Skip to main content Accessibility help

Morality in autism spectrum disorder: A systematic review

  • E. E. Dempsey (a1), C. Moore (a1), S. A. Johnson (a1) (a2), S. H. Stewart (a1) (a3) (a4) and I. M. Smith (a1) (a2) (a5)...


Moral reasoning and decision making help guide behavior and facilitate interpersonal relationships. Accounts of morality that position commonsense psychology as the foundation of moral development, (i.e., rationalist theories) have dominated research in morality in autism spectrum disorder (ASD). Given the well-documented differences in commonsense psychology among autistic individuals, researchers have investigated whether the development and execution of moral judgement and reasoning differs in this population compared with neurotypical individuals. In light of the diverse findings of investigations of moral development and reasoning in ASD, a summation and critical evaluation of the literature could help make sense of what is known about this important social-cognitive skill in ASD. To that end, we conducted a systematic review of the literature investigating moral decision making among autistic children and adults. Our search identified 29 studies. In this review, we synthesize the research in the area and provide suggestions for future research. Such research could include the application of an alternative theoretical framework to studying morality in autism spectrum disorder that does not assume a deficits-based perspective.


Corresponding author

Author for Correspondence: E. E. Dempsey, Department of Psychology and Neuroscience, Dalhousie University, P.O. Box 15000, 1355 Oxford Street, Halifax, Nova Scotia, B3H 4R2, Canada. E-mail:


Hide All

The authors also wish to thank Ty Pratt and Stef Hartlin for screening studies for relevance for this review.



