Researchers have conclusively shown that people with autistic traits show less empathy

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Researchers have conclusively shown that people with autistic traits show less empathy and reduced understanding of other people’s feelings in a new study out today from the University of Bath and King’s College London.

Whilst autism might be associated with social difficulties, there has been debate in recent years about whether the autistic community experience difficulties in processing emotion or not and the exact form this takes.

This has centred on difficulties in measuring empathy, but also on the complicating factor that many autistic people also experience alexithymia, the condition otherwise known as ‘emotional blindness’.

Those with alexithymia face difficulties in understanding their own and others’ emotions, yet it was less clear whether autistic people without the condition faced the same challenge.

For the new study, published in a Special Issue on Empathy in the Journal of Autism and Developmental Disorders, Dr. Punit Shah, Lucy Livingston and colleagues addressed limitations in previous research.

Across two large-scale surveys, sampling over 650 adults from the general population, they measured the links between autistic tendencies, alexithymia, and scored individuals on a detailed empathy test.

Their results found that having more autistic tendencies was linked to lower empathy, even after factoring in alexithymia.


Types of empathy

Before we continue, let’s have a look at the different forms of empathy. Empathy comes in three main flavors:

  • Cognitive empathy — The ability to infer about beliefs and knowledge of other people.
  • Affective empathy — Also called emotional empathy; the ability to infer about emotions felt by other people.
  • Compassionate empathy — Also called empathetic concern; this is what moves you to help others.
  • Motor empathy — The unconscious mirroring of body language or facial expressions of another person.

Empathy & imitation

Below is the Russian doll model of empathy and imitation, presented in a paper from 2008:[1]

Empathy (right) induces a similar emotional state in the subject and the object, with at its core the perception–action mechanism (PAM). The doll’s outer layers, such as sympathetic concern and perspective-taking, build upon this hard-wired socio-affective basis. Sharing the same mechanism, the doll’s imitation side (left) correlates with the empathy side. Here, the PAM underlies motor mimicry, coordination, shared goals, and true imitation. Even though the doll’s outer layers depend on prefrontal functioning and an increasing self–other distinction, these outer layers remain connected to its inner core. (Image attribution: de Waal – redesign by Embrace ASD)

Interestingly, cognitive empathy is often taken to be the form of empathy which the others rely on, but it’s actually the other way around; basically, each type of empathy informs the other type, starting with motor empathy and emotional contagion, then emotional empathy and sympathetic concern, and then perspective-taking and cognitive empathy.[2]

If there are any impairments in one type of empathy preceding the other, this has consequences for the type of empathy informed by it.

For instance, a psychopath lacks emotional empathy, which has a profound effect on their perspective-taking and cognitive empathy. It also means they compensate a lot more with imitation (the left side of the model) for their lack of emotionality.

Also, you might have noticed the statement increased self–other distinction on the sides of the diagram.

It’s interesting how motor mimicry is subconscious and involuntary, and thus largely negates the self, but motor mimicry and emotional contagion then inform the next type of empathy, and the next.

Motor empathy

We will have a look at affective and cognitive empathy first, but let’s start with motor empathy in autism. In autistic people, there seem to be some differences in motor empathy, specifically in motor contagion.

 Before I can explain some of these motor differences in autism, let me explain what motor contagion is first (which highly relates to motor mimicry).

In humans, some of the brain regions involved in executing actions are activated just by observing an action, rather than necessarily having to perform the action in question yourself. This mechanism by which our brain regions activate by observing others is called the mirror system, which is part of motor cognition. 

So observing, imagining, or in any way representing an action triggers the motor programs used to execute that same action.[3]

Some studies indicate that there are interference effects between observed and executed movements. That interference is thought to be a form of motor contagion, which is the influence that observed motor functions have.[4] Think for example of a person yawning, where observing the act of yawning—perhaps even the mention of it—can give you the urge to yawn. In other words, yawns are contagious, called yawn contagion.

In a similar fashion to the yawns, by observing someone jump for instance, your brain regions that would be involved if you were to jump yourself, become activated. If what you observe is incongruent with the execution of your own movements, then this brings about the aforementioned interference effects.

In other words, when interpreting the actions of another, it can disrupt your own actions—either subtly or severely.

