How Autism May Affect Sympathy and Empathy

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People with autism spectrum disorder are sometimes described as lacking empathy—the ability to feel along with others—or sympathy—the ability to feel for others. While this is a persistent autistic stereotype, it is not true for all people on the spectrum.

Research into the link between autism and empathy has evolved over the past 40 years. Initially, it was believed that a lack of empathy was a universal autistic trait, however, more recent research indicates that the ability to have and show empathy varies among people on the spectrum.

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

Understanding Empathy

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

Children with autism, however, may miss the social cues and not respond in the same way for a number of reasons. Autistics commonly have difficulty interpreting non-verbal communication, such as body language and facial expressions, so they may not understand the other person’s emotions. 

In addition, children with autism may not respond to other people’s emotions in socially expected ways. This may be because children learn social skills through mimicry and repetition. Children with autism do not tend to engage in spontaneous imitation of others and may have difficulty displaying typical expressions of empathy.

The skill of "mind-reading"—understanding another's thoughts through careful observation of body language, vocal tone, facial expression, etc.—is key to empathy. People with autism often have a very difficult time with this aspect of empathy.

Showing Empathy

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

To empathize with another person, 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 may have difficulty with one or more of those stages.

Feeling Empathy

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.

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. 

While cognitive empathy can be lower in autistics, 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

Another aspect of showing empathy is the ability to name emotions. 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 people with alexithymia have a harder time expressing empathy, regardless of whether or not they are autistic. However, autistic people 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.

Teaching Empathy

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 autistics 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 autistics to improve eye contact, body language, and verbal communication.

A Word From Verywell

While many people with autism may appear to lack empathy, 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. People with autism can be taught skills to better recognize other people's feelings and learn tools to show empathy in socially expected ways.

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