Hide All
Akechi, H., Kikuchi, Y., Tojo, Y., Hakarino, K., & Hasegawa, T. (2018). Mind perception and moral judgment in autism. Autism Research, 11, 12391244.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC.: Author.
Aschenbrenner, S., Tucha, O., & Lange, K.W. (2001). Regensburger Wortflüssigkeitstest (RWT). Göttingen, Germany: Hogrefe.
Baez, S., Rattazzi, A., Gonzalez-Gadea, M. L., Torralva, T., Vigliecca, N., Decety, J., … Ibanez, A. (2012). Integrating intention and context: Assessing social cognition in adults with Asperger syndrome. Frontiers in Human Neuroscience, 6, 302.
Bagby, R. M., Parker, J. D. A., & Taylor, G. J. (1994). The twenty-item Toronto Alexithymia Scale—I. Item selection and cross-validation of the factor structure. Journal of Psychosomatic Research, 38, 2332. http://
Barnes, J. L., Lombardo, M. V., Wheelwright, S., & Baron-Cohen, S. (2009). Moral dilemmas film task: A study of spontaneous narratives by individuals with autism spectrum conditions. Autism Research, 2, 148156.
Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a ‘theory of mind’? Cognition, 21, 3746. doi:10.1016/0010-0277(85)90022-8
Baron-Cohen, S., Tager-Flusberg, H., & Lombardo, M. (Eds.). (2013). Understanding other minds: Perspectives from developmental social neuroscience. Oxford, UK: Oxford University Press.
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, 163175.
Bellesi, G., Vyas, K., Jameel, L., & Channon, S. (2018). Moral reasoning about everyday situations in adults with autism spectrum disorder. Research in Autism Spectrum Disorders, 52, 111.
Blair, R. J. (1996). Brief report: Morality in the autistic child. Journal of Autism & Developmental Disorders, 26, 571579.
Blair, R. J. (2008). Fine cuts of empathy and the amygdala: Dissociable deficits in psychopathy and autism. Quarterly Journal of Experimental Psychology, 61, 157170.
Bos, J., & Stokes, M. A. (2018). Cognitive empathy moderates the relationship between affective empathy and wellbeing in adolescents with autism spectrum disorder. European Journal of Developmental Psychology, 2018, 114.
Brewer, R., Marsh, A. A., Catmur, C., Cardinale, E. M., Stoycos, S., Cook, R., & Bird, G. (2015). The impact of autism spectrum disorder and alexithymia on judgments of moral acceptability. Journal of Abnormal Psychology, 124, 589595.
Buon, M., Dupoux, E., Jacob, P., Chaste, P., Leboyer, M., & Zalla, T. (2013). The role of causal and intentional judgments in moral reasoning in individuals with high functioning autism. Journal of Autism and Developmental Disorders, 43, 458470. doi:10.1007/s10803-012-1588-7
Button, K. S., Ioannidis, J. P., Mokrysz, C., Nosek, B. A., Flint, J., Robinson, E. S., & Munafò, M. R. (2013). Power failure: Why small sample size undermines the reliability of neuroscience. Nature Reviews Neuroscience, 14, 365376.
Channon, S., Fitzpatrick, S., Drury, H., Taylor, I., & Lagnado, D. (2010). Punishment and sympathy judgments: Is the quality of mercy strained in Asperger’s syndrome? Journal of Autism and Developmental Disorders, 40, 12191226.
Channon, S., Lagnado, D., Fitzpatrick, S., Drury, H., & Taylor, I. (2011). Judgments of cause and blame: Sensitivity to intentionality in Asperger’s syndrome. Journal of Autism and Developmental Disorders, 41, 15341542.
Crane, L., Goddard, L., & Pring, L. (2009). Sensory processing in adults with autism spectrum disorders. Autism, 13, 215228.
Cushman, F., Sheketoff, R., Wharton, S., & Carey, S. (2013). The development of intent-based moral judgment. Cognition, 127, 621.
Davidson, J. (2008). Autistic culture online: Virtual communication and cultural expression on the spectrum. Social & Cultural Geography, 9, 791806.
Dunn, L. M., & Dunn, L. M. (1997). PPVT-III: Peabody picture vocabulary test. Circle Pines, Minnesota; American Guidance Service.
Dunn, L.M., Dunn, L.M. & Whetton, C. (1982) British Picture Vocabulary Scale. Windsor, UK: Nelson.
