Dr. Tony Attwood’s Advice on Improving Empathetic Attunement

People who have an ASD are often accused of lacking empathy, being callous and not caring about other people. However, some of the kindest people I know have an ASD. Why is there such a contradiction? Psychologists divide the concept of empathy into three components: cognitive empathy (to know); emotional empathy (to feel); and compassionate empathy (to respond). Those with an ASD can have difficulties with each of these three components of empathy.

Cognitive Empathy

This is the ability to read body language in order to reocognize when someone is distressed and determine the degree of distress. Those with an ASD are often able to read “the headlines,” that is, they are aware of the obvious signs of distress, such as noticing that someone is crying. The difficulty is in the “fine print,” that is, reading the more subtle and transitory expressions and contextual cues that help to precisely determine what someone is thinking and feeling. People with an ASD take time to cognitively process information conveyed non-verbally, and the signs may be fleeting and confusing. Neurotypicals rarely “freeze” a facial expression or body posture, and can be oblique in speech; for example, when being asked, “Are you okay?” may reply, “Yes,” but are not actually feeling okay.

If the signs of distress are subtle and not recognized, then there will not be the anticipated response indicating empathy, hence the accusation of a lack of empathy and callousness. It is, therefore, a question of not reading and being uncertain of the more subtle body language cues that indicate distress, not necessarily a lack of caring and compassion.

We tend to think of the ability to “read” what someone is thinking or feeling as an ability to read facial expressions, tone of voice, prosody of speech and contextual cues. Research has confirmed that these cognitive aspects of empathy are impaired in those who have an ASD. However, from my clinical experience and having read so many autobiographies, I have observed that some people with an ASD seem to have an emotional “sixth sense,” that is, an intuitive ability to accurately perceive a negative “atmosphere” on entering a social situation, or instantaneously knowing the negative mood of someone they know well. Psychologists have yet to explain this characteristic of ASD. My advice is to trust your “sixth sense” intuition in such situations—it is probably accurate.

One very significant problem for those with an ASD is not a lack of emotional sensitivity, but rather an oversensitivity to the negative emotions in others. This can cause the person to avoid social situations in which the prevailing emotions are negative, due to their being exceptionally vulnerable to “bad vibes.”

Emotional Empathy

This is the ability to “feel” someone’s distress. Neurotypicals have the intuitive and immediate ability to “put themselves in someone’s shoes,” and to resonate with and absorb someone’s feelings. While people with an ASD may have emotional empathy for experiences that they themselves have been familiar with, they may have difficulty being empathic with emotional experiences they have not personally known. The mental process for the person with an ASD is to remember the feelings they experienced and to be empathic. Without personal experience of those feelings or the depth of emotion, they experience confusion in trying to identify the other person’s emotion, and have difficulty achieving empathy.

Compassionate Empathy

This is the ability to know how to respond to someone’s feelings, especially distress. Neurotypicals expect a response that is appropriate in terms of intensity and efficacy. This can be difficult for someone with an ASD, who may be able to read the signals and appreciate the depth of feeling, but is unsure how to respond. This is compounded by fear of making a mistake or rejection when deciding how to respond and with what intensity. Sometimes it feels as though there is less risk of making a mistake or rejection by doing nothing.

Neurotypicals usually anticipate words and gestures of compassion and affection, but the problem for those with an ASD is that these may not be their own most effective and preferred emotion repair strategies. Their preferred repair mechanisms can be solitude or the distraction and enjoyment of their special interest. When the neurotypical, therefore, is deliberately left alone to recover, or the person with an ASD starts talking about their special interest in an attempt to lighten the mood, the perception by the neurotypical is that the person with an ASD is lacking compassion and empathy.

The solution here is for the neurotypical to state clearly both his or her feelings and the depth of those feelings, and what actions would alleviate the distress; or for the person with an ASD to ask exactly what he or she can do to help the person feel better.

Accusations of a lack of empathy and not caring can be made in relation to the ability to express the conventional signs of grief. Neurotypicals express and alleviate their feelings of grief at a funeral or family gathering by communal crying. The person with an ASD may not be able to resonate with this “infectious” method of expressing grief, and they may then be assumed to be callous. There may well be deep grief, but often not expressed in the way anticipated by neurotypicals. Grief can be expressed by a temporary increase in the characteristics of ASD, such as isolation and social withdrawal, engagement in the special interest (as an antidote to feeling sad), and an increase in anxiety and sensory sensitivity. Neurotypicals may not recognize these characteristics as signs of grieving.

One of the characteristics of expressing emotional empathy is attentive listening with emotionally empathic comments to someone’s personal experiences, such as saying, “Oh dear,” or, “How sad for you,” or sounds such as “Mmm” or “Tut tut.” There can also be body movements and gestures, such as nodding or shaking the head, or making a facial expression consistent with the feelings of the neurotypical in a particular part of the narrative. Neurotypical women in particular are expected to engage in such behaviour to indicate emotional empathy. However, the person with an ASD may be listening attentively to the story line, but not apparently giving an indication of empathy for the circumstances and experiences being described. This is especially conspicuous when women who have an ASD are listening to a conversation or story with a female companion, friend or family member. Again, this can lead to the neurotypical making the false assumption that the person with an ASD lacks empathy.

It is possible for those with an ASD to eventually, perhaps over decades, learn the subtle cues that indicate when an expression of empathy is required, and to recognize the depth and intensity of response expected by the neurotypical. Because it is a difficulty reading body language, and not an indication of a lack of ability to care or express compassion, the person with an ASD needs guidance and encouragement rather than criticism and rejection.