Empathy Deficits Research Articles

Expanding upon the ‘extreme male brain’ theory of autism as a common link between other major risk factors: A hypothesis

On average, males have a stronger preference for physical systems and machines over interpersonal interactions; they have lower average levels of cognitive empathy or social cognition than females; and they have higher rates of ‘extreme’ intelligence when it comes to abstract concepts such as those found in mathematics and sciences. All three traits are also commonly associated with individuals with an autism spectrum disorder or ASD; clearly, it is not coincidental that incidence rates of autism are reportedly four times higher in males than in females.The common link between the majority of risk factors assessed in this review (including technological advancements, advanced parental age, socioeconomic status, and genetic predispositions towards ASDs in families of scientists and engineers) can be traced to a specific hormone, testosterone. It was established that traits which are typically associated with males are also typically associated with ASDs as well as individuals with antisocial personality disorder, or APD. The key distinction between individuals who are considered to be ‘autistic’ as opposed to those who are considered ‘sociopathic’ lies in the difference between their empathy deficits: whereas those who are ‘autistic’ are said to lack cognitive empathy (the ability to identify and understand the thoughts and feelings of others and to respond to these with appropriate emotions), those who are ‘sociopathic’ are said to lack emotional empathy (which is responsible for inhibiting acts of physical aggression or violence). This would explain why autistic individuals can have elevated testosterone levels without becoming physically aggressive.

Spontaneous versus deliberate vicarious representations: different routes to empathy in psychopathy and autism

Sir, We read the article recently published by Meffert et al. (2013) with great interest. The authors used functional MRI to investigate vicarious emotional representation in psychopathic offenders, scanning 18 psychopaths and 26 non-offending control subjects. Participants were either presented with video clips of short emotional interactions or experienced similar interactions themselves. Results showed that although psychopaths showed normal patterns of neural activation in response to experience, abnormal patterns of activation were observed during observation of others’ interactions in those regions known to be involved in vicarious emotional experience. However, when participants were instructed to ‘feel with the hands in the videos’ differences in activation between psychopaths and control subjects were significantly reduced in numerous regions of interest, including the medial and anterior left insula, left anterior cingulate cortex, and bilateral angular gyri (Meffert et al. , 2013). The authors conclude that these results point toward reduced spontaneous but intact deliberate vicarious representations in psychopathy. Psychopathy represents a severe disorder of personality, characterized by a callous lack of empathy, shallow affect, and a lack of remorse or guilt (Hare, 1991, 2003). Traditional theories have emphasized poor recognition of others’ distress cues, including emotional facial expressions, as central to empathy deficits observed in psychopathy (Blair et al. , 2001, 2004; Montagne et al. , 2005; Dadds et al. , 2006; Dolan and Fullam, 2006; see also meta-analyses by Marsh and Blair, 2008; Wilson et al. , 2011). These findings are extended through the more recent results of Meffert et al. (2013), which suggest that psychopaths may exhibit a particular breakdown in the neural processes that underlie the spontaneous vicarious experience of the emotions of others. Thus, Meffert et al. (2013) findings add significantly to current understanding of empathy deficits in psychopathy, distinguishing between …

Facial Mimicry in 6–7 Year Old Children with Disruptive Behavior Disorder and ADHD

BackgroundImpairments in facial mimicry are considered a proxy for deficits in affective empathy and have been demonstrated in 10 year old children and in adolescents with disruptive behavior disorder (DBD). However, it is not known whether these impairments are already present at an earlier age. Emotional deficits have also been shown in children with attention-deficit/hyperactivity disorder (ADHD).AimsTo examine facial mimicry in younger, 6–7 year old children with DBD and with ADHD.MethodsElectromyographic (EMG) activity in response to emotional facial expressions was recorded in 47 children with DBD, 18 children with ADHD and 35 healthy developing children.ResultsAll groups displayed significant facial mimicry to the emotional expressions of other children. No group differences between children with DBD, children with ADHD and healthy developing children were found. In addition, no differences in facial mimicry were found between the clinical group (i.e., all children with a diagnosis) and the typically developing group in an analysis with ADHD symptoms as a covariate, and no differences were found between the clinical children and the typically developing children with DBD symptoms as a covariate.ConclusionFacial mimicry in children with DBD and ADHD throughout the first primary school years was unimpaired, in line with studies on empathy using other paradigms.

