Empathy spectrum and how to develop emotional and cognitive empathy

Vera Bernard-Opitz

It is obvious that empathy covers a wide spectrum. Time and again, we encounter people who seem to have no empathy for others - spreading hate speech on the internet, bullying and inflicting suffering in schools, workplaces, and politics. One wonders where the empathy has gone. Fortunately, in contrast, there are people who do everything they can to make life easier for others, whether in private relationships or as an outreach for social or societal improvement. But what is the neurological basis of empathy, and what about empathy in people with autism? Is it true that people with autism don't have feelings for others, or is that a myth and they are actually empathetic? What can be done if some of them find it difficult to empathize with others? 


In MRI studies well-known autism researcher Simon Baron-Cohen of Cambridge University has found that empathy areas are activated differently in different clinical groups. According to his clinical observations and MRI studies, he describes two sides of empathy:


1) Affective empathy: empathizing, noticing the other person's sensations in addition to one's own feelings.

2) Cognitive empathy: empathizing with someone, perceiving their point of view, their perspective on things, and seeing the world from their perspective.


According to his research, there are clear differences between these two neurological networks in people with autism and people with personality disorders. While those affected with autism show affective empathy, this is insufficiently developed in people with personality disorders. In contrast, the reverse is true for cognitive empathy, where neural networks show less activity in individuals with autism than in those with personality disorders (Baron-Cohen, 2017). Other researchers have found that alexithymia, which is a reduced ability to identify and describe one’s own emotions, can be observed in subgroups of individuals with autism.  These individuals lack an inner life and cannot relate to their own or other feelings.  Brett & Maybery recently (2021) summarized the intensive debate on empathy in autism and the role of alexithymia.

Strengths in affective empathy 

Baron-Cohen points out that participants with autism reacted emotionally to situations in which people were suffering: for example, when shown a hand being struck by a piano lid. According to MRI scans, their empathy area responds to photos of such pain situations with activation. This corresponds to everyday observations: Often, even young children with autism try to comfort or help others. Also at later ages, many of them show compassion. It does not seem to be their intention to disappoint or hurt others even when showing problem behaviors. According to the above research the myth that all individuals with autism are without emotional empathy does not hold true. 


On the other hand, there are adolescents and adults who complain that they have few feelings and therefore cannot easily understand emotions nor empathize or sympathize with others. They also have difficulties talking about feelings and social relations. Some parents describe the lack of empathy as a painful shortcoming. 

  • When trying to elicit an emotional response to an unfortunate incident, one client asked:  "Why do I need to know this?" 


The question arises if this client belongs to the subgroup of affected individuals who are comorbid for alexithymia. An alternative explanation could be that he may have lost his affective empathy due to childhood trauma (such as severe mobbing). Can empathy can be lost through negative life events and can it be revived through therapy?

Problems with cognitive empathy

It may be easier to target cognitive empathy as a developmental goal. From the first year this usually develops in stages. For example, toddlers with autism often only point to liked objects or activities (so-called "protoimperative pointing"), but do not point to alert others (so-called "protodeclarative pointing"). They indicate interest regarding their own needs (manding), but tend not be interested in describing and reporting to others (tacting). In contrast, neurotypical children alert, describe and report. They intuitively know that their interaction partner has not seen something interesting, so they point or even make sounds to attract attention. This is a good starting point in communication training for young children with autism. Older children with more severe impairment can also benefit from overcoming their restricted communicative functions through these specific exercises. 


Using the well-known ToM test (Theory of Mind), it became clear that neurotypical children as young as 4 years old can imagine to be someone else with different knowledge than their own. For children with autism, it is difficult to envision themselves into someone else's perspective even at older ages (Korkmaz, 2011).  

- For example, young children cannot hide properly because they do not take into account that the other person sees them, even if they cover their eyes or that the other children know where they have hidden before.

- Even for older children and adolescents, lying, deceiving someone, being ashamed, or keeping a secret are often only possible after specific instruction. 

- The same is true for interests, fascinations, and opinions, which many people with autism assume everyone must also share. 

- Conversations are also heavily dependent on considering the prior knowledge, opinions, and interests of the other person.  Here, too, there is often a need to prevent exclusion and misunderstanding.