This paper explores the effect masks have on the development of children, specifically, on their ability to perceive facial emotions. This ability to perceive facial expressions or emotions impacts the child’s ability to socialize and interact with others. This paper explores this potential deficit in socialization and interaction by examining the neurological architecture of facial perception and emotional perception of faces and the pathological effects that result from an improperly developed facial-emotional recognition system. With supporting evidence from studies that observed that adults have difficulty perceiving facial expression, leading to anti-social behavior, and a study that was done to examine the impact of mask and COVID mandates on children in Rhode Island, this paper concludes that masks will likely have developmental consequences for children. This paper argues that these consequences will likely express themselves as sociopathy and autism based on the neurological data discussed herein. These effects will likely have a life-long impact on the child. For the boy who cannot see faces, life will be exceedingly difficult.
What might a mask do to a child? As I’ve continued to explore and learn about the neurophysiology of the human brain, one question that has come to mind for me, especially in light of what is going on in American, is what impact a mask has on the psychological wellbeing of a child. Members of our media have frequently stated, and the doctors trotted out by them on national television, that masks will protect children against COVID. Even if this were true, the secondary effects of masks are hardly considered, talked about, or explored. An inability to weigh such effects against the alleged benefits results in an action taken without the requisite forethought or planning. As such, the goal of this paper will be to explore the effectiveness of masks, look into how a child’s experience with faces impacts their development, whether or not adults have difficulty identifying faces and how this impacts their ability to socialize, and if there are immediately observable effects from masks or other COVID mandates on children.
Evidence for the Effectiveness of Masks Against the Transmission of Illnesses
Masks are a highly controversial subject, for what reason, I am not entirely certain of. I am not inclined to say that masks are ineffective for a proper mask that’s fitted and sanitized in a controlled environment for a specific and defined purpose. I believe they are. However, given the evidence available on the effectiveness of masks, I do not think they are generally useful for the public. In fact, I would say they have no clear benefit.
In a study done by Cowling et al., 2010, it was shown that “there is little evidence to support the effectiveness of face masks to reduce the risk of infection.” More importantly, this study emphasized masks that were properly put on, sanitization, and the washing of hands. These variables often confound the data on the utility of masks, leading to an indirect benefit but no clear or direct benefit. A study by Rengasamy et al., 2004 highlights this point. “The relationship between microbial penetration through respirator filters and the aerodynamic diameter, length or other physical characteristics of microorganisms remains controversial.” Specifically, “Respirator maintenance, storage, and decontamination are important factors to be considered when using respirators.” A study from Bazant and Bush, 2021, also highlights the fact that numerous variables affect the efficacy of guidelines, including mask-wearing, which confound the one-size-fits-all rules many states, counties, and the CDC have laid out.
Of the systemic reviews done on masks, very few have shown any clear benefit either, likely because environment, mask use, and sanitization are confounding factors, as was identified previously. For example, a study done by bin-Reza et al., 2011 looked at eight randomized control trials of face mask use and whether they prevented the spread of influenza or not. The authors identified that six out of the eight randomized control trials showed no significant differences between masks and other interventions, such as washing one’s hands. The authors also identified that eight of nine retrospective observational studies showed that mask use was only independently associated with a reduced risk of severe acute respiratory syndrome; i.e., to say that masks are effective is an ad hoc, ergo propter hoc fallacy. None of the studies reviewed by the authors in the 2011 paper showed a conclusive relationship between face mask use and protection from influenza.
A more recent paper, Jefferson et al., 2020, also identified that face mask usage “probably makes little or no difference to the outcome of laboratory-confirmed influenza compared to not wearing a mask.” This study also examined the utility of N95/P2 respirators in comparison to medical/surgical masks. The authors identified that randomized control trials did not show a clear reduction in respiratory viral infection using medical/surgical masks during seasonal influenza. This is in line with bin-Reza et al.’s findings. Secondly, the authors identified that “there were no clear differences between the use of medical/surgical masks compared with N95/P2 respirators in healthcare workers when used in routine care to reduce respiratory viral infection.” I.e., neither N95/P2 masks nor medical/surgical masks reduced respiratory viral infection. Any positive effects associated with masks are also likely confounded by the variables noted above; once again, to say that masks are effective is an ad hoc, ergo propter hoc fallacy.
