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{{Short description|Psychological theory regarding individuals on the autism spectrum}}
[[File:Double empathy problem image.jpg|thumb|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
{{Autism rights movement}}
The [[theory]] of the '''double empathy problem''' is a [[psychology|psychological]] and [[sociology|sociological]] theory first coined in 2012 by [[Damian Milton]], an [[autistic]] autism researcher.<ref name=":1">{{Cite journal |last=Milton |first=Damian E. M. |date=October 2012 |title=On the ontological status of autism: the 'double empathy problem' |url=http://kar.kent.ac.uk/62639/1/Double%20empathy%20problem.pdf |journal=[[Disability & Society]] |language=en |volume=27 |issue=6 |pages=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 [[Social relation|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 [[Empathy|empathize]] with non-autistic people, whereas most non-autistic people also struggle to understand and empathize with autistic people. This lack of mutual understanding may stem from bidirectional differences in
Apart from findings that generally demonstrated mismatch effects (e.g., in empathy and mentalizing/theory of mind/mind-reading),<ref>{{Citation |last1=Milton |first1=Damian E. M. |title=Autism and the 'double empathy problem' |date=2023-01-04 |work=Conversations on Empathy |pages=78–97 |url=https://www.taylorfrancis.com/books/9781003189978/chapters/10.4324/9781003189978-6 |access-date=2025-03-13 |edition=1 |place=London |publisher=Routledge |language=en |doi=10.4324/9781003189978-6 |isbn=978-1-003-18997-8 |last2=Waldock |first2=Krysia Emily |last3=Keates |first3=Nathan}}</ref> some studies have provided evidence for matching effects between autistic individuals, although findings for matching effects with experimental methods are more mixed with both supportive and non-supportive findings.<ref name=":59">{{Cite journal |last1=Matyjek |first1=Magdalena |last2=Dziobek |first2=Isabel |last3=Hamilton |first3=Antonia |last4=Wheatley |first4=Thalia |date=2025-01-14 |title=Social Interaction Style in Autism: A critical review of social behaviours and outcomes in autistic and neurotypical interactions |url=https://psyarxiv.com/tkmyw/ |journal=[[PsyArXiv]] |doi=10.31234/osf.io/tkmyw|url-access=subscription }}</ref> Some studies from the 2010s and 2020s have shown that most autistic individuals are able to socialize and communicate effectively,<ref name=":2">{{cite journal |last1=Crompton |first1=Catherine J. |last2=Ropar |first2=Danielle |last3=Evans-Williams |first3=Claire V. M. |last4=Flynn |first4=Emma G. |last5=Fletcher-Watson |first5=Sue |year=2020 |title=Autistic peer-to-peer information transfer is highly effective |journal=[[Autism (journal)|Autism]] |volume=24 |issue=7 |pages=1704–1712 |doi=10.1177/1362361320919286 |pmc=7545656 |pmid=32431157}}</ref><ref name=":60">{{Cite journal |last1=De Laet |first1=Hannah |last2=Wiersema |first2=Jan R. |last3=Nijhof |first3=Annabel D. |date=2025-01-08 |title=Adults with autism prefer to communicate with others who also have autism: a mixed-method study |url=https://osf.io/f7yr4_v1/ |website=PsyArXiv |doi=10.31234/osf.io/f7yr4}}</ref> empathize adequately,<ref>{{Cite journal |last1=Partington |first1=Hannah |last2=Chowdhury |first2=Ishita |last3=Wu |first3=Ruihan |last4=Tojo |first4=Mizuki |last5=Hughes |first5=Gillian |last6=Bird |first6=Zoe |last7=Leow |first7=Karen Hui En |last8=Dziwisz |first8=Malwina |last9=Jones |first9=Beth |date=2024-12-02 |title=A Meeting of Minds: Is Mentalizing Absent in Autism or Dependent Upon Like-Mindedness? |url=https://psyarxiv.com/tmpnk/ |journal=PsyArXiv |doi=10.31234/osf.io/tmpnk |url-access=subscription}}</ref><ref name=":60" /><ref>{{Cite journal |last1=Kimber |first1=Lesley |last2=Verrier |first2=Diarmuid |last3=Connolly |first3=Stephen |date=2024-09-16 |title=Autistic People's Experience of Empathy and the Autistic Empathy Deficit Narrative |journal=Autism in Adulthood |volume=6 |issue=3 |pages=321–330 |doi=10.1089/aut.2023.0001 |issn=2573-9581 |pmc=11447414 |pmid=39371354|pmc-embargo-date=September 16, 2025 }}</ref><ref name=":22">{{Cite journal |last1=Szechy |first1=Kathryn A. |last2=Turk |first2=Pamela D. |last3=O'Donnell |first3=Lisa A. |date=2023-08-17 |title=Autism and Employment Challenges: The Double Empathy Problem and Perceptions of an Autistic Employee in the Workplace |journal=Autism in Adulthood |volume=6 |issue=2 |pages=205–217 |doi=10.1089/aut.2023.0046 |pmid=39139509 |pmc=11317796 |s2cid=260998172 |issn=2573-9581}}</ref><ref name=":39">{{Cite journal |last1=Komeda |first1=Hidetsugu |last2=Kosaka |first2=Hirotaka |last3=Saito |first3=Daisuke N. |last4=Mano |first4=Yoko |last5=Jung |first5=Minyoung |last6=Fujii |first6=Takeshi |last7=Yanaka |first7=Hisakazu T. |last8=Munesue |first8=Toshio |last9=Ishitobi |first9=Makoto |last10=Sato |first10=Makoto |last11=Okazawa |first11=Hidehiko |date=2014-10-20 |title=Autistic empathy toward autistic others |url=https://doi.org/10.1093/scan/nsu126 |journal=[[Social Cognitive and Affective Neuroscience]] |publisher=[[Oxford University Press]] |volume=10 |issue=2 |pages=145–152 |doi=10.1093/scan/nsu126 |issn=1749-5016 |pmc=4321632 |pmid=25332405}}</ref><ref name=":8">{{Cite journal |last1=Komeda |first1=Hidetsugu |last2=Kosaka |first2=Hirotaka |last3=Fujioka |first3=Toru |last4=Jung |first4=Minyoung |last5=Okazawa |first5=Hidehiko |date=2019-06-04 |title=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 |journal=[[Frontiers in Psychiatry]] |volume=10 |pages=376 |doi=10.3389/fpsyt.2019.00376 |issn=1664-0640 |pmc=6558937 |pmid=31231254 |doi-access=free}}</ref> build better rapport,<ref>{{Cite journal |last=Foster |first=Sarah J. |last2=Patel |first2=Siddhi |last3=Wilks |first3=Charlotte E. H. |last4=Dodd |first4=Michelle |last5=Calderon |first5=Rachel |last6=Ropar |first6=Danielle |last7=Fletcher-Watson |first7=Sue |last8=Ackerman |first8=Robert A. |last9=Crompton |first9=Catherine J. |last10=Sasson |first10=Noah J. |date=2025-06-30 |title=Verbal Collaboration in Same- and Mixed-Neurotype Groups of Autistic and Non-Autistic Adults |url=https://www.liebertpub.com/doi/10.1089/aut.2024.0361 |journal=Autism in Adulthood |language=en |doi=10.1089/aut.2024.0361 |issn=2573-9581}}</ref><ref name=":3">{{cite journal |last1=Crompton |first1=Catherine J. |last2=Sharp |first2=Martha |last3=Axbey |first3=Harriet |last4=Fletcher-Watson |first4=Sue |last5=Flynn |first5=Emma G. |last6=Ropar |first6=Danielle |year=2020 |title=Neurotype-Matching, but Not Being Autistic, Influences Self and Observer Ratings of Interpersonal Rapport |journal=[[Frontiers in Psychology]] |volume=11 |page=586171 |doi=10.3389/fpsyg.2020.586171 |pmc=7645034 |pmid=33192918 |doi-access=free}}</ref> and display [[Reciprocity (social psychology)|social reciprocity]]<ref name=":4">{{cite journal | doi=10.1177/13623613211005918 | title=Peer preferences and characteristics of same-group and cross-group social interactions among autistic and non-autistic adolescents | year=2021 | last1=Chen | first1=Yu-Lun | last2=Senande | first2=Laura L. | last3=Thorsen | first3=Michael | last4=Patten | first4=Kristie | journal=Autism | volume=25 | issue=7 | pages=1885–1900 | pmid=34169757 | pmc=8419288 }}</ref> with most other autistic individuals.<ref name=":1" /><ref name=":0">{{Cite journal |last=DeThorne |first=Laura S. |date=2020-03-01 |title=Revealing the Double Empathy Problem |journal=The ASHA Leader |volume=25 |issue=3 |pages=58–65 |language=EN |doi=10.1044/leader.ftr2.25042020.58|s2cid=216359201 |doi-access=free }}</ref> A 2024 systematic review of 52 papers found that most autistic people have generally positive [[interpersonal relation]]s and communication experiences when interacting with most autistic people, and autistic-autistic interactions were generally associated with better [[quality of life]] (e.g., [[mental health]] and emotional [[well-being]]) across various domains.<ref name=":50">{{Cite journal |last1=Watts |first1=Georgina |last2=Crompton |first2=Catherine |last3=Grainger |first3=Catherine |last4=Long |first4=Joseph |last5=Botha |first5=Monique |last6=Somerville |first6=Mark |last7=Cage |first7=Eilidh |date=2024-06-03 |title='A certain magic' – autistic adults' experiences of interacting with other autistic people and its relation to Quality of Life: A systematic review and thematic meta-synthesis |url=https://journals.sagepub.com/doi/10.1177/13623613241255811 |journal=Autism |language=en |doi=10.1177/13623613241255811 |pmid=38829019 |issn=1362-3613}}</ref> This theory and subsequent findings challenge the commonly held belief that the [[social skills]] of all autistic individuals are inherently and universally impaired across contexts, as well as the theory of "[[mind-blindness]]" proposed by prominent autism researcher [[Simon Baron-Cohen]] in the mid-1990s, which suggested that empathy and [[theory of mind]] are universally [[Empathy#Impairment|impaired in autistic individuals]].<ref name=":10" /><ref name=":12" /><ref name=":41">{{Cite journal |last=Boucher |first=Jill |date=2012 |title=Putting theory of mind in its place: psychological explanations of the socio-emotional-communicative impairments in autistic spectrum disorder |url=http://journals.sagepub.com/doi/10.1177/1362361311430403 |journal=Autism |language=en |volume=16 |issue=3 |pages=226–246 |doi=10.1177/1362361311430403 |issn=1362-3613 |pmid=22297199 |s2cid=30738704|url-access=subscription }}</ref><ref name=":13">{{Cite journal |last=Shanker |first=Stuart |date=2004-10-01 |title=The Roots of Mindblindness |url=http://journals.sagepub.com/doi/10.1177/0959354304046179 |journal=[[Theory & Psychology]] |language=en |volume=14 |issue=5 |pages=685–703 |doi=10.1177/0959354304046179 |issn=0959-3543 |s2cid=143801835|url-access=subscription }}</ref>
The double empathy concept and related concepts such as bidirectional social interaction have been supported by a substantial number of studies in recent years and has the potential to shift goals of [[Intervention (counseling)|interventions]] and public [[psychoeducation]] or stigma reduction regarding autism.<ref name=":49" /><ref>{{Cite journal |last1=Scheerer |first1=Nichole E. |last2=Ng |first2=Catalina Sau Man |last3=Gurba |first3=Ava N. |last4=McNair |first4=Morgan L. |last5=Lerner |first5=Matthew D. |last6=Hargreaves |first6=April |date=2024-12-04 |title=Editorial: Break the stigma: autism |journal=Frontiers in Psychiatry |language=English |volume=15 |doi=10.3389/fpsyt.2024.1513447 |doi-access=free |issn=1664-0640}}</ref><ref>{{Cite journal |last1=Pearson |first1=Amy |last2=Surtees |first2=Andrew |last3=Crompton |first3=Catherine J. |last4=Goodall |first4=Craig |last5=Pillai |first5=Dhanya |last6=Sedgewick |first6=Felicity |last7=Au-Yeung |first7=Sheena K. |date=2022-09-27 |title=Editorial: Addressing community priorities in autism research |journal=Frontiers in Psychology |volume=13 |doi=10.3389/fpsyg.2022.1040446 |doi-access=free |issn=1664-1078 |pmc=9552333 |pmid=36237673}}</ref><ref>{{Cite journal |last1=Schuck |first1=Rachel K. |last2=Fung |first2=Lawrence K. |date=2024-01-10 |title=A dual design thinking – universal design approach to catalyze neurodiversity advocacy through collaboration among high-schoolers |journal=Frontiers in Psychiatry |volume=14 |doi=10.3389/fpsyt.2023.1250895 |doi-access=free |issn=1664-0640 |pmc=10806093 |pmid=38268559}}</ref><ref>{{Cite journal |last1=Schuck |first1=Rachel K. |last2=Geng |first2=Alicia |last3=Doss |first3=Yvette |last4=Lin |first4=Florence |last5=Crousore |first5=Hannah |last6=Baiden |first6=Kaitlynn M. P. |last7=Dwyer |first7=Patrick |last8=Williams |first8=Zachary J. |last9=Wang |first9=Mian |date=2024-08-08 |title=A qualitative investigation into autistic adults' perspectives on intervention goals for autistic children |url=https://journals.sagepub.com/doi/10.1177/27546330241266718 |journal=Neurodiversity |language=en |volume=2 |doi=10.1177/27546330241266718 |issn=2754-6330}}</ref><ref>{{Cite journal |last1=Hull |first1=Laura |last2=Rane |first2=Shravani |last3=Lee |first3=Samman Hang-Lai |last4=Sedgewick |first4=Felicity |date=2024-03-22 |title="Just Ask What Support We Need": Autistic Adults' Feedback on Social Skills Training |url=https://www.liebertpub.com/doi/10.1089/aut.2023.0136 |journal=Autism in Adulthood |language=en |doi=10.1089/aut.2023.0136 |issn=2573-9581}}</ref><ref name=":7">{{Cite journal |last1=Gernsbacher |first1=Morton Ann |last2=Yergeau |first2=Melanie |date=2019 |title=Empirical Failures of the Claim That Autistic People Lack a Theory of Mind |journal=[[Archives of Scientific Psychology]] |language=en |volume=7 |issue=1 |pages=102–118 |doi=10.1037/arc0000067 |pmc=6959478 |pmid=31938672}}</ref><ref name=":5">{{Cite web |last=Milton |first=Damian |date=2018-03-02 |title=The double empathy problem |url=https://www.autism.org.uk/advice-and-guidance/professional-practice/double-empathy |access-date=2023-03-19 |website=[[National Autistic Society]] |language=en}}</ref><ref name=":9">{{Cite journal |last1=Milton |first1=Damian |last2=Gurbuz |first2=Emine |last3=López |first3=Beatriz |date=October 2022 |title=The 'double empathy problem': Ten years on |url=http://journals.sagepub.com/doi/10.1177/13623613221129123 |journal=Autism |language=en |volume=26 |issue=8 |pages=1901–1903 |doi=10.1177/13623613221129123 |issn=1362-3613 |pmid=36263746 |s2cid=253020669|url-access=subscription }}</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">{{Cite journal |last1=Cassidy |first1=Sarah |last2=Bradley |first2=Louise |last3=Shaw |first3=Rebecca |last4=Baron-Cohen |first4=Simon |date=2018-07-31 |title=Risk markers for suicidality in autistic adults |journal=[[Molecular Autism]] |language=en |volume=9 |issue=1 |pages=42 |doi=10.1186/s13229-018-0226-4 |issn=2040-2392 |pmc=6069847 |pmid=30083306 |doi-access=free }}</ref> and 2022,<ref name=":28">{{Cite journal |last1=Richards |first1=Gareth |last2=Baron-Cohen |first2=Simon |date=2022-05-19 |title=Evidence of partner similarity for autistic traits, systemizing, and theory of mind via facial expressions |url=https://doi.org/10.1038/s41598-022-11592-z |journal=[[Scientific Reports]] |language=en |volume=12 |issue=1 |pages=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">{{cite web |date=2020-12-19 |title=A Conversation About 'The Pattern Seekers' by Simon Baron-Cohen |url=https://thinkingautismguide.com/2020/12/a-conversation-about-pattern-seekers-by.html}}</ref><ref>{{Cite web |last1=Wright |first1=Robert |last2=Baron-Cohen |first2=Simon |date=2023-06-21 |title=Autism and the Two Kinds of Empathy |url=https://www.youtube.com/watch?v=rkHbsC2lsAA |access-date=2023-06-25 |website=[[YouTube]]}}</ref>▼
In recognition of the findings that support the double empathy theory, Baron-Cohen positively acknowledged the theory and related findings in multiple autism research articles,<ref name=":56">{{Cite journal |last1=Camm-Crosbie |first1=Louise |last2=Bradley |first2=Louise |last3=Shaw |first3=Rebecca |last4=Baron-Cohen |first4=Simon |last5=Cassidy |first5=Sarah |date=2018-11-29 |title='People like me don't get support': Autistic adults' experiences of support and treatment for mental health difficulties, self-injury and suicidality |journal=Autism |language=en |volume=23 |issue=6 |pages=1431–1441 |doi=10.1177/1362361318816053 |issn=1362-3613 |pmc=6625034 |pmid=30497279}}</ref><ref>{{Cite journal |last1=Bailey |first1=Julie |last2=Parsons |first2=Owen E. |last3=Baron-Cohen |first3=Simon |last4=Baker |first4=Sara T. |date=2022-11-30 |title=A pilot study of autistic and non-autistic adults' systemizing in a learning task using observational measures of attention, misunderstanding, and reasoning |url=https://www.repository.cam.ac.uk/handle/1810/343143 |journal=Cambridge Educational Research e-Journal |volume=9 |doi=10.17863/CAM.90555 |issn=2634-9876}}</ref><ref name=":27">{{Cite journal |last1=Cassidy |first1=Sarah |last2=Bradley |first2=Louise |last3=Shaw |first3=Rebecca |last4=Baron-Cohen |first4=Simon |date=2018-07-31 |title=Risk markers for suicidality in autistic adults |journal=[[Molecular Autism]] |language=en |volume=9 |issue=1 |pages=42 |doi=10.1186/s13229-018-0226-4 |issn=2040-2392 |pmc=6069847 |pmid=30083306 |doi-access=free }}</ref><ref name=":28">{{Cite journal |last1=Richards |first1=Gareth |last2=Baron-Cohen |first2=Simon |date=2022-05-19 |title=Evidence of partner similarity for autistic traits, systemizing, and theory of mind via facial expressions |url=https://doi.org/10.1038/s41598-022-11592-z |journal=[[Scientific Reports]] |language=en |volume=12 |issue=1 |pages=8451 |bibcode=2022NatSR..12.8451R |doi=10.1038/s41598-022-11592-z |pmc=9118825 |pmid=35589769}}</ref> including a 2025 paper on the impact of [[self-disclosure]] on improving empathy of non-autistic people towards autistic people to bridge the "double [[empathy gap]]",<ref>{{Cite journal |last1=Rum |first1=Yonat |last2=Genzer |first2=Shir |last3=Golan |first3=Ofer |last4=Allison |first4=Carrie |last5=Baron-Cohen |first5=Simon |last6=Perry |first6=Anat |date=2025-04-09 |title=Empathy and Interest Towards an Autistic Person and the Effect of Disclosing the Diagnosis |journal=Journal of Autism and Developmental Disorders |language=en |doi=10.1007/s10803-025-06802-2 |issn=0162-3257|doi-access=free |pmid=40202683 }}</ref> as well as on [[podcast]]s<ref name=":26">{{cite web |date=2020-12-19 |title=A Conversation About 'The Pattern Seekers' by Simon Baron-Cohen |url=https://thinkingautismguide.com/2020/12/a-conversation-about-pattern-seekers-by.html}}</ref><ref>{{Cite web |last1=Wright |first1=Robert |last2=Baron-Cohen |first2=Simon |date=2023-06-21 |title=Autism and the Two Kinds of Empathy |url=https://www.youtube.com/watch?v=rkHbsC2lsAA |access-date=2023-06-25 |website=[[YouTube]]}}</ref> and a [[documentary]]<ref>{{Cite web |title=The Documentary - Autism, empathy and psychopaths |url=https://www.bbc.co.uk/sounds/play/w3ct7yx4 |access-date=2025-05-19 |website=[[BBC Sounds]] |language=en-GB}}</ref> since the late 2010s. In a 2017 research paper partly co-authored by Milton and Baron-Cohen, the problem of mutual incomprehension between autistic people and non-autistic people was mentioned.<ref>{{Cite journal |last1=Martin |first1=Nicola |last2=Milton |first2=Damian Elgin Maclean |last3=Sims |first3=Tara |last4=Dawkins |first4=Gemma |last5=Baron-Cohen |first5=Simon |last6=Mills |first6=Richard |date=2017-10-02 |title=Does "mentoring" offer effective support to autistic adults? A mixed-methods pilot study |url=https://www.emerald.com/insight/content/doi/10.1108/AIA-06-2017-0013/full/html |journal=[[Advances in Autism]] |language=en |volume=3 |issue=4 |pages=229–239 |doi=10.1108/AIA-06-2017-0013 |issn=2056-3868}}</ref>
▲The double empathy concept and related concepts such as bidirectional social interaction have been supported by or partially supported by a substantial number of studies in
== History ==
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=== Development and spread of mind-blindness theory ===
{{Main|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
Mind-blindness implies an inability to make sense of and predict another person's [[behavior]], and to attribute [[mental state]]s such as [[knowledge]], [[belief]]s, [[desire]]s, [[emotion]]s, and [[intention]]s to oneself and others.<ref>{{Cite journal |last1=Gallagher |first1=Helen L. |last2=Frith |first2=Christopher D. |author-link2=Chris Frith |date=2003-02-01 |title=Functional imaging of 'theory of mind' |url=https://www.cell.com/trends/cognitive-sciences/abstract/S1364-6613(02)00025-6 |journal=[[Trends in Cognitive Sciences]] |language=English |volume=7 |issue=2 |pages=77–83 |doi=10.1016/S1364-6613(02)00025-6 |issn=1364-6613 |pmid=12584026 |s2cid=14873867|citeseerx=10.1.1.319.778 }}</ref><ref>{{Citation |last=Wilkinson |first=Lee A. |title=Mindblindness |date=2011 |url=http://link.springer.com/10.1007/978-0-387-79061-9_1795 |encyclopedia=Encyclopedia of Child Behavior and Development |pages=955–956 |editor-last=Goldstein |editor-first=Sam |access-date= |place=Boston, MA |publisher=[[Springer US]] |language=en |doi=10.1007/978-0-387-79061-9_1795 |isbn=978-0-387-77579-1 |editor2-last=Naglieri |editor2-first=Jack A.|url-access=subscription }}</ref> The claim that autistic people lack theory of mind is taught across a wide range of psychology textbooks<ref>{{Cite book |last=Kellogg |first=Ronald Thomas
=== 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">{{Cite journal |last1=Dinishak |first1=Janette |last2=Akhtar |first2=Nameera |date=June 2013 |title=A Critical Examination of Mindblindness as a Metaphor for Autism |url=https://onlinelibrary.wiley.com/doi/10.1111/cdep.12026 |journal=[[Child Development Perspectives]] |language=en |volume=7 |issue=2 |pages=110–114 |doi=10.1111/cdep.12026|url-access=subscription }}</ref> in response to the replication studies (mostly
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 [[Uta Frith|Frith]]–[[Francesca Happé|Happé]] Animations Test,<ref>{{Cite journal |last1=Livingston |first1=Lucy A. |last2=Shah |first2=Punit |last3=White |first3=Sarah J. |last4=Happé |first4=Francesca |date=2021-07-10 |title=Further developing the Frith–Happé animations: A quicker, more objective, and web-based test of theory of mind for autistic and neurotypical adults |journal=[[Autism Research]] |language=en |volume=14 |issue=9 |pages=1905–1912 |doi=10.1002/aur.2575 |issn=1939-3792 |pmid=34245112 |s2cid=235786838|doi-access=free |url=https://orca.cardiff.ac.uk/id/eprint/141537/3/aur.2575.pdf }}</ref> Baron-Cohen's "[[Reading the Mind in the Eyes Test|Reading the Mind in the Eyes]]" task,<ref name=":24">{{Cite journal |last1=Baron-Cohen |first1=Simon |last2=Wheelwright |first2=Sally |last3=Hill |first3=Jacqueline |last4=Raste |first4=Yogini |last5=Plumb |first5=Ian |date=February 2001 |title=The "Reading the Mind in the Eyes" Test Revised Version: A Study with Normal Adults, and Adults with Asperger Syndrome or High-functioning Autism |url=https://onlinelibrary.wiley.com/doi/10.1111/1469-7610.00715 |journal=Journal of Child Psychology and Psychiatry |language=en |volume=42 |issue=2 |pages=241–251 |doi=10.1111/1469-7610.00715 |pmid=11280420 |s2cid=3016793 |issn=0021-9630|url-access=subscription }}</ref><ref>{{Cite journal |last=Yeung |first=Michael K. |date=2022-02-01 |title=A systematic review and meta-analysis of facial emotion recognition in autism spectrum disorder: The specificity of deficits and the role of task characteristics |url=https://www.sciencedirect.com/science/article/pii/S0149763421005893 |journal=[[Neuroscience & Biobehavioral Reviews]] |language=en |volume=133 |
