Autism and Empathy

guinea pig

What is autism?

When I give people the formal definition of autism, I see their eyes glaze over as it is rather long winded and meaningless to those who know little about autism. So I’m not going to talk about autism diagnosis, which is somewhat complex, but one aspect of autism: empathy.

Many people equate “lack of empathy” with autism, so much so that whenever someone has been inconsiderate, others may joke that they were “being a bit autistic”. Say this around me and I get really annoyed as autism is more than lack of empathy and most inconsiderate people are not autistic. Autistic empathy problems are fairly specific. Hurting other people without remorse is generally considered as “lacking empathy”, although shrinks prefer to use the term “callous and unemotional” as it does not ascribe a cause to the behaviour. This is important as there can be many different causes to this type of behaviour.  I will give you 3 adapted real life examples of callous behaviour involving the death of an animal to see whether you can identify the one most likely to be a case of autism.

(a)   A 5 year old boy was playing with his pet hamster. The hamster bit him as he was a bit rough. The boy got his baseball bat out and bludgeoned the hamster to death. In explanation of what had happened, he showed no remorse and said “It bit me on purpose, so it deserved to die”.

(b)  A 10 year old boy was playing golf. He was very good at golf. A squirrel appeared in his line of sight, and he had the question as to whether his driving accuracy was good enough to hit the squirrel. He hit the squirrel with the golf ball striking the squirrel hard and killing it. In explanation of what happened, he showed no remorse saying “My aim is very good”.

(c)    Two 8 year old boys were pulling at a cat’s tail to hear it hiss which they found funny. They tied string to its tail and used that to pull it around. Then they thought it would be funny to set the string alight, which then set the cat alight. In explanation of what happened, they showed no remorse saying “We don’t know what happened to the cat; it had nothing to do with us”.

In Big Sis’s Oxford School Dictionary (apologies, this is sadly the only dictionary our household possesses), empathy is described as “Noun. The ability to understand and share in someone else’s feelings”.  In order to empathise, you require the ability to do the following:

1)      Be aware that other beings (animals or humans) have independent thought, action and feeling; this is sometimes called having a ‘theory of mind’.

2)      Be able to experience and recognize your own emotions and feelings and the situations in which different emotions arise.

3)      Be able to imagine that others may have the same feelings, emotions and thoughts that you experience if they were in similar situations.

Autistic “lack of empathy” relates to inability or difficulty with the fundamental step, step 1, which impacts ability to completely master steps 2 and 3. This “step 1” ability is something that you either have, or don’t have. It relates to abnormal brain wiring which goes awry in pregnancy and early infancy. None of us were ever sat down and taught “this is a table: it does not think, act or feel; this is a human, it is able to think, act and feel”, we just realise it ourselves one day, usually in infancy. To an autistic child, something this fundamental is not obvious. A typical complaint from parents of autistic children, and what I imagine would be the most painful as a parent; is that an autistic child may see parents as no different from anyone else, or indeed, any other object. An autistic child may show interest in a parent as a “biscuit dispenser” or “toy-buyer”, but are unlikely ever to have an intimate and confiding relationship with anyone including their parent, due to their inability to recognise other people as thinking, sentient beings. It is hard to comprehend or to believe, but if you are not naturally aware that other people have independent thought or feeling, then the death of a parent would affect you as much as the loss of a toy (provided someone else stepped in to dispense biscuits and buy toys). Classically, without step 1, steps 2 and 3 are impaired. Autistic children find difficulty in describing emotion in themselves as well as others. Some autistic children with good intellect are able to behave empathically. They are able to actively learn that others are thinking sentient beings, and are able to learn what someone would feel and think in a given situation. They learn it in much the same way that we might learn the highway code. It does not come naturally, but we can learn to behave in the way that is required of us. Just as with the highway code learning, actively learnt behaviour can slip in times of tiredness or stress, and is useless in new situations where the rules are unknown.

“Lack of empathy” frequently occurs in children without autism. The work of the clinicians in an autism assessment is to differentiate these children from autistic children.

Children with ADHD, who have a different brain wiring problem have a tendency to impulsivity. They can behave as if they lack empathy as they typically do things without thinking. If someone falls over, it can look very funny. All of us like to laugh when we see people falling over, which is why slapstick comedy is so successful. In real life, most of us would be able to inhibit our impulse to laugh if the person was actually hurt and crying in pain. The ADHD child, cannot inhibit impulses, and therefore will laugh, appearing to “lack empathy”. However, if you question the child afterwards they are able to interpret the situation empathically and realise that they should not have laughed, although they might say “but I couldn’t help it.” Of course some children with ADHD will also have autism spectrum disorder, as one brain wiring problem increases the risk of another.

