Systematic instead of empathic

Many people with autism find it difficult to understand facial expressions and body positions of others. They are also usually unable to empathize with the meaning of the gaze, prior knowledge, thinking and assumptions of the interlocutor. In contrast, they show more interest in objects, facts, routines, rules, or systems than in the other person and social interaction.

- For example, Tim uses his mother's hand like an extension of his own to get to his beloved car on the shelf. He uses it like a tool and does not notice that it belongs to his mother. 

- Even in the pool, 4-year-old Daniel talks to his father about black holes and refractions of light, ignoring the other children's water play.  

- At recess, Tanja runs with her head down to the swings and often bumps into other children, ignoring them. 

- In the elevator is a very pregnant woman who is disgruntled by the 8-year-old Andre poking her belly and asking if a baby is in there. 

- Robert doesn't understand why his monologues about plumbing aren't catching on and his classmates are turning away from him.

- The adult Jens runs into stores to see where there is a cleaning room where he can find the beloved disposable gloves. In doing so, he completely ignores the perplexed facial expressions of the staff.

- When asked about the interview for the computer specialist, Stefan describes that there were chairs in the room and people sat down. He assumes that the other person has comparable images in his mind as he does and does not know what specifically may be relevant to the listener about his experience.

The list of examples could be continued endlessly, but it makes clear that some people with autism are not that interested in interactions and find empathy with others difficult. In contrast, they often have above-average abilities in recognizing patterns, rules and predictable processes. In this way, many people at the upper end of the spectrum have contributed to developments in technology, computer systems, engineering, or even art. They are considered "systematists." Things should be in the same place, specific procedures should be followed, and rules and morals should be implemented, even if it causes upset (Baron-Cohen, 2017).

Empathy Spectrum

In the population, empathy is distributed in a bell curve, with people with extremely low empathy at one endpoint and people of extremely high sensitivity at the other end of the distribution. 

Empathy genes

Research has confirmed that the neural empathy network develops on a genetic basis. In a study of 742 neurotypical twins, affective empathy was approximately 52-57% innate, while cognitive empathy was approximately 27% innate (Melchers et al., 2016). Thus, we can assume that the development of both affective and cognitive empathy can be influenced by both genetics and the environment. Here, early parent-child interactions or even early therapies can have a positive influence. Since empathy changes throughout life, it is also possible to make empathy with others a goal later in life and this can be true for people with autism as well.

In addition to a cognitive and an emotional side, motor empathy can also play a role. This includes imitating the other person such as synchronizing facial expressions, gestures, and body posture of the other person (Dziobek et al, 2008). These rely on mirror neuron activity, another important component of social and empathic behavior. It is directional that imitation and shared gaze are considered key behaviors for communication and social behavior. Therefore, they play a central role in early intervention for young children with autism and in later stages of life. 

Molly Wright Ted talk

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Seven-year-old Molly Wright spoke on this topic and it became the most popular talk in the popular TED Talk series, with 50 million views.

Certainly, one cannot draw a direct conclusion from little Molly's remarks about the development of personality disorders or the increase in autism in recent decades. As emphasized, genetic causes play an important role in the development of empathy. But the evidence hits a sore spot: that early interaction is central to healthy brain development and that it is often ignored. The general hectic pace and the ever-increasing media consumption often leaves no time for emotional exchange, interaction, and fantasy play. 

Therapy goal: Emotional empathy 

From the very beginning of our work with young children with autism in the Singapore Step program ("Structured Teaching for Exceptional Pupils"), empathetic interactions, mirroring facial expressions and body posture, exaggerated praise, and emotional learning were a core focus. What is the child's current state of mind and what are his/her interests and motivations? What is fun for him/her and what are functional learning goals? For example, language songs were used in circle games to encourage everyone to imitate a child's spontaneous movement.

Emotional reciprocity, motivating tasks, and emotional learning continue to be central components of good ABA/AVT programs. Here, the importance of feelings as well as taking a social perspective is increasingly emphasized. 

- Certainly, "heartless therapies" do little to promote children's emotional development. Mirroring the child, acting out pain, joy, fear, etc., and emotional responsiveness should be emphasized especially during the early critical periods of emotional development.

- Thus, ABA programs such as the Early Start Denver Model (ESDM, Rogers & Dawson, 2010) or Koegel and Schreibman's Pivotal Response Training (PRT training of key behaviors) use early childhood interaction games to build positive relationships. Sessions are built on the child's initiative with new goals introduced in small increments. 

- Comparable programs that use the ABA method of Verbal Behavior also have demonstrated good results. Therapists first try to develop a positive relationship with the child through "pairing." During the course of therapy they also address both the child's verbal and nonverbal behaviors and specifically expand on the child's initiative to communicate (Barbara & Rasmussen, 2007).

Therapy goal: Adopting the social perspective

It is not easy in therapy to separate training programs for emotional and cognitive empathy, and one may wonder whether the term "social empathy" should be sufficient (Dirlich-Wilhelm, oral communication). It also takes a lot of efforts to teach empathy, especially at later ages. On the other hand, cognitive empathy can be specifically stimulated and expected social behaviors can be demonstrated in a variety of social situations, thus making it easier to have positive interactions.

In addition to structured programs for recognizing and naming feelings, facial expressions, gestures, and social situations, role-playing with puppets and animals, as well as video modeling, can help move from the perspective of the "I" to that of a counterpart "YOU" 

- Taking the perspective of a doll that has fallen down and needs to be comforted, an animal that is hungry and needs to be fed, or even watering a wilting plant can help develop empathy.

- Integrated play groups have been developed for young children. Here so-called "expert children" develop collaborative games from the self-stimulations or unusual interests of the child with autism (Wolfberg, 2019). 

- Role-playing with other children or acting in a group of adolescents have also been shown to be helpful in moving from one's own internal view into the "shoes of another" (Stefonek, 2016). 
- The use of video modeling can also contribute to the training of social initiative, emotional expression, and communicative competence (Nikopoulos, 2021).

Cognitive behavior modification can also help through various strategies. This can focus on being stuck in a "Me-perspective”, irrational thoughts, and stress intolerance. 

- In our AutismConcrete-series Jed Baker has highlighted specific strategies and worksheets for learning empathic listening and empathizing with others' feelings (Baker, 2017).

- Joel Shaul has also offered visual aids through numerous free materials, videos, and games to help children and young adults ages 6 to 18 better understand and feel better about themselves and others (Shaul, 2020).

Certainly, saving the world through interaction games with young children is a naïve child's dream. However, emphasizing early childhood interaction, empathy, and emotional intelligence in therapy, education, and certainly policy is central to a content life and peaceful coexistence. Observation, questioning, and empathy with the other person should be a must for ABA and cognitive therapists. This is a good basis for feeling understood by children, adolescents and adults with autism. 

It is possible that individuals who are on the autism spectrum like Greta Thunberg can also be leaders. And even 7-year-old Molly Wright with her admirable commitment to the importance of early childhood interaction can be thought-provoking.

The following example shows that targeted training can make communication easier for people with and without autism:  

- A youngster with autism talks enthusiastically about his fascination with stalactite caves and notices just in time that his conversation partners are giving each other bored looks. His spontaneous comment: "Oh dear, that was "Me-talk" and I wanted to do "You-talk"", which is surely a good lesson for many of us!

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