J Autism Dev Disord (2009) 39:938–945
DOI 10.1007/s10803-009-0700-0
ORIGINAL PAPER
Emotion Recognition in Children and Adolescents
with Autism Spectrum Disorders
Sanna Kuusikko Æ Helena Haapsamo Æ Eira Jansson-Verkasalo Æ
Tuula Hurtig Æ Marja-Leena Mattila Æ Hanna Ebeling Æ
Katja Jussila Æ Sven Bölte Æ Irma Moilanen
Published online: 10 February 2009
Ó Springer Science+Business Media, LLC 2009
Abstract We examined upper facial basic emotion rec-
ognition in 57 subjects with autism spectrum disorders
(ASD) (M = 13.5 years) and 33 typically developing
controls (M = 14.3 years) by using a standardized com-
puter-aided measure (The Frankfurt Test and Training of
Facial Affect Recognition, FEFA). The ASD group scored
lower than controls on the total scores of FEFA and per-
ceived ambiguous stimuli more often as a negative
emotion. The older ASD group (C12 years) performed
better than the younger ASD group (\12 years) on the
blended emotions of FEFA. The results support the find-
ings that individuals with ASD have difficulties in emotion
recognition. However, older subjects with ASD seem to
have better skills than younger subjects with ASD.
S. Kuusikko (&)
H. Haapsamo
T. Hurtig
M.-L. Mattila

H. Ebeling
K. Jussila
I. Moilanen
Institute of Clinical Medicine, Department of Child Psychiatry,
University and University Hospital of Oulu, P.O. Box 26,
90029 OYS Oulu, Finland
e-mail: kuusisan@paju.oulu.fi; sanna.kuusikko@gmail.com
E. Jansson-Verkasalo
Faculty of Humanities, Logopedics, University of Oulu, Oulu,
Finland
E. Jansson-Verkasalo
Department of Clinical Neurophysiology, University Hospital
of Oulu, Oulu, Finland
T. Hurtig
Institute of Health Sciences, University of Oulu, Oulu, Finland
S. Bölte
Department of Child and Adolescent Psychiatry, J.W. Goethe
University Frankfurt/M, Deutschorden Str. 50, 60528 Frankfurt,
Germany
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Keywords Asperger syndrome
Development