Other children without brain wiring (neurodevelopmental) problems can develop difficulties with steps 2 and 3. For step 2, I will give two simple examples, but there are likely many permutations for the development of what shrinks call “callous and unemotional” symptoms in the absence of autism. Firstly, Children who are emotionally neglected and not stimulated to interact with others and experience emotion can have difficulty in experiencing and recognising emotions in themselves and others. The classic example of this is from Romanian orphanages. After the fall of the Communist government in Romania in 1989, aid workers found thousands of abandoned children being housed in orphanages in terrible conditions where abuse and neglect were rife.  Babies were literally left alone in cots day in and day out with minimal human contact. When discovered, many of these children appeared to be autistic, as they had difficulties with social interaction, communication and empathy. However, the majority of these children, when adopted out to loving families, gradually acquired the ability to empathise and socially interact normally. Their early childhood experiences of neglect had impaired their ability to experience emotion amongst other things, and therefore they had difficulty in understanding emotion in themselves and others. Love, not rote learning of rules was able to restore their empathy as the majority did not have brain wiring problems.

Secondly, young children who suffer emotional abuse (which can occur alone or with physical and sexual abuse) or are constantly witness to violence and trauma, may have had no biological difficulty in experiencing emotions, but as their emotions are too hurtful due to the extremely stressful environment, they may employ a defence mechanism of “blocking out” or “numbing”/ “desensitisation” of emotions in order to survive. Channelling “I am a block of wood” is sometimes your only defence in a situation where you are entirely powerless. These children find allowing themselves to experience emotion difficult or impossible, which limits their ability to understand emotion in others, even long after the abuse/ trauma has ended.

These two groups of children may have “attachment disorders”; some may grow up to develop “personality disorders”. Emotional availability of parents and care givers and exposure to violence lie on a continuum, and it is likely that even within the general population, there is variation in how in tune people are with their own emotions and the emotions of others even if they have not been through abuse and trauma.

There are children who have no difficulty with step 1 and 2, but have problems with step 3. They understand that people have emotions and they experience their own emotions. However, their own emotions are so over-encompassing, often due to insecurity; that they are unable to think about or care about the emotions and feelings of others. These children may have suffered abuse or neglect as children and pushing heavily for their own needs and wants has been the only way they have been able to survive. If these children are asked about emotions, they are able to describe them well. They are able to demonstrate theory of mind in non-emotive tasks and may even, in a hypothetical scenario that does not involve them, have no difficulty in seeing both points of view. However, when the scenario is switched to involve them, their thinking becomes self-focused and there is no room to think about other people’s feelings. Their own feelings are always prioritised over that of others. These children may be thought of as “narcissistic” and may grow up to have personality difficulties.

Finally, there are children who have no problem with empathy but choose to behave in a hurtful way to other people for their own reasons; they gain pleasure from being in power and deliberately causing pain, to gain membership to a culture or subculture, to extort money, to gain respect or retribution to name a few.

Hopefully, by now, you may have a better chance of determining which of our “animal killers” is the most likely to have an autistic spectrum disorder. Scroll down, to see if you are right.

 

 

 

 

 

Case (a) by ascribing intent to the hamster is in possession of basic theory of mind (a more clearly autistic response in this situation would have been to say “The hamster was hurting me so I stopped it from hurting me”); in this case additional examples of behaviour would need to be examined to argue a case one way or another. Case (b) has autism. There is clearly no theory of mind going on here, the squirrel was a mere target for target practice and may as well have been an inanimate object. Case (c) is definitely not autism as cooperating to torture a cat requires social skill between the two boys, unless there is a clear “leader” and “follower”. By attempting to deceive people by denying knowledge of what happened implies quite a sophisticated theory of mind. They would need to realise that you did not know what really happened, and that if they denied knowledge, they may be able to convince you that they were not involved.

Autism has several other criteria (the formal definition of autism being of “a triad of difficulties in social interaction, communication and restricted and repetitive interests”),  so you would never make a diagnosis based on something as simplistic as the above.  It is however useful to illustrate the importance of detailed information in assessment of every single feature of autism as scenarios which present behaviourally in a very similar way (e.g. killing of an animal) may have very different causes. A typical autism assessment involves information gathered from multiple sources and in depth interview and observation by a multi-disciplinary team.

