Empathy deficits represent an important social impairment in autism spectrum disorders (ASD), but little is known about the early development of empathy prior to diagnosis. This study examined empathic responding to parental distress in toddlers at risk for an ASD. Children later diagnosed with an ASD engaged in less empathic responding at 24 and 30 months than children with no later diagnosis. Lower empathic responding was associated with higher autism symptomatology at 30 months. This is the first study to examine empathy deficits in response to parental distress in toddlers prior to ASD diagnosis. Early empathic responding may represent a unique developing social skill that indexes the overall severity of later ASD symptomatology in at-risk children.