Eye region
High-functioning autism
Interpretation

Self-esteem
Understanding emotions usually requires multi-sensory
processing (e.g., Klucharev and Sams 2004). Emotions and
the feelings of others are interpreted from speech prosody
as well as from facial and body gestures. The fetus can
already recognize the prosody of speech before birth (e.g.,
Smith et al. 2007) and for infants, facial expressions
become another main source to identify emotional states in
others (Meltzoff and Moore 1977; Woodhead et al. 1995).
The ability to interpret others’ emotions (more exactly)
improves with age, achieving adult level (of interpretation)
around the age of 10–11 (e.g., Custrini and Feldman 1989;
Tonks et al. 2007). The ability to recognize the emotional
state of others requires the ability to divide attention and
focus gaze on relevant information. Most of this processing
is subconscious. From speech prosody, a commanding
expression has been reported to be the easiest to recognize,
while a sad expression is the most difficult (e.g., Kujala
et al. 2005). There is no full consensus as to which basic
emotion (i.e., happiness, sadness, fear, anger, surprise, or
disgust) is the easiest to decode from facial expressions. In
some studies, disgust or happiness has been reported to be
the easiest, whereas fear has been reported to be the most
difficult emotion to recognize (e.g., Ekman and Friesen
1976; Kohler et al. 2004; Montagne et al. 2007).
Autism spectrum disorders (ASD), such as Asperger
syndrome (AS) and High-functioning autism (HFA) are
characterized by impairment in social interaction, such as
difficulty in forming friendships and a lack of under-
standing of emotions and minds of others (Theory of mind
J Autism Dev Disord (2009) 39:938–945
[ToM]; e.g., Baron-Cohen et al. 1985; Kaland et al. 2007).
Caregivers of children with ASD have reported oddness in
their child’s social development as early as at 30 months of
age (Howlin and Asgharian 1999) as shown by impairment
of social orienting and joint attention (Dawson et al.
2004a). Social oddness may be due to abnormal eye-to-eye
contact, since children with ASD tend to avoid eye-to-eye
gaze. Furthermore, impaired social interaction may also be
linked to deficient skills in recognizing social cues from
other people’s facial expressions, body postures, and
speech prosody (e.g., Attwood et al. 1988; Korpilahti et al.
2007; Macdonald et al. 1989). For example, some studies
report that children with AS are more focused on the lower
part (i.e., the mouth) than the upper part (e.g., eyes) of the
face in making conclusions about facial emotion (e.g.,
Gross 2004; Klin et al. 2002). However, some researchers
suggest that children with autism also use the upper part of
the face in making conclusions about facial expression
(e.g., van der Geest et al. 2002; Laihaie et al. 2006), the eye
region avoidance being rather an attentional strategy in
individuals with autism. In the end, children with ASD
have been shown to ignore or neglect especially negative
facial affects (i.e., distress, fear, and discomfort) demon-
strated by adults or by photos as early as at age three (e.g.,
Dawson et al. 2004b; Sigman 1992). Difficulties in rec-
ognizing negative emotion, such as fear and sadness from
photos of faces are evident even in adults with ASD (e.g.,
Ashwin et al. 2007; Boraston et al. 2007; Pelphrey et al.
2002). In accordance with atypical face processing, recent
studies have shown that processing of basic emotions from
speech is impaired in individuals with AS (Kujala et al.
2005; Korpilahti et al. 2007). Kujala et al. 2005 reported
that adults with ASD recognized commanding and scornful
auditory stimuli as well as controls, but not sad ones.
Findings are not, however, so far conclusive, since some
reports have shown that children with autism are equally
able as typically developing children to recognize emotions
or even complex mental states from dynamic and static
faces (e.g., Back et al. 2007; Castelli 2005; Buitelaar et al.
1999) and that is why more research data of emotion rec-
ognition in individuals with ASD are still needed.
Because impairment in emotion recognition seems to be
rather permanent in individuals with ASD, intervention
tools for improving emotional recognition skills of indi-
viduals with ASD are desirable. One computer-aided
instrument to test and teach the recognition of facial
emotions is the Frankfurt Test and Training of Facial
Affect Recognition (FEFA; Bölte et al. 2003). Its effects
have been demonstrated on both behavioral and neuro-
biological level in adults (Bölte et al. 2006). However, it is
not yet well known how typically developing children and
adolescents perform on the FEFA. Also, we wanted to
focus on basic emotions as they are universal and primitive
939
reactions towards outside stimuli and not dependent on
cognitive processing or learned in the cultural environment
as more complex mental states are. Furthermore, regardless
of many previous studies of emotion recognition skills of
individuals with ASD, the research field is lacking studies
which are focused on that what emotion individuals with
ASD are decoding when they do not get the correct inter-
pretation from the shown facial expression.
The objectives of this study were (a) to evaluate basic
facial emotion recognition in partial faces (i.e., the eye
region) in typically developing children and children and
adolescents with ASD by using the FEFA. (b) To study
whether emotion recognition skills improve with age in
individuals with and without ASD, and (c) to study what
emotions are identified by individuals with ASD when they
rate emotions incorrectly (i.e., what emotions people with
ASD identify when they get the task wrong).
Methods
Participants
ASD probands were gathered from an epidemiological
study conducted in 2000–2003 (see Mattila et al. 2007) and
from the patient records of Oulu University Hospital in
2003. Controls were recruited from randomly selected
mainstream schools in Oulu in 2006 (Kuusikko et al.
2008a, b).
The ASD diagnoses were confirmed by a trained diag-
nostician clinical psychologist (KJ) as well as a
pediatrician (M-LM) based on the ICD-10 criteria (WHO
1993). Diagnoses of AS and HFA were distinguished from
each other by using the participants’ history of delays or
