Measures of empathy in children and adolescents: A systematic review of questionnaires

Table 1 Characteristics of included studies aimed at presenting or validating original questionnaires (n = 16)

Ref.	Measure	Country	Language	Setting	Participants	Sample size	Age, yr	Gender
Bryant[98], 1984	BEI	NA	English	NA	Healthy	128 + 163 + 73	7/10/14	NA
Litvack-Miller et al[99], 1997	IRI	Canada	English	Schools	Healthy	478	7-12	NA
Rey[63], 2003	SME	Colombia	Spanish	Schools (centers)	Healthy + CD	224 + 94	11-18	100/100
Garton et al[89], 2005	F&T	Australia	English	Schools	Healthy	413	8-10	53
Jolliffe and Farrington[6], 2006	BES	United Kingdom	English	Schools	Healthy	720	14.8 ± 0.48	50.8
Dadds et al[100], 2007	GEM	Australia	English	Schools	Healthy	2612	4-16	52.8
Funk et al[82], 2008	CEAQ	United States	English	Schools	Healthy	213	10-13	49.6
Sallquist et al[62], 2009	DPES	United States	English	Maternity hospital	Healthy	168	4.49 ± 0.07	52.9
Auyeung et al[64], 2009	EQ-C	United Kingdom	English	Schools (centers)	Healthy + ASD	1256 + 265	4-11	46.3/82.6
Rieffe et al[83], 2010	EQ	Netherlands	Dutch	Schools and centers	Healthy	109	1-5	47.7
Whitt and Howard[101], 2013	ES-PPI	United States	English	Rehab services	Antisocial	707	15.5 ± 1.2	87
Lopèz-Pèrez and Fernadèz[102], 2014	TECA	Spain	Spanish	NA	Healthy	670	10-16	NA
Vossen et al[88], 2015	AMES	Netherlands	Dutch	Households	Healthy	450	10-15	50
Wang and Wang[87], 2015	EToMS	China	Chinese	Schools	Healthy	189	3-6	50.8
Raine and Chen[29], 2017	CASES	United States	English	Community	Healthy	428	11-12	NA
Richaud et al[35], 2017	EQ	Argentina	Spanish	Schools	Healthy	479	9-12	46.3

Age is reported in years, as either mean ± SD or age range according to original available data; gender is reported as percentage of males. AMES: Adolescent Measure of Empathy and Sympathy; ASD: Autism spectrum disorder; BES: Basic Empathy Scale; BEI: Bryant’s Empathy Index; CASES: Cognitive, Affective and Somatic Empathy Scales; CD: Conduct disorder; CEAQ: Children’s Empathic Attitudes Questionnaire; DPES: Dispositional Positive Empathy Scale; EQ-C: Empathy Quotient for Children; EQ: Empathy Questionnaire; ES-PPI: Empathy Scale-Psychopathic Personality Inventory; EtoMS: Empathy and Theory of Mind Scale; F&T: Feeling and Thinking Scale; GEM: Griffith Empathy Measure; IRI: Interpersonal Reactivity Index; SME: Scale to Measure Empathy; TECA: Cognitive and Affective Empathy Scale (Test de Empatia Cognitiva y Afectiva); NA: not available.

Table 2 Included studies aimed at validating adaptations (n = 6, A) or translations of the included measures (n = 19, B), and assessing further psychometric properties (n = 6, C)

Ref.	Measure	Language	Sample size
(A) Adaptation studies
Auyeung et al[95], 2012	EQ– adolescent version	English	1243
Bensalah et al[60], 2016	BES – child version	French	410
Merino-Soto and Grimaldo-Muchotrigo[103], 2015	BES – short version	Spanish	135
Overgaauw et al[59], 2017	EQ – CA version	Dutch	1250
Pechorro et al[104], 2018	BES – short version	Portuguese	543
Salas-Wright et al[105], 2013	BES – short version	Spanish	208
Sánchez-Pérez et al[58], 2014	BES – parent report	Spanish	364
(B) Translation studies
Albiero et al[106], 2009	BES	Italian	665
Albiero et al[107], 2010	BES	Italian	1191
Čavojová et al[108], 2012	BES	Slovak	429
D'Ambrosio et al[109], 2009	BES	French	446
de Wied et al[110], 2007	BEI	Dutch	1978
del Barrio et al[111], 2004	BEI	Spanish	832
Geng et al[112], 2012	BES	Chinese	1524
Soroa et al[113], 201	TECA	Basque	504
Grazzani et al[114], 2017	EQ	Italian	304
Hawk et al[115], 2013	IRI	Dutch	501
Herrera-López et al[116], 201	BES	Spanish	747
Liu et al[117], 2018	CASES	Chinese	860
Lucas-Molina et al[118], 2018	EQ	Spanish	103
Pechorro et al[119], 2015	BES	Portuguese	221
Mestre-Escriva et al[120], 2004	IRI	Spanish	1285
Rudra et al[121], 2016	EQ-C	Bengali	51
Vilte et al[122], 2016	CEAQ	Spanish	297
You et al[123], 2018	BES	Korean	1524
Zengin et al[124], 2018	AMES	Turkish	212
(C) Psychometric Properties
Anastácio et al[125], 2016	BES	Portuguese	1029
Carrasco Ortiz et al[126], 2011	IRI	Spanish	721
Holgado Tello et al[127], 2013	IRI	Spanish	721
Lasa Aristu et al[128], 2008	BEI	Spanish	2714
Lucas-Molina et al[129], 2016	BEI	Spanish	2050
Pechorro et al[72], 201	BES	Portuguese	377

