Do People With Autism Have ‘Normal’ Empathy & Emotions?

Elemy
Updated: June 8, 2020

There are many myths and misunderstandings about how autism spectrum disorder (ASD) changes the way people experience and express their emotions and sympathy. Chief among these myths is that people with autism don’t have “normal” empathy and emotions — that autistic individuals are coldly logical and analytical, and cannot relate to other human beings. This is not true. People with autism have the full range of human emotions. They may have a condition known as alexithymia, which thwarts their ability to understand and process their emotions. It also impedes their ability to communicate those emotions to others.

Autism & Alexithymia

Experts say that what we now understand to be a misconception about autism is because of outdated research in the field, dating back to when little was known about the functioning of the disorder.

Writing in The Conversation, scientists at the Autism Research Group in London explain that there is some truth to people with ASD being very good at analytical problem-solving, but that such people have the full range of human emotions. However, they express and experience those emotions in very different ways than neurotypical individuals.

This struggle to identify and articulate their own emotions is one of the characteristic symptoms of autism. In some people, this takes the form of a condition known as alexithymia, a term that literally means “no words for feelings.” It is essentially the inability to describe emotions.

Alexithymia is not limited to people with autism. It occurs in 10% of the general population, but as many as 50% of people on the autism spectrum have it.

Recent research (like that published in the Cortex journal) has suggested that it is alexithymia, not autism, that hinders interoception, the understanding of what a person is feeling or experiencing in a given moment. This also makes it difficult for people with alexithymia to regulate their behaviors.

Alexithymia and autism are very closely linked, but the boundaries of both disorders are still not fully understood.

Expressing Emotion & Empathy

People with autism sometimes report having strong feelings about an emotional event even as their bodies do not show a typically corresponding reaction. For example, someone with autism may not show any signs of grief at a funeral. Similarly, they might say they are feeling calm when they are showing physical signs of agitation and alertness. To other people, this might appear confusing and untrue.

This leads to the appearance that people on the autism spectrum don’t show emotion in ways that others would understand, says writers for Spectrum. This is then taken to mean that people with autism lack empathy and cannot recognize feelings, which is an incorrect assumption. People with autism who have volunteered for testing reported feeling “typical or even excessive empathy,” but agreed that their own ability to recognize and communicate these emotions in ways that neurotypical people would understand is limited.

Researchers have suggested that autistic people with alexithymia will know that they are having an emotional response to something, but they will not be sure of what the emotion actually is. However, researchers are also quick to point out that not every autistic person will have alexithymia, and that autism does not cause alexithymia.

Is Alexithymia the Real Issue?

To determine whether people with autism have “normal” empathy and emotions, the researchers looked at four groups of people. The groups were divided into:

Patients with autism and alexithymia.
Patients with autism but not alexithymia.
Patients with alexithymia, but not autism.
Patients with neither alexithymia nor autism.

Their testing found that patients with autism but not alexithymia had normal levels of empathy. Patients who had alexithymia with or without autism were less empathetic, suggesting that it is not autism that is the driver behind the lack of empathy, but the alexithymia.

That being said, people who have alexithymia will still care about the feelings of other people, but they might not know how to suitably respond to these feelings, especially when the feelings in question are strong, such as to show compassion to someone in grief or to be patient with someone who is angry. However, patients with alexithymia are still having emotional reactions. A study in the Journal of Abnormal Psychology found that such patients “showed more distress in response to witnessing others’ pain,” compared to people who did not have alexithymia.

In fact, the writers for Spectrum argue that alexithymia, more than autism itself, is to blame for autism being associated with difficulties in recognizing other people’s emotions.

Complex Relationships

People with autism often struggle with making eye contact with other people. Being able to pick up on nonverbal cues from the eyes and mouth is a vital part of recognizing emotions, and this is why autistic people struggle. But is that autism, or is it alexithymia? Researchers writing in the Journal of Autism and Developmental Disorders found that people on the autism spectrum, regardless of a diagnosis of alexithymia, “spend less time looking at faces” than neurotypical people. However, when people on the autism spectrum who do not have alexithymia look at faces, they do so in a way similar to how neurotypical people do.

On the other hand, people with alexithymia, regardless of a diagnosis of autism, do look at faces for a normal amount of time, but they have a “disturbance” in the recognition of facial emotions, per a study in the Neuropsychiatric Disease and Treatment journal. This might be why people with alexithymia cannot be easily empathetic or show normal emotions, and why some people on the autism spectrum are better at communicating their emotions than others.

The researchers writing for Spectrum are confident that it is not autism that impairs the recognition of emotions, arguing that since only half of people with autism have alexithymia, as many as 50% of autistic people will be able to suitably process and recognize emotions. People who have autism are able to use other cues, like context and social guidelines, to make decisions about what to say and how to react rather than relying on an understanding of their own emotions. People who have alexithymia, but not autism, will struggle to read those cues and then speak or behave in an acceptable way.

Alexithymia and autism have a “complex relationship,” writes Frontiers in Psychology, and it is not always easy to see how and where they overlap. This does lead to confusion about the emotional and expressive abilities of autistic people and people with alexithymia (who may or may not have autism). Generally speaking, autistic people and people with alexithymia (who may or may not have autism) are capable of having “normal” empathy and emotions, but they will struggle in different ways to show those emotions in ways that neurotypical people will understand and expect.

Can Empathy Be Taught?

There is a degree to which people who have autism can be taught to boost their levels of empathy. Per the Journal of Applied Behavioral Analysis, researchers have found that in studies where autistic patients are shown roleplaying situations intended to elicit empathetic responses (and are rewarded when they display those responses), “people with autism learned how to demonstrate empathy using appropriate words and gestures.” In Behavior Analysis in Practice, researchers explained that they have been able to teach empathy to children with autism, using a combination of modeling, prompting, and reward for focusing on another person’s emotions with acceptable phrases, tone of voice, facial expressions, and body language.

These techniques have shown promise that empathetic behavior can be taught. Emotional empathy, however, requires other therapies, like cognitive behavioral therapy. Other studies have looked at using animals, especially horses (“the ultimate therapists,” according to Psychology Today) to help autistic patients develop emotional empathy.

Other researchers have suggested that classrooms should incorporate media that is designed to teach children with autism how to recognize and reflect emotions, in such a way that the teaching process does not overstimulate or overwhelm the students. The idea is that the learning process should be as smooth as possible, which is an important enough guideline for any patient with autism, but especially important for children who are trying to learn how they can comfortably and clearly express their emotions. Empathy from educators, concludes the researchers, “may therefore facilitate the development of empathy in children with autism.”