Responses to others' pain in adults with autistic traits: The influence of gender and stimuli modality

Group empathy for pain is stronger than individual empathy for pain in the auditory modality

Humans live in collective groups and are highly sensitive to perceived emotions of a group, including the pain of a group. However, previous research on empathy for pain mainly focused on the suffering of a single individual ("individual empathy for pain"), with limited understanding of empathy for pain to a group ("group empathy for pain"). Thus, the present study aimed to investigate the cognitive neural mechanisms of group empathy for pain in the auditory modality. The study produced group painful voices to simulate the painful voices made by a group, and recruited 34 participants to explore differences between their responses to group painful voices and individual painful voices using the event-related potential (ERP) techniques. The results revealed that group painful voices were rated with higher pain intensity, more negative affective valence, and larger P2 amplitudes than individual painful voices. Furthermore, trait affective empathy scores of the participants were positively correlated with their P2 amplitudes of group painful voices. The results suggested that the group empathy for pain may facilitate affective empathetic processing in auditory modality.

Intact painful sensation but enhanced non-painful sensation in individuals with autistic traits

Somatosensory abnormalities are commonly recognized as diagnostic criteria in autism spectrum disorder (ASD), and may also exist in individuals with autistic traits. The present research included two studies to explore the painful and non-painful sensation and their cognitive-neurological mechanisms of individuals with autistic traits. Study 1 included 358 participants to assess the relationship between autistic traits and pain/non-pain sensitivities using questionnaires: the Autism Spectrum Quotient (AQ), the Pain Sensitivity Questionnaire, and the Highly Sensitive Person Scale, respectively. Study 1 found that autistic traits were positively correlated with non-pain sensitivity, but not associated with pain sensitivity. Study 2 recruited 1,167 participants whose autistic traits were assessed using the AQ. Subsequently, thirty-three participants who scored within the top 10% and bottom 10% on the AQ were selected into High-AQ and Low-AQ groups, respectively, to explore the cognitive-neural responses of individuals with autistic traits to both painful and non-painful stimuli with event-related potential (ERP) technology. Results of Study 2 showed that the High-AQ group showed higher intensity ratings, more negative emotional reactions, and larger N1 amplitudes than the Low-AQ group to the non-painful stimuli, but no difference of response to the painful stimuli was found between High-AQ and Low-AQ groups. These findings suggest that individuals with autistic traits may experience enhanced non-painful sensation but intact painful sensation.

Resting-state EEG Microstate Features Can Quantitatively Predict Autistic Traits in Typically Developing Individuals

Autism spectrum disorder (ASD) is not a discrete disorder and that symptoms of ASD (i.e., so-called "autistic traits") are found to varying degrees in the general population. Typically developing individuals with sub-clinical yet high-level autistic traits have similar abnormities both in behavioral performances and cortical activation patterns to individuals diagnosed with ASD. Thus it's crucial to develop objective and efficient tools that could be used in the assessment of autistic traits. Here, we proposed a novel machine learning-based assessment of the autistic traits using EEG microstate features derived from a brief resting-state EEG recording. The results showed that: (1) through the Least Absolute Shrinkage and Selection Operator (LASSO) algorithm and correlation analysis, the mean duration of microstate class D, the occurrence rate of microstate class A, the time coverage of microstate class D and the transition rate from microstate class B to D were selected to be crucial microstate features which could be used in autistic traits prediction; (2) in the support vector regression (SVR) model, which was constructed to predict the participants' autistic trait scores using these four microstate features, the out-of-sample predicted autistic trait scores showed a significant and good match with the self-reported scores. These results suggest that the resting-state EEG microstate analysis technique can be used to predict autistic trait to some extent.

Group membership modulates empathic neural responses to pain in deaf individuals

Empathy deficiencies are prevalent among deaf individuals. It has yet to be determined whether they exhibit an ingroup bias in empathic responses. This study employed explicit and implicit empathy tasks (i.e. attention-to-pain-cue [A-P] task and attention-to-nonpain-cue [A-N] task) to explore the temporal dynamics of neural activities when deaf individuals were processing painful/nonpainful stimuli from both ingroup models (deaf people) and outgroup models (hearing people), which aims to not only assist deaf individuals in gaining a deeper understanding of their intergroup empathy traits but also to aid in the advancement of inclusive education. In the A-P task, we found that (i) ingroup priming accelerated the response speed to painful/nonpainful pictures; (ii) the N2 amplitude of painful pictures was significantly more negative than that of nonpainful pictures in outgroup priming trials, whereas the N2 amplitude difference between painful and nonpainful pictures was not significant in ingroup priming trials. For N1 amplitude of the A-N task, we have similar findings. However, this pattern was reversed for P3/late positive component amplitude of the A-P task. These results suggest that the deaf individuals had difficulty in judging whether hearing individuals were in pain. However, their group identification and affective responses could shape the relatively early stage of pain empathy.

