Empathy Questionnaire (EmQue)

1. Abstract

The Empathy Questionnaire (EmQue) is a standardized parent-report psychometric instrument designed to evaluate empathy-related behaviors in toddlers and young children aged approximately 12 to 36 months and extending into early preschool ages. Developed by Carolien Rieffe, Lotte Ketelaar, and Corine H. Wiefferink (2010) at Leiden University and the Dutch Foundation for the Deaf and Hard of Hearing Child (NSDSK), the EmQue addresses a critical methodological challenge in developmental affective science: the assessment of early emerging affective and prosocial dispositions prior to the emergence of reliable child self-report capabilities. The instrument operationalizes empathy as a multidimensional construct comprising three developmentally grounded subscales across 20 manifest items: Emotion Contagion (items measuring immediate affective mirroring and shared distress), Attention to Others’ Feelings (items indexing visual and behavioral orientation toward peers’ emotional displays), and Prosocial Actions (items capturing instrumental, comforting, and boundary-respecting behaviors directed toward distressed or expressive interaction partners).

Caregivers rate each item on a 3-point Likert-type response scale: “Not at all applicable (as far as you are aware of)” (or “No”), “A little or sometimes applicable” (or “Sometimes”), and “Clearly or often applicable” (or “Often”). Confirmatory factor analyses across clinical and non-clinical developmental samples have established that the three-factor correlated model offers superior fit compared to unidimensional or alternative bi-factor formulations. The EmQue demonstrates sound internal consistency across developmental stages, longitudinal stability across early childhood transitions, robust convergent validity with observational indices of laboratory-elicited empathy (such as simulated distress paradigms), and predictable associations with child temperament (e.g., negative affectivity, effortful control) and language acquisition. By capturing early variations in affective resonance, attentional tuning, and proactive prosociality, the EmQue serves as a foundational screening and research instrument in developmental psychopathology, communicative disorders, and early social-emotional intervention evaluation.

2. Keywords

Empathy Questionnaire, EmQue, empathy assessment, emotion contagion, prosocial behavior, attention to emotions, early childhood, toddler socio-emotional development, parent-report questionnaire, developmental psychometrics, affective empathy, behavioral observation

3. Authors

The Empathy Questionnaire was conceptualized, constructed, and psychometrically validated by a research team specializing in developmental psychology, emotional competence, and childhood communication disorders:

• Carolien Rieffe, Ph.D. — Professor of Developmental Psychology in the Department of Developmental and Educational Psychology at Leiden University, The Netherlands; also affiliated with the Focus on Emotions Research Group and the Dutch Foundation for the Deaf and Hard of Hearing Child (NSDSK), Amsterdam, The Netherlands. Professor Rieffe specializes in social, emotional, and moral development in typically developing children, children on the autism spectrum, and deaf or hard-of-hearing pediatric populations.
• Lotte Ketelaar, Ph.D. — Developmental psychologist and clinical researcher affiliated with the Department of Developmental and Educational Psychology at Leiden University and the Dutch Foundation for the Deaf and Hard of Hearing Child (NSDSK), Amsterdam, The Netherlands, with empirical expertise in toddler peer interactions, auditory impairment, and early emotional regulation.
• Corine H. Wiefferink, Ph.D. — Senior Health Services and Developmental Researcher at the Dutch Foundation for the Deaf and Hard of Hearing Child (NSDSK), Amsterdam, The Netherlands, focusing on language pathology, early childhood intervention, and parent-child social communication.

Institutional Contact / Research Repository: Focus on Emotions (www.focusonemotions.nl), Leiden University and NSDSK, The Netherlands.

4. Purpose

The fundamental purpose of the Empathy Questionnaire (EmQue) is to provide an ecologically valid, developmentally sensitive, and psychometrically sound assessment of early empathy components in young children ranging from infancy/toddlerhood through the early school years. While empathy represents a central cornerstone of social competence, moral development, conflict resolution, and healthy interpersonal affiliation, quantifying empathic dispositions in very young populations poses formidable empirical barriers. Laboratory observational experiments (e.g., standard adult simulated pain, distress, or injury paradigms pioneered by Carolyn Zahn-Waxler and colleagues) provide granular behavioral indicators; however, such simulations require extensive micro-coding, demanding training protocols, and artificial laboratory environments that may evoke inhibition, stranger anxiety, or transient state reactivity rather than typical trait-level responsiveness.

