Double empathy problem

Both autistic and non-autistic people can find it difficult to empathize with each other. The fact that both people in the interaction have trouble with understanding and empathy is why the theory is called the "double empathy problem".<ref name=":25">Crompton, Catherine J.; DeBrabander, Kilee; Heasman, Brett; Milton, Damian; Sasson, Noah J. (2021-05-11). "Double Empathy: Why Autistic People Are Often Misunderstood". Frontiers for Young Minds. 9: 554875. doi:10.3389/frym.2021.554875. hdl:20.500.11820/94ee032a-6103-470a-bc06-08337dd6b512. ISSN 2296-6846.</ref>

The theory of the double empathy problem is a psychological and sociological theory first coined in 2012 by Damian Milton, an autistic autism researcher.<ref name=":1">Milton, Damian E. M. (October 2012). "On the ontological status of autism: the 'double empathy problem'". Disability & Society. 27 (6): 883–887. doi:10.1080/09687599.2012.710008. ISSN 0968-7599. S2CID 54047060.</ref> This theory proposes that many of the difficulties autistic individuals face when socializing with non-autistic individuals are due, in part, to a lack of mutual understanding between the two groups, meaning that most autistic people struggle to understand and empathize with non-autistic people, whereas most non-autistic people also struggle to understand and empathize with autistic people. This lack of understanding may stem from bidirectional differences in communication style, social-cognitive characteristics, and experiences between autistic and non-autistic individuals, but not necessarily an inherent deficiency. Recent studies have shown that most autistic individuals are able to socialize, communicate effectively,<ref name=":2">Crompton, Catherine J.; Ropar, Danielle; Evans-Williams, Claire V. M.; Flynn, Emma G.; Fletcher-Watson, Sue (2020). "Autistic peer-to-peer information transfer is highly effective". Autism. 24 (7): 1704–1712. doi:10.1177/1362361320919286. PMC 7545656. PMID 32431157.</ref> empathize well,<ref name=":33">Sheppard, Elizabeth; Webb, Sophie; Wilkinson, Helen (2023-11-18). "Mindreading beliefs in same- and cross-neurotype interactions". Autism. doi:10.1177/13623613231211457. ISSN 1362-3613.</ref><ref name=":22">Szechy, Kathryn A.; Turk, Pamela D.; O'Donnell, Lisa A. (2023-08-17). "Autism and Employment Challenges: The Double Empathy Problem and Perceptions of an Autistic Employee in the Workplace". Autism in Adulthood. doi:10.1089/aut.2023.0046. ISSN 2573-9581. S2CID 260998172.</ref><ref name=":39">Komeda, Hidetsugu; Kosaka, Hirotaka; Saito, Daisuke N.; Mano, Yoko; Jung, Minyoung; Fujii, Takeshi; Yanaka, Hisakazu T.; Munesue, Toshio; Ishitobi, Makoto; Sato, Makoto; Okazawa, Hidehiko (2014-10-20). "Autistic empathy toward autistic others". Social Cognitive and Affective Neuroscience. Oxford University Press. 10 (2): 145–152. doi:10.1093/scan/nsu126. ISSN 1749-5016. PMC 4321632. PMID 25332405.</ref><ref name=":8">Komeda, Hidetsugu; Kosaka, Hirotaka; Fujioka, Toru; Jung, Minyoung; Okazawa, Hidehiko (2019-06-04). "Do Individuals With Autism Spectrum Disorders Help Other People With Autism Spectrum Disorders? An Investigation of Empathy and Helping Motivation in Adults With Autism Spectrum Disorder". Frontiers in Psychiatry. 10: 376. doi:10.3389/fpsyt.2019.00376. ISSN 1664-0640. PMC 6558937. PMID 31231254.</ref><ref name=":3">Crompton, Catherine J.; Sharp, Martha; Axbey, Harriet; Fletcher-Watson, Sue; Flynn, Emma G.; Ropar, Danielle (2020). "Neurotype-Matching, but Not Being Autistic, Influences Self and Observer Ratings of Interpersonal Rapport". Frontiers in Psychology. 11: 586171. doi:10.3389/fpsyg.2020.586171. PMC 7645034. PMID 33192918.</ref> and display social reciprocity<ref name=":4">Chen, Yu-Lun; Senande, Laura L.; Thorsen, Michael; Patten, Kristie (2021). "Peer preferences and characteristics of same-group and cross-group social interactions among autistic and non-autistic adolescents". Autism. 25 (7): 1885–1900. doi:10.1177/13623613211005918. PMC 8419288. PMID 34169757.</ref> with most other autistic individuals.<ref name=":1" /><ref name=":0">DeThorne, Laura S. (2020-03-01). "Revealing the Double Empathy Problem". The ASHA Leader. 25 (3): 58–65. doi:10.1044/leader.ftr2.25042020.58. S2CID 216359201.</ref> This theory and subsequent findings challenge the commonly held belief that the social skills of autistic individuals are inherently impaired, as well as the theory of "mind-blindness" proposed by prominent autism researcher Simon Baron-Cohen in the mid-1980s, which suggested that empathy and theory of mind are universally impaired in autistic individuals.<ref name=":10" /><ref name=":12" /><ref name=":41">Boucher, Jill (2012). "Putting theory of mind in its place: psychological explanations of the socio-emotional-communicative impairments in autistic spectrum disorder". Autism. 16 (3): 226–246. doi:10.1177/1362361311430403. ISSN 1362-3613. PMID 22297199. S2CID 30738704.</ref><ref name=":13">Shanker, Stuart (2004-10-01). "The Roots of Mindblindness". Theory & Psychology. 14 (5): 685–703. doi:10.1177/0959354304046179. ISSN 0959-3543. S2CID 143801835.</ref>

The double empathy concept has been consistently supported by a substantial number of studies in recent years and has the potential to radically shift goals of interventions and public psychoeducation regarding autism.<ref name=":41" /><ref name=":7">Gernsbacher, Morton Ann; Yergeau, Melanie (2019). "Empirical Failures of the Claim That Autistic People Lack a Theory of Mind". Archives of Scientific Psychology. 7 (1): 102–118. doi:10.1037/arc0000067. PMC 6959478. PMID 31938672.</ref><ref name=":5">Milton, Damian (2018-03-02). "The double empathy problem". National Autistic Society. Retrieved 2023-03-19.</ref><ref name=":9">Milton, Damian; Gurbuz, Emine; López, Beatriz (October 2022). "The 'double empathy problem': Ten years on". Autism. 26 (8): 1901–1903. doi:10.1177/13623613221129123. ISSN 1362-3613. PMID 36263746. S2CID 253020669.</ref> In recognition of recent findings that support the theory, Baron-Cohen positively recognized the theory of the double empathy problem in two research articles in 2018<ref name=":27">Cassidy, Sarah; Bradley, Louise; Shaw, Rebecca; Baron-Cohen, Simon (2018-07-31). "Risk markers for suicidality in autistic adults". Molecular Autism. 9 (1): 42. doi:10.1186/s13229-018-0226-4. ISSN 2040-2392. PMC 6069847. PMID 30083306.</ref> and 2022,<ref name=":28">Richards, Gareth; Baron-Cohen, Simon (2022-05-19). "Evidence of partner similarity for autistic traits, systemizing, and theory of mind via facial expressions". Scientific Reports. 12 (1): 8451. Bibcode:2022NatSR..12.8451R. doi:10.1038/s41598-022-11592-z. PMC 9118825. PMID 35589769.</ref> as well as in multiple podcasts since 2020.<ref name=":26">"A Conversation About 'The Pattern Seekers' by Simon Baron-Cohen". 2020-12-19.</ref><ref>Wright, Robert; Baron-Cohen, Simon (2023-06-21). "Autism and the Two Kinds of Empathy". YouTube. Retrieved 2023-06-25.</ref>

History

Development and spread of mind-blindness theory

Main article: Mind-blindness

Earlier studies on autism regarding theory of mind and empathy had concluded that a lack of theory of mind was one of the primary symptoms of autism. The most popular of these studies were those led by Simon Baron-Cohen in the 1980s and 1990s, who used the term "mind-blindness" to describe his theory in an attempt to empirically explain the tendency of autistic people to avoid eye contact,<ref name=":10">Baron-Cohen, Simon; Leslie, Alan M.; Frith, Uta (1985-10-01). "Does the autistic child have a "theory of mind" ?". Cognition. 21 (1): 37–46. doi:10.1016/0010-0277(85)90022-8. ISSN 0010-0277. PMID 2934210. S2CID 14955234.</ref><ref name=":11">Baron-Cohen, Simon (1988-10-01). "Social and pragmatic deficits in autism: Cognitive or affective?". Journal of Autism and Developmental Disorders. 18 (3): 379–402. doi:10.1007/BF02212194. PMID 3049519. S2CID 2050249.</ref><ref>Baron-Cohen, Simon; Campbell, Ruth; Karmiloff-Smith, Annette; Grant, Julia; Walker, Jane (November 1995). "Are children with autism blind to the mentalistic significance of the eyes?". British Journal of Developmental Psychology. 13 (4): 379–398. doi:10.1111/j.2044-835X.1995.tb00687.x. S2CID 34341464.</ref> proposing a homogeneous explanation of autism as due to either a lack of theory of mind or developmental delay in theory of mind in early childhood.<ref name=":12">Baron-Cohen, Simon (1990-01-01). "Autism: A Specific Cognitive Disorder of 'Mind-Blindness'". International Review of Psychiatry. 2 (1): 81–90. doi:10.3109/09540269009028274. ISSN 0954-0261.</ref> Some have additionally described the supposed social impairment present in autistic people as "an extreme form of egocentrism with the resulting lack of consideration for others".<ref>Frith, Uta (2004). "Emanuel Miller lecture: Confusions and controversies about Asperger syndrome". Journal of Child Psychology and Psychiatry. 45 (4): 672–686. doi:10.1111/j.1469-7610.2004.00262.x. ISSN 0021-9630. PMID 15056300.</ref>

