An Expert Discussion on Autism and Empathy

Do you feel me? Autism, empathic accuracy and the double empathy problem

LAY ABSTRACT

The assumption that autistic people lack empathy, particularly imagining how others feel, has been much debated and is now being challenged by an alternative view: the 'double empathy problem'. This suggests that non-autistic people may find it equally difficult to imagine how autistic people feel. Although this perspective is gaining popularity, research testing whether non-autistic people can accurately imagine and feel an autistic person's emotions is still limited. Our study used video clips of autistic and non-autistic people recounting emotional events to test if participants from the general population could: track the intensity of the narrators' emotions; name and feel the same emotion; match where the narrator felt the emotion and indicate how intensely they felt the emotion using a body map. Our results show that participants found it significantly harder to track autistic narrators' emotions compared to non-autistic narrator's emotions, especially when viewing clips of narrators feeling happy and sad. We also found that participants felt emotions more intensely in the body when viewing clips of autistic narrators compared to non-autistic narrators, especially when describing anger and fear. These findings support the double empathy problem and have strong implications for therapeutic and interpersonal relationships with autistic people.

A Cross-sectional Conceptual Replication and Longitudinal Evaluation of the PANSS-Autism-Severity-Score Measure Suggests it Does Not Capture Autistic Traits in Individuals With Psychosis

BACKGROUND

Autism and psychosis co-occur at elevated rates, with implications for clinical outcomes, functioning, and suicidality. The PANSS-Autism-Severity-Score (PAUSS) is a measure of autism trait severity which has not yet been validated externally or longitudinally.

STUDY DESIGN

Participants were derived from the GROUP and SCOPE datasets. Participants included 1448 adults with schizophrenia spectrum disorder (SSD), 800 SSD-siblings, 103 adults diagnosed with an autistic spectrum condition (ASC), and 409 typically-developing controls (TC). Analyses from the original validation study were conducted with SSD participants, and extended into ASC, SSD-sibling, and TC participants. Test-retest reliability of the PAUSS at 2-weeks and long-term stability 3 and 6-years was also examined.

STUDY RESULTS

Results differed in important ways from the original validation. SSD participants reported higher PAUSS scores than other groups, with only a fraction of ASC participants scoring as "PAUSS-Autistic." Cronbach's alpha was acceptable for the SSD cohort only. Two-week stability of the PAUSS was fair to good for all PAUSS scores. Long-term stability was poor for most PAUSS items but fair for total PAUSS score.

CONCLUSIONS

Results suggest that the PAUSS does not appear appropriate for assessing autism, with the low rate of PAUSS-Autistic in the ASC population suggesting the PAUSS may not accurately reflect characteristics of autism. The relative lack of long-term stability is cause for concern and suggestive that the PAUSS is capturing features of psychosis rather than autism traits.

Empathic disequilibrium as a new framework for understanding individual differences in psychopathology

Introduction

Empathy is part of basic social cognition and is central to everyday interactions. Indeed, emotional and cognitive empathy deficits are related to various psychopathologies, yet the links reported have been inconsistent. Thus, the mechanism underlying these inconsistent links is poorly understood. At least a partial answer may lie in that the dependency between cognitive and emotional empathy has been overlooked. Here, we examined the (dis)equilibrium between emotional and cognitive empathy and how it relates to individual differences in clinical traits. We further examined a possible mediator of these links-emotional reactivity.

Methods

Participants (N = 425) from the general population reported on their empathy, emotional reactivity, autistic traits, psychopathic tendencies, and symptoms of depression and anxiety.

Results

Beyond empathy, both extremes of empathic disequilibrium were associated with various features of clinical conditions; Higher emotional relative to cognitive empathy was related to the social domain of autism and anxiety, while higher cognitive relative to emotional empathy was related to the non-social domain of autism, depression symptoms, and psychopathic tendencies. The associations with autistic traits, anxiety, and psychopathic tendencies were mediated by emotional reactivity.

Discussion

Our findings suggest a new framework for understanding how individual variability in empathy is expressed in various psychopathologies.

