This item is intended to tap early empathy. Empathy refers to “the interpersonal sharing of emotional states brought about by knowledge or observation by one person of the other person’s experience or emotional state” (Hutman & DaPretto, 2009, p. 367). Early empathy (a.k.a.‘emotion contagion’ or ‘primitive emotion contagion’) is sometimes called “the first level of empathy” (Rieffe, Ketelaar, & Wiefferink, 2010, p. 362). Early empathy emerges in infancy and continues until about age one year and refers to the infant’s ability to orient to the distress of others, often responding with their own distress cries (e.g., Zahn-Waxler & Radke-Yarrow, 1982). After the first year, children’s behavior begins to change as they “start to show helping behavior, even when they have become distressed. They also imitate the distress behaviors of others, possibly ‘trying on’ the expressions to better understanding them” (Preston & de Waal, 2002, p. 1).By the middle of their second year, children respond with sympathetic concern rather than distress cries to simple pain and distress in others, “but it is not until the later preschool years that children can infer [others’] emotional states from knowing about the particular events that another experiences, from the contexts in which the events occur, and from knowledge of an individual’s history and preferences” (Brownell, Zerwas, & Balaram, 2002,p. 28). Consequently, early empathy (as seen in infancy), and the later emerging and more complex ‘true’ empathy (see description of item 34)are profoundly different in nature and process and should not be confused. As Lewis (2002) explains:

“Infants exhibit behaviors that appear empathic. These behaviors are predicated on social contagion rather than on cognitions…This developmental sequence, going from social reflexes, such as social contagion, to cognitions, such as self-representation, constitutes an important shift in the human child’s development…in development we have evidence for two processes: one, an immediate prewired and species-specific process: the other, a delayed process requiring experience and higher mental functions” (p. 42).

Given the developmental timetable with which early empathy is evidenced, there is good justification for its construal as an Early theory of mind competency. Social theorists appear to agree that a primary function of early empathy is to help individuals form and maintain social bonds (and with regard to infancy, the mother-infant bond is generally invoked; Anderson & Keltner, 2002; Preston & de Waal, 2002). Early empathy and the emerging helping behaviors seen at the end of infancy and into the second year of life tend to co-occur with the onset of cooperative play (Brownell et al., 2002) and other cognitive milestones including self-awareness and agency (Hutman & DaPretto, 2009).

Early Empathy in ASD

Most research examining early empathy (and emotion contagion) in ASD concludes that,compared to neurotypical samples, children with ASD are impaired in their behavioralresponses to signals of emotional distress (Charman et al., 1997; Scrambler, Hepburn, Rutherford, Wehner, & Rogers, 2007; Sigman, Kasari, Kwon, & Yirmiya, 1992). At the same time(and note that this research was not conducted on infants), a few studies of high functioning children (Blair, 1999; for review see Blair, 2008) and adolescents and adults (Hadjikhani et al., 2014) have found no differences between individuals with ASD andneurotypical controls in their levels of affective arousal (as measured by ectodermal response or brain imaging)to stimuli depicting emotional distress. In fact, since the late 1990s, the prevailing view among researchers has been that a lack of an appropriate (ora more muted) behavioral response in ASD to distress displays is not due to lack of a physiological response or affective arousal but rather to a deficit in cognitive and affective understanding. This should not be taken to mean that children with ASD do not have an empathy deficit. What it means is that empathy, especially the later emerging ‘true’ empathy (see description of item 34), is complex and multifaceted and can, thusly, be variably affected within and across individuals.

With regard to overt behavioral reactions to other’s distress among young children with ASD, a more muted response is correlated with higher autism severity (Scrambler et al., 2007) and greater impairment in early imitation and joint attention (Charman et al., 1997). From a prognostic standpoint, disruptions in later emerging (true)empathy are most severe in individuals who have ostensible problems in infancy (Preston & de Waal, 2002; although one exception is regressive type ASD which tends to carry a poor prognosis). This underscores the importance of early identification and treatment of ASD-related signs and symptoms early in development.

Early Empathy in ADHD

We are not aware of peer-reviewed literature examining early empathy (i.e., emotion contagion) in ADHD. To report literature in this area, please contact the authors at . For information regarding true empathy in ADHD, see description of item 34.

Early Empathy in DoHH

We are aware of only one study that has examined early empathy in oral or late-signing children who are DOHH. Hutchins, Allen, and Scheffer (in preparation) examined early empathy using caregiver report (i.e., The Theory of Mind Inventory-2) in a small sample (n = 12) of children with corrected hearing loss (primarily CI). According to caregiver-report, 33% of the children obtained scores for early empathy that fell in the clinical range. Hutchins et al. also found that age of implantation was negatively correlated with theory of mind competency which suggests developmental delay related to decreased opportunities to participate and learn from social exchanges that are required for the development of theory of mind.

REFERENCES

Anderson, C., & Keltner, D. (2002). The role of empathy in the formation and maintenance of social bonds. Behavioral and Brain Sciences, 25, 21-22.

Blair, R. (2008). Fine cuts of empathy and the amygdale: Dissociable deficits in psychopathy and autism. The Quarterly Journal of Experimental Psychology, 61(1), 157-170.

Blair, R. (1999). Psychological responsiveness to the distress of others in children with autism. Personality and Individual Differences, 26, 477-485.

Brownell, C., Zerwas, S., & Balaram, G. (2002). Peers, cooperative play, and the development of empathy in children. Behavioral and Brain Sciences, 25, 28-29.

Charman, T., Swettenham, J., Baron-Cohen, S., Cox, A., Baird, G., & Drew, A. (1997). Infants with autism: An investigation of empathy, pretend play, joint attention, and imitation. Developmental Psychology, 35(5), 781-789.

Hadjikhani, N., Zurcher, N.,Rogier, O., Hippolyte, L., Lemonnier, E., Ruest, T., et al., & Gillberg, C. (2014). Emotional contagion for pain is intact in autism spectrum disorders. Translational Psychiatry, 4, doi:10/1038/tp.2013.113

Hutman, T., & DaPretto, M. (2009). The emergence of empathy during infancy. Cognition, Brain, and Behavior: An Interdisciplinary Journal, 8(4), 267-390.

Lewis, M. (2002). Empathy requires the development of self.Behavioral and Brain Sciences, 25, 42.

Preston, S., & de Waal, F. (2002). Empathy: Its ultimate and proximate bases. Behavioral and Brain Sciences, 25, 1-72.

Rieffe, C., Ketelaar, L., Wiefferink, C. (2010). Assessing empathy in young children: Construction and validation of an Empathy Questionnaire (EmQue). Personality and Individual Differences, 49, 362-367.

Scrambler, D., Hepburn, S., Rutherford, M., Wehner, E., & Rogers, S. (2007). Emotional responsivity in children with autism, children with other developmental disabilities, and children with typical development. Journal of Autism and Developmental Disorders, 37, 553-563.

Sigman, M., Kasari, C., Kwon, J., & Yirmiya, N. (1992). Responses to the negative emotions of others by autistic, mentally retarded, and normal children. Child Development, 63, 796-807.

Zahn-Waxler, C., Radke-Yarrow, M. (1982). The development of altruism: Alternative research strategies. In N. Eisenberg (Ed.), The development of prosocial behavior (109-137). New York: Academic Press.

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