Autism and shame
I am providing a lengthy article because I think it offers important insights regarding people on the autism spectrum. Van Trigt, Colonnesi, Brummelman, Jorgenson & Nicolic (2023) published “Autistic Traits and Self-Conscious Emotions in Early Childhood” in Child Development. Here’s the highly edited article:
Self-conscious emotions arise from evaluating the self through the eyes of others. Given that children with autistic traits may experience difficulties with understanding others' minds, they might show less attuned self-conscious emotions. Self-conscious emotions reflect the interpersonal self, that is, how the self relates to others. Some self-conscious emotions, such as guilt and embarrassment after misbehavior motivate prosocial behaviors and evoke forgiveness and appeasement in others. Other self-conscious emotions, such as shame, are considered less socially adaptive, as they trigger withdrawal and avoidance, thereby inhibiting prosocial behaviors. A lack or surplus of self-conscious emotions could lead to problems in forming and maintaining social relationships, since self-conscious emotions help people navigate social situations in which they misbehaved or broke social rules. Given the difficulties in navigating social relationships, children with more autistic traits might be prone to disturbances in self-conscious emotions after transgression.
We tested the novel hypothesis that young children with more autistic traits display lower levels of guilt and embarrassment and greater shame after doing something wrong. Three core self-conscious emotions that typically occur after breaking social norms or rules are guilt, shame, and embarrassment. All three self-conscious emotions are thought to be a reaction to social valuation that serves to motivate people to behave in socially appropriate ways. They all require self-evaluation as well as the awareness of others' evaluation of the self. However, they also differ from each other in important ways. Guilt involves a negative sense or evaluation of one's own displayed behavior—a specific action, but it does not inflict a negative evaluation of the whole self. When individuals experience guilt, they regret their action and wish they behaved differently. Thus, feelings of guilt motivate individuals to show prosocial behavior and repair the negative consequences of the action that caused these feelings, such as by apologizing and repairing. Observational studies show that even 2- and 3-year-olds show such guilt-related behaviors.
Embarrassment involves evaluations of the presented self, as opposed to the core self in shame. This generates more short-term and situation-specific negative evaluations about oneself. Expressions of embarrassment may serve as appeasement, a nonverbal acknowledgment of shared social standards, and a nonverbal apology. These expressions have been described as withdrawing behavior (e.g., gaze or head aversions) accompanied by a smile, also known as embarrassed or coy smiles. Traditionally, it has been thought that embarrassment may occur only after children become self-aware at around 18 months old. However, recent research has shown that embarrassment-related reactions, in the form of coy smiles (as a result of social exposure), may appear already in infancy.
Shame involves a negative sense about the entire self. When individuals evaluate the whole self negatively, they may not be motivated to repair, as there is little they can do to repair the whole self. In fact, they may rather hide themselves. They may physically shrink as if to hide from evaluation. Shame is often considered an inhibitor of prosocial behavior and is reflected through withdrawal behaviors—such as aversion of the eyes, head, or the whole body—while having a neutral or negative facial expression. These behaviors can be observed in toddlers, suggesting children can experience shame from an early age. However, some scholars have argued that these behaviors are not rooted in shame but in fearful avoidance, perhaps because toddlers may not yet be able to experience shame as a distinct emotion. We, therefore, refer to these behaviors as shame-like avoidance.
Autism spectrum disorder is a neurodevelopmental disorder associated with severe and pervasive deficits in social interaction. Some of the main autistic traits are diminished social awareness and social communication, limited affective engagement, and stereotyped motor mannerisms. Whereas children with ASD have no difficulties in conceptual self-awareness (i.e., they recognize themselves in the mirror), they do show disturbances in interpersonal self (i.e., they have difficulty understanding their role in social interactions and how others may see them as social agents). This disturbed interpersonal self may be reflected through less attuned self-conscious emotions in social situations. There is preliminary evidence for this idea in children with ASD. For example, when children with ASD see themselves in the mirror, they recognize themselves and show interest in their mirror image; however, they do not show self-conscious emotions, such as embarrassment and coyness. Less attuned self-conscious emotions seen in children with ASD may be due to sociocognitive deficits, such as deficits in ToM.
Theory of mind represents the ability to accurately attribute mental states, such as feelings, thoughts, and intentions, to oneself and others and to understand and explain others' and one's own behaviors based on mental states. False belief—the realization that others can have beliefs that are different from one's own—is an important aspect in the development of ToM, and typically develops, in an explicit way, around the age of 4 years. Other aspects of ToM, such as understanding of intentions and emotions, develop earlier, between the ages of 2- and 5 years. Emotion recognition—the ability to accurately assess emotions based on external cues, such as facial expressions—is the necessary first step for emotion understanding, and thus also an important part of ToM and children's social functioning.
Impairments in ToM abilities may contribute to disturbances in self-conscious emotions after transgression. If children do not understand they broke a norm or hurt somebody's feelings and do not understand another person's perspective (e.g., they broke a friend's toy and they do not understand that this event made the friend sad), they are unlikely to experience guilt and embarrassment. And if children do not understand accurately another person's feelings and thoughts and cannot predict their behaviors, they may focus on the self, feelings of failure, and experience shame and show more avoidance and withdrawal. This idea is based on past research that indicated that children with lower ToM abilities cannot accurately predict others' reactions in social situations because they do not understand others' mental states, experience these social situations as stressful and unpredictable, and, therefore, show avoidance and withdrawal in social situations. Similarly, there is experimental evidence showing that compared with people experiencing guilt, people experiencing shame before engaging in a perspective taking task, show worse perspective taking. Therefore, the experience of guilt and embarrassment may be related to advanced ToM abilities whereas the experience of shame may be related to lower levels of ToM abilities.
As children with more autistic traits have been shown to have lower ToM abilities, they may show less guilt and embarrassment and more shame-related withdrawal, partly caused by impairments in ToM (i.e., difficulties in recognizing and understanding others' emotions and beliefs). It is of note that we do not expect impairments in ToM to be the sole cause of unattuned self-conscious emotions. There may be alternative pathways of autistic traits to unattuned self-conscious emotions, such as communication deficits, lower levels of affective empathy or elevated levels of fear or anxiety.
So far, the association between autistic traits or ASD and self-conscious emotions has been investigated only in older children and adolescents. One self-report study found that 7- to 14-year-old children with ASD show less guilt than children without ASD. A multi-informant study found that 4- to 18-year-old children and adolescents with ASD show less guilt and more shame than children and adolescents without ASD. An observational study found that, during an embarrassment-eliciting task, 6- to 12-year-old children with ASD show reduced signs of embarrassment and shyness. Another observational study showed that preschool children with ASD, unlike other children, showed fewer coy smiles when seeing themselves in the mirror, suggesting reduced shyness and altered interpersonal self. Also, a parent-report study found that 2- to 14-year-old children with ASD showed more avoidant symptoms than typically developing children. Together, these empirical findings confirm that older children with ASD have disturbed self-conscious emotional expressions.
Participants were 98 children aged 2–5 years (24–72 months, 92% White; 50% girls), accompanied by one of their parents, ages 22–48 years (M = 35.76, SD = 6.14; 83% mothers). Parents mostly had a Dutch ethnicity (81.6%), were relatively highly educated and were, based on monthly household income, from various socioeconomic status.
Overall, we found evidence that children with more autistic traits show more verbal shame-like avoidance. There was also some evidence for more nonverbal shame-like avoidance; however, the evidence lacks statistical significance. Our findings did not support the idea that children with more autistic traits show less guilt and embarrassment after transgression. Although children with more autistic traits showed lower ToM levels, disturbances in self-conscious emotions were not due to lower ToM in children with more autistic traits. More broadly, these findings highlight that children with more autistic traits may express disturbances in some but not all self-conscious emotions and may experience deficits in ToM already in early childhood, but these deficits do not necessarily translate into less attuned self-conscious emotions at this age.
Our findings do not support our hypothesis that ToM functions as a mechanism in the relation between autistic traits and less attuned self-conscious emotions. Children with more autistic traits showed lower levels of ToM, yet this did not, in turn, relate to less guilt, less embarrassment, or more shame-like avoidance. Our post hoc findings indicated that children with lower levels of emotion understanding show more verbal shame-like avoidance, but children with more autistic traits do not show deficits in this ToM ability. However, children with more autistic traits showed deficits in belief understanding, but this ToM ability was unrelated to shame-like avoidance. These findings are in line with the idea that difficulties with understanding others' emotions causes uncertainty in complex social situations and, therefore, more shame-like avoidance. More advanced ToM skills such as first order and false belief seem, however, unrelated to shame-like avoidance. These findings also shed light on the likely reasons of why ToM is not a mechanism through which autistic traits are related to disturbances in self-conscious emotions. Children with higher autistic traits seem not to show any deficits in the ToM ability that may matter for the experience of self-conscious emotions—emotion understanding, but only in belief understanding, which, importantly, does not seem to play an important role in the experience of self-conscious emotion, as we hypothesized.
It is suggested that there are more pathways to social impairments in autism than ToM, encompassing more broad impairments in social affective information processing. Regarding the elevated expressions of verbal shame-like avoidance in our study, it may be that children with more autistic traits have elevated levels of social anxiety, including elevated fear of negative evaluations, which, in turn, could explain more shame-like behaviors such as avoidance. Overall, our findings imply that children with more autistic traits have more sociocognitive deficits and display less attuned verbal shame-like avoidance, but the latter is not necessarily rooted in the former. Despite experiencing more sociocognitive deficits, children with more autistic traits do not display less attuned self-conscious emotions other than shame-like avoidance. However, our findings show that impaired ToM skills are already present in early childhood in children with more autistic traits, even in a nonclinical sample. ToM deficits may not necessarily relate to problems in social behavior, such as unattuned self-conscious emotional expressions, but more so to communication deficits. In our study, communication deficits could manifest as elevated verbal shame-like avoidance, which may be a precursor for later social impairments in ASD.
As ToM skills do not necessarily relate to disturbances in self-conscious emotions, interventions for regulating self-conscious emotions in ASD may have to focus on these emotions directly, possibly through directly targeting disturbed self-conscious emotions. For example, in the case of excessive shame experiences, enhancing (self-)compassion with mindfulness interventions may be a useful option.
Our work shows that children with more autistic traits have more deficits in ToM and show more shame-like avoidance after a transgression in early childhood. This implies that children with high levels of autistic traits may have difficulties in how they relate to other people early in development, especially when there is a threat to social status and existing relationships due to a transgression. As shame is known to hinder the repair of social relationships after wrongdoing, it may cause young children with more autistic traits to feel not socially connected. Therefore, new intervention strategies to regulate shame through enhancing (self-)compassion, such as mindfulness interventions, which have been found to be effective in preschool children and in older children with ASD, may be considered when targeting children with more autistic traits.
I know this is a long article but I find it fascinating that it may be that shame-like avoidance in children on the autism spectrum plays a major role in leading to sociocognitive deficits and that focusing on ToM alone doesn’t help. This may mean that when young children are brought in for assessment, we need to ask more questions about their experiences with discipline.