Autism as a difference or a disorder? Exploring the views of individuals who use peer-led online support groups for autistic partners

LAY ABSTRACT

Individuals who use peer-led online support groups for partners of autistics describe diverse views of autism, with some describing autism as a difference and others describing it as a disorder. I conducted online interviews with 162 non-autistics who believed they were in relationships with autistics and who participated in online support groups on social media. I analyzed their responses by constantly comparing each interview to previous interviews to develop a theory about their social experiences. As many as one-third of autistics participate in romantic relationships, and many of their partners seek support through groups on social media. Few studies explore what it is like to be a non-autistic person who is in a relationship with an autistic person. The way that participants viewed autism influenced the way that they viewed themselves, their partners, and their relationships. Many participants who were dissatisfied in their relationships shared that they believed their partners were autistic, but their partners had never been formally evaluated and did not self-identify as autistic. Future research should explore ways that autism labels are (mis)applied by the general public based on negative stereotypes about autism.

Do Neurotypical People Like or Dislike Autistic People?

Background

This study investigated whether neurotypical individuals' judgments that they dislike a person are more common when viewing autistic individuals than when viewing neurotypical individuals.

Methods

Videos of autistic and neurotypical targets were presented to a group of perceivers (neurotypical adults) who were asked whether or not they liked each target and why.

Results

It was more common for perceivers to "like" neurotypical than autistic targets. The number of "likes" each target received correlated highly with perceiver ratings of target social favorability. Perceivers cited perceived awkwardness and lack of empathy as being reasons for deciding they disliked targets.

Conclusions

The findings shed light on how neurotypical people (mis)perceive autistic people. Such perceptions may act as a barrier to social integration for autistic people.

Lay summary

Why was this study done?: Previous research has found that nonautistic people tend to form less positive first impressions of autistic people than they do of other nonautistic people. These studies have tended to present questions such as "How trustworthy is this person?" or "How attractive is this person?" along with ratings scales. However, although it is known that nonautistic people tend to give lower ratings on these scales, we do not know whether this amounts to a dislike for autistic people or just lower levels of liking.What was the purpose of this study?: This study aimed to find out whether nonautistic people are less likely to say they like (and more likely to say they dislike) autistic people than other nonautistic people.What did the researchers do?: The researchers presented videos of autistic and nonautistic people to other nonautistic adults. The people watching the videos were not told that some of the people in the videos were autistic. They were asked to decide whether they liked or disliked the person in each video and to say why they had made their decision by choosing from a range of options.What were the results of the study?: Nonautistic people were more likely to say they disliked the person in the video if they were autistic, even though they did not know the diagnosis. The most common reasons for disliking a person was that they appeared awkward, and that they appeared to lack empathy.What do these findings add to what was already known?: It was already known that nonautistic people tend to rate autistic people less positively on ratings scales. This study suggests that when making judgments-of either liking or disliking-they will sometimes go so far as to say they dislike autistic people.What are potential weaknesses in the study?: All of the people in the video clips were male, while those watching the videos were mainly female. Therefore, we do not know whether the same observations would be made for perceptions of autistic females. The number of participants watching the videos was relatively small: a larger sample would give more reliable findings.How will these findings help autistic adults now or in the future?: The findings add to previous research showing nonautistic people's misperceptions of autistic people could be a barrier to social integration for autistic people. They highlight the need for interventions at the societal level aimed at reducing misunderstanding and promoting tolerance.

Explaining Variance in Social Symptoms of Children with Autism Spectrum Disorder

The social symptoms of autism spectrum disorder are likely influenced by multiple psychological processes, yet most previous studies have focused on a single social domain. In school-aged autistic children (n = 49), we compared the amount of variance in social symptoms uniquely explained by theory of mind (ToM), biological motion perception, empathy, social reward, and social anxiety. Parent-reported emotional contagion-the aspect of empathy in which one shares another's emotion-emerged as the most important predictor, explaining 11-14% of the variance in social symptoms, with higher levels of emotional contagion predicting lower social symptom severity. Our findings highlight the role of mutual emotional experiences in social-interactive success, as well as the limitations of standard measures of ToM and social processing in general.

Moral foundations theory in autism spectrum disorder: A qualitative investigation

LAY ABSTRACT

Morality is important for how humans treat each other and non-human animals. Differences in moral thinking have been found between autistic and neurotypical individuals. This research has relied on ways of thinking about moral psychology that suggest that mature morals develop as individuals learn to take the perspectives of others. Yet, even autistic individuals, who sometimes differ in their ability to take others' perspectives, make moral judgements that are similar to neurotypical individuals. Moral foundations theory suggests that moral psychology is not hierarchical but differs depending on culture. This theory could therefore help make sense of similarities and differences in autistic and neurotypical moral thinking. Moral foundations theory has not yet been investigated among autistic individuals. In this study, we interviewed autistic adults as a first attempt at understanding how moral foundations theory fits with autistic moral thinking. We found that all five moral foundations of moral foundations theory were represented in the interviews, yet certain foundations appeared more prominent than others. The autistic adults interviewed in our study discussed issues of care and fairness more than of loyalty, authority or purity when prompted to discuss moral transgressions. Future research should use quantitative methods to compare groups of autistic and neurotypical individuals to clarify similarities and differences in moral thinking between the groups.

