Journal of Autism and Developmental Disorders

, Volume 49, Issue 10, pp 4067–4078 | Cite as

The Empathizing–Systemizing Theory and ‘Extreme Male Brain’ (EMB) Theory in Parents of Children with Autism Spectrum Disorders (ASD): An Explorative, Cross-Sectional Study

  • Francesco Craig
  • Andrea De Giacomo
  • Rosa Savino
  • Marta Ruggiero
  • Luigi Russo
  • Isabella Fanizza
  • Lucia Margari
  • Antonio TrabaccaEmail author
Original Paper


The aim of this study was to evaluate whether empathizing and systemizing are part of the parental broad autism phenotype (BAP). Parents (N = 76) of preschool children with a diagnosis of ASD and parents (N = 48) of typically developing (TD) children completed the Empathy Quotient (EQ) and Systemizing Quotient-Revised (SQ-R) questionnaires. The E–S discrepancy (D score) was used to test for sex differences in five “brain types”. Our results suggest that the E–S theory do not seem to be part of the BAP. However, a stronger drive to systemize than empathize (Type S brain) could be a highly inheritable cognitive endophenotype of mothers of children with ASD. This study should be repeated with a larger sample size.


Autism spectrum disorder Parental broad autism phenotype Empathizing Systemizing Extreme male brain theory 