The EmQue was engineered to circumvent these limitations by systematically leveraging parental ecological observations. Caregivers observe toddlers across thousands of mundane, high-frequency natural social interactions across domestic, day-care, and playground contexts. The instrument translates parental knowledge into quantifiable behavioral indices, serving multiple theoretical and clinical objectives:

• Developmental Profiling: To distinguish between the reflexive, visceral experience of affective sharing (emotion contagion), the cognitive-perceptual orienting toward emotional expressions (attention to feelings), and deliberate behavioral attempts to alleviate another person’s emotional or physical discomfort (prosocial actions).
• Early Clinical Identification and Screening: To identify atypical developmental trajectories characterized by hypo-responsiveness or hyper-reactivity to others’ distress. Deficits in empathy constitute core clinical features in neurodevelopmental disorders, such as autism spectrum conditions (ASCs) and early-emerging conduct problems marked by callous-unemotional (CU) traits. Conversely, excessive personal distress and emotional contagion without regulatory modulation can serve as early markers for vulnerability to internalizing disorders, including childhood separation anxiety and generalized anxiety.
• Special Population Inquiries: The EmQue was specifically designed and extensively deployed to investigate developmental pathways in pediatric populations with sensory and communicative challenges, such as deaf and hard-of-hearing (DHH) toddlers, children with developmental language disorder (DLD), and children with cochlear implants. By utilizing concrete, non-verbal behavioral descriptions, the instrument decouples empathic capacity from expressive linguistic fluency.
• Intervention Efficacy and Outcome Tracking: To quantify longitudinal changes resulting from early childhood interventions, such as parent-child interaction therapies, social-emotional nursery programs, and auditory rehabilitation regimens.

5. Psychological Construct

Empathy is widely recognized in contemporary affective neuroscience and developmental psychology as a multi-layered construct involving the capacity to understand, experience, and respond adaptively to the emotional states of conspecifics. Drawing upon foundational frameworks formulated by Martin L. Hoffman, Nancy Eisenberg, and Frans de Waal, the authors of the EmQue conceptualize early childhood empathy not as a monolithic cognitive entity, but as a triad of interconnected neurobehavioral processes that emerge dynamically during the first three years of life.

Dimension 1: Emotion Contagion (7 items)

Emotion contagion represents the phylogenetically older, biologically wired, sensorimotor component of empathy. It entails the involuntary, automatic mirroring and affective resonance of another person’s valence and arousal. In the infant and young toddler, observing peer distress (e.g., loud crying or acute shrieking) activates neural mirror mechanisms, somatosensory representations, and autonomic arousal, resulting in the child experiencing an emotional state congruent with the observed model. Within the EmQue, this dimension captures both positive resonance (e.g., Item 3: laughing when seeing others laugh) and negative shared distress (e.g., Item 1: becoming upset when another child cries; Item 4: needing comfort when a peer is in pain; Item 13: freezing or crying when another child becomes frightened). While emotion contagion provides the immediate affective spark for empathic engagement, unchecked contagion without emotional regulation can devolve into self-focused personal distress, prompting avoidance (e.g., Item 19: looking away when a peer cries) or secondary somatic imitation (e.g., Item 7: pretending to fall after witnessing a peer’s tumble).

Dimension 2: Attention to Others’ Feelings (7 items)

Attention to others’ emotions reflects the perceptual-cognitive orienting and monitoring of socio-emotional cues within the child’s visual and auditory environment. Before a child can execute intentional prosocial intervention, they must detect, appraise, and attend to the emotional signals transmitted by conspecifics. This dimension gauges the child’s curiosity, social vigilance, and exploratory gaze directed toward emotional scenes involving peers and adults. Manifest behaviors include halting ongoing activities to observe interpersonal anger or peer conflicts (Item 6: watching attentively when an adult scolds another child; Item 18: stopping one’s own play to inspect an angry peer; Item 20: seeking to observe peer arguments) and actively tuning into auditory emotional markers (Item 9: looking up when hearing laughter; Item 15: looking up when another child cries). This orienting response bridges raw perceptual sensation and higher-order mentalizing, establishing the attentional bandwidth required to interpret social causality.

