EMO-T program helps PWS children with emotional challenges

Children in study saw gains in expressing, comprehending emotions

Steve Bryson, PhD avatar

by Steve Bryson, PhD |

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EMO-T, a new emotional skill training program, helped children with Prader-Willi syndrome (PWS) express, recognize, understand, and regulate emotions, a study suggested.

After EMO-T, scores related to emotional expression and comprehension matched those of control participants without PWS.

Regulating and expressing emotions requires prerequisite emotion skills, said the researchers, who recommended EMO-T for use by those with PWS in the study, “What underlies emotion regulation abilities? An innovative programme based on an integrative developmental approach to improve emotional competencies: Promising results in children with Prader–Willi syndrome,” which was published in Frontiers in Psychiatry.

Studies report PWS behavioral symptoms include difficulty expressing, recognizing, understanding, and regulating basic emotions — referred to as emotional competencies (EC).

Compared with unaffected young people matched for developmental age, children with PWS make, on average, up to 20% more errors in identifying and assigning emotions. Moreover, the emotional expressions of children with PWS are difficult to interpret.

Few therapeutic programs specifically address EC in children with PWS, however.

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Testing EMO-T on PWS groups, control groups

Researchers in France evaluated the impact of the new EMO-T training program on emotional competencies in 25 PWS children (14 girls, 11 boys), ages 5.5-10.5.

The patients’ average IQ was 75.7 and their average intellectual developmental age was 5.7. The researchers recruited a group of 25 unaffected children matched by sex and chronological age, and a second group of 25 matched by sex and developmental age as controls.

All the children were assigned a series of tasks to assess EC.

Expression tasks included EMOrea, wherein researchers recorded facial expressions while participants watched a funny video, and EMOmim, where the child had to produce emotionally based facial expressions on demand.

Recognition assessment involved the Matching task — selecting a picture of a person expressing the same emotion in a target picture — and the Identification task, where they had to point to the picture of a person expressing a specified emotion. Participants also had to name a person’s emotion from a short video in the Naming task.

For comprehending emotions, the Affective Judgment Questionnaire (AJQ) task was applied. Children were presented with short illustrated stories and asked to say which emotion the character felt and justify their response. At the same time, parents completed an Emotion Regulation Checklist (ECR) on their child’s emotional regulation.

PWS children were then assigned either the EMO-T intervention, conducted by one of their therapists weekly over six 30-minute sessions, or to continue their usual rehabilitation with their therapist as a control comparison.

Each session consisted of the same exercises of increasing complexity to train their emotional expression, recognition, and comprehension abilities.

Sessions followed the same sequence: sorting fixed emotional facial expressions and naming live emotional expressions (recognition), mimicking and recognizing emotions (expression), and emotional attribution, as well as expressing emotional experience with words (comprehension).

Lastly, all the PWS children were retested at the end of the program at six weeks and again three months later.

Pre-test scores across the two PWS groups were similar, but were significantly lower than those in the two unaffected control groups.

Immediately after EMO-T, scores for the EMOmim task (making faces) and the three recognition tasks (Matching, Identification, and Naming) were significantly higher than among the PWS control group. Three months later, the EMOmim task and the Naming scores remained unchanged, while the Matching and Identification scores increased significantly.

For emotional comprehension, PWS children receiving EMO-T had higher AJQ scores than PWS controls.

Lasting gains with emotional training

Analyses showed a significant rise in scores after the intervention, with a strong tendency to increase at the second post-EMO-T session. Scores from the parents’ ECR questionnaire showed improvement in emotional regulation after EMO-T, without any change thereafter.

By the second, three-month assessment, scores for the EMOmim task, the three recognition tasks, and the AJQ tasks were significantly higher than the PWS controls’ scores.

EMOmim and AJQ task scores were similar to those of the two unaffected control groups. Similarly, scores for the three recognition tasks were similar to controls matching development age, but remained lower than those of chronologically age-matched controls.

Finally, scores on the parental ERC questionnaire for emotional regulation remained significantly lower than those of the two unaffected control groups and statistically similar to the PWS control group. The four groups were comparable regarding the EMOrea task (recording facial expressions).

“These results support that emotion regulation abilities require prerequisite emotion skills, which should be more fully considered in current training programs,” the researchers wrote. “Because emotion regulation disorders strongly impact all areas of life, an integrative developmental approach appears crucial especially in the case of neurodevelopmental disorders.”

“Further studies should be conducted to explore this perspective,” they said.