Emotion Dysregulation and Empathic Behavior Among Adolescents with ASD: A Pilot Study

Background: Empathy is a key component of socio-emotional interaction. Empathy research suggests that individuals with ASD have specific impairments in cognitive empathy (seeking and interpreting socio-emotional cues) whereas their affective empathy (emotional contagion) is intact. However, findings are contradictory, and there may be a gap between the abilities individuals with ASD display in mentalizing tasks and the use of these abilities in real-life situations, due to higher complexity of the latter, thus calling for a use of more ecologically valid paradigms.

Objectives: To explore the mechanisms underlying empathy deficits among adolescents with ASD, using a behavioral paradigm and eye tracking.

Methods: Six adolescent males with ASD (clinically diagnosed and verified using ADOS-2) with no intellectual impairment, and eight typically developing (TD) male controls, matched on age and cognitive abilities, were video-recorded while undertaking the Prosocial Empathic Behavioral Assessment (PEBA) - an ecological paradigm that involves 3 minutes of a friendly interaction with an unfamiliar peer, one minute of a response to the peer’s sudden distress (following a disturbing text message), and one minute of a return to friendly interaction. Participants wore eye tracking glasses (SMI model 2WA). Socio-emotional behaviors during the last three minutes of the interaction (friendly-distress-back to friendly, each one minute long) were coded minute by minute by trained blind raters.

Results: Behaviorally, in the friendly phase the groups displayed similar levels of appropriate affect, whereas in the distress phase adolescents with ASD displayed lower levels of appropriate affect, compared to the TD group. This difference persisted in the return to friendly phase. Levels of vocal synchrony differed between groups significantly only in the distress phase, due to a decrease in the ASD group. In contrast, levels of facial expression synchrony were significantly lower in the ASD group compared to controls in the friendly and return to friendly phases only. Eye tracking has shown that whereas in the friendly phase fixation time on the peer’s upper face was similar in both groups, in the distress phase adolescents with ASD fixated less than controls on the upper face, a trend that persisted in the return to friendly phase.

Conclusions: These preliminary results demonstrate an altered empathic response in adolescents with ASD, which was characterized by a reduced display of appropriate affect and vocal synchrony and diminished eye gaze to the peer’s eye region. The latter may reflect an attempt of participants with ASD to down-regulate their own arousal.

The inappropriate affect and diverted eye gaze persisted when the peer allegedly overcame her distress and restored friendly interaction. Furthermore, when the peer returned to a friendly conversation, TD adolescents regained facial expression synchrony, while adolescents with ASD did not. These findings may indicate a difficulty among adolescents with ASD to regulate their own emotions and to adjust them to the partner’s changing mental state. Future research could include psychophysiological measurement in order to further clarify the role of emotion regulation in adolescents’ empathic behavior.