Brief Report: Empathic Responsiveness of High Functioning Children with Autism to Expressed and Anticipated Distress

Autism as a Disorder of Affective Empathy

Since the first description by Leo Kanner, individuals with autism spectrum disorder (ASD) have been attributed a reduced empathy. However, it has not yet been clarified how empathy is specifically impaired in autism. Typically, scholars distinguish between the affective and the cognitive dimensions of empathy. The latter largely overlaps with the concept of the theory of mind (ToM), according to which we need internal inferences or simulations for gaining access to the hidden mental states of others. Since a deficit in ToM is a widely accepted explanation for difficulties of individuals with ASD in social interactions, limitations in cognitive empathy are accordingly assumed. Regarding affective empathy, there are contradictory results using various methods, showing an impaired affective empathy. The main aim of the paper is to present ASD primarily as a disorder of shared interpersonal and interaffective experiences and thus of affective empathy by means of a phenomenological analysis considering empirical studies. In this framework, a deficit of the ToM is accepted but criticized as a central explanatory approach for ASD since (1) it assumes a fundamental inaccessibility of other people, which does not correspond to our everyday social situations, and (2) it manifests developmentally long after the first signs of ASD, which means that its deficit cannot explain the basic autistic difficulties in social interactions.

Quantity and quality of empathic responding by autistic and non-autistic adolescent girls and boys

Empathy evokes support for the person in distress, and thus strengthening social cohesion. The question is to what extent empathic reactions can be observed in autistic adolescents and autistic girls in particular, since there is evidence that they have better social skills than boys, which might hinder their recognition as autistic. We examined 193 adolescents (autistic/non-autistic boys/girls) during an in vivo task in which the experimenter hurt herself. In line with our predictions, no group or gender differences appeared related to their attention for the event; yet autistic girls and boys showed less visible emotional arousal, indicative of less affective empathy. Autistic girls and boys reacted by comforting the experimenter equally often as their non-autistic peers, but autistic boys seemed to address the problem more often than any other group; while girls (autistic and non-autistic) more often addressed the emotion of the person in need. Our findings highlight that empathic behaviour – to some extent – seems similar between autistic and non-autistic boys and girls. However, differences exist, in terms of expressed emotional arousal and gender-specific comforting styles. Autistic girls’ higher levels of emotion-focused comforting could be explained by well-developed social skills, camouflaging, or emotional investment in relationships with others.

Enhanced social learning of threat in adults with autism

Background

Recent theories have linked autism to challenges in prediction learning and social cognition. It is unknown, however, how autism affects learning about threats from others “demonstrators” through observation, which contains predictive learning based on social information. The aims of this study are therefore to investigate social fear learning in individual with autism spectrum disorder (ASD) and to examine whether typically developing social cognition is necessary for successful observational learning.

Methods

Adults with ASD (n = 23) and neurotypical controls (n = 25) completed a social fear learning (SFL) procedure in which participants watched a “demonstrator” receiving electrical shocks in conjunction with a previously neutral conditioned stimulus (CS+), but never with a safe control stimulus (CS−). Skin conductance was used to measure autonomic responses of learned threat responses to the CS+ versus CS−. Visual attention was measured during learning using eye tracking. To establish a non-social learning baseline, each participant also underwent a test of Pavlovian conditioning.

Results

During learning, individuals with ASD attended less to the demonstrator’s face, and when later tested, displayed stronger observational, but not Pavlovian, autonomic indices of learning (skin conductance) compared to controls. In controls, both higher levels of attention to the demonstrator’s face and trait empathy predicted diminished expressions of learning during test.

Limitations

The relatively small sample size of this study and the typical IQ range of the ASD group limit the generalizability of our findings to individuals with ASD in the average intellectual ability range.

Conclusions

The enhanced social threat learning in individuals with ASD may be linked to difficulties using visual attention and mental state attributions to downregulate their emotion.

Does Theory of Mind Training Enhance Empathy in Autism?

Youth with ASD often show limited or atypical empathic responsiveness. The direct effects of social skills interventions on enhancing empathic responsiveness is unknown. Data from a randomized controlled trial were used to investigate whether a Theory of Mind training improves the empathic responsiveness, measured through structured observations. The current study included a large sample (n = 135) of 8–13-year-old children with ASD. When comparing the change scores of empathic responsiveness from baseline to post-test, the intervention group performed significantly better than the waitlist group. Thus, the current findings support the use of Theory of Mind training as intervention of ASD by showing its efficacy also in improving one’s empathic responsiveness, in addition to previous knowledge regarding the improvements in empathic understanding.

Empathy Impairment in Individuals With Autism Spectrum Conditions From a Multidimensional Perspective: A Meta-Analysis

Background: Although empathy has always been considered to be impaired in individuals with autism spectrum conditions (ASCs), the relevant findings have been inconsistent. The present meta-analysis aims to determine which empathy components are impaired and how culture, gender, and age moderate such empathy impairment.

Methods: By using “Autism,” “Asperger Syndrome,” “Empathy,” and related Chinese synonyms as keywords, we searched the databases of Weipu, Wanfang, CNKI, Web of Science, Science Direct, SpringerLink, and Elsevier through “subject” and “keyword” searches. We also conducted a manual search according to the references. In total, 51 studies from Eastern and Western countries were included in this meta-analysis, which comprised 144 independent effects, 2,095 individuals with ASCs and 2,869 controls without ASCs. For the retrieved data, Hedge's g was taken as the quantitative measure of effect, and CMA V2.0 software was used for publication bias tests (by using Rosenthal's Classic Failsafe-N and Egger's methods), heterogeneity tests (by using a Q-test, I²-test, and H-test) and a moderating effect test (by using a univariate regression model).

Results: The results showed that the empathy impairment evident in individuals with ASCs is component specific; that is, trait-cognitive empathy, trait-empathic concern, state-cognitive empathy, and state-empathic concern are impaired, whereas state-empathic accuracy remains intact, and trait-empathic accuracy is superior to the trait-empathic accuracy in neurotypical individuals. The univariate regression model showed that gender moderates the impairment of the trait-empathic concern, trait-empathic accuracy, and state-cognitive empathy in autistic individuals and that age moderates the impairment of the trait-cognitive empathy, trait-empathic accuracy, state-empathic concern, and state-empathic accuracy in autistic individuals. However, culture does not moderate any empathy components (trait-cognitive empathy, trait-empathic concern, or state-cognitive empathy) involved in the present meta-analysis.

Conclusions: These findings contribute to ending the controversy over the empathic integrity of individuals with ASCs and shed some light on future research about the empathy impairment of autistic individuals. More specifically, subsequent studies should distinguish specific empathy components and consider the role of gender and age when demonstrating empathy impairment in individuals with ASCs. Moreover, related studies based on Asian collectivist cultural samples and female samples should be further enriched.