BackgroundMany complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients... Show moreBackgroundMany complaints in medicine and in advanced illnesses are about communication. Little is known about which specific communications harm. This study explored the perspectives of patients with advanced cancer about potentially harmful communication behaviors by oncologists and helpful alternatives.MethodsAn online survey design was used that was based on literature scoping and patient/clinician/researcher input. Patients with advanced cancer (n = 74) reflected on the potential harmfulness of 19 communication situations. They were asked whether they perceived the situation as one in which communication could be harmful (yes/no). If they answered “yes,” they were asked whether they perceived the examples as harmful (yes/no) or helpful (yes/no) and to provide open comments. Results were analyzed quantitatively and qualitatively (content analysis).ResultsCommunication regarding information provision, prognosis discussion, decision-making, and empathy could be unnecessarily potentially harmful, and this occurred in various ways, such as making vague promises instead of concrete ones (92%), being too directive in decision-making (qualitative), and not listening to the patient (88%). Not all patients considered other situations potentially harmful (eg, introducing the option of refraining from anticancer therapy [49%] and giving too much [prognostic] information [60%]). Exploring each individual patients' needs/preferences seemed to be a precondition for helpful communication.ConclusionsThis article provides patient perspectives on oncologists' unnecessarily potentially harmful communication behaviors and offers practical tools to improve communication in advanced cancer care. Both preventable pitfalls and delicate challenges requiring an individualized approach, where exploration might help, are described. Although providing difficult and unwelcome news is a core task for clinicians, this study might help them to do so while preventing potentially unnecessary harm. Show less
This thesis investigated the development of emotional functioning in 2-to-6-year-old children with and without autism. Whereas autistic children experienced more challenges in the emotional domain,... Show moreThis thesis investigated the development of emotional functioning in 2-to-6-year-old children with and without autism. Whereas autistic children experienced more challenges in the emotional domain, their emotional abilities improved with age, and developed in similar ways as observed in non-autistic children. On the one hand, this thesis showed that autistic children might deal with emotions in a different way, and they might experience various difficulties when communicating emotions with non-autistic people. One the other hand, it is important to note that the difficulties could be bidirectional. As stated by the “double empathy problem”, non-autistic people may experience the same difficulties when communicating with autistic people. This could be a meaningful direction for future research, investigating emotional communication as a two-way interaction rather than focusing only on how people with autism react to people without autism. Furthermore, this thesis showed that autistic children had the potential to learn and to develop in the emotional domain. Again, this points to the importance of investigating how to create an inclusive social environment, which is not only nurturing for children without autism, but can also benefit the development of children with autism and with other special needs. Show less
Empathy is assumed to be a universal human motivation to act altruistically toward others. Developmental models of empathy explaining when and how children acquire the capacity to empathize have... Show moreEmpathy is assumed to be a universal human motivation to act altruistically toward others. Developmental models of empathy explaining when and how children acquire the capacity to empathize have been proposed. However, the existing knowledge is largely built upon studies conducted in the Western context. To fill this gap, a cross-culturally validated measure of empathy for children is needed. The purpose of this study was to assess the Japanese version of the Empathy Questionnaire (EmQue), a parent-reported measure of empathy in preschool children, including its construct validity, measurement invariance across genders, and reliability. A total of 550 children aged 1-6 years participated in this study (M (age) = 4.17 years, SD = 1.21). Their mothers completed the Japanese EmQue. Confirmatory factor analysis confirmed the hypothesized three-factor structure (emotional contagion, attention to others' feelings, and prosocial actions) in the 13-item Japanese EmQue. The internal consistencies of the three scales were high. Measurement invariance across gender groups was also supported. Overall, the results demonstrate that the Japanese EmQue is a reliable and valid measure of the empathy of Japanese preschool children. It can serve as a tool in future studies to elucidate the role of culture in shaping empathy in early childhood. Show less