Mind-blindness implies an inability to make sense of and predict another person's behavior, and to attribute mental states such as knowledge, beliefs, desires, emotions, and intentions to oneself and others.<ref>Gallagher, Helen L.; Frith, Christopher D. (2003-02-01). "Functional imaging of 'theory of mind'". Trends in Cognitive Sciences. 7 (2): 77–83. doi:10.1016/S1364-6613(02)00025-6. ISSN 1364-6613. PMID 12584026. S2CID 14873867.</ref><ref>Wilkinson, Lee A. (2011), "Mindblindness", in Goldstein, Sam; Naglieri, Jack A. (eds.), Encyclopedia of Child Behavior and Development, Boston, MA: Springer US, pp. 955–956, doi:10.1007/978-0-387-79061-9_1795, ISBN 978-0-387-77579-1</ref> The claim that autistic people lack theory of mind is taught across a wide range of psychology textbooks<ref>Kellogg, Ronald Thomas (2007). Fundamentals of cognitive psychology. Los Angeles, CA: SAGE Publications. ISBN 978-1-4129-3692-7. OCLC 77520655.</ref><ref>Kirk, Samuel A.; Gallagher, James; Coleman, Mary Ruth; Anastasiow, Nicholas J. (2008). Educating exceptional children (12th ed.). Boston, MA: Houghton Mifflin. ISBN 978-0-547-12413-1. OCLC 276275401.</ref><ref>Myers, David G. (2010). Myers' psychology for AP (1st ed.). New York, NY: Worth Publishers. ISBN 978-1-4292-4436-7. OCLC 670478661.</ref><ref>Myers, David G. (2011). Exploring psychology (8th ed.). New York, NY: Worth Publishers. ISBN 978-1-4292-1635-7. OCLC 568677536.</ref><ref>Mash, Eric J.; Wolfe, David A. (2016). Abnormal child psychology (6th ed.). Australia: Cengage Learning. ISBN 978-1-305-10542-3. OCLC 908991427.</ref><ref>Coon, Dennis; Mitterer, John O.; Martini, Tanya (2018). Psychology : modules for active learning (14th ed.). Boston, MA: Cengage Learning. ISBN 978-1-305-96411-2. OCLC 990766461.</ref><ref>Sigelman, Carol K.; Rider, Elizabeth A. (2018). Life-span human development (9th ed.). Australia: Cengage Learning. ISBN 978-1-337-51606-8. OCLC 1100692276.</ref> and promoted by over 75% of the top 500 scholarly articles indexed for "theory of mind" and "autism" on Google Scholar,<ref name=":7" /><ref>Gernsbacher, Morton Ann (2018-02-25). "Critical Review of Autism and Theory and Mind: A Tech Report". Open Science Framework. doi:10.17605/OSF.IO/3R2QY.</ref> serving as one of psychology's widely promoted topics throughout psychological literature, practice, and instruction.<ref name=":29">Gernsbacher, Morton Ann (February 2007). "On Not Being Human". APS Observer. 20 (2): 5–32. ISSN 1050-4672. PMC 4266404. PMID 25520547.</ref><ref>Yergeau, Melanie (2013-09-05). "Clinically Significant Disturbance: On Theorists Who Theorize Theory of Mind". Disability Studies Quarterly. 33 (4). doi:10.18061/dsq.v33i4.3876. ISSN 2159-8371.</ref><ref>Yergeau, Melanie; Huebner, Bryce (2017-09-06). "Minding Theory of Mind: Minding Theory of Mind". Journal of Social Philosophy. 48 (3): 273–296. doi:10.1111/josp.12191.</ref> Mind-blindness has also been embraced by scholars in other disciplinary areas such as sociology,<ref>Willey, Angela; Subramaniam, Banu; Hamilton, Jennifer A.; Couperus, Jane (2015). "The Mating Life of Geeks: Love, Neuroscience, and the New Autistic Subject". Signs: Journal of Women in Culture and Society. 40 (2): 369–391. doi:10.1086/678146. ISSN 0097-9740. S2CID 146561474.</ref> philosophy,<ref name=":46">Barnbaum, Deborah R. (2008). The ethics of autism : among them, but not of them. Bloomington, IN: Indiana University Press. ISBN 978-0-253-22013-4. OCLC 560616889.</ref> economics,<ref>Singer, Tania; Fehr, Ernst (2005-04-01). "The Neuroeconomics of Mind Reading and Empathy". American Economic Review. 95 (2): 340–345. doi:10.1257/000282805774670103. hdl:10419/33340. ISSN 0002-8282. PMID 29125271. S2CID 1480492.</ref> anthropology,<ref>Boyer, Pascal (2003-03-31). "Functional origins of religious concepts: ontological and strategic selection in evolved minds". Journal of the Royal Anthropological Institute. 6 (2): 195–214. doi:10.1111/1467-9655.00012.</ref> robotics,<ref>Scassellati, Brian (2002). "Theory of mind for a humanoid robot". Autonomous Robots. 12 (1): 13–24. doi:10.1023/A:1013298507114. S2CID 1979315.</ref> and narratology.<ref>Barnes, Jennifer L. (2012). "Fiction, imagination, and social cognition: Insights from autism". Poetics. 40 (4): 299–316. doi:10.1016/j.poetic.2012.05.001.</ref>

Problems with earlier studies on theory of mind and empathy in autism

The mind-blindness hypothesis, in addition to being questioned shortly after its publication,<ref name=":13" /> has faced a great deal of criticism from the scientific community over the years,<ref name=":7" /><ref name=":23">Dinishak, Janette; Akhtar, Nameera (June 2013). "A Critical Examination of Mindblindness as a Metaphor for Autism". Child Development Perspectives. 7 (2): 110–114. doi:10.1111/cdep.12026.</ref> in response to the replication studies (mostly with false-belief tasks) that have failed to reveal significant differences in theory of mind between autistic and non-autistic participants,<ref>Ozonoff, Sally; Pennington, Bruce F.; Rogers, Sally J. (1991). "Executive Function Deficits in High-Functioning Autistic Individuals: Relationship to Theory of Mind". Journal of Child Psychology and Psychiatry. 32 (7): 1081–1105. doi:10.1111/j.1469-7610.1991.tb00351.x. ISSN 0021-9630. PMID 1787138.</ref><ref>Oswald, Donald P.; Ollendick, Thomas H. (1989). "Role taking and social competence in autism and mental retardation". Journal of Autism and Developmental Disorders. 19 (1): 119–127. doi:10.1007/BF02212723. ISSN 0162-3257. PMID 2708295. S2CID 46444974.</ref><ref>Tager-Flusberg, Helen; Sullivan, Kate (1994). "A second look at second-order belief attribution in autism". Journal of Autism and Developmental Disorders. 24 (5): 577–586. doi:10.1007/BF02172139. ISSN 0162-3257. PMID 7814307. S2CID 25194344.</ref> as well as the growing body of evidence for the high degree of heterogeneity in autistic brains at a neurobiological level.<ref>Toal, F.; Daly, E. M.; Page, L.; Deeley, Q.; Hallahan, B.; Bloemen, O.; Cutter, W. J.; Brammer, M. J.; Curran, S.; Robertson, D.; Murphy, C.; Murphy, K. C.; Murphy, D. G. M. (July 2010). "Clinical and anatomical heterogeneity in autistic spectrum disorder: a structural MRI study". Psychological Medicine. 40 (7): 1171–1181. doi:10.1017/S0033291709991541. ISSN 0033-2917. PMID 19891805. S2CID 10216391.</ref><ref>Lenroot, Rhoshel K.; Yeung, Pui Ka (2013). "Heterogeneity within Autism Spectrum Disorders: What have We Learned from Neuroimaging Studies?". Frontiers in Human Neuroscience. 7: 733. doi:10.3389/fnhum.2013.00733. ISSN 1662-5161. PMC 3812662. PMID 24198778.</ref><ref>Chapman, Robert (2020-08-17). "The reality of autism: On the metaphysics of disorder and diversity". Philosophical Psychology. 33 (6): 799–819. doi:10.1080/09515089.2020.1751103. hdl:1983/309dc16c-cfe9-4356-81b8-6d95510b5eb0. ISSN 0951-5089. S2CID 203059811.</ref>