EPA-0936 - Stimulants improve theory of mind in children with attention deficit/hyperactive disorder

Impairments in ‘theory of mind’ (ToM) were linked to social cognition and reciprocal relationships deficits in children with attention deficit/ hyperactivity disorder (ADHD). Twenty-four children with ADHD (13 with inattentive type and 11 with combined type, mean age 10.2 years) completed the Interpersonal Reactivity Index (IRI), a self-reported empathy questionnaire. All children performed the ‘faux pas’ task and a computerized ToM task in two different sessions either with or without administration of methylphenidate (MPH). Administration of MPH was associated with an improvement in cognitive and affective ToM. Children with ADHD-combined type had significantly lower scores in total IRI and the fantasy scale compared to children with ADHD-inattentive type. We conclude that deficits in empathy and ToM may play an important role in the impairments in social cognition and peer relationship in children with ADHD, especially children a hyperactive component. Stimulants may improve ToM and empathic functions. Future studies including larger samples and additional cognitive tasks are warranted in order to generalize these results and to identify possible underlying mechanisms for improvement in ToM following the administration of MPH. Baseline With MPH Post-hoc t tests P-value Faux Pas Recognition Accuracy Overall Score, mean (SD) 8.87 (1.15) 9.54 (0.83) n/a Control stories 4.66 (0.48) 4.79 (0.41) -1.00 0.32 Faux Pas stories 4.21 (0.78) 4.75 (0.53) -3.41 <0.01 ToM computerized task Overall Score, mean (SD) -0.0996 (0.57) 0.1900 (0.52) -2.64 0.02 Cognitive Index -0.0079 (0.30) 0.1279 (0.29) n/a Affective Index -0.0917 (0.29) 0.0621 (0.25) n/a

Addressing the empathy deficit: beliefs about the malleability of empathy predict effortful responses when empathy is challenging.

Empathy is often thought to occur automatically. Yet, empathy frequently breaks down when it is difficult or distressing to relate to people in need, suggesting that empathy is often not felt reflexively. Indeed, the United States as a whole is said to be displaying an empathy deficit. When and why does empathy break down, and what predicts whether people will exert effort to experience empathy in challenging contexts? Across 7 studies, we found that people who held a malleable mindset about empathy (believing empathy can be developed) expended greater empathic effort in challenging contexts than did people who held a fixed theory (believing empathy cannot be developed). Specifically, a malleable theory of empathy--whether measured or experimentally induced--promoted (a) more self-reported effort to feel empathy when it is challenging (Study 1); (b) more empathically effortful responses to a person with conflicting views on personally important sociopolitical issues (Studies 2-4); (c) more time spent listening to the emotional personal story of a racial outgroup member (Study 5); and (d) greater willingness to help cancer patients in effortful, face-to-face ways (Study 6). Study 7 revealed a possible reason for this greater empathic effort in challenging contexts: a stronger interest in improving one's empathy. Together, these data suggest that people's mindsets powerfully affect whether they exert effort to empathize when it is needed most, and these data may represent a point of leverage in increasing empathic behaviors on a broad scale.

Emotional contagion for pain is intact in autism spectrum disorders

Perceiving others in pain generally leads to empathic concern, consisting of both emotional and cognitive processes. Empathy deficits have been considered as an element contributing to social difficulties in individuals with autism spectrum disorders (ASD). Here, we used functional magnetic resonance imaging and short video clips of facial expressions of people experiencing pain to examine the neural substrates underlying the spontaneous empathic response to pain in autism. Thirty-eight adolescents and adults of normal intelligence diagnosed with ASD and 35 matched controls participated in the study. In contrast to general assumptions, we found no significant differences in brain activation between ASD individuals and controls during the perception of pain experienced by others. Both groups showed similar levels of activation in areas associated with pain sharing, evidencing the presence of emotional empathy and emotional contagion in participants with autism as well as in controls. Differences between groups could be observed at a more liberal statistical threshold, and revealed increased activations in areas involved in cognitive reappraisal in ASD participants compared with controls. Scores of emotional empathy were positively correlated with brain activation in areas involved in embodiment of pain in ASD group only. Our findings show that simulation mechanisms involved in emotional empathy are preserved in high-functioning individuals with autism, and suggest that increased reappraisal may have a role in their apparent lack of caring behavior.