Furthermore, autism intervention research based on theory of mind has shown little efficacy,<ref>{{Cite journal |last1=Fletcher-Watson |first1=Sue |last2=McConnell |first2=Fiona |last3=Manola |first3=Eirini |last4=McConachie |first4=Helen |date=2014-03-21 |title=Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD) |journal=[[Cochrane Database of Systematic Reviews]] |language=en |volume=2014 |issue=3 |pages=CD008785 |doi=10.1002/14651858.CD008785.pub2 |pmc=6923148 |pmid=24652601}}</ref><ref>{{Cite journal |last1=Sandbank |first1=Micheal |last2=Bottema-Beutel |first2=Kristen |last3=Crowley |first3=Shannon |last4=Cassidy |first4=Margaret |last5=Dunham |first5=Kacie |last6=Feldman |first6=Jacob I. |last7=Crank |first7=Jenna |last8=Albarran |first8=Susanne A. |last9=Raj |first9=Sweeya |last10=Mahbub |first10=Prachy |last11=Woynaroski |first11=Tiffany G. |date=2020 |title=Project AIM: Autism intervention meta-analysis for studies of young children. |journal=[[Psychological Bulletin]] |language=en |volume=146 |issue=1 |pages=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>{{Cite book |last=Bogdashina |first=Olga
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">{{Cite book |last=Constantino |first=John N. |title=The social responsiveness scale |publisher=Western Psychological Services |year=2002 |___location=Los Angeles, CA}}</ref> a 2002 quantitative measure of social reciprocity in children which has since been used extensively in autism research,<ref>{{Cite journal |last1=Constantino |first1=John N. |last2=Todd |first2=Richard D. |date=May 2003 |title=Autistic Traits in the General Population: A Twin Study |url=http://archpsyc.jamanetwork.com/article.aspx?doi=10.1001/archpsyc.60.5.524 |journal=[[Archives of General Psychiatry]] |language=en |volume=60 |issue=5 |pages=524–530 |doi=10.1001/archpsyc.60.5.524 |issn=0003-990X |pmid=12742874|url-access=subscription }}</ref><ref>{{Cite journal |last1=Constantino |first1=John N. |last2=Gruber |first2=Christian P. |last3=Davis |first3=Sandra |last4=Hayes |first4=Stephanie |last5=Passanante |first5=Natalie |last6=Przybeck |first6=Thomas |date=May 2004 |title=The factor structure of autistic traits |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.2004.00266.x |journal=Journal of Child Psychology and Psychiatry |language=en |volume=45 |issue=4 |pages=719–726 |doi=10.1111/j.1469-7610.2004.00266.x |issn=0021-9630 |pmid=15056304|url-access=subscription }}</ref><ref>{{Cite journal |last1=Towbin |first1=Kenneth E. |last2=Pradella |first2=Anne |last3=Gorrindo |first3=Tristan |last4=Pine |first4=Daniel S. |last5=Leibenluft |first5=Ellen |date=June 2005 |title=Autism Spectrum Traits in Children with Mood and Anxiety Disorders |url=https://zenodo.org/record/1235253 |journal=[[Journal of Child and Adolescent Psychopharmacology]] |language=en |volume=15 |issue=3 |pages=452–464 |doi=10.1089/cap.2005.15.452 |issn=1044-5463 |pmid=16092910}}</ref><ref>{{Cite journal |last1=Nguyen |first1=Phuong H. |last2=Ocansey |first2=Maku E. |last3=Miller |first3=Meghan |last4=Le |first4=Dung T. K. |last5=Schmidt |first5=Rebecca J. |last6=Prado |first6=Elizabeth L. |date=2019-07-29 |title=The reliability and validity of the social responsiveness scale to measure autism symptomology in Vietnamese children |journal=Autism Research |language=en |volume=12 |issue=11 |pages=1706–1718 |doi=10.1002/aur.2179 |issn=1939-3792 |pmc=7397486 |pmid=31355545}}</ref><ref>{{Cite journal |last1=Kerr-Gaffney |first1=Jess |last2=Harrison |first2=Amy |last3=Tchanturia |first3=Kate |date=July 2020 |title=The social responsiveness scale is an efficient screening tool for autism spectrum disorder traits in adults with anorexia nervosa |journal=European Eating Disorders Review |language=en |volume=28 |issue=4 |pages=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
=== 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-cognitive 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, interaction/communication style, and [[social
While
== Double empathy and bidirectional social-interaction or communication studies ==
=== Interpersonal rapport, empathy, and social-interaction or 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>{{Cite journal |last1=Sasson |first1=Noah J. |last2=Faso |first2=Daniel J. |last3=Nugent |first3=Jack |last4=Lovell |first4=Sarah |last5=Kennedy |first5=Daniel P. |last6=Grossman |first6=Ruth B. |date=2017-02-01 |title=Neurotypical Peers are Less Willing to Interact with Those with Autism based on Thin Slice Judgments |journal=Scientific Reports |language=en |volume=7 |issue=1 |pages=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 [[bias]]es 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
=== The importance of social reciprocity ===
One major factor influencing communication effectiveness is social reciprocity.
