Face Blindness: A Disorder We’ve (Often) Been Missing

1. Face Blindness: A Disorder We’ve (Often) Been Missing Sherryse Corrow Institute of Child Development University of MN

2. Goal Bridging the gap between research and applied work. http://researchfestival.nih.gov/festival06/default.htm

3. A child . . . • Few friends, if any. Socially isolated. • Does not look at face frequently, except perhaps in fleeting moments. • Experiences a degree of anxiety at school, but not at home with family. • Is especially anxious when going out in public or on field trips. • Occasionally has difficulty with simple instructions like” you are going to be partners with Annie, please go sit with her.” • Has difficulty with social interactions.

4. Clarification Face Blindness = Developmental Prosopagnosia (DP)

5. Outline • What is DP? • Definition • Prevalence • Symptoms and Consequences • Reasons for Studying DP • What causes DP? • What do we know about DP in childhood? • Case Studies • Comorbidities • How can we differentiate DP from ASD? • How can DP be identified in the classroom and what should be done about it?

6. What is Developmental Prosopagnosia? Definition, Prevalence, Symptoms, Reasons for Studying DP

7. What is Developmental Prosopagnosia (DP)? • Developmental Prosopagnosia: An inability to recognize faces despite no history of brain damage and intact early visual processing and intellectual function (Duchaine & Nakayama, 2006).

8. “Prosopagnosia is clearly not "face blindness" - people with the condition can see faces fine - what they can't do is distinguish people by their facial features. Faces just seem all the same - in the same way that you might have trouble distinguishing sheep by their faces.”

9. “Take a dozen donuts--all chocolate sprinkles or cinnamon twists. Now look at each one. Note the details - see the curves, the angles of the sprinkles. Name them: George, Susan, Harry, Joe, Billy, etc. Now mix them all up. Who was George? Are you sure? But you saw them in exact detail right? Same thing for me with faces. I see them perfectly, but I can no more tell one face from another than one donut from another - even though they are all different - when they go away and come back.”

10. Prevalence Prevalence rates of approximately 2% are common around the world. ~2% ~2% ~2% ~2% ~2% Prevalence: Kennerknecht et al. (2006), Kennerknecht et al., (2008), Bowles et al. (2009), Duchaine, (2008) Image: http://en.loadtr.com/World_Map-483552.htm

11. Symptoms: There are many symptoms of DP, most of which are social in nature. • Failure to recognize someone if they dramatically change their appearance (e.g. hairstyle) or are encountered out of their expected context. • Reliance on other cues for recognition such as: hairstyle, voice, gait, clothing, context, etc. • Little interest in TV shows that portray human characters. • Social Isolation and anxiety.

12. “Four years ago on Christmas Eve we all laughed when he ran to me saying "there’s a strange man at the door!" It was one of my Dad's infrequent visits, my older sons knew it was Grandpa.”

13. “She is 9 years old and has very little friends. We found it interesting that her 2 friends have distinctive looks. One has slightly darker skin and one has a round face.”

14. Social Consequences (Adults): There are many social consequences of DP that affect the ability to create and maintain friendships. • Feelings of embarrassment, guilt, and failure • Avoidance of social situations • Anxiety • Limited employment opportunities • Loss of self-confidence • Difficulty telling others about DP • Dependence on others in social situations Yardley et al. 2008

15. Social Consequences (Children): The social consequences of DP in childhood may be even more severe. • Limitations in activities and courses (e.g. drama). • “Ostracized by peers”– appearing aloof and unfriendly. • Unable to maintain social relationships. • Concerns about getting lost and being separated from parents or teachers. • Extreme difficulty with the transition to middle school (more students, different each hour). Diaz, 2008

16. ” A face blind child does not have the secure feeling to know whether she is talking with someone she knows or a stranger.” “I remember in 2nd grade, not being able to tell Stuart the bully from Jack, the guy who protected me from the bully.”

17. Why Study DP? Why is DP in particular a problem/mystery? • Better understand the disorder so that the social consequences can be alleviated. • Help to identify the disorder early in life. Many do not realize they have DP until adulthood (Behrmann & Avidan, 2005; Duchaine & Nakayama, 2006). • DP, by definition, begins early in life—warranting research in childhood populations. • To better understand how face recognition works and inform theories of face processing (Duchaine & Nakayama, 2006).

18. What causes DP? Experiential Factors, Neurological Factors, Genetic Factors

19. Experience Based TheoriesCould early deprivation lead to DP? • Children deprived of all visual input in the first few months of life show a configural-deficit in face processing (Le Grand et al. 2001, 2003, & 2004). • Children who are raised in instutionalized settings (Pollack et al., 2010) or who are extremely shy (Brunet et al. 2010) show slight deficits in face processing. www.cs.mcgill.ca Nytimes.com

20. Neurologically Based Theories Is DP a result of inadequate development of the cortex? • It is possible that some are born with a deficit in or lack of the proper functioning of a neural mechanism needed to properly encode face information. • The Fusiform Face Area, is a portion of the fusiform gyrus that is associated with face recognition in adults. • The findings are mixed. It may be that some with DP have a neurological deficit and others do not. http://labnic.unige.ch/nic/htms/fmri.html Haxby et al. 2001

21. Genetics Based Theories Is face recognition inherited from our parents? • This is the most widely accepted theory in the literature. • Many investigators have reported cases in which many family members will have DP (e.g. Duchaine et al., 2007). • Wilmer et al. (2010) reported a higher concordance rate of face recognition skills in monozygotic twins (0.70) than dizygotic twins (0.29). • However, it is unlikely that ALL cases of DP can be explained by genetic factors (Duchaine, 2008).

22. What do we know about DP in Childhood? Case Studies and Comorbidities

23. Where is research being done with kids?

24. Case Study ReportsAn Introduction to the Childhood Literature • Most are parent-reported and self-diagnosed due to inadequate testing methods and lack of awareness (Bowles et al., 2009). • Why is it important to look at these cases? • To better understand how DP is manifest in childhood. • Because DP could have a large effect on social development in other domains (Joy & Brunsdon, 2002). • We need to better understand DP so that we can differentiate DP from other disorders such as Autism Spectrum Disorders. • To-date, only 5 case studies and one experimental study has investigated DP in children.

25. The ProblemDP in childhood is probably much more serious than DP in adulthood. • Prosopagnosia is probably a lot more difficult for a child than for an adult. • Most people do not know about DP • Clinicians • Educators • Researchers • Parents

26. “Children change schools more often than adults change jobs. Children change classrooms more often than adults change offices. Children are expected to recognize their parents' friends who have no context for the child to know them.Even if a child learns her classmates, when the school year changes, she has to [sometimes] relearn who they are.A face blind child does not have the secure feeling to know whether she is talking with someone she knows or a stranger.”

28. How can we differentiate DP from ASD? When so many of the criteria are so similar?

29. Commonalities and DifferencesHow can ASD be distinguished from DP? • Direct Symptoms: • Unusual eye contact • Failure to develop peer relationships • Indirect Symptoms: • Lack of spontaneous seeking to share enjoyment • Lack of social reciprocity • Unlikely to show: • Restricted and stereotyped patterns of behavior, interests and activities.

30. “Our child very often will just reach fora book at school during breaks, recess etc. rather than try to play with anyone. He has a few casual friends, but no close friends. I'm sure it is because he can't find them. He is still very young - early elementary school.” “I was always shy as a child, much more so than I am as an adult. Always being told to look up at people when I spoke to them & to hold my head straight (by my grandmother, no-one else minded) because I tended not to look at their faces I suppose. “

31. How can DP be identified in the classroom and what should done about it?

32. How to Identify DP in a Child Things to Look For How to Test for DP • Social isolation and anxiety. • “Mistakes” in recognizing classmates. • Discrepancy between behavior at home and at school. • Similar to high functioning ASD but lack of stereotyped or restricted behaviors. • NEPSY • WMS • CMS • Home-made Tests

33. Adapting the Learning EnvironmentTraining Face Recognition • Training studies with individuals with DP have been few and far between. • DeGutis et al. (2007) successfully trained an adult to recognize faces. • Two children have been trained to recognize photographs of familiar faces but the effects did not generalize to other people. • A pilot study of a training program in our lab may be effective.

34. Adapting the Learning EnvironmentEncouraging Effective Coping Strategies • Have the children in the classroom wear name tags. • Schedule one-on-one time between the child and other students. • Face Blindness is a form of “blindness” to a certain degree. Identify yourself when you approach the child. • Maintain a picture set of students in the classroom with key identifiers written on the back of each one.