Empathy in autistic children: Emotional overarousal in response to others' physical pain.

Li et al. (2024) watched autistic and neurotypical kids view pictures of people in pain. They tracked heart rate and pupil size to measure body stress. Kids also told the team how sorry they felt for the hurt person.

The study wanted to know if autistic children show less outward concern because they feel calmer or because they feel overwhelmed.

Autistic kids’ bodies were more stressed, yet they said they felt less sorry. Their hearts raced and pupils grew bigger, but their empathy scores stayed low.

The mismatch points to emotional overload, not lack of caring.

Szakal et al. (2026) pooled 34 studies and found the empathy gap is larger in autistic girls than boys. Tianbi’s data now show this gap starts early and comes with hidden body stress.

Zhao et al. (2019) saw the same pattern in adults: higher autistic traits meant lower prosocial acts because empathy was low. The child and adult lines match, showing the trait stays stable.

Heald et al. (2020) found no gaze differences when neurotypical adults with high autistic traits looked at emotional faces. That null result seems to clash with Tianbi’s child pain findings. The gap fades once you note M studied sub-clinical adults using eye tracking, while Tianbi tested clinical children during pain empathy. Different age, method, and task explain the seeming contradiction.

If a child looks flat while others are hurt, check for body stress, not coldness. Teach calming tactics first, then label and role-play caring words. Reduce noise, give wait time, and praise small signs of concern so the child learns to show empathy without overload.