Empathy enables people to share, understand, and show concern for others' emotions. However, this capacity may be more difficult to acquire for children with hearing loss, due to limited social... Show moreEmpathy enables people to share, understand, and show concern for others' emotions. However, this capacity may be more difficult to acquire for children with hearing loss, due to limited social access, and the effect of hearing on empathic maturation has been unexplored. This four-wave longitudinal study investigated the development of empathy in children with and without hearing loss, and how this development is associated with early symptoms of psychopathology. Seventy-one children with hearing loss and cochlear implants (CI), and 272 typically-hearing (TH) children, participated (aged 1-5 years at Time 1). Parents rated their children's empathic skills (affective empathy, attention to others' emotions, prosocial actions, and emotion acknowledgment) and psychopathological symptoms (internalizing and externalizing behaviors). Children with CI and TH children were rated similarly on most of the empathic skills. Yet, fewer prosocial actions were reported in children with CI than in TH children. In both groups, affective empathy decreased with age, while prosocial actions and emotion acknowledgment increased with age and stabilized when children entered primary schools. Attention to emotions increased with age in children with CI, yet remained stable in TH children. Moreover, higher levels of affective empathy, lower levels of emotion acknowledgment, and a larger increase in attention to emotions over time were associated with more psychopathological symptoms in both groups. These findings highlight the importance of social access from which children with CI can learn to process others' emotions more adaptively. Notably, interventions for psychopathology that tackle empathic responses may be beneficial for both groups, alike. Show less
Research on precursors of empathy, and on the association between empathy and aggression in early childhood is scarce and contradictory. It is likely that these contradictory results can be... Show moreResearch on precursors of empathy, and on the association between empathy and aggression in early childhood is scarce and contradictory. It is likely that these contradictory results can be explained by taking into account other factors that are related to empathy and aggression. Therefore, our main aim was to study early manifestations of empathy as a predictor of aggression during the first years of life, while taking into account the role of precursors of empathy and possible moderators of the association between empathy and aggression. Early manifestations of empathy could be predicted from emotional responses in infancy, as infants who were more emotionally reactive themselves were also more sensitive to emotions of others during toddlerhood. In addition, impaired empathy already was a risk factor of aggression from the age of 20 months. High levels of aggression were associated with low levels of affective empathy, but not cognitive empathy. The negative association between empathy and aggression was stronger for girls, children with high levels of inhibition, and children with low levels of social attention. It is important to take these factors into account in further research and intervention programs that target empathy and its association with aggression in early childhood. Show less
In a social environment composed mostly of people with typical hearing, deaf or hard of hearing (DHH) children experience social interactions differently from their typically hearing (TH) peers,... Show moreIn a social environment composed mostly of people with typical hearing, deaf or hard of hearing (DHH) children experience social interactions differently from their typically hearing (TH) peers, which could guide them towards different patterns for processing other people’s emotions. This thesis aimed to unravel whether hearing status affects how children encode, interpret, and react to others’ emotions in a social context, and whether their responses are associated with psychosocial functioning, using a variety of measures that included eye tracking, pupillometry, behavioral tasks, parent reports, and longitudinal follow-up. DHH children’s skills for perceiving others’ basic emotions were on par with their TH peers. Improved emotional functioning was associated with improved psychosocial functioning to a similar degree in DHH and TH children alike. Yet, DHH children still faced difficulties when they had to process an emotion with adequate knowledge about social rules and causes of emotions. Moreover, DHH children used a visual cue-based encoding strategy to compensate for ambiguous or unavailable information in social situations, and recruited more cognitive resources to process unfamiliar emotional expressions. The findings underscore the need to look into possible qualitative differences between typical and atypical development. These individual differences reflect compensatory strategies to support daily living, or signal a need for support in a certain domain. Show less
Meulen, M. van der; Wierenga, L.M.; Achterberg, M.; Drenth, N.; IJzendoorn, M.H. van; Crone, E.A. 2020
