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Autism: Family Life - Tactics for Getting Normal Again
Autism continuing education psychology CEUs

Section 12
Sharing Humor & Laughter in Autism

CEU Question 12 | CEU Answer Booklet | Table of Contents | Autism
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

Everyday humour and laughter can tell us about children's ability to engage with and understand others. A group of 19 pre-school children with autism and 16 pre-school children with Down's syndrome, matched onLaughter Autism Family Life counselor CEU non-verbal mental age, participated in a cross-sectional study. Parental reports revealed no group differences in overall frequencies of laughter or laughter at tickling, peekaboo or slapstick. However, in the autism group, reported laughter was rare in response to events such as funny faces or socially inappropriate acts, but was common in strange or inexplicable situations. Reported responses to others' laughter also differed: children with autism rarely attempted to join in others' laughter and rarely attempted to re-elicit it through acts of clowning or teasing. Analysis of videotaped interactions also showed no group differences in frequencies of child or adult laughter. However, the children with autism showed higher frequencies of unshared laughter in interactive situations and lower frequencies of attention or smiles in response to others' laughter. Humour is an affective and cultural phenomenon involving the sharing of affect, attention and convention; children with autism show problems in some simple affective and mutual as well as joint attentional and cultural aspects of humorous engagement.

"The tragic (and the dramatic). . . are universal. The comic (is) ... bound to its time, society, cultural anthropology" (Umberto Eco, Travels in hyperreality, 1986)

Humour and laughter are fundamentally relational phenomena and can tell us a lot about the interpersonal, affective, socio-cognitive and cultural skills of young children. Despite their potential as developmental and diagnostic tools, however, we know little about their everyday occurrence in very early development and even less in atypical development. Humour and laughter in children with autism are of particular relevance because their difficulties centre specifically around relating to other people (Hobson, 1989), sharing cultural conventions (Lord, 1993; Loveland, 1991) and understanding others' emotional, attentional and intentional states (Baron-Cohen, 1989; Hobson, 1986a, b; Leslie, 1987; Mundy, 1995), and because the debate surrounding the nature of the primary deficit in autism is still unresolved. The present paper opens up a body of everyday phenomena for investigation in terms of interpersonal understanding and contributes to the debate about social understanding in autism with naturalistic data from children with autism and children with Down's syndrome.

Psychological theories of humour development in recent years have focused mainly on individual cognition, i.e. on the individual's processing of incongruity and its resolution, rather than on social, emotional or cultural processes. However, in older writings, humour and laughter are acknowledged as relational and social phenomena (Bergson, 1911; Freud, 1905; Johnson, 1978; Koestler, 1964; Lowenfield, 1935; Luquet, 1930; Wolfenstein, 1954/1978). A joke may be a joke when even one person laughs at it (Crawford, 1999), but one person's laughter is needed to make a joke funny. Whether humour and laughter could ever develop if they were never shared with another human being may be one of those questions that can only be indirectly answered. That humour exists between people rather than somehow in the joke itself, is also evident from the forms and topics of humour which do not travel well across cultures and contexts. Sharing humour may show a more complex acculturation than sharing tragedy, requiring subtle implicit reference to socio-cultural rules rather than their explicit acknowledgement (Eco, 1986). Sharing laughter with others reveals both cultural and emotional attunement with them, namely a mutuality of interest in the topic of the laughter and/or an interest in the laughter of the others as an affective state in its own right. It is well known that the presence of others facilitates laughter to humorous events in adults and in children (Chapman, 1976; Glenn, 1989) and that laughter itself can be contagious (Provine, 1992). Although no clear evidence exists regarding the onset of contagious or socially facilitated laughter in infancy, it may begin from the middle of the first year (Reddy, personal observation).

The primary focus on cognitive processes underlying humour has led to a dearth of information about humour early in development. The cognitive skills for the humorous appreciation of incongruity (absurdity or the juxtaposition of different frames of reference) are believed to develop after 18 months (McGhee, 1979), although primitive precursors to humour can be seen earlier in laughter in response to tickling, peekaboo and chasing (Shultz, 1976). Potentially humorous behaviour in infants younger than 18 months has consequently been rarely explored, and study of the production and use of humour in actual engagement has been neglected in favour of studies of responses to controlled humorous 'stimuli'.

