Autism and LGBT identities

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Autism_and_LGBT_identities

Current research indicates that autistic people have higher rates of LGBT identities and feelings than the general population. A variety of explanations for this have been proposed; The Lancet's "Commission on the future of care and clinical research in autism" commented that it "might be part of a different concept of self, less reliance on or reference to social norms, or part of a neurodiverse lived experience of (and outlook on) the world." While autistic people are more likely to be non-heterosexual than the general population, the majority of autistic people are heterosexual.

Early studies and limitations

Early claims that autistic people lack a sex drive or desire for sexuality have been regarded as an inaccurate and negative stereotype. These claims were a result of methodological problems. More recent evidence indicates that most autistic people express an interest in both romance and sexuality.

Autism and sexual orientation

Most autistic people are heterosexual. However, it has been noted that autistic people are less likely to identify as heterosexual than their non-autistic counterparts. Some attempt to explain this as part of an association between autism, prenatal hormones and sexual orientation. That is not the only proposed explanation, however. Studies on sexual orientation and autism suggest that more autistic people have homosexual and bisexual feelings compared to the general population. Studies have indicated higher incidence of asexuality among autistic people, though a 2019 review article stated that this "should be interpreted with caution, bearing in mind the difficulty of establishing social relations in persons with ASD." Similarly, a survey of asexual individuals found that about 7% to 8% of respondents had acquired an autism diagnosis, approximately 4 times larger than the American population estimate.

A 2020 review that included the topic of autism and sexual orientation in academic literature said it was a "common theme" for autistic individuals to question their sexuality. While it is suspected that non-heterosexual orientation is more common in autistic people, the exact percentages have frequently varied from study to study. The increased incidence of non-heterosexuality in the autistic population is present when measuring for self-reported sexual orientation, sexual behavior, and sexual interests alike.

Some studies have indicated that autistic women have higher rates of non-heterosexual orientation than autistic men do. This was also corroborated by an online survey conducted by the University of Cambridge and published in Autism Research. That survey suggested that autistic women had a wider range of sexual identification than both their non-autistic counterparts and autistic men. Younger respondents had a higher likelihood for reporting themselves as homosexual than did older respondents.  According to a 2021 review, some studies indicated that autistic females were about three to four times as likely to identify as bisexual, when compared to non-autistic females.

Some autistic people who participated in sex education programs have reported that more information about non-heterosexuality in these programs would have better assisted their needs. However, while a report in the Journal of Autism and Developmental Disorders characterized this as an issue that affected autistic individuals, it stated that information about sexual orientation (and gender identity) was "severely lacking" within sex education programs for the general population as well, in the United States. Autistic people may also be more tolerant towards homosexuality, according to some initial research. A 2018 study suggested that individuals with a higher Broad Autism Phenotype (BAP) had a higher likelihood of same-sex attraction.

Autism and gender identity

Gender dysphoria is a diagnosis given to transgender people who experience discomfort related to their gender identity. Some studies have shown that autistic children may be more likely to experience gender dysphoria. There are also other studies that describe other possible causes or explanations for these diagnosis.

While scientific literature is filled with case studies of autistic children with gender dysphoria, including boys and girls, the first study to assess the convergence of gender dysphoria and autism was not published until 2010. Researchers in the Netherlands examined 129 children and adolescents who were diagnosed with gender identity disorder (GID under DSM-4 diagnosis) in 2010, finding that 4.7%, that being 6 individuals, were also diagnosed as autistic. In another study, from December 2011 to June 2013, over half of the 166 young adults referred to the NHS Gender Identity Development Service were assessed as autistic. In March 2014, researchers from the Children's National Medical Center, Arcadia University, and National Institute of Mental Health, assessed gender diversity in autistic children, and found that those who were autistic were 7.59 times more likely to be gender diverse than those who were not autistic. One of the study's authors, psychologist John Strang, argued that children were more likely to be gender non-conforming because they were not as "worried about what people thought" as those who were older and were not noticing "the social expectations or the social biases" toward transgender people. Finn V. Gratton, a specialist in both autism and transgender topics, similarly suggested in 2019 that, "Research finds that autistic resistance to social conditioning appears to play an important role in the incidence of transgender identity. If this is true, then autistic rates of transgender incidence may represent true rates in the human population—rates which are suppressed in the neurotypical population due to their higher susceptibility to social conditioning."

Some sources have alternative explanations for either the Gender Dysphoria or Gender Identity Disorder diagnosis, or the Autism Spectrum Disorder diagnosis, generally explaining some traits found in either diagnosis to be a symptom of the other, or found to be a symptom of the other when combined with another diagnosis. One source describes two individuals with suspected Asperger's who had feelings of being different, and assumed it to be Gender Dysphoria, and requested a sex change. These individuals several years later came to reject their "Trans phase", and the conclusion for the article suggests screening for Asperger's for those asking for sex reassignment surgery. Another study suggested that those with ASD can have social issues, and others missing social cues about a child's gender presentation may cause them to develop gender dysphoria. Another study suggested the opposite, and that those with gender dysphoria may exhibit ASD symptoms due to their gender dysphoria diagnosis, however the article also states this is unclear whether it should be a separate diagnosis. Many articles also suggested a connection between those with ASD and Gender Dysphoria having unusual interests, pre-occupations, or obsessive–compulsive disorder (OCD), which may be an alternative explanation for one or both diagnoses. Those with 'unusual interests' and 'pre-occupations' to feminine dresses, activities and objects, to instead have these interests or pre-occupations due to "the need for sensory input belonging to the ASD diagnosis". Some sources describe the connection between OCD, ASD, and gender dysphoria, to be more of an obsession about gender-related material due to the OCD caused by ASD, and not a true diagnosis of gender dysphoria. With one study warning against treatment of gender dysphoria in cases where ASD and OCD are present in the patient. One study also found that those assigned male at birth with gender dysphoria were more likely to have obsessions and compulsions, with many of those being gender related, which may support this hypothesis. However this study also found no symptoms of this in those assigned female at birth, so there may be a different underlying factor.

In December 2014, four researchers concluded that being on the autism spectrum does not "preclude gender transition" and suggested methods for assisting such individuals in "exploring their gender identities". One of the study's authors, Katherine Rachlin, said that, sometimes, being transgender can "look like the spectrum experience" to clinicians. A study by Yale School of Medicine scientists in March 2015 concurred, stating that those on the autism spectrum should be treated equally to other individuals for gender dysphoria, and suggested that clinicians "broaden the social frame" and facilitate an "exploration of gender roles". Another study by Boston Children's Hospital researchers in October 2016 reported that about 23 percent of young people with gender dysphoria at the on-site gender clinic had Asperger's syndrome, and recommended "routine autism screening at gender clinics". A Finnish study in April 2015 recommended that the autism spectrum be recognized seriously in developing guidelines for treating "child and adolescent gender dysphoria".

