Insight

Is your child emotionally unaware?

Is your child:

  • Unable to comment on his own emotions?
  • Struggling to describe or explain her feelings?
  • Surprisingly unconcerned about the world outside his head?
  • Irresponsible or immature?
  • Wanting to engage with others but having no idea what to say?
  • Unable to articulate a long-term goal?
  • Unsure how to answer an open-ended question?
  • Friendly and kind but unable to make real, close connections with peers?
  • Not seeming to really understand his or herself personally, emotionally and in relationship to goals and responsibilities?

LET'S TALK ABOUT IT

Insight is a powerful thing. Understanding yourself is important as you develop from a young child to an adult.

Some children, adolescents and adults struggle to have insight or understanding into who they are personally, emotionally and in a relationship.

Parents of teenagers often voice concern that “my child is not responsible,” “he doesn’t have personal goals,” and “she wants to make YouTube videos as her career” or “he wants to be a professional gamer.” We often hear, “he or she is so smart, but . . .”

For parents, a lack of personal and emotional insight may not be obvious when a child is young. Subtle difficulties may be observed. Some children struggle to articulate their likes and dislikes. Others are not sure what to say about their own emotions.

When you ask, “how do you feel most of the time?” These kids often say, “I don’t know” or “bored.” Sometimes children who lack this insight appear to have a limited range of emotions. Facial expression may not vary. A child may use less than the typical amount of gestures to communicate.

Children with challenges in insight may be hard to read. These children have difficulty reading other people’s cues, emotions and interests. They often say they don’t ever think about feelings or think about themselves in relationship to others.

Typical children can generally describe their feelings fairly well. Gifted children, due to their tendency to be emotionally intense in concert with high intellect, should be able to describe their feelings.

It is cause for concern when describing feelings not something some a child can do, even while he or she may be great at describing other topics, such as the anatomy of the human body or the intricacies of the Battle of the Bulge.

When asking their child about feelings, parent might hear, “I don’t like talking about emotions,” “I can’t describe my feelings,” or “I don’t like all these questions.”

Below are examples of three children with limited personal and emotional insight.

Example 1: One clinician asked a child about his future and he said “I’d live in the Australian Outback by myself (he was 8). I’d have a big truck and I’d shoot you if you came there.” He said “Marriage? It’s to perpetuate the human species. I don’t want to do it.” When asked about feelings he said “I don’t know. I’m just bored.” He denied experiencing any other emotions.

This child was very matter of fact and polite. He wanted to be alone, and he did not think about his feelings or have insight into himself. He was not unhappy, but he was a bit disconnected. His fantasy turned out to be related to a TV show he liked about the Outback. He needed support to develop who he was personally and emotionally. (He also needed to learn not to tell people he would shoot them.)

Example 2: A less extreme example includes the adolescent who explained that he was depressed last year. When asked about his emotions, he shared that he does not feel any. He said that his parents told him he was depressed. He noticed that he sometimes had a very blank feeling that other people called “depression.” He said, “we’ve been working on it,” referring to he and his parents.

He could not describe any emotion, but he did note that he was not depressed any longer. He was not able to articulate why or how he knew. His facial expression was limited in range, and he used little nonverbal communication (like gestures). He had experienced a successful school year with good grades and developed two friendships. He was 18 and with an overall IQ score in the Very Superior range and 99.9th percentile. Clinicians get concerned when we see a child with such a high IQ who is unable to talk openly about simple emotions or elaborate on emotional experiences during a conversation. He needed regular therapy to work on his own insight and to continue to develop reciprocal relationships.

Example 3: An adolescent girl presented with Above Average ability and a particularly strong vocabulary. She stared blankly at the examiner when she was asked, “what do you do for fun?” After a long pause with no exchange, the examiner followed up with “maybe some favorite games or books?” The teenager said, “both of those.”

When asked, “what will you do on vacation next week?” she again stared blankly. When the examiner confirmed, “aren’t you going on vacation?” she said, “yes.” This teenager was smart, kind, compliant and unable to elaborate. She had no idea how she was doing in life, how she felt or what her strengths were as a person. She repeated 5 times in her interview that she had “wonderful friends” and that “friends don’t judge you outwardly.” She could offer no examples beyond these statements.

CLINICAL DESCRIPTION

Personal and emotional insight and personal responsibility can be subtle challenges that may fly under the radar in the absence of other symptoms. Often, bright children who are compliant and successful in school are not identified as having challenges until the teenage years. These challenges can pose a serious problem in identity development [Erik Erikson, Stages of Identity Development] and may be a marker for high functioning autism.

During identity development, children, teenagers and adults view themselves through a social-emotional lens and discover their strengths and weaknesses. This process is an important component of building self-esteem in the childhood years and developing a sense of identity in the teen years, which leads to meaningful relationships in the early adult years.

In Erikson’s theory, children develop interests, independence and responsibility as part of coming to their own identity. Some children and adolescents, particularly those with autism, need support in this process and guidance in discovering interests, strengths and how we relate to other people.

The companion to a lack of personal and emotional insight is challenge with perspective taking or understanding this information about others. See the companion article to this one on perspective taking.

Depression vs. Autism: For clinicians diagnosing disorders, it is important to differentiate the limited emotions shown in depressed children from the poor insight seen in autism.

Depressed teens tend to appear flat and offer limited responses. The difference is that the teenagers with Autism Spectrum Disorders who have these challenges are generally not depressed. If they are depressed, they tend not to have insight into their emotions.

It can be very helpful to ask the parent how a teenager feels and then ask the teenager during the interview or questionnaires of the assessment. For children with autism, the ratings between parent and child tend to differ dramatically. The child reports a near perfect emotional profile, but the parents are concerned about aggression, depression or anger. By contrast, most depressed teenagers are well aware of their emotional distress and will often report it quite accurately.

Autism Spectrum Disorder is about social communication. This disorder includes social challenges and restricted and repetitive patterns of behavior or interests. Social communication difficulties in autism often include difficulty with knowing what to say, carrying on back-and-forth conversations and reciprocity. Individuals with ASD may struggle to know how to contribute meaningfully to a conversation or interaction. They may not have the insight into their own strengths and weaknesses to assess their contribution. When a teenager does not know how she feels, this challenge can limit the ability to converse and connect meaningfully with peers.

What happens for these individuals with autism is as follows:

Autism is a disorder of connectivity [1,2]. This phrase means that parts of the brain do not always make fluid connections to other parts of the brain, and social and emotional memories are not always properly categorized or stored. A child with an Autism Spectrum Disorder may recall with detail an event that happened four years earlier. He or she may have strong emotions for that one memory but may not be able to tell you what happened yesterday at school.

Memories are stored in the neuro-network: He or she is not making a strongly connected framework. The typical brain stores emotional memories with information like “That was embarrassing, I won’t make that mistake again” or “I was so worried when I got lost at the zoo and again when I couldn’t find mom in the grocery store.”

Emotional Memories are like, ‘Inside Out’: Children who are developing normally take on memories, label emotions, and note coping responses. Experiences are grouped and understood. To better understand insight and emotional memory, the movie Inside Out offers up a great metaphor. In the movie, memory drawers hold a vast array of information that is filed. With autism, the filing system might not be so organized.

Insight enacts emotional memories. Children with the poor emotional insight often associated with autism often remember isolated events and do not have a framework with emotional labels that group memories into learning experiences. Some children with autism do not draw upon social or emotional memories, and thus they struggle to describe these experiences.

Facts are easier. Children with poor insight tend to remember factual information well. They make better connections between facts than they do between emotions. Often, a child with ASD will explode when he or she is frustrated with a sibling and then forget the incident 10 minutes later, thus not learning from the emotional experience. Parents may be gasping for breath as they notice that their child has completely moved on from the tough moment. A failure to label and recognize emotions early also means a child is not learning from these experiences or attending to his or her own emotional response.

Shadow Effect’: The problem, of course, with this lack of learning from experience is that the child continues to fall further and further behind his or her peers. Sometimes, the compounded effect of missing out on social experiences and associated memories is referred to as the ‘Shadow Effect’ of disabilities. In a sense, these missed opportunities tend to ‘stick with you’ and continue to wreak havoc on your social skills. Intervention early and often is needed to stop this chain of events and to get a child on track developmentally.

WHAT TO DO IF YOUR CHILD DOES NOT UNDERSTAND FEELINGS

Practice with your child. Label your own emotional experiences and mention your coping strategies. Comment once on an emotion your child may be feeling when he or she appears to be having a positive or negative emotional experience. If the experience is negative, use few words and guide your child to calm down with a strategy that works for him or her (listening to music, jumping on a trampoline, snuggling under a blanket, being alone in his room). Later, when everyone is calm, comment on the emotion and try to have a discussion about what experiences and small feelings led to bigger feelings and less control.

Model and role-play: Engage in a role-playing activity with your child. Take pictures of each of you making the face you would make when you experience a certain emotion. Put these pictures in an emotion book, and note the experiences on each emotion page that can lead you to feel that way. Use this book as a reference together to discuss feelings.

Feedback is king: Give specific praise and feedback so your child has a clear view of his or her strengths and weaknesses. Be positive yet realistic. Don’t tell your child he’s the next Ronaldo in soccer if he isn’t. Instead, point out attributes that your child can verify. For example, “You got the highest grade in class on your math test. You are really good at math.”

Help your child understand who he is: Encourage and voice your child’s strengths in emotional attributes like kindness, positivity, and willingness to help others. Be clear and specific. Many children with autism never say a negative word about another person. Many children are kind and accepting of everyone, which needs to be voiced to that child as a positive attribute.

Seek therapy: A child with poor personal and emotional insight needs to participate in psychotherapy with a clinician who works with children and teens on the Autism Spectrum. When it does not come naturally to express emotions and make those personal connections, therapy can help. A social group may also provide a chance to learn more about oneself and about others.

Encourage goal setting: For the personal responsibility component, try to notice strengths and make reasonable connections like “You work so well with the younger kids at the community center; maybe you could do a job that involves children.” Or “You are a computer whiz; you could think about computer science or computer programming as a career (instead of professional gamer).”

Encourage authentic experiences. Most children feel more engaged in an activity when they see the purpose or the reason behind doing something. A week-long shadow internship in a career of interest can be helpful in seeing why we take certain classes or need to make certain grades. These kids and teenagers also do very well with teachers who see their strengths and can think outside the box in terms of assignments and encouragement in a certain field or subject.

SIMILAR SYMPTOMS

If your child is struggling with a similar problem, not directly addressed in this section, see the list below for links to information about other related symptom areas.

  • Social skills (Socializing): poor social skills often go along with challenges with insight
  • Restricted patterns of behavior or interests (Restricted and Repetitive, Repetitive Behavior, Perseverating, Rigidity, Rigid Behavior) poor insight often accompanies social challenges, so it is important to look for rigid patterns of behavior or interests
  • Pragmatic language: children who do not understand social language often also struggle with insight
  • Social Motivation: children with poor insight may also struggle significantly with perspective taking and with social motivation
  • Self-Esteem: children with poor self-esteem may not have the confidence to make social connections or the willingness to fail or make a mistake. Building social skills and social successes can be so important as it builds confidence and provides sources of pride

POTENTIAL DISABILITIES

Children who have significant problems in this area may have any of the following potential disabilities. *Note, this does not serve as a diagnosis in any way. See ‘Where to Go for Help’ section for professionals who can diagnose or provide a referral.

  • Autism Spectrum Disorder (ASD): includes deficits in social communication and restricted interests or behaviors. In children, social skills deficits are present for ASD even while some children have social motivation and others do not
  • Language Disorder: includes deficits in language that impact social skills. Children who struggle with language may struggle to articulate who they are and what their strengths are
  • Intellectual Disability: includes deficits in cognitive ability (low IQ scores) that inhibit appropriate insight and responsibility

WHERE TO GO FOR HELP

If your child is struggling with this symptom to the point that it is getting in the way of his learning, relationships, or happiness, the following professionals could help; they may offer diagnosis, treatment, or both.