The effect of top-down attention on empathy fatigue

Prolonged exposure to others' suffering can lead to empathy fatigue, especially when individuals struggle to effectively regulate their empathic capacity. Shifting active attention away from emotional components toward cognitive components of others' suffering is an effective strategy for mitigating empathy fatigue. This research investigated how top-down attentional manipulation modulates empathy fatigue in both auditory (Study 1) and visual (Study 2) modalities. Participants completed two tasks in both studies: (i) the attention to cognitive empathy task (A-C task) and (ii) the attention to emotional empathy task (A-E task). Each task included three blocks (Time Block 1, Time Block 2, and Time Block 3) designed to induce empathy fatigue. Study 1 revealed that the A-C task reduced empathy fatigue and N1 amplitudes than the A-E task in Time Block 3, indicating that attention to cognitive empathy might decrease auditory empathy fatigue. Study 2 indicates that the A-C task caused a longer N2 latency than the A-E task, signifying a decelerated emotional empathic response when attention was on cognitive empathy in the visual modality. Overall, prioritizing cognitive empathy seems to conserve mental resources and reduce empathy fatigue. This research documented the relationship between top-down attention and empathy fatigue and the possible neural mechanism.

The relationship between autistic traits and empathy in adolescents: An ERP study

Based on the mind-blindness hypothesis, a large number of studies have shown that individuals with autism-spectrum disorder (ASD) and autistic traits have empathy deficits. However, the recent double empathy theory contradicts the mind-blindness hypothesis and suggests that individuals with ASD and autistic traits do not necessarily lack empathy. Thus, the presence of empathy deficits in individuals with ASD and autistic traits is still controversial. We recruited 56 adolescents (28 high autistic traits, 28 low autistic traits, 14-17 years old) in this study to explore the relationship between empathy and autistic traits. The study participants were required to undertake the pain empathy task, during which the electroencephalograph (EEG) activities were recorded. Our results show that empathy was negatively associated with autistic traits at the questionnaire, behavioral, and EEG levels. Our results also suggested that empathy deficits in adolescents with autistic traits may be manifested mainly in the late stages of cognitive control processing.

Empathy for pain in individuals with autistic traits during observation of static and dynamic stimuli

Previous studies have reported that individuals with autistic traits, like those with Autism Spectrum Disorder (ASD), may have impaired empathic responses when observing static stimuli of others' pain. However, it remains unclear whether individuals with autistic traits exhibit impaired empathy for pain in response to dynamic stimuli. The present study addressed this question by recruiting 529 individuals whose autistic traits were assessed using the autism-spectrum quotient (AQ) questionnaire. Thirty participants who scored within the top 10% and bottom 10% on the AQ were selected into High-AQ and Low-AQ groups, respectively. This study employed painful whole-body action pictures and videos as static and dynamic stimuli. Both groups were instructed to judge whether the models in the stimuli were experiencing pain, and their reaction times, accuracy and event-related potential (ERP) data were recorded. Results showed that the P2 amplitudes were larger in the High-AQ group than in the Low-AQ group when viewing painful static stimuli, while no difference between the two groups was found when viewing painful dynamic stimuli. These results suggest that autistic traits influenced the emotional processing of others' pain in response to static stimuli.

Altered nociceptive behavior and emotional contagion of pain in mouse models of autism

Individuals with autism spectrum disorder (ASD) have altered sensory processing but may ineffectively communicate their experiences. Here, we used a battery of nociceptive behavioral tests to assess sensory alterations in two commonly used mouse models of ASD, BTBR T⁺ Itpr3^tf /J (BTBR), and fragile-X mental retardation-1 knockout (Fmr1-KO) mice. We also asked whether emotional contagion, a primitive form of empathy, was altered in BTBR and Fmr1 KO mice when experiencing pain with a social partner. BTBR mice demonstrated mixed nociceptive responses with hyporesponsivity to mechanical/thermal stimuli and intraplantar injections of formalin and capsaicin while displaying hypersensitivity on the acetic acid test. Fmr1-KO mice were hyposensitive to mechanical stimuli and intraplantar injections of capsaicin and formalin. BTBR and Fmr1-KO mice developed significantly less mechanical allodynia following intraplantar injections of complete Freund's adjuvant, while BTBR mice developed slightly more thermal hyperalgesia. Finally, as measured by the formalin and acetic acid writhing tests, BTBR and Fmr1-KO mice did not show emotional contagion of pain. In sum, our findings indicate that depending on the sensation, pain responses may be mixed, which reflects findings in ASD individuals.