There have been developments of new theory-of-mind measures when existing measures were perceived by some researchers as inadequate.<ref name=":7" /> There have been some successful replications demonstrating differences in theory of mind and empathy with some measures such as the Frith–Happé Animations Test,<ref>Livingston, Lucy A.; Shah, Punit; White, Sarah J.; Happé, Francesca (2021-07-10). "Further developing the Frith–Happé animations: A quicker, more objective, and web‐based test of theory of mind for autistic and neurotypical adults". Autism Research. 14 (9): 1905–1912. doi:10.1002/aur.2575. ISSN 1939-3792. PMID 34245112. S2CID 235786838.</ref> Baron-Cohen's "Reading the Mind in the Eyes" task,<ref name=":24">Baron‐Cohen, Simon; Wheelwright, Sally; Hill, Jacqueline; Raste, Yogini; Plumb, Ian (February 2001). "The "Reading the Mind in the Eyes" Test Revised Version: A Study with Normal Adults, and Adults with Asperger Syndrome or High‐functioning Autism". Journal of Child Psychology and Psychiatry. 42 (2): 241–251. doi:10.1111/1469-7610.00715. ISSN 0021-9630. PMID 11280420. S2CID 3016793.</ref><ref>Yeung, Michael K. (2022-02-01). "A systematic review and meta-analysis of facial emotion recognition in autism spectrum disorder: The specificity of deficits and the role of task characteristics". Neuroscience & Biobehavioral Reviews. 133: 104518. doi:10.1016/j.neubiorev.2021.104518. ISSN 0149-7634. PMID 34974069. S2CID 245591561.</ref> and self-report empathy questionnaires — which have been criticized for being vague and imprecise as well as not considering social interaction contexts, reference groups, and the substantially lowered social-desirability bias of autistic individuals.<ref name=":38">Fletcher-Watson, Sue; Bird, Geoffrey (2019-11-01). "Autism and empathy: What are the real links?". Autism. 24 (1): 3–6. doi:10.1177/1362361319883506. ISSN 1362-3613. PMID 31674189. S2CID 207816582.</ref> In addition, several independent teams have repetitively failed to replicate highly cited and widely taught findings with picture-sequencing tasks and false-belief tasks such as the Sally–Anne test.<ref name=":7" /> Such mixed and inconsistent findings with many different measures have raised doubts regarding the generalizability and validity of the mind-blindness theory of autism.<ref name=":7" /><ref>Rajendran, Gnanathusharan; Mitchell, Peter (2007). "Cognitive theories of autism". Developmental Review. 27 (2): 224–260. doi:10.1016/j.dr.2007.02.001. S2CID 34448439.</ref>

Furthermore, autism intervention research based on theory of mind has shown little efficacy,<ref>Fletcher-Watson, Sue; McConnell, Fiona; Manola, Eirini; McConachie, Helen (2014-03-21). "Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD)". Cochrane Database of Systematic Reviews. 2014 (3): CD008785. doi:10.1002/14651858.CD008785.pub2. PMC 6923148. PMID 24652601.</ref><ref>Sandbank, Micheal; Bottema-Beutel, Kristen; Crowley, Shannon; Cassidy, Margaret; Dunham, Kacie; Feldman, Jacob I.; Crank, Jenna; Albarran, Susanne A.; Raj, Sweeya; Mahbub, Prachy; Woynaroski, Tiffany G. (2020). "Project AIM: Autism intervention meta-analysis for studies of young children". Psychological Bulletin. 146 (1): 1–29. doi:10.1037/bul0000215. ISSN 1939-1455. PMC 8783568. PMID 31763860.</ref> and theory-of-mind experiments typically fail to take into account the fact that autistic people have different sensory experiences, which vary between autistic individuals, than non-autistic people.<ref>Bogdashina, Olga (2016). Sensory perceptual issues in autism and asperger syndrome : different sensory experiences – different perceptual worlds (2nd ed.). London: Jessica Kingsley Publishers. ISBN 978-1-84905-673-1. OCLC 922835761.</ref> Academics have also noted that many autistic children and adults pass some theory-of-mind tasks but performances vary substantially between diverse tasks and between autistic individuals; hence, Baron-Cohen's earlier repeated assertion of mind-blindness being a universal characteristic of autism across contexts<ref name=":40">Baron-Cohen, Simon (2008). "Theories of the autistic mind". The Psychologist. 21: 112–116.</ref><ref>Baron-Cohen, Simon (2009). "Autism: The Empathizing-Systemizing (E-S) Theory". Annals of the New York Academy of Sciences. 1156 (1): 68–80. Bibcode:2009NYASA1156...68B. doi:10.1111/j.1749-6632.2009.04467.x. PMID 19338503. S2CID 1440395.</ref><ref>Baron-Cohen, Simon (2010-11-20), Savic, Ivanka (ed.), "Empathizing, systemizing, and the extreme male brain theory of autism", Progress in Brain Research, Sex Differences in the Human Brain, their Underpinnings and Implications, Elsevier, 186: 167–175, doi:10.1016/b978-0-444-53630-3.00011-7, ISBN 9780444536303, PMID 21094892</ref> has also been called into question by other researchers since the 1990s.<ref name=":41" /><ref>Bailey, Anthony; Phillips, Wendy; Rutter, Michael (1996). "Autism: Towards an Integration of Clinical, Genetic, Neuropsychological, and Neurobiological Perspectives". Journal of Child Psychology and Psychiatry. 37 (1): 89–126. doi:10.1111/j.1469-7610.1996.tb01381.x. ISSN 0021-9630. PMID 8655659.</ref><ref>Bauminger, Nirit; Kasari, Connie (1999). "Brief report: Theory of mind in high-functioning children with autism". Journal of Autism and Developmental Disorders. 29 (1): 81–86. doi:10.1023/A:1025974701090. PMID 10097997. S2CID 42761063.</ref><ref>Beversdorf, D. Q.; Anderson, J. M.; Manning, S. E.; Anderson, S. L.; Nordgren, R. E.; Felopulos, G. J.; Nadeau, S. E.; Heilman, K. M.; Bauman, M. L. (1998-11-01). "The effect of semantic and emotional context on written recall for verbal language in high functioning adults with autism spectrum disorder". Journal of Neurology, Neurosurgery & Psychiatry. 65 (5): 685–692. doi:10.1136/jnnp.65.5.685. ISSN 0022-3050. PMC 2170365. PMID 9810938.</ref><ref>Buitelaar, Jan K.; Wees, Marleen van der; Swaab-Barneveld, Hanna; Gaag, Rutger Jan van der (1999). "Verbal Memory and Performance IQ Predict Theory of Mind and Emotion Recognition Ability in Children with Autistic Spectrum Disorders and in Psychiatric Control Children". Journal of Child Psychology and Psychiatry. 40 (6): 869–881. doi:10.1111/1469-7610.00505. ISSN 0021-9630. PMID 10509882.</ref><ref>Ozonoff, Sally; Rogers, Sally J.; Pennington, Bruce F. (1991). "Asperger's Syndrome: Evidence of an Empirical Distinction from High-Functioning Autism". Journal of Child Psychology and Psychiatry. 32 (7): 1107–1122. doi:10.1111/j.1469-7610.1991.tb00352.x. ISSN 0021-9630. PMID 1787139.</ref> In recent years, Baron-Cohen has revised his understanding and his recent well-powered studies have found substantial heterogeneity in empathy and theory of mind among autistic people, with lower performances or scores in theory-of-mind and empathy tasks among autistic people on average, but also a substantial proportion (around 40–60%) of autistic people showing "unimpaired" or even above-average performances in some rather controversial theory-of-mind and empathy measures.<ref>Baksh, R. Asaad; Abrahams, Sharon; Bertlich, Maya; Cameron, Rebecca; Jany, Sharon; Dorrian, Terin; Baron-Cohen, Simon; Allison, Carrie; Smith, Paula; MacPherson, Sarah E.; Auyeung, Bonnie (2021-10-03). "Social cognition in adults with autism spectrum disorders: Validation of the Edinburgh Social Cognition Test (ESCoT)". The Clinical Neuropsychologist. 35 (7): 1275–1293. doi:10.1080/13854046.2020.1737236. hdl:20.500.11820/ea02ab9c-73be-4e85-916a-7612aa640013. ISSN 1385-4046. PMID 32189564. S2CID 151487088.</ref><ref>Greenberg, David M.; Warrier, Varun; Allison, Carrie; Baron-Cohen, Simon (2018-11-27). "Testing the Empathizing–Systemizing theory of sex differences and the Extreme Male Brain theory of autism in half a million people". Proceedings of the National Academy of Sciences. 115 (48): 12152–12157. Bibcode:2018PNAS..11512152G. doi:10.1073/pnas.1811032115. ISSN 0027-8424. PMC 6275492. PMID 30420503.</ref><ref>Lombardo, Michael V.; Lai, Meng-Chuan; Auyeung, Bonnie; Holt, Rosemary J.; Allison, Carrie; Smith, Paula; Chakrabarti, Bhismadev; Ruigrok, Amber N. V.; Suckling, John; Bullmore, Edward T.; MRC AIMS Consortium; Bailey, Anthony J.; Baron-Cohen, Simon; Bolton, Patrick F.; Bullmore, Edward T. (2016-10-18). "Unsupervised data-driven stratification of mentalizing heterogeneity in autism". Scientific Reports. 6 (1): 35333. Bibcode:2016NatSR...635333.. doi:10.1038/srep35333. ISSN 2045-2322. PMC 5067562. PMID 27752054.</ref> Similar results have been consistently demonstrated by other research teams.<ref>Hajdúk, Michal; Pinkham, Amy E.; Penn, David L.; Harvey, Philip D.; Sasson, Noah J. (April 2022). "Heterogeneity of social cognitive performance in autism and schizophrenia". Autism Research. 15 (8): 1522–1534. doi:10.1002/aur.2730. ISSN 1939-3792. PMID 35460541. S2CID 248345497.</ref><ref>Bird, G.; Cook, R. (2013-07-23). "Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism". Translational Psychiatry. 3 (7): e285. doi:10.1038/tp.2013.61. ISSN 2158-3188. PMC 3731793. PMID 23880881.</ref>

