Stop Hurting Start Helping. Empathy in children with disruptive behavior, attention-deficit and autism spectrum disorders

To date, various psychiatric disorders such as disruptive behavior, attention-deficit/hyperactivity and autism spectrum disorders have been associated with deficits in empathy in school-aged children and adolescents. In this dissertation, behavioral and physiological measures were used to study empathy in 6-7 year old children with disruptive behavior (DBD), attention deficit/hyperactivity (ADHD) and autism spectrum disorders (ASD). A better understanding of the nature of empathy deficits in children with psychiatric disorders ultimately may help in better differentiating between children with these disorders and may serve as a guidance for developing novel treatment approaches. First, it was demonstrated that facial mimicry, as a psychophysiological marker of empathy, can be reliably assessed using facial electromyography. Children aged 6-7 years old showed emotion-specific facial EMG activity following the presentation of happy, angry, fearful and sad expressions. Second, with regard to empathy in children with DBD and ADHD inconsistent results were found. Teachers reported reduced affective empathy in response to sadness and distress in children with DBD as well as in children with ADHD. Parents, however, did not report empathy deficits of their child. Children with DBD or ADHD showed no deficits in facial mimicry, nor in their self-report of empathic feelings in response to sad story vignettes. Finally, empathy induced prosocial behavior in response to sadness and distress was assessed with a computer task; results suggest that impairment in children with a diagnosis is related to symptoms of DBD rather than to symptoms of ADHD. Third, an attempt was made to explore empathy in response to sadness and distress of others assessed with multiple measures as a risk factor in the persistence of proactive aggressive behavior. In order to obtain sufficient variance in proactive aggressive behavior, children with ADHD and DBD were combined with typically developing (TD) children. At baseline, low levels of parent-reported empathic traits in response to distress of others were associated with high parent-reported proactive aggression. Similarly, teacher-reported empathy was negatively related to teacher-reported proactive aggression. At follow-up one year later, a higher level of parent-reported empathy at baseline was associated with a relatively larger decrease in parent-reported proactive aggression. However, no associations were found between pro-active aggression and empathy assessed with any of the three paradigms in children. Finally, results show that 6-7 year old children with ASD have deficits in fear recognition and fear mimicry, but only when they have severe deficits in social responsiveness. In line with the empathy imbalance theory, lower levels of parent- and teacher-rated cognitive empathy were found, and similar levels of affective empathy in children with ASD compared to typically developing children. Prosocial behavior in response to distress signals of a peer was similar in ASD as in TD children. Taken together, some questions have been answered and new questions have been raised regarding empathy in children with psychiatric disorders. Some directions have been provided for further study on how we can stimulate empathy and provide environments and treatments that help children in clinical population to hurt less and help more