This study focused on empathic and prosocial orientations in preschool children who vary in externalizing problems. Children were categorized as low, moderate, or high risk for developing disruptive behavior disorders, depending on severity of current behavior problems. Hypothetical and real encounters with others in distress were used to examine children's affect, behavior, autonomic activity, and social cognitions. When children witnessed someone in distress, empathic concern and prosocial behaviors were present at similar levels for all risk groups. However, moderate and high-risk children were less able than low-risk children to remain positively engaged with distress victims. Girls showed more prosocial behavior than boys, and boys showed more anger than girls. During sadness mood inductions to assess autonomic activity, risk groups did not differ on heart rate or vagal tone. Girls showed higher skin conductance than boys, with high-risk girls showing the highest levels. Higher heart rate (and heart rate deceleration) predicted empathic concern and prosocial behavior, whereas lower heart rate was associated with aggression and avoidance, irrespective of risk. Although biological correlates of emotions and behaviors that reflect caring versus indifference to others' distress are identified, they do not support an early direct link to externalizing psychopathologies.