Autism and Emotion: A Narrative Review

Autism spectrum disorder (ASD) includes a variety of childhood-onset and lifelong neurodevelopmental condition with an enduring impact on multiple domains of functioning characterized by persistent deficits in social communication, restricted and repetitive behavior interest, and activities. They often find it hard to recognize and control emotions but their emotional expression can be improved by various intervention techniques that in turn can help them understand and respond more appropriately to other people. Problems in the area on emotional reciprocity among individual with ASD involve recognizing, understanding, expressing, and regulating emotions. Their ability in emotional reciprocity is often improved with a comprehensive treatment approach, especially by focused emotional enhancement intervention. In this review, we followed the standard IMRAD (Introduction, Methods, Results, and Discussion) structure to critically examine the condition of autism and its relation with genetic mechanism, and how theories of emotion and theory of mind associated with persons with ASD, some of the widely used assessment tools and future research direction in the emotional development of individuals diagnosed with ASD by using the narrative review method. Records collected through research databases such as Scopus, PubMed, Web of Science, Medline, EBSCO and published books with ISBN (International Standard Book Number), and published test manuals were evaluated in-depth and summarized based on the subtopic of the proposed title. A critical theoretical analysis of the genetic mechanism of emotions, theories of emotions, and theory of mind was explained in connection with ASD.

Processing of expressions by individuals with autistic traits: Empathy deficit or sensory hyper-reactivity?

Individuals with autistic traits display impaired social interaction and communication in everyday life, but the underlying cognitive neural mechanisms remain very unclear and still remain controversial. The mind-blindness hypothesis suggests that social difficulties in individuals with autistic traits are caused by empathy impairment in individuals; however, the intense world theory suggests that these social difficulties are caused by sensory hyper-reactivity and sensory overload, rather than empathy impairment. To further test these two theories, this study investigated event-related potentials (ERPs) to explore the cognitive neural processing of repetitive expressions in individuals with autistic traits. This study employed the Mandarin version of the autism-spectrum quotient (AQ) to assess autistic traits in 2,502 healthy adults. Two subset groups were used, e.g., the participants of a high-AQ group were randomly selected among the 10% of individuals with the highest AQ scores; similarly, the participants in the low-AQ group were randomly selected from the 10% of participants with the lowest AQ scores. In an experiment, three different facial expressions (positive, neutral, or negative) of the same person were presented successively and pseudo-randomly in each trial. Participants needed to define the expression of the face that was presented last. The results showed that compared with the low-AQ group, the high-AQ group exhibited higher P1 amplitudes induced by the second and third presented expressions, as well as higher P3 amplitudes induced by the third presented negative expressions. This indicates that individuals with autistic traits may experience overly strong perception, attention, and cognitive evaluation to repetitive expressions, particularly negative expressions. This result supports the intense world theory more strongly than the mind-blindness hypothesis.

Altered neuronal habituation to hearing others' pain in adults with autistic traits

This study tested the hypothesis that autistic traits influence the neuronal habituation that underlies the processing of others' pain. Based on their autism-spectrum quotient (AQ), two groups of participants were classified according to their autistic traits: High-AQ and Low-AQ groups. Their event-related potentials in response to trains of three identical audio recordings, exhibiting either painful or neutral feelings of others, were compared during three experimental tasks. (1) In a Pain Judgment Task, participants were instructed to focus on pain-related cues in the presented audio recordings. (2) In a Gender Judgment Task, participants were instructed to focus on non-pain-related cues in the presented audio recordings. (3) In a Passive Listening Task, participants were instructed to passively listen. In the High-AQ group, an altered empathic pattern of habituation, indexed by frontal-central P2 responses of the second repeated painful audio recordings, was found during the Passive Listening Task. Nevertheless, both High-AQ and Low-AQ groups exhibited similar patterns of habituation to hearing others' voices, both neutral and painful, in the Pain Judgment and Gender Judgment Tasks. These results suggest altered empathic neuronal habituation in the passive processing of others' vocal pain by individuals with autistic traits.

