This interview with Sharon Koczaja, L.C.S.W.-R, Q.C.S.W., B.C.D., discusses why autism social skills training is so important for individuals on the Autism Spectrum developing empathy.
Q: Why do high functioning individuals on the Autism Spectrum have difficulty with empathy?
A: Autism is often characterized by a deficit in empathetic functioning. (S. Baron-Cohen, 2002) Abnormal neural connectivity has been offered as an explanation for this and other abnormalities seen in autism. (M. Belmonte, et al,. 2004) As early as 20 months of age, children with autism were found to be delayed in some aspect of empathy. (T Swettenham et al., 1997) While many higher functioning people with an Autism Spectrum Disorder may be able to experience affective empathy (identification with the emotions of another person) once they understand how that person is feeling in a particular situation, their cognitive ability to read others’ social cues and know how to respond often lags. This may be exacerbated by sensory processing challenges (such as difficulty filtering out background noise during a conversation), a rote rather than a dynamic learning style which makes it difficult for our students to generalize from one rapidly shifting interpersonal interaction to another or by a difficulty decoding the nonverbal aspects of communication.
Q: What are some examples where these individuals have difficulty reading social cues?
A: Here are a few examples.
A boy whose father was hospitalized and having major surgery required additional support during the school day. A classmate, lacking in empathy, yelled “How come he gets all the attention? It’s not fair!”
A boy whose dog had to be euthanized in the past feels sad when a classmate cries because his pet died, and approaches that classmate to express condolences and even share his own similar experience. However, a week later the same boy screams at the same classmate to “shut up” when the classmate cries after failing a spelling test, because this time he doesn’t recognize that the classmate is feeling the same frustration that he himself would experience in that situation.
Q: How does this deficit affect success with social interactions?
A: If a person with an Autism Spectrum Disorder responds with a facial expression or voice tone which is out of sync with what another person has just expressed, he or she may be perceived as indifferent or unfriendly. Statements that minimize or invalidate what another person expresses can result in that person feeling misunderstood, hurt, or annoyed and not wanting to continue a friendship. Social isolation may result which can lead to the co-morbid conditions of depression or anxiety.
Q: What are some specific techniques and strategies for teaching empathy to individuals with ASDs?
A: It is important to begin by helping students recognize their own emotions and why it is important to connect with the feelings of others. We must focus on teaching skills such as inferring the contents of others’ minds and seeing things from others’ viewpoints.
We can use photos of people portraying various emotions, mirrors, or icons of faces depicting feelings to help students develop emotional recognition skills from facial expression, body language, and voice tone. Playing charades and the guided viewing of silent movie clips can be entertaining ways to guess what actors are feeling. Social skill sheets or scripts about recognizing and showing understanding for others’ feelings can be particularly effective teaching tools when combined with contextual stories and role play during social skills groups. Talking and drawing about a specific interpersonal interaction can help our students with processing emotions and taking others’ perspectives. Cognitive behavioral board games and activity books can be fun, dynamic tools for teaching empathy skills to children on the spectrum.
Q: What kinds of materials and resources are available to teach empathy skills?
A: Some of the many resources designed to teach empathy include:
- Dr. Simon Baron-Cohen's "Mind Reading" (interactive computer program)
- Dr. Jed Baker's skill sheet on empathic listening and showing caring for others
- Dr. Tony Attwood's "CAT-kit" (emotions icons)
- Dr. Richard Gardner's "The Helping, Caring and Sharing Game"
- Dr. Playwell's "Caring About Others' (game)
- Mary Anne McElmurry's "Caring: Learning to Value Yourself, Family, Friends and School"
In our clinical work with this population, Dr. Carol Gray’s ” Comic Strip Conversations” (a technique that incorporates speech and thought bubbles and color-coded emotions into a series of stick figure drawings of actual interactions which can be processed grid by grid) can be particularly effective with teaching our students to recognize their own and others’ emotions and to take others’ perspectives. Michelle Garcia Winner has developed the ILAUGH Model of Social Cognition providing a framework to explain the multiple skills and concepts that must mastered to in order to succeed at social interaction and personal problem solving.
Q: Can people who are on the Autism Spectrum improve in their empathy skills?
A: Empathy is a complex emotional state which involves several component skills (G. Dewar, 2009):
- A sense of self awareness and the ability to distinguish one’s own feelings from another’s.
- Taking the other’s perspective.
- Being able to regulate one’s own responses.
We have been pleased with the success our students can achieve when sequential instruction is carefully presented in each of these areas. Students' mastery needs to be demonstrated across settings , in school, home and the community. Students with autism can grow in their ability to read body language, facial expression and tone of voice while paying attention to contextual cues, inferring others’ mental states, taking others’ perspectives, and demonstrating recognition and understanding of others’ feelings. Mastering these skills have a direct correlation to the opportunity to live a socially more fulfilling life.
About Sharon Koczaja, Licensed Clinical Social Worker, Board Certified Diplomat in Clinical Social Work from Center for Spectrum Services.
Sharon Koczaja, L.C.S.W.-R, Q.C.S.W., B.C.D. is a New York State Licensed Clinical Social Worker, Certified School Social Worker, and Board Certified Diplomat in Clinical Social Work. She holds Qualified Clinical Social Worker and School Social Work Specialist credentials, and is a member of the Academy of Certified Social Workers. Ms. Koczaja has 30 years of experience doing psychotherapy with individuals, families, and groups in settings in mental health clinics, day treatment programs, and residential programs. For the last 23 years, Ms. Koczaja has been employed by Center for Spectrum Services where she serves as a Family Service Coordinator providing family counseling and support services to parents of enrolled students. Ms. Koczaja is also a therapist through the Spectrum Services Clinic and in the Center-based School Program providing individual counseling and social skills groups for people of all ages with Autism Spectrum Disorders.
Center for Spectrum Services is a not-for-profit program serving the autism community in New York’s Mid-Hudson Valley. Day schools in Kingston and Ellenville, New York provide state-of-the-art classes utilizing research-based practices. Community-based services provide evaluations for preschoolers and therapy services in home. Spectrum Services Clinic offers comprehensive evaluations for Autism Spectrum Disorders, trainings, consultations, after-school social skill groups and counseling. For more information visit www.centerforspectrumservices.org.