Research from 2011 indicates this interference significantly increases when the observed movements are interpreted as being directed toward a goal.

This suggests a greater discrepancy between perception and motor functions during observation of goal-directed versus non-goal-directed actions.[5] 

In other words, seeing someone perform a goal-oriented action (e.g. throwing a ball into a net) that is incongruent with an action you are performing is more “disruptive” to your own movements than seeing someone perform a non-goal-directed action (e.g. arbitrarily spinning a ball).

So actions with what we interpret to be deeper motivations or an explicit goal have a more significant interference effect.

Why am I explaining all this? Because a study from 2007 found that autistic children did not show any interference effects, either from action or from the act of looking into another person’s eyes in order to deduce information (called gaze observation).[6]

 This may sound positive, but do note that the disruption is caused by a transfer of information. So the lack of said transfer means no information is inferred about the other person’s motivations or theory of mind.

A control experiment explored the importance of the information coming from the model’s gaze pattern in eliciting the effects of motor contagion in normally developing children.

Results highlight the importance of gaze direction in motor contagion, demonstrating that in normal children blocking the gaze prevented the transfer of interference.[7]

So what the research indicated is that eye gaze (maintaining eye contact) plays a central role in eliciting motor contagion. In other words, our tendency to look around rather than into people’s eyes contributes to impairments in motor empathy, which in turn can influence the other types of empathy, and the way we interact with and perceive other people.

Research from 2005 and 2000 respectively indicates these motor empathy impairments are not only due to differences in processing gaze,[8] but also in processing faces.[9] Both have a significant effect on social situations in general,[10] which presents as theory of mind issues or impairments in cognitive empathy.

Lack of gaze

Interestingly, research from 2012 indicates that both autistic people and those with conduct disorder* show impairments in facial mimicry (motor empathy) and emotion recognition (cognitive empathy), though for autistic people this pertains to all basic emotions, whereas for those with conduct disorder this is only the case for negative emotions.[11]

Conduct disorder is a precursor for primary psychopathy, secondary psychopathy, and in particular ASPD.

The researchers hypothesize that impaired motor and cognitive empathy in both disorders are a consequence of lack of attention to the eyes (lack of gaze). However, there are major differences in emotional empathy deficits between ASD and conduct disorder, probably due to emotional autonomic hyper-responsivity (which is to say subconscious/involuntary emotional responses that can be quite intense) due to hyper-responsivity of the amygdala; whereas those with conduct disorder show emotional hypo-responsivity (a lack of emotional responses).[12]

However, both mechanisms seem to be influenced by a lack of attention to the eyes.[13] So as you can see, motor empathy impairments can have a significant effect on our ability to identify and discriminate between emotions.

Moreover, research from 2005 indicates that in contrast to neurotypical children, children with autism fail to use information from a person’s action or gaze to plan their subsequent action. This inability to use information from person’s gaze produces a lack of understanding of the motor intention of others.[14] This is what causes impairments in theory of mind as well.

Theory of mind

In autistic individuals it is said that cognitive empathy (which theory of mind is part of) is impaired. In my experience, however, we tend to have a fair theory of mind when it comes to other autistic people, but understanding neurotypicals can be more challenging—as it often is for them to understand us, as well.

Generally speaking, when people with very different experiences of the world interact with one another, they will struggle to empathise with each other. This is referred to as the double empath problem, by Damian Milton.[15]

And indeed, research from 2015 by Elizabeth Sheppard et al. indicates that neurotypicals struggle to read the emotions of autistic people, and show to be ineffective in interpreting the behaviour of autistic individuals, which could also contribute to the social difficulties seen in autism.[16]

A paper published in 2017 by Dimitris Bolis et al. presents a framework called the dialectical misattunement hypothesis, which views conditions such as autism not merely as (disordered) function within single brains, but as a dynamic interpersonal mismatch that encompasses various levels of description.[17] In other words, challenges with theory of mind or communication for example are not solely down to the individual, but are to be overcome by all parties involved.

Empathy spectrum

Irrespective of lower cognitive empathy on average, both cognitive and affective empathy in autistic people lie on a spectrum. Some autistic people may think they are low on empathy (on the Empathy Quotient I score 6/80), but in my experience this is not due to a lack of empathy, but problems accessing one’s feelings, or (occasional) challenges understanding the emotional complexity of certain situations.