Dimension 3: Prosocial Actions (6 items)

Prosocial actions denote the goal-directed, purposeful behaviors undertaken by the child to comfort, assist, protect, or alleviate the perceived distress or negative affective state of another individual. Unlike involuntary contagion, prosocial behavior requires self-other differentiation—the cognitive realization that the distress originates within the other entity and that targeted outward action is required. Hoffman identified the toddler period (around 14 to 24 months) as the pivotal window where “egocentric empathy” transforms into rudimentary “veridical empathy,” wherein children offer developmentally appropriate comfort. In the EmQue, prosocial actions span direct comforting and cheer-up behaviors (Item 5: attempting to comfort a crying child; Item 8: trying to cheer up an upset peer; Item 17: attempting to help a frightened peer), conflict intervention (Item 14: trying to halt quarrelling peers), and advanced inhibitory social consideration (Item 2: striving not to disturb a caregiver seeking peace; Item 11: leaving a parent alone when autonomous activity is requested). This dimension closely interfaces with the early moral self and executive inhibitory control.

6. Theoretical Framework

The construction of the EmQue is anchored in several converging theoretical paradigms across developmental affective science, comparative ethology, and social neuroscience:

Hoffman’s Stage Theory of Empathy and Moral Development

The primary theoretical foundation derives from Martin L. Hoffman’s developmental model of empathy. Hoffman postulated that empathic distress develops across five distinct structural stages:

1. Global Empathy: Observed in early infancy, where infants lack clear self-other boundaries and cry reactively to the tape-recorded cries of other neonates (pure reactive contagion).
2. Egocentric Empathy: Emerging around 12 months, where infants recognize that another is distressed but respond using strategies they themselves find comforting (e.g., bringing their own mother or favorite blanket to comfort an injured playmate).
3. Empathy for Another’s Feelings: Maturing around 2 to 3 years, where the child realizes that another individual possesses internal psychological states distinct from their own, enabling differentiated, context-appropriate prosocial interventions.
4. Empathy for Another’s General Plight: Developing in late childhood, addressing chronic societal or existential conditions.

The EmQue maps specifically across Stages 1, 2, and 3, capturing the crucial developmental inflection point where raw contagion transforms into deliberate prosocial alleviation mediated by emergent cognitive appraisal.

Preston and de Waal’s Perception-Action Model (PAM)

From an evolutionary perspective, the EmQue reflects Stephanie Preston and Frans de Waal’s Perception-Action Model (PAM) of empathy. PAM posits that the perception of an emotional state in an interaction partner automatically activates the observer’s own neural representations of that state, generating matching somatic and autonomic responses. According to de Waal’s “Russian Doll” architecture of empathy, outer cognitive layers (perspective-taking and targeted helping) are built upon, and remain causally dependent upon, the inner core of emotional contagion and state matching. The three subscales of the EmQue perfectly reflect this tiered architecture: the foundational core (Emotion Contagion), the sensory orientation interface (Attention to Others’ Feelings), and the outer prosocial behavioral output (Prosocial Actions).

Eisenberg’s Heuristic Model of Prosocial Disposition and Emotion Regulation

A third theoretical pillar is Nancy Eisenberg’s affective-regulation framework, which differentiates true sympathy (other-oriented concern accompanied by prosocial motivation) from personal distress (self-focused, aversive emotional reaction accompanied by withdrawal or flight). Eisenberg demonstrated that whether emotion contagion leads to prosocial helping or defensive withdrawal depends entirely on individual differences in effortful control and attentional regulation. The inclusion within the EmQue of items evaluating personal dysregulation (Item 4: needing comfort oneself; Item 13: freezing; Item 19: looking away) versus active helping (Item 5, Item 8) enables researchers to test Eisenberg’s regulatory mediation hypotheses directly within early toddler development.