AMES: Adolescent Measure of Empathy and Sympathy; BES: Basic Empathy Scale; BEI: Bryant’s Empathy Index; CA: children and adolescents; CASES: Cognitive, Affective and Somatic Empathy Scales; CEAQ: Children’s Empathic Attitudes Questionnaire; EQ: Empathy Questionnaire; EQ-C: Empathy Quotient for Children; IRI: Interpersonal Reactivity Index; TECA: Cognitive and Affective Empathy Scale (Test de Empatia Cognitiva y Afectiva).

Table 3 First validation of selected questionnaires (n = 16)

Name	Validation	Subscales	n	Response	Age	R	IC	Reliability	Criterion	Convergent /divergent
BEI	Bryant[98], 1984	None	22	1 (low) to 5 (high)	C, A	SR	α = 0.54 to 0.79	T-R: r = 0.74 to .83	NA	NA
IRI	Litvack-Miller et al[99], 1997	Fantasy;	28	0 (not well) to 4 (very well)	C	SR	NA	NA	NA	NA
		Perspective-taking;
		Empathic concern;
		Personal distress
SME	Rey[63], 2003	None	15	1 (never) to 4 (always)	A	SR	α = 0.78	NA	HC > CD:	NA
									P = 0.008
F&T	Garton et al[89], 2005	Affective;	12	1 (not like me) to 5 (very like me)	C	SR	α = 0.54 to 0.69	NA	F > M	NA
		Cognitive
BES	Jolliffe and Farrington[6], 2006	Affective;	20	1 (agree) to 5 (disagree)	A	SR	α = 0.79 to 0.85	NA	F > M:	IRI: r = 0.43 to 0.53;
		Cognitive							P < 0.0001	TAS: r = –0.20 to –0.17;
										SDS: r = –0.11 to 0.00
GEM	Dadds et al[100], 2007	Cognitive;	23	–4 (disagree) to +4 (agree)	C, A	PR	α = 0.81 (tot);	IRR: r = 0.40 to 0.38;	F > M:	IQ: r = 0.30 (cogn);
		Affective					α = 0.62 to 0.83	T-R: r = 0.69	P < 0.001	CAI-C: r = –0.12 to –0.31;
										CAI-N: r = 0.05 to 0.25;
										IRT: r = 0.30 to 0.56
CEAQ	Funk et al[82], 2008	None	16	No/Maybe/Yes	C	SR	α = 0.77	RPR = 0.75; RPSI = 1.75	F > M:	BEI: r = 0.57;
									P < 0.01	SDQ-PS: r = 0.39;
										SDQ-CP: r = –0.17;
										CSDTC: r = 0.39
DPES	Sallquist et al[62], 2009	None	7	1 (really untrue) to 4 (really true)	P	PR	α = 0.81	NA	NA	ITSEA-E: r = 0.43;
										ITSEA-SC: r = 0.35;
										Task = 0.47
EQ-C	Auyeung et al[64], 2009	None	27	1 (disagree) to 4 (agree)	P, C, A	PR	α = 0.93	T-R: r = 0.86	HC-F > HC-M > ASD;	SQ-C: r = –0.13
									P < 0.001
EQ	Rieffe et al[83], 2010	Emotion contagion;	20	1 (never) to 3 (often)	I, P	PR	α = 0.58 to 0.80	NA	NA	NA
		Attention to others;
		Prosocial actions
ES-PPI	Whitt and Howard[101], 2013	None	5	1 (false) to 4 (true)	A	SR	α = 0.69	NA	NA	BSI-PS: r = 0.11 to 0.30; APSD: r = –0.18 to –0.08; MAYSI-2: r = 0.08 to 0.21
TECA	Lopèz-Pèrez and Fernadèz[102], 2014	Perspective taking;	30	1 (disagree) to 4 (agree)	C, A	SR		NA	NA	NA
		Emotion understanding;
		Personal distress;
		Empathic joy
AMES	Vossen et al[88], 2015	Affective;	12	1 (never) to 5 (always)	C, A	SR	α = 0.75 to 0.86	T-R: r = 0.56 to 0.69	F > M;	IRI-EC: r = 0.29 to 0.63;
		Cognitive;							P < 0.01	IRI-PT: r = 0.21 to 0.45;
		Sympathy								PBS: r = 0.14 to 0.50;
										PA: r = –0.07 to -0.36
EToMS	Wang and Wang[87], 2015	Empathy;	16	1 (never) to 5 (always)	P	PR	α = 0.71 to 0.83	NA	F > M	WL-NiceToM: r = 0.21;
		Nice ToM;								SL-NastyToM: r = 0.33;
		Nasty ToM								FB: r = 0.27 (E) –0.28 (NiceToM)
CASES	Raine and Chen[29], 2017	Affective;	30	0 (rarely) to 2 (often)	C	SR	α = 0.63 to 0.91	NA	F > M	IQ: r > 0;
		Cognitive;								RPAQ-R: r = –0.11;
		Somatic								CBCL-Ext: r < 0;
										APSD: r = –0.12 to –0.39
EQ	Richaud et al[35], 2017	Emotion contagion;	15	1 (never) to 4 (always)	C	SR	ω = 0.70 to 0.76	NA	NA	PBS-C: r = 0.23 to 0.79;
		Self-other awareness;								PBS-L: r = 0.21 to 0.49;
		Perspective taking;								IRI-PT: r = 0.32 to 0.37;
		Emotional regulation;								PVAS: r = –0.18 to –0.31;
		Empathic action								EIS: r = –0.24

Validation refers to the original article in which the questionnaire was first validated. Construct refers to the original article in which the definition of the empathy construct for each questionnaire was provided; n refers to number of items. Response refers to the number of available Likert-scale responses for each item of the questionnaires. Age refers to the age range in which the original validation of the questionnaire was performed (i.e. infants, aged 1–3 years; preschool children aged 3–6 years; children aged 6–13 years; adolescents aged 13–18 years). R refers to type of report, either self- or parent-report. IC refers to internal consistency, measured by either Cronbach’s alpha or McDonald’s omega. Criterion and convergent/divergent refer to criterion and convergent/divergent validity, respectively. α: Cronbach’s alpha; A: adolescents; AMES: Adolescent Measure of Empathy and Sympathy; APSD: Antisocial Personality Screening Device; ASD: autism spectrum disorder; BES: Basic Empathy Scale; BEI: Bryant’s Empathy Index; BSI: Brief Symptom Inventory; C: children; CAI: Cruelty to Animals Inventory; CASES: Cognitive, Affective and Somatic Empathy Scales; CBCL: Child Behaviour Checklist; CD: conduct disorder; CEAQ: Children’s Empathic Attitudes Questionnaire; CSDTC: Crandall Social Desirability Test for Children; DPES: Dispositional Positive Empathy Scale; EIS: Emotional Instability Scale; EmQue: Empathy Questionnaire; EQ: Empathy Questionnaire; EQ-C: Empathy Quotient for Children; ES-PPI: Empathy Scale-Psychopathic Personality Inventory; EToMS: Empathy and Theory of Mind Scale; F: females; FB: false belief; F&T: Feeling and Thinking Scale; GEM: Griffith Empathy Measure; HC: healthy controls; I: infants; IC: internal consistency; IQ: intelligence quotient; IRI: Interpersonal Reactivity Index; IRR: inter-rater reliability; IRT: Interpersonal Response Task; ITSEA: Infant-Toddler Social and Emotional Assessment; M: males; MAYSI: Massachusetts Youth Screening Instrument; NA: not available; P: preschool children; PA: physical aggression; PBS: Prosocial Behaviour Scale; PR: parent-report; PVAS: Physical and Verbal Aggression Scale; R: report; RPAQ: Reactive–Proactive Aggression Questionnaire; RPR: Rasch Person Reliability; RPSI: Rasch Person Separation Index; SDQ: Strengths and Difficulties Questionnaire; SDS: Social Desirability Scale; SL: strategic lie; SME: Scale to Measure Empathy; SQ-C: Systemising Quotient for Children; SR: self-report; TAS: Toronto Alexithymia Scale; TECA: Cognitive and Affective Empathy Scale (Test de Empatia Cognitiva y Afectiva); ToM: Theory of mind; T-R: Test-retest; WL: White lie; ω: McDonald’s omega.