Autism & empathy

People often ask if autistic people lack empathy. The answer largely depends on what you mean by empathy. But regarding emotional empathy—the type of empathy people are most familiar with—the answer is, “No, we don’t lack empathy.” In fact, quite the opposite is the case.

If you think you lack empathy and you are in fact autistic (or think you might be), your answer is likely to be found in alexithymia. More on that later in this post.

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.

For a more comprehensive description of the different types of empathy, have a look at:

The different types of empathy

Empathy & imitation

Below is the Russian doll model of empathy and imitation, presented in a paper from 2008:^[1]Putting the altruism back into altruism: the evolution of empathy

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]Putting the altruism back into altruism: the evolution of empathy

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]The role of motor contagion in the prediction of action

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]The role of motor contagion in the prediction of action 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]Motor contagion: goal-directed actions are more contagious than non-goal-directed actions 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 an action or from the act of looking into another person’s eyes in order to deduce information (called gaze observation).^[6]Motor contagion from gaze: the case of autism 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]Motor contagion from gaze: the case of autism

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]Neural basis of eye gaze processing deficits in autism but also in processing faces.^[9]Abnormal ventral temporal cortical activity during face discrimination among individuals with autism and Asperger syndrome Both have a significant effect on social situations in general,^[10]Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism 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]Motor, Emotional, and Cognitive Empathy in Children and Adolescents with Autism Spectrum Disorder and Conduct Disorder

• 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]Motor, Emotional, and Cognitive Empathy in Children and Adolescents with Autism Spectrum Disorder and Conduct Disorder

However, both mechanisms seem to be influenced by a lack of attention to the eyes.^[13]Motor, Emotional, and Cognitive Empathy in Children and Adolescents with Autism Spectrum Disorder and Conduct Disorder 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]Failure to read motor intentions from gaze in children with autism 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 empathize with each other. This is referred to as the double empathy problem, by Damian Milton.^[15]On the ontological status of autism: the ‘double empathy problem’

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]How Easy is it to Read the Minds of People with Autism Spectrum Disorder?

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]Beyond Autism: Introducing the Dialectical Misattunement Hypothesis and a Bayesian Account of Intersubjectivity 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. 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 were 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.^[18]The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development (Smith, 2017) 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:

Autism & synesthesia

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.^[19]Can Neurotypical Individuals Read Autistic Facial Expressions? Atypical Production of Emotional Facial Expressions in Autism Spectrum Disorders 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 hotkeys 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 autistic people.^[20]Cognitive empathy moderates the relationship between affective empathy and wellbeing in adolescents with autism spectrum disorder

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.^[21]Cognitive empathy moderates the relationship between affective empathy and wellbeing in adolescents with autism spectrum disorder

Only when cognitive empathy is high are autistic people able to experience the positive relationship between affective empathy and personal wellbeing,^[22]Cognitive empathy moderates the relationship between affective empathy and wellbeing in adolescents with autism spectrum disorder 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.^[23]Psychoanalysis and empirical research: the example of alexithymia A research study from 2014 indicated an association between the number of traumatic experiences and alexithymia, and the influence of emotional avoidance and numbing within this relationship.^[24]Traumatic experiences, alexithymia, and posttraumatic symptomatology: a cross-sectional population-based study in Germany

The prevalence of alexithymia among autistic people is so high (40–65%,^[25]The validity of using self-reports to assess emotion regulation abilities in adults with autism spectrum disorder^[26]Brief report: cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives with some studies indicating a prevalence as high as 70%^[27]Measuring the effects of alexithymia on perception of emotional vocalizations in autistic spectrum disorder and typical development), that it is often mistaken for an aspect of autism itself.

For more information on what alexithymia is and what causes it, have a look at:

Alexithymia & autism guide

To the extent I can, I compensate with cognitive empathy—impaired as it may be. But this is indicative of high-functioning autism; though my cognitive empathy is impaired, I can compensate for some of my shortcomings by paying attention to social signals, facial expressions, microexpressions, and of course what is being said.

I observe and I learn—to the best of my abilities