7. Validity

Psychometric evaluations across several clinical, community, and cross-cultural cohorts have substantiated the multi-dimensional validity of the Empathy Questionnaire.

Construct and Factorial Validity

In the seminal validation investigation by Rieffe, Ketelaar, and Wiefferink (2010), confirmatory factor analysis (CFA) was conducted on parent reports of typically developing toddlers and young children aged 1 to 5 years (N = 349). The hypothesized three-factor model yielded satisfactory construct validity, outperforming alternative one-factor and two-factor structures across goodness-of-fit indices (RMSEA < .06; CFI > .90). Every item loaded significantly onto its designated latent construct, confirming that emotion contagion, social attention, and prosocial helping represent empirical entities that correlate yet maintain distinct functional variance.

Convergent and Criterion Validity

The convergent validity of the EmQue has been rigorously evaluated against standardized observational paradigms in developmental laboratories. Ketelaar and colleagues (2013) demonstrated that children scoring high on the EmQue Prosocial Actions subscale exhibited significantly higher rates of instrumental helping and comforting behaviors when an experimenter feigned minor injury (stubbing a toe or pinching a finger in a clipboard) compared to low-scoring peers (r = .38 to .46, p < .001). Similarly, the Attention to Others’ Feelings subscale demonstrated significant positive correlations with visual fixation duration on the experimenter’s face during distress episodes, validated via automated eye-tracking and micro-behavioral video coding (r = .41, p < .01).

Discriminant and Divergent Validity

The subscales exhibit marked functional divergence that aligns with theoretical expectations. While Prosocial Actions correlates positively with validated measures of executive function, inhibitory control, and expressive vocabulary, the Emotion Contagion subscale correlates positively with parent-rated negative emotionality and sensory sensitivity on the Toddler Behavior Assessment Questionnaire (TBAQ) and the Children’s Behavior Questionnaire (CBQ). Crucially, Emotion Contagion does not correlate with formal language ability, confirming that affective state-matching operates independently of linguistic competence.

Known-Groups and Clinical Validity

The EmQue has demonstrated clinical sensitivity in diverse developmental populations:

• Deaf and Hard-of-Hearing (DHH) Children: Research utilizing the EmQue revealed that DHH toddlers born to hearing parents exhibited comparable levels of basic Emotion Contagion relative to typically hearing peers, but showed selective reductions in Attention to Others’ Feelings and Prosocial Actions when access to contextual auditory-linguistic communication was restricted (Ketelaar et al., 2012).
• Autism Spectrum Conditions: In cohorts assessed for early signs of autism, children at elevated familial likelihood or with confirmed ASD diagnoses scored substantially lower on both Attention to Others’ Feelings and Prosocial Actions, while exhibiting atypical patterns of contagion characterized by acute distress or detached avoidance (Rieffe et al., 2010).

8. Reliability

The EmQue possesses robust psychometric reliability across internal consistency, inter-rater concordance, and temporal stability metrics within early childhood samples.

Internal Consistency

In the initial psychometric standardization by Rieffe et al. (2010), Cronbach’s alpha coefficients demonstrated good internal consistency across all subscales despite the modest item count tailored for toddler assessment:

• Emotion Contagion (7 items): Cronbach’s α = .72 to .76 across age cohorts.
• Attention to Others’ Feelings (7 items): Cronbach’s α = .74 to .78 across cohorts.
• Prosocial Actions (6 items): Cronbach’s α = .69 to .74 across cohorts.

Subsequent cross-cultural adaptation studies (e.g., Italian, Spanish, Turkish, and Chinese translations) have replicated internal consistency estimates, typically reporting composite reliabilities (ω) ranging from .70 to .82 across dimensions.

