An Intervention to Improve Empathic Communication in Children with Autism Spectrum Disorder: a Randomized Controlled Trial

Autism Spectrum Disorder (ASD) is associated with impaired understanding of others’ feelings and thinking, a process known as cognitive empathy. Although there is evidence showing relatively intact affective empathy in individuals with ASD, they generally do not demonstrate the typical empathic verbal expressions, facial expressions, and body language when responding to others’ emotions in line with the social norm (Fletcher-Watson & Bird, 2020). Empathic communication is, however, crucial for building close interpersonal relationships. The majority of individuals with ASD face difficulties in building relationships. And importantly, recent studies have shown that loneliness is a significant predictor of mental health problems such as anxiety and depression among individuals with ASD (Schiltz et al., 2020).

Given that empathic communication may facilitate the building of social relationships, which may in turn improve mental health, the proposed study aims to examine the effectiveness of empathic communication training for children with ASD, and the impact on their social life and mental health. A review of the literature demonstrated that while there are quite a lot of training programs aimed at improving emotion recognition among children with ASD, there is a lack of intervention targeting empathic communication for that population. Some studies based on the Theory of Mind and play-based intervention, such as the Early Start Denver Model, were effective in improving empathic responses (Dawson et al., 2010; Holopainen et al., 2018). Many of these studies, however, are single-case studies or studies with a small sample size.

The proposed study will examine the effectiveness of empathic communication training with an experimental design and a sample size with sufficient power. The intervention will apply visual framework instruction to teach empathic responses, and video feedback will be given to participants to improve their usage of verbal responses and questions to express empathy during conversation with others. To assess the effectiveness and outcomes of the intervention, multiple methodologies will be applied. The outcome measures include observers’ evaluation of empathic responses during conversation, skin conductance measures of empathic emotional arousal, parents’ reports of trait empathy, and children’s verbal responses in a story task. The long term impact on participants’ social relationships and mental health will be assessed by a follow-up assessment one year after the intervention. It is hoped that learning the social norms of how to express empathy with verbal expression while interacting with others would improve the social life and well-being of children with ASD.