Additionally, it has been argued that many professionals and, likewise, parents seem to have neglected that reciprocity needs to be mutual and symmetrical.<ref name=":31" /> For example, John Constantino's Social Responsiveness Scale,<ref name=":34">Constantino, John N. (2002). The social responsiveness scale. Los Angeles, CA: Western Psychological Services.</ref> a 2002 quantitative measure of social reciprocity in children which has since been used extensively in autism research,<ref>Constantino, John N.; Todd, Richard D. (May 2003). "Autistic Traits in the General Population: A Twin Study". Archives of General Psychiatry. 60 (5): 524–530. doi:10.1001/archpsyc.60.5.524. ISSN 0003-990X. PMID 12742874.</ref><ref>Constantino, John N.; Gruber, Christian P.; Davis, Sandra; Hayes, Stephanie; Passanante, Natalie; Przybeck, Thomas (May 2004). "The factor structure of autistic traits". Journal of Child Psychology and Psychiatry. 45 (4): 719–726. doi:10.1111/j.1469-7610.2004.00266.x. ISSN 0021-9630. PMID 15056304.</ref><ref>Towbin, Kenneth E.; Pradella, Anne; Gorrindo, Tristan; Pine, Daniel S.; Leibenluft, Ellen (June 2005). "Autism Spectrum Traits in Children with Mood and Anxiety Disorders". Journal of Child and Adolescent Psychopharmacology. 15 (3): 452–464. doi:10.1089/cap.2005.15.452. ISSN 1044-5463. PMID 16092910.</ref><ref>Nguyen, Phuong H.; Ocansey, Maku E.; Miller, Meghan; Le, Dung T. K.; Schmidt, Rebecca J.; Prado, Elizabeth L. (2019-07-29). "The reliability and validity of the social responsiveness scale to measure autism symptomology in Vietnamese children". Autism Research. 12 (11): 1706–1718. doi:10.1002/aur.2179. ISSN 1939-3792. PMC 7397486. PMID 31355545.</ref><ref>Kerr‐Gaffney, Jess; Harrison, Amy; Tchanturia, Kate (July 2020). "The social responsiveness scale is an efficient screening tool for autism spectrum disorder traits in adults with anorexia nervosa". European Eating Disorders Review. 28 (4): 433–444. doi:10.1002/erv.2736. ISSN 1072-4133. PMC 8653883. PMID 32243021.</ref> consisted of the item that asks whether the child "is regarded by other children as odd or weird", which, although seems to indicate a lack of social or emotional reciprocity in the regarder, is used instead to indicate a lack of social or emotional reciprocity in the target child.<ref name=":31" /> Several other items in the questionnaire, such as the one that asks whether the child "is not well coordinated in physical activities", seem completely unrelated to reciprocity.<ref name=":31" /><ref name=":34" />

Counter-theory to mind-blindness

Around the early 2010s, academics began to suggest that some studies of theory-of-mind and empathy tests may have misinterpreted autistic people having difficulty understanding non-autistic or neurotypical people as being an intrinsic social deficit present in autistic individuals. They argued that it seemed more likely that autistic people were specifically having trouble understanding neurotypical people in some contexts, due to differences in experiences and social-cognition between the two groups.<ref name=":1" /><ref>Jackson-Perry, David (2017-09-14). "Autism and Asperger syndrome in adults". Disability & Society. 32 (8): 1280–1282. doi:10.1080/09687599.2017.1362181. ISSN 0968-7599. S2CID 149435804.</ref><ref>Rogers, Kimberley; Dziobek, Isabel; Hassenstab, Jason; Wolf, Oliver T.; Convit, Antonio (2007-04-01). "Who Cares? Revisiting Empathy in Asperger Syndrome". Journal of Autism and Developmental Disorders. 37 (4): 709–715. doi:10.1007/s10803-006-0197-8. ISSN 1573-3432. PMID 16906462. S2CID 13999363.</ref> The theory of the double empathy problem was coined in 2012 by Damian Milton as a counter-theory to mind-blindness in an effort to explain this phenomenon of mutual misunderstanding, defined as follows:

The "double empathy problem": a disjuncture in reciprocity between two differently disposed social actors which becomes more marked the wider the disjuncture in dispositional perceptions of the lifeworld – perceived as a breach in the "natural attitude" of what constitutes "social reality" for "non-autistic spectrum" people and yet an everyday and often traumatic experience for "autistic people".<ref name=":1" />

The claim that autism is characterized by a lack of social or emotional reciprocity has become a truism in academia; for instance, in a 2004 research article examining a hypothesized autism susceptibility gene, the opening line simply stated, without any scientific citations or supporting data, that "impaired reciprocal social interaction is one of the core features of autism".<ref name=":31" /><ref>Wassink, T. H.; Piven, J.; Vieland, V. J.; Pietila, J.; Goedken, R. J.; Folstein, S. E.; Sheffield, V. C. (2004-04-06). "Examination of AVPR1a as an autism susceptibility gene". Molecular Psychiatry. 9 (10): 968–972. doi:10.1038/sj.mp.4001503. ISSN 1359-4184. PMID 15098001. S2CID 238751.</ref> The double empathy theory, subsequent findings, and findings in the broader theory of mind and empathy literature in the past two to three decades contest common assumptions about autistic people in the fields of psychology and psychiatry, which are often riddled with information regarding autism and theory of mind (e.g., autistic people are universally deficient in empathy or theory of mind) that is outdated, overgeneralized, empirically questionable with inconsistent findings, and potentially societally harmful, but still often assumed by some researchers, educators, students, and practitioners as factual.<ref name=":7" /><ref name=":31" /><ref>Marocchini, Eleonora (2023-02-01). "Impairment or difference? The case of Theory of Mind abilities and pragmatic competence in the Autism Spectrum". Applied Psycholinguistics. 44 (3): 365–383. doi:10.1017/S0142716423000024. ISSN 0142-7164. S2CID 256541508.</ref>

While the concept of double empathy had existed in prior publications,<ref name=":29" /><ref name=":31">Gernsbacher, Morton Ann (2006). "Toward a Behavior of Reciprocity". The Journal of Developmental Processes. 1 (1): 139–152. PMC 4296736. PMID 25598865.</ref> Milton named and significantly expanded on it.<ref name=":1" /><ref name=":5" /><ref name=":9" /><ref>Rozsa, Matthew (2021-06-06). "Being autistic may amount to a language difference — not an impairment". Salon. Retrieved 2023-03-19.</ref> Since 2015, there has been an increasing number of research studies, including experimental studies, qualitative research, and real-life social interaction studies, many of which emerging under the banner of critical autism studies, supporting the double empathy theory and the findings appear consistent.<ref name=":2" /><ref name=":33" /><ref name=":22" /><ref name=":39" /><ref name=":8" /><ref name=":3" /><ref name=":4" /><ref name=":14">Rifai, Olivia M.; Fletcher-Watson, Sue; Jiménez-Sánchez, Lorena; Crompton, Catherine J. (2022-03-01). "Investigating Markers of Rapport in Autistic and Nonautistic Interactions". Autism in Adulthood. 4 (1): 3–11. doi:10.1089/aut.2021.0017. ISSN 2573-9581. PMC 8992924. PMID 36600904.</ref><ref name=":20">Scheerer, Nichole E.; Boucher, Troy Q.; Sasson, Noah J.; Iarocci, Grace (2022-09-01). "Effects of an Educational Presentation About Autism on High School Students' Perceptions of Autistic Adults". Autism in Adulthood. 4 (3): 203–213. doi:10.1089/aut.2021.0046. ISSN 2573-9581. PMC 9645669. PMID 36606156.</ref><ref name=":17">Bolis, Dimitris; Lahnakoski, Juha M.; Seidel, Daniela; Tamm, Jeanette; Schilbach, Leonhard (2020-10-26). "Interpersonal similarity of autistic traits predicts friendship quality". Social Cognitive and Affective Neuroscience. Oxford University Press. 16 (1–2): 222–231. doi:10.1093/scan/nsaa147. ISSN 1749-5016. PMC 7812635. PMID 33104781.</ref><ref name=":35">Morrison, Kerrianne E.; Debrabander, Kilee M.; Jones, Desiree R.; Faso, Daniel J.; Ackerman, Robert A.; Sasson, Noah J. (2020). "Outcomes of real-world social interaction for autistic adults paired with autistic compared to typically developing partners". Autism. 24 (5): 1067–1080. doi:10.1177/1362361319892701. PMID 31823656. S2CID 209317731.</ref><ref name=":32">Crompton, Catherine J.; Hallett, Sonny; Ropar, Danielle; Flynn, Emma; Fletcher-Watson, Sue (2020). "'I never realised everybody felt as happy as I do when I am around autistic people': A thematic analysis of autistic adults' relationships with autistic and neurotypical friends and family". Autism. 24 (6): 1438–1448. doi:10.1177/1362361320908976. PMC 7376620. PMID 32148068.</ref><ref name=":19">Williams, Gemma L.; Wharton, Tim; Jagoe, Caroline (2021). "Mutual (Mis)understanding: Reframing Autistic Pragmatic "Impairments" Using Relevance Theory". Frontiers in Psychology. 12: 616664. doi:10.3389/fpsyg.2021.616664. PMC 8117104. PMID 33995177.</ref><ref>Chen, Yu-Lun; Schneider, Maxwell; Patten, Kristie (2022-07-22). "Exploring the role of interpersonal contexts in peer relationships among autistic and non-autistic youth in integrated education". Frontiers in Psychology. 13: 946651. doi:10.3389/fpsyg.2022.946651. ISSN 1664-1078. PMC 9355587. PMID 35936294.</ref><ref name=":16" /><ref name=":37">Granieri, Jessica E.; McNair, Morgan L.; Gerber, Alan H.; Reifler, Rebecca F.; Lerner, Matthew D. (2020-06-04). "Atypical social communication is associated with positive initial impressions among peers with autism spectrum disorder". Autism. 24 (7): 1841–1848. doi:10.1177/1362361320924906. ISSN 1362-3613. PMID 32498545. S2CID 219331201.</ref><ref name=":48">Glass, Devyn; Yuill, Nicola (2023-06-13). "Moving Together: Social Motor Synchrony in Autistic Peer Partners Depends on Partner and Activity Type". Journal of Autism and Developmental Disorders. doi:10.1007/s10803-023-05917-8. ISSN 1573-3432. PMID 37310543. S2CID 259147542.</ref>

