Reexamining empathy in autism: Empathic disequilibrium as a novel predictor of autism diagnosis and autistic traits

Ido Shalev; Varun Warrier; David M. Greenberg; Paula Smith; Carrie Allison; Simon Baron-Cohen; Alal Eran; Florina Uzefovsky

doi:10.1002/aur.2794

Reexamining empathy in autism: Empathic disequilibrium as a novel predictor of autism diagnosis and autistic traits

Ido Shalev, Varun Warrier, David M. Greenberg, Paula Smith, Carrie Allison, Simon Baron-Cohen, Alal Eran, Florina Uzefovsky

Department of Music

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

A large body of research showed that autistic people have intact emotional (affective) empathy alongside reduced cognitive empathy. However, there are mixed findings and these call for a more subtle understanding of empathy in autism. Empathic disequilibrium refers to the imbalance between emotional and cognitive empathy and is associated with a higher number of autistic traits in the typical population. Here we examined whether empathic disequilibrium predicts both the number of autistic traits and autism diagnosis. In a large sample of autistic (N = 1905) and typical individuals (N = 3009), we examined empathic disequilibrium and empathy as predictors of autistic traits and autism diagnosis, using a polynomial regression with response surface analysis. Empathy and autistic traits were measured using validated self-report questionnaires. Both empathic disequilibrium and empathy predicted linearly and non-linearly autism diagnosis and autistic traits. Specifically, a tendency towards higher emotional than cognitive empathy (empathic disequilibrium towards emotional empathy) predicted both autism diagnosis and the social domain of autistic traits, while higher cognitive than emotional empathy was associated with the non-social domain of autism. Empathic disequilibrium was also more prominent in autistic females. This study provides evidence that beyond empathy as was measured thus far, empathic disequilibrium offers a novel analytical approach for examining the role of empathy. Empathic disequilibrium allows for a more nuanced understanding of the links between empathy and autism. Lay summary: Many autistic individuals report feelings of excessive empathy, yet their experience is not reflected by most of the current literature, typically suggesting that autism is characterized by intact emotional and reduced cognitive empathy. To fill this gap, we looked at both ends of the imbalance between these components, termed empathic disequilibrium. We show that, like empathy, empathic disequilibrium is related to autism diagnosis and traits, and thus may provide a more nuanced understanding of empathy and its link with autism.

Original language	English
Pages (from-to)	1917-1928
Number of pages	12
Journal	Autism Research
Volume	15
Issue number	10
DOIs	https://doi.org/10.1002/aur.2794
State	Published - Oct 2022

Bibliographical note

Publisher Copyright:
© 2022 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.

Funding

Florina Uzefovsky was supported by the National Institute for Psychobiology in Israel (NIPI), and by the Israel Science Foundation (Grant No. 449/14). Ido Shalev was supported by a Negev scholarship granted by Ben‐Gurion University of the Negev. Simon Baron‐Cohen received funding from the Wellcome Trust 214322\Z\18\Z. In addition, Simon Baron‐Cohen received funding from Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No 777394. The JU receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA and AUTISM SPEAKS, Autistica, SFARI. Simon Baron‐Cohen also received funding from the Autism Research Trust, the Templeton World Charitable Fund, the MRC, SFARI, and the NIHR Cambridge Biomedical Research Centre. The research was supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care East of England at Cambridgeshire and Peterborough NHS Foundation Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, NIHR or Department of Health and Social Care. Autism Research Trust; Innovative Medicines Initiative, Grant/Award Number: 777394; Israel Science Foundation, Grant/Award Number: 449/14; Kreitman School of Advanced Graduate Studies, Ben‐Gurion University of the Negev; Medical Research Council; National Institute for Psychobiology in Israel, Hebrew University of Jerusalem; Peterborough NHS Foundation Trust; Simons Foundation Autism Research Initiative; Templeton World Charitable Fund; Wellcome Trust, Grant/Award Number: 214322\Z\18\Z; Department of Health; Health Research; National Institute for Health Research; Biomedical Research Centre; AUTISM SPEAKS; Horizon 2020; European Union; Ben‐Gurion University of the Negev Funding information

Funders	Funder number
AUTISM
Autism Research Trust
National Institute for Psychobiology in Israel
Peterborough NHS Foundation Trust
Templeton World Charitable Fund
Health Research
Wellcome Trust	214322
European Federation of Pharmaceutical Industries and Associations
Simons Foundation Autism Research Initiative
NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
Medical Research Council
National Institute for Health and Care Research
Department of Health and Social Care
European Commission
Hebrew University of Jerusalem
Israel Science Foundation	449/14
Ben-Gurion University of the Negev
Horizon 2020
Innovative Medicines Initiative	777394
NIHR Cambridge Biomedical Research Centre

Keywords

autism
cognitive
emotional empathy
empathy
response surface analysis

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10.1002/aur.2794

Cite this

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abstract = "A large body of research showed that autistic people have intact emotional (affective) empathy alongside reduced cognitive empathy. However, there are mixed findings and these call for a more subtle understanding of empathy in autism. Empathic disequilibrium refers to the imbalance between emotional and cognitive empathy and is associated with a higher number of autistic traits in the typical population. Here we examined whether empathic disequilibrium predicts both the number of autistic traits and autism diagnosis. In a large sample of autistic (N = 1905) and typical individuals (N = 3009), we examined empathic disequilibrium and empathy as predictors of autistic traits and autism diagnosis, using a polynomial regression with response surface analysis. Empathy and autistic traits were measured using validated self-report questionnaires. Both empathic disequilibrium and empathy predicted linearly and non-linearly autism diagnosis and autistic traits. Specifically, a tendency towards higher emotional than cognitive empathy (empathic disequilibrium towards emotional empathy) predicted both autism diagnosis and the social domain of autistic traits, while higher cognitive than emotional empathy was associated with the non-social domain of autism. Empathic disequilibrium was also more prominent in autistic females. This study provides evidence that beyond empathy as was measured thus far, empathic disequilibrium offers a novel analytical approach for examining the role of empathy. Empathic disequilibrium allows for a more nuanced understanding of the links between empathy and autism. Lay summary: Many autistic individuals report feelings of excessive empathy, yet their experience is not reflected by most of the current literature, typically suggesting that autism is characterized by intact emotional and reduced cognitive empathy. To fill this gap, we looked at both ends of the imbalance between these components, termed empathic disequilibrium. We show that, like empathy, empathic disequilibrium is related to autism diagnosis and traits, and thus may provide a more nuanced understanding of empathy and its link with autism.",

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Reexamining empathy in autism: Empathic disequilibrium as a novel predictor of autism diagnosis and autistic traits

Abstract

Bibliographical note

Funding

Keywords

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