as possible on the basis of their full-scale IQ as well as gender and chronological age.

Materials/Tasks

Counterfactual-emotion tasks. The researchers used stories in which two children experienced identical outcomes. For one (target) child, a counterfactual alternative was available that would have resulted in a different outcome. Depending on whether the story children were responsible for the outcomes, the stories elicited first-order or second-order emotions. In addition, depending on the positive or negative nature of the outcome, the stories were intended to elicit downward or upward counterfactual reasoning, respectively (Roese, 1997). In all stories, children were asked to judge whether one child would feel “better,” “worse,” or “the same” about the outcome compared with the other child, and explain why.

Eight stories were used, two for each CF emotion type (disappointment, relief, regret, contentment). All scenarios involved two children who experienced the same outcome (i.e., both either achieve or do not achieve what they desire). For the target child, a counterfactual alternative was available that would have resulted in a better (upward) or worse (downward) outcome. In the first-order stories, emotions were elicited by highlighting that the target child nearly attained a positive or negative outcome, for example, upward counterfactual—disappointment story:

Both Tess and Rosie love to read. They often visit the library to borrow books. Tess has been waiting for one of her favorite books on cats, which has been on loan for a long time. Rosie has also been waiting on one of her favorite books on ghosts, but that is also on loan. That afternoon Tess and Rosie visit the library again. Rosie immediately sees that her favorite ghost book has not been returned yet. Tess goes to the animal book section and sees that somebody else is just taking her favorite cat book and walking away.

Questions: Who is more disappointed about not being able to loan their book, Rosie, who immediately saw that the ghost book was not there, or Tess, who saw someone else just take the cat book, or do they both feel the same? Why? (Begeer, De Rosnay, Lunenburg, Stegge, & Terwogt, 2014, p. 310)

The near attainment of the outcome was intended to elicit disappointment (when a positive outcome was not attained) or contentment (when a negative outcome was avoided). In the second-order emotion stories, a target child always made an active decision that led to the avoidance of a positive or negative outcome. This was intended to elicit regret or relief, for example, a downward counterfactual relief story:

Bill and Pete are going on a school trip. They are allowed to choose between going on a sports day in the playing fields or to a kids’ museum. Bill wants to go to the museum. Pete chooses the sports day. When the teacher asks them what they chose, Bill says he wants to go to the museum. Pete changes his mind and also says he wants to go to the museum. On the day of the trip, it is pouring with rain. Children who chose to go to the sports day in the playing fields have to stay at school.

Questions: Who is happier about choosing the museum, Bill, who chose the museum right away, or Pete, who changed his mind, or do you think they are both equally happy? Why? (Begeer et al., 2014, p. 310)

At the end of each story, children were reminded of the outcome and of the behavior that that differentiated the two children in the story. Following this, children were asked whether one child in the story would feel “better,” “worse,” or “the same” about the outcome compared with the other protagonist and explain why.

Second-order false belief (FB) task. Participating children also completed a second-order FB story derived from Sullivan, Zaitchik, and Tager-Flusberg (1994). A series of probe and control questions were asked to ensure that the child was following the story. After each probe or control question was answered, feedback or correction was provided to the child. Finally, the second-order FB question was asked, and the child was prompted to justify his or her response.

John and Mary are playing together in the park. They see the ice cream man coming. Mary really wants to buy an ice-cream cone but she doesn’t have any money. The ice-cream man says to Mary: “Don’t be sad, you can go home and get some money. I’ll be here in the park all day long.” So Mary goes home to get money to buy an ice-cream cone. Now, John sees the ice-cream cart start to move away. John asks, “Hey, where are you going?” The ice-cream man says, “I’m going to the school to sell ice-cream. I can sell more ice-cream at the school.” John goes off to his house to have some lunch. Mary is at her house getting money for ice-cream. Mary walks outside her house and sees the ice-cream man going by. “Hey, where are you going?” asks Mary. “I’m going to the school to sell ice-cream,” says the ice-cream man. Mary says, “Well, I’m so glad I know that. Now I have some money to buy an ice-cream cone, so I will follow you to the school.” Now, John has finished his lunch and he goes over to Mary’s house to play with her. John knocks on the door. Mary’s mother comes to the door. John asks her, “Where’s Mary?” Mary’s mother says, “Mary went to buy an ice-cream cone.” So John goes off to find Mary. Second-order false-belief question. “Where does John think Mary went to buy an ice-cream cone?” Justification question. “Why?” (Sullivan et al., 1994, p. 402)

Scoring of Tasks

Counterfactual emotions. Children who correctly judged that the child who nearly attained a better or worse outcome would feel worse or better than the other child, respectively, were awarded one point. When children judged that both children would feel the same, or that the nontarget protagonist would feel better/worse, they received no points. Children who named the target child and provided an explanation in which it was clear that they had thought about an alternative situation (i.e., what would have happened if the protagonist had not made an active decision or change in routine) were awarded an additional point.

Second-order FB task. Children were scored as passing the second-order FB task when they showed second-order reasoning, which included a response that indicated they understood the thoughts of one child on the thoughts of another child, including an appropriate justification.

Results

The ability to explain emotions based on counterfactual reasoning improved with age, and all children generally found first-order emotions (i.e., disappointment and contentment) easier to explain than second-order emotions (i.e., regret and relief).

TD children performed better than their HFASD counterparts across all story types, although this difference was more marked for downward counterfactual stories (i.e., contentment and relief).

Children with HFASD had specific difficulty in understanding of downward emotions (i.e., contentment and relief) relative to TD children. This indicated that children with HFASD had more difficulty reasoning from counterfactual alternatives when the outcome was positive (i.e., comparing the outcome with a more negative situation).

Although TD children and children with HFASD did not differ on intelligence, the children with HFASD performed less well on the second-order FB task.

Children with HFASD were not specifically impaired in understanding second-order emotions based on counterfactual reasoning, despite the finding that they were performing more poorly on the second-order FB situations.

For the TD children, there were modest positive associations between CF-emotions and second-order FB, with the exception of disappointment. By contrast, in the HFASD group, second-order FB reasoning was not related to understanding CF-emotions.

For children with HFASD performance on all story types was associated with IQ scores; in contrast, for TD children, there was no association between story performance and IQ scores.

Implications

Given the difficulties persons with ASD typically exhibit with second-order emotions, the children’s performance in this study was surprising. The fact that their performance was dependent on IQ scores, rather than on performance on a second-order ToM task, may indicate that they arrived at the correct responses in a different manner than the TD children. Although the authors asked the children to justify their responses, they do not provide a discussion of those justifications. The participating children were listening to stories about other children, not generating situations in which they personally engaged in counterfactual reasoning. The research task would have required interpersonal affective ToM, not intrapersonal affective ToM. Several studies have shown that persons with ASD produce better fictional stories of others than stories of their own personal experiences (Goldman, 2008; Rollins, 2014). From this study, therefore, we do not know whether the children can themselves engage in counterfactual reasoning and, even if they can engage in counterfactual reasoning, whether they experience counterfactual emotions. For typical children, there is a difference of two or more years between when they can do counterfactual reasoning and when they understand the emotions associated with the reasoning (Guttentag & Ferrell, 2008). Children with ASD may exhibit a greater discrepancy between the cognitive and affective components of counterfactual reasoning.

Children and adolescents with ASD typically exhibit difficulty regulating their behaviors and emotions. A number of programs focus on increasing the ability of persons to self-regulate, but I do not know of any programs that specifically address the linguistic and cognitive concepts of counterfactual reasoning in facilitating self-regulation. Speech-language pathologists could consider incorporating counterfactual reasoning into programs that target self-regulation.

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