abnormal functioning prior to the age of three (i.e., delays
or abnormal functioning prior to the age of three = HFA,
no delays or abnormal functioning prior to the age of
three = AS). Diagnostic confirmation was obtained with
the autism diagnostic interview-revised (ADI-R; Lord et al.
1995) and the autism diagnostic observation schedule
(ADOS; Lord et al. 2000). All participants with ASD had a
full-scale IQ greater than 75 (Wechsler Intelligence Scale
for Children—Third Revision, Wechsler 1991) and they
did not meet criteria for other severe developmental dis-
orders (e.g., Fragile X).
Parents of control children were asked to complete the
autism spectrum screening questionnaire (ASSQ; Ehlers
et al. 1999). To be included in the further analyses, the
parent-rated ASSQ score had to be less than seven.
A total of 26 subjects with HFA aged 9.9–24.3 years (M =
13.7 ± 3.5 years), 31 subjects with AS aged 9.8–21.2 years
(M = 13.3 ± 2.7 years), and 33 typically developing control
subjects aged 10.5 and 16.7 years (M = 14.3 ± 1.5 years
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940
took part in the study. The difference between the mean ages
of each diagnostic group was significant; the participants in
the control group were thus older than participants in the AS
and HFA groups (v2 = 11.6, df = 2, p \ .01). In addition, the
proportion of boys was higher in the AS (23 boys, 8 girls) and
HFA (21 boys, 5 girls) groups than in the control group (15
boys, 18 girls). The mean age for boys in the AS, HFA, and
control groups were 9.8 (SD = 3.0), 9.9 (SD = 3.8), and 11.5
(SD = 1.5). There were no significant age difference among
boys (v2 = 3.5, df = 2, p = ns). For the girls, mean ages
were, respectively 10.6 (SD = 1.0), 11.3 (SD = 0.8), and
10.5 (SD = 1.6) yielding girls with AS and HFA being sta-
tistically significantly older than control girls (v2 = 12.3,
df = 2, p \ .01).
Procedure
The study was approved by the Ethics Committee of Oulu
University Hospital, Finland, and the control sample was
approved by the Chief of Education, the principals of the
schools involved, and the teachers of randomly selected
classes at the schools taking part in the study. After
parental consent, the children, accompanied by one or both
parents, were invited to the out-patient clinic, where the
study task was administered to the child in the presence of
a study researcher (KK, KL).
Instrument
The FEFA is a computer-based emotion recognition test,
which investigates the face processing and emotion rec-
ognition with black and white pictures presenting six basic
emotions (i.e., happiness, sadness, fear, anger, surprise, and
disgust) and neutral (Bölte et al. 2003). The FEFA com-
prises two submodules: 50 pictures of faces (i.e., the Face
Submodule) and 40 pictures of eyes (i.e., the Eye Sub-
module). Each picture is shown in the computer screen
separately within all six emotions written side of the pic-
ture as an answer option (See photo in Bölte and Poustka
2003). Participant is asked to select correct emotion by
clicking it with the computer mouse. Normative data for
FEFA have been collected in Germany with typically
developed adults (N = 22, M = 29.7 years), yielding a
mean score of 42.9 for the Face Submodule and 34.5 for
the Eye Submodule (Bölte et al. 2006). The psychometric
properties of FEFA have been reported to be excellent
(Bölte and Poustka 2003).
In this study the Eye Submodule was used. The answers
are rated on a binary scale (i.e., 0 = not correct and
1 = correct). Of the 40 pictures (i.e., FEFA Total scale), 25
pictures have one correct answer (i.e., Pure Emotion scale)
and 15 have two alternative correct answers (i.e., Blended
Emotion scale).
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J Autism Dev Disord (2009) 39:938–945
The Pure Emotions scale consists of six pictures of
happy eyes, four pictures of sad eyes, three pictures of
fearful eyes, five pictures of angry eyes, one picture of
surprised eyes, two pictures of disgusted eyes, and four
pictures of neutral eyes. In addition, one picture was
removed from the sadness scale and from further analyses
because most of the participants (i.e., 80.0% of the ASD
group and 93.9% of the controls) misclassified it as hap-
piness. Thus, the maximum score was 39 on the FEFA
Total scale, 24 on the Pure Emotion scale, and three on the
sadness scale.
The Blended Emotion scale consists of four blends of
surprise-fear, three blends of sadness-neutral, two blends of
anger-disgust, one blend of sadness-fear; sadness-anger;
fear-anger; neutral-happiness; neutral-anger; and happi-
ness-surprise. The maximum score on the Blended
Emotion scale was 15.
Statistical Analyses
The analyses were performed with the Statistical Package
for Social Sciences (SPSS/Win 14.0). Variables were
normally distributed, but due to some other violations of
parametric testing (i.e., small sample sizes and small
number of variables in some sum scores of the data) sub-
sequent analyses were performed using nonparametric
tests. Mann–Whitney U-test (Z) was used to calculate the
group differences between gender, diagnostic status, and
age group on the FEFA scales. Chi-square test (v2) was
used to compare incorrectly rated emotions and blended
emotions in different diagnostic groups. p values lower
than .01 are considered as significant due to correction of
multiple testing. However, also results with p value lower
than .05 are reported. All p values reported are two-tailed.
Results
Diagnose and Gender Differences on FEFA Within
ASD Probands and Controls
The AS and HFA groups performed similarly on the FEFA.
The only statistically significant difference between par-
ticipants with AS or HFA was seen on the disgust scale:
participants with AS scored higher than participants with
HFA (M = 1.6 vs. 1.2, z = 2.8, df = 1, p \ .01). There-
fore, we combined AS and HFA participants into a single
group (i.e., ASD group) for all subsequent analyses. A
gender difference was found in the ASD on the Anger
scale: boys with ASD scored higher than girls with ASD
(M = 0.5 vs. 0.4, z = 2.2, df = 1, p \ .05). In the control
group significant gender differences were found on the
Pure positive scale (i.e., scales of Happiness ? Surprise)
J Autism Dev Disord (2009) 39:938–945 941

and Happiness scale: control girls scored higher on these
scales than did control boys (M = 6.1 vs. 5.0, z = 2.8,
df = 1, p \ .01; M = 0.9 vs. 0.7, z = 2.8, df = 1, p \ .01,
respectively). Due to significant gender differences in the
ASD and control groups, genders were examined sepa-
rately on the Pure positive scale, on the Happiness scale
and on the Anger scale. In addition, surprise and disgust
were the easiest and anger the most difficult emotion to
recognize in the ASD group, whereas surprise was the
easiest and anger the most difficult emotion to recognize in
the control group (See Fig. 1).
Age Differences on The FEFA Within ASD Probands
and Controls
Age was included in the statistical models to examine whe-
ther performance on the FEFA improves with age among the
groups. Children were divided into two age groups, those
under 12 years of age and those 12 years or older. There
were no significant differences on FEFA scales between the
younger ASD (n = 14, M = 10.9 years) and younger con-
trol group (n = 3, M = 11.2 years). However, the older
ASD group (n = 43, M = 14.3 years) scored lower than the
older control group (n = 30, M = 14.6 years) on the FEFA
Total scale (M = 26.9 vs. 28.9, z = 2.4, df = 1, p \ .05) and
on the FEFA Pure Emotion scale (M = 14.9 vs. 16.6,
z = 2.4, df = 1, p \ .05) (see Table 1). Older girls with
ASD performed significantly lower than older control girls
on the Pure positive scale, on the Happiness scale, and on the
Anger scale (M = 4.1 vs. 6.1, z = 2.9, df = 1, p \ .01;
M = 3.4 vs. 5.2, z = 3.3, df = 1, p \ .001; M = 1.8 vs. 3.0,
z = 3.2, df = 1, p \ .01, respectively). There were no sig-
nificant differences between younger groups or between
older boy groups on the Pure positive scale, Happiness scale
or the Anger scale.
0,9
Pure emotions
0,8 means for ASD
Pure emotions
0,7 means for controls
0,6
0,5
0,4
0,3
In addition, younger children with ASD scored lower
than older participants with ASD on the FEFA Total scale
(M = 23.8 vs. 26.9, z = 2.3, p \ .05) and significantly
lower on the Blended Emotion scale (M = 10.6 vs. 12.0,
z = 3.0, df = 1, p \ .01) (See Fig. 2).
Differences Between Diagnostic Groups on
Discrimination of Blended Emotions
When the emotion was a blend between surprise and fear,
participants with ASD interpreted the blend significantly
more often as fear compared to the controls (56.1 vs. 18.2%,
v2 = 12.8, df = 1, p \ .001) (See Fig. 3). Controls also
decoded sadness-neutral blended emotions as neutral more
often than ASD probands (56.3 vs. 31.6%, v2 = 6.0, df = 1,
p \ .05). There were no significant differences between
ASD probands and controls decoding the blends of anger-
disgust, sadness-fear, sadness-anger, fear-anger, neutral-
happiness, neutral-anger, or happiness-surprise.
Analysis of Incorrectly Classified Emotions in ASD
Probands and Controls
We were interested in finding out with what emotion the
participants confused the correct emotion when the clas-
sification was incorrect on the Pure Emotion scale. We
divided the six emotions into positives (i.e., happiness and
surprise) and negatives (i.e., sadness, fear, anger, and dis-
gust). We were also interested in seeing with what emotion
the participants confused the neutral faces if the classifi-
cation was incorrect.
In their incorrect answers, the ASD probands rated anger
as the other negative emotion (44.8%) significantly more
often compared to the controls (26.1%) (v2 = 20.9, df = 1,
p \ .001) (See Fig. 4). On the other hand, the ASD pro-
bands misclassified disgust as a positive emotion (i.e.,
surprise) (17.5%) more often than the controls (6.1%)
(v2 = 6.0, df = 1, p \ .05) in their incorrect answers.
Furthermore, in their incorrect answers the controls inter-
preted a neutral expression more often as a negative
(14.4%) than a positive (3.0%) emotion, whereas ASD
probands divided their false answers more equally between
negative (17.1%) and positive (11.8%) emotions (v2 = 4.2,
df = 1, p \ .05).

0,2

0,1 Discussion
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Our aim was to study emotion recognition in children with
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ASD and typically developing children. Similarly as found

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earlier in children with autism, the ASD probands per-

Fig. 1 Means of pure emotion answers divided by number of items in formed significantly lower on the FEFA emotion
each emotion recognition test compared to the controls. Specifically, for

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Table 1 Mean scores of the FEFA scales on ASD and control groups
FEFA Scales (maximum score) M (SD) z (df = 1) M (SD) z (df = 1)
Participants under 12 years old Participants on or above 12 years old
ASD N = 14 Controls N = 3 ASD N = 43 Controls N = 30

FEFA total (39) 23.9 (4.4) 25.7 (5.0) 1.4 26.9 (3.7) 28.9 (3.5) 2.4*
Pure emotion total (24) 13.1 (3.2) 14.3 (4.5) 1.0 14.9 (3.0) 16.6 (3.0) 2.4*
Pure positive (7) 3.7 (1.7) 5.3 (1.5) 0.5 4.5 (1.5) 5.6 (1.1) 3.0

Pure negative (13) 6.9 (1.6) 5.3 (4.0) 1.2 7.4 (1.8) 7.7 (1.8) 0.6
Happiness (6) 3.1 (1.8) 4.3 (1.5) 0.6 3.8 (1.5) 4.8 (1.1) 3.0

Sadness (3) 1.5 (0.8) 1.7 (0.6) 0.8 1.7 (0.8) 1.7 (0.5) 0.2
Fear (3) 1.6 (1.4) 1.0 (1.7) 0.9 2.0 (1.1) 1.7 (1.1) 1.3
Anger (5) 2.3 (0.6) 1.7 (1.2) 1.7 2.3 (0.9) 2.7 (0.7) 2.1*
Surprise (1) 0.6 (0.5) 1.0 (0.0) 0.8 0.8 (0.4) 0.8 (0.4) 0.7
Disgust (2) 1.4 (0.6) 1.0 (1.0) 1.2 1.4 (0.7) 1.6 (0.7) 1.0
Neutral (4) 2.6 (0.9) 3.7 (0.6) 0.5 2.9 (1.0) 3.3 (1.0) 1.5
Blended emotion total (15) 10.6 (1.4) 11.3 (0.6) 1.6 12.0 (1.2) 12.3 (1.2) 1.3


p \ .01, * p \ .05, two-tailed
Note: Old ASD group \ old control group on FEFA total scale; Pure emotion total scale; Pure positive emotion scale; Happiness scale; Anger
scale

0% 20 % 40 % 60 % 80 % 100 %
*
30,0
ASD < 12 years More fear
controls < 12 years
25,0 ASD 12 years No difference
controls 12 years
20,0 † More surprised

15,0

More neutral
10,0
No difference
5,0
More sadness

0,0
FEFA Total Blended Emotions
†
p < .01, * p < .05, 2-tailed.
Fig. 2 Differences with age on the mean scores of the FEFA total
and the blended emotion scales. Note: The young ASD group \ the
old ASD group on the mean scores of the FEFA total and the blended
emotion scales
the girls with ASD, expressions of happiness and anger were
more difficult to recognize from the eyes compared to the
control girls even the girls with ASD were significantly
older than the control girls. These findings may be due to the
fact that individuals with autism need more exaggerated
facial gestures to be able to interpret the emotional state of
others (Rutherford and McIntosh 2007) correctly, or that
they need more cues, such as verbal or environmental
contents, to decode the emotion correctly (Grossman et al.
2002; Lindner and Rosén 2006).
ASD Control
Fig. 3 Rates of answers on blended emotions of surprise-fear and
neutral-sadness in ASD and control groups
In the case of blended emotions, children with ASD
perceived in ambiguous stimuli more often negative emo-
tions, such as fear, than did the controls. Compared to
controls, the ASD probands also misinterpreted anger in
their incorrect answers more often to another negative
emotion. These findings give rise to the question of whe-
ther ASD probands have a tendency to interpret emotions
as negative rather positive. If so, is it due to their consid-
erable amount of negative experiences, difficulties with
experiencing and containing their own aggressiveness, or
because they often interpret the reactions of others as
aggressive based on their own projective identification?
When the understanding and interpreting of others’

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J Autism Dev Disord (2009) 39:938–945 943

0% 20 % 40 % 60 % 80 % 100 % However, in their incorrect answers ASD probands

interpreted disgust more often as surprise, although this
Sadness Happiness
ASD
Control was not statistically significant (p \ .05), whereas control
interpreted it as another negative emotion, anger. This
ASD
finding may reflect the only difference that was found
Control
between children with HFA and AS: the emotion repre-
senting disgust was significantly more difficult to recognize
for children with HFA than for those with AS. This could
ASD
mean that children with AS are somewhat more able than
Fear

Control
children with HFA to differentiate between emotions as
well as to verbalize them, although the finding is rather
ASD
small and specific. Replications of this finding are thus
Anger

Control needed. Furthermore, ASD probands’ incorrect answers on

the neutral expression scale were fairly equally divided
Surprised

ASD between incorrect positive and incorrect negative emotions,

Control whereas the incorrect ratings by controls were more on the
negative side. This finding may reflect the fact that neutral
ASD expression was more difficult to recognize for the ASD
Disgust

Control group than the control group, and/or that individuals with
ASD tend to interpret all faces, even neutral ones, as
meaningful (Bölte et al. 2008).
Neutral

