Untangling the Social and Empathy Dynamics of Autism

But Yonat Rum and Anat Perry are asking different questions about autism, ones that consider the perspectives, abilities and life experiences of those on the autism spectrum. More specifically, these psychology researchers at the Hebrew University of Jerusalem (HUJI) approach autism through the lens of neurodiversity, an increasingly accepted theoretical perspective that views autism not as a problem to be solved, but as the result of natural variations in the human brain. This approach is leading to greater recognition of the strengths of autistic individuals, and allowing for the development of policies and practices to include them in society.

The Literature on Autism and Empathy

Recently, Rum has shifted her attention to how empathy presents in adults with autism. This has led to research collaborations with Azrieli Faculty Fellow Anat Perry, founder and director of the Social Cognitive Neuroscience Lab at HUJI. Perry and her team study the social, cognitive and neural aspects of social behaviours in healthy and clinical populations in two main areas: neural mechanisms that enable empathy, and interpersonal distance in social interactions. Rum’s and Perry’s overlapping research interests led them to partner on “Empathic Accuracy in Clinical Populations” (Frontiers in Psychiatry, June 2020), a review of 34 peer-reviewed studies, published between 1997 and 2019, on empathic accuracy—the ability to accurately judge others’ thoughts and feelings—in individuals with autism or another neurological or behavioural disorder.

The overall findings from the eight studies involving autism suggest that empathic accuracy is reduced in individuals with ASD. However, Rum and Perry note a number of factors that complicate the validity of this finding. To start with, the body of research is too small to support broad conclusions about empathic accuracy and autism. Also, females were significantly underrepresented in these studies, which makes it impossible to generalize the results among the wider population. Another mitigating factor is that empathic accuracy can be more difficult for individuals with ASD due to challenges with attention, executive functioning and motor skills. Rum and Perry say it is unclear to what extent this was taken into account during the development of the eight studies. Altogether, they say, these factors reflect the need for more research into autism and empathic accuracy that considers these variables.

To discern how we understand other people’s emotions, Perry has developed a naturalistic yet controlled empathic accuracy paradigm. She applied this approach in “The contribution of linguistic and visual cues to physiological synchrony and empathic accuracy” (Cortex, November 2020). The goal of this study, which involved neurotypical participants, was to better understand the behavioural and physiological dynamics of two main aspects of empathy: mentalizing, which is understanding another person’s emotional state through context, and experience sharing, which is resonating with another person’s emotions.

The study consisted of two phases. The first involved video-recording 28 male and female individuals—the “targets”—conducting an empathic accuracy task: telling an emotional story about their lives. The stories focused on topics such as the illness of a family member, a romantic breakup or a conflict with a friend. During their storytelling, each target’s heart rate was tracked with an electrocardiogram. The targets were then asked to watch their own story and continuously rate their affective valence (how positive or negative they felt) when telling the story. They also reported the specific emotions they felt, and rated the intensity of each on a scale from one (not at all) to nine (a lot).

In the second phase, the same stories were presented to 72 new participant “observers” in one of three ways: video with audio, video only or audio only. The observers each watched and/or listened to nine stories and were asked to continuously rate each target’s affective valence with the same measure previously used by the targets. Following each story, they were asked to specify the emotions they inferred that the target had felt. Their heart rates were recorded throughout the experiment. Lastly, all of the observers completed two well-established empathy questionnaires.

Perry and her research team had hypothesized that empathic accuracy would be greater when audio was present, and that physiological synchrony, a proxy for experience sharing, would be greater with the video-only versions. Their key findings revealed that, indeed, when there were audio cues, either alone or with video, observers showed high empathic accuracy, meaning they recognized the targets’ emotions well. This may be because words are so influential that when they are present, one relies mostly on them to make inferences. When visual cues were presented alone, empathic accuracy scores were much lower but still better than chance. However, with visual cues only, heart rate synchrony was highest, meaning that observers’ heart rates were in sync with those of the targets. Without words, one needs to interpret emotions from body language alone, which may elevate the importance of physiological synchrony as an indicator of empathy.

This study was our first using this naturalistic empathic accuracy paradigm.

“We can now leverage this paradigm to study how different information channels contribute to or hinder empathy in diverse populations, from people with attention deficits to stroke patients and, of course, in people on the autism spectrum,” says Perry, whose Azrieli Fellowship is funding one of her research programs in this area, called “Empathic accuracy and its dysfunction in autism: neurobehavioural characterization and potential modulation.”

Perry and Rum will now conduct a new study that uses the same format but involves individuals with autism, as both observers and targets. Their investigations will include a specific focus on females with ASD, an understudied clinical population that is just starting to be acknowledged by the scientific community.

“Yonat helped me realize that, yes, people with ASD may have deficits in understanding others, but no one studies how well we understand them,” Perry says. “British sociologist Damian Milton refers to this as the ‘double empathy problem’—empathy involves reciprocity between two social actors. Both sides need to understand each other.”

Echoes Rum: “Empathy is a mutual process that requires understanding by both sides. If a neurotypical person observes an autistic person, how much will they empathize? That’s what we want to find out.”