The social-cognitive basis of personality disorders

The review summarizes recent results on abnormalities in social cognition in patients with personality disorders that predispose them to develop dysfunctional interaction with others. The review starts with more basic social cognition processes, such as emotion recognition and reactions to social exclusion that are followed by more complex processes such as cognitive and affective empathy. The deficits in social cognition depend on the particular function that is investigated and is strongly associated with characteristic symptoms of particular personality disorders. Thus, patients with borderline personality disorder are hypersensitive for social threat, they show deficits in cognitive empathy and high emotion contagion, that is, they share emotions of others without properly discriminating between one's own feelings and those of others. Psychopaths are characterized by deficiency in facial fear recognition and emotional empathy similar to patients with narcissistic personality disorder. Studies on social cognition in cluster A and C personality disorders are sparse. Research indicates deficits in social cognition in patients with personality disorders, but more research is needed to investigate social cognition in cluster A and C personality disorders and to compare deficits in social cognitive functions across personality disorders.

Emotional Empathy in Children with Autism Spectrum Disorder: Evidence from Biofeedback Measurement and Eye Movements

Autism spectrum disorders(ASD) are considered as a series of pervasive developmental disorders, and characterized by deficits in social interaction, delays and deviance in communication, and repetitive behaviors, rituals and interests. Emotional empathy refers to unconscious experience of emotions consistent with and in response to those of others and imitation of the facial expression, induced by shared representations of perception and emotional contagion. Eye-tracking studies have demonstrated that the visual fixation patterns of children with autism in social situations differ from normal patterns. Children with autism do not seem to attend spontaneously to salient features of the social stimulus in the way that most people do. It is possible that this reflects an attentional style that limits empathic arousal. Children with autism, relative to typically developing children, focused less on the eye region of faces when viewing social stimulus, because they avoid eye contact with others in order to decrease arousal. Previous studies explored emotional empathic responses to affective stimuli in children with ASD, but their results are inconsistent. The present research was designed to investigate the emotional empathy and the face scanning patterns of children with ASD using biofeedback measurement and eye-tracking. Fifteen children with ASD, fifteen typically developing(TD) children, and fifteen children with intellectual disability(ID) viewed eighty emotional faces with happiness, sadness, fear and anger from the Chinese Facial Affective Picture System(each emotional category consists of twenty pictures). Facial electromyography(EMG) activity, eye movements and automatic physiological responses, including skin conductance(SCR), skin temperature(TEMP) and PLUS, were recorded during the experiment. Comparing with typically developing children, children with ASD demonstrated atypical processing patterns of emotional faces with reduced responses of automatic facial EMG, and automatic physiological(SCRs, TEMP, PLUS). This suggested that a failure to perceive emotional faces in children with ASD. Furthermore, results of eye-tracking showed that the children with ASD less viewed the eye areas than the typically developing children. At the same time, the fixation time and fixation counts of face for children with ASD were significantly less than the intellectual disability group and the typically children group. The fixation time of fear faces for children with ASD was significantly less than the happy faces and sad faces. This suggested that the limited eye gaze for emotional faces in children with ASD. The results suggest that a failure to orient to emotional relevant stimuli(four basic emotional faces: happiness, sadness, fear and anger) may be caused by the lower fixation time to the eye areas, and avoidance of emotional stimulus may become the default coping mechanism for some individuals with autism. In conclusion, the current study demonstrates deficits in emotional empathy and limited eye gaze in children with ASD, which may be contributing to their problems in the face scanning patterns.

Overlap between autism and schizophrenia: history and current status

Purpose– Considerable confusion surrounds the overlapping of autism and schizophrenia. This has significant implications for clinicians given that correct diagnosis is critical for treatment.Design/methodology/approach– This paper sets out to clarify the position by reviewing the history and current status of the relationship between autism and schizophrenia. A general review was conducted using a chronological approach that focused on phenomenology, aetiology, genetic mechanisms and treatment.Findings– Persons with autism are far more rigid, have difficulties set shifting and get far more upset and aggressive when their routines have changed. They have far more severe theory of mind and empathy deficits than those with schizophrenia.Research limitations/implications– Future diagnostic refinement by means of molecular genetic studies will alter the diagnostic categories. Further studies of the conditions of autism and schizophrenia are therefore necessary.Practical implications– Both conditions need treatment both clinically and practically.Originality/value– This paper elucidates the relationship between autism and schizophrenia from a historical and current perspective. It emerges that this confusion is likely to be resolved by molecular genetic studies that will alter the diagnostic categories.