Early humorous exchanges in typical development
Humorous exchanges are central to social interactions with infants as young as 3 months of age (Ambrose, 1963; Darwin, 1872; Washburn, 1929), and during the first year, developments in infant laughter at humorous events reveal an increase in non-reflexive laughter, an increasing appreciation of culturally inappropriate acts, and a grasp of playful intentions in others. In the middle of the first year, infants laugh mainly at events involving physical or intense sensory contact--especially tactile stimulation such as tickling -- but by 11 or 12 months of age, infants laugh more at distal events such as funny faces and sounds, or events involving socially inappropriate or incongruous acts such as mother waddling like a duck or sucking from the baby bottle (Sroufe & Wunsch, 1972). Laughter at increasingly more complex events may result from a tendency to respond most positively to challenges that are just at the edge of their capacities (Sroufe & Wunsch, 1972; Zigler, Levine, & Gould, 1966), and newly discovered patterns and norms are often violated and distorted in fun and exploration (Garvey, 1977; Groos, 1901/1976). Infant laughter at the violation of social expectancies (Sroufe & Wunsch, 1972) reveals the infant's grasp of the social conventions governing the use of objects and the performance of actions, and infant laughter at others' teasing and joking shows an understanding of playful versus serious intentions in others (Nakano & Kanaya, 1993; Trevarthen & Hubley, 1978).

From around 10 months of age, infants begin to be active humorists as well as appreciative respondents, laughing before rather than after the termination of humorous events (Sroufe & Wunsch, 1972), initiating key aspects of familiar playful sequences themselves (Bruner & Sherwood, 1976) and initiating novel games and humorous interactions as well as routine ones (Bates, Benigni, Bretherton, Camaioni, & Volterra, 1979; Reddy, 1991; Trevarthen & Hubley, 1978). Mischief begins at this age, specifically teasing and clowning, aimed at provoking laughter and other emotional reactions in others (Reddy, 1991). Clowning may involve the ritual violation of the sacred (Handelman, 1981), and the ability to accept intimacy (Lowenfield, 1935), but at its simplest level involves sensitivity to others' amusement and the repetition of, often exaggerated, acts that have previously elicited laughs. Teasing others requires some understanding of others' emotional attitudes, expectations and intentions (Dunn, 1988; Leekam, 1991; Nakano & Kanaya, 1993; Reddy, 1991; Stern, 1985) and the provocative violation of social understandings, conventions and agreements (Alford, 1983; Miller, 1986; Pawluk, 1989; Reddy, 1991). Clowning and teasing require two corresponding 'skills' in both the comic and their 'audience': one, an interest in others' emotional reactions and a desire to elicit them (or let them be elicited); and two, the ability to perceive (and respond to) causal links between one's actions and others' reactions. Teasing, in addition, requires a shared knowledge of social meanings, conventions and agreements that may then be playfully violated. Both clowning and teasing maybe precursors of joint attentional abilities (Bakeman & Adamson, 1984; Mundy, Sigman, & Kasari, 1993) as they involve the infant's active directing of others' attention to acts by the self before infants are able to direct attention to external targets (Reddy, Hay, Murray, & Trevarthen, 1997; Reddy, 1998, 1999).

Evidence of humour and laughter in autism
Evidence about humour in autism is sparse. Older writings and some anecdotal reports suggest that 'seeing the funny side of things' is a problem in autism, as is laughing in moderation or in balance with others (Asperger, 1952/1991; Lord, 1993). In typical development, humour is related to behaviours less evident in autism; playfulness, curiosity and disobedience (Barnett, 1991). Children with autism have deficits in 'showing-off' or drawing attention to themselves or to their acts (Dahlgren & Gillberg, 1989; Wetherby & Prutting, 1984), although it is unclear whether this extends to clowning. Although older autistic children are reported to tease, the nature of this teasing is unclear (Kanner, 1943; Lord, 1993), and while children with autism and Asperger's syndrome often get teased by peers, they are reported to have particular difficulty in responding to teasing with understanding, thus perhaps increasing the likelihood of being teased (Asperger, 1952/1991; Wing, 1991).

The very few recent studies on this topic suggest that children and adults with autism may not have a problem with humour per se, but only with humour involving complex cognitive skills. High functioning adults with autism produce a variety of forms of humour, including verbal and conceptual incongruities, multiple meanings and jocular acts of pretence with the functions of objects, and only show deficits in humour with high cognitive demands (Van Bourgondien & Mesibov, 1987). Parents of school-age children with autism do, however, report some problems in humour-related interactions, particularly in relation to clowning rather than to teasing (Briscall, 1995). In the only available exploration of humour and laughter in young school-age children with autism, St James and Tager-Flusberg (1994) suggest that the simpler forms of humorous interaction (which typically occur in the first year of infancy) may be unaffected. They observed parent-child interactions in the home for six children with autism and six children with Down's syndrome (DS) individually matched on language level with ages ranging from 3 to 7 years. Although there was a large variability within groups, they found more humour episodes overall in the DS group, but when total humour was a covariate, there was a significant difference between groups in only one category of humorous response -- non-verbal incongruity (i.e. humorous inappropriate acts with objects) -- with the children with DS producing (or responding to) relatively higher frequencies of such acts than the children with autism. In all other categories--tickling, familiar routines, silly/slapstick, funny sounds, teasing, verbal incongruity and riddles-there were no significant group differences, although jokes and riddles were completely absent in the autism group. The authors suggest that it may be only the cognitively more complex forms of humour that are affected in autism (incongruity and above), since the developmentally simpler, more affective, forms of humour such as tickling, familiar routines and slapstick show no apparent deficit in autism.