Test-Retest Reliability and Temporal Stability

Test-retest reliability was evaluated across a 6-to-8 week interval in community toddler samples. Intraclass correlation coefficients (ICC) were robust:

• Emotion Contagion: ICC = .78 (95% CI [.71, .84])
• Attention to Others’ Feelings: ICC = .82 (95% CI [.76, .87])
• Prosocial Actions: ICC = .75 (95% CI [.68, .81])

Over extended developmental intervals (e.g., 12 to 24 months), longitudinal tracking demonstrates moderate rank-order stability (r values ranging from .42 to .55), reflecting both developmental trait persistence and ongoing socio-cognitive maturation.

Inter-Rater Agreement

Concordance between primary maternal and secondary paternal ratings yields Pearson correlations ranging from r = .52 to r = .66 (p < .001). Cross-informant agreement between parents and professional day-care educators or nursery teachers is moderate (r = .35 to .48), which is consistent with meta-analytic benchmarks for socio-emotional rating scales across disparate environmental settings.

9. Factor Analysis

The structural taxonomy of the EmQue was systematically verified through sequential exploratory and confirmatory psychometric modeling.

Exploratory Factor Analysis (EFA)

During scale construction, item selection began from an initial pool of candidate descriptors derived from developmental literature and clinical observation. Principal Axis Factoring (PAF) with oblique (Promax) rotation was conducted to allow theoretical inter-correlations among empathy facets. The scree plot inspection, Horn’s parallel analysis, and eigenvalues > 1.0 supported a clear three-factor solution accounting for approximately 42.8% of the total variance.

Confirmatory Factor Analysis (CFA)

In the primary CFA reported by Rieffe et al. (2010), three competing models were evaluated using robust maximum likelihood (MLR) estimation to account for categorical, slightly skewed distribution profiles common in early developmental scales:

1. Unidimensional Model (1 Latent Factor): Assumed all 20 items reflected a single general “Global Empathy” dimension. This model showed poor fit: χ²(170) = 485.32, p < .001; CFI = .712; TLI = .678; RMSEA = .094 (90% CI [.084, .103]).
2. Two-Factor Model (Affective vs. Behavioral): Collapsed Contagion and Attention into a single perceptual/affective factor versus Prosocial Action. Fit remained suboptimal: χ²(169) = 362.15; CFI = .823; TLI = .801; RMSEA = .072.
3. Three-Factor Correlated Model (Theoretical Structure): Partitioned items into Emotion Contagion, Attention to Others’ Feelings, and Prosocial Actions. This model exhibited superior fit: χ²(167) = 241.89, p < .001; χ²/df = 1.45; CFI = .932; TLI = .923; RMSEA = .046 (90% CI [.034, .057]); SRMR = .051.

Factor Loadings and Latent Inter-correlations

Standardized factor loadings across all manifest items were statistically significant (p < .001):

• Emotion Contagion: Loadings ranged from .42 (Item 19) to .73 (Item 1).
• Attention to Others’ Feelings: Loadings ranged from .48 (Item 12) to .75 (Item 18).
• Prosocial Actions: Loadings ranged from .45 (Item 2) to .76 (Item 5).

The latent factor correlations indicated moderate associations between dimensions:

• Contagion ↔ Attention: r = .48 (p < .001)
• Attention ↔ Prosocial: r = .52 (p < .001)
• Contagion ↔ Prosocial: r = .36 (p < .001)

These moderate latent correlations confirm that while early empathy mechanisms share common developmental variance, they do not constitute redundant constructs.

10. Instrument / Measurement Tool

• Instrument Name: Empathy Questionnaire
• Acronym: EmQue
• Target Population: Toddlers and preschool-aged children (typically 12 to 36 months, validated up to 5 years / 60 months)
• Informant / Administration Mode: Primary caregivers (mothers, fathers), legal guardians, or nursery/day-care teachers familiar with the child; pencil-and-paper or digital electronic administration
• Administration Time: Approximately 5 to 10 minutes
• Total Item Count: 20 items
• Response Scale (Authentic): 3-point Likert-type scale:
  • Not at all applicable (as far as you are aware of) — [often labeled “No”]
  • A little or sometimes applicable — [often labeled “Sometimes”]
  • Clearly or often applicable — [often labeled “Often”]
• Item Scoring Protocol: Items are typically scored on a 1–3 (or 0–2) numeric continuum:
  • “Not at all applicable” / “No” = 1 point (or 0)
  • “A little or sometimes applicable” / “Sometimes” = 2 points (or 1)
  • “Clearly or often applicable” / “Often” = 3 points (or 2)