In the past few years, the double empathy theory has been supported by many autism researchers, including Catherine Crompton,<ref name=":2" /><ref name=":3" /><ref name=":14" /><ref name=":32" /> Morton Ann Gernsbacher,<ref name=":7" /> Baron-Cohen himself,<ref name=":27" /><ref name=":28" /><ref name=":26" /> and the editor-in-chief of the academic journal Autism, Sue Fletcher-Watson.<ref name=":2" /><ref name=":3" /><ref name=":38" /><ref name=":14" /><ref name=":32" /> The theory has also been approached by research projects in various disciplinary areas,<ref name=":9" /> including but not limited to psychology, sociology,<ref>Milton, Damian E. M. (2016-11-25). "Disposable dispositions: reflections upon the work of Iris Marion Young in relation to the social oppression of autistic people". Disability & Society. 31 (10): 1403–1407. doi:10.1080/09687599.2016.1263468. ISSN 0968-7599. S2CID 151500732.</ref> philosophy,<ref>Chapman, Robert (2019-07-04). "Autism as a Form of Life: Wittgenstein and the Psychological Coherence of Autism: Autism as a Form of Life". Metaphilosophy. 50 (4): 421–440. doi:10.1111/meta.12366. S2CID 181423539.</ref> neuroscience,<ref name=":17" /><ref>Bolis, Dimitris; Balsters, Joshua; Wenderoth, Nicole; Becchio, Cristina; Schilbach, Leonhard (2017). "Beyond Autism: Introducing the Dialectical Misattunement Hypothesis and a Bayesian Account of Intersubjectivity". Psychopathology. 50 (6): 355–372. doi:10.1159/000484353. hdl:11858/00-001M-0000-002E-0068-A. ISSN 0254-4962. PMID 29232684. S2CID 3595888.</ref> linguistics,<ref name=":19" /> film studies,<ref>Eastwood, Steven; Evans, Bonnie; Gaigg, Sebastian; Harbord, Janet; Milton, Damian (2022-02-07). "Autism through cinema: co-creation and the unmaking of knowledge". International Journal of Qualitative Studies in Education: 1–18. doi:10.1080/09518398.2022.2025492. ISSN 0951-8398. S2CID 246669071.</ref> and design.<ref>Gaudion, Katie; Hall, Ashley; Myerson, Jeremy; Pellicano, Liz (June 2014). "Design and wellbeing: Bridging the empathy gap between neurotypical designers and autistic adults" (PDF). Design for Sustainable Wellbeing and Empowerment. 2014: 61–77.</ref>

Double empathy and bidirectional communication studies

Interpersonal rapport, empathy, and communication effectiveness

It has been suggested that non-autistic people tend to have a poor understanding of autistic people and lack emotional empathy for autistic people, just as autistic people may have a poor understanding of non-autistic people.<ref name=":1" /><ref name=":20" /><ref name=":16" /><ref>Sasson, Noah J.; Faso, Daniel J.; Nugent, Jack; Lovell, Sarah; Kennedy, Daniel P.; Grossman, Ruth B. (2017-02-01). "Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments". Scientific Reports. 7 (1): 40700. Bibcode:2017NatSR...740700S. doi:10.1038/srep40700. ISSN 2045-2322. PMC 5286449. PMID 28145411.</ref> Whilst autistic people sometimes have difficulties in understanding non-autistic people and struggle to socialize with non-autistic people, it is likely that most non-autistic people often hold negative stereotypes, views, and/or biases regarding autistic differences, and also struggle to understand autistic people's communication, emotions, and intentions, resulting in and contributing to this "double empathy problem".<ref name=":20" /><ref name=":45" />

Studies from the 2010s and 2020s that have used autistic-autistic pairs to test interpersonal rapport, empathy, and communication effectiveness in adults have shown that autistic adults generally perform better in empathy, rapport, and communication effectiveness when paired with other autistic adults,<ref name=":2" /><ref name=":39" /><ref name=":35" /><ref name=":16" /> that higher interpersonal rapport may be present in autistic-autistic interactions than in those between autistic and neurotypical people,<ref name=":3" /><ref name=":14" /><ref name=":37" /> and that autistic people may be able to understand and predict each other's thoughts and motivations better than neurotypical people<ref name=":3" /><ref>Chown, Nicholas (2014-11-26). "More on the ontological status of autism and double empathy". Disability & Society. 29 (10): 1672–1676. doi:10.1080/09687599.2014.949625. ISSN 0968-7599. S2CID 143826899.</ref> as well as possibly autistic close relatives.<ref>Sucksmith, E.; Allison, C.; Baron-Cohen, S.; Chakrabarti, B.; Hoekstra, R. A. (2013-01-01). "Empathy and emotion recognition in people with autism, first-degree relatives, and controls". Neuropsychologia. 51 (1): 98–105. doi:10.1016/j.neuropsychologia.2012.11.013. ISSN 0028-3932. PMC 6345368. PMID 23174401.</ref>

The importance of social reciprocity

One major factor influencing communication effectiveness is social reciprocity. Past research from the 1980s and 1990s has indicated that when professionals, peers, and parents are taught to act reciprocally to autistic children, non-autistic children are considerably more likely to reciprocate with autistic children, who end up becoming more responsive.<ref>Odom, S. L.; Strain, P. S. (1986). "A comparison of peer-initiation and teacher-antecedent interventions for promoting reciprocal social interaction of autistic preschoolers". Journal of Applied Behavior Analysis. 19 (1): 59–71. doi:10.1901/jaba.1986.19-59. PMC 1308041. PMID 3710949.</ref><ref>McEvoy, Mary A.; Nordquist, Vey M.; Twardosz, Sandra; Heckaman, Kelly A.; Wehby, Joseph H.; Denny, R. Kenton (1988). "Promoting autistic children's peer interaction in an integrated early childhood setting using affection activities". Journal of Applied Behavior Analysis. 21 (2): 193–200. doi:10.1901/jaba.1988.21-193. PMC 1286111. PMID 3417581.</ref> Non-autistic children can demonstrate reciprocity via imitation, which improves social responsiveness in all children, including autistic children; when a random person imitates an autistic child engaging in object manipulation by manipulating a duplicate object in the same way that the child does, the child makes longer and more frequent eye contact with the person.<ref>Dawson, Geraldine; Adams, Alexandra (June 1984). "Imitation and social responsiveness in autistic children". Journal of Abnormal Child Psychology. 12 (2): 209–226. doi:10.1007/BF00910664. ISSN 0091-0627. PMID 6725782. S2CID 36581183.</ref><ref>Tiegerman, Ellenmorris; Primavera, Louis H. (March 1984). "Imitating the autistic child: Facilitating communicative gaze behavior". Journal of Autism and Developmental Disorders. 14 (1): 27–38. doi:10.1007/BF02408553. ISSN 0162-3257. PMID 6706896. S2CID 38198496.</ref> Similarly, when mothers imitate their autistic children's manipulation of toys, the children not only gaze longer and more frequently at their mothers, but also engage in more exploratory and creative behavior with the toys, on top of showing considerably more positive affect.<ref>Dawson, Geraldine; Galpert, Larry (April 1990). "Mothers' use of imitative play for facilitating social responsiveness and toy play in young autistic children". Development and Psychopathology. 2 (2): 151–162. doi:10.1017/S0954579400000675. ISSN 0954-5794. S2CID 145739085.</ref>

