Early Predictors of Empathy At School Age in Siblings of Children with ASD

Background:   Children with ASD attend less and demonstrate less affective response to others’ distress (Sigman et al., 1992).  Response to distress has been associated with the ability to intuit the internal states of others and with the quality of social interactions.  Attenuated distress response has been documented as early as 12 months of age in infants later diagnosed with ASD (Hutman et al., 2010).  Infant siblings of children with autism who were not later diagnosed with ASD did not show atypical distress response.  However, a subset of 12-month-old infant siblings with non-specific delays did show a significant reduction in attentiveness to distress relative to typically developing controls (Hutman et al., 2012). 

Objectives:   This study sought to determine whether reduced empathic concern was evident in 5½-year-old siblings of children with ASD.  Early characteristics such as joint attention, social attention, response to distress, verbal and non-verbal cognitive skills were evaluated as predictors of individual differences in empathy at 5½ years.

Methods:   Participants were 23 children with no family history of autism and 40 children with a sibling diagnosed with autistic disorder (Sibs). When children were 5½, their parents completed a 23-item, Likert-scale measure, characterizing the affective and cognitive components of their child’s empathic behavior in a variety of contexts (Griffith Empathy Measure; Dadds et al., 2008).  Predictors of empathy that were tested include verbal and non-verbal cognitive skills (Mullen, 1995), response to distress (Sigman et al., 1992), preferential attention to social stimuli (Hutman et al., 2012), and response to an examiner’s bids for joint attention (RJA; Early Social Communication Scales; Seibert, Hogan, & Mundy, 1982).  Predictive measures were administered when infants were 12 and 18 months old.

Results: Parent ratings of child empathy did not differ between low-risk controls and Sibs who were not themselves diagnosed with ASD (p’s>.6).  However, a subset of high-risk infants who demonstrated developmental delays at 5½ years (n=12) received lower cognitive empathy ratings from their parents than high- and low-risk participants who were developing typically (p=.03).  Delays observed in this group include elevated ADOS scores and impaired language skills.  Significant predictors during infancy of individual differences in parent-reported empathy at school entry included attention to an examiner feigning distress at 12 and 18 months (p’s<.01).  Relations were still in evidence when we controlled for ASD symptom severity (Gotham et al., 2009).  Parent-reported empathy at 5½ years was not related to affective response to the examiner’s distress, RJA, or verbal and non-verbal cognitive skills measured during the second year (p’s≥.06).

Conclusions:   Impaired empathic response is not consistently evident among 5½- year-old siblings of children with autistic disorder.  Parents reported decreased cognitive empathy in a subset of Sibs with developmental delays, but who do not meet criteria for ASD.  A similar pattern has been reported in 12-month-old Sibs with developmental delays (Hutman et al., 2012). This study provides support for developmental continuity between distress response at 12 months and parent-reported empathy at 5½ years.  Implications for early detection and intervention will be discussed.