Does current evidence indicate that individuals with autism spectrum disorder (ASD) are not empathetic?

Empathy in Autism: What Current Evidence Actually Shows

Current evidence definitively refutes the outdated notion that autistic individuals lack empathy; instead, research demonstrates they experience a specific pattern of empathic disequilibrium characterized by intact or even heightened emotional (affective) empathy alongside reduced cognitive empathy, with substantial heterogeneity across individuals. 1, 2, 3

The Empathic Disequilibrium Model

The most recent and sophisticated research reveals that autism is not characterized by absent empathy, but rather by an imbalance between emotional and cognitive components of empathy:

Emotional (Affective) Empathy

• Autistic individuals demonstrate intact emotional empathy - the capacity to feel along with others' emotions - and many report experiencing excessive empathy that can be overwhelming 1, 2
• Young autistic children (ages 1-6) do not differ from non-autistic peers in experiencing emotional contagion and feeling along with others' negative emotions, according to longitudinal research 2
• A 2022 study of 1,905 autistic individuals found that empathic disequilibrium toward higher emotional than cognitive empathy specifically predicted autism diagnosis and social domain traits 1
• Autistic females show more prominent empathic disequilibrium patterns than males 1

Cognitive Empathy

• Cognitive empathy - the ability to understand and identify others' mental states - is consistently reduced in autism 1, 4, 3
• A 2024 study using the Textual Empathy Test demonstrated that high-functioning autistic individuals showed lower cognitive empathy ratings compared to controls, regardless of social distance (friend vs. stranger) 4
• This deficit overlaps substantially with impaired Theory of Mind, which represents difficulty inferring hidden mental states of others 5, 6

The Critical Role of Emotional Reactivity

Altered emotional reactivity mediates the relationship between autism and both empathic components, providing a mechanistic explanation for empathy differences 4:

• Autistic individuals show decreased emotional reactivity when imagining themselves in emotional situations 4
• This reduced emotional reactivity statistically mediates the impact of autism on both affective and cognitive empathy 4
• The difficulty is not indifference to others' feelings, but rather not knowing how to respond appropriately despite feeling emotions 2

Heterogeneity: The Empathy Heterogeneity Hypothesis

The most important clinical insight is that empathy manifestations in autism show far greater variability than in non-autistic populations 3:

• A 2025 study using the Perth Empathy Scale (N=239 autistic individuals) revealed that while mean differences exist, there is substantially greater heterogeneity of empathic tendencies within the autistic sample 3
• This heterogeneity means that group-level mean differences are not generalizable to all autistic individuals 3
• Some autistic individuals may have empathy profiles indistinguishable from or exceeding non-autistic peers 3

Developmental Trajectory and Potential for Growth

Autistic children demonstrate similar improvements in empathy skills over time as non-autistic children, providing evidence for learning potential 2:

• Longitudinal tracking of 1- to 6-year-old autistic children over 4 consecutive years showed parallel developmental trajectories to non-autistic peers 2
• While autistic children experienced more difficulty attending to others, acknowledging emotions, and initiating prosocial actions, they showed comparable improvement rates 2
• This indicates that autistic children have the capacity to learn and improve empathy skills with appropriate support 2

Clinical Implications and Common Pitfalls

What Clinicians Must Understand

• Avoid perpetuating the harmful stereotype that autistic individuals lack empathy - this mischaracterization can lead to social exclusion and misunderstanding 1, 3
• Recognize that difficulties in social interactions stem from impaired cognitive empathy and altered emotional reactivity, not from emotional indifference 4, 6
• The American Academy of Child and Adolescent Psychiatry emphasizes that autistic individuals have fundamental difficulty understanding "invisible" social rules and context, which is distinct from not caring 5

Assessment Considerations

• Use multidimensional empathy measures like the Perth Empathy Scale that separately assess cognitive and affective components 3
• Evaluate empathic disequilibrium patterns, not just overall empathy scores 1
• Consider that concrete and literal thinking patterns in autism affect how empathy is expressed, not whether it exists 5
• Screen for anxiety and sensory overload, which can interfere with empathic responding despite intact emotional empathy 7

Treatment Approaches

• Modified CBT with visualization helps autistic individuals understand the "invisible" social, cognitive, and emotional context that underlies appropriate empathic responses 5
• Social skills groups and social thinking curricula should focus on teaching how to express empathy rather than assuming empathy is absent 5
• Interventions must accommodate concrete thinking patterns and communication differences 5
• Early intensive behavioral interventions improve social-communicative outcomes when started early 8

Distinguishing Autism from Conditions with True Empathy Deficits

Autism must be differentiated from conditions characterized by genuine lack of emotional empathy 7, 5:

• Unlike antisocial personality disorder or conduct disorder, autistic individuals retain emotional empathy and concern for others 7
• The social impairments in autism arise from cognitive difficulties understanding social context, not from callousness or lack of caring 5
• Anxiety disorders can be differentiated because individuals with anxiety have developed social insight that is impaired in autism 7