Factors Associated with Empathic Behavior in Children and Adolescents with High-Functioning ASD

Background:  

A lack of empathy is emphasized in diagnostic guidelines and clinical observations of autism spectrum disorder (ASD). Yet, given the high degree of clinical heterogeneity in ASD (e.g., Jones & Klin, 2009; Mundy, 2007), the expression of empathy may be affected by multiple factors. Therefore, we addressed possible reasons why some youths with ASD do not show empathic responses while others do.

Objectives:  

This is the first large-scale study to explore associations of social cognition, executive functioning, temperament, and co-morbid problem behaviors with empathic behavior of high-functioning children and adolescents with ASD (HFASD).

Methods:  

Participants with HFASD (6-18 years) were classified as ‘empathic’ (n=45) when both direct observations and parent reports confirmed their empathic responsiveness to others’ emotions. Participants who were not rated empathic during the direct observation and/or by their parents were classified as ‘non-empathic’ (n=80). Children completed an advanced Theory of Mind test (ToM), while parents completed the Social Responsiveness Scale (SRS), the Behavior Rating Inventory of Executive Function (BRIEF), the Disruptive Behavior Disorders scale (DBD), the Wing Subgroups Questionnaire (WSQ), and the Emotionality Activity Sociability temperament survey (EAS).

Results:  

MANOVAs with group (empathic vs. non-empathic) and age (below vs. above 13 years) as factors showed that the empathic group had significantly fewer symptoms of conduct disorder than the non-empathic group (F(1, 125) = 4.68, p <.05). Other main effects of group were not found. The younger age group showed more executive functioning problems (F(1,125) = 3.51, p =.06), activity (WSQ: F(1,125) = 7.41, p <.01; DBD: F(1,125) = 6.19, p <.05), emotionality (F(1,125) = 14.40, p <.001), and poorer social cognition than the older age group (ToM: F(1,125) = 6.46, p =.01; SRS social cognition: F(1,125) = 7.97, p <.01). Furthermore, group x age analyses demonstrated that empathic children had more executive functioning problems and hyperactivity symptoms than empathic adolescents (BRIEF: F(1,45) = 5.07, p <.05; DBD hyperactivity: F(1,45) = 12.90, p =.001) and non-empathic children (BRIEF: F(1,52) = 4.40, p <.05; DBD hyperactivity: F(1,52) = 11.67, p = .001). Empathic adolescents were rated by their parents as having fewer social motivation problems when compared to non-empathic adolescents (SRS social motivation: F(1,73) = 6.06, p <.05; EAS sociability: F(1,73)= 7.22, p <.01).

Conclusions:  

Differences in social cognition do not explain the observed differences in empathic behavior in children and adolescents with HFASD. However, problems in executive functioning such as inhibition problems seem to be particularly evident in young empathic children with HFASD. The findings stress the importance of age in empathic behavior. Children’s empathic responses may be produced by a general drive to be active, whereas adolescents’ empathic responses are associated with social motivation. Hence, instead of empathy being a general deficit in ASD, individual social and non-social factors are associated with the expression of empathy in children and adolescents with HFASD.