Empathic responding in preschool-aged children with familial risk for autism

Relationship between the Broader Autism Phenotype and empathy among students

Previous research has shown that persons with a higher level of the broad autism phenotype (BAP) experience deficits in empathy. The aim of the present study is to investigate a multivariate relationship between the BAP and different aspects of empathy. In a sample of 293 university students, we explored the relationship between the BAP and the following aspects of empathy: fantasy, empathic concern, perspective taking, and personal distress. The BAP level was measured using The Broad Autism Phenotype Questionnaire (BAPQ), and the Interpersonal Reactivity Index was used for multidimensional assessment of empathy disposition. Canonical correlation analysis yielded two functions (Function 1  ̶  Rc2 = 17.31%, Function 2  ̶  Rc2 = 10.82%). In Function 1, IRI subscales Personal Distress (PD) (rs = .92) and Perspective Taking (PT) (rs = -.39) are associated significantly with all three domains of the BAP. The strongest correlation PD and PT show with Rigid and Pragmatic Language domains of the BAP, while they demonstrate a weaker relationship with the Aloofness domain. In Function 2, IRI subscales Empathic Concern (EC) (rs = -.98), Fantasy (FS) (rs = -.46), PT (rs = -.43) and PD (rs = -.31) are related to the Aloofness domain of the BAP. The results imply that the relationship between BAP and empathy differs for different aspects of these two constructs. The more detailed understanding of the relationship between BAP and empathy obtained through the multivariate approach provides a basis from which to create programs for the more efficient promotion of empathy skills.

Preliminary evidence supporting the clinical utility of an Analog Task of Prosocial Helping

BACKGROUND

Prosocial helping is a fundamental communication behaviour that supports successful social relationships. This study investigated the clinical utility of the Analog Task of Prosocial Helping (AToP-H): a tool for assessing how helping is influenced by the communicative function it serves and the cues used to elicit helping in young children with and without a social communication disorder.

AIMS

To present evidence of the AToP-H's reliability, validity and clinical utility.

METHODS & PROCEDURES

The AToP-H examines three communicative functions expressed through helping-instrumental (request-based), informative (information-based) and empathic (emotion-based) helping-within a naturalistic context. Prosocial helping is elicited using semi-structured interactions in which increasingly explicit cues are provided to scaffold child responses. To gather reliability and validity evidence, the AToP-H was administered to 20 children with autism spectrum disorder (ASD) (49-79 months) and 20 with typical development (37-77 months).

OUTCOMES & RESULTS

Procedural reliability and inter-observer agreement for the AToP-H were high. Item-level codes were consistent with overall task performance, showing strong internal consistency. Supporting construct validity, higher scores were observed in older children with ASD, consistent with an expectedly protracted developmental period for prosocial helping. Children with ASD required more cues to elicit helping overall and informative and empathic helping in particular. Furthermore, more children with ASD did not respond or required explicit cues to respond with informative and empathic helping. Supporting criterion-related validity, total helping cue scores were significantly correlated with measures of social cognition, social abilities and receptive language, but were only weakly correlated with general language.

CONCLUSIONS & IMPLICATIONS

The AToP-H shows promise in measuring helping performance as an indicator of young children's social communication strengths and weaknesses as well as scaffolding cues to facilitate intervention planning.

WHAT THIS PAPER ADDS

What is already known on the subject Prosocial helping is critical for successful relationships, which can be difficult for children with social communication disorders such as ASD. Two factors that influence helping are the communicative function of the helping behaviour and the cues used to elicit helping. Existing helping tasks have been developed for research purposes, focusing on internal validity with little attention to applying or generalizing results to clinical settings or groups. Thus, assessing factors that influence helping behaviours in naturalistic, ecologically valid contexts could provide clinicians with critical information to improve prosocial helping in children with social communication disorders. What this paper adds to existing knowledge This paper presents preliminary psychometric evidence for a naturalistic clinical task: the AToP-H, which assesses instrumental (request-based), informative (information-based) and empathic (emotion-based) helping elicited with increasingly explicit cues. What are the potential or actual clinical implications of this work? Evidence from samples of young children with and without ASD supports the reliability and validity of AToP-H scores. The AToP-H shows promise as a clinical tool to effectively assess and plan interventions targeting social communication, prosocial helping and associated interactions.