Prosocial behavior and empathy are important aspects of developing social relations in childhood. Prior studies showed protracted structural development of social brain regions associated with... Show moreProsocial behavior and empathy are important aspects of developing social relations in childhood. Prior studies showed protracted structural development of social brain regions associated with prosocial behavior. However, it remains unknown how structure of the social brain is influenced by genetic or environmental factors, and whether overlapping heritability factors explain covariance in structure of the social brain and behavior. The current study examined this hypothesis in a twin sample (aged 7-9-year; N = 512). Bilateral measures of surface area and cortical thickness of the medial prefrontal cortex (mPFC), temporo-parietal junction (TPJ), posterior superior temporal sulcus (pSTS), and precuneus were analyzed. Results showed genetic contributions to surface area and cortical thickness for all brain regions. We found additional shared environmental influences for TPJ, suggesting that this region might be relatively more sensitive to social experiences. Genetic factors also influenced parent-reported prosocial behavior (A = 45%) and empathy (A = 59%). We provided initial evidence that the precuneus shares genetically determined variance with empathy, suggesting a possible small genetic overlap (9%) in brain structure and empathy. These findings show that structure of the social brain and empathy are driven by a combination of genetic and environmental factors, with some factors overlapping for brain structure and behavior. Show less
Hiele, K. van der; Egmond, E.E.A. van; Jongen, P.J.; Klink, J.J.L. van der; Beenakker, E.A.C.; Eijk, J.J.J. van; ... ; Visser, L.H. 2020
Background: Recent studies report deficits in social cognition in individuals with multiple sclerosis (MS). Social cognitive skills such as empathy are important for adequate social and... Show moreBackground: Recent studies report deficits in social cognition in individuals with multiple sclerosis (MS). Social cognitive skills such as empathy are important for adequate social and occupational functioning. Our objectives are: (1) to examine whether empathy differs between individuals with MS and healthy controls, (2) to examine relations between empathy and cognitive, psychological and occupational functioning. Methods: 278 individuals with MS (relapsing-remitting subtype) and 128 healthy controls from the MS@Work study participated in this investigation. The participants completed questionnaires about demographics, cognitive, psychological and occupational functioning, and underwent neurological and neuropsychological examinations. Mann-Whitney U-tests were used to examine group differences in empathy. Pearson and Spearman rank correlation analyses were used to examine relations between empathy and the other measures. Results: Empathy did not differ between individuals with MS and healthy controls. In individuals with MS, higher empathy was correlated with a higher educational level (X-2(df) = 13.2(2), p = 0.001), better verbal learning (r = 0.20, p = 0.001), less symptoms of depression (r=-0.21, p = 0.001), higher extraversion (r = 0.25, p <= 0.001), agreeableness (r = 0.55, p <= 0.001) and conscientiousness ( r = 0.27, p <= 0.001) and better occupational functioning in terms of work scheduling and output demands (r = 0.23, p = 0.002) and less cognitive/psychological work barriers (r = -0.21, p = 0.001). In healthy controls, higher empathy was correlated with less symptoms of depression (r = -0.34, p <= 0.001), less fatigue (r = -0.37, p <= 0.001), higher agreeableness (r = 0.59, p <= 0.001) and better occupational functioning in terms of work ability as compared to lifetime best (r = 0.28, p = 0.001) and less cognitive/psychological work barriers (r = -0.34, p <= 0.001). Empathy did not differ between unemployed and employed individuals with MS or healthy controls. Conclusion: Empathy did not differ between individuals with MS and healthy controls. Within both investigated groups, higher empathy was weakly to moderately correlated with less symptoms of depression, higher agreeableness and better occupational functioning. We also found unique correlations for empathy within the investigated groups. Longitudinal studies are needed to further examine social cognition in relation to cognitive, psychological and occupational functioning in both individuals with MS and healthy controls. It would be particularly interesting to concurrently examine changes in the brain network involved with social cognition. Show less
Individuals with autism spectrum disorder (ASD) and individuals with conduct disorder (CD) are characterized by notable impairments in social-emotional functioning. In this thesis social-emotional... Show moreIndividuals with autism spectrum disorder (ASD) and individuals with conduct disorder (CD) are characterized by notable impairments in social-emotional functioning. In this thesis social-emotional impairments were investigated using a cognitive neuroscience perspective (i.e., studying cognitive mechanisms and associated neural processes and structures). First, we directly compared groups of ASD and CD to test the hypothesized dissociable deficits in understanding other’s emotions in ASD in contrast to deficits in feeling other’s emotions in CD. This was done by comparing brain activity during basic emotion processing to assess cognitive and affective aspects of empathy, and by comparing white matter tracts that may underlie social-emotional processing. Second, we examined the neural processes at the level of social interactions in ASD and in CD, which has been overlooked by prior work, by studying interactive decision-making in response to other’s emotions. The results of the first part of this thesis show that different neural mechanisms underlie social-emotional difficulties in ASD and CD. Results of the second part imply that uncovering the neural correlates of interacting with others might lead to refined models of social-emotional deficits in ASD and CD that are different from previous accounts based on merely observing other’s emotions. Show less
