A Multi-Method Study of Empathic Responding in High-Risk Siblings at Preschool Age

Background: Individuals with autism spectrum disorder (ASD) show deficits in social and emotional reciprocity. The younger siblings of children with ASD (high-risk siblings) are at elevated risk for the disorder and for subclinical deficits in social-emotional functioning. Empathy is an essential component of social-emotional development. Previous studies have shown that higher levels of empathy in high-risk siblings during the second and third years of life predict lower ASD symptomatology and likelihood of diagnosis. 

Objectives: We examined whether observed and parent-reported empathy and prosocial behavior related to ASD outcome and symptom severity in high- and low-risk siblings at 4- to 6-years of age.

Methods:  Participants were 35 children between 4 and 6 years old who participated in a longitudinal study of children at risk for ASD. High-risk siblings had at least one older sibling with ASD and low-risk siblings had no known family history of ASD. Children were assigned to one of three outcome groups based on a diagnostic assessment at 4-6 years: Low-Risk (n=13), High-Risk/No ASD (n=14), or ASD (n=8). Symptom severity was assessed with the ADOS. Empathy was measured through behavioral observation and parent report. For the behavioral observation, children’s responses to an examiner’s distress after an accident resulting in feigned injury and dropped toys were reliably rated from 1-4 on three scales: Empathic Concern (ICC=.95), Prosocial Behavior (.78), and Personal Distress (.96). For the parent report, we used the Empathy/Prosocial Response scale from the Conscience Measure (Kochanska et al., 1994), yielding a mean score of 13 items rated from 1-7 (n=38). 

Results:  Children did not differ by outcome group in Empathic Concern or Prosocial Behavior. Children did, however, differ by outcome group in Personal Distress; high-risk children with ASD showed lower levels of distress than high-risk children without ASD, p<.05 (see Table 1). For parent-reported Empathy/Prosocial Response, outcome group differences approached significance (see Table 1). Additionally, higher levels of Empathic Concern, r(30)=-.40, p<.05, and Personal Distress, r(31)=-.42, p<.05, but not Prosocial Behavior, r(31)=-.01, ns, were associated with lower levels of ADOS severity. Likewise, children with higher parent-rated empathy tended to have lower ADOS severity, r(25)=-.34, p<.10, when examined within the high-risk group only. 

Conclusions:  Results suggest that children with ASD continue to show deficits associated with empathy, as well as some areas of strength at preschool age. Prosocial behavior was unimpaired in the high-risk children who were diagnosed with ASD at our 4- to 6-year time point and was not associated with ASD symptom severity. In contrast, children’s emotional responses to the examiner’s distress did relate to ASD diagnosis and symptom severity. Somewhat unexpectedly, self-focused rather than other-focused responses related more strongly to ASD. This suggests that the personal distress rating may have functioned as a more age appropriate index of affective response in this sample. Findings are consistent with previous reports (McDonald & Messinger, 2012) suggesting that empathy may be a protective factor in the social-emotional development of children at elevated familial risk for ASD.