Empathy, Theory of Mind, and Prosocial Behaviors in Autistic Children

BACKGROUND

Previous research has suggested that children with autism spectrum disorder (ASD) display fewer prosocial behaviors, and the role of empathy or Theory of Mind (ToM) in prosocial behaviors of autistic children remains unclear.

METHODS

Data were obtained from an ongoing longitudinal study in Guangzhou, China. A total of 96 autistic children and 167 typically developing (TD) children were enrolled. Prosocial behaviors were assessed using a subscale of the Strength and Difficulties Questionnaire and Dictator Game (DG) paradigm with stickers as incentives. Empathic traits and ToM ability were measured using the children's Empathy Quotient and the Chinese version of ToM toolkit. Generalized linear models were used to assess the differences of prosocial behaviors and empathic traits, ToM ability between the two groups and the associations between empathic traits, ToM ability and prosocial behaviors in autistic children.

RESULTS

Compared with TD children, autistic children exhibited worse ToM ability and performed less pro-socially in the DG paradigm, while there were no differences regarding empathic traits. In autistic children, empathic traits especially affective empathy, were positively associated with parent-reported prosocial behaviors [β = 0.17, 95% confidence interval (CI): 0.07-0.27; β = 0.47, 95%CI: 0.33-0.60]. ToM ability was associated with DG paradigm (β = 1.03, 95%CI: 0.16-1.89).

CONCLUSION

Autistic children showed less pro-sociality and ToM ability than TD children. In autistic children, empathic trait was associated with parent-reported prosocial behaviors while their ToM ability was associated with prosocial behaviors in experimental condition. Our findings indicated that better ToM ability and empathic trait might promote prosocial behaviors in autistic children.

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

Siblings of children with ASD have, as a group, more autistic traits than typically developing individuals. A high prevalence of autistic traits may (or may not) include lower scores on measures of empathy and prosocial behavior compared with typically developing individuals. The purpose of this study was to conduct a systematic review of studies of empathy and prosocial behavior in siblings of individuals with ASD. We conducted a comprehensive literature search of studies published until March 2020. We identified 16 studies with a total of 1066 siblings that met inclusion criteria. Based on the review, we conclude that the current literature suggests that siblings of individuals with ASD exhibit normative empathic abilities and prosocial behavior.

Quantity and quality of empathic responding by autistic and non-autistic adolescent girls and boys

Empathy evokes support for the person in distress, and thus strengthening social cohesion. The question is to what extent empathic reactions can be observed in autistic adolescents and autistic girls in particular, since there is evidence that they have better social skills than boys, which might hinder their recognition as autistic. We examined 193 adolescents (autistic/non-autistic boys/girls) during an in vivo task in which the experimenter hurt herself. In line with our predictions, no group or gender differences appeared related to their attention for the event; yet autistic girls and boys showed less visible emotional arousal, indicative of less affective empathy. Autistic girls and boys reacted by comforting the experimenter equally often as their non-autistic peers, but autistic boys seemed to address the problem more often than any other group; while girls (autistic and non-autistic) more often addressed the emotion of the person in need. Our findings highlight that empathic behaviour – to some extent – seems similar between autistic and non-autistic boys and girls. However, differences exist, in terms of expressed emotional arousal and gender-specific comforting styles. Autistic girls’ higher levels of emotion-focused comforting could be explained by well-developed social skills, camouflaging, or emotional investment in relationships with others.