Lastly, a much more recent study, conducted during the spread of COVID-19, also examined the utility of masks. Guerra and Guerra, 2021, identified that mask mandates at a state level did not lead to reduced COVID-19 surges. I.e., the use of masks and mask mandates are not associated with reduced spread nor a reduction in cases. Several factors could affect this: compliance, proper use of face masks, whether the masks were sanitized or not, the rooms people find themselves in, or whether people wash their hands. The number of variables affecting the efficacy of masks will certainly confound whether masks are useful, but more importantly, no other data previously examined show a clear benefit. In other words, for most intents and purposes, masks are effectively useless for the general public; there is no clear benefit to wearing a mask; you are better off washing your hands.
The Neuroanatomy of Facial Recognition and Emotional Recognition and How a Lack of Experience with Faces May Impact Socialization
To start, the Brain represents faces in a twofold manner: visually and representationally. Haxby, Hoffman, and Gobbini, 2000 layout the hierarchal framework for how this occurs. Mainly, the core system for “seeing” faces is found within the occipitotemporal regions in the extrastriate visual cortex, which mediates the visual analysis of faces. However, the representation of faces is mediated by the fusiform gyrus (FFA) and the superior temporal sulcus. These areas also recruit other regions of the brain, which act in tandem with the visual and representational systems, e.g., the limbic system, which includes the amygdala, insula, cingulate cortex, frontal lobe, orbitofrontal lobe, nucleus accumbens, and ventral tegmentum. Importantly, the FFA or FG is not merely involved in invariant perception of faces. I.e., emotional perception was perceivable within the FFA. Thus, it is likely that the FFA processes static form-based information utilized by other brain regions depending on task demand. Judgments about identity and emotional expressions may rely on information represented within the FFA but recruit different processing pathways in the extended face-processing network. The inclusion of the FFA in emotional representation and processing in the face-processing network, as noted above, was identified by Williams, Davis, and Kim, 2013.
Importantly, the development of the FFA occurs over a long period of time. Golarai et al., 2007 identified that the ventral stream (VS) (the stream through which information flows about objects or faces rather than spaces, i.e., the dorsal stream) “undergoes a prolonged maturation that varies temporally across functional regions.” The development of these regions is not determined by what they are stimulated by but by how they develop. These regions' healthy development is also correlated with the recognition of category-specific memories, e.g., faces, emotions, rules, objects, etc. Golarai et al., 2010 builds on their previous work. The authors found that “prolonged development of face-selective activation in the ventral temporal cortex (VTC) through adolescence was associated with increases in the size of face-selective regions, increases in responsiveness and selectivity for face stimuli, differentiation of distributed responses to faces and objects in the VTC, and behavior improvements in face recognition memory. This finding shows that the development of face recognition occurs over a long time and “requires extensive experience.” Another paper by Golarai, Liberman, and Grill-Spector, 2015 builds on this finding even further. By age 7, the distributed representation of faces, objects, and scenes was developed. However, variances in the degree of face selectivity continued to develop into adulthood. This affirms the finding that extensive experience is required for the proper and healthy development of the facial recognition system. This finding is supported by Gomez et al., 2018, which highlights that visual maps developed very early in the ventral visual stream provide a framework that structures and informs the organization of high-level visual regions. Importantly, this creates a window that changes how the visual cortex and VS, and the visual regions process information from our visual experience from childhood to adulthood. Together, these papers highlight the fact that the development of the facial recognition system occurs through experience, is shaped by experience and informs how we perceive the world over time. Thus, if this system and these regions do not receive proper input, they do not properly develop, leading to impairments.
In Blair, 2003, these developmental issues are explored. Mainly, developmental issues arising from an inability to respond to facial expressions properly are Autism, Psychopathy, and Sociopathy. These issues arise from at least two problems, the inability to receive or perceive socially reinforcing stimuli through the recognition of facial expressions and an inability to perceive and recognize the conditional valance of a facial expression relative to one’s behavior in light of cultural norms. The paper also highlights the importance of the FFG, specifically that an increase in attention to emotional expressions also increases activity within the FFG. These problems could be identified in childhood but progressed into adulthood.
For example, Wootton et al., 1997 identified the relationship between the ineffective rearing of children and child conduct problems. Specifically, “ineffective parenting was associated with conduct problems only in children without significant levels of callous (e.g., lack of empathy, manipulativeness) and unemotional (e.g., lack of guilt, emotional constrictedness) traits. In contrast, children high on these traits,” callous and unemotional children, “exhibited a significant number of conduct problems, regardless of the quality of parenting they experience.” I.e., conduct problems were associated with parenting that led to callous and unemotional children, antisocial children (a fact which is supported by further studies, as Wootton’s data admittedly had confounds: Simons-Morton et al., 2008; Laulik et al., 2013), and children who were callous and unemotional, also antisocial children; sociopathic and psychopathic children. This problem partly arises from an inability to properly pick up on social cues (Wootton et al., 1997) and issues arising from parenting and early development that impact the amygdala (Gard et al., 2017). The emotional issues of these children seem to be related to limbic abnormalities in the amygdala (as noted previously), parahippocampal gyrus, ventral striatum, and the anterior and posterior cingulate gyri. The processing of affective stimuli was also impacted by the overactivation of the bilateral frontotemporal cortex (Kiehl et al., 2001). Tsuchida and Fellows, 2012 identified the role that the orbitofrontal and lateral prefrontal cortex (PFC) plays in detecting facial expressions. Specifically, lesions to the ventromedial PFC (vmPFC) impaired the detection of subtle facial expressions. Patients who had vmPFC damage were able to detect emotional signals but had trouble discriminating between emotions. Patients with dorsomedial PFC (dmPFC) damage didn’t affect emotional recognition. These findings suggest that the PFC is responsible for detecting emotional stimuli (recognizing them) and classifying them. Together, these findings suggest that issues that are both exogenous and endogenous can affect the development of a child (Wootton et al., 1997; Simons-Morton et al., 2008; Laulik et al., 2013), leading to an inability to process affective stimuli (Kiehl et al., 2001; Gard et al., 2017) and to detect and classify emotional stimuli (Tsuchida and Fellows, 2012). This finding, when considered with the work of Golarai et al., 2007, 2010, Golarai, Liberman, and Grill-Spector, 2015, and Gomez et al., 2008, which highlight the importance of visual stimuli for the development of the visual system, affirm the likelihood that if the visual and limbic regions do not receive proper stimuli through experience, they will develop in an unhealthy manner. The main concern with improper child-rearing and the pathological development of the visual and limbic systems here would be sociopathy.
The other concern would also be a form of developmental autism. Blair, 2003 argues that “individuals with autism may be able to recognize the expressions of others,” however, “it is highly likely that they fail to adequately process the emoter’s referent and that they therefore process the display incorrectly because of their impairment in theory of mind.” This failure to adequately process the emoter’s referent, leading to an inability to socialize or recognize conditional valances properly, may be impacted by the amygdala and hypoactivation of the anterior cingulate cortex and the anterior insula (Adolphs, Sears and Piven, 2001 and Martino et al., 2009). These impact how the child focuses on information, assesses errors in his activity, and how he processes that information about himself (interoception and proprioception). Thus, his problems with conditional valance and social reinforcement. Other studies have also shown that the FFG is less active in children with ASD (Wang et al., 2004). Paired with the fact that FFG is impacted by experience throughout development and helps to identify emotions, not merely focus on them (Golarai et al., 2010, Golarai, Liberman, and Grill-Spector, 2015, Gomez et al., 2008, Monroe et al., 2013), this suggests that ASD is, in part, related to how a child develops.
Lozier, Vanmeter, and Marsh 2014’s findings support this concept. Specifically, “neurodevelopmental processes and social experience produce improvements in general face-emotion recognition ability overtime during typical development,” however, “children with ASD may experience disruption in these processes, which suggested distributed functional impairment in the neural architecture that subserves face-emotion processing.” As other papers cited here have demonstrated and as this paper argues, these impairments have “downstream developmental consequences.” A formal meta-analysis by Uljarevic and Hamilton, 2013 shows that one of the impairments is difficulty in recognizing emotions. Jung et al., 2021 performed a correlation analysis that revealed larger left FFA or fusiform gyrus (FG) volume was associated with better facial emotion recognition, identification, and emotional intensity recognition in patients with schizophrenia spectrum psychosis. Although this paper did not look at individuals with ASD, the fact that FG or FFA volume was associated with better facial and emotional recognition, and that this is impacted, in part, through experience (Golarai et al., 2010, etc.), i.e., an increase in grey matter, a lack of experience with faces and facial emotions may impair a child’s ability to identify and recognize facial emotion and emotional intensity, leading to “downstream developmental consequences.” Interestingly, a paper by Ammons et al., 2021 identifies how this may occur. The Medial-Fusiform Sulcus’s size is the “dividing line between animate, human-centric, small size, and foveally presented visual stimuli laterally, and inanimate, object, and place-centric, large-size, and peripherally presented visual stimuli medially. ASD may be “misplaced” to the medial side of the FG.” In other words, the brain of ASD individuals may be interpreting faces as objects; in part, a lack of experience with faces and emotions may enable the brain to redistribute neural activity to other areas, the MFS, leading to an inability to recognize and identify facial emotions properly and to confuse them with objects. This supports and is supported by the work of Bormann-Kischkel, Vilsmeier, and Baude, 1995 who identified that high-functioning ASD individuals are “significantly impaired” at recognizing emotions. Specifically, the ASD group relied on other strategies to recognize emotions when they did. A difference in strategy may be related to the MFS’s size in ASD individuals and the fact that the brain redistributed neural activity to a region that was used and impacted by experiential stimuli more frequently.
In short, a child’s lack of experience with faces, interaction with others, and poor or neglectful parenting would likely lead to downstream developmental issues, such as autism and sociopathy.
Do Adults Have an Impaired Ability to Recognize Faces and Facial Emotion Because of Face Masks?
There have been several studies that have explored how masks impact the ability of adults to identify faces and facial emotions. A study by Carragher and Hancock, 2020 showed that face masks have a “detrimental effect on human face matching performance. The effect observed was similar for both familiar and unfamiliar faces. Facial recognition systems also had an impaired ability to recognize faces when one face was masked, and another was not. Together, both human and recognition systems had an impaired ability to recognize faces when they were masked. Marini et al., 2021 also showed that face masks make it harder to identify emotions, harder to identify a previously known face, and that transparent masks still complicate the identification of faces but enable some emotional recognition while still enabling trust. Grundmann, Epstude, and Scheibe, 2021 expanded on the social impact of wearing masks. As noted in Marini et al., 2021 in their discussion on trust, Grundmann, Epstude, and Scheibe, 2021, “face masks curtail emotion-recognition and perceptions of closeness.” Specifically, “face masks may undermine the success of our social interactions,” likely by decreasing trust. The authors also identified that because emotional recognition is a subcomponent of empathy, predicting prosocial behavior and masks impair emotional recognition, prosocial behavior would also likely be impaired. Lastly, Noyes et al., 2021 identified that masks generally impair facial recognition, but recognition is slightly improved for people who are adept at perceiving faces. However, this finding could be confounded by familiarity with faces and thus may not indicate an ability to perceive faces more effectively. These findings show that, even in adults who have generally completely developed the ability to recognize faces and facial emotion, masks impair people’s ability to recognize other faces and emotions. This impairment also has negative social consequences, such as diminished prosocial behavior and an increased likelihood of improperly reading the affective cues of others.
Is There Any Evidence of Developmental Disorders in Children Because of Lockdown Measures?
A recent paper by Deoni et al., 2021 highlighted the negative impact of COVID-19 measures on children in Rhode Island. Independent of COVID infection, the environment produced by lockdowns and mandates led to a significant negative impact on infant and child development. When yearly mean scores were compared, there was a striking decline in overall cognitive function in children beginning n 2020 and continuing through 2021. This effect primarily affected males more than females, was higher for individuals from lower socio-economic statuses, but was buffered by the mother's education. This was observed at an individual level and a group level. Unfortunately, the severest effect was seen amongst infants born during COVID. The standard deviation for these children's early learning composite (ELC) values were 86.3+/-17.9 and 78.9+/-21.6, while the general mean standard deviation for ELC is 100. Overall, these families reported that they stayed at home, wore masks (which is of considerate importance), and were socially distanced, suggesting that the effects were driven by the environmental conditions produced through mandates, not infection. However, no test was done to confirm past infection status on these individuals. Overall, the results of this study suggest that early development, and perhaps development in general, is impaired by the environmental conditions brought about through lockdowns and COVID mandates. This is in line with what this paper is arguing.
This data is suggestive of the fact that mandates, including mask mandates, have a negative impact on the development of children. However, given that facial identification and facial emotional recognition develop into young adulthood through extensive experience, this study is highly suggestive of the possibility that even past infanthood, masks, and other mandates will have a negative impact on the development of children. As noted previously, the most likely negative affective disorders from masks that this author thinks will occur, based on the evidence, are sociopathy and developmental autism.
At the beginning of this paper, I asked the question, what impact does a mask have on the emotional wellbeing of a child. What I have identified in this paper is this:
- Face masks have no clear benefit.
- Through a child’s development into young adulthood, they are developing the ability to identify faces and to associate them with emotions, which through extensive experience, they learn to recognize.
- Children who do not thoroughly develop this ability to identify faces and facial emotions face negative social consequences and downstream developmental issues, e.g., the issues associated with sociopathy and autism.
- Fully developed adults show an impaired ability to identify faces in masks, which affects how they socialize and if they trust others, and children in RI have already been shown to be negatively impacted by COVID measures and mandates.
In conclusion: a gross cost-benefit analysis shows that masks have no clear benefit for children and likely have a costly, negative effect on a child’s ability to interpret emotions and recognize faces, which are correlated with affective disorders such as autism and sociopathy. Such affective disorders have long-term negative consequences that would last long after masks are gone, e.g., an inability or unwillingness to trust others, poor social skills, conduct problems, and difficulty interpreting the emotional affect of others.
For the boy who cannot see faces, life will be exceedingly difficult.
Face masks to prevent transmission of influenza virus: a systematic review – Cowling et al., 2010
Respiratory protection against bioaerosols: Literature review and research needs – Rengasamy et al., 2004
A guideline to limit indoor airborne transmissions of COVID-19 – Bazant and Bush, 2021
The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence – bin-Reza et al., 2011
Physical interventions to interrupt or reduce the spread of respiratory viruses – Jefferson et al., 2020
Mask mandate and use efficacy in state-level COVID-19 containment – Guerra and Guerra, 2021
The distributed human neural system for face perception – Haxby, Hoffman, and Gobbini, 2000
Emotional expressions evoke a differential response in the fusiform face area – Williams, Davis, and Kim, 2013
Differential development of high-level visual cortex correlates with category-specific recognition memory – Golarai et al., 2007
Differential development of the ventral visual cortex extends through adolescence – Golarai et al., 2010
Experience Shapes the Development of Neural Substrates of Face Processing in Human Ventral Temporal Cortex – Golarai, Liberman, and Grill-Spector, 2015
Development differentially sculpts receptive fields across early and high-level human visual cortex – Gomez et al., 2018
The Fusiform Response to Faces: Explicit Versus Implicit Processing of Emotion Monroe et al., 2013
Facial expressions, their communicatory functions and neuro–cognitive substrates – Blair, 2003
Ineffective parenting and childhood conduct problems: The moderating role of callous-unemotional traits. – Wootton et al., 1997
Parenting Behavior and Adolescent Conduct Problems – Simons-Morton et al., 2008
The link between personality disorder and parenting behaviors: A systematic review – Laulik et al., 2013
The Long Reach of Early Adversity: Parenting, Stress, and Neural Pathways to Antisocial Behavior in Adulthood – Gard et al., 2017
Limbic abnormalities in affective processing by criminal psychopaths as revealed by functional magnetic resonance imaging – Kiehl et al., 2001
Are You Upset? Distinct Roles for Orbitofrontal and Lateral Prefrontal Cortex in Detecting and Distinguishing Facial Expressions of Emotion – Tsuchida and Fellows, 2012
Abnormal Processing of Social Information from Faces in Autism – Adolphs, Sears, and Piven, 2001
Functional Brain Correlates of Social and Nonsocial Processes in Autism Spectrum Disorders: An Activation Likelihood Estimation Meta-Analysis – Martino et al., 2009
Neural Correlates of Facial Affect Processing in Children and Adolescents With Autism Spectrum Disorder – Wang et al., 2004
Impairments in facial affect recognition associated with autism spectrum disorders: A meta-analysis – Lozier, Vanmeter, and Marsh, 2014
Recognition of Emotions in Autism: A Formal Meta-Analysis – Uljarevic and Hamilton, 2013
Fusiform gyrus volume reduction associated with impaired facial expressed emotion recognition and emotional intensity recognition in patients with schizophrenia spectrum psychosis – Jung et al., 2021
The Mid-Fusiform Sulcus in Autism Spectrum Disorder: Establishing a Novel Anatomical Landmark Related to Face Processing – Ammons et al., 2021
The Development of Emotional Concepts in Autism – Bormann-Kischkel, Vilsmeier, and Baude, 1995
Surgical face masks impair human face matching performance for familiar and unfamiliar faces – Carragher and Hancock, 2020
The impact of facemasks on emotion recognition, trust attribution and re-identification – Marini et al., 2021
Face masks reduce emotion-recognition accuracy and perceived closeness – Grundmann, Epstude, and Scheibe, 2021
The effect of face masks and sunglasses on identity and expression recognition with super-recognizers and typical observers – Noyes et al., 2021
Impact of the COVID-19 Pandemic on Early Child Cognitive Development: Initial Findings in a Longitudinal Observational Study of Child Health – Deoni et al., 2021