Recognition of Pain as Another Deficit in Young Males with High Callous-Unemotional Traits

Prior research on callous-unemotional (CU) traits supports a deficit in recognizing fear in faces and body postures. Difficulties recognising others' emotions may impair the typical behavioural inhibition for violent behaviour. However, recent research has begun to examine other distress cues such as pain. The present study examined emotion recognition skills, including pain, of school-excluded boys aged 11-16 years (N = 50). Using dynamic faces and body poses, we examined the relation between emotion recognition and CU traits using the youth psychopathic traits inventory (YPI) and the inventory of CU traits. Violent delinquency was covaried in regression analyses. Although fearful facial and fearful bodily expressions were unrelated to CU traits, recognition of dynamic pain facial expressions was negatively related to CU traits using the YPI. The failure to replicate a fear and sad deficit are discussed in relation to previous research. Also, findings are discussed in support of a general empathy deficit for distress cues which may underlie the problem behaviour of young males with CU traits.

Cultivation of empathy in individuals with high-functioning autism spectrum disorder

High-functioning individuals with autism spectrum disorder (HF-ASD) typically lack cognitive empathy, compromising their moral agency from both a Kantian and a Humean perspective. Nevertheless, they are capable of exhibiting moral behavior, and sometimes, they exhibit what may be deemed ‘super-moral’ behavior. The empathy deficit poses, to varying degrees, limitations with respect to their moral motivation and moral agency. To compensate for this deficit, individuals with HF-ASD rely primarily, and justifiably, on the formation and application of moral rules. Educators who focus predominantly on empathy, however, may be less effective in the moral education of individuals with HF-ASD because they neglect the preference for rules of the latter. In this article, I argue that an individualized balance of empathy-based and rule-based strategies in the context of moral education is needed to assist individuals with HF-ASD in their challenges with moral motivation and moral agency.

Empathic competencies in violent offenders

Violent offending has often been associated with a lack of empathy, but experimental investigations are rare. The present study aimed at clarifying whether violent offenders show a general empathy deficit or specific deficits regarding the separate subcomponents. To this end, we assessed three core components of empathy (emotion recognition, perspective taking, affective responsiveness) as well as skin conductance response (SCR) in a sample of 30 male violent offenders and 30 healthy male controls. Data analysis revealed reduced accuracy in violent offenders compared to healthy controls only in emotion recognition, and that a high number of violent assaults was associated with decreased accuracy in perspective taking for angry scenes. SCR data showed reduced physiological responses in the offender group specifically for fear and disgust stimuli during emotion recognition and perspective taking. In addition, higher psychopathy scores in the violent offender group were associated with reduced accuracy in affective responsiveness. This is the first study to show that mainly emotion recognition is deficient in violent offenders whereas the other components of empathy are rather unaffected. This divergent impact of violent offending on the subcomponents of empathy suggests that all three empathy components can be targeted by therapeutic interventions separately.

Alexithymia and Empathy Predict Changes in Autonomic Arousal During Affective Stimulation

Alexithymia, the inability to describe one's own emotions, is linked to deficits in empathy, manifesting as a diminished capacity to recognize or understand the emotions and mental states of others. Several brain centers of autonomic control and interoception that are activated in empathy are thought to misfunction in alexithymia. We hypothesized that individual differences in autonomic changes under affective stimulation might be associated with differences in alexithymia and empathy. We studied 21 healthy volunteers, comparing their alexithymia and empathy scores with changes in their sympathetic autonomic arousal, indexed by the palmar skin potential level, during 3 tasks: playing a computer game, performing mental arithmetic, and watching a negative emotional valence video. Both autonomic and subjective sense of arousal increased at the beginning of each task and then gradually subsided over the course of the task. Higher autonomic arousal at the onset of the computer game was associated with higher empathy scores, and at the onset of the negative video with higher scores for both empathy and alexithymia. Alexithymia delayed the habituation of autonomic arousal during the computer game, while the empathy score was related to a faster decline in arousal during the negative video task. High alexithymia and high empathy scores were linked to increased autonomic arousal at the onset of emotional stimulation, but were distinguishable in the rates of habituation of the evoked arousal. Our data provide insight into the relationships among interacting psychological traits, physiologic regulation, and the arousal dimension of emotional experience.

