EMPATHY AND ITS IMPLICATIONS IN HIGH-FUNCTIONING INDIVIDUALS WITH AUTISM SPECTRUM DISORDER ( ASD )

Individuals with Autism Spectrum Disorder (ASD) are characterized, among other criteria, by their impairment in the ability to empathize with others. This may serve as a major underlying cause behind other deficiencies in greater areas of social cognition such as casual social interaction and relationshipbuilding skills. This review will examine exactly where initial empathetic impairment lies—in particular, it separates empathy into its affective and cognitive components and tests for each area independently. It will first introduce empirical studies supporting the view that although individuals with ASD are lacking in cognitive empathy, there is no significant difference in affective empathy between individuals with ASD and typically developing controls. Furthermore, this review will examine the implications of ASD individuals’ deficiency in cognitive empathy for their larger-scale social functioning capacities. Empirical research, as well as firsthand, anecdotal accounts from ASD research participants, sheds light on the challenging nature of the social interactions experienced by those with ASD. Taken as a whole, this body of research will ultimately be seen to show (a) that a curvilinear relationship exists between empathic skills and social anxiety; and (b) that a lack of empathic skills may result in a resounding sense of social exclusion and psychological isolation. ______________________________________________________________________________ The phenomenon of empathy can be described as the ability to mentally align oneself to the cognitive and emotional perspective of another, or in more colloquial terms, “put oneself in another’s shoes. ” It allows one to tune into how someone else is feeling or what he or she might be thinking, enabling sophisticated and meaningful interaction between humans. Social psychologists have long argued that empathy can facilitate understanding and act as a glue for social relationships; thus, it follows that impairments in this capability will produce negative consequences in social interactive ability. According to Davis’ original taxonomy (1983), empathy consists of two components: the affective and the cognitive. Affective empathy occurs when an observer experiences an appropriate emotional response to the affective or emotional state of another individual—for example, feeling fright upon seeing a frightened person, or feeling pity at the sadness of another. It should be noted that the elicited emotion does not need to match the observed emotion. For example, one may feel relief at the death of a friend due to the fact that their friend’s suffering has ended— this is also affective empathy, as it is an appropriate emotional response to an observed affective state. Cognitive empathy, on the other hand, is described as using a ‘theory of mind’ to essentially read the minds of others. It involves setting aside one’s own current perspective, attributing a mental state or attitude to another person, and subsequently inferring the likely content of that mental state. For example, a student can infer through cognitive empathy that his or her classmate will not know about an upcoming midterm because the classmate was absent on the day it was announced in class (Davis, 1983). Furthermore, the distinction between empathy and the related notion of sympathy should be clarified. Sympathy, as defined by Bennett (1998), occurs when the observer references only how he or she would feel in similar circumstances as the individual in question. Consider a scenario in L. Chen / IUJCS 7 (2012) 18 which an observer encounters a homeless person: the observer might sympathize by imagining how he himself would feel if he were homeless. To empathize with the homeless person, in its most accurate form, requires acknowledging the true thoughts and feelings of the homeless individual— thoughts and feelings that may not coincide with the observer’s own (Bennett, 1998). A core deficit in individuals with Autism Spectrum Disorder (ASD) lies in their deficiency in empathetic ability (Baren-Cohen & Wheelwright, 2004). For reliability purposes, this review will focus specifically on individuals with high-functioning autism (HFA) and Asperger Syndrome (AS), as it may be more difficult for lower-functioning autistic individuals to participate correctly in elaborate experiments or report evidence in a coherent manner. Furthermore, it should be acknowledged that AS is differentiated from HFA by the absence of any significant delay in language or cognitive development. HFA is defined as autism in the presence of normal intelligence, as measured by IQ (American Psychiatric Association [DSM-IVTR], 2000). Regarding the aforementioned deficit in empathy, impairment in HFA and AS patients appears to lie particularly in the domain of cognitive empathy, leaving affective empathy rather unaffected. This theory has been gleaned by a number of studies demonstrating