I don’t get the impression I have significant cognitive empathy impairments in general, although this might be an indication of a lack of insight, or social/cognitive blind spots. Me thinking I don’t have significant cognitive impairments may ironically be an indication of said impairments. Either way, cognitive empathy seems to correlate with age/experience and maturation of the brain as well, as my cognitive empathy and general awareness was certainly much lower when I was younger.

Emotional empathy is definitely present in autistic people, and in fact rather than impairments, we tend to have a great amount of emotional empathy. However, arguably our emotional empathy can be pathological; we sometimes care for others to a degree that we sacrifice our own wellbeing, and some of us even experience mirror–touch synesthesia, where an individual experiences the same sensation as the person they observe. You can read more on synesthesia here:

Autistic synesthetes

Lack of affect

Sometimes we project our own emotions onto others and confuse that with empathy. This may contribute to theory of mind issues. Either way, we certainly care about other people’s emotions; sometimes not so much for people we don’t know, but once we come to know them, we can acquire a deep sense of caring for them—even though we perhaps don’t tend to show it.

On that note, we often present with reduced affect display (sometimes referred to as lack of affect), which means a lack of emotional expressions. This can easily be confused with a lack of emotions, which is then often confused with callousness. Due to this reduced affect display, neurotypicals often have challenges reading our facial expressions.[18] But I assure you, whereas we may outwardly appear emotionless, internally we tend to have very strong emotions.

Additionally, autistic people may be unable to show empathy in certain situations, for example when in distress,or when a situation or underlying motivations are not understood or perhaps misunderstood. Often, when the context or motivations are made salient, we do show empathy.

Fluctuating empathy

Autistic people can have intense feelings and emotions, but it doesn’t necessarily translate to other people. But for some autistic people their empathy doesn’t quite register to themselves, even though they may be quite empathetic in terms of behavior.

For many years I’ve been puzzled by my own empathy, as it seemed so inconsistent. Here are a few examples of my occasional lack of empathy:

  • In my late teens a family member added me on a program to chat, but not long thereafter I blocked her; not only did this family member lack the intellect to engage with me in a mutually conducive way, but they set letters as hot keys for a myriad of emoticons, so with every sentence they would type, there would be at least three emoticons instead of particular letters. This was too much for me to handle, and so I blocked her. In hindsight it surprises me that I didn’t feel guilty about that at the time, as I likely would today. Either way, my mother told me I was cold-hearted, and was repulsed by my actions. It never occurred to me to take this family member’s feelings into consideration. I didn’t understand this person very well—perhaps in part on account of a significant difference in intelligence—nor did I have a good relationship with this person, so it was challenging for me to show emotional empathy. But certainly, I showed a lack of cognitive empathy as well.
  • I was walking outside, when a young woman fell on the street with her bicycle. I was about six meters away from her, and I chuckled as I continued walking, while to my surprise a man and a woman came from two different directions from a distance further than I was from the woman, in order to help her. I didn’t figure she needed any help. I fell with my bicycle often, and never required people’s help. In fact it would likely embarrass me further.
  • A few years back an uncle of mine died. I went to the funeral, and most people cried. But for me, it was all ritual, and I failed to experience an emotional component. Perhaps because I had no particular relationship with my uncle, even though I saw him frequently. Or perhaps this points to cognitive differences in autism.

In recent years I have come to discover I can show a surprising amount of empathy, however. Basically I feel empathy towards those I can relate to, provided I have already established a relationship with them. If there is no relationship, I will still feel empathy, but it is more fleeting, and doesn’t necessarily lead to empathetic behavior.

Cognitive empathy

Research from 2018 revealed that cognitive empathy is very important for personal wellbeing in people with autism.[19]

Moderated regression analyses revealed that for the ASD group only, cognitive empathy appeared to moderate the relationship between affective empathy and personal wellbeing.

Specifically, when cognitive empathy was low, the relationship between affective empathy and personal wellbeing was significant and negative. However, when cognitive empathy was high, the relationship between affective empathy and personal wellbeing was significant and positive.[20]

Only when cognitive empathy is high are autistic people able to experience the positive relationship between affective empathy and personal wellbeing,[21] which I suspect may have something to do with our greater ability to contextualize certain situations, and to be mindful.