The interaction between pain and attractiveness perception in others

When considering the “beauty-is-good” stereotype, facial attractiveness should facilitate empathy for pain. On the other hand, having in mind the “threat value of pain” hypothesis, pain cues would be more salient, and thus, its processing would not suffer influence by facial attractiveness. The event-related potential (ERP) allows investigating if one of these theories could predict individuals’ responses regarding the perception of pain or attractiveness in others’ faces. We tracked 35 participants’ reactions to pictures depicting more and less attractive faces displayed in a painful and non-painful condition. Each participant completed the following two tasks when presented the images of faces: (1) the Pain Judgment Task, in which participants should rate the pain levels, and (2) the Attractiveness Judgment Task, in which participants should rate the attractiveness. Results showed that participants exhibited differences rating more and less attractive faces in the non-painful pictures, but not in the painful pictures. These results were observed in P3 and LPC amplitudes in the Pain Judgment Task, as well as in N170 and P2 amplitudes in the Attractive Judgment Task. Our results suggested that both explicit and implicit empathic pain processing inhibited the processing of attractiveness perception. These findings supported the “threat value of pain” hypothesis. Besides, in the Attractive Judgment Task, the N170 and P2 amplitudes for more attractive painful pictures were larger than those for more attractive non-painful pictures. In contrast, no significant difference was found between the amplitudes for painful and non-painful, less attractive pictures. Our findings suggest that explicit facial attractiveness processing for more attractive face images potentiates the implicit empathy for pain processing, therefore partly supporting the “beautiful-is-good” stereotype.

Top-down attention modulation on the perception of others' vocal pain: An event-related potential study

Pain is typically expressed through various sensory (e.g., visual and auditory) modalities: the human voice conveys information about social and affective communication. While the empathic responses to others' pain in the visual modality are modulated by top-down attention constraints, it remains unclear whether empathy for such expressions in the auditory modality also involves such top-down modulation mechanisms. Therefore, the present study investigates how neural correlates of empathic processes to others' vocal pain are modulated by the task-instructed attention manipulations. Each participant completed the following three tasks: (1) Pain Judgment Task, in which participants were instructed to pay attention to pain cues in vocal stimuli, (2) Gender Judgment Task, in which participants were instructed to pay attention to non-pain cues in vocal stimuli; (3) Passive Listening Task, a control task in which participants were instructed to passively listen to the vocal stimuli without any required response. The earlier frontal-central N1 response to either others' painful or neutral voice was greater in the Pain Judgment Task than in the other two tasks, suggesting a general attention modulation on the bottom-up sensory processing of vocal stimuli. The frontal-central P2 responses to others' painful voices was greater in the Pain Judgment Task than in the other two tasks, but not to others' neutral voices, thus suggesting selective attention modulation on the P2 response to others' pain. Late positive complex (LPC) to others' painful and neutral voices differed significantly regardless of task manipulations, thus suggesting empathic pain modulation on LPC response. All these results demonstrated top-down attention modulation on affective sharing responses others' vocal pain, but not on cognitive appraisal process of others' vocal pain.

Top-down Effects on Empathy for Pain in Adults with Autistic Traits

While empathic responses of individuals with autism-spectrum disorder have been reported to be modulated by top-down attention, it remains unclear whether empathy for pain in typically developing individuals with autistic traits also involves such top-down modulation mechanisms. This study employed the autism-spectrum quotient (AQ) to quantify autistic traits in a group of 1,231 healthy adults. Two subset groups (High-AQ and Low-AQ groups) were randomly selected from the highest and lowest 10% AQ scores respectively. We explored whether participants in both groups would differ in their response to others’ pain when their attention was directed toward (A-P tasks) or away (A-N tasks) from pain cues in auditory and visual experimental modalities. Compared to Low-AQ individuals, High-AQ individuals exhibited more suppressed N1 and P2 amplitudes in response to painful vocal cues in auditory A-N tasks. This suggests suppressed attentional and emotional processes of empathy for pain when High-AQ individuals have their attention directed away from others’ pain cues. No significant difference was found between both groups in the auditory A-P task, nor in the visual A-P and A-N tasks. These results suggest that top-down attention modulation of cortical empathic responses to others’ vocal pain is influenced by autistic traits.