Lack of empathy, or difficulties with empathy, are commonly associated with autism spectrum disorder (ASD). Many people on the autism spectrum struggle to understand the emotions, perspectives, and experiences of others. However, the relationship between autism and empathy is complex.
What is empathy?
Empathy is the ability to understand and share the feelings and experiences of another person. It involves both cognitive and affective components:
- Cognitive empathy – Understanding another person’s perspective or mental state.
- Affective empathy – Sharing and responding to the emotions of others.
True empathy requires both components – not just knowing how someone feels, but caring about how they feel.
Is lack of empathy a core symptom of autism?
Difficulties with empathy are not considered a core diagnostic symptom of ASD in major diagnostic manuals like the DSM-5. The core symptoms involve challenges with:
- Social communication and interaction
- Restricted interests and repetitive behaviors
However, impairments in empathy are very common among those with ASD. Research suggests autistic individuals have more trouble with cognitive empathy than affective empathy. They may struggle to understand emotions, nonverbal cues, and perspectives different from their own. But many still care deeply about others.
Causes
There are several theories as to why people with ASD often have empathy difficulties:
Theory of mind deficits
Many autistic people have trouble with “theory of mind” – the ability to attribute mental states like beliefs, emotions, and intentions to others. This makes it difficult to take the perspective of others.
Weak central coherence
Individuals with ASD tend to focus on details rather than the bigger picture. This can make it hard to understand the meaning of events and situations.
Executive functioning challenges
ASD involves difficulties with planning, impulse control, and cognitive flexibility. This can make it hard to connect emotions with contexts and respond appropriately.
Alexithymia
Alexithymia, or difficulty identifying and describing one’s own emotions, is common in ASD. This can make it hard to understand the emotions of others.
Sensory sensitivities
Many people with ASD have sensory processing issues and can be oversensitive to stimuli like noise and touch. This may impact their ability to pick up on social cues.
Connections between autism and empathy
Average or enhanced affective empathy
While cognitive empathy is impaired in ASD, some studies show affective empathy is average or even enhanced. Autistic people may have strong emotional reactions to others’ suffering.
Empathy skills can improve
With support and interventions targeting theory of mind, central coherence, and executive functions, autistic people can improve perspective taking and empathy.
Empathy deficits are variable
Not all autistic individuals struggle equally with empathy. Some have profound deficits, while others demonstrate solid empathy skills, especially with support.
Challenges understanding own emotions
The alexithymia common in ASD makes it hard to be aware of and describe one’s own emotions. This contributes to difficulty identifying emotions in others.
Motivation to empathize
Even when understanding others’ perspectives, some autistic people have little motivation to respond emotionally unless the person is familiar.
Is lack of empathy required for an ASD diagnosis?
Impairments in empathy and social-emotional reciprocity are very common in ASD, but not universal. Some criteria include it, while others focus just on core symptoms:
DSM-5 diagnostic criteria
The DSM-5 diagnostic manual does not list lack of empathy as a core symptom of ASD. It mentions “deficits in social-emotional reciprocity” under social communication challenges.
The Empathy Quotient (EQ)
The EQ screening tool uses lack of empathy as one of its diagnostic criteria. It is designed to quantify empathy levels in ASD.
ASD clinical judgment
When diagnosing ASD, clinicians often assess empathy impairments. But a low EQ alone would not make an ASD diagnosis if core symptoms were absent.
Strategies to improve empathy in autism
Though empathy deficits in ASD are common, many strategies can help:
Social skills groups
Groups teaching social cues, body language, and facial expressions provide perspective-taking practice.
Cognitive behavioral therapy (CBT)
CBT targeting theory of mind, executive functions, and alexithymia can enhance empathy.
Social stories
Stories describing social situations and appropriate responses help autistic kids learn empathy.
Role playing
Role playing different perspectives allows practicing empathy in a safe environment.
Relating to interests
Relating emotions and perspectives to an autistic child’s special interest can make them more tangible.
Explicit empathy teaching
Directly teaching the cognitive stages of empathy development equips autistic people with a skill set.
Sensory supports
Tools like noise-cancelling headphones reduce overwhelming sensations so autistic people can focus on empathy.
Conclusion
While lack of empathy is very common in ASD, it is not considered a core diagnostic symptom. Autism involves challenges with cognitive empathy, though affective empathy may be intact. Teaching perspective taking and emotion identification skills can improve empathy. Supporting sensory issues and building on special interests also helps. With comprehensive interventions, many autistic individuals can demonstrate meaningful empathy, especially towards familiar people.