Dziobek, I., Rogers, K., Fleck, S., Bahnemann, M., Heekeren, H. R., Wolf, O. T., & Convit, A. (2008). Dissociation of cognitive and emotional empathy in adults with Asperger syndrome using the multifaceted empathy test (MET). Journal of Autism and Developmental Disorders, 38, 464473. doi:10.1007/s10803-007-0486-x
Fadda, R., Parisi, M., Ferretti, L., Saba, G., Foscoliano, M., Salvago, A., & Doneddu, G. (2016). Exploring the role of theory of mind in moral judgment: The case of children with autism spectrum disorder. Frontiers in Psychology, 7, 18.
Gallese, V. (2006). Intentional attunement: A neurophysiological perspective on social cognition and its disruption in autism. Brain Research, 1079, 1524.
Gleichgerrcht, E., Torralva, T., Rattazzi, A., Marenco, V., Roca, M., & Manes, F. (2013). Selective impairment of cognitive empathy for moral judgment in adults with high functioning autism. Social Cognitive and Affective Neuroscience, 8, 780788.
Graham, J., Haidt, J., & Nosek, B. A. (2009). Liberals and conservatives rely on different sets of moral foundations. Journal of Personality and Social Psychology, 96, 10291046.
Grant, C. M., Boucher, J., Riggs, K. J., & Grayson, A. (2005). Moral understanding in children with autism. Autism, 9, 317331. doi:10.1177/1362361305055418
Grant, T., Furlano, R., Hall, L., & Kelley, E. (2018). Criminal responsibility in autism spectrum disorder: A critical review examining empathy and moral reasoning. Canadian Psychology, 59, 6575. doi:10.1037/cap0000124
Greene, J. D., Sommerville, R. B., Nystrom, L. E., Darley, J. M., & Cohen, J. D. (2001). An fMRI investigation of emotional engagement in moral judgment. Science, 293, 21052108.
Griffin, C., Lombardo, M. V., & Auyeung, B. (2016). Alexithymia in children with and without autism spectrum disorders. Autism Research, 9, 773–780.
Haidt, J. (2001). The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychological Review, 108, 8395. doi:10.1037//0033-295X.
Hamlin, J.K., Wynn, K., Bloom, P., & Mahajan, N. (2011). How infants and toddlers react to antisocial others. Proceedings of the National Academy of Sciences of the United States of America, 108, 1993119936. doi: 10.1073/pnas.1110306108
Hill, E., Berthoz, S., & Frith, U. (2004). Brief report: Cognitive processing of own emotions in individuals with autistic spectrum disorder and in their relatives. Journal of Autism and Developmental Disorders, 34, 229235.
Hirvelä, S., & Helkama, K. (2011). Empathy, values, morality and Asperger's syndrome. Scandinavian Journal of Psychology, 52, 560572.
Hobson, R. P. (2012). Autism, literal language and concrete thinking: Some developmental considerations. Metaphor and Symbol, 27, 421.
Hoffman, M. L. (1987). The contribution of empathy to justice and moral judgment. In Eisenberg, N., & Strayer, J. (Eds.), Empathy and its development (pp. 4780). New York, NY: Cambridge University Press.
Hoffmann, F., Koehne, S., Steinbeis, N., Dziobek, I., & Singer, T. (2016). Preserved self-other distinction during empathy in autism is linked to network integrity of right supramarginal gyrus. Journal of Autism and Developmental Disorders, 46, 637648.
Howlin, P., Moss, P., Savage, S., & Rutter, M. (2013). Social outcomes in mid-to later adulthood among individuals diagnosed with autism and average nonverbal IQ as children. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 572581.
Jaarsma, P., & Welin, S. (2012). Autism as a natural human variation: Reflections on the claims of the neurodiversity movement. Health Care Analysis, 20, 2030.
Japanese WISC-III Publication Committee. (1998). Japanese Wechsler Intelligence Scale for Children. Tokyo, Japan: Nihon Bunka Kagakusha.
Johnson, S. A., Filliter, J. H., & Murphy, R. R. (2009). Discrepancies between self-and parent-perceptions of autistic traits and empathy in high functioning children and adolescents on the autism spectrum. Journal of Autism and Developmental Disorders, 39, 17061714.