Some studies have noted an overlap between those with autism and those who are transgender. British researchers in 2011 concluded that trans men had more autistic traits than trans women. However, a study by British researchers in 2013 concluded that there was "no significant difference" between trans men and trans women in autistic traits observed. Steven Stagg and Jaime Vincent of Anglia Ruskin University concluded in September 2019 that some of those seeking advice and help for their gender identity may be autistic, whether diagnosed or not, with these abilities impeding possible support, and urged clinicians treating individuals who are transgender or non-binary, especially those assigned female at birth, to consider whether they have undiagnosed ASD. Four researchers in January 2020 suggested "overlap between autism and transgender identity", possibly more in trans men than trans women, and stated that anxiety and depression were the highest in autistic individuals who were transgender. Scientists with the Autism Research Centre at University of Cambridge, using data from 600,000 adults in the UK, concluded in August 2020 that adults who were transgender or gender diverse were three to six times more likely to have an autistic diagnosis than those who were cisgender, and suggested that between 3.5 and 6.5% of transgender and gender diverse adults in the UK are autistic.

Other researchers have noted the prevalence of autistic traits among those who identify as non-binary or genderqueer. Two Warwick University researchers, utilizing data from 446 UK adult respondents, concluded in January 2016 that, based on their sample, genderqueer individuals were more likely to be autistic than any other group with gender dysphoria. New York University researchers, using a sample of 492 children, stated in February 2016 that autistic children were seven times more likely to experience gender variance as compared to those not on the spectrum.

In popular culture

See also: Autism spectrum disorders in the media, Media portrayal of LGBT people, and Societal and cultural aspects of autism § Media portrayals

Autistic characters that are part of the LGBTQ community are occasionally depicted in popular culture, whether in literature, animated or live-action series. Some have called for better representation. For instance, in June 2015, author Heidi Cullinan wrote in Spectrum that there is not nearly enough works of fiction with autistic people and even fewer who are part of the LGBTQ community, inspiring her to write a story with a gay autistic protagonist. She also said that autistic people deserve to see themselves in stories, like anyone else. In March 2021, queer autistic novelist Naoise Dolan echoed this in an interview with PinkNews, calling for more visibility, saying that popular culture and art would be improved if "there were more queer autistics out there," along with other groups that are marginalized. She also criticized bad portrayals of autistic characters and expressed her desire to "deliberately write the most counter-stereotypical autistic character possible" in her novel, Exciting Times.

Occasionally, LGBTQ autistic characters appear in literature. For example, a 2015 novel, Carry the Ocean, by Heidi Cullinan also had a gay protagonist. In the novel, the protagonist, Jeremey Samon, meets an autistic boy named Emmet Washington, who wants to date him, and through the course of the book, their romantic relationship develops. Other characters in literature are lesbians. For example, Ada Hoffman's debut novel, in June 2019, The Outside, has a lesbian and autistic protagonist, Yasira Shien, who once had a lover named Tiv. The book's sequel, "The Fallen," came out in July 2021, with a reappearance of Yasira, and the book was praised for its "excellent neurodiverse representation." Xan West's 2019 novella, "Their Troublesome Crush," has a character, Ernest, who is openly autistic and demiromantic. West said they wrote the character from their own experience as an autistic demiromantic person. Ernest has been described as "a show tunes–loving submissive," and has a metamour, the partner of his partner, named Nora. Furthermore, Judith, the protagonist of Xan West's 2020 novel, Tenderness, is an "autistic Jewish bisexual midsize fat femme" who has chronic pain. Zack Smedley's 2019 novel, Tonight We Rule the World tells the story of Owen, a "bisexual high schooler...on the autism spectrum."

LGBTQ autistic characters have also appeared in animated series. Luz Noceda from The Owl House was confirmed to be bisexual by Dana Terrace, coded as autistic, and confirmed as neurodivergent.

Some creators of animated series are autistic and part of the LGBTQ community. The creator of Dead End: Paranormal Park, Hamish Steele, a gay man who is autistic, has said that he incorporated his experiences into characters such as Norma Khan in the show of the same name, who is LGBTQ, but it has not been confirmed she is autistic, only as "neurodiverse".

Live-action television series have LGBTQ autistic characters as well. For instance, in March 2020, it was announced that the series Everything's Gonna Be Okay was introducing a "queer storyline" for autistic protagonist Matilda, who explores her sexual identity as a pansexual woman, and her friend, Drea, becomes her girlfriend. The show's creator, Josh Thomas, told The Advocate that he likes "having queer people in my show," noted that autistic people have "an extreme emotional vulnerability" and said that is "exciting that people on the spectrum are boldly leading and as far as identity goes."

Sex differences in autism

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Sex_differences_in_autism

Males are more frequently diagnosed with autism than females. It is debated whether this is due to a sex difference in rates of autism spectrum disorders (ASD) or whether females are underdiagnosed.The prevalence ratio is often cited as about 4 males for every 1 female diagnosed. Other research indicates that it closer to 3:1 or 2:1. One in every 42 males and one in 189 females in the United States is diagnosed with autism spectrum disorder. There is some evidence that females may also receive diagnoses somewhat later than males; however, thus far results have been contradictory.

Several theories exist to explain the sex-based discrepancy, such as a genetic protective effect, the extreme male brain theory and phenotypic differences in the presentation between sexes, which may all be intertwined. Researchers have also debated whether a diagnostic gender bias has played a role in females being underdiagnosed with autism spectrum disorder. Researchers have also speculated a gender bias in parental reporting due to the expectations and socialization of gender roles in society.

Since autism is a largely genetic and hereditary condition, genetic factors that lead to differences depending on sex come into play, such as the role of androgen signalling in male development or X-linked mutations, whose associated genetic conditions are typically more common and severe in males. The extreme male brain theory suggests that autistic brains show an exaggeration of the features associated with male brains, such as increased size and decreased relative connectivity as well as systematic thinking over empathetic thinking. The imprinted brain hypothesis suggests genomic imprinting is at least partly responsible for the sex differences in autism and points to the evidence for a common genetic cause with schizophrenia.

Compared to men, women are generally required to be more impaired by their autism or have more cognitive or behavioural conditions than their male counterparts to meet autism spectrum criteria. There is evidence of increased incidence of social anxiety, anorexia nervosa and self-harm in autistic females, though the increased rates of anorexia nervosa and other eating disorders may be due to confusion or conflation with avoidant/restrictive food intake disorder (ARFID), which is particularly common in autism. Autistic girls and women show higher social motivation and a greater capacity for typical friendships than autistic boys and men, are less likely to be hyperactive, impulsive, have issues with conduct or stereotyped behavioural traits, and have been shown to mask their conditions more frequently than autistic men. Autistic males often exhibit more easily observed behaviors at a younger age resulting in parental observance and subsequent evaluation of the child. In contrast, behavior of young females is more often overlooked, regardless of any associated at-risk factors for ASD or other developmental delays. Ultimately, this may contribute to females more frequently receiving their ASD diagnosis later in life than their male counterpart. There is a growing consensus among neuroscientists that the number of autistic women has been vastly underrepresented due to the assumption that it is primarily a male condition.

Background

Main article: History of Asperger syndrome

Hans Asperger was one of the first people to study autism, yet all of his four study subjects were male. Another early researcher, Leo Kanner described "autistic disturbances of affective contact" in the group consisting of eight boys and three girls.

In the modern day, women are less likely to be diagnosed as autistic than men; they are often misdiagnosed or not noticed to be neurodivergent by doctors. Women are also more likely to be diagnosed as autistic at a later age than men.