Therapy or interventions that target the cognitive dimensions of empathy may thus improve personal wellbeing. In my experience that has been very helpful—in particular help with identifying emotions, recognizing defense mechanisms, roleplay to improve theory of mind, and learning to have more self-compassion.

Alexithymia

It takes a lot longer for me to feel emotional empathy, but it’s far from absent, and I have a strong sense of justice as well. But my empathy—strong as it may be for the ones I love—doesn’t always register for me, even though my actions tend to be informed by it. This is the difficulty with having alexithymia, which is the inability to access certain emotions.

There is also a clear link between alexithymia and emotional trauma.[22] A research study from 2014 indicated an association between number of traumatic experiences and alexithymia, and the influence of emotional avoidanceand numbing within this relationship.[23]

The prevalence of alexithymia among autistic people is so high (40–65%,[24][25] with some studies indicating a prevalence as high as 70%[26]), that it is often mistaken for an aspect of autism itself.

References

1, 2.Putting the altruism back into altruism: the evolution of empathy
3, 4.The role of motor contagion in the prediction of action
5.Motor contagion: goal-directed actions are more contagious than non-goal-directed actions
6, 7.Motor contagion from gaze: the case of autism
8.Neural basis of eye gaze processing deficits in autism
9.Abnormal ventral temporal cortical activity during face discrimination among individuals with autism and Asperger syndrome
10.Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism
11, 12, 13.Motor, Emotional, and Cognitive Empathy in Children and Adolescents with Autism Spectrum Disorder and Conduct Disorder
14.Failure to read motor intentions from gaze in children with autism
15.On the ontological status of autism: the ‘double empathy problem’
16.How Easy is it to Read the Minds of People with Autism Spectrum Disorder?
17.Beyond Autism: Introducing the Dialectical Misattunement Hypothesis and a Bayesian Account of Intersubjectivity
18.Can Neurotypical Individuals Read Autistic Facial Expressions? Atypical Production of Emotional Facial Expressions in Autism Spectrum Disorders
19, 20, 21.Cognitive empathy moderates the relationship between affective empathy and wellbeing in adolescents with autism spectrum disorder
22.Psychoanalysis and empirical research: the example of alexithymia
23.Traumatic experiences, alexithymia, and posttraumatic symptomatology: a cross-sectional population-based study in Germany
24.The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder
25.Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives
26.Measuring the effects of alexithymia on perception of emotional vocalizations in autistic spectrum disorder and typical development

Using computerised simulations, in advanced statistics used for the very first time in the history of autism research, autism was the more ‘dominant’ and statistically important link to empathy when compared to alexithymia.

These simulations showed that the results would be found around 90% of the time in the population.

Their results were found in two studies and held after factoring in both participants’ age and gender.

Lead researcher and expert on social processing in autism, Dr. Punit Shah from Bath’s Department of Psychology explains: “These findings provide some of the strongest evidence to date that autism is linked to lower empathy in the general population.

Although many have associated autism with poor social skills, prior to this study the association with empathy was much less clear.

By drawing on large samples and using advanced statistical techniques we hope these robust results can help settle a long-standing debate and will make an important contribution for future autism support.”

Study co-author, Lucy Livingston, of the Institute of Psychiatry, Psychology & Neuroscience at King’s College London, added: “Autism being linked with lower empathy is not necessarily a negative thing.

Empathy is useful in social situations, but it can be a mentally tiring exercise.

It is also thought that selective empathy, such as understanding some people’s feelings while ignoring others’, can lead to negative behaviours such as excluding some groups from society.

It may be that lower empathy for those with autism actually has unforeseen benefits that we do not fully understand yet.”

Bath psychology student Lois Player was also part of the research team for the study. This is the first time an undergraduate second year has co-authored a paper at Bath.

The researchers hope their results will be used to improve understanding and acceptance of people with autistic tendencies and diagnosed autism.

They suggest it is important for policymakers, clinicians, and educators, to be aware of such behaviours in order to create more autism-friendly environments.

More information: Punit Shah et al, Trait Autism is a Better Predictor of Empathy than Alexithymia, Journal of Autism and Developmental Disorders (2019). DOI: 10.1007/s10803-019-04080-3

Journal information: Journal of Autism and Developmental Disorders
Provided by University of Bath

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