In contrast, in a 1992 study on reciprocal interactions, non-autistic preschoolers, called "peer tutors", were taught to prompt for the verbal labels of preferred toys from autistic target children; the peer tutors were told to "wait for the target child to initiate a request for a toy", "ask the target child for the label of the toy", "give the toy to the target child when he labeled it", and "praise the correct answer".<ref name=":36">McGee, Gail G.; Almeida, M. Connie; Sulzer-Azaroff, Beth; Feldman, Robert S. (1992). "Promoting reciprocal interactions via peer incidental teaching". Journal of Applied Behavior Analysis. 25 (1): 117–126. doi:10.1901/jaba.1992.25-117. PMC 1279660. PMID 1582961.</ref> None of the autistic children maintained their initiation with the peer tutors even after the training sessions were completed, which was likely because their interaction was neither mutual nor symmetrical.<ref name=":31" /><ref name=":36" /> When social interaction is neither mutual nor symmetrical between autistic and non-autistic peers, a double empathy problem occurs, which is likely exacerbated through professionals, peers, and parents neglecting the reciprocal nature of reciprocity.<ref name=":31" />

Bullying and subsequent masking

See also: Autistic masking

Some researchers have argued that autistic people likely understand non-autistic people to a higher degree than vice versa, due to the frequency of masking – i.e., the conscious or subconscious suppression of autistic behaviors and the compensation of difficulties in social interaction by autistic people with the goal of being perceived as neurotypical.<ref name=":1" /><ref>Pearson, Amy; Rose, Kieran (2021-03-01). "A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice". Autism in Adulthood. 3 (1): 52–60. doi:10.1089/aut.2020.0043. ISSN 2573-9581. PMC 8992880. PMID 36601266.</ref><ref>Petrolini, Valentina; Rodríguez-Armendariz, Ekaine; Vicente, Agustín (2023). "Autistic camouflaging across the spectrum". New Ideas in Psychology. 68: 100992. doi:10.1016/j.newideapsych.2022.100992. hdl:10810/59712. S2CID 253316582.</ref> Masking begins at a young age as a coping strategy, partly to avoid harassment and bullying,<ref name=":44">Cage, Eilidh; Cranney, Rebekah; Botha, Monique (2022-09-01). "Brief Report: Does Autistic Community Connectedness Moderate the Relationship Between Masking and Wellbeing?". Autism in Adulthood. 4 (3): 247–253. doi:10.1089/aut.2021.0096. ISSN 2573-9581. PMC 9645674. PMID 36606159.</ref><ref>Drake, Kimberly (2022-04-19). "Masking in Autism: The 'Why' Matters". Psych Central. Retrieved 2023-04-15.</ref><ref name=":43">Botha, Monique; Dibb, Bridget; Frost, David M. (2022-03-16). ""Autism is me": an investigation of how autistic individuals make sense of autism and stigma". Disability & Society. 37 (3): 427–453. doi:10.1080/09687599.2020.1822782. hdl:1893/32042. ISSN 0968-7599. S2CID 225116488.</ref> which are highly common experiences for autistic children and adults.<ref>Dickter, Cheryl L.; Burk, Joshua A.; Zeman, Janice L.; Taylor, Sara C. (2020-06-01). "Implicit and Explicit Attitudes Toward Autistic Adults". Autism in Adulthood. 2 (2): 144–151. doi:10.1089/aut.2019.0023. ISSN 2573-9581. PMC 8992843. PMID 36601572. S2CID 212921826.</ref><ref>Humphrey, Neil; Hebron, Judith (2015-08-03). "Bullying of children and adolescents with autism spectrum conditions: a 'state of the field' review". International Journal of Inclusive Education. 19 (8): 845–862. doi:10.1080/13603116.2014.981602. ISSN 1360-3116. S2CID 12261937.</ref><ref>Weiss, Jonathan A.; Fardella, Michelle A. (2018-05-25). "Victimization and Perpetration Experiences of Adults With Autism". Frontiers in Psychiatry. 9: 203. doi:10.3389/fpsyt.2018.00203. ISSN 1664-0640. PMC 5980973. PMID 29887806.</ref><ref>Schroeder, Jessica H.; Cappadocia, M. Catherine; Bebko, James M.; Pepler, Debra J.; Weiss, Jonathan A. (July 2014). "Shedding Light on a Pervasive Problem: A Review of Research on Bullying Experiences Among Children with Autism Spectrum Disorders". Journal of Autism and Developmental Disorders. 44 (7): 1520–1534. doi:10.1007/s10803-013-2011-8. ISSN 0162-3257. PMID 24464616. S2CID 254567709.</ref> High rates of peer victimization are also seen in autistic children and adults.<ref>Shtayermman, Oren (2007). "Peer Victimization in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Link to Depressive Symptomatology, Anxiety Symptomatology and Suicidal Ideation". Issues in Comprehensive Pediatric Nursing. 30 (3): 87–107. doi:10.1080/01460860701525089. ISSN 0146-0862. PMID 17885828. S2CID 38242770.</ref><ref>Fisher, Marisa H.; Taylor, Julie Lounds (May 2016). "Let's talk about it: Peer victimization experiences as reported by adolescents with autism spectrum disorder". Autism. 20 (4): 402–411. doi:10.1177/1362361315585948. ISSN 1362-3613. PMC 4662636. PMID 26019304.</ref>

Whilst many health professionals and researchers have argued from time to time that autism is characterized by a lack of social or emotional reciprocity, the bullying and victimization targeted at autistic people by non-autistic people, along with the problem of ableism in autism research,<ref name=":30">Botha, Monique (2021-09-28). "Academic, Activist, or Advocate? Angry, Entangled, and Emerging: A Critical Reflection on Autism Knowledge Production". Frontiers in Psychology. 12: 727542. doi:10.3389/fpsyg.2021.727542. ISSN 1664-1078. PMC 8506216. PMID 34650484.</ref><ref name=":6">Botha, Monique; Cage, Eilidh (2022-11-24). ""Autism research is in crisis": A mixed method study of researcher's constructions of autistic people and autism research". Frontiers in Psychology. 13: 1050897. doi:10.3389/fpsyg.2022.1050897. ISSN 1664-1078. PMC 9730396. PMID 36506950.</ref><ref>"Report of the Special Rapporteur on the rights of persons with disabilities" (PDF). United Nations General Assembly (43rd ed.). 2019-12-17. Retrieved 2023-06-05.</ref> has been viewed as a demonstration of non-autistic people's lack of social or emotional reciprocity towards autistic people,<ref name=":31" /> further suggesting what Milton has described to be a "disjuncture in reciprocity" (i.e., the presence of a "double empathy gap") between autistic and non-autistic people.<ref name=":1" />

Anthropomorphism and understanding for animals

See also: Anthropomorphism and Personification

An area of social-cognitive strength in autistic people centers upon anthropomorphism.<ref name=":47">Atherton, Gray; Cross, Liam (2018-04-17). "Seeing More Than Human: Autism and Anthropomorphic Theory of Mind". Frontiers in Psychology. 9: 528. doi:10.3389/fpsyg.2018.00528. ISSN 1664-1078. PMC 5932358. PMID 29755383.</ref> A 2018 study has shown that autistic people are likely more prone to object personification,<ref>White, Rebekah; Remington, Anna (2018). "Object personification in autism: This paper will be very sad if you don't read it". Autism. 23 (4): 1042–1045. doi:10.1177/1362361318793408. ISSN 1362-3613. PMID 30101594. S2CID 51969215.</ref> suggesting that autistic empathy may be more complex and all-encompassing, contrary to the popular belief that autistic people lack empathy. Whilst neurotypical participants have outperformed autistic participants in the Reading the Mind in the Eyes test designed by Baron-Cohen in 2001,<ref name=":24" /> autistic participants have outperformed neurotypical participants in a cartoon version of said test in a 2022 study,<ref>Cross, Liam; Piovesan, Andrea; Atherton, Gray (2022-07-20). "Autistic people outperform neurotypicals in a cartoon version of the Reading the Mind in the Eyes". Autism Research. 15 (9): 1603–1608. doi:10.1002/aur.2782. ISSN 1939-3792. PMC 9543219. PMID 35855595.</ref> supporting the view of social-cognitive differences rather than deficits in the autistic population.

Some autistic people also appear to possess a heightened understanding, empathy, and sensitivity towards animals,<ref name=":47" /><ref>Prothmann, Anke; Ettrich, Christine; Prothmann, Sascha (2009). "Preference for, and Responsiveness to, People, Dogs and Objects in Children with Autism". Anthrozoös. 22 (2): 161–171. doi:10.2752/175303709X434185. ISSN 0892-7936. S2CID 143563380.</ref><ref>Lam, Gary Yu Hin; Holden, Emily; Fitzpatrick, Megan; Raffaele Mendez, Linda; Berkman, Karen (2020-01-22). ""Different but connected": Participatory action research using Photovoice to explore well-being in autistic young adults". Autism. 24 (5): 1246–1259. doi:10.1177/1362361319898961. ISSN 1362-3613. PMID 31968999. S2CID 210864853.</ref><ref>Miralles, Aurélien; Grandgeorge, Marine; Raymond, Michel (2022-04-15). "Self-perceived empathic abilities of people with autism towards living beings mostly differs for humans". Scientific Reports. 12 (1): 6300. Bibcode:2022NatSR..12.6300M. doi:10.1038/s41598-022-10353-2. ISSN 2045-2322. PMC 9012821. PMID 35428857.</ref> once again suggesting social-cognitive differences in autistic people, but not global deficits.