Theories explaining gender diagnosis disparity

Extreme male brain theory

Main article: Empathizing–systemizing theory

Simon Baron-Cohen's extreme male brain theory states that autistic males have higher doses of prenatal testosterone and on average have a more systemising brain, as opposed to the more empathising female brain. He suggests that autistic brains show an exaggeration of the features associated with male brains. These are mainly size and connectivity, with males generally having a larger brain, which is seen in an exaggerated form in those with ASD. Individuals with ASD were found to have widespread abnormalities in interconnectivity in specific brain regions. This could explain the different results on empathy tests between men and women as well as the deficiencies in empathy seen in ASD, as empathy requires several brain regions to be activated which need information from many different areas of the brain. Baron-Cohen therefore argues that genetic factors play a role in autism prevalence and that children with technically minded parents are more likely to be diagnosed with autism.

Imprinted brain hypothesis

Main article: Imprinted brain hypothesis

The imprinted brain theory suggests genomic imprinting is at least partly responsible for the sex differences in autism and implicates schizophrenia as well, claiming that genetic and physiological evidence suggests the two conditions are on a spectrum in which some mutations in certain genes cause lower social cognition but higher practical cognition (autism) while other mutations in the same genes cause lower practical cognition with higher social cognition (schizophrenia).

Female protective effect hypothesis

According to the female protective effect hypothesis, more extreme genetic mutations are required for a girl to develop autism than for a boy. In 2012, Harvard researchers published findings suggesting that, on average, more genetic and environmental risk factors are required for girls to develop autism, compared to boys. The researchers analyzed DNA samples of nearly 800 families affected by autism and nearly 16,000 individuals with a variety of neurodevelopmental disorders. They looked for various types of gene mutations. Overall, they found that females diagnosed with autism or another neurodevelopmental disorder had a greater number of harmful mutations throughout the genome than did males with the same disorders. Women with an extra X chromosome, 47, XXX or triple X syndrome, have autism-like social impairments in 32% of cases.

Hypothesis of female underdiagnosis

The prevalence ratio is often cited as about 4 males for every 1 female diagnosed. Other research indicates that it closer to 3:1 or 2:1.

Some authors, clinicians and experts like Judith Gould, Tony Attwood, Lorna Wing and Christopher Gillberg have proposed that autism in females may be underdiagnosed due to better natural superficial social mimicry skills in females, partially different set of symptoms and less knowledge about autism in females among experts. In his preword to the book Asperger's and Girls, Attwood writes: "These tentative explanations for the apparent underrepresentation of girls with Asperger's Syndrome have yet to be examined by objective research studies."

Specifically, Gould has discussed the idea that a pervasive developmental disorder called pathological demand avoidance, which is not officially included in diagnostic manuals, may offer a glimpse into how autism in females may present in some cases.

Another clinician, William Mandy, hypothesized referrals for ASD assessment are often started by teachers. Girls with ASD may sometimes lack the skills of social communication and this is not noticed until they are in a school setting. Therefore, girls suggested to have ASD may receive delayed or no clinical assessment. Compared with males, females with autism are more likely to mask their restricted interests (strong or intense interests in specific topics or objects), which could decrease the chances of diagnosis.

Female phenotype

Some have suggested a differential phenotype for autistic women; "a female-specific manifestation of autistic strengths and difficulties, which fits imperfectly with current, male-based conceptualisations" of autism. Autistic women have been shown to score higher in self-reports of § Autistic masking, which may factor into the different phenotype. One study found evidence for a diagnostic bias against girls who meet criteria for ASD. In some cases where females showed severe autistic traits, they failed to meet the criteria for a diagnosis, because of the lack of sensitivity to the female phenotype.

Differences in gender and sexuality identification

Main article: Autism and LGBT identities

Sexuality is often discussed within the autistic community, with many observations that identities other than cis-hetero seem to be more common than is observed in the neurotypical population. There have not been many formal studies on this to date, however members of the community speculate that autistic individuals generally have different ideals, perceptions and desires than neurotypicals or simply do not comprehend or agree with society's expectation, making them more apt to diverge from the norm.

A study looking at the co-occurrence of ASD in patients with gender dysphoria found 7.8% of patients to be on the autism spectrum. Another study consisting of online surveys that included those who identified as nonbinary and those identifying as transgender without diagnoses of gender dysphoria found the number to be as high as 24% of gender diverse people having autism, versus around 5% of the surveyed cisgender people. A possible hypothesis for the correlation may be that autistic people are less able to conform to societal norms, which may explain the high number of autistic individuals who identify outside the stereotypical gender binary. As of yet, there have been no studies specifically addressing the occurrence of autism in intersex individuals.

A study conducted by Byers and Nichols (2014) explored the level of sexual satisfaction of high-functioning autistic individuals, with researchers testing the sexual and relationship satisfaction of neurotypical versus high functioning autistic individuals. The results suggest that men with ASD are generally less satisfied with their relationship or marriage compared to neurotypical men and women, and women with ASD.

High-functioning autism

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/High-functioning_autism 

 

High-functioning autism
Other names	Sukhareva Syndrome
Specialty	Psychiatry
Symptoms	Trouble with social interaction, impaired communication, restricted interests, repetitive behavior
Complications	Social isolation, employment problems, family stress, being bullied, self-harm
Usual onset	By age two or three
Duration	Long-term
Causes	Genetic and environmental factors
Diagnostic method	Based on behavior and developmental history
Differential diagnosis	Asperger syndrome, ADHD, Tourette syndrome, anxiety, bipolar disorder, obsessive–compulsive disorder
Treatment	Behavioral therapy, speech therapy, psychotropic medication
Medication	Antipsychotics, antidepressants, stimulants (associated symptoms)

High-functioning autism (HFA) is an autism classification where a person exhibits no intellectual disability, but may exhibit deficits in communication, emotion recognition and expression, and social interaction. HFA is not included in either the American Psychological Association's DSM-5 or the World Health Organization's ICD-10, neither of which subdivides autism based on intellectual capabilities.

Characterization

High-functioning autism is characterized by features similar to those of Asperger syndrome. The defining characteristic recognized by psychologists is a significant delay in the development of early speech and language skills, before the age of three years. The diagnostic criteria of Asperger syndrome exclude a general language delay.

Further differences in features of people with high-functioning autism from those with Asperger syndrome include the following:

• Lower verbal reasoning ability
• Better visual/spatial skills (higher performance IQ)
• Less deviating locomotion (e.g. clumsiness)
• Problems functioning independently
• Curiosity and interest for many different things
• Not as good at empathizing with other people
• Male to female ratio (4:1) much smaller

As of 2013, Asperger Syndrome and High-functioning autism are no longer terms used by the American Psychological Association, and have instead both been merged into autism spectrum disorder (ASD). As of 2021, the World Health Organization also retired the terms and merged them into autism spectrum disorder.

Comorbidities

Individuals with autism spectrum disorders, including high-functioning autism, risk developing symptoms of anxiety. While anxiety is one of the most commonly occurring mental health symptoms, children and adolescents with high functioning autism are at an even greater risk of developing symptoms.

There are other comorbidities, the presence of one or more disorders in addition to the primary disorder, associated with high-functioning autism. Some of these include bipolar disorder and obsessive–compulsive disorder (OCD). In particular the link between HFA and OCD, has been studied; both have abnormalities associated with serotonin.