However, we cannot yet conclude that children with autism are 'above' the 12-month level of typically developing infants in terms of humour and laughter, or that there are no simple affective and relational problems in humorous exchanges in autism. This study involved very small and heterogeneous groups of school-age children, and the findings may not generalize to a larger sample or to pre-school children. Only episodes where laughter actually occurred were analysed, and there may have been critical failures to laugh or unsuccessful attempts by others to elicit laughter. In more private contexts, there may be other differences in the elicitors of laughter between the two groups of children that can be reported by the family. Furthermore, we do not yet know anything about children's interest in and responses to others' laughter or their own attempts to make others laugh, all of which are necessary before we can determine whether the affective aspects of humour and laughter are disrupted in children with autism.

Debates about the primary deficit in autism
Research on autism shows that deficits in young children with autism involve several aspects of social relations: affective engagement with others, the understanding of others' intentions, affective and attentional states and joint attention deficits. All of these skills are evident in the humorous interactions of typical infants before the end of their first year. However, there is considerable disagreement about the age of onset of the disorder and about the nature of the primary deficit. The mentality-specific conceptual deficit view (Baron-Cohen, 1989; Leslie, 1987; Perner, 1991) argues that the deficit appears at 18 months, following the failure of a critical cognitive representational mechanism. Affective disturbance views, however (Hobson, 1989; Trevarthen, Aitken, Papoudi, & Robarts, 1996), suggest an onset earlier in infancy, whose basis lies in disturbances in the ability to engage emotionally with others. Simple humorous exchanges involving emotional engagement may provide evidence to illuminate a part of the debate about autism. St James and Tager-Flusberg (1994), with their findings about the lack of group differences in simple humour, suggest support for a cognitive deficit view and conclude that the claim for an affective and interpersonal basis for the constellation of deficits in autism (Hobson, 1989) is weakened. However, even inappropriate acts with objects may require an affective and social basis. They need, for instance, an interest in what other people think of as appropriate actions (Williams, Costall, & Reddy, 1999; Williams, Reddy, & Costall 2001). More evidence is needed about other affective aspects of humour before we can resolve this issue.
- Reddy, Vasudevi, Williams, Emma & Amy Vaughan, Sharing humour and laughter in autism and down's syndrome, British Journal of Psychology, May 2002, Vol. 93, Issue 2.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #5
The preceding section contained information about sharing humor and laughter in autism. Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 12
Why is humor and laughter in children with autism of particular relevance? Record the letter of the correct answer the CEU Answer Booklet.