Autistic perspectives and dehumanizing research

Autistic theory of mind, argued to have facilitated the release of cognitive resources, is typically based on the use of rules and logic and may be modulated by differences in thinking.<ref>Spikins, Penny; Wright, Barry; Hodgson, Derek (2016-10-01). "Are there alternative adaptive strategies to human pro-sociality? The role of collaborative morality in the emergence of personality variation and autistic traits". Time and Mind. 9 (4): 289–313. doi:10.1080/1751696X.2016.1244949. ISSN 1751-696X. S2CID 151820168.</ref><ref>Hadjikhani, N.; Zürcher, N. R.; Rogier, O.; Hippolyte, L.; Lemonnier, E.; Ruest, T.; Ward, N.; Lassalle, A.; Gillberg, N.; Billstedt, E.; Helles, A.; Gillberg, C.; Solomon, P.; Prkachin, K. M.; Gillberg, C. (2014-01-14). "Emotional contagion for pain is intact in autism spectrum disorders". Translational Psychiatry. 4 (1): e343. doi:10.1038/tp.2013.113. ISSN 2158-3188. PMC 3905223. PMID 24424389.</ref> If autistic people were inherently poor at theory of mind and social communication, an interaction between a pair of autistic people would logically be more challenging than one between an autistic and neurotypical person.<ref name=":2" /><ref name=":3" /> As a result, Milton has described the belief that autistic people lack theory of mind as a myth analogous to the now-discredited theory that vaccines cause autism.<ref name=":15">Milton, Damian E. M. (2014). "Autistic expertise: A critical reflection on the production of knowledge in autism studies". Autism. 18 (7): 794–802. doi:10.1177/1362361314525281. ISSN 1362-3613. PMID 24637428. S2CID 206715678.</ref>

Many autistic activists have shown support for the double empathy concept, and have argued that past studies done on theory of mind in autism have served to stigmatize autistic people,<ref name=":0" /><ref name=":23" /><ref>Gernsbacher, Morton Ann (2017-08-06). "Editorial Perspective: The use of person-first language in scholarly writing may accentuate stigma". Journal of Child Psychology and Psychiatry. 58 (7): 859–861. doi:10.1111/jcpp.12706. PMC 5545113. PMID 28621486.</ref> place the responsibility for autistic-neurotypical misunderstandings solely on autistic people,<ref name=":16">Heasman, Brett; Gillespie, Alex (2018). "Perspective-taking is two-sided: Misunderstandings between people with Asperger's syndrome and their family members". Autism. 22 (6): 740–750. doi:10.1177/1362361317708287. ISSN 1362-3613. PMC 6055325. PMID 28683569.</ref> and dehumanize autistic people by portraying them as unempathetic.<ref name=":6" /> Many autistic activists have advocated for the inclusion of autistic people in autism research, promoting the slogan "nothing about us without us".<ref name=":15" /><ref>Charlton, James I. (1998). Nothing about us without us : disability oppression and empowerment. Berkeley, CA: University of California Press. ISBN 978-0-520-92544-1. OCLC 42417786.</ref><ref>Bertilsdotter Rosqvist, Hanna; Chown, Nick; Stenning, Anna (2020). Neurodiversity studies : a new critical paradigm. Abingdon, Oxon: Routledge. ISBN 978-0-429-32229-7. OCLC 1150829242.</ref> In addition, autistic individuals may tend to have a reliable and scientific understanding of autism that is also less stigmatizing,<ref>Gillespie-Lynch, Kristen; Kapp, Steven K.; Brooks, Patricia J.; Pickens, Jonathan; Schwartzman, Ben (2017). "Whose Expertise Is It? Evidence for Autistic Adults as Critical Autism Experts". Frontiers in Psychology. 8: 438. doi:10.3389/fpsyg.2017.00438. ISSN 1664-1078. PMC 5368186. PMID 28400742.</ref> contrary to the implication that autistic people lack the ability to infer to their selves.

Research has shown that autistic people are more likely to be dehumanized by non-autistic people,<ref name=":6" /><ref>Cage, Eilidh; Di Monaco, Jessica; Newell, Victoria (2019-11-21). "Understanding, attitudes and dehumanisation towards autistic people". Autism. 23 (6): 1373–1383. doi:10.1177/1362361318811290. ISSN 1362-3613. PMID 30463431. S2CID 53722683.</ref> and first-hand accounts of autism research, including autoethnographies,<ref name=":30" /> blogs,<ref>Luterman, Sara (2019-07-15). "What it's like to be autistic at an autism research conference". Spectrum. Simons Foundation. Retrieved 2023-04-11.</ref><ref>Rose, Kieran (2020-02-29). "Regarding the use of dehumanising rhetoric". The Autistic Advocate. Retrieved 2023-04-11.</ref> commentaries,<ref>Michael, Cos (2021-06-01). "Is Being Othered a Co-Occurring Condition of Autism?". Autism in Adulthood. 3 (2): 118–119. doi:10.1089/aut.2021.0019. ISSN 2573-9581. PMC 8992897. PMID 36601468.</ref> and editorials,<ref name=":29" /><ref>Cowen, Tyler (2009-07-13). "Autism as Academic Paradigm". The Chronicle of Higher Education. Retrieved 2023-04-11.</ref> have described autism research to often be dehumanizing to autistic people. Furthermore, autistic people are said to be "less domesticated" at morphological, physiological, and behavioral levels, and have integrity equivalent to that of non-human animals.<ref name=":43"/> Autism has been described as an epidemic,<ref>Liu, Ka‐Yuet; King, Marissa; Bearman, Peter S. (March 2010). "Social Influence and the Autism Epidemic". American Journal of Sociology. 115 (5): 1387–1434. doi:10.1086/651448. ISSN 0002-9602. PMC 2927813. PMID 20503647.</ref> and in some cases, lack of empathy is used to link autism with terrorism.<ref name=":38"/> Autistic people are also said to be an economic burden, and extensive arguments supporting the use of eugenics in autism have been published, with exceptions being made only for those who are economically productive and normative enough to not make others uncomfortable.<ref name=":43"/>

As a result of this dehumanization, the lack of understanding and resultant stigma and marginalization felt by autistic people in social settings may negatively impact upon their mental health, employment, accessibility to education and services, and experiences with the criminal justice system.<ref name=":5" /><ref>Camus, Lorna; Macmillan, Kirsty; Rajendran, Gnanathusharan; Stewart, Mary (2022-05-10). "'I too, need to belong': Autistic adults' perspectives on misunderstandings and well-being". PsyArXiv. doi:10.31234/osf.io/5mysh.</ref><ref>Redman, S.; Downie, M.; Rennison, R.; Batten, A. (2009). Don't write me off : make the system fair for people with autism. London: National Autistic Society.</ref><ref>Baldwin, Susanna; Costley, Debra; Warren, Anthony (October 2014). "Employment Activities and Experiences of Adults with High-Functioning Autism and Asperger's Disorder". Journal of Autism and Developmental Disorders. 44 (10): 2440–2449. doi:10.1007/s10803-014-2112-z. ISSN 0162-3257. PMID 24715257. S2CID 254569665.</ref><ref>"Criminal Legal System - Autistic Self Advocacy Network". Autistic Self Advocacy Network. 3 November 2022. Retrieved 2023-03-26.</ref> Autistic people have increased premature mortality rates and one of the leading causes of death in autistic people is suicide,<ref>Hirvikoski, Tatja; Mittendorfer-Rutz, Ellenor; Boman, Marcus; Larsson, Henrik; Lichtenstein, Paul; Bölte, Sven (March 2016). "Premature mortality in autism spectrum disorder". British Journal of Psychiatry. 208 (3): 232–238. doi:10.1192/bjp.bp.114.160192. ISSN 0007-1250. PMID 26541693. S2CID 25884060.</ref> which is likely exacerbated by this stigma and marginalization.<ref name=":30" /> Additionally, many autistic people often feel trapped by the stereotypes this largely non-autistic society has of autism,<ref name=":45">Treweek, Caroline; Wood, Chantelle; Martin, Jilly; Freeth, Megan (April 2019). "Autistic people's perspectives on stereotypes: An interpretative phenomenological analysis". Autism. 23 (3): 759–769. doi:10.1177/1362361318778286. ISSN 1362-3613. PMID 29848001. S2CID 44086997.</ref> and have reported changing their behavior (i.e., masking) as a result of those stereotypes.<ref name=":43" /> Because a lack of theory of mind is believed to impair autistic people's understanding of their selves and other people, the claim that autistic people lack theory of mind is seen to dispute their autonomy, devalue their self-determination, and undermine their credibility.<ref>Yergeau, Melanie (2018). Authoring autism : on rhetoric and neurological queerness. North Carolina, NC: Duke University Press. doi:10.1215/9780822372189. ISBN 978-0-8223-7218-9. OCLC 982501293.</ref>

Limitations and future directions

The literature on double empathy is still relatively young, and the generalizability of double empathy findings to younger autistic children as well as autistic people with an intellectual disability, speech-language impairment, and/or higher support needs is unknown, may be confounding, and will require further research.<ref name=":2" /><ref name=":21">Yeung, Siu Kit (2022-07-21). "Directions for Open Scholarship in Autism – Embracing Open Scholarship to Meaningfully Improve Lives of Autistic People Together". PsyArXiv. doi:10.31234/osf.io/xzkjh.</ref>