Author Contributions

FC conceived of the study, participated in its design and coordination and drafted the manuscript; AD participated in the design and interpretation of the data; RS participated in the design and interpretation of the data; MR participated in the design and coordination of the study and performed the measurement; LR participated in the design of the study and performed the statistical analysis; IF participated in the design and coordination of the study and performed the measurement; LM participated in its design and coordination and helped to draft the manuscript; AT conceived of the study, and helped to draft the manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  2. Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in Cognitive Sciences, 6(6), 248–254.CrossRefPubMedGoogle Scholar
  3. Baron-Cohen, S. (2006). The hyper-systemizing, assortative mating theory of autism. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 30(5), 865–872. Scholar
  4. Baron-Cohen, S. (2009). Autism: the empathizing-systemizing (E-S) theory. Annals of the New York Academy of Sciences, 1156, 68–80. Scholar
  5. Baron-Cohen, S. (2010). Empathizing, systemizing, and the extreme male brain theory of autism. Progress in Brain Research, 186, 167–175. Scholar
  6. Baron-Cohen, S., Auyeung, B., Nørgaard-Pedersen, B., Hougaard, D. M., Abdallah, M. W., Melgaard, L., et al. (2015). Elevated fetal steroidogenic activity in autism. Molecular Psychiatry, 20(3), 369–376. Scholar
  7. Baron-Cohen, S., Richler, J., Bisarya, D., Gurunathan, N., & Wheelwright, S. (2003). The systemizing quotient: An investigation of adults with Asperger syndrome or high-functioning autism, and normal sex differences. Philosophical Transactions of the Royal Society of London. Series B, Biological sciences, 358(1430), 361–374. Scholar
  8. Baron-Cohen, S., & Wheelwright, S. (2004). The empathy quotient: an investigation of adults with Asperger syndrome or high functioning autism, and normal sex differences. Journal of Autism and Developmental Disorders, 34(2), 163–175.CrossRefPubMedGoogle Scholar
  9. Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism-spectrum quotient (AQ): Evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31(1), 5–17.CrossRefPubMedGoogle Scholar
  10. Billeci, L., Calderoni, S., Conti, E., Gesi, C., Carmassi, C., Dell’Osso, L., et al. (2016). The Broad Autism (Endo)Phenotype: Neurostructural and neurofunctional correlates in parents of individuals with autism spectrum disorders. Frontiers in Neuroscience, 10, 346. Scholar
  11. Chaste, P., & Leboyer, M. (2012). Autism risk factors: Genes, environment, and gene-environment interactions. Dialogues in Clinical Neuroscience, 14(3), 281–292.PubMedPubMedCentralGoogle Scholar
  12. Flint, J., & Munafò, M. R. (2007). The endophenotype concept in psychiatric genetics. Psychological Medicine, 37(2), 163–180. Scholar
  13. Floris, D. L., Lai, M. C., Nath, T., Milham, M. P., & Di Martino, A. (2018). Network-specific sex differentiation of intrinsic brain function in males with autism. Mol Autism, 9, 17. Scholar
  14. Freitag, C. M. (2007). The genetics of autistic disorders and its clinical relevance: A review of the literature. Molecular Psychiatry, 12(1), 2–22. Scholar
  15. Gerdts, J., & Bernier, R. (2011). The broader autism phenotype and its implications on the etiology and treatment of autism spectrum disorders. Autism Research and Treatment, 2011, 545901. Scholar
  16. Goldenfeld, N., Baron-Cohen, S., & Wheelwright, S. (2005). Empathizing and systemizing in males, females, and autism. Clinical Neuropsychiatry: Journal of Treatment Evaluation, 2(6), 8.Google Scholar
  17. Gottesman, I. I., & Gould, T. D. (2003). The endophenotype concept in psychiatry: Etymology and strategic intentions. American Journal of Psychiatry, 160(4), 636–645. Scholar
  18. Greenberg, D. M., Warrier, V., Allison, C., & Baron-Cohen, S. (2018). Testing the Empathizing-Systemizing theory of sex differences and the Extreme Male Brain theory of autism in half a million people. Proceedings of the National Academy of Sciences of the United States of America, 115(48), 12152–12157. Scholar
  19. Grove, R., Baillie, A., Allison, C., Baron-Cohen, S., & Hoekstra, R. A. (2013). Empathizing, systemizing, and autistic traits: Latent structure in individuals with autism, their parents, and general population controls. Journal of Abnormal Psychology, 122(2), 600–609. Scholar
  20. Hasegawa, C., Kikuchi, M., Yoshimura, Y., Hiraishi, H., Munesue, T., Nakatani, H., et al. (2015). Broader autism phenotype in mothers predicts social responsiveness in young children with autism spectrum disorders. Psychiatry and Clinical Neurosciences, 69(3), 136–144. Scholar
  21. Hurley, R. S., Losh, M., Parlier, M., Reznick, J. S., & Piven, J. (2007). The broad autism phenotype questionnaire. Journal of Autism and Developmental Disorders, 37(9), 1679–1690. Scholar
  22. Jacquemont, S., Coe, B. P., Hersch, M., Duyzend, M. H., Krumm, N., Bergmann, S., et al. (2014). A higher mutational burden in females supports a “female protective model” in neurodevelopmental disorders. American Journal of Human Genetics, 94(3), 415–425. Scholar
  23. Jeste, S. S., & Geschwind, D. H. (2014). Disentangling the heterogeneity of autism spectrum disorder through genetic findings. Nature Reviews Neurology, 10(2), 74–81. Scholar
  24. Kidron, R., Kaganovskiy, L., & Baron-Cohen, S. (2018). Empathizing-systemizing cognitive styles: Effects of sex and academic degree. PLoS ONE, 13(3), e0194515. Scholar
  25. Lai, M. C., Lombardo, M. V., Chakrabarti, B., Ecker, C., Sadek, S. A., Wheelwright, S. J., … Consortium, M. A. (2012). Individual differences in brain structure underpin empathizing-systemizing cognitive styles in male adults. Neuroimage, 61(4), 1347–1354.
  26. Lord, C., Rutter, M., DiLavore, P. C., Risi, S., & Gotham, K. (2012). Autism diagnostic observation schedule (2nd ed., Vol. Volume ADOS-2). Torrence, CA: Western Psychological Services.Google Scholar
  27. Losh, M., Childress, D., Lam, K., & Piven, J. (2008). Defining key features of the broad autism phenotype: A comparison across parents of multiple- and single-incidence autism families. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 147B(4), 424–433. Scholar
  28. Pisula, E., & Ziegart-Sadowska, K. (2015). Broader autism phenotype in siblings of children with ASD–A review. International Journal of Molecular Sciences, 16(6), 13217–13258. Scholar
  29. Rossignol, D. A., Genuis, S. J., & Frye, R. E. (2014). Environmental toxicants and autism spectrum disorders: A systematic review. Translational Psychiatry, 4, e360. Scholar
  30. Rubenstein, E., & Chawla, D. (2018). Broader autism phenotype in parents of children with autism: A systematic review of percentage estimates. Journal of Child and Family Studies, 27(6), 1705–1720. Scholar
  31. Rubenstein, E., Edmondson Pretzel, R., Windham, G. C., Schieve, L. A., Wiggins, L. D., DiGuiseppi, C.,… Daniels, J. (2017). The broader autism phenotype in mothers is associated with increased discordance between maternal-reported and clinician-observed instruments that measure child autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(10), 3253–3266.
  32. Takeuchi, H., Taki, Y., Sassa, Y., Hashizume, H., Sekiguchi, A., Fukushima, A., et al. (2014). Regional gray matter volume is associated with empathizing and systemizing in young adults. PLoS ONE, 9(1), e84782. Scholar
  33. Tick, B., Bolton, P., Happé, F., Rutter, M., & Rijsdijk, F. (2016). Heritability of autism spectrum disorders: A meta-analysis of twin studies. Journal of Child Psychology and Psychiatry, 57(5), 585–595. Scholar
  34. Wechsler, D. (1991). WISC-III: Wechsler intelligence scale for children: Manual. San Antonio, TX: The Psychological Corporation.Google Scholar
  35. Wechsler, D. (2002). The Wechsler preschool and primary scale of intelligence (3rd ed.). San Antonio, TX: The Psychological Corporation Canadian Journal of School Psychology.Google Scholar
  36. Wright, D. B., & Skagerberg, E. M. (2012). Measuring empathizing and systemizing with a large US sample. PLoS ONE, 7(2), e31661. Scholar
  37. Zhao, X., Leotta, A., Kustanovich, V., Lajonchere, C., Geschwind, D. H., Law, K.,… Wigler, M. (2007). A unified genetic theory for sporadic and inherited autism. Proceedings of the National Academy of Sciences of the United States of America, 104(31), 12831–12836.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Francesco Craig
    • 1
  • Andrea De Giacomo
    • 2
  • Rosa Savino
    • 1
  • Marta Ruggiero
    • 1
  • Luigi Russo
    • 1
  • Isabella Fanizza
    • 1
  • Lucia Margari
    • 2
  • Antonio Trabacca
    • 1
    Email author
  1. 1.Unit for Severe Disabilities in Developmental Age and Young AdultsScientific Institute, IRCCSBrindisiItaly
  2. 2.Child Neuropsychiatry Unit, Department of Basic Medical Sciences, Neuroscience and Sense OrgansUniversity of Bari “Aldo Moro”BariItaly

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