  Note: Standard scoring evaluates subscales as mean item scores (sum of answered subscale items divided by the number of subscale items), maintaining scale comparability across subscales with differing item counts. Subscale allocation:

  • Emotion Contagion: Items 1, 4, 7, 10, 13, 16, 19 (7 items)
  • Attention to Others’ Feelings: Items 3, 6, 9, 12, 15, 18, 20 (7 items)
  • Prosocial Actions: Items 2, 5, 8, 11, 14, 17 (6 items)
• Total Score Calculation: A Global Empathy index can be derived by computing the overall mean across all 20 items; however, individual subscale profiling is strongly recommended to identify dissociation across affective contagion and prosocial responding.

11. Permissions & Fee and Test Year

The Empathy Questionnaire (EmQue) was constructed and empirically published in 2010 by Carolien Rieffe, Lotte Ketelaar, and Corine H. Wiefferink. The instrument was developed under the auspices of Leiden University and the Dutch Foundation for the Deaf and Hard of Hearing Child (NSDSK) through publicly funded academic research.

Licensing and Accessibility: The EmQue is an open-access psychometric instrument available free of charge for non-commercial academic research, pedagogical investigations, and clinical screening. Researchers and clinicians can freely download the questionnaire in multiple language translations directly from the Focus on Emotions research portal (www.focusonemotions.nl). No royalty fees or proprietary user licenses are required. Users are expected to cite the original 2010 psychometric validation paper in all resulting scientific publications, presentations, and reports. Commercial redistribution or incorporation into for-profit commercial platforms requires explicit written permission from the corresponding author, Prof. Dr. Carolien Rieffe.

12. References

Eisenberg, N., Spinrad, T. L., & Sadovsky, A. (2006). Empathy-related responding in children. In M. Killen & J. G. Smetana (Eds.), Handbook of moral development (pp. 517–549). Lawrence Erlbaum Associates Publishers.

Hoffman, M. L. (2000). Empathy and moral development: Implications for caring and justice. Cambridge University Press. https://doi.org/10.1017/CBO9780511805851

Ketelaar, L., Rieffe, C., Wiefferink, C. H., & Frijns, J. H. (2012). Does hearing lead to understanding? Empathy in toddlers with and without cochlear implants. International Journal of Pediatric Otorhinolaryngology, 76(6), 830–836. https://doi.org/10.1016/j.ijporl.2012.02.046

Ketelaar, L., Rieffe, C., Wiefferink, C. H., & Frijns, J. H. (2013). Social competence and empathy in young children with normal hearing and with cochlear implants. The Journal of Deaf Studies and Deaf Education, 18(4), 518–530. https://doi.org/10.1093/deafed/ent022

Preston, S. D., & de Waal, F. B. (2002). Empathy: Its ultimate and proximate bases. Behavioral and Brain Sciences, 25(1), 1–20. https://doi.org/10.1017/s0140525x02000018

Rieffe, C., Ketelaar, L., & Wiefferink, C. H. (2010). Assessing empathy in young children: Construction and validation of an Empathy Questionnaire (EmQue). Personality and Individual Differences, 49(5), 362–367. https://doi.org/10.1016/j.paid.2010.03.046

Rothbart, M. K., Ahadi, S. A., Hershey, K. L., & Fisher, P. (2001). Investigations of temperament at three to seven years: The Children’s Behavior Questionnaire. Child Development, 72(5), 1394–1408. https://doi.org/10.1111/1467-8624.00355

Zahn-Waxler, C., Radke-Yarrow, M., Wagner, E., & Chapman, M. (1992). Development of concern for others. Developmental Psychology, 28(1), 126–136. https://doi.org/10.1037/0012-1649.28.1.126

13. Items of the Scale (Questionnaire)