Observable comorbidities associated with HFA include ADHD and Tourette syndrome. HFA does not cause, nor include, intellectual disabilities. This characteristic distinguishes HFA from low-functioning autism; between 40 and 55% of individuals with autism also have an intellectual disability.

Behavior

An association between HFA and criminal behavior is not completely characterized. Several studies have shown that the features associated with HFA may increase the probability of engaging in criminal behavior. While there is still a great deal of research that needs to be done in this area, recent studies on the correlation between HFA and criminal actions suggest that there is a need to understand the attributes of HFA that may lead to violent behavior. There have been several case studies that link the lack of empathy and social naïveté associated with HFA to criminal actions.

There is still a need for more research on the link between HFA and crimes, because many other studies point out that most people with ASD are more likely to be victims and less likely to commit crimes than the general population. But there are also small-subgroups of people with autism that commit crimes because they lack understanding of the laws they have broken. Misunderstandings are especially common regarding autism and sex offenses, since many people with autism do not receive sex education.

Cause

Main article: Causes of autism

Although little is known about the biological basis of autism, studies have revealed structural abnormalities in specific brain regions. Regions identified in the "social" brain include the amygdala, superior temporal sulcus, fusiform gyrus area and orbitofrontal cortex. Further abnormalities have been observed in the caudate nucleus, believed to be involved in restrictive behaviors, as well as in a significant increase in the amount of cortical grey matter and atypical connectivity between brain regions.

Diagnosis and IQ

Normalized IQ distribution with mean 100 and standard deviation 15

HFA is not a recognised diagnosis by the American Psychological Association (DSM-5) or the World Health Organization (ICD-10). HFA is often, however, used in clinical settings to describe a set of symptoms related to an autism spectrum disorder whereby they exhibit standard autism indicators although have an intelligence quotient (IQ) of 70 or greater.

For modern IQ tests, the raw score is transformed to a normal distribution with mean 100 and standard deviation 15. This results in approximately two-thirds of the population scoring between IQ 85 and IQ 115 and about 2.5 percent each above 130 and below 70.

IQ scales are ordinally scaled. The raw score of the norming sample is usually (rank order) transformed to a normal distribution with mean 100 and standard deviation 15. While one standard deviation is 15 points, and two SDs are 30 points, and so on, this does not imply that mental ability is linearly related to IQ, such that IQ 50 would mean half the cognitive ability of IQ 100. In particular, IQ points are not percentage points.

A diagnosis of intellectual disability is in part based on the results of IQ testing. Borderline intellectual functioning is the categorization of individuals of below-average cognitive ability (an IQ of 71–85), although not as low as those with an intellectual disability (70 or below).

People with high IQs are found at all levels of education and occupational categories. The biggest difference occurs for low IQs with only an occasional college graduate or professional scoring below 90.

Treatment

While there exists no single treatment or medicine for people with autism, there exists several strategies to help lessen the symptoms and effects of the condition.

Augmentative and alternative communication

Augmentative and alternative communication (AAC) is used for autistic people who cannot communicate orally. People who have problems speaking may be taught to use other forms of communication, such as body language, computers, interactive devices, and pictures. The Picture Exchange Communication System (PECS) is a commonly used form of augmentative and alternative communication with children and adults who cannot communicate well orally. People are taught how to link pictures and symbols to their feelings, desires and observation, and may be able to link sentences together with the vocabulary that they form.

Speech-language therapy

Speech–language therapy can help those with autism who need to develop or improve communication skills. According to the organization Autism Speaks, "speech-language therapy is designed to coordinate the mechanics of speech with the meaning and social use of speech". People with autism may have issues with communication, or speaking spoken words. Speech-language pathologists (SLP) may teach someone how to communicate more effectively with others or work on starting to develop speech patterns. The SLP will create a plan that focuses on what the child needs.

Occupational therapy

Occupational therapy helps autistic children and adults learn everyday skills that help them with daily tasks, such as personal hygiene and movement. These skills are then integrated into their home, school, and work environments. Therapists will oftentimes help people learn to adapt their environment to their skill level. This type of therapy could help autistic people become more engaged in their environment. An occupational therapist will create a plan based on a person's needs and desires and work with them to achieve their set goals.

Applied behavioral analysis (ABA)

Applied behavior analysis (ABA) is considered the most effective therapy for autism spectrum disorders by the American Academy of Pediatrics. ABA focuses on teaching adaptive behaviors like social skills, play skills, or communication skills and diminishing problematic behaviors such as self-injury by creating a specialized plan that uses behavioral therapy techniques, such as positive or negative reinforcement, to encourage or discourage certain behaviors over-time. However, ABA has been strongly criticised by the autistic community, who view it as abusive and detrimental to autistic children's growth.

Sensory integration therapy

Sensory integration therapy helps people with autism adapt to different kinds of sensory stimuli. Many with autism can be oversensitive to certain stimuli, such as lights or sounds, causing them to overreact. Others may not react to certain stimuli, such as someone speaking to them. Many types of therapy activities involve a form of play, such as using swings, toys and trampolines to help engage people with sensory stimuli. Therapists will create a plan that focuses on the type of stimulation the person needs integration with.

Neurofeedback

Studies suggest Neurofeedback alleviates certain symptoms of autism, such as emotional outbursts, hyperactivity, resistance to change, and stimming. Although considered a safe, non-invasive procedure, it may potentially involve some side effects. 

Medication

There are no medications specifically designed to treat autism. Medication is usually used for symptoms associated with autism, such as depression, anxiety, or behavioral problems. Medicines are usually used after other alternative forms of treatment have failed.

Criticism of functioning labels

Many medical professionals, autistic people, and supporters of autistic rights disagree with the categorisation of individuals into "high-functioning autism" and "low-functioning autism", stating that the "low-functioning" label causes people to put low expectations on a child and view them as lesser. Furthermore, critics of functioning labels state that an individual's functioning can fluctuate from day to day, and categories do not take this into consideration. Levels of functioning are unrelated to intellectual disability. Additionally, individuals with "medium-functioning autism" are typically left out of the discussion entirely, and due to the non-linear nature of the autistic spectrum, individuals can be high-functioning in some areas while at the same time being medium or low functioning in other areas.

Social (pragmatic) communication disorder

From Wikipedia, the free encyclopedia

https://en.wikipedia.org/wiki/Social_(pragmatic)_communication_disorder 

 

Social (pragmatic) communication disorder
Other names	SPCD
Specialty	Speech–language pathology
Symptoms	Impaired social relatedness, verbal and nonverbal communication skills, and semantic language skills

Social (pragmatic) communication disorder (SPCD) - previously called semantic-pragmatic disorder (SPD) or pragmatic language impairment (PLI) - is a disorder in understanding pragmatic aspects of language. People with SCD have special challenges with the semantic aspect of language (the meaning of what is being said) and the pragmatics of language (using language appropriately in social situations). Individuals have difficulties with verbal and nonverbal social communication.

Relates to Pragmatic Language Impairment and Autism Spectrum Disorder. It has only been since 2013 that SPCD has become its own category in the DSM-5. In creating this new category it allowed individuals to be considered with a form of communication disorder distinct from PLI and ASD. As well, SPCD lacks behaviors associated with restrictions and repetition which are seen in ASD.