that, compared with typically developing controls, those with HFA and AS tend to score substantially lower on cognitive empathy-related measures of assessment but reveal no significant differences in measures of affective empathy. Rogers et al. (2007) studied the dual-dimensional nature of empathy in AS through the use of multiple questionnaires that targeted each aspect of empathy distinctly. These questionnaires included the Interpersonal Reactivity Index (IRI), tailored to measure affective and cognitive empathy as separate entities, and a modified version of the Strange Stories task (Happé, 1994), designed to measure theory of mind. To date, the IRI is the only published measure that tests for empathy on a multi-dimensional level. It is comprised of two cognitive scales—perspective-taking (PT) and fantasy (F)—and two affective scales—empathic concern (EC) and personal distress (PD). Regarding the cognitive aspect, the PT scale assesses the tendency to spontaneously adopt the psychological viewpoint of others, while the F scale measures the participant’s tendency to identify with fictional characters such as those from books, movies and plays. As for the affective aspect, the EC scale taps the participant’s feelings of warmth, compassion and concern for others while the PD scale assesses self-oriented feelings of anxiety and discomfort resulting from tense interpersonal settings. For the modified Strange Stories test, participants read short stories and subsequently answer questions about the text that require them to infer a character’s thoughts, feelings, or intentions. After statistical analysis and comparison, it was found that AS groups scored significantly lower than controls on the cognitive scales of the IRI (PT and F). This indicates a very obvious deficit in the capacity of AS patients for cognitive empathy—that is, AS patients seem to have trouble taking the perspective of and identifying with other people, both real and fictional. However, results were quite different for the affective scales. There was no significant difference between the AS group and control group on the EC scale; in addition, the AS group actually scored higher than controls on the PD scale. These findings confirm the dissociation between cognitive and affective empathy, as well as suggest that socially directed emotional capacity remains preserved in AS individuals. In other words, people with AS are able to elicit just as much care, concern and compassion for others as typically developing individuals do. They also seem to experience a higher sense of socially induced anxiety and discomfort; however, it should be kept in mind that this may simply reflect a generally increased baseline level of stress and anxiety in AS individuals. On the Strange Stories test, the AS group again scored significantly lower than their typically developing counterparts, as expected. These scores correlate with their lower performance on cognitive measures, as the ‘theory of mind’ tested by the Strange Stories task is closely reminiscent of cognitive empathic ability. It follows logically that deficits in areas of social cognition (such as cognitive empathy) will manifest themselves through internal and external struggles in one’s social realm. A study by Bellini (2004) addressed the relationship between empathic skills and various social anxiety L. Chen / IUJCS 7 (2012) 19 measures in AS and HFA adolescents. This relationship was examined by administering the Social Skills Rating System (SSRS), the Multidimensional Anxiety Scale for Children (MASC), and the Social Anxiety Skills for Adolescents (SAS-A) to a group of AS or HFA adolescents, and the SSRS and Behavioral Assessment System for Children (BASC) to the parents of the adolescents. The SSRS is a questionnaire designed to gather information on the social behavior of children 3-18 years old, measuring whether the child uses various social skills during social interactions. The MASC consists of four basic anxiety scales that assess the major dimensions of anxiety—physical symptoms, social anxiety, harm avoidance, and separation/panic. The SAS-A is a self-report measure of social anxiety on three factors: (1) fear of negative evaluation, (2) social avoidance and distress in new situations, and (3) social avoidance and distress in general. The BASC, administered to parents, measures the multidimensional nature of children’s behavior through items assessing anxiety, social skill problems, and other behaviors. Results found that adolescents with ASD reported levels of anxiety that were significantly higher than the mean of the normative sample, as determined by the MASC. On the parent version of the BASC, significant differences were found in the subscales of anxiety and internalizing problems. On the SAS-A, 49% of participants scored at a level indicating high social anxiety while 12% scored for low social anxiety. After correlational analysis, a curvilinear (inverted Ushaped) relationship was found between the SSRS empathy subscale and al