• Empathy supports prosocial behavior — but not directly.  
  For both autistic and neurotypical children, empathy predicted prosocial behavior through social interactions. In other words, children who showed more empathy tended to engage more socially, and those social interactions created opportunities for prosocial behavior to develop.

• Early emotional and behavioral symptoms changed the pathway.  
  Certain early symptoms influenced how strongly empathy translated into prosocial behavior. These symptoms didn’t erase empathy — they shaped how easily children could act on it. Internalizing symptoms (worry, sadness, withdrawal) weakened the link between empathy and social engagement. Externalizing symptoms (impulsivity, acting out) made it harder for children to use empathy in social situations.

• Autistic and neurotypical children showed similar overall patterns, with some differences in strength.  
  The pathways existed in both groups, but autistic children showed a stronger influence of social interaction quality on prosocial behavior; and a greater impact of early emotional symptoms on whether empathy translated into action. This suggests autistic children may have empathy capacities that are intact but expressed differently depending on social context and regulation demands.

• Social interactions were the key mediator.  
  Across groups, social engagement acted as the “bridge” between empathy and prosocial behavior. When children had more positive or frequent social interactions, empathy was more likely to show up as helping, sharing, or comforting.

These findings reinforce a neuroaffirming, developmental perspective: autistic children often have empathy — the question is whether the environment supports them in expressing it.

1. Empathy expression depends on social opportunities, not just internal capacity.

Supporting prosocial behavior means supporting the context, not “fixing” the child. Children may feel concern or notice others’ emotions but struggle to act on it when:

• the social situation is fast‑moving

• they are unsure what to do

• they are overwhelmed or dysregulated

• they are navigating unfamiliar peers

2. Emotional and behavioral symptoms can mask empathy, not replace it.

Internalizing symptoms may look like, hesitation, withdrawal, or uncertainty about how to join in. Externalizing symptoms may look like impulsive responding or difficulty pausing to notice others’ cues. In both cases, the child may still care deeply — they just need support to translate empathy into action.

What helps:

• co‑regulation (an adult helping a child return to calm by offering steady, supportive presence — like modeling slow breathing, using a soothing voice, or sharing a calming activity together)

• modeling simple prosocial actions

• slowing down interactions

• visual supports for “what to do when someone is upset”
• predictable routines for peer engagement

3. Social interaction quality matters more than quantity.

For autistic children especially, prosocial behavior grows when:

• interactions are structured, predictable, and supportive

• adults scaffold turn‑taking and shared attention

• peers are coached to be patient and responsive

• the child feels emotionally safe

The study reframes prosociality as something that emerges from empathy, social learning, regulation, and emotional wellbeing. This helps shift conversations with families away from “they don’t care” toward “they care, and here’s how we can help them show it.”

This research supports a neuroaffirming understanding of autistic children’s social and emotional development by showing that empathy is present, but its expression depends on regulation, context, and support. Early emotional symptoms can interfere with social engagement — not empathy itself — and prosocial behavior grows through safe, supported interactions rather than pressure or correction. For early intervention teams, this means prioritizing co‑regulation, emotional safety, predictable social routines, child‑led engagement, and scaffolding social opportunities instead of expecting spontaneous prosociality. This perspective helps families see their child’s strengths and understand the “why” behind social behaviors, reducing stigma and increasing compassion.

Simple Play (Sensorimotor & Exploratory)

These activities focus on cause-and-effect, sensory exploration, and basic motor skills—like banging, mouthing, or dropping—just to see what happens.

• Scoop & Transfer: Move cotton balls between containers using spoons, tongs, or hands to explore movement and resistance.

• Blow the Cotton Ball: Blow through a straw to move a cotton ball across a table and notice how breath changes its speed.

• Squish & Pull: Pull cotton balls apart, roll them tighter, or dip them in water to explore texture changes.

• Snow Bin: Explore a bin filled with cotton balls, cups, and scoops; search for hidden objects.

• Soak & Paint: Soak cotton balls in water and let children paint them, noticing how water changes their weight and texture.

• Stamping With Paint: Dip cotton balls in paint and stamp them onto paper to make simple marks and cheerful colors (petals, raindrops, sunshine).

  Tip for little hands: If touching wet or painted cotton balls feels too messy or uncomfortable, clip a clothespin onto the top to turn it into a simple handle. This keeps fingers clean, supports grasp development, and still lets children explore stamping, painting, dipping, and color play with ease.

Combination Play (Functional & Constructive)

These activities involve using materials together with intention—building, matching, or organizing.

• Color Match: Dye cotton balls with food coloring and match them to colored cups or paper circles.

• Fill the Shape: Place cotton balls inside drawn shapes (circle, heart, square) to complete the outline.

• Sticky Wall Build: Stick cotton balls onto contact paper to create lines, clusters, or simple patterns.

• Cotton Ball Towers: Use playdough and craft sticks to build small structures with cotton balls as connectors.

• Pathways: Arrange cotton balls to create a road or trail for cars or animals to follow.

• Rescue Mission: Hide small toys under cotton balls and use tools to uncover them.

• Name Art: Arrange cotton balls to spell out a child’s name, then glue them down and paint them all the same or different colors.

• Apple Tree Craft: Paint cotton balls red and glue them onto a tree template to create an apple tree.

Symbolic Play (Pretend & Representational)

These activities support imagination, role play, and storytelling.

• Fluffy Animals: Glue cotton balls to a paper plate to make a sheep or bunny, then fold the plate so it stands up as a character.

• Clouds & Rainbows: Glue cotton balls as clouds and add rainbow strips to create a weather scene that can become part of a story.

• Snow Play: Use cotton balls as snow for animals, people, or vehicles and narrate what happens in the snowy world.

• Campfire: Pretend cotton balls are marshmallows to roast on sticks; add hot chocolate or camping props.

• Clouds & Weather Stories: Use cotton balls as clouds in a weather story (“The clouds are getting bigger… is it going to snow”).

• Doctor Play: Use cotton balls as pretend bandages, medicine pads, or shots for stuffed animals.

• Food Pretend: Use cotton balls as ice cream scoops, popcorn, or whipped cream in pretend cooking.

• Animal Characters: Roll cotton balls into bunnies, sheep, or owls with simple props and bring them into a story.

• Magic Potions: Use cotton balls in cups with colored water (or pretend colors) as ingredients for potions or soups.

• Create a Scene: Use cotton balls as clouds, snow, sheep, or rocks in a small‑world scene and narrate what happens.

• Character Helpers: Use cotton balls as treasures, magic snowballs, or healing stones that characters use in a story.