Presentation

1. Issues with communication for social purposes
2. Unable to adapt communication to context
3. Struggles to follow conversation and story type situation
4. Unable to understand abstract ideas.

Symptoms

Individuals with social communication disorder have particular trouble understanding the meaning of what others are saying, and they are challenged in using language appropriately to get their needs met and interact with others. Children with the disorder often exhibit:

• Delayed language development
• Language disorders (similar to the acquired disorder of aphasia) such as word search pauses, jargoning, word order errors, word category errors, verb tense errors.
• Stuttering or cluttering speech
• Repeating words or phrases
• Tendency to be concrete or prefer facts to stories
• Difficulties with:
  • Pronouns or pronoun reversal
  • Understanding questions
  • Understanding choices and making decisions
  • Following conversations or stories (conversations are "off-topic" or "one-sided")
  • Extracting the key points from a conversation or story; they tend to get lost in the details
  • Verb tenses
  • Explaining or describing an event
  • Understanding satire or jokes and contextual cues
  • Reading comprehension
  • Reading body language
  • Making and maintaining friendships and relationships because of delayed language development
  • Distinguishing offensive remarks

According to Bishop and Norbury (2002), children with semantic pragmatic disorder can have fluent, complex and clearly articulated expressive language but exhibit problems with the way their language is used. These children typically are verbose. However, they usually have problems understanding and producing connected discourse, instead giving conversational responses that are socially inappropriate, tangential and stereotyped. They often develop eccentric interests but not as strong or obsessional as people with autism spectrum disorders.

The current view, therefore, is that the disorder has more to do with communication and information processing than language. For example, children with semantic pragmatic disorder will often fail to grasp the central meaning or saliency of events. This then leads to an excessive preference for routine and "sameness" (seen in autism spectrum disorders), as children with SCD struggle to generalize and grasp the meaning of situations that are new; it also means that more difficulties occur in a stimulating environment than in a one-to-one setting.

A further problem caused by SCD is the assumption of literal communication. This would mean that obvious, concrete instructions are clearly understood and carried out, whereas simple but non-literal expressions such as jokes, sarcasm and general social chatting are difficult and can lead to misinterpretation. Lies are also a confusing concept to children with SCD as it involves knowing what the speaker is thinking, intending and truly meaning beyond a literal interpretation.

Diagnosis

Due to the fact that the SPCD has only been categorized in the last six years, diagnosis is yet to be fully established. In the DSM-5, the child is diagnosed with SCD if the child does not meet the criteria for other disorders such as ASD and PDD-NOS. Common assessments used to identify SPCD are:

1. The developmental, dimensional and diagnostic interview (3Di) 
2. The child communication checklist (CCC)
3. The strengths and difficulties questionnaire (SDQ)
4. Natural Observation
5. Targeted Observation of Pragmatics in Children's Conversations (TOPICC)
6. Analysis of Language Impaired Children's Conversation (ALICC)
7. Structured Observation 
8. Test of Language Competence 
9. Assessment of Comprehension and Expression (ACE 6‐11)
10. Test of Pragmatic Language 
11. Bus story 
12. Expression, Reception and Recall of Narrative Instrument (ERRNI)

Although there are several tests that can be done to try to identify SPCD, there are some tests that are better suited to diagnose SPCD than others. As well, there is not a specific assessment or test that is able to diagnose SPCD unlike other disorders such as ASD, DLD and PLI.

The DSM-5 categorizes SCD as a communication disorder within the domain of neurodevelopmental disorders, listed alongside other disorders of speech and language which typically manifest in early childhood. The DSM-5 diagnostic criteria for social communication disorder is as follows:

• A. Persistent difficulties in the social use of verbal and nonverbal communication as manifested by all of the following:

1. Deficits in using communication for social purposes, such as greeting and sharing information, in a manner that is appropriate for the social context.
2. Impairment of the ability to change communication to match context or the needs of the listener, such as speaking differently in a classroom than on a playground, talking differently to a child than to an adult, and avoiding use of overly formal language.
3. Difficulties following rules for conversation and storytelling, such as taking turns in conversation, rephrasing when misunderstood, and knowing how to use verbal and nonverbal signals to regulate interaction.
4. Difficulties understanding what is not explicitly stated (e.g., making inferences) and nonliteral or ambiguous meanings of language (e.g., idioms, humor, metaphors, multiple meanings that depend on the context for interpretation).

• B. The deficits result in functional limitations in effective communication, social participation, social relationships, academic achievement, or occupational performance, individually or in combination.
• C. The onset of symptoms is in the early developmental period (but deficits may not become fully manifested until social communication demands exceed limited capacities).
• D. The symptoms are not attributable to another medical or neurological condition or to low abilities in the domains of word structure and grammar, and are not better explained by autism spectrum disorder, intellectual disability (intellectual developmental disorder), global developmental delay, or another mental disorder.

Treatment

Treatments for SCD are less established than for treatments for other disorders such as autism. Similarities between SCD and some aspects of autism leads some researchers to try some treatments for autism with people with SCD.

Speech therapy can help individuals who have communication disorders. Speech and language therapy treatment focuses on communication and social interaction. Speech therapists can work with clients on communication in various settings.

Similar or related disorders

Hyperlexia is a similar but different disorder where main characteristics are an above-average ability to read with a below-average ability to understand spoken or written language. Joanne Volden wrote an article in 2002 comparing the linguistic weaknesses of children with nonverbal learning disability to PLI.

Differences between SCD and autism

Communication problems are also part of the autism spectrum disorder (autism); however, individuals with autism also show a restricted pattern of behavior, according to behavioral psychologists. The diagnosis of SCD can only be given if autism has been ruled out. It is assumed that those with autism have difficulty with the meaning of what is being said due to different ways of responding to social situations.

Prior to the release of the DSM-5 in 2013, SCD was not differentiated from a diagnosis of autism. However, there were a large number of cases of children experiencing difficulties with pragmatics that did not meet the criteria for autism. The differential diagnosis of SCD allows practitioners to account for social and communication difficulties which occur to a lesser degree than in children with autism. Social communication disorder is distinguished from autism by the absence of any history (current or past) of restricted/repetitive patterns of interest or behavior in SCD.

History

In 1983, Rapin and Allen suggested the term "semantic pragmatic disorder" to describe the communicative behavior of children who presented traits such as pathological talkativeness, deficient access to vocabulary and discourse comprehension, atypical choice of terms and inappropriate conversational skills. They referred to a group of children who presented with mild autistic features and specific semantic pragmatic language problems. In the late 1990s, the term "pragmatic language impairment" (PLI) was proposed.

Rapin and Allen's definition has been expanded and refined by therapists who include communication disorders that involve difficulty in understanding the meaning of words, grammar, syntax, prosody, eye gaze, body language, gestures, or social context. While autistic children exhibit pragmatic language impairment, this type of communication disorder can also be found in individuals with other types of disorders including auditory processing disorders, neuropathies, encephalopathies and certain genetic disorders.

