Empathy Impairment in Individuals With Autism Spectrum Conditions From a Multidimensional Perspective: A Meta-Analysis

Abstract

Background: Although empathy has always been considered to be impaired in individuals with autism spectrum conditions (ASCs), the relevant findings have been inconsistent. The present meta-analysis aims to determine which empathy components are impaired and how culture, gender, and age moderate such empathy impairment.Methods: By using “Autism,” “Asperger Syndrome,” “Empathy,” and related Chinese synonyms as keywords, we searched the databases of Weipu, Wanfang, CNKI, Web of Science, Science Direct, SpringerLink, and Elsevier through “subject” and “keyword” searches. We also conducted a manual search according to the references. In total, 51 studies from Eastern and Western countries were included in this meta-analysis, which comprised 144 independent effects, 2,095 individuals with ASCs and 2,869 controls without ASCs. For the retrieved data, Hedge's g was taken as the quantitative measure of effect, and CMA V2.0 software was used for publication bias tests (by using Rosenthal's Classic Failsafe-N and Egger's methods), heterogeneity tests (by using a Q-test, I2-test, and H-test) and a moderating effect test (by using a univariate regression model).Results: The results showed that the empathy impairment evident in individuals with ASCs is component specific; that is, trait-cognitive empathy, trait-empathic concern, state-cognitive empathy, and state-empathic concern are impaired, whereas state-empathic accuracy remains intact, and trait-empathic accuracy is superior to the trait-empathic accuracy in neurotypical individuals. The univariate regression model showed that gender moderates the impairment of the trait-empathic concern, trait-empathic accuracy, and state-cognitive empathy in autistic individuals and that age moderates the impairment of the trait-cognitive empathy, trait-empathic accuracy, state-empathic concern, and state-empathic accuracy in autistic individuals. However, culture does not moderate any empathy components (trait-cognitive empathy, trait-empathic concern, or state-cognitive empathy) involved in the present meta-analysis.Conclusions: These findings contribute to ending the controversy over the empathic integrity of individuals with ASCs and shed some light on future research about the empathy impairment of autistic individuals. More specifically, subsequent studies should distinguish specific empathy components and consider the role of gender and age when demonstrating empathy impairment in individuals with ASCs. Moreover, related studies based on Asian collectivist cultural samples and female samples should be further enriched.

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

“…This hypothesis should be tested by comparing "pure" ASD and ODD/CD with patients with ADHD and comorbidity conditions. Interestingly, recent studies shed some light on future research about specific empathy impairments in ASD and ODD/CD individuals, suggesting that different mechanisms and factors may be involved in empathic problems in such conditions [71,72].…”

Empathy and Prosocial Behavior in Siblings of Children with Autism Spectrum Disorder: a Systematic Review

“…Some studies have demonstrated heightened empathy in siblings of children with ASD (e.g., McDonald et al, 2017;Shivers, 2019), suggesting that some siblings may benefit from their experiences of having a brother or sister with ASD, and develop understanding and compassion. Intact empathic abilities in siblings of children with ASD suggest that the presence of more autistic traits on a group level does not necessarily include deficits in empathy like those characteristic of ASD (Harmsen, 2019;Song et al, 2019). However, future studies should examine whether levels of autistic traits and empathy are related in siblings.…”

“…Individuals with ASD display lower scores on conventional measures of empathy and prosocial behavior (Harmsen, 2019;Russell et al, 2012;Song et al, 2019). Some studies have found that individuals with ASD primarily display difficulties with cognitive empathy, whereas affective empathy appears to be comparable with that of TD individuals (e.g., Deschamps et al, 2014;Rogers et al, 2007).…”

“…In addition, it seems that typically developing adults have difficulties with understanding the emotions displayed by individuals with ASD (Sheppard et al, 2016), suggesting a two-way, double-empathy problem (Milton, 2012). Notwithstanding these challenges sometimes experienced by social partners, evidence suggests that, in general, ASD is linked to difficulties with at least some domains of empathy and prosocial behavior (Harmsen, 2019;Song et al, 2019). In a general population sample, Zhao et al (2019) found that empathy partially mediated the relationship between autistic traits and prosocial behavior.…”

Judging meaning: A domain-level difference between autistic and non-autistic adults

“…[ 9 ]). In addition, we note that definitions of ‘theory of mind' are not consistently agreed-upon and ‘theory of mind’ tests often tap related constructs such as emotion perception, figurative language comprehension and empathy; with the exception of figurative language, meta-analyses provide support for average differences between autistic and non-autistic people in some aspects of these other constructs (see [ 8 , 10 , 11 ]). In addition to a difference on the ‘social understanding' factor, we hypothesized that there would be no difference on ‘core language' factor between autistic and non-autistic groups, as structural language impairments are not a core feature of autism [ 1 ].…”