Cradling bias is absent in children with autism spectrum disorders

Objective: This study investigated relations among empathy and cradling bias in children diagnosed with autism spectrum disorders (ASDs). Method: Twenty children with ASDs and 20 typically developing (TD) children, aged 5–15 years old, cradled a doll as if it were an infant s/he was putting to sleep on three separate occasions. We recorded side preference on each occasion. Results: Children with ASDs showed no preference for cradling side whereas TD children showed a strong left-sided preference. To the best of our knowledge, children with ASDs are the only population that does not exhibit cradling bias. Conclusion: An absence of cradling bias and empathy deficits in ASD may be related. If so, these data support the hypothesis that leftward cradling is a characteristic of enhanced quality of caregiver-infant interaction and bonding.

Impaired emotional contagion following severe traumatic brain injury

Empathy deficits are widely-documented in individuals after severe traumatic brain injury (TBI). This study examined the relationship between empathy deficits and psychophysiological responsivity in adults with TBI to determine if impaired responsivity is ameliorated through repeated emotional stimulus presentations. Nineteen TBI participants (13 males; 41years) and 25 control participants (14 males; 31years) viewed five repetitions of six 2-min film clip segments containing pleasant, unpleasant, and neutral content. Facial muscle responses (zygomaticus and corrugator), tonic heart rate (HR) and skin conductance level (SCL) were recorded. Mean responses for each viewing period were compared to a pre-experiment 2-min resting baseline period. Self-reported emotional empathy was also assessed. TBI participants demonstrated identical EMG response patterns to controls, i.e. an initial large facial response to both pleasant and unpleasant films, followed by habituation over repetitions for pleasant films, and sustained response to unpleasant films. Additionally, an increase in both arousal and HR deceleration to stimulus repetitions was found, which was larger for TBI participants. Compared to controls, TBI participants self-reported lower emotional empathy, and had lower resting arousal, and these measures were positively correlated. Results are consistent with TBI producing impairments in emotional empathy and responsivity. While some normalisation of physiological arousal appeared with repeated stimulus presentations, this came at the cost of greater attentional effort.

Age-dependent changes in the neural substrates of empathy in autism spectrum disorder

In typical development, empathic abilities continue to refine during adolescence and early adulthood. Children and adolescents with autism spectrum disorders (ASD) show deficits in empathy, whereas adults with ASD may have developed compensatory strategies. We aimed at comparing developmental trajectories in the neural mechanisms underlying empathy in individuals with ASD and typically developing control (TDC) subjects. Using an explicit empathizing paradigm and functional magnetic resonance imaging, 27 participants with ASD and 27 TDC aged 12-31 years were investigated. Participants were asked to empathize with emotional faces and to either infer the face's emotional state (other-task) or to judge their own emotional response (self-task). Differential age-dependent changes were evident during the self-task in the right dorsolateral prefrontal cortex, right medial prefrontal cortex, right inferior parietal cortex, right anterior insula and occipital cortex. Age-dependent decreases in neural activation in TDC were paralleled by either increasing or unchanged age-dependent activation in ASD. These data suggest ASD-associated deviations in the developmental trajectories of self-related processing during empathizing. In TDC, age-dependent modulations of brain areas may reflect the 'fine-tuning' of cortical networks by reduction of task-unspecific brain activity. Increased age-related activation in individuals with ASD may indicate the development of compensatory mechanisms.