Prior to the release of the DSM-5, there was debate over the relationship between semantic pragmatic disorder and autistic disorder, as the clinical profile of semantic pragmatic disorder is often seen in children with high-functioning autism. Before the DSM-5 specified SCD as a separate diagnosis, people with SCD symptoms were often diagnosed with pervasive developmental disorder not otherwise specified (PDD-NOS).

As mentioned in the introduction, SPCD has only been around since 2013. Before it emerged as its own disorder SPCD could have fallen into ASD, PLI, DLD, etc. The reason being because several of these disorders include an issue with social communication. In terms of developmental language disorder (DLD), individuals with this disorder have issues with language form and content and there seem to be any developmental cause. In social environments DLD seemed to have less difficulties than SPCD.

In regards to ASD, ASD behaviors normally involve repetitive behaviors which are normally not present in SPCD. It does not mean that SPCD does not show such behaviors.

PLI tends to be the disorder that is more common to SPCD than the other disorders due to the fact that both disorders are focused on the pragmatic difficulties individuals have in language with both disorders. SPCD has an element of social communication that is lacking or undeveloped, unlike PLI.

In terms of Specific language impairment, there tends to a lot of similarities to SCPD and PLI but SLI deals with Semantic-Pragmatic issues. This means that there are several issues that fall into Semantic- Pragmatic issues such as uncommon word choice, speaking to oneself out loud and interesting, unimpaired phonology and syntax.

Social intelligence

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Social_intelligence

Social intelligence is the capacity to know oneself and to know others. Social intelligence develops from experience with people and learning from success and failures in social settings. It is more commonly referred to as "tact", "common sense", or "street smarts".

Definitions

Social scientist Ross Honeywill postulates that social intelligence is an aggregated measure of self- and social-awareness, evolved social beliefs and attitudes, and a capacity and appetite to manage complex social change. Psychologist Nicholas Humphrey believes that it is social intelligence, rather than quantitative intelligence, that defines who we are as humans.

The original definition (by Edward Thorndike in 1920) is "the ability to understand and manage men and women and boys and girls, to act wisely in human relations". It is thus equivalent to interpersonal intelligence, one of the types of intelligence identified in Howard Gardner's theory of multiple intelligences, and closely related to theory of mind.

It would make sense that the two concepts, social intelligence and interpersonal intelligence, would work hand in hand with one another, however, they did not. Initially, there was some cross over but eventually, the two subjects diverged into two unique fields of study. 

Other authors have restricted the definition to deal only with knowledge of social situations, perhaps more properly called social cognition or social marketing intelligence, as it pertains to trending socio-psychological advertising and marketing strategies and tactics. According to Sean Foleno, social intelligence is a person's competence to optimally understand one's environment and react appropriately for socially successful conduct.

The multiple definitions listed indicate there is yet to be a consensus on the operational definition of social intelligence.

Hypothesis

The social intelligence hypothesis states that social intelligence, that is, complex socialization such as politics, romance, family relationships, quarrels, collaboration, reciprocity, and altruism,

• (1) was a driving force in developing the size of human brains and
• (2) today provides our ability to use those large brains in complex social circumstances.

This hypothesis claims that the demands of living together is what drives our need for intelligence, and that social intelligence is an evolutionary adaptation for dealing with highly complex social situations, as well as gaining and maintaining power in social groups.

Archaeologist Steve Mithen believes that there are two key evolutionary periods of human brain growth that contextualize the social intelligence hypothesis. The first was about two million years ago, when the brain more than doubled in size. Mithen believes that this growth was because people were living in larger, more complex groups, and had to keep track of more people and relationships. These changes required a greater mental capacity and, in turn, a larger brain size.

The second key growth period in human brain size occurred between 600,000 and 200,000 years ago, when the brain reached its modern size. While this growth is still not fully explained, Mithen believes that it is related to the evolution of language. Language may be the most complex cognitive task we undertake. Language is directly related to social intelligence because it is primarily used to mediate social relationships.

Social intelligence was a critical factor in brain growth. Social and cognitive complexity co-evolve.^[8]

Measurement

The social intelligence quotient (SQ) is a statistical abstraction, similar to the ‘standard score’ approach used in IQ tests, with a mean of 100. Scores of 140 or above are considered to be very high. Unlike the standard IQ test, it is not a fixed model. It leans more toward Jean Piaget's theory that intelligence is not a fixed attribute, but a complex hierarchy of information-processing skills underlying an adaptive equilibrium between the individual and the environment. Therefore, an individual can change their SQ by altering their attitudes and behavior in response to their social environment.

SQ has until recently been measured by techniques such as question and answer sessions. These sessions assess the person's pragmatic abilities to test eligibility in certain special education courses; however, some tests have been developed to measure social intelligence. This test can be used when diagnosing autism spectrum disorders. This test can also be used to check for some non-autistic or semi-autistic conditions such as semantic pragmatic disorder or SPD, schizophrenia, dyssemia and ADHD.

Some social intelligence measures exist which are self-report. Although easy to administer, there is some question as to whether self-report social intelligence measures would better be interpreted in terms of social self-efficacy (that is, one's confidence in one's ability to deal with social information).

People with low SQ are more suited to work with low customer contact, as well as in smaller groups or teams, or independently, because they may not have the required interpersonal communication and social skills for success with customers and other co-workers. People with SQs over 120 are considered socially skilled, and may work exceptionally well with jobs that involve direct contact and communication with other people.

George Washington University Social Intelligence Test: Is one of the only ability measures available for assessing social intelligence and was created in June 1928 by Dr.Thelma Hunt a psychologist from George Washington University. It was originally proposed as a measurement of a person's capacity to deal with people and social relationships. The test is designed to assess various social abilities which consisted of observing human behavior, social situation judgement, name & face memory and theory of mind from facial expressions. The George Washington University Social Intelligence Test revised second edition consists of items as quoted:

• Observation of human behavior
• Recognition of the mental state of the speaker
• Memory for names and faces
• Judgment in social situations
• Sense of humor

Differences from intelligence

Nicholas Humphrey points to a difference between intelligence being measured by IQ tests and social intelligence. Some autistic children are extremely intelligent because they have well developed skills of observing and memorizing information, however they have low social intelligence. For a long time, the field was dominated by behaviorism, that is, the theory that one could understand animals including humans, just by observing their behavior and finding correlations. But recent theories indicate that one must consider the inner structure behavior.

Additional views

Social intelligence is closely related to cognition and emotional intelligence. Research psychologists studying social cognition and social neuroscience have discovered many principles in which human social intelligence operates. In early work on this topic, psychologists Nancy Cantor and John Kihlstrom outlined the kinds of concepts people use to make sense of their social relations (e.g., "What situation am I in?, What kind of person is this?, Who is talking to me?"), the rules they use to draw inferences ("What did he mean by that?") and plan actions ("What am I going to do about it?").

More recently, popular science writer Daniel Goleman has drawn on social neuroscience research to propose that social intelligence is made up of social awareness (including empathy, attunement, empathic accuracy, and social cognition) and social facility (including synchrony, self-presentation, influence, and concern). Goleman's research indicates that our social relationships have a direct effect on our physical health, and the deeper the relationship the deeper the impact. Effects include blood flow, breathing, mood such as fatigue and depression, and weakening of the immune system.