Comparing the writing skills of autistic and nonautistic university students: A collaboration with autistic university students

LAY ABSTRACT

We do not know very much about the writing skills of autistic university students. Studies with autistic children and teenagers show that some autistic young people have difficulties writing. Other autistic people are talented writers. In fact, some autistic people would rather write than speak. Good writers often imagine other people's points of view when writing. Autistic people sometimes have difficulties understanding others' points of view. Yet, autistic people often work much harder to understand others' points of view than not-autistic people do. We collaborated with autistic university student researchers to see if autistic university students are better or worse at writing than nonautistic students. Autistic university students in our study were better writers than nonautistic students. Autistic students in our study had higher nonverbal intelligence than nonautistic students. Autistic students also put themselves under more pressure to write perfectly than nonautistic students did. Autistic students did not show any difficulties understanding other minds. This study shows that some autistic university students have stronger writing skills and higher intelligence than nonautistic university students. Yet, autistic students may be too hard on themselves about their writing. Fun activities that help students explore their ideas without pressure (like theater games) may help autistic students be less hard on their writing. Teachers can help autistic students express themselves through writing by encouraging them to write about their interests, by giving them enough time to write, and by letting them write using computers if they want to. This study shows that collaborations with autistic people can help us understand strengths that can help autistic people succeed.

What Is Important in Measuring Quality of Life? Reflections by Autistic Adults in Four Countries

Relevant and valid measurement is crucial in determining whether interventions and supports have improved the quality of life (QoL) of autistic people. However, it is possible that researchers' and services' use of general population QoL tools may overlook issues of specific importance. To advance methodology, we conducted a preliminary exploration of the need and basis for cross-cultural development of additional autism-specific QoL questions. Nine consultation groups with autistic adults (n = 38) were held in Argentina, Australia, Singapore, and the United Kingdom to examine the items of the World Health Organization QoL questionnaire (WHOQOL-BREF) and the WHOQOL Disabilities add-on module. Each group discussion was transcribed and analyzed thematically to identify missing issues and nuances of particular significance to autistic people. Themes seen as important and particularly relevant to QoL of autistic people included a positive autistic identity, other people's lack of understanding of autism, sensory issues, and autistic people's contributions to society. There were notable similarities across sites indicating that creation of cross-cultural autism-specific items is likely to be possible; the themes identified could inform the focus of items for measurement of QoL. This project represents an initial step toward fuller international consultation, and subsequent development of an autism-specific module for addition to the core WHOQOL model.

Lay summary

Why was this project done?: Quality of life (QoL) refers to how satisfied a person is with their life now, taking into account their experiences and the conditions in which they live. There are questionnaires for the general public to rate their QoL, but these may ask questions in ways that are not important or relevant for autistic people; for example, some autistic people have few or no friends, but are fine with this. Also questionnaires miss out topics such as sensory overload that impact on QoL for autistic people.What was the purpose?: We wanted to try to understand whether the questions in the World Health Organization Questionnaire (WHOQOL-BREF for short), and in the optional add-on Disabilities questionnaire, were important and relevant to autistic people from different countries and cultures. We also wanted to find out whether autistic people thought there were other important topics missing from these questionnaires.What did the researchers do?: We held 9 consultation groups about the WHO questionnaire items, with 38 autistic people in 4 countries: the United Kingdom, Singapore, Australia, and Argentina. Researchers, including members of the autism community, read the typed out discussions a number of times to find common themes, especially what was particularly relevant, or topics and experiences that were missing. First we analyzed the four United Kingdom groups, and then the other five groups.What did the researchers find?: Autistic people we consulted thought that most of the existing items of the WHOQOL questionnaires were important. From the discussions, we found 13 themes that were identified as particularly relevant to QoL, including being positive about one's autistic identity, other people's (lack of) knowledge of autism, sensory issues, mental health difficulties, the nature of friendships, and supporting other people as carers or volunteers.What do these findings add to what was already known?: The discussions from the four countries were quite similar. The items from the WHO QoL questionnaires were mostly viewed as important and relevant by autistic people, but a number of issues are missing, which seem different in autism and should be included in any improved measurement of QoL.What are potential weaknesses?: The project was a first step in consultation about measuring autistic adults' QoL, involving only four countries, and all except one group conducted in English. Only one group included people with intellectual disability.How will these findings help autistic adults now or in the future?: Having good QoL is central for everyone. Our consultation found that some topics highly relevant for autistic people are not included in QoL questionnaires developed for the general population. Our findings suggest that it will be both important and possible to develop a set of internationally appropriate items for autistic people to add to the existing WHO QoL questionnaires. This would allow researchers and health workers to measure accurately the QoL of autistic adults and to be able to judge how helpful supports and services are in improving QoL.

