Ideas and concepts for Doctors around the lack of empathy in children with autism

When helping kids on the spectrum, one of the key features that families can often focus on is the “lack of empathy”. 

Helping kids and their families understand the emotional literacy around empathy may help to navigate this space better in my opinion. 

So what are the patterns of “lack of empathy” we can observe when working with this group?

It’s hard to find information around this, but over the years, these are the patterns that I have observed. 

1 The child can pick up a lot of feelings in the external world but finding it very hard to process it and use it effectively.  It might feel very overwhelming for them. They may then detach from their feelings or avoid it in order to cope. 

2 They have intense internal feelings but they can’t seem to process and use that effectively. They then try to detach from that or find some form of distraction in order to cope. 

3 They have great difficulties picking up feelings in general both externally and internally. They can seem generally quite detached emotionally. 

Based on the above observations, I sometimes define empathy as “input/receptive/internal empathy”, versus “output/expressive/external empathy”. 

Some children on the spectrum may actually have intense “input empathy” to the point of discomfort, and then find it hard to express that as “output empathy”. 

Underneath, it’s deeply empathetic, caring, and intense. It just doesn’t show it clearly on the outside.  Hence, there’s much misunderstanding around this observation as a “lack of empathy”. It can trick many many people, including parents.

Some children on the spectrum may try to emulate “output/external empathy” through logical processes, but it can be quite “clunky”. This can be a pattern with girls on the spectrum as they can emulate “output/external empathy” better than the boys.  They may go unnoticed until later years, where they may decompensate due to the complexity of the social world in high schools and beyond.

Helping the child and their family to understand and accept their experiences and difficulties above, can help them to redirect their energy on creating a life that is still congruent with their values, despite the challenges. They may also find significant others, who may complement them, and scaffold for their weaknesses. 

Have you observed these patterns in children with ASD traits?