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">{{Cite journal |last1=McGee |first1=Gail G. |last2=Almeida |first2=M. Connie |last3=Sulzer-Azaroff |first3=Beth |last4=Feldman |first4=Robert S. |date=1992 |title=Promoting reciprocal interactions via peer incidental teaching |journal=Journal of Applied Behavior Analysis |language=en |volume=25 |issue=1 |pages=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" />
Line 45 ⟶ 49:
{{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 [[Autistic masking|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>{{Cite journal |last1=Pearson |first1=Amy |last2=Rose |first2=Kieran |date=2021-03-01 |title=A Conceptual Analysis of Autistic Masking: Understanding the Narrative of Stigma and the Illusion of Choice |journal=Autism in Adulthood |volume=3 |issue=1 |pages=52–60 |doi=10.1089/aut.2020.0043 |issn=2573-9581 |pmc=8992880 |pmid=36601266}}</ref><ref>{{Cite journal |last1=Petrolini |first1=Valentina |last2=Rodríguez-Armendariz |first2=Ekaine |last3=Vicente |first3=Agustín |date=2023 |title=Autistic camouflaging across the spectrum |journal=[[New Ideas in Psychology]] |language=en |volume=68 |
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">{{Cite journal |last=Botha |first=Monique |date=2021-09-28 |title=Academic, Activist, or Advocate? Angry, Entangled, and Emerging: A Critical Reflection on Autism Knowledge Production |journal=Frontiers in Psychology |volume=12 |pages=727542 |doi=10.3389/fpsyg.2021.727542 |issn=1664-1078 |pmc=8506216 |pmid=34650484 |doi-access=free}}</ref><ref name=":6">{{Cite journal |last1=Botha |first1=Monique |last2=Cage |first2=Eilidh |date=2022-11-24 |title="Autism research is in crisis": A mixed method study of researcher's constructions of autistic people and autism research |journal=Frontiers in Psychology |volume=13 |pages=1050897 |doi=10.3389/fpsyg.2022.1050897 |issn=1664-1078 |pmc=9730396 |pmid=36506950 |doi-access=free}}</ref><ref>{{Cite web |date=2019-12-17 |title=Report of the Special Rapporteur on the rights of persons with disabilities |url=https://documents-dds-ny.un.org/doc/UNDOC/GEN/G19/346/54/PDF/G1934654.pdf |access-date=2023-06-05 |website=[[United Nations General Assembly]] |edition=43rd}}</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|Personification}}
An area of social-cognitive strength in autistic people centers upon [[anthropomorphism]].<ref name=":47">{{Cite journal |last1=Atherton |first1=Gray |last2=Cross |first2=Liam |date=2018-04-17 |title=Seeing More Than Human: Autism and Anthropomorphic Theory of Mind |journal=Frontiers in Psychology |volume=9 |pages=528 |doi=10.3389/fpsyg.2018.00528 |issn=1664-1078 |pmc=5932358 |pmid=29755383 |doi-access=free}}</ref> A 2018 study has shown that autistic people are likely more prone to object [[personification]],<ref>{{Cite journal |last1=White |first1=Rebekah |last2=Remington |first2=Anna |date=2018 |title=Object personification in autism: This paper will be very sad if you don't read it |url=https://ora.ox.ac.uk/objects/uuid:edc2de03-af02-4dd4-8851-e567cb6b255a/files/m9bf3237ef0d6bf1fc913108a420348cb |journal=Autism |language=en |volume=23 |issue=4 |pages=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 the said test in a 2022 study,<ref>{{Cite journal |last1=Cross |first1=Liam |last2=Piovesan |first2=Andrea |last3=Atherton |first3=Gray |date=2022-07-20 |title=Autistic people outperform neurotypicals in a cartoon version of the Reading the Mind in the Eyes |journal=Autism Research |language=en |volume=15 |issue=9 |pages=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 [[animal]]s,<ref name=":47" /><ref>{{Cite journal |last1=Prothmann |first1=Anke |last2=Ettrich |first2=Christine |last3=Prothmann |first3=Sascha |date=2009 |title=Preference for, and Responsiveness to, People, Dogs and Objects in Children with Autism |url=https://www.tandfonline.com/doi/full/10.2752/175303709X434185 |journal=Anthrozoös |language=en |volume=22 |issue=2 |pages=161–171 |doi=10.2752/175303709X434185 |issn=0892-7936 |s2cid=143563380|url-access=subscription }}</ref><ref>{{Cite journal |last1=Lam |first1=Gary Yu Hin |last2=Holden |first2=Emily |last3=Fitzpatrick |first3=Megan |last4=Raffaele Mendez |first4=Linda |last5=Berkman |first5=Karen |date=2020-01-22 |title="Different but connected": Participatory action research using Photovoice to explore well-being in autistic young adults |url=http://journals.sagepub.com/doi/10.1177/1362361319898961 |journal=Autism |language=en |volume=24 |issue=5 |pages=1246–1259 |doi=10.1177/1362361319898961 |pmid=31968999 |s2cid=210864853 |issn=1362-3613|url-access=subscription }}</ref><ref>{{Cite journal |last1=Miralles |first1=Aurélien |last2=Grandgeorge |first2=Marine |last3=Raymond |first3=Michel |date=2022-04-15 |title=Self-perceived empathic abilities of people with autism towards living beings mostly differs for humans |journal=Scientific Reports |language=en |volume=12 |issue=1 |pages=6300 |doi=10.1038/s41598-022-10353-2 |issn=2045-2322 |pmc=9012821 |pmid=35428857|bibcode=2022NatSR..12.6300M }}</ref> once again suggesting social-cognitive differences in autistic people, but not global deficits.
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Autistic theory of mind, argued to have facilitated the release of [[Cognitive resource theory|cognitive resources]], is typically based on the use of rules and [[logic]] and may be modulated by differences in [[Thought|thinking]].<ref>{{Cite journal |last1=Spikins |first1=Penny |last2=Wright |first2=Barry |last3=Hodgson |first3=Derek |date=2016-10-01 |title=Are there alternative adaptive strategies to human pro-sociality? The role of collaborative morality in the emergence of personality variation and autistic traits |journal=[[Time and Mind]] |volume=9 |issue=4 |pages=289–313 |doi=10.1080/1751696X.2016.1244949 |issn=1751-696X |s2cid=151820168 |doi-access=free|url=http://eprints.whiterose.ac.uk/109704/2/Are_there_alternative_adaptive_strategies_to_human_pro_sociality_The_role_of_collaborative_morality_in_the_emergence_of_personality_va.pdf }}</ref><ref>{{Cite journal |last1=Hadjikhani |first1=N. |last2=Zürcher |first2=N. R. |last3=Rogier |first3=O. |last4=Hippolyte |first4=L. |last5=Lemonnier |first5=E. |last6=Ruest |first6=T. |last7=Ward |first7=N. |last8=Lassalle |first8=A. |last9=Gillberg |first9=N. |last10=Billstedt |first10=E. |last11=Helles |first11=A. |last12=Gillberg |first12=C. |last13=Solomon |first13=P. |last14=Prkachin |first14=K. M. |last15=Gillberg |first15=C. |date=2014-01-14 |title=Emotional contagion for pain is intact in autism spectrum disorders |journal=Translational Psychiatry |language=en |volume=4 |issue=1 |pages=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 and autism|vaccines cause autism]].<ref name=":15">{{Cite journal |last=Milton |first=Damian E. M. |date=2014 |title=Autistic expertise: A critical reflection on the production of knowledge in autism studies |url=http://kar.kent.ac.uk/62633/1/Autistic%20expertise.pdf |journal=Autism |language=en |volume=18 |issue=7 |pages=794–802 |doi=10.1177/1362361314525281 |issn=1362-3613 |pmid=24637428 |s2cid=206715678}}</ref>