Kana, R. K., Keller, T. A., Cherkassky, V. L., Minshew, N. J., & Just, M. A. (2009). Atypical frontal-posterior synchronization of Theory of Mind regions in autism during mental state attribution. Social Neuroscience, 4, 135152.
Kant, I. (1785/2002). Groundwork for the Metaphysics of Morals. New Haven, CT: Yale University Press.
Kasari, C., Locke, J., Gulsrud, A., & Rotheram-Fuller, E. (2011). Social networks and friendships at school: Comparing children with and without ASD. Journal of Autism and Developmental Disorders, 41, 533544.
Kenny, L., Hattersley, C., Molins, B., Buckley, C., Povey, C., & Pellicano, E. (2016). Which terms should be used to describe autism? Perspectives from the UK autism community. Autism, 20, 442462.
Knobe, J. (2003). Intentional action and side effects in ordinary language. Analysis, 63, 190194.
Kohlberg, L. (1969). Stage and sequence: The cognitive-developmental approach to socialization. In Goslin, D. A. (Ed.), Handbook of socialization theory and research (pp. 347480). Chicago, IL: Rand McNally.
Kohlberg, L. (1971). From is to ought: How to commit the naturalistic fallacy and get away with it in the study of moral development. In Mischel, T. (Ed.), Cognitive development and epistemology (pp. 151235). New York: Academic Press.
Komeda, H., Osanai, H., Yanaoka, K., Okamoto, Y., Fujioka, T., Arai, S., … & Kawatani, M. (2016). Decision making processes based on social conventional rules in early adolescents with and without autism spectrum disorders. Scientific Reports, 6, 19.
Koster-Hale, J., Dungan, J., Saxe, R., & Young, L. (2013). Thinking in patterns: Using multi-voxel pattern analyses to find neural correlates of moral judgment in neurotypical and ASD populations. Proceedings of the Annual Meeting of the Cognitive Science Society, 34, 56485653.
Kretschmer, A., Lampmann, S. A., & Altgassen, M. (2014). Relations between moral reasoning, theory of mind and executive functions in children with autism spectrum disorders. International Journal of Developmental Disabilities, 60, 174183.
Legiša, J., Messinger, D. S., Kermol, E., & Marlier, L. (2013). Emotional responses to odors in children with high-functioning autism: Autonomic arousal, facial behavior and self-report. Journal of Autism and Developmental Disorders, 43, 869879.
Lehrl, S. (1995). Mehrfachwahl-Wortschatz-Intelligenztest: MWT-B. Balingen, Deutschland: PERIMED-spitta.
Leslie, A. M., Mallon, R., & Dicorcia, J. A. (2006). Transgressors, victims, and cry babies: Is basic moral judgment spared in autism?. Social Neuroscience, 1, 270283.
Li, Y., & Liu, A. (2017). Moral judgment and its relationship with theory of mind in patients with autism spectrum disorder. Chinese Mental Health Journal, 31, 366370.
Li, J., Zhu, L., & Gummerum, M. (2014). The relationship between moral judgment and cooperation in children with high-functioning autism. Scientific Reports, 4, 4314.
Loas, G., Fremaux, D., Otmani, O., & Verrier, A. (1995). Prevalence of alexithymia in a general population study in 183 “normal” subjects and in 263 students. Annales Médico-Psychologiques, 153, 355357.
Lord, C., Rutter, M., DiLavore, P. C., Risi, S., Gotham, K., & Bishop, S. L. (2015). Autism Diagnostic Observation Schedule—Second Edition, ADOS-2. Manual (Part I): Modules, 1–4. Torrance, California: Western Psychological Services.
Lord, C., Rutter, M., & Le Couteur, A. (1994). Diagnostic Interview-Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders, 24, 659685.
Margoni, F., Scarpa, L., & Surian, L. (2017). The acquisition of intent-based moral judgment in children with typical development and children with autism. Psicologia Clinica Dello Sviluppo, 21, 5177.
Margoni, F., & Surian, L. (2016). Mental state understanding and moral judgment in children with autistic spectrum disorder. Frontiers in Psychology, 7, 15.
Marsh, A. A., & Cardinale, E. M. (2012). Psychopathy and fear: Specific impairments in judging behaviors that frighten others. Emotion, 12, 892898.