ASD
Control
Correct emotion Incorrect, Negative emotion
Incorrect, Positive emotion Incorrect, Neutral expression
Fig. 4 Rates of correctly and incorrectly classified emotions on ASD
and control groups.Note: ASD [ controls anger as another negative
emotion. ASD [ controls disgust as a positive emotion. ASD [
controls neutral as a positive emotion
feelings is impaired or delayed, others’ aggressiveness as
well as tenderness towards self may come as a surprise
every time. Responses toward others may thus be atypical
considering the situation: individuals with ASD may overly
interpret and anticipate negative responses from others.
Atypical responses of individuals with ASD might be self-
protection from a situation or feeling, which is too difficult
to cope with. Atypical responses in social situations may be
one reason why individuals with ASD are rejected by
peers, causing negative experiences. Furthermore, rejection
as well as withdrawal from social situations may cause a
critical lack of real-life practise in understand the feelings
of others. Instead of reality, the interpretation of others’
feelings may thus also be based on one’s imagination and
self-esteem. In addition, social anxiety symptoms are
reported to be common in children and adolescents with
ASD (e.g., Kuusikko et al. 2008b; Melfsen et al. 2006).
Therefore, it is also possible that children with ASD are
more sensitive and more prone to focus their selective
attention towards negative rather positive emotions, simi-
larly to individuals with social and generalized anxiety are
(e.g., Beck 1976; Eysenk 1992).
The skills to recognize emotions from the eye region
improved significantly with chronological age in individuals
with ASD. It may be that in individuals with ASD, emotion
recognition skills improve over a longer period of time than
in typically developing children. It thus seems that ASD
probands do not achieve the level of their typically devel-
oping control counterparts, which is why it would be very
useful to teach emotion recognition in therapeutic settings
(away from the natural settings) to individuals with ASD.
There are studies showing improvement of facial emotion
recognition with practice in individuals with autism (e.g.,
Bölte et al. 2006; Golan and Baron-Cohen 2006; Silver and
Oakes 2001). However, because generalizing adapted skills
from one situation to another is a well-known impairment in
ASD, the intervention should start early and focus on
building a positive self-esteem in individuals with ASD.
A larger sample of control children under age 12 years
old may have enhanced our power to detect greater asso-
ciations between age group and FEFA outcomes. Partly
due to data power in control groups, no significant differ-
ences were found between younger and older control
groups. Moreover, in the used measure, there were low rate
of emotions in each scale. That may have prevented us
from obtaining the statistically significant differences
between the groups. Finally, data samples were not FSIQ-
matched, but all participants attended mainstream schools.
Previous studies have shown that high-functioning children
with autism score higher than low-functioning children
with autism on emotion recognition. This may reflect the
finding that the children with ASD in our study performed
better (M = 26.1) than for example in the study of
Albertowski et al. (2007), where the mean score on the Eye

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Submodule was 19.3 in a group of 45 children with autism
(M = 12.3 years, Raven-IQ = 98 ± 27.4) (Albertowski
et al. 2007).
In summary, children and adolescents with ASD seem to
have more difficulties than typically developing children
and adolescents in recognizing emotions from the upper
part of the face. However, the emotion recognition skills of
individuals with ASD may to improve with age, even
thought they do not seem to achieve the level of typically
developing individuals. Thus, it is important to examine
and develop new intervention tools to teach emotion rec-
ognition strategies at an early stage to individuals with
ASD. Finally, helping children with ASD to understand the
minds of others may prevent children with ASD from
experiencing negative series of vicious circles and possibly
reduce their psychiatric comorbidity, such as social anxiety
and depression, in adolescence and adulthood.
Acknowledgments The research was supported by The Alma and
K. A. Snellman Foundation, Oulu, Finland (PI: S. Kuusikko, H. Ha-
apsamo, M-L. Mattila); Child Psychiatric Research Foundation,
Finland (PI: S. Kuusikko, M-L. Mattila); Child Psychiatric Research
Foundation, Northern Ostrobothnia Hospital District Area, Finland
(PI: S. Kuusikko, M-L. Mattila); Emil Aaltonen Foundation, Finland
(PI: H. Ebeling); the Rinnekoti Research Foundation, Espoo, Finland
(PI: M-L. Mattila); Thule Institute, University of Oulu (PI: I.
Moilanen); and Juselius Foundation (PI: I. Moilanen). The Graduate
School of Circumpolar Wellbeing, Health and Adaptation is
acknowledged for their support. We want to thank the participants of
the study, Clinical Psychologist Raija Ollikainen for translating the
FEFA in Finnish, Ms Kaisa Kouri, Ms Katja Larinen, and Mr Jukka
Rahko for their help in data collection, and Leena Joskitt for her
statistical advises.
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