Do First Impressions of Autistic Adults Differ Between Autistic and Nonautistic Observers?

Background

Autistic adults receive unfavorable first impressions from typically developing (TD) adults, but these impressions improve when TD adults are made aware of their diagnosis. It remains unclear, however, how autistic adults form first impressions of other autistic adults, and whether their impressions are similarly affected by diagnostic awareness.

Methods

In this study, 32 autistic and 32 TD adults viewed brief videos of 20 TD and 20 autistic adults presented either with or without their diagnostic status and rated them on character traits and their interest in interacting with them in the future.

Results

Findings indicated that autistic raters shared the TD tendency to evaluate autistic adults less favorably than TD adults, but these judgments did not reduce their social interest for interacting with autistic adults as they did for TD raters. Furthermore, informing raters of the diagnostic status of autistic adults did not improve first impressions for autistic raters as they did for TD raters, suggesting that autistic raters either already inferred their autism status when no diagnosis was provided or their impression formation is less affected by awareness of a person's diagnosis.

Conclusions

Collectively, these results demonstrate that autistic observers make trait inferences about autistic adults comparable with those made by TD observers-suggesting a similar sensitivity to perceiving and interpreting social signifiers that differ between TD and autistic presentation styles-but unlike their TD counterparts, these trait judgments are not perceived as an impediment to subsequent social interaction and are relatively consistent regardless of diagnostic disclosure.

Lay summary

Why was this study done?: Typically developing (TD) adults often form negative first impressions of autistic adults and report less of a desire to interact with them. These biases affect the social experiences of autistic adults and can contribute to their social disability. More optimistically, however, first impressions of autistic adults improve when TD adults are more knowledgeable about autism and are made aware of their diagnostic status, suggesting that familiarity and understanding can promote acceptance of autistic differences. One group that has high familiarity with autism is autistic adults themselves, but no study to date has examined how autistic adults form impressions of TD adults and other autistic adults.What was the purpose of this study?: The purpose of this study was to examine whether first impressions of, and social interest in, autistic adults differ between autistic and TD raters, and determine whether disclosure of a person's diagnosis affects these patterns differently for autistic and TD raters.What did the researchers do?: A total of 32 TD and 32 autistic adult raters viewed videos of 40 unfamiliar adults (20 TD and 20 autistic individuals) and rated each person on six traits (awkwardness, attractiveness, assertiveness, likeability, trustworthiness, and intelligence) and four items assessing their social interest in future interaction with the person in the video. Videos were presented either with or without the person's diagnosis to see whether this information affects impressions formed by autistic and TD raters.What were the results of the study?: Consistent with prior work, TD raters formed more negative first impressions of autistic adults than TD adults. Meanwhile, autistic raters formed more positive impressions overall, but shared the TD pattern of rating autistic adults less favorably than TD adults on several traits. However, contrary to theories about reduced social motivation in autism, autistic raters expressed greater interest than TD raters in future interaction with people in the videos and this social interest was largest for other autistic people. Finally, diagnostic disclosure improved impressions of autistic adults made by TD raters but not by autistic raters.What do these findings add to what was already known?: These findings provide empirical evidence that autistic adults detect and interpret autistic social differences similarly to TD adults, but they express greater inclusivity and less discriminatory attitudes about these differences. These results add to a growing literature about how autistic people are perceived, how these perceptions affect their social experiences, and how similarity between social partners can support social connection.What are potential weaknesses in the study?: The included sample was predominantly Caucasian and male, and did not include participants with intellectual disability. Future studies should examine whether the patterns here extend to more diverse samples.How will these findings help autistic adults now or in the future?: This study provides additional evidence that social opportunities for autistic adults are affected by the perceptions and biases of potential social partners. Autistic observers may share the TD bias toward less favorable trait evaluation of autistic adults, but this did not lessen their social interest in interacting with autistic adults the way it did for TD observers. Opportunities for autistic adults to interact with other autistic adults may facilitate relationship development in this population who often struggle to have their social needs met. In addition, findings suggest that acceptance of autistic people increases with familiarity of autism itself. Improving attitudes about autism among TD people may be one effective way to improve the social experiences of autistic people within neurotypical environments.