Milton agrees that there currently remain large gaps in this area of research.<ref name=":9" /> The vast majority of studies on double empathy, bidirectional communication, and socialization so far have not included autistic children and autistic people who are nonverbal or have an intellectual disability.<ref name=":25" /><ref name=":2" /> There exists a high degree of comorbidity between autism and intellectual disability; roughly 30% of autistic people have an intellectual disability,<ref>Bilder, Deborah; Botts, Elizabeth L.; Smith, Ken R.; Pimentel, Richard; Farley, Megan; Viskochil, Joseph; McMahon, William M.; Block, Heidi; Ritvo, Edward; Ritvo, Riva-Ariella; Coon, Hilary (2012-09-25). "Excess Mortality and Causes of Death in Autism Spectrum Disorders: A Follow up of the 1980s Utah/UCLA Autism Epidemiologic Study". Journal of Autism and Developmental Disorders. 43 (5): 1196–1204. doi:10.1007/s10803-012-1664-z. ISSN 0162-3257. PMC 4814267. PMID 23008058.</ref><ref>Polyak, Andrew; Kubina, Richard M.; Girirajan, Santhosh (2015-07-22). "Comorbidity of intellectual disability confounds ascertainment of autism: implications for genetic diagnosis". American Journal of Medical Genetics Part B: Neuropsychiatric Genetics. 168 (7): 600–608. doi:10.1002/ajmg.b.32338. PMID 26198689. S2CID 7635120.</ref><ref>Katusic, Maja Z.; Myers, Scott M.; Weaver, Amy L.; Voigt, Robert G. (2021-12-01). "IQ in Autism Spectrum Disorder: A Population-Based Birth Cohort Study". Pediatrics. 148 (6): e2020049899. doi:10.1542/peds.2020-049899. ISSN 0031-4005. PMID 34851412. S2CID 243762735.</ref><ref>Shenouda, Josephine; Barrett, Emily; Davidow, Amy L.; Sidwell, Kate; Lescott, Cara; Halperin, William; Silenzio, Vincent M. B.; Zahorodny, Walter (2023-02-01). "Prevalence and Disparities in the Detection of Autism Without Intellectual Disability". Pediatrics. 151 (2): e2022056594. doi:10.1542/peds.2022-056594. ISSN 0031-4005. PMID 36700335. S2CID 256273971.</ref> while just roughly 1–3% of the global population or lower has an intellectual disability.<ref>McKenzie, Katherine; Milton, Meagan; Smith, Glenys; Ouellette-Kuntz, Hélène (2016-04-15). "Systematic Review of the Prevalence and Incidence of Intellectual Disabilities: Current Trends and Issues". Current Developmental Disorders Reports. 3 (2): 104–115. doi:10.1007/s40474-016-0085-7. ISSN 2196-2987. S2CID 76296047.</ref><ref>McBride, Orla; Heslop, Pauline; Glover, Gyles; Taggart, Laurence; Hanna-Trainor, Lisa; Shevlin, Mark; Murphy, Jamie (2021-01-28). "Prevalence estimation of intellectual disability using national administrative and household survey data: The importance of survey question specificity". International Journal of Population Data Science. 6 (1): 1342. doi:10.23889/ijpds.v6i1.1342. ISSN 2399-4908. PMC 8188522. PMID 34164584.</ref> In addition, roughly 20–30% of autistic children are either nonverbal or minimally verbal.<ref>Brignell, Amanda; Chenausky, Karen V.; Song, Huan; Zhu, Jianwei; Suo, Chen; Morgan, Angela T. (2018-11-05). "Communication interventions for autism spectrum disorder in minimally verbal children". Cochrane Database of Systematic Reviews. 2018 (11): CD012324. doi:10.1002/14651858.CD012324.pub2. PMC 6516977. PMID 30395694.</ref> A 2023 study by Glass & Yuill<ref name=":48" /> suggested the presence of similar or higher social synchrony between autistic pairs compared to non-autistic pairs under certain conditions, with participants including autistic children and autistic people who are nonverbal or minimally verbal.

Moreover, double empathy and bidirectional communication studies typically fail to take into account the vast differences in autism and factors like masking, which may possibly interfere with autistic people's ability to communicate and empathize with one another. Conceptual replications and further studies on double empathy are needed in different groups, including siblings of autistic people, non-autistic pupils in schools including autistic peers, late-diagnosed autistic adults, parents of autistic children, and autism service providers.<ref name=":18">Mitchell, Peter; Sheppard, Elizabeth; Cassidy, Sarah (2021). "Autism and the double empathy problem: Implications for development and mental health". British Journal of Developmental Psychology. 39 (1): 1–18. doi:10.1111/bjdp.12350. PMID 33393101. S2CID 230489027.</ref><ref name=":21" />

Emphasizing that empathy and reciprocity are a "two-way street",<ref name=":1" /><ref name=":31" /> Milton and many other researchers propose that further autism research should focus on bridging the double empathy gap by empowering autistic individuals, building rapport and appreciation for their worldview, educating non-autistic people about what being autistic means, and moving towards a more continuous understanding of neurodiversity.<ref name=":5" /><ref name=":9" /><ref name=":20" /><ref>Kapp, Steven K.; Gillespie-Lynch, Kristen; Sherman, Lauren E.; Hutman, Ted (2013). "Deficit, difference, or both? Autism and neurodiversity". Developmental Psychology. 49 (1): 59–71. doi:10.1037/a0028353. ISSN 1939-0599. PMID 22545843.</ref><ref>Jaarsma, Pier; Welin, Stellan (2012). "Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement". Health Care Analysis. 20 (1): 20–30. doi:10.1007/s10728-011-0169-9. ISSN 1065-3058. PMID 21311979. S2CID 18618887.</ref><ref>Chapple, Melissa; Davis, Philip; Billington, Josie; Myrick, Joe Anthony; Ruddock, Cassie; Corcoran, Rhiannon (2021-07-27). "Overcoming the Double Empathy Problem Within Pairs of Autistic and Non-autistic Adults Through the Contemplation of Serious Literature". Frontiers in Psychology. 12: 708375. doi:10.3389/fpsyg.2021.708375. ISSN 1664-1078. PMC 8354525. PMID 34385964.</ref> It has also been suggested that the medical model of autism – the traditional and dominant model of autism in which autism is viewed as a disorder and deficit<ref>Milton, Damian E. M.; Bracher, Mike (June 2013). "Autistics speak but are they heard?". Medical Sociology Online. 7 (2): 61–69.</ref> – should be moved away from due to its approach being too narrow, individualistic, and deficit-based,<ref name=":42">Pellicano, Elizabeth; den Houting, Jacquiline (November 2021). "Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science". Journal of Child Psychology and Psychiatry. 63 (4): 381–396. doi:10.1111/jcpp.13534. ISSN 0021-9630. PMC 9298391. PMID 34730840.</ref> as well as how its messaging could contribute to ableism, prejudice, and stigma towards autistic people,<ref name=":6" /><ref name=":42" /><ref>Woods, Richard (2017-08-09). "Exploring how the social model of disability can be re-invigorated for autism: in response to Jonathan Levitt". Disability & Society. 32 (7): 1090–1095. doi:10.1080/09687599.2017.1328157. ISSN 0968-7599. S2CID 148783346.</ref><ref>Bottema-Beutel, Kristen; Kapp, Steven K.; Lester, Jessica Nina; Sasson, Noah J.; Hand, Brittany N. (2021-03-01). "Avoiding Ableist Language: Suggestions for Autism Researchers". Autism in Adulthood. 3 (1): 18–29. doi:10.1089/aut.2020.0014. ISSN 2573-9581. PMC 8992888. PMID 36601265.</ref> further widening this double empathy gap.

See also

• Discrimination against autistic people
• Inclusion (disability rights)
• Medical model of disability
• Social model of disability

Further reading

• Milton, Damian (2017). A Mismatch of Salience: Explorations from the Nature of Autism from Theory to Practice. Hove, East Sussex: Pavillion. ISBN 978-1-911028-76-5. OCLC 1019482019.
• Milton, Damian Elgin Maclean; Heasman, Brett; Sheppard, Elizabeth (2020). "Double Empathy". In Volkmar, Fred R. (ed.). Encyclopedia of Autism Spectrum Disorders. New York, NY: Springer. pp. 1–9. doi:10.1007/978-1-4614-6435-8_102273-2. ISBN 978-1-4614-6435-8.

External links

• The dictionary definition of double empathy problem at Wiktionary
• Zamzow, Rachel (2021-07-22). "Double empathy, explained". Spectrum. Simons Foundation. doi:10.53053/MMNL2849. S2CID 243309008.
• Crompton, Catherine J.; DeBrabander, Kilee; Heasman, Brett; Milton, Damian; Sasson, Noah (2021-05-11). "Double Empathy: Why Autistic People Are Often Misunderstood". Frontiers for Young Minds. Frontiers Media. 9: 554875. doi:10.3389/frym.2021.554875. hdl:20.500.11820/94ee032a-6103-470a-bc06-08337dd6b512.
• "Milton's 'double empathy problem': A summary for non-academics". Reframing Autism. 2020-12-17.