Educational researcher Raymond H. Hartjen asserts that expanded opportunities for social interaction enhances intelligence. This suggests that children require continuous opportunities for interpersonal experiences in order to develop a keen 'inter-personal psychology'. Traditional classrooms do not permit the interaction of complex social behavior. Instead, students in traditional settings are treated as learners who must be infused with more and more complex forms of information. The structure of schools today allows very few of these skills, critical for survival in the world, to develop. Because we so limit the development of the skills of "natural psychologist" in traditional schools, graduates enter the job market handicapped to the point of being incapable of surviving on their own. In contrast, students who have had an opportunity to develop their skills in multi-age classrooms and at democratic settings rise above their less socially skilled peers. They have a good sense of self, know what they want in life and have the skills to begin their quest.

The issue here is psychology versus social intelligence—as a separate and distinct perspective, seldom articulated. An appropriate introduction contains certain hypothetical assumptions about social structure and function, as it relates to intelligence defined and expressed by groups, constrained by cultural expectations that assert potential realities, but make no claims that there is an "exterior" social truth to be defined. This perspective pursues the view that social structures can be defined with the warning that what is mapped into the structure and how that information is stored, retrieved, and decided upon are variable, but can be contained in an abstract and formal grammar—a sort of game of definitions and rules that permit and project an evolving intelligence. Two halves of the coin: one half psychology; the other half social. Unfortunately, most references to social intelligence relate to an individual's social skills. Not mentioned, and more important, is how social intelligence (speaking of a group or assembly of groups) processes information about the world and shares it with participants in the group(s). Are there social structures or can they be designed to accumulate and reveal information to the individual or to other groups. The bigger question is how groups and societies map the environment (ecological, social and personal) into a social structure. How is that structure able to contain a worldview and to reveal that view to the participants? How are decisions made?

J. P. Guilford was the first researcher to approach the problem of social intelligence from the measurement viewpoint. He had developed a test of social intelligence, and suggested that the social intelligence is a unit, that does not depend on common intellectual factor, but related with the comprehension of behavioral information.

Sympathy

From Wikipedia, the free encyclopedia
https://en.wikipedia.org/wiki/Sympathy

Sympathy is the perception of, understanding of, and reaction to the distress or need of another life form. According to David Hume, this sympathetic concern is driven by a switch in viewpoint from a personal perspective to the perspective of another group or individual who is in need. Hume explained that this is the case because "the minds of all men are similar in their feelings and operations" and that "the motion of one communicates itself to the rest" so that as "affections readily pass from one person to another… they beget correspondent movements."

Etymology

The roots of the word sympathy are the Greek words sym, which means "together", and pathos, which refers to feeling or emotion. See sympathy § Etymology for more information.

Distinctions between sympathy and related concepts

Main article: Empathy § Distinctions between empathy and related concepts

The related word empathy is often used interchangeably with sympathy, even though the terms now have different meanings. Dictionaries distinguish the two terms. Compassion and pity are also related concepts.

Causes

Medical personnel aid a suffering woman after the 2010 Haiti earthquake.

Prerequisites for feeling sympathy include: attention to a subject, believing that subject is in a state of need, and the specific characteristics of a given situation. To feel sympathy for a person or group, you must first pay attention to them. Distractions severely limit the ability to produce strong affective responses. When not distracted, people can attend to and respond to a variety of emotional subjects and experiences. Attention facilitates the experience of sympathy; without giving undivided attention sympathy cannot be experienced in many situations.

The perceived need of an individual/group elicits sympathy. Different states of need (such as perceived vulnerability or pain) require different sorts of human reactions, including those that range from attention to sympathy. A person with cancer might draw a stronger feeling of sympathy than a person with a cold. The conditions in which sympathy is deemed an appropriate response are organized into individual differences and situational differences.

Opinions about human deservingness, interdependence, and vulnerability motivate sympathy. A person who seems "deserving" of aid is more likely to be helped. A belief in human interdependence fuels sympathetic behavior.

Sympathy is also believed to be based on the principle of the powerful helping the vulnerable (young, elderly, sick). This desire to help the vulnerable has been suggested to stem from paternalistic motives to protect and aid children and the weak. In this theory, people help other people in general by generalizing the maternal/paternal instincts to care for their own children or family.

Individual moods, previous experiences, social connections, novelty, salience, and spatial proximity also influence the experience of sympathy. Individuals experiencing positive mood states and people who have similar life experiences are more likely to produce sympathy.

People in spatial or geographic proximity (such as neighbors and citizens of a given country) are more likely to experience sympathy towards each other. Social proximity follows the same pattern: Members of certain groups (e.g. racial groups) are more sympathetic to people who are also members of the group. Social proximity is linked with in-group/out-group status. People within the same group are interconnected and share successes and failures and therefore experience more sympathy towards each other than to out-group members, or social outsiders.

New and emotionally provoking situations also heighten empathic emotions, such as sympathy. People seem to habituate to events that are similar in content and type and strength of emotion. The first horrific event that is witnessed will elicit a greater sympathetic response compared to the subsequent experiences of the same horrific event.

Evolutionary origins

The evolution of sympathy is tied to the development of social intelligence: a broad range of behaviors and their associated cognitive skills, such as pair bonding, the creation of social hierarchies, and alliance formation. Researchers theorize that empathic emotions, or those relating to the emotions of others, arose due to reciprocal altruism, mother-child bonding, and the need to accurately estimate the future actions of conspecifics. Empathic emotions emerged from the need to create relationships that were mutually beneficial and to better understand the emotions of others that could avert danger or stimulate positive outcomes.

Small groups of socially dependent individuals may develop empathic concerns, and later sympathy, if certain prerequisites are met. The individuals in this community must have a long enough lifespan to encounter several opportunities to react with sympathy. Parental care relationships, alliances during conflicts, and the creation of social hierarchies are associated with the onset of sympathy in human interactions. Sympathetic behavior originally came about during dangerous situations, such as predator sightings, and moments when aid was needed for the sick and/or wounded. The evolution of sympathy as a social catalyst can be seen in both primate species and in human development.

Communication

Verbal communication is one way individuals communicate feelings of sympathy. People can express sympathy by addressing the emotions being felt by themselves and others involved and by acknowledging the current environmental conditions for why sympathy is the appropriate reaction.

Nonverbal communication includes speech intonation, facial expression, body motions, person-to-person physical contact, how far people position themselves in relation to each other, posture, and appearance. Such forms of expression can convey messages related to emotion as well as opinions, physical states (fatigue), and understanding. People produce emotion-specific facial expressions that are often the same from culture to culture and are often reproduced by observers, which facilitates the observers' own understanding of the emotion and/or situation. There are six universal emotions: happiness, sadness, fear, surprise, disgust, and anger.

Facial expressions can communicate sympathy and other emotions nonverbally.

Nonverbal communication cues are often subconscious and difficult to control. Deliberate regulation of emotion and nonverbal expression is often imperfect. Nonverbal gestures and facial expressions are also generally better understood by observers than by the person experiencing them first hand.

