Home Health Care Strategies for Helping Clients With Autism Learn Empathy

Strategies for Helping Clients With Autism Learn Empathy

by Kylie Grace Davis
written by
little boy comforting friend

I recently read a book recommended by our elementary school counselor called, “Unselfie: Why Empathetic Kids Succeed in Our All-About-Me-World.” The premise of the book says society is becoming less empathetic and more self-absorbed. The author, Michele Borba, EdD, calls this the selfie syndrome.

Borba describes nine essential empathy habitsemotional literacy, moral identity, perspective taking, moral imagination, self-regulation, kindness, collaboration, moral courage and leadership—which educators and caregivers can develop and nurture in children to instill in them the “empathy advantage.” The book presents various empathy-building activities to help kids connect and feel with others. Borba says cultivating empathy leads to raising successful, resilient kids and the foundation for empathy is face-to-face human connection.

“Unselfie” speaks primarily to parents and educators, but I found numerous applications for SLPs. As I read, I thought about the layers upon layers of cognitive-communication skills involved in developing empathy. The skills required to communicate empathy go beyond basic expressive and receptive language. Joint attention, theory of mind, executive function, emotional regulation and social language are all vital parts of communicating empathy.

A few of the Essential Empathy Habits described in the book stood out to me and best exemplify how closely cognitive-communication skills interrelate with putting empathy into practice:

  • Emotional literacy: the ability to recognize and understand the feelings and needs of yourself and others.
  • Perspective taking: stepping into others’ shoes to understand their feelings, thoughts and views.
  • Self-regulation: the ability to manage strong emotions and reduce personal stress to help others.

Sound familiar?

Emotional literacy begins with joint attention, an important developmental step in the acquisition of basic speech and language skills. This requires a child to coordinate their attention with others to share emotion, attention and intention. Joint attention teaches children the importance of communication, when and where to look for social cues and how to read others’ facial expressions.

Joint attention goes hand-in-hand with development of theory of mind: the ability to recognize that other people have thoughts and ideas different from our own. Theory of mind allows us to understand our communication partners’ ideas, feelings and perspectives, and ultimately respond in thoughtful, meaningful ways.

Taking others’ perspectives into consideration is also a part of executive function. Executive function skills involve deliberately planning and executing our words, actions and behaviors. Executive function activates the thought processes behind self-regulation, such as thought organization, strategic thinking, problem solving and mental flexibility. These kinds of insight help our students to regulate their emotions by observing others and reflecting on their own actions to appropriately modify their behavior.

As SLPs, we know these skills are underdeveloped in students with autism spectrum disorder. Empathy building activities present huge challenges for students with autism because they first need to understand shared attention and perspective taking. Students with autism may not identify nonverbal social cues so showing and sharing emotion through facial expression and body language can be difficult. Consequently, peers may perceive kids with autism as disinterested or unsympathetic.

As concrete thinkers, students with autism often need explicit instruction in feeling vocabulary—happy, sad, excited, disappointed, anxious—and visuals to illustrate social events and ideas—loss, change, friendship and relationship. Regulating emotions requires students with autism to use complex, sometimes abstract, executive functions. Experiencing strong emotions, without the right cognitive tools to manage them, can result in impulsivity, stress, dysregulation and often, isolation from their peers—the exact face-to-face interaction imperative to practicing empathy.

We know the important role that empathy plays in our students’ success and quality of life. We’ve identified some of the necessary cognitive-communication skills required for students to develop and effectively communicate empathy. Students with autism find many of these skills challenging.

What strategies can we use to help these students communicate their feelings and understand others’ feelings? For students who want to connect and feel with others, but don’t know how, what tools can we give them? What visual supports and social stories can we use to explain what it means to be empathetic? How can we use what we already know about autism intervention, such as using explicit instruction and positive reinforcement, to nurture empathy?

As SLPs, how can we give our students with autism the empathy advantage?


Kylie Grace Davis, MS, CCC-SLP, works for the Montrose County School District in western Colorado. Her previous clinical experience includes skilled rehabilitation services, mobile modified barium swallow studies and tracheostomy management in long-term acute care hospitals in Denver. kylie.davis@mcsd.org




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Amanda April 6, 2017 - 6:29 pm

I absolutely agree that these skills are part of building empathy, and children with ASD can partially learn some of these skills through explicit teaching, but I also think there needs to be implicit and natural learning of these skills for them to truly take hold in any child. In my opinion, that means extinguishing competition in learning environments and instead stressing cooperative learning, getting rid of rewards and punishments and fading cues, scripting, and prompts as soon as possible. And above all, children must be shown complete and deep empathy in order to develop it. I don’t think that is happening frequently enough in our systems as so much of it seems consequence-based.

Alex April 8, 2017 - 5:16 pm

As an autistic person myself, I completely disagree with the idea of “extinguishing competition in learning environments.” I agree with the good intentions behind it, but it has caused just as many problems as it has solved. Competition is a fact of life and always will be, and we need to prepare people for it.

Instead of trying to get rid of competition entirely, just maintain a healthy balance between competition and cooperation. Teach kids that all people have inherent dignity and worth whether they win or lose any particular competition. That the winner today might be the loser tomorrow, and the loser today might be the winner tomorrow. That a person who doesn’t win in one area of life might win in another area of life.

And the thing is, if you get rid of competition in education, you inherently lose the ability to teach all the values I mentioned above.

Kylie April 10, 2017 - 12:27 pm

Amanda, I really appreciate your focus on scaffolding to support independence and generalization of skills. That’s so important! Thank you for sharing the strategies that you find helpful!

Alex April 8, 2017 - 6:03 pm

Also, to answer the broader question being asked in the original post, explicit learning is definitely key. I agree with Amanda’s point above that ultimately there needs to be implicit and natural learning as well, but sometimes we can just be totally oblivious until things are explicitly explained to us to get the ball rolling.

I feel like whatever progress I made between age 3 when I was diagnosed and age 13 when I no longer had an IEP was owing to my parents and my O.T’s. I don’t remember specifically what we did but when I think of my growth in these areas I associate it with the OT’s that I had more so than the SLP’s. But I’m glad you’re asking these questions because SLP’s can certainly be helpful in reinforcing what parents and other professionals are doing.

Kylie April 10, 2017 - 12:16 pm

Thanks Alex! I really appreciate your insights!

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