The aim of this thesis was to study the link between hearing loss, language skills, and social functioning in deaf and hard of hearing (DHH) children. Sufficient language skills are an... Show moreThe aim of this thesis was to study the link between hearing loss, language skills, and social functioning in deaf and hard of hearing (DHH) children. Sufficient language skills are an essential prerequisite to develop appropriate communication skills, in order to join in conversations with others. Both their hearing loss and their diminished communication skills prevent DHH children from learning by observing their surroundings (incidental learning). As a result, DHH children showed more difficulty in understanding others’ thoughts and wishes (Theory of Mind or ToM). DHH teenagers reported to have difficulties with understanding others’ emotions and showed lower levels of prosocial behavior. Higher communication skills, but not language skills, were related to better ToM development and higher empathic abilities. Second, the role of early identification and intervention of hearing loss on the social-emotional development of DHH children was studied. This was illustrated in a longitudinal study showing that early cochlear implantation resulted in higher language and communication skills. In turn, these improved skills prevented the development of early signs of psychopathology. To conclude, this thesis shows that in order to stimulate the social-emotional development of DHH children, their opportunities for incidental learning have to be increased. Show less
One of the most prominent changes in adolescence is social reorientation. In other words, adolescents develop more intimate relationships with peers, they discover what it is like to be involved in... Show moreOne of the most prominent changes in adolescence is social reorientation. In other words, adolescents develop more intimate relationships with peers, they discover what it is like to be involved in a romantic relationship, and they take (social) risks by for example showing risky driving in the presence of friends. Given that social networks with peers become central elements in the adolescent’s life, investigating the role of individual differences related to the development of social reorientation seems highly relevant. This dissertation contributes to a better understanding of stability and change in social reorientation during adolescence by explaining the crucial role of empathy in social interactions from a brain and behavioral perspective. Future research can benefit from the presented studies by applying it to a more detailed analysis of individual differences in this important period in life, which may help to explain why some adolescents are successful in developing social competencies and relationships, whereas others experience difficulties. Eventually, this may lead to the development of interventions for youth who do not cope well with the social requirements from the environments, and help to improve their lives and the lives of individuals around them Show less
In this thesis we examine how different aspects of emotion regulation are linked to social functioning and psychopathology in children and adolescents with Autism Spectrum Disorder (ASD) compared... Show moreIn this thesis we examine how different aspects of emotion regulation are linked to social functioning and psychopathology in children and adolescents with Autism Spectrum Disorder (ASD) compared to their typically developing (TD) peers. We take a broad perspective on emotion regulation by examining i) Emotion awareness, ii) Coping, and iii) Empathy. Main findings where that children with ASD scored lower on social functioning and higher on internalizing behavior, compared to their TD peers. Furthermore, all three aspects of emotion regulation were related with social functioning and psychopathology in both groups. Although children with ASD appeared to be motivated to engage in peer interactions, cognitive and affective impairments may prevent them from effectively deal with the own and other__s emotions. This thesis showed that internalizing and externalizing behavior in children with ASD mainly stems from impaired emotion regulation. Clinical implications and suggestions for further research are also given. Show less
In the present thesis, a homogeneous upper middle class sample of firstborn girls and their mothers were followed from infancy (18 and 24 months) to middle childhood (89 months) using... Show moreIn the present thesis, a homogeneous upper middle class sample of firstborn girls and their mothers were followed from infancy (18 and 24 months) to middle childhood (89 months) using questionnaires and observations. The focus of the study was on three components of moral behavior, i.e. empathy, compliance and prosocial behavoir. The longitudinal development and stability of empathy and compliance from infancy to middle childhood was described, and their relation to prosocial behavior in middle childhood. Empathic concern towards mother increased from 18 to 24 months, but strongly decreased from 24 to 89 months. Empathic concern toward an unfamiliar person decreased from 18 to 89 months. Compliance increased from 18 to 89 months. Only empathy towards mother seems to be fertile ground for donating to charitable organizations like UNICEF. Also, the role of antecedent and concurrent sensitivity and attachment security in prosocial, externalizing, and internalizing behavior in middle childhood was investigated. Results showed that, controlling for concurrent influences, maternal sensitivity and attachment security in infancy predicted prosocial and externalizing behavior Show less