 

 

10 comments

  1. claire

    An interesting blog but I disagree with your fundamental point about lack of empathy in autism and that this is learnt by some hf individuals on the spectrum. My own point of view is that the difficulty in hf autitic people is not in the feeling of empathy, but in knowing how to express it or how to manage the social interactions around showing empathy (we all know how awkward it can be when, for example, a work colleague cries in your presence). I used to think autism =lack of empathy. Then I had my son. I clearly recall him watching teletubbies aged about 18 months. The tubby toast machine was broken and toast was shooting everywhere. I think toddlers were meant to find this funny, but my toddler was hyterical. ‘Poor tubbies!’ he cried over and over. I actually recall thinking ’empathy, he’s not autistic then’. I am a child psychologist btw! Similarly, when the bridge broke while Thomas the Tank engine was on it, he would cry and cry. ‘Oh dear’ was one of his earliest phrases. As he grew older, he withdrew more and I truly believe that he found the feelings so painful that his withdrawal was a sort of protection. Like a hypersensitivity that we would recognise in autism in hearing or taste, but his is to feelings. Of course my ds is autistic. He still guards himself from extremes of feelings. He avoids scary or tense films (at 13, he won’t yet watch Dr Who). Last week he went in his brother’s room to get a book, thinking his brother was asleep. His brother sat up in bed and said (not yelled or shouted) ‘boo’. My son cried for 20 mins and even accepted a hug, this so frightened him.

  2. claire

    To conclude. My son’s pattern of interaction has been to withdraw from painful experiences including social interactions which have the capacity to trigger emotions he experiences as overwhelming. Does he understand how someone else would feel in a situation? Almost always, though he can’t always clearly describe those feelings, he certainly feels them. Over feels them.

    • Shrinkgrowskids

      Thanks Claire, your points are valid and thanks for adding this. As a child psychologist you’ll know that autism is made up of a myriad of symptoms and that to “meet criteria” you need to meet an overall threshold, so if you have severe impairments in one area, you can meet criteria while only having lesser impairment in others. This makes diagnosis and lay understanding of autism difficult to grasp (and to write about!). There are certainly some children with autism like your son. Some may even have better empathy, which is why I tried to stress that autism is not equated to “lack of empathy” and is made up of many other symptoms which individually need assessment. For the autistic children with lack of empathy, I hope I give a generally accurate description, although inevitably different people will vary, and one can not give a perfect account that will apply to everyone, in the same way that no two people’s experience of cancer will be the same, as everyone is unique. You will see from the piece that I deliberately avoided talking about autism diagnosis as it is rather more complex! In an assessment of your son, he would not score for lack of empathy, which means that he scored sufficiently in other areas to meet criteria for autism. I guess my piece was trying to describe what would and would not be scored as autistic lack of empathy in someone who had these symptoms, but I agree with you that I could have highlighted more strongly that a proportion of children with autism do not have this symptom at all. Thanks for reading and responding to my post, engagement is really appreciated and helps to both improve thinking on an issue and writing about it!

  3. GB

    I wondered about this blog post. I am an actuary, and at an actuarial conference I was once at, an actuary described us as ‘the most autistic profession’. I have recently changed jobs and I have been exposed to another group of actuaries, and one is, dare I say it, socially inept, and many psychologists would describe him as being further along that autism spectrum than normal…

    BUT some leading autism researchers think that autism and empathy are connected, none other than Dr Sacha-Cohen. (Try this https://www.getguidance.com/calculators/243-whats-my-empathy-quotient if you want to find out your empathy quotient according to this leading experts scale)

    I have found that autism is a broad definition. Many of those who are classed such have empathy ‘deficiencies’/ Is this enough to make a damning conclusion by association? I don’t know… but hope that the topic is better understood, for the sake of those who deal with actuaries!

    • Shrinkgrowskids

      Hi Greg, I’m not sure what your question is? Or was it just an excuse to get your link in? ;-). Most autistic children (and adults) have deficits in empathy and I don’t think that my post disputes this. However, there are more people that lack empathy than there are people with autism and there are some people with mild autism who have adequate empathy. Think Venn diagram of large circle of “lack of empathy” and small circle mostly within large circle for “autism”. In addition, you can have the most impaired empathy in the world, but if you do not satisfy the other criteria for autism, you will not get a diagnosis. In particular, with the new DSM classification, there is a shift towards emphasis on restricted and repetitive behaviour, meaning that many of the tradional high functioning autistics may no longer come under this diagnostic label, but the new label of “social communication disorder”. The new criteria is controversial, but I won’t get into that. I have heard some lay people say “well, we are all somewhere on the spectrum”, but that is not true, even the broad definition of autistic spectrum does not cover the majority of the general population, however, this discussion, and the one on autism diagnosis is a bit too much for a light hearted blog site. My post was largely intended to highlight that whilst (obviously) autism and empathy are linked, they are not equated and there are MANY causes of lack of empathy, many of which are actively preventable by decent parenting(preventing abuse).

