How Autism May Affect Sympathy and Empathy

People with autism spectrum disorder are sometimes described as lacking empathy (the ability to feel along with others) and/or sympathy (the ability to feel for others). While this is a persistent stereotype of all people with autism, these challenges are not experienced by everyone on the spectrum.

Research into the link between autism, empathy, and sympathy has evolved over the past 40 years. Initially, it was believed that a lack of empathy and sympathy was a universal trait of autism, but more recent research indicates that this varies among individuals with the condition.

The questions of whether people with autism truly empathize or sympathize with others, what stands in the way of a traditional response, whether this can be taught, and whether an apparent lack of empathy or sympathy really reflects a lack of emotional connectedness are more nuanced than early research suggests.

Elements of Empathy and Sympathy

A lack of expressed sympathy or empathy may not be the result of a lack of emotion in someone who has autism, but rather due to underdeveloped skills. There are several elements involved in showing empathy to others.

To connect with another person in these ways, one must:

• Recognize the other person's feelings
• Understand the other person's hopes, dreams, and/or expectations
• Have the emotional experience to relate personally to another's feelings
• Have the tools to physically and verbally express empathic feelings
• Share a cultural understanding that displays of empathy are expected and desired

People with autism who struggle to show empathy and sympathy may have difficulty with one or more of these.

Awareness and Processing

Empathy is a two-dimensional emotion. It is experienced both on a cognitive level— recognizing and understanding another’s mental state—and on an affective or emotional level—feeling the emotions of others. In those with autism, these experiences can sometimes seem at odds with one another.

Research shows people with autism may struggle with cognitive empathy because they are unable to recognize and name emotions based on facial expressions. Eye scan studies found people with autism tend to look at the periphery of a face rather than pay attention to the eyes and mouth, where emotions are typically displayed. 

However, while cognitive empathy can be lower in people with autism, affective empathy—which is based on instincts and involuntary responses to the emotions of others—can be strong and overwhelming. In fact, newer research suggests that some people with autism may actually feel other people's emotions more intensely.

Picking up on other's emotions and experiencing them internally can feel overpowering and confusing, which may cause a person to shut down and withdraw from crowds.

Labeling Emotions

The ability to name emotions is an important step toward experiencing empathy and sympathy. Many people with autism experience alexithymia, which is an inability to recognize and label the emotions they feel. Alexithymia can also occur in people without autism, and the connection between empathy and alexithymia is being explored.

A 2018 study published in the Journal of Autism and Developmental Disorders found that people with alexithymia have a harder time expressing empathy, regardless of whether or not they have autism. However, people with this condition who do not have alexithymia were better able to show empathy.

The study authors note the ability to understand and label your own emotions appears to be the key to recognizing those emotions in others.

Response

Most typically, developing people learn appropriate body language and words to express sympathy and empathy by observing and imitating parents and other people. For example, a neurotypical 4-year-old might recognize an expression of pain from a friend and respond by kissing the boo-boo because she's seen someone else do that before. 

Children with autism, however, may miss social cues and not respond in the same way as others for a number of reasons. Among them:

• Those with autism commonly have difficulty interpreting non-verbal communication, such as body language and facial expressions. 
• Children with autism do not tend to engage in spontaneous imitation of others. Because children learn social skills through mimicry and repetition, those with autism may have difficulty displaying typical expressions of empathy.

Not About a Lack of Care

Unlike empathy, a shared perspective isn’t required to feel sympathy for others. For example, one can feel sympathy for animals or people who have been through a terrible ordeal that they themselves have not personally experienced. But for people on the autism spectrum, sympathy may not come as naturally as it may for others.

In a 2018 study, 254 adults with autism and 133 people without were given an online survey where they were asked to rate photographs based on the amount of sympathy they had for the individual in the photo. Researchers found those with autism gave lower sympathy ratings for people in distressing scenarios, compared to controls.

The study authors note that this does not mean people with autism are uncaring. The results suggest a difference in how individuals with lower levels of cognitive empathy process emotional cues.

A 2019 study published in the journal Autism gave an online survey to 87 people with autism and 263 neurotypical adults. Researchers found people with autism commonly engage in object personification attributing emotions to inanimate objects.

For example, a shirt that never gets worn is lonely or a doll that isn't played with feels sad. Notably, those on the spectrum often used distressing emotions to describe how objects felt, which may indicate personification is used as a way to process their own emotions.

Can It Be Taught?

Cognitive empathy can be taught to children with autism, according to research published in the Journal of Applied Behavioral Analysis.

The study used puppets or dolls to role-play situations that elicit empathetic responses and used a token system to reward the expected empathetic response. Over the course of several sessions, subjects learned how to demonstrate empathy using appropriate words and gestures.

Further research shows children with autism can be taught empathy using modeling, prompting, and reinforcement to respond to another person's emotions with appropriate phrases, tone of voice, facial expressions, and gestures.

While these techniques can be used to teach empathetic behavior, they cannot teach empathy at the emotional level. Other therapies, including cognitive-behavioral therapy, have been shown to be effective in improving emotional empathy.

Another treatment that is being explored for helping people with autism develop emotional empathy is equine therapy. A form of experiential therapy that involves interactions between patients and horses, equine therapy involves grooming and riding horses.

Research published in the journal Anthropology and Medicine in 2018 found that horse-assisted therapy appears to help those with autism to open up and become more aware of their own emotions and the emotions of those around them.

The study authors note the specific movements and rhythms of the horse, the sensory experience of riding, and getting to know the personality of the horse appear to resonate emotionally with people with autism.

Equine therapy was also found to help individuals improve eye contact, body language, and verbal communication.

A Word From Verywell

While many people with autism may appear to lack empathy and sympathy, it is not the case for all people with autism. For those who struggle with displaying appropriate empathetic responses, the reasons may relate more to social communication issues than a lack of underlying emotional response.