A Friendly Article: The Qualitative Investigation of Anthropomorphism in Autistic and Nonautistic Adults

Background

Anthropomorphism is the attribution of human characteristics to nonhuman agents. This common tendency is thought to be driven by a heightened motivation for social connection and may therefore be expected to be reduced in autistic individuals given that this group has been claimed to demonstrate reduced social motivation in some settings. However, the subject of anthropomorphism in autism has not been studied extensively, and online forums, autobiographical accounts, and recent research on the topic suggest that, contrary to this expectation, anthropomorphism is commonly experienced by autistic individuals.

Methods

We conducted semi-structured interviews with eight autistic and eight nonautistic adults, all who reported a tendency to anthropomorphize. We recorded, transcribed, and analyzed the interviews according to the thematic analysis framework with the objective of identifying similarities and differences in the lived experiences of anthropomorphism in autistic and nonautistic individuals.

Results

Individuals in both groups described anthropomorphism as comforting, promoting a sense of safety and friendship with, and feelings of empathy and sympathy toward, nonhuman agents. Autistic individuals stressed the important role anthropomorphized agents played in their life, particularly when growing up: easing loneliness and helping develop an understanding of emotions and relationships. Participants also expressed negative aspects of the phenomenon, with both autistic and nonautistic individuals worrying about anthropomorphized agents' feelings and well-being. For some individuals, such thoughts and feelings caused distress and were experienced as intrusive due to their involuntary nature.

Conclusions

Autistic and nonautistic adults showed very similar anthropomorphic patterns. Although preliminary in nature, our findings highlight characteristics of anthropomorphic experiences for autistic and nonautistic individuals, furthering our understanding of individual differences in social cognition. By illustrating the important role nonhuman agents may play in the lives of autistic individuals, our findings may also guide future research and practice.

Lay summary

Why was this study done?: 'Anthropomorphism' is when you feel that non-human items have human characteristics, for example if you experience plants, animals, or household objects as having thoughts or feelings. Anthropomorphism is experienced by many people in many different ways. Researchers think it might happen when people have a strong desire for social connection. This has led some to suggest that autistic people will be less likely to anthropomorphise due to difficulties in social understanding and motivation. However, researchers have not examined this directly, and our prior research, together with comments in online forums and autobiographical accounts, indicated that autistic individuals may experience a special relationship with non-human items.What was the purpose of this study?: The purpose of the study was to speak directly to people who anthropomorphise and hear about their experiences. We could then compare patterns of anthropomorphism between autistic and non-autistic adults.What did the researchers do?: We interviewed 16 adults (8 autistic and 8 non-autistic) who told us they anthropomorphised, and asked about their personal experiences of anthropomorphism.What were the results of the study?: Autistic and non-autistic adults described very similar experiences of anthropomorphism. People in both groups described anthropomorphism as comforting, and said that it gave them a sense of safety and friendship. They also cared for, and experienced feelings of empathy toward, anthropomorphised items. Individuals in both groups worried about anthropomorphised items' feelings and well-being and this caused some people considerable distress. Autistic individuals stressed the important role anthropomorphised items played in their life, particularly when growing up: reducing loneliness and helping them develop an understanding of emotions and relationships.What do these findings add to what was already known?: Our findings show that there are many similarities in the experiences of anthropomorphism in autistic and non-autistic adults. The findings also show how, for some autistic adults, anthropomorphism was helpful in developing relationships with other people.What are potential weaknesses in the study?: The small number of participants means that we do not know whether the findings would apply to all people who experience anthropomorphism.How will these findings help autistic adults now or in the future?: By showing the various ways in which autistic individuals attach social meanings (such as feelings of caring or friendship) to anthropomorphised items, our findings add to a growing number of studies which challenge the commonly-held assumption that autistic individuals are less motivated to make social connections. Our work shows that autistic individuals may be highly motivated to connect socially, and that meaningful social connections and expressions of empathy need not be limited to human beings.