  • CLEAR Child Psychology: to obtain a customized profile of concerns for your child, or to consult ‘live’ with a psychologist. In-person and virtual assessment services are also available with CLEAR
  • Psychologist or Neuropsychologist: to provide an evaluation for diagnostic clarification; a psychologist may also run a social skills group to provide direct strategies and practice to improve social skills
  • Psychotherapist: to provide Cognitive Behavioral Therapy (CBT) interventions that have been shown to be effective in helping children with ASD make gains in recognizing and understanding emotions, personal insight, improving perspective taking and social skills and managing co-occurring depression and anxiety
  • Applied Behavior Analysis (ABA) Therapist: to provide Applied Behavior Analysis using principles of reinforcement to increase desired behaviors like communication and language and to decrease undesired behaviors like hitting/tantrums. For older children, ABA may be a good way to address personal responsibility, social skills, conversation, and social perspective taking
  • Speech and Language Pathologist (SLP): to provide speech and/or language support. The SLP is an important member of your treatment team if your child has language delays. Treatment works best if all team members can communicate with one another to make sure your child is getting comprehensive services

These professionals may recommend or administer the following tests for this symptom:

  • CELF-5: this measure of language assesses Vocabulary, Language Comprehension, Expressive and Receptive Language, Pragmatic Language, and Language Memory
  • WISC-V: this measure of intelligence provides information on abilities in verbal comprehension, fluid reasoning, visual spatial, working memory, and processing speed. Understanding a child’s cognitive profile can help us understand strengths and weaknesses that may be associated with ASD. The WISC-V can also help guide what other measures need to be administered to get a better picture of overall functioning. This test may be very broad, including language, motor, attention, memory, executive functioning, sensory processing, emotions, behavior, and more
  • ADOS-2 Module 3: this measure of social communication and restricted, repetitive behavior is used to rule in or out the presence of an Autism Spectrum Disorder. The ADOS-2 gives information that can guide the formation of treatment goals

LEARN MORE

[1] Kroncke, Willard, & Huckabee (2016). Assessment of autism spectrum disorder: Critical issues in clinical forensic and school settings. Springer, San Francisco.

[2] Fein, Deborah (2011).  “The Neuropsychology of Autism”

Amazon: https://www.amazon.com/Neuropsychology-Autism-Deborah-Fein/dp/0195378318/

[3] Berns, Roberta M. (2010). Child, family, school, community: Socialization and support.

Amazon: https://www.amazon.com/Child-Family-School-Community-Socialization/dp/1305088972/

[4] Mendler, Allen (2013). Teaching your students how to have a conversation.

Amazon: http://www.edutopia.org/blog/teaching-your-students-conversation-allen-mendler

[5] Ozonoff, Sally & Dawson, Geraldine & McPartland, James C. (2014). A parent’s guide to high functioning autism spectrum disorder: How to meet the challenges and help your child thrive.

Amazon: https://www.amazon.com/Parents-High-Functioning-Autism-Spectrum-Disorder/dp/1462517471/

[6] UCLA PEERS Clinic https://www.semel.ucla.edu/peers

[7] Giler, Janet Z. (2000). Socially ADDept: A manual for parents of children with ADHD and / or learning disabilities.

Amazon: https://www.amazon.com/Socially-ADDept-Children-Learning-Disabilities/dp/0966696921/

[8] Giler, Janet Z. (2011). Socially ADDept: Teaching social skills to children with ADHD, LD, and Asperger’s.

Amazon: https://www.amazon.com/Socially-ADDept-Teaching-Children-Aspergers/dp/047059683X/

[9] Baker, Jed. (2006) Social skills picture book for high school and beyond. https://www.amazon.com/Social-Skills-Picture-School-Beyond/dp/1932565353/

[10] Baker, Jed. (Retrieved 2017). Social skills books and resources for ASD.

http://socialskillstrainingproject.com/books.html

[11] Gray, Carol & Attwood, Tony (2010). The New Social Story Book, Revised and Expanded 10th Anniversary Edition: Over 150 Social Stories that Teach Everyday Social Skills to Children with Autism or Asperger’s Syndrome, and their Peers.

Amazon: https://www.amazon.com/Social-Story-Revised-Expanded-Anniversary/dp/1935274058/

[12] McConnell, Nancy & LoGuidice (1998). That’s Life! Social language.

Amazon: https://www.amazon.com/Thats-Social-Language-Nancy-McConnell/dp/0760602247/

[13] Erikson, Erik. Stages of Psychosocial Development.

Image Credit:
Description: Tired school boy with hand on face sitting at desk in classroom. Bored schoolchild…
Stock Photo ID: #244833715 (Bigstock)
By: Rido81
Emotional-inteligence
Previously Licensed on: August 15, 2018
Stylized by Katie Harwood exclusively for CLEAR Child Psychology

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