      • Jonathan Jewell

        I dunno, the examples here seem a bit extreme, Holan, and not sure if they really do a lot for the autism cause – in particular the slaughtering the hamster example* I’m also not sure about the ADHD example, but I’ve commented on that in a previous post of yours.

        I used to work 1:1 with an autistic child, and I recognise some of the things you are talking about. I was also, as you know, a children’s nurse and teacher, but I’ll stick to personal and, perhaps, more general experiences I’ve had.

        A while back, I saw this video about a girl called Carly, and I would be interested in your thoughts on it:

        Now, I’m not going to say that your characterisation is better or worse than this (mine is an ‘n of one’ study after all!), but I certainly have more empathy with this from my time with him, than yours. I kind of feel that, if anything, the notion that the child would ‘formulate’ the kind of ‘retrospective interpretation/justification’ of what happened, that you give, is just out of sync. with the person I was dealing with.

        But I’m open, as ever, to challenge on that 🙂

        * that said, know your site is not about causes and more about observations, reflections and the lingua franca between the language of psych and lay people.

      • Shrinkgrowskids

        Thanks j, great to have engagement as usual but not sure if you got the wrong end of the stick. The boy with the hamster was not autistic which was part of the point of the whole post. I can only write from the point of view of a diagnostician and clinician as I am neither autistic nor parent of an autistic child meaning that I will never know what it is truly like to live with autism. I do however have expertise in diagnosing autism (n of 200+) which is what I intended this piece to be about, or more specifically differentiating lack of empathy in autism from lack of empathy due to other causes. The piece was neither meant to be a description of how to diagnose autism (multiple different symptoms of which lack of empathy is only one which is neither necessary or sufficient for diagnosis) or a description of how it feels to be autistic, which your you tube clip made by an autistic girl depicts (although again, autism has a varied profile and no two people’s experience will be the same, her depiction had a strong sensory sensitivity component, which again (in ICD criteria) is another symptom which is neither necessary or sufficient). I guess that the impetus for the piece was that in autism clinics we often had referals of children with lack of empathy as the presenting symptom which had led other professionals to worry about autism and I wanted to convey that this need not be the case, that there are many different causes for lack of empathy and that lack of empathy is only one aspect of autism. The cases I describe are all adaptations of real cases that presented for autism assessment and the only one that was assessed to be autistic was the one involving the squirrel. I agree that choosing animal deaths may have been too sensation seeking, but it does reflect the cases being seen by tier 4 child psychiatrists like myself, who tend to see more extreme psychopathology. Also I would reiterate the point of the post which is that the majority of this type of behaviour is perpetrated by children without autism but who have other more preventable problems.

  4. hyperpolymath

    Sorry, just to that point, I suppose it’s clear in retrospect I’m unclear…

    …simply to say, there, that mental health and sociopathy are closely linked, perhaps not in psychiatry, but in the popular press.

    I know your perspective and background (in that at least), but I think the examples obscure the point rather than elucidate, in that that they run the reader down well-established ‘habit paths’ because of priming by the popular Press.

    For instance, this retitled Schizophrenia, would trigger all kinds of schema; stigma that is bound up with mental health. Not directly analogous but perhaps a homology.

    The rest of my post, I think is more about the title of your blog – shrink grows kids. Recognising you don’t have a child with autism, I was just wondering about the lessons that come out of this for others. But perhaps, and this is without judgement, this is not either the purpose here.

    Thanks though for the reply and clarity – I think I should take lessons from you! 🙂

  5. Shrinkgrowskids

    Thanks. I think that you might be right, which was SO not the point of my post, but the reverse. The point of my post was that the majority of people who do hurtful things DO NOT have autism. In the same way that in society, the majority of crime, violence and nasty things are NOT committed by people with major mental health problems, but problems created by society. I hope that if you read this post carefully, you will see that this is the point I am trying to make, but probably as you say, people are primed to jump to conclusions and my post was probably not written well enough.

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