Stimulants improve theory of mind in children with attention deficit/hyperactivity disorder

Impairments in 'theory of mind' (ToM) were linked to social cognition and reciprocal relationships deficits in children with attention deficit/hyperactivity disorder (ADHD). Twenty-four children with ADHD (13 with inattentive type and 11 with combined type, mean age 10.2 years) completed the Interpersonal Reactivity Index (IRI), a self-reported empathy questionnaire. All children performed the 'faux pas' task and a computerized ToM task in two different sessions either with or without administration of methylphenidate (MPH). Administration of MPH was associated with an improvement in cognitive and affective ToM. Children with ADHD-combined type had significantly lower scores in total IRI and the fantasy scale compared to children with ADHD-inattentive type. We conclude that deficits in empathy and ToM may play an important role in the impairments in social cognition and peer relationship in children with ADHD, especially children a hyperactive component. Stimulants may improve ToM and empathic functions. Future studies including larger samples and additional cognitive tasks are warranted in order to generalize these results and to identify possible underlying mechanisms for improvement in ToM following the administration of MPH.

Cognitive empathy partially mediates the association between negative schizotypy traits and social functioning

The present study aimed to examine empathy in individuals with schizotypy and to explore whether empathy mediates the associations between schizotypy traits and social functioning in college students. 1083 (376 males, mean age 18.78±0.86 years) Chinese university students completed questionnaires measuring empathy, social functioning, and schizotypy. Participants were categorized into four groups based on their scores on the Chapman Psychosis Proneness scales: mixed schizotypy, positive schizotypy, negative schizotypy, and healthy controls. Participants in the negative schizotypy group reported significantly poorer scores on both affective and cognitive empathy than those in the positive schizotypy and healthy control groups. The mixed schizotypy group showed lower affective empathy than the healthy control group. Scores on both cognitive and affective empathy in the positive schizotypy group were similar to those in the healthy control group. In addition, cognitive empathy was found to be a partial mediator of the association between negative schizotypy traits and social functioning. Results suggest that while individuals with negative schizotypy have deficits in empathy, individuals with positive schizotypy show empathy abilities comparable to that of healthy controls. Moreover, only cognitive empathy partially mediated the relationship between negative schizotypy and social functioning.

Concurrent and prospective effects of psychopathic traits on affective and cognitive empathy in a community sample of late adolescents

A deficit in affective rather than cognitive empathy is thought to be central to psychopathic traits. However, empirical evidence for empathy deficits in adolescents with psychopathic traits is limited. We investigated the concurrent and prospective effects of psychopathic traits on affective and cognitive trait empathy in late adolescence. A community sample of 107 males and 126 females who were approximately 16-year olds at Time 1 participated in four annual waves. Sex-specific classes of adolescents' psychopathic traits were created using Latent Class Analyses. Subsequently, we investigated class differences in level and development of empathy. For both sexes, Latent Class Analyses produced two classes: one class with low and one with moderate levels of psychopathic traits. Consistent with our hypothesis, for both sexes, adolescents with moderate levels of psychopathic traits reported lower mean levels of affective empathy than adolescents with low levels of psychopathic traits. In addition, female adolescents with moderate psychopathic traits reported lower mean levels of cognitive empathy. Male adolescents showed a trend in this direction. No differences between classes were found in development of empathy, which increased over years. This is the first study to show that male and female adolescents with higher levels of psychopathic traits have lower levels of affective empathy not only concurrently but also prospectively over a 3-year period. Females additionally showed a similar pattern on cognitive empathy. In this community sample, developmental results suggest that adolescents with higher levels of psychopathic traits have relative rather than absolute empathy deficits.

Emotional Empathy and Psychopathy in Offenders: An Experimental Study

Previous studies associated psychopathy in adults with deficits in empathy but these studies did not directly compare cognitive and emotional facets of empathy. The present study sought to establish whether psychopathy is associated with impairments in emotional empathy among adult offenders. Participants were 90 male offenders scoring low (n = 29), medium (n = 33) or high (n = 28) on the Psychopathy Checklist-Revised (PCL-R) and n = 28 male noncriminal controls. Empathy functioning was assessed through self-report and computerized decision tasks, differentiating between perspective-taking (cognitive empathy) and compassion (emotional empathy). Against expectations, level of psychopathy among the offenders was not associated with either emotional or cognitive empathy. Offenders however had lower scores for both cognitive and emotional components of empathy functioning than controls. Both facets of empathy showed small but significant positive correlations with education level and social desirability. The methods employed to assess differences in empathy functioning may not be sensitive enough to assess differences in forensic samples.