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Opinion / Viewpoint

People with autism can read emotions, feel empathy

by ,  /  12 July 2016
The Experts:
Expert

Rebecca Brewer

Lecturer, University of East London
Expert

Jennifer Murphy

Graduate student, King’s College London

There is a persistent stereotype that people with autism are individuals who lack empathy and cannot understand emotion. It’s true that many people with autism don’t show emotion in ways that people without the condition would recognize1.

But the notion that people with autism generally lack empathy and cannot recognize feelings is wrong. Holding such a view can distort our perception of these individuals and possibly delay effective treatments.

We became skeptical of this notion several years ago. In the course of our studies of social and emotional skills, some of our research volunteers with autism and their families mentioned to us that people with autism do display empathy.

Many of these individuals said they experience typical, or even excessive, empathy at times. One of our volunteers, for example, described in detail his intense empathic reaction to his sister’s distress at a family funeral.

Yet some of our volunteers with autism agreed that emotions and empathy are difficult for them. We were not willing to brush off this discrepancy with the ever-ready explanation that people with autism differ from one another. We wanted to explain the difference, rather than just recognize it.

So we looked into the overlap between autism and alexithymia, a condition defined by a difficulty understanding and identifying one’s own emotions. People with high levels of alexithymia (which we assess with questionnaires) might suspect they are experiencing an emotion, but are unsure which emotion it is. They could be sad, angry, anxious or maybe just overheated. About 10 percent of the population at large — and about 50 percent of people with autism — has alexithymia2.

Ignorance of anger:

It’s tempting to think that having autism somehow causes alexithymia, but it’s worth remembering that you can have autism without alexithymia and vice versa. Also, even though there are higher rates of alexithymia in people with autism, there are equally high rates in people with eating disorders, depression, substance abuse, schizophrenia and many other psychiatric and neurological conditions.

So can alexithymia explain why some individuals with autism have difficulties with emotions and some don’t? Perhaps it is alexithymia, not autism, that caused the emotional difficulties we heard about from some of our participants, the difficulties that people often assume happen in everybody with autism.

To find out, we measured empathy for another’s pain in four groups of people: individuals with autism and alexithymia; individuals with autism but not alexithymia; individuals with alexithymia but not autism; and individuals with neither autism nor alexithymia3.

We found that individuals with autism but not alexithymia show typical levels of empathy, whereas people with alexithymia (regardless of whether they have autism) are less empathic. So autism is not associated with a lack of empathy, but alexithymia is.

People with alexithymia may still care about others’ feelings, however. The inability to recognize and understand anger might make it difficult to respond empathically to anger specifically. But alexithymic individuals know that anger is a negative state and are affected by others being in this state. In fact, in a separate test we conducted last year, people with alexithymia showed more distress in response to witnessing others’ pain than did individuals without alexithymia4.

Facing feelings:

Autism is associated with other emotional difficulties, such as recognizing another person’s emotions. Although this trait is almost universally accepted as being part of autism, there’s little scientific evidence to back up this notion.

In 2013, we tested the ability of people with alexithymia, autism, both conditions or neither to recognize emotions from facial expressions. Again, we found that alexithymia is associated with problems in emotion recognition, but autism is not5. In a 2012 study, researchers at Goldsmiths, University of London found exactly the same results when they tested emotion recognition using voices rather than faces6.

Recognizing an emotion in a face depends in part on information from the eyes and mouth. People with autism often avoid looking into other people’s eyes, which could contribute to their difficulty detecting emotions.

But again, we wanted to know: Which is driving gaze avoidance — autism or alexithymia? We showed movies to the same four groups described above and used eye-tracking technology to determine what each person was looking at in the movie.

We found that people with autism, whether with or without alexithymia, spend less time looking at faces than do people without autism. But when individuals who have autism but not alexithymia look at faces, they scan the eyes and mouth in a pattern similar to those without autism.

By contrast, people with alexithymia, regardless of their autism status, look at faces for a typical amount of time, but show altered patterns of scanning the eyes and mouth. This altered pattern might underlie their difficulties with emotion recognition7. (People who have autism or alexithymia and would like to participate in our studies can click here for details.)

Emotional rescue:

We think these results, and the others we have found since, disprove the theory that autism impairs emotion recognition8,9. If people assume that someone with autism lacks empathy, they will be wrong about half the time (because only half of individuals with autism have alexithymia). Making this assumption is unfair and can be hurtful.

What’s more, our work demonstrates that we urgently need tools to help individuals who have both autism and alexithymia understand their own and other people’s emotions. Meanwhile, people with autism who don’t have alexithymia might focus on building on their emotional strengths to mitigate the social difficulties associated with the condition.