Many [[autistic activists]] and a growing number of autism researchers have shown support for the double empathy concept, and have argued that some past studies and articles regarding theory of mind and empathy in autism (especially the universal core deficit version by Baron-Cohen from the 1980s to 2011) have served to
Research has shown that autistic people are more likely to be dehumanized by non-autistic people,<ref name=":6" /><ref>{{Cite journal |last1=Cage |first1=Eilidh |last2=Di Monaco |first2=Jessica |last3=Newell |first3=Victoria |date=2019-11-21 |title=Understanding, attitudes and dehumanisation towards autistic people |url=http://journals.sagepub.com/doi/10.1177/1362361318811290 |journal=Autism |language=en |volume=23 |issue=6 |pages=1373–1383 |doi=10.1177/1362361318811290 |issn=1362-3613 |pmid=30463431 |s2cid=53722683|hdl=1893/30633 |hdl-access=free }}</ref> and first-hand accounts of autism research, including [[autoethnographies]],<ref name=":30" /> [[blog]]s,<ref>{{Cite web |last=Luterman |first=Sara |date=2019-07-15 |title=What it's like to be autistic at an autism research conference |url=https://www.spectrumnews.org/opinion/what-its-like-to-be-autistic-at-an-autism-research-conference/ |access-date=2023-04-11 |website=Spectrum |publisher=[[Simons Foundation]] |language=en-US}}</ref><ref>{{Cite web |last=Rose |first=Kieran |date=2020-02-29 |title=Regarding the use of dehumanising rhetoric |url=https://theautisticadvocate.com/2020/02/regarding-the-use-of-dehumanising-rhetoric/ |access-date=2023-04-11 |website=The Autistic Advocate |language=en-GB}}</ref> [[Commentary (philology)|commentaries]],<ref>{{Cite journal |last=Michael |first=Cos |date=2021-06-01 |title=Is Being Othered a Co-Occurring Condition of Autism? |journal=Autism in Adulthood |language=en |volume=3 |issue=2 |pages=118–119 |doi=10.1089/aut.2021.0019 |issn=2573-9581 |pmc=8992897 |pmid=36601468}}</ref> and [[editorial]]s,<ref name=":29" /><ref>{{Cite web |last=Cowen |first=Tyler |date=2009-07-13 |title=Autism as Academic Paradigm |url=https://www.chronicle.com/article/autism-as-academic-paradigm/ |access-date=2023-04-11 |website=[[The Chronicle of Higher Education]] |language=en}}</ref> have described autism research to often be dehumanizing to autistic people. Furthermore, autistic people are said to be "less domesticated" at [[Morphology (biology)|morphological]], [[Physiology|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>{{Cite journal |last1=Liu |first1=Ka-Yuet |last2=King |first2=Marissa |last3=Bearman |first3=Peter S. |date=March 2010 |title=Social Influence and the Autism Epidemic |journal=[[American Journal of Sociology]] |language=en |volume=115 |issue=5 |pages=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
== Limitations and future directions ==
The literature on double empathy is still relatively young, and the generalizability of double empathy and bidirectional interaction findings to younger autistic children as well as autistic people with an [[intellectual disability]], [[Speech and language impairment|speech-language impairment]], and/or [[
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 [[
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. Acknowledging these differences which may affect communication within and between autistic and non-autistic groups,
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
== Triple empathy problem ==
Autistic individuals are more likely to face significant [[health disparities]], including a higher prevalence of co-occurring health conditions and a lower [[life expectancy]] compared to their neurotypical peers,<ref name=":52" /><ref>{{Cite journal |last1=Sala |first1=Regina |last2=Amet |first2=Lorene |last3=Blagojevic-Stokic |first3=Natasa |last4=Shattock |first4=Paul |last5=Whiteley |first5=Paul |date=2020-06-30 |title=Bridging the Gap Between Physical Health and Autism Spectrum Disorder |journal=[[Neuropsychiatric Disease and Treatment]] |volume=16 |pages=1605–1618 |doi=10.2147/ndt.s251394 |doi-access=free |issn=1178-2021 |pmc=7335278 |pmid=32636630}}</ref><ref name=":53">{{Cite journal |last1=Doherty |first1=Mary |last2=Neilson |first2=Stuart |last3=O'Sullivan |first3=Jane |last4=Carravallah |first4=Laura |last5=Johnson |first5=Mona |last6=Cullen |first6=Walter |last7=Shaw |first7=Sebastian C. K. |date=2022-02-22 |title=Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study |journal=[[BMJ Open]] |language=en |volume=12 |issue=2 |pages=e056904 |doi=10.1136/bmjopen-2021-056904 |issn=2044-6055 |pmc=883251 |pmid=35193921}}</ref><ref name=":54">{{Cite journal |last1=Shaw |first1=Sebastian C. K. |last2=Carravallah |first2=Laura |last3=Johnson |first3=Mona |last4=O'Sullivan |first4=Jane |last5=Chown |first5=Nicholas |last6=Neilson |first6=Stuart |last7=Doherty |first7=Mary |date=2023-10-17 |title=Barriers to healthcare and a 'triple empathy problem' may lead to adverse outcomes for autistic adults: A qualitative study |journal=Autism |language=en |volume=28 |issue=7 |pages=1746–1757 |doi=10.1177/13623613231205629 |issn=1362-3613 |pmc=11191657 |pmid=37846479}}</ref> and thus are more likely to use emergency services.<ref>{{Cite journal |last1=Nicolaidis |first1=Christina |last2=Raymaker |first2=Dora |last3=McDonald |first3=Katherine |last4=Dern |first4=Sebastian |last5=Boisclair |first5=W. Cody |last6=Ashkenazy |first6=Elesia |last7=Baggs |first7=Amanda |date=2012-11-21 |title=Comparison of Healthcare Experiences in Autistic and Non-Autistic Adults: A Cross-Sectional Online Survey Facilitated by an Academic-Community Partnership |journal=[[Journal of General Internal Medicine]] |language=en |volume=28 |issue=6 |pages=761–769 |doi=10.1007/s11606-012-2262-7 |issn=0884-8734 |pmc=3663938 |pmid=23179969}}</ref> Despite increased awareness of these health inequities, many autistic people encounter substantial barriers when accessing [[healthcare]] services.<ref name=":56" /><ref name=":53" /><ref name=":54" /> Shaw et al. (2023)<ref name=":54" /> conducted a qualitative study involving 1,248 autistic adults to investigate these challenges, revealing a complex interplay of factors that contribute to adverse health outcomes. Key themes emerged from the participants' experiences, such as early barriers to care, communication mismatches, feelings of doubt from both patients and healthcare providers, a sense of helplessness and [[fear]] in navigating the system, and a tendency toward healthcare avoidance – each contributing to significant health risks.