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Table of Contents

Anxiety in 3- to 7-year-old children with autism spectrum disorder seeking treatment for disruptive behavior
Autism, Ahead of Print.
Anxiety is a common and impairing problem in children with autism spectrum disorder, but little is known about it in preschool children with autism spectrum disorder. This article reports on the characteristics of anxiety symptoms in young children with autism spectrum disorder using a parent-completed rating scale. One hundred and eighty children (age 3–7 years) participated in a clinical trial of parent training for disruptive behaviors. Anxiety was measured as part of pre-treatment subject characterization with 16 items from the Early Childhood Inventory, a parent-completed scale on child psychiatric symptoms. Parents also completed other measures of behavioral problems. Sixty-seven percent of children were rated by their parents as having two or more clinically significant symptoms of anxiety. There were no differences in the Early Childhood Inventory anxiety severity scores of children with IQ < 70 and those with ⩾70. Higher levels of anxiety were associated with severity of oppositional defiant behavior and social disability. Anxiety symptoms are common in preschoolers with autism spectrum disorder. These findings are consistent with earlier work in school-age children with autism spectrum disorder. There were no differences in anxiety between children with IQ below 70 and those with IQ of 70 and above. Social withdrawal and oppositional behavior were associated with anxiety in young children with autism spectrum disorder.
Obesity, physical activity, and sedentary behaviors in adolescents with autism spectrum disorder compared with typically developing peers
Autism, Ahead of Print.
Decreased engagement in beneficial physical activity and increased levels of sedentary behavior and unhealthy weight are a continued public health concern in adolescents. Adolescents with autism spectrum disorder may be at an increased risk compared with their typically developing peers. Weekly physical activity, sedentary behavior, and body mass index classification were compared among adolescents with and without autism spectrum disorder. Analyses included 33,865 adolescents (autism spectrum disorder, n = 1036) from the 2016–2017 National Survey of Children’s Health (United States). After adjustment for covariates, adolescents with autism spectrum disorder were found to engage in less physical activity and were more likely to be overweight and obese compared with their typically developing peers (p’s < 0.05). As parent-reported autism spectrum disorder severity increased, the adjusted odds of being overweight and obese significantly increased and physical activity participation decreased (p-for-trends < 0.001). The findings suggest there is a need for targeted programs to decrease unhealthy weight status and support physical activity opportunities for adolescents with autism spectrum disorder across the severity spectrum.
Scanpath similarity measure reveals not only a decreased social preference, but also an increased nonsocial preference in individuals with autism
Autism, Ahead of Print.
We compared scanpath similarity in response to repeated presentations of social and nonsocial images representing natural scenes in a sample of 30 participants with autism spectrum disorder and 32 matched typically developing individuals. We used scanpath similarity (calculated using ScanMatch) as a novel measure of attentional bias or preference, which constrains eye-movement patterns by directing attention to specific visual or semantic features of the image. We found that, compared with the control group, scanpath similarity of participants with autism was significantly higher in response to nonsocial images, and significantly lower in response to social images. Moreover, scanpaths of participants with autism were more similar to scanpaths of other participants with autism in response to nonsocial images, and less similar in response to social images. Finally, we also found that in response to nonsocial images, scanpath similarity of participants with autism did not decline with stimulus repetition to the same extent as in the control group, which suggests more perseverative attention in the autism spectrum disorder group. These results show a preferential fixation on certain elements of social stimuli in typically developing individuals compared with individuals with autism, and on certain elements of nonsocial stimuli in the autism spectrum disorder group, compared with the typically developing group.
Psychosocial deficits across autism and schizotypal spectra are interactively modulated by excitatory and inhibitory neurotransmission
Autism, Ahead of Print.
Continued human and animal research has strengthened evidence for aberrant excitatory–inhibitory neural processes underlying autism and schizophrenia spectrum disorder psychopathology, particularly psychosocial functioning, in clinical and nonclinical populations. We investigated the extent to which autistic traits and schizotypal dimensions were modulated by the interactive relationship between excitatory glutamate and inhibitory GABA neurotransmitter concentrations in the social processing area of the superior temporal cortex using proton magnetic resonance spectroscopy. In total, 38 non-clinical participants (20 females; age range = 18–35 years, mean (standard deviation) = 23.22 (5.52)) completed the autism spectrum quotient and schizotypal personality questionnaire, and underwent proton magnetic resonance spectroscopy to quantify glutamate and GABA concentrations in the right and left superior temporal cortex. Regression analyses revealed that glutamate and GABA interactively modulated autistic social skills and schizotypal interpersonal features (pcorr < 0.05), such that those with high right superior temporal cortex glutamate but low GABA concentrations exhibited poorer social and interpersonal skills. These findings evidence an excitation–inhibition imbalance that is specific to psychosocial features across the autism and schizophrenia spectra.
Gender differences in self-reported camouflaging in autistic and non-autistic adults
Autism, Ahead of Print.
Social camouflaging describes the use of strategies to compensate for and mask autistic characteristics during social interactions. A newly developed self-reported measure of camouflaging (Camouflaging Autistic Traits Questionnaire) was used in an online survey to measure gender differences in autistic (n = 306) and non-autistic adults (n = 472) without intellectual disability for the first time. Controlling for age and autistic-like traits, an interaction between gender and diagnostic status was found: autistic females demonstrated higher total camouflaging scores than autistic males (partial η2 = 0.08), but there was no camouflaging gender difference for non-autistic people. Autistic females scored higher than males on two of three Camouflaging Autistic Traits Questionnaire subscales: Masking (partial η2 = 0.05) and Assimilation (partial η2 = 0.06), but not on the Compensation subscale. No differences were found between non-autistic males and females on any subscale. No differences were found between non-binary individuals and other genders in either autistic or non-autistic groups, although samples were underpowered. These findings support previous observations of greater camouflaging in autistic females than males and demonstrate for the first time no self-reported gender difference in non-autistic adults.

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