The Role of Executive Functions in the Development of Empathy and Its Association with Externalizing Behaviors in Children with Neurodevelopmental Disorders and Other Psychiatric Comorbidities.

Chiara Cristofani,Annarita Milone,Elena Valente,Gabriele Masi,Gianluca Sesso,Laura Ruglioni,Pietro Muratori,Pamela Fantozzi,Simone Pisano,Lisa Polidori,Paola Cristofani,Chiara Pfanner,Antonio Narzisi,Emanuela Inguaggiato

doi:10.3390/brainsci10080489

Abstract

Executive functions have been previously shown to correlate with empathic attitudes and prosocial behaviors. People with higher levels of executive functions, as a whole, may better regulate their emotions and reduce perceived distress during the empathetic processes. Our goal was to explore the relationship between empathy and executive functioning in a sample of children and adolescents diagnosed with Attention Deficit and Hyperactivity Disorder alone or associated with comorbid Disruptive Behavior Disorders and/or Autism Spectrum Disorder. We also aimed to examine the role of empathic dimensions and executive skills in regulating externalizing behaviors. The 151 participants with ADHD were assigned to four groups according to their psychiatric comorbidity (either “pure” or with ASD and/or ODD/CD) and assessed by means of either parent- or self-reported questionnaires, namely the BRIEF−2, the BES, and the IRI. No questionnaire was found to discriminate between the four groups. Affective Empathy was found to positively correlate with Emotional and Behavioral Regulation competences. Furthermore, Aggressiveness and Oppositional Defiant Problems were positively associated with Executive Emotional and Behavioral Regulation competences. On the other hand, Rule-Breaking Behaviors and Conduct Problems were negatively associated with Affective Empathy and with Behavioral skills. Our study provides an additional contribution for a better understanding of the complex relationship between empathic competence and executive functions, showing that executive functioning and empathic attitudes interact with each other to regulate aggressive behaviors. This study further corroborates developmental models of empathy and their clinical implications, for which externalizing behaviors could be attenuated by enhancing executive functioning skills.

Highlights

Feeling empathy for someone means understanding his/her emotions and/or personally experiencing the same; it means creating a customized space in one’s own inner world to host the world of the other
The present study aims to explore possible relationships between the different facets of empathy and the specific subcomponents of executive functions (EF) in a clinical sample of children and adolescents primarily diagnosed with ADHD, compared to children with comorbid autism spectrum disorder (ASD) or ODD/Conduct Disorders (CD) or both
Scores are compared between ADHD group, ASD group, ODD/CD

Summary

Introduction

Feeling empathy for someone means understanding his/her emotions and/or personally experiencing the same; it means creating a customized space in one’s own inner world to host the world of the other. The cognitive facet of empathy implies the ability to understand the inner situation of the other and to take his/her own perspective [2]. The affective component of empathy is defined as the ability to share the emotional state of others [3]. The latter implies the involvement of limbic and paralimbic structures and develops earlier than the cognitive one, which assumes a fine-tuned maturation of prefrontal and temporal networks [4]

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