Empathy in adolescents with early brain injury

When children experience early brain injury, parents are often most concerned about how their child will fare socially. Given that empathy is a fundamental mechanism of social behaviour, it is likely that deficits in empathy will have potentially wide-ranging consequences. Empathic processes are particularly pertinent during adolescence, given that this is an important period of social change and identity formation, representing rapid biopsychosocial growth. The aim of this study was to investigate levels of empathy in adolescents who have experienced early brain injury, and to explore the predictive value of empathy in determining social and emotional outcome in this population. Seventy-three adolescent participants were recruited through an existing study at the Royal Children’s Hospital in Melbourne, Australia. All had MRI-documented brain injury (diverse in location and aetiology) which occurred at least two years prior to their participation. Inclusion criteria ensured English fluency, an IQ of at least 70, and sufficient reading ability (Grade 3 and above). Participants and their caregivers completed a multidimensional measure of empathy, a child-modified version of the Interpersonal Reactivity Index (IRI; Davis, 1980). The IRI consists of two cognitive empathy scales, Fantasy and Perspective Taking; and two affective empathy scales, Empathic Concern and Personal Distress, the latter of which is considered maladaptive. Participants and their caregivers also completed a measure of depression (RADS-2; W. M. Reynolds, 2002), along with a battery of social and emotional functioning scales. It was hypothesized that: (a) Adolescents with brain injuries will display empathic deviations compared to a normal adolescent population; (b) The extent of empathic deviations will be determined by a combination of injury-related factors (specifically, it was predicted that poorer empathic outcome will be observed in those with injuries that occurred between 19 – 47 months of age, those with frontal injuries, and those with injuries to the right hemisphere); (c) It was also hypothesized that empathy levels would assist in predicting social and emotional outcome (specifically, those with greater empathic impairments will fare worse socially and emotionally). Results lend partial support to the first hypothesis; participants demonstrated deficits in some domains of empathy and not others. Participants and caregivers reported lower levels of an adaptive form of empathy (Perspective Taking) and higher levels of a maladaptive form of empathy, (Personal Distress) relative to normative standards. No main effects were demonstrated with respect to the remaining two empathy scales (Fantasy and Empathic Concern). Hierarchical regression analyses revealed partial support for the second hypothesis; injury timing predicted self-reported Perspective Taking and Personal Distress; frontal lobe involvement predicted self-reported Fantasy; and right hemispheric involvement was associated with Empathic Concern, however this was only demonstrated in caregiver-reported empathy. Findings relating to the value of empathy in predicting social outcome were mixed. Empathy contributed to the prediction of all positive social variables with the exception of school adjustment. However, scores on negative social variables were mainly predicted by levels of Perspective Taking. In terms of emotional outcome, empathy significantly contributed to the prediction of the majority of the emotional variables, however much of this variance was attributed to the Personal Distress scale. This study has taken an initial step towards exploring empathic abilities in a population of adolescents with early brain injury, taking into consideration the role of injury timing and broad location. It demonstrates that affective and cognitive forms of empathy play a differential role in later socio-emotional development. Furthermore, it is hoped that the findings from this research may assist in targeting future interventions for adolescents who have sustained a brain injury.