Social endophenotypes in autism spectrum disorder: A scoping review

Endophenotypes are measurable markers of genetic vulnerability to current or future disorder. Autism spectrum disorder (ASD) is well-suited to be examined within an endophenotype framework given past and current emphases on the broader autism phenotype and early detection. We conducted a scoping review to identify potential socially-related endophenotypes of ASD. We focused on paradigms related to sociality (e.g., theory of mind (TOM), social attention), which comprise most of this literature. We integrated findings from traditional behavioral paradigms with brain-based measures (e.g., electroencephalography, functional magnetic resonance imaging). Broadly, infant research regarding social attention and responsivity (Research Domain Criteria (RDoC) domain of affiliation) and attention to faces and voices (social communication) finds consistent abnormality in vulnerable infant siblings. Several additional paradigms that have shown differences in vulnerable infants and young children include animacy perception tasks (perception and understanding of others), measures of recognition and response to familiar faces (attachment), and joint attention and false-belief tasks (understanding mental states). Research areas such as alexithymia (the perception and understanding of self), empathic responding, and vocal prosody may hold interest; however, challenges in measurement across populations and age ranges is a limiting factor. Future work should address sex differences and age dependencies, specificity to ASD, and heterogeneous genetic pathways to disorder within samples individuals with ASD and relatives.

A telehealth approach to improving clinical trial access for infants with tuberous sclerosis complex

Background

Research in rare genetic syndromes associated with ASD is often hampered by the wide geographic distribution of families and the presence of medical comorbidities, such as epilepsy, that may preclude travel to clinical sites. These challenges can limit the sample size and generalizability of the cohorts included in both natural history studies and clinical trials. Tuberous sclerosis complex (TSC) is a rare genetic syndrome that confers an elevated risk for autism spectrum disorder (ASD), with social communication delays identified in this population as early as 12 months of age. Early identification of risk necessitates parallel testing of early intervention, prompting the first randomized controlled clinical trial of behavioral intervention for infants with TSC (NCT03422367). However, considerable early recruitment challenges have mandated the systematic identification of enrollment barriers followed by modification of the study design to address these barriers.

Methods

Caregivers were interviewed regarding barriers to enrollment (phase 1). Adaptations to the intervention were made to address these barriers (phase 2). Outcomes based on this modification to the study design were defined by enrollment rate and participant demographics.

Results

Qualitative reports from caregivers indicated that distance and time were the primary barriers to clinical trial enrollment. The intervention was then modified to a remote model, with at-home, parent-delivered intervention, and weekly video conferencing with interventionists at the study sites. Enrollment increased 10-fold (from 3 to 30 participants) within 1 year and included a more diverse and clinically representative cohort of infants.

Conclusion

The design and implementation of more scalable methods to disseminate research remotely can substantially improve access to clinical trials in rare neurodevelopmental disorders. The lessons learned from this trial can serve as a model for future studies not only in rare conditions, but in other populations that lack adequate access, such as families with limited financial or clinical resources. Continued efforts will further refine delivery methods to enhance efficiency and ease of these delivery systems for families.

What are Replicable Aspects of the Broader Autism Phenotype among College Students?

Are people with heightened autistic traits less likely to help other people? Recent research suggests that heightened autistic traits are associated with reduced self-reported prosocial behavior among college students. However, the growing literature examining sub-clinical traits associated with autism, or the Broader Autism Phenotype (BAP), among college students has invested insufficient attention in replication of findings, potential interrelationships between constructs, or the degree to which social desirability bias may contribute to findings. To identify replicable aspects of the BAP, we administered a battery of measures to 391 undergraduate students. Replicating prior work, findings suggested that self-reported difficulties understanding the self and others (but not less feeling for others) and sensory atypicalities are core aspects of the BAP. Reduced social desirability bias was also associated with the BAP. Prior associations between reduced prosocial tendencies and the BAP were not replicated. Findings highlight the importance of assessing multiple potential aspects of the BAP, particularly reduced susceptibility to the social desirability bias, when using self-report measures.

Does Theory of Mind Training Enhance Empathy in Autism?

Youth with ASD often show limited or atypical empathic responsiveness. The direct effects of social skills interventions on enhancing empathic responsiveness is unknown. Data from a randomized controlled trial were used to investigate whether a Theory of Mind training improves the empathic responsiveness, measured through structured observations. The current study included a large sample (n = 135) of 8–13-year-old children with ASD. When comparing the change scores of empathic responsiveness from baseline to post-test, the intervention group performed significantly better than the waitlist group. Thus, the current findings support the use of Theory of Mind training as intervention of ASD by showing its efficacy also in improving one’s empathic responsiveness, in addition to previous knowledge regarding the improvements in empathic understanding.