At the same time, alexithymia doesn’t preclude acting in a prosocial and moral fashion. Indeed, one of our studies shows exactly this in individuals with autism9. Although people who have alexithymia but not autism find it acceptable to say hurtful things to others, people who have both autism and alexithymia do not. We think people with autism use other information (such as social rules) to decide whether what they say will be hurtful, rather than relying on their understanding of emotions.

We recommend that researchers test some of the basic assumptions about the capabilities of people with autism. Importantly, they should try to separate the impact of autism from that of conditions such as alexithymia that frequently accompany it10.


References:
  1. Brewer R. et al. Autism Res. 9, 262-271 (2016) PubMed
  2. Berthoz S. and E.L. Hill Eur. Psychiatry 20, 291-298 (2005) PubMed
  3. Bird G. et al. Brain 133, 1515-1525 (2010) PubMed
  4. Brewer R. et al. J. Abnorm. Psychol. 124, 589-595 (2015) PubMed
  5. Cook R. et al. Psychol. Sci. 24, 723-732 (2013) PubMed
  6. Heaton P. et al. Psychol. Med. 42, 2453-2459 (2012) PubMed
  7. Bird G. et al. J. Autism Dev. Disord. 41, 1556-1564 (2011) PubMed
  8. Oakley B.F.M. et al. J. Abnorm. Psychol. In press
  9. Brewer R et al. J. Affect. Disord. Under review
  10. Cook J.L. et al. Brain 136, 2816-2824 (2013) PubMed
  • Katarzyna Sinclair

    “There is a persistent stereotype that people with autism are individuals who lack empathy and cannot understand emotion.” It is not a stereotype, it is Simon Baron-Cohen’s mindblindness theory and it is about time he officially acknowledged that the theory was false.

    • Shonagh Mc Aulay

      Baron-Cohen does distinguish clearly between cognitive empathy (difficult for people with autism) and emotional empathy (not impaired in people with autism).

  • Tracey Walker

    extreme empathy and empath but its so overwhelming I cannot express outward what is going on inward I mute – and have to process it deal with it within and then I can express. As a child it was so much I just went mute until all the internal anxiety because I could not express it and the anger of others because I would be mute just made me more mute….

  • Planet Autism

    Of course we have empathy and recognise feelings. We just often don’t know why someone else has particular feelings because we may have missed the body language or misinterpreted a situation. Or sometimes it’s because we haven’t been in that exact or similar situation ourselves. If you’ve heard of the intense world theory of autism (Markram) you will know that we have too much empathy. Sometimes this is why eye contact is difficult (avoidance) and we can often pick up on a mood in a room and feel it physically. Anyway, there are different types of empathy (cognitive empathy and affective empathy being just two of them) and we struggle with some but not others. I scored very highly on the reading the mind in the eyes test. But 2D pictures are not real moving people.

  • Ag a Dog Doo

    Apparently, you cannot read emotions or feel empathy.

    If you could, you would not call us “people with autism”.

    Take away Autism Speaks FNA’s ability to mischaracterise what makes us us as a separate thing to us. What do they have left? What if everyone thought of our neurologies the same way they thought of their own neurologies? Or to put it more baldly, their sex or their skin colour?

    Calling us “with autism” helps curebies convince idiots that what makes us us is a disease, a separate thing to us. That somehow my brain is a separate thing to me.

    I have said it many times before, I will say it again: I defy, challenge, you to think of something more ridiculous than that.

  • Cat

    Of COURSE autistic people have empathy. But if eye contact was painfully intense for me at exactly the stage when people are learning to read faces, if people kept forcing me into situations and behaviours that were uncomfortable for me and ignoring or dismissing my protests, and if I became keenly aware that other people did not experience the world the same way I did, then I bet my way of doing empathy would look different too.

    • Ethyl

      I think it is easier to “give your eyes” to someone you trust, anyhow. If you see someone as aggressive, of course you are going to hide your eyes. That’s why I don’t like Dr. Amy Klins work that insists getting eye contact is going to ease autism symptoms. It seems so wrong to me, I must confess, because I went to a child care worker symposium based on supposed children’s lack of ability to bond that could be overcome by forcing eye contact. It was abuse…and I was complicit. I only tried it one time, and my husband stopped the abuse of my 6 month old son. When we “get” autism, we will “get” it from the eyes of the autistic, not the researcher. Science is so clueless when it comes to empathy…When we give it to autistics, we will truly be capable of understanding them, not forcing them to live in the world we want to force them into.

      When my son created his own blog on my push…he had a teacher ask him what would he suggest when it came to understanding the autistic kids in his class.

      “Wait for them to come to you.”

      His blog only lasted a week, but I have never forgotten the advice he gave. It seems so common sense. I need to remember it. I am far too bossy…

  • Lydia

    It will be a releve for a lot of people with autisme
    If these findings will be (public) well known.
    I hope yournalisme will help in this.

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