Mason, O., Tyson, M., Jones, C., & Potts, S. (2005). Alexithymia: Its prevalence and correlates in a British undergraduate sample. Psychology and Psychotherapy: Theory, Research and Practice, 78, 113125.
Mazza, M., Pino, M. C., Mariano, M., Tempesta, D., Ferrara, M., De Berardis, D., … & Valenti, M. (2014). Affective and cognitive empathy in adolescents with autism spectrum disorder. Frontiers in Human Neuroscience, 8, 16.
McGillivray, L., Becerra, R., & Harms, C. (2017). Prevalence and demographic correlates of alexithymia: A comparison between Australian psychiatric and community samples. Journal of Clinical Psychology, 73, 7687.
Mercier, H., & Sperber, D. (2011). Why do humans reason? Arguments for an argumentative theory. Behavioral and Brain Sciences, 34, 5774.
Mill, J. S. (1863). Utilitarianism. London, UK: Parker, Son and Bourn.
Moore, C. (2006). The development of commonsense psychology. Mahwah, NJ: Lawrence Erlbaum Associates Publishers.
Moore, A. B., Clark, B. A., & Kane, M. J. (2008). Who shalt not kill? Individual differences in working memory capacity, executive control, and moral judgment. Psychological Science, 19, 549557.
Moran, J. M., Young, L. L., Saxe, R., Lee, S. M., O'Young, D., Mavros, P. L., & Gabrieli, J. D. (2011). Impaired theory of mind for moral judgment in high-functioning autism. Proceedings of the National Academy of Sciences, 108, 26882692.
Nichols, S. (2002). Norms with feeling: Towards a psychological account of moral judgment. Cognition, 84, 221236.
Patil, I., Melsbach, J., Hennig-Fast, K., & Silani, G. (2016). Divergent roles of autistic and alexithymic traits in utilitarian moral judgments in adults with autism. Scientific Reports, 6, 115.
Pellizzoni, S., Siegal, M., & Suian, L. (2010). The contact principle and utilitarian moral judgments in young children. Developmental Science, 13, 265270.
Petermann, F. & Petermann, U. (2008). Hamburg-Wechsler-Intelligenztest für Kinder IV (HAWIK-IV). Bern, Germany: Huber.
Piaget, J. (1932). The moral judgment of the child. Oxford, UK: Harcourt, Brace.
Rakoczy, H., Kaufmann, M., & Lohse, K. (2016). Young children understand the normative force of standards of equal resource distribution. Journal of Experimental Child Psychology, 150, 396403.
Raven, J., Raven, J. C. & Court, J. (1998). Raven's progressive matrices and vocabulary scales. Oxford, UK: Oxford Psychologists Press.
Reitan, R.M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271276.
Rogé, B., & Mullet, E. (2011). Blame and forgiveness judgements among children, adolescents and adults with autism. Autism, 15, 702712.
Rueda, P., Fernández-Berrocal, P., & Baron-Cohen, S. (2015). Dissociation between cognitive and affective empathy in youth with Asperger Syndrome. European Journal of Developmental Psychology, 12, 8598.
Salvano-Pardieu, V., Blanc, R., Combalbert, N., Pierratte, A., Manktelow, K., Maintier, C., … Fontaine, R. (2016). Judgment of blame in teenagers with Asperger's syndrome. Thinking & Reasoning, 22, 251273.
Schmidt, K. H., & Metzler, P. (1992). Wortschatztest (WST): Ein RASCH-skalierter Test zur Abschätzung der verbalen Intelligenz [Vocabulary test (WST): A Rasch-calibrated test for assessment of verbal intelligence]. Göttingen, Germany: Beltz Test.
Schneider, K., Pauly, K. D., Gossen, A., Mevissen, L., Michel, T. M., Gur, R. C., … & Habel, U. (2013). Neural correlates of moral reasoning in autism spectrum disorder. Social, Cognitive and Affective Neuroscience, 8, 702710.
Schulte-Rüther, M., Greimel, E., Markowitsch, H. J., Kamp-Becker, I., Remschmidt, H., Fink, G. R., & Piefke, M. (2011). Dysfunctions in brain networks supporting empathy: An fMRI study in adults with autism spectrum disorders. Social Neuroscience, 6, 121.
Sellaro, R., Güroǧlu, B., Nitsche, M. A., van den Wildenberg, W. P., Massaro, V., Durieux, J., … & Colzato, L. S. (2015). Increasing the role of belief information in moral judgments by stimulating the right temporoparietal junction. Neuropsychologia, 77, 400408.
