Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Oct 19, 2021; 11(10): 876-896
Published online Oct 19, 2021. doi: 10.5498/wjp.v11.i10.876
Measures of empathy in children and adolescents: A systematic review of questionnaires
Gianluca Sesso, Giulio Emilio Brancati, Pamela Fantozzi, Emanuela Inguaggiato, Annarita Milone, Gabriele Masi
Gianluca Sesso, Giulio Emilio Brancati, Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56100, Italy
Pamela Fantozzi, Emanuela Inguaggiato, Annarita Milone, Gabriele Masi, IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone 56128, Italy
Author contributions: Masi G and Sesso G contributed to study conception and design; Sesso G and Brancati GE performed the systematic search and drafted the manuscript; Fantozzi P and Inguaggiato E revised the draft and contributed to the interpretation of the data; Milone A and Masi G critically revised the article; all the authors approved the final version of the article to be published.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Gabriele Masi, MD, Chief Doctor, Senior Researcher, IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Viale del Tirreno 331, Calambrone 56128, Italy.
Received: February 16, 2021
Peer-review started: February 16, 2021
First decision: May 13, 2021
Revised: May 15, 2021
Accepted: August 19, 2021
Article in press: August 19, 2021
Published online: October 19, 2021

Empathy has long been considered a multidimensional construct, encompassing cognitive, affective and behavioral domains. Deficits in empathic competences in early childhood contribute to psychopathology, and have been variably implicated in several clinical conditions, such as autism spectrum disorders (ASD) and conduct disorders.


To identify and describe empirically validated questionnaires assessing empathy in children and adolescents and to provide a summary of related theoretical perspectives on empathy definitional issues.


A systematic review of the literature was conducted. Three bibliographic databases were searched. A total of 47 studies were selected for final analysis and 16 distinct measures were identified and described.


Questionable to excellent levels of internal consistency were observed, while few studies assessed test–retest reliability. Although construct definitions only partially overlapped, affective and cognitive domains of empathy were the commonest internal factors that were often separately evaluated. New facets of the construct (i.e., somatic empathy and sympathy) and specific clinical populations (i.e., ASD) could be specifically addressed through more recent instruments.


The combination of different assessment methods is recommended in order to foresee further improvements in this field and try to overcome the problem of limited convergence with more objective measures.

Keywords: Empathy, Assessment, Child, Adolescent, Autistic disorder, Conduct disorder

Core tip: Measures of empathy in children and adolescents constitute useful clinical tools for evaluating impairments in empathic competences and social skills within neurodevelopmental disorders and psychiatric conditions. However, the choice of the instrument to use should clearly vary, depending on the setting and the object of study. The present review could be useful to clinicians and researchers to allow a direct comparison of the available measures and identify strengths and limitations of each one depending on different purposes.