Communicating using physical touch has the unique ability to convey affective information upon contact. The interpretation of this information is context-sensitive. The touch of the hand on the shoulder during a funeral might be the fastest method of conveying sympathy. Patting a person on their back, arms, or head for a few seconds can effectively convey feelings of sympathy between people. Nonverbal communication seems to provide a more genuine communication of sympathy, because it is difficult to control nonverbal expressions and so difficult to be deliberately insincere in that medium. The combination of verbal and nonverbal communication facilitates the acknowledgment and comprehension of sympathy.

Human behavior

People make decisions by weighing costs against potential outcomes. Research on decision-making distinguishes two mechanisms, often labeled "System 1" (or "gut") and "System 2" (or "head"). System 1 uses affective cues to dictate decisions, whereas System 2 is based in logic and reason. For example, deciding on where to live based on how the new home feels would be a System 1 decision, whereas deciding based on the property value and personal savings would be a System 2 decision.

Sympathy is a System 1 agent. It provides a means of understanding another person's experience or situation, good or bad, with a focus on their individual well-being. It is often easier to make decisions based on emotional information, because all humans have general understanding of emotions. It is this understanding of emotions that allows people to use sympathy to make their decisions.

Sympathy helps to motivate philanthropic, or aid-giving, behavior (e.g. donations, community service). The choice to donate, and the subsequent decision of how much to give, can be separated into two emotion-driven decision-making processes: Mood management, or how people act to maintain their moods, influences the initial decision to donate because of selfish concerns (to avoid regret or feel better). However, how a person feels about the deservingness of the recipient determines how much to donate. Human sympathy in donation behavior can influence the amount of aid given to people and regions that are in need. Increasing how emotional a description is, presenting individual cases instead of large groups, and using less information and numerical data can positively influence giving behavior.

Sympathy also plays a role in maintaining social order. Judging people's character helps to maintain social order, making sure that those who are in need receive the appropriate care. The notion of interdependence fuels sympathetic behavior; such behavior is self-satisfying because helping someone who is connected to you through some way (family, social capital) often results in a personal reward (social, monetary, etc.). Regardless of selflessness or selfishness, sympathy facilitates the cycle of give and take that is necessary for maintaining a functional society.

Healthcare

Sympathy also impacts how doctors, nurses, and other members of society think about and treat people with different diseases and conditions. The level of sympathy exhibited by health care providers corresponds to patient characteristics and disease type. One factor that influences sympathy is controllability: the degree to which the afflicted individual could have avoided contracting the disease or medical condition. For example, people express less sympathy toward individuals who had control during the event when they acquired HIV. Even less sympathy is granted to individuals who have control over the means by which they contracted HIV, such as individuals who engage in prostitution.

Sympathy in health-related decision making is heavily based on disease stigma. Disease stigma can lead to discrimination in the workplace and in insurance coverage. High levels of stigma are also associated with social hostility. Several factors contribute to the development of disease stigmas, including the disease's time course, severity, and the dangers that the disease might pose to others. Sexual orientation of individual patients has also been shown to affect stigma levels in the case of HIV diagnoses. Sympathy is generally associated with low levels of disease stigma.

Sympathy for HIV patients is related to increased levels of knowledge regarding HIV and a lower likelihood of avoiding individuals with HIV.

Neuroscience perspectives

Sympathy is being studied with new technology.

Social and emotional stimuli related to the well-being of another person can be studied with technology that tracks brain activity (such as Electroencephalograms and functional Magnetic Resonance Imaging). Amygdala and insula activation occur when a person experiences emotions, such as fear and disgust respectively. Primary motor regions also activate during sympathy. This could be caused by humans' motor reactions to emotional faces (reflecting the expressions on their own faces) which seems to help people better understand the other person's emotion. Researchers also suggest that the neural mechanisms that are activated when personally experiencing emotions are also activated when viewing another person experiencing the same emotions (via mirror neurons). Pain seems to activate a region known as the cingulate cortex, in addition to activation that is mentioned earlier. The temporal parietal junction, orbitofrontal cortex, and ventral striatum are also thought to play a role in the production of emotion.

Generally, empathic emotions (including sympathy) require the activation of top-down and bottom-up activity. Top-down activity refers to cognitive processes that originate from the frontal lobe and require conscious thought whereas bottom-up activity begins from sensation of stimuli in the environment. From the sensory level, people sense and experience the emotional cues of another. At the same time, top-down responses make sense of the emotional inputs streaming in and apply motive and environmental influence analyses to better understand the situation. Top-down processes include attention to emotion and emotion regulation.

Child development

A baby will often cry at the sound of another baby's cries.

Sympathy is a stage in social and moral development. It generally arises when a child is between two and three years old, although some instances of empathic emotion can be seen as early as 18 months. Basic sharing of emotions, a precursor for sympathy, can be seen in infants. For example, babies will often begin to cry when they hear another baby crying nearby. This suggests the infant can recognize emotional cues in its environment, even if it cannot fully comprehend the emotion. Another milestone in child development is the ability to mimic facial expressions. Both of these processes act on sensory and perceptual pathways; executive functioning for empathic emotions does not begin during these early stages. Because of this, children and young adults experience another person's pain differently: Young children tend to be negatively aroused more often in comparison to the older subjects.

Sympathy can elicit prosocial and altruistic behaviour. Altruistic behaviour happens when people who experience emotional reactions consistent with the state of another person feel "other-oriented" (inclined to help other people in need or distressed).

People are more inclined to help those in need when they cannot easily escape the situation. If exit is easy, an individual is likely to reduce their own distress (from sympathy; feeling bad) by avoiding contact with the other(s) in need. However sympathy is still experienced when it is easy to escape the situation, suggesting that humans are "other oriented" and altruistic.

The use or acceptance of sympathy can be both altruistic and self-satisfying in social situations. Parenting styles (specifically level of affection) can influence the development of sympathy. Prosocial and moral development extends into adolescence and early adulthood as humans learn to better assess and interpret the emotions of others. Prosocial behaviours have been observed in children between one and two years old. It is difficult to measure emotional responses in children that young by means of self-report methods as they are not as able to articulate such responses as well as adults can.

Theory of mind

The development of theory of mind—the ability to view the world from perspectives of other people—is strongly associated with the development of sympathy and other complex emotions. These emotions are called "complex" because they involve more than just one's own emotional states; complex emotions involve the interplay of multiple people's varying and fluctuating thoughts and emotions within given contexts. The ability to experience vicarious emotion, or to imagine how another person feels, is essential for empathic concern. Moral development is similarly tied to the understanding of outside perspectives and emotions. Moral reasoning has been divided into five categories, beginning with a hedonistic self-orientation and ending with an internalized sense of needs of others, including empathic emotions.

Innate feature

One study sought to determine whether sympathy demonstrated by children was solely for personal benefit, or if the emotion was an innate part of development. Parents, teachers, and 1,300 children (aged six and seven) were interviewed regarding each child's behavior. Over the course of one year, questionnaires were filled out regarding the progress and behavior of each child. This was followed by an interview. The study concluded that children develop sympathy and empathy independently of parental guidance. The study also found that girls are more sympathetic, prosocial, and morally motivated than boys. Prosocial behavior has been noted in children as young as twelve months when showing and giving toys to their parents, without promoting or being reinforced by praise. Levels of prosocial behavior increased with sympathy in children with low moral motivation, as it reflects the link between innate abilities and honing them with the guidance of parents and teachers.