Senju, A., Southgate, V., White, S., & Frith, U. (2009). Mindblind eyes: An absence of spontaneous theory of mind in Asperger syndrome. Science, 325, 883885.
Senland, A. K., & Higgins-D'Alessandro, A. (2016). Sociomoral reasoning, empathy, and meeting developmental tasks during the transition to adulthood in autism spectrum disorder. Journal of Autism and Developmental Disorders, 46, 30903105.
Shulman, C., Guberman, A., Shiling, N., & Bauminger, N. (2012). Moral and social reasoning in autism spectrum disorders. Journal of Autism and Developmental Disorders, 42, 13641376.
Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22, 255262.
Skolnick Weisberg, D. & Leslie, A.M. (2012). The role of victims' emotions in preschoolers' moral judgments. Review of Philosophy and Psychology, 3, 439455.
Smetana, J. (1981). Preschool children's conception of moral and social rules. Child Development, 52, 13331336.
Steele, S., Joseph, R. M., & Tager-Flusberg, H. (2003). Brief report: Developmental change in theory of mind abilities in children with autism. Journal of Autism and Developmental Disorders, 33, 461467.
Stocké, V. (2009). Deutsche Kurzskala zur Erfassung des Bedürfnisses nach sozialer Anerkennung. In: Glöckner-Rist, A., (ed.). Zusammenstellung Sozialwissenschaftlicher Items und Skalen. ZIS Version 13.00. Bonn, Germany: GESIS.
Stratton-Lake, P. (2014). Intuitionism in ethics. In Zalta, E. (Ed.), Stanford Encyclopedia of Philosophy.
Takeda, T., Kasai, K., & Kato, N. (2007). Moral judgment in high-functioning pervasive developmental disorders. Psychiatry and Clinical Neurosciences, 61, 407414.
Tsoi, L., Dungan, J. A., Chakroff, A., & Young, L. L. (2018). Neural substrates for moral judgments of psychological versus physical harm. Social Cognitive and Affective Neuroscience, 13, 460470.
Turiel, E. (1983). The development of social knowledge: Morality and convention. Cambridge, UK: Cambridge University Press.
Von Aster, M., Neubauer, A., & Horn, R. (2006). Wechsler Intelligenztest für Erwachsene (WIE). Frankfurt, Germany: Pearson.
Wang, D., & Qian, M. (1997). Combined Raven's test (second revision in Chinese). Tianjin: Department of Medical Psychology, Tianjin Medical University.
Wechsler, D. (1991). WISC-III: Wechsler Intelligence Scale for Children. San Antonio, TX: Psychological Corporation.
Wechsler, D. (1997). Wechsler Adult Intelligence Scale—Third Edition. San Antonio, TX: Psychological Corporation.
Wechsler, D. (1999a). Echelle clinique de mémoire de Wechsler-révisé: Manuel. Paris, France: Centre de Psychologie Appliquée, Pearson.
Wechsler, D. (1999b). Wechsler Abbreviated Scale of Intelligence. San Antonio, TX: Psychological Corporation.
Wechsler, D. (2001). Wechsler Test of Adult Reading. San Antonio, TX: Psychological Corporation.
Wechsler, D. (2005). WISC-IV. Echelle d'Intelligence de Wechsler pour Enfants—Quatrième Édition. Paris, France: Centre de Psychologie Appliquée, Pearson.
Wechsler, D. (2011). Wechsler Abbreviated Scales of Intelligence—Second Edition (WASI-II). San Antonio, TX: Psychological Corporation.
Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: Representation and constraining function of wrong beliefs in young children's understanding of deception. Cognition, 13, 103128.
Yamada, M., Camerer, C. F., Fujie, S., Kato, M., Matsuda, T., Takano, H., … & Takahashi, H. (2012). Neural circuits in the brain that are activated when mitigating criminal sentences. Nature Communications, 3, 759, 16.
Zalla, T., Barlassina, L., Buon, M., & Leboyer, M. (2011). Moral judgment in adults with autism spectrum disorders. Cognition, 121, 115126.
Zalla, T., & Leboyer, M. (2011). Judgment of intentionality and moral evaluation in individuals with high functioning autism. Review of Philosophy and Psychology, 2, 681698.


Morality in autism spectrum disorder: A systematic review

  • E. E. Dempsey (a1), C. Moore (a1), S. A. Johnson (a1) (a2), S. H. Stewart (a1) (a3) (a4) and I. M. Smith (a1) (a2) (a5)...


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed