Socioemotional Reciprocity Difficulties in Children Living with Autism Spectrum Disorder

Dear Editor, Children living with autism spectrum disorder (ClwASD) face challenges in social interactions and communication across different settings (classroom, playground, and home) due to socioemotional challenges. The Diagnostic and Statistical Manual of Mental Disorders – 5th Edition mentions deficits in conversations involving expressive and receptive language for these children due to abnormal social approaches such as sharing of reduced interests, affect, pace of communication, social skill deficits, and emotions.[1] Lack of facial expressions and poor eye contact make it nonverbally hard for ClwASD to participate in communication in social situations. The ability to integrate body language and gestures with communication is essentially challenging for most of these children. Misinterpretation of social cues and language hinders comprehension of jokes, humors, and metaphors; ClwASD face challenges in responding to peers and adults by understanding their emotions and feelings. Many etiologies are identified for causing ASD, and the spectrum also encompasses a wide range of intellectual functioning abilities beyond the neurophysiological changes in the brain. Play Perplexes through Socioemotional Complexities Limited play is observed in ASD due to neurobiological changes in the brain that affect their imagination and creativity. Engaging in pretend or parallel play is puzzling for ClwASD as they have challenges in responding to social cues. Peers and adults interact to engage and socially provide cues for ClwASD in play; overwhelms the ClwASD to experience social anxiety due to discomfort in the settings, and socially, they tend to withdraw themselves. Play can be used as a form of communication to treat challenging and injurious behavior in these children. Forms of self-expression can be taught using play, and response interruption/redirection is helpful in prompting among these children to reduce their maladaptive behavior during play activities. Fostering play skills can enhance social skills, teamwork, problem-solving, and choice-making in ClwASD – mentions the World Journal of Clinical Pediatrics.[2] Play is a comprehensive approach to teaching skills across various domains for ClwASD and play increases the developmental trajectory of milestones attained by neurotypical peers of the same age. Sensory Challenges in Socioemotional Behavior Regulating sensory sensitivities in environments around with adaptive responses is difficult for ClwASD. Hyper- and hyposensory behavior is related to the settings around leading to difficulties in emotional regulation and rigidity in ClwASD. Processing sensory stimuli is challenging as neural networks in the brain have difficulties in integrating signals, leading to sensory dysfunctions in most ClwASD. Specific visuals, sounds, textures, or smells elicit atypical behavioral responses and variations in 96% of ClwASD – mentions Pediatric Research.[3] Proximal development of senses in ASD phenotype is limited and makes it hard to understand facial gestures (visual), language deficits (auditory), or avoid hugs and touch (tactile). Resisting changes in schedules or routines is often associated with sensory behavioral differences in individuals with ClwASD. Additionally, new environments or interacting with unfamiliar people can exacerbate difficulties in multi-sensory integration for them. Sensory behaviors can be regulated by understanding the under-responsiveness and over-responsiveness of sensory processing. Supportive sensory modification of the ambience (home, school, and playground) by eliminating overstimulating/understimulating objects enables ClwASD to participate successfully in their daily activities. Preparation of persons with ASD for changes in routine/schedule transitions can easily channelize their differences in sensory behavior. Occupational therapy is very efficient in facilitating sensory dysfunction; teaching the essential skills needed for coping with sensory processing difficulties is assessed and treated by an occupational therapist. Rigidity in Patterns and Repetitive Behaviors Emotional regulation is challenging due to the fixation of interests and routines in ClwASD. Socioemotional behaviors exhibit as deficits in social interactions when neurodivergent kids show more attachment to inanimate objects/items than people present around them. Preference for specific routes/routines/schedules leads to emotional distress when unexpected changes happen in daily life. Engaging in repetitive behaviors such as hand-flapping, body-rocking, and facial expressions for ClwASD when around peers/adults is to relieve their social anxiety and the sensory sensitivities they face. To regulate social skills in ClwASD during various situations, many evidence-based treatment methods are suggested to the stakeholders. Scripting, behavior therapy, social stories, structured play groups, technology-aided instruction, functional communication training, peer-mediated interventions, and incidental teaching are some of the effective treatments for training social skills with objective outcomes. Severity Patterns for Socioemotional Deficits Difficulties in socioemotional reciprocity are diverse and range from mild to severe among ClwASD, which impacts their ability to navigate social situations around them in their daily lives. Interventions planned for ClwASD should be customized and tailored to support individualistic needs. Skill deficits are heterogeneous in ClwASD and the levels of support can vary widely. Significant development milestones and navigating social situations can be effective as interventions are provided at an early age after diagnosis. Support should be accommodated with the levels of behaviors that interfere with the functioning of the individuals in their day-to-day lives. The use of empirical outcome-based treatments can reduce the levels of support and increase independence in persons with autism. The spectrum comprises unique phenotypes that require a display of empathy and understanding from society. Acceptance and awareness of autism can help individuals around to support differences in the abilities of ClwASD. Patient informed consent There is no need for patient informed consent. Ethics committee approval There is no need for Ethics Committee approval. Financial support and sponsorship No funding was received. Conflict of interest There is no conflict of interest to declare. Author contribution area and rate (%) Jemima Wilson (50%): Contributed to writing a manuscript draft and literature search. Srikanth Pallerla (50%): Contributed to writing a manuscript draft and review of the manuscript.

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