Empathy deficits, callous-unemotional traits and structural underpinnings in autism spectrum disorder and conduct disorder youth.
Check for callous-unemotional traits before labeling an autistic teen as unempathetic—autism alone mainly affects cognitive empathy, not the ability to care.
01Research in Context
What this study did
The team scanned and tested 94 boys . Half had autism, half had conduct disorder, and 24 typical boys served as controls.
Each teen filled out two short forms: one on empathy, one on callous-unemotional (CU) traits. CU means low guilt and shallow emotions.
MRI scans measured thickness in brain areas linked to empathy. The goal was to see if CU traits explain why autistic youth often score low on empathy tests.
What they found
After removing the effect of CU traits, autism still showed its own empathy fingerprint. Autistic teens had lower cognitive empathy—understanding others’ thoughts—yet their emotional empathy—sharing feelings—stayed intact.
Conduct-disorder teens with high CU traits had the lowest empathy scores and the thinnest empathy-related cortex. Brain structure matched behavior only when CU was high.
How this fits with other research
Dziobek et al. (2008) first split empathy into thinking versus feeling in adults with Asperger’s. They also found intact emotional empathy, so Tkalcec et al. (2023) now show the same split holds in autistic teens once CU traits are removed.
Stagg et al. (2022) showed autistic adolescents miss hidden emotions when context is added. Antonia’s team extends this by showing the empathy gap is real but narrow—only the cognitive side lags, and CU traits can magnify it.
MacFarland et al. (2025) removed ADHD noise to spotlight sensory issues. Antonia uses the same tactic—removing CU noise—to reveal autism-specific empathy patterns.
Why it matters
When you see low empathy scores in an autistic teen, run a quick CU screener. If CU is high, target guilt and perspective-taking together. If CU is low, teach cognitive empathy skills while building on their intact emotional empathy. This keeps you from over-pathologizing autistic social style and guides sharper, kinder goals.
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02At a glance
03Original abstract
Distinct empathy deficits are often described in patients with conduct disorder (CD) and autism spectrum disorder (ASD) yet their neural underpinnings and the influence of comorbid Callous-Unemotional (CU) traits are unclear. This study compares the cognitive (CE) and affective empathy (AE) abilities of youth with CD and ASD, their potential neuroanatomical correlates, and the influence of CU traits on empathy. Adolescents and parents/caregivers completed empathy questionnaires (N = 148 adolescents, mean age = 15.16 years) and T1 weighted images were obtained from a subsample (N = 130). Group differences in empathy and the influence of CU traits were investigated using Bayesian analyses and Voxel-Based Morphometry with Threshold-Free Cluster Enhancement focusing on regions involved in AE (insula, amygdala, inferior frontal gyrus and cingulate cortex) and CE processes (ventromedial prefrontal cortex, temporoparietal junction, superior temporal gyrus, and precuneus). The ASD group showed lower parent-reported AE and CE scores and lower self-reported CE scores while the CD group showed lower parent-reported CE scores than controls. When accounting for the influence of CU traits no AE deficits in ASD and CE deficits in CD were found, but CE deficits in ASD remained. Across all participants, CU traits were negatively associated with gray matter volumes in anterior cingulate which extends into the mid cingulate, ventromedial prefrontal cortex, and precuneus. Thus, although co-occurring CU traits have been linked to global empathy deficits in reports and underlying brain structures, its influence on empathy aspects might be disorder-specific. Investigating the subdimensions of empathy may therefore help to identify disorder-specific empathy deficits.
Autism research : official journal of the International Society for Autism Research, 2023 · doi:10.1002/aur.2993