Shaw et al. (2023)<ref name=":54" /> constructed a model illustrating a chronological journey that outlines how barriers to healthcare access can lead to detrimental health outcomes for autistic individuals. Their work emphasizes the necessity of amplifying autistic voices in discussions about healthcare and highlights the relevance of the double empathy problem within medical contexts, thereby proposing the concept of a "triple empathy problem".<ref name=":54" />
This expanded framework, further elaborated by Josefson (2024),<ref name=":51">{{Cite journal |last=Josefson |first=Charles |date=2024-11-12 |title=Toward a neuroinclusive culture: designing neuroinclusivity with Triple Empathy Theory |journal=Disability & Society |language=en |pages=1–24 |doi=10.1080/09687599.2024.2424193 |issn=0968-7599 |s2cid=274018332|doi-access=free }}</ref> encompasses:
▲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 autism|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>{{Cite journal |last1=Bilder |first1=Deborah |last2=Botts |first2=Elizabeth L. |last3=Smith |first3=Ken R. |last4=Pimentel |first4=Richard |last5=Farley |first5=Megan |last6=Viskochil |first6=Joseph |last7=McMahon |first7=William M. |last8=Block |first8=Heidi |last9=Ritvo |first9=Edward |last10=Ritvo |first10=Riva-Ariella |last11=Coon |first11=Hilary |date=2012-09-25 |title=Excess Mortality and Causes of Death in Autism Spectrum Disorders: A Follow up of the 1980s Utah/UCLA Autism Epidemiologic Study |journal=Journal of Autism and Developmental Disorders |language=en |volume=43 |issue=5 |pages=1196–1204 |doi=10.1007/s10803-012-1664-z |issn=0162-3257 |pmc=4814267 |pmid=23008058}}</ref><ref>{{Cite journal |last1=Polyak |first1=Andrew |last2=Kubina |first2=Richard M. |last3=Girirajan |first3=Santhosh |date=2015-07-22 |title=Comorbidity of intellectual disability confounds ascertainment of autism: implications for genetic diagnosis |url=https://www.biorxiv.org/content/biorxiv/early/2014/11/17/011528.full.pdf |journal=[[American Journal of Medical Genetics Part B: Neuropsychiatric Genetics]] |language=en |volume=168 |issue=7 |pages=600–608 |doi=10.1002/ajmg.b.32338 |pmid=26198689 |s2cid=7635120}}</ref><ref>{{Cite journal |last1=Katusic |first1=Maja Z. |last2=Myers |first2=Scott M. |last3=Weaver |first3=Amy L. |last4=Voigt |first4=Robert G. |date=2021-12-01 |title=IQ in Autism Spectrum Disorder: A Population-Based Birth Cohort Study |url=https://publications.aap.org/pediatrics/article/148/6/e2020049899/183390/IQ-in-Autism-Spectrum-Disorder-A-Population-Based |journal=Pediatrics |language=en |volume=148 |issue=6 |pages=e2020049899 |doi=10.1542/peds.2020-049899 |pmid=34851412 |s2cid=243762735 |issn=0031-4005}}</ref><ref>{{Cite journal |last1=Shenouda |first1=Josephine |last2=Barrett |first2=Emily |last3=Davidow |first3=Amy L. |last4=Sidwell |first4=Kate |last5=Lescott |first5=Cara |last6=Halperin |first6=William |last7=Silenzio |first7=Vincent M. B. |last8=Zahorodny |first8=Walter |date=2023-02-01 |title=Prevalence and Disparities in the Detection of Autism Without Intellectual Disability |url=https://publications.aap.org/pediatrics/article/151/2/e2022056594/190525/Prevalence-and-Disparities-in-the-Detection-of |journal=Pediatrics |language=en |volume=151 |issue=2 |pages=e2022056594 |doi=10.1542/peds.2022-056594 |pmid=36700335 |s2cid=256273971 |issn=0031-4005|url-access=subscription }}</ref> while just roughly 1–3% of the global population or lower has an intellectual disability.<ref>{{Cite journal |last1=McKenzie |first1=Katherine |last2=Milton |first2=Meagan |last3=Smith |first3=Glenys |last4=Ouellette-Kuntz |first4=Hélène |date=2016-04-15 |title=Systematic Review of the Prevalence and Incidence of Intellectual Disabilities: Current Trends and Issues |journal=Current Developmental Disorders Reports |language=en |volume=3 |issue=2 |pages=104–115 |doi=10.1007/s40474-016-0085-7 |s2cid=76296047 |issn=2196-2987|doi-access=free }}</ref><ref>{{Cite journal |last1=McBride |first1=Orla |last2=Heslop |first2=Pauline |last3=Glover |first3=Gyles |last4=Taggart |first4=Laurence |last5=Hanna-Trainor |first5=Lisa |last6=Shevlin |first6=Mark |last7=Murphy |first7=Jamie |date=2021-01-28 |title=Prevalence estimation of intellectual disability using national administrative and household survey data: The importance of survey question specificity |url=https://ijpds.org/article/view/1342 |journal=[[International Journal of Population Data Science]] |volume=6 |issue=1 |page=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>{{Cite journal |last1=Brignell |first1=Amanda |last2=Chenausky |first2=Karen V. |last3=Song |first3=Huan |last4=Zhu |first4=Jianwei |last5=Suo |first5=Chen |last6=Morgan |first6=Angela T. |date=2018-11-05 |title=Communication interventions for autism spectrum disorder in minimally verbal children |journal=Cochrane Database of Systematic Reviews |language=en |volume=2018 |issue=11 |pages=CD012324 |doi=10.1002/14651858.CD012324.pub2 |pmc=6516977 |pmid=30395694}}</ref> A 2023 study by Glass & Yuill<ref name=":48" /> found support for 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.
* the difficulty neurotypical people have relating to or understanding the needs of neurodivergent people,
▲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. Acknowledging these differences which may affect communication within and between autistic and non-autistic groups, a 2024 study by Gillespie-Smith et al.<ref>{{Cite journal |last1=Gillespie-Smith |first1=Karri |last2=Mair |first2=Ally Pax Arcari |last3=Alabtullatif |first3=Aljawharah |last4=Pain |first4=Helen |last5=McConachie |first5=Doug |date=2024-02-16 |title=A Spectrum of Understanding: A Qualitative Exploration of Autistic Adults' Understandings and Perceptions of Friendship(s) |url=https://www.pure.ed.ac.uk/ws/files/388423107/Gillespie-SmithEtal2023AAASpectrumOfUnderstanding.pdf |journal=Autism in Adulthood |volume=6 |issue=4 |pages=438–450 |language=en |doi=10.1089/aut.2023.0051 |issn=2573-9581}}</ref> suggested a need to (re)frame the double empathy problem to be understood as a ''Spectrum of Understanding'', which sees double empathy in the context of a continuum of neurocommunicative learning, situated between poles of understanding and misunderstanding. In this sense, the ''Spectrum of Understanding'' simply illustrates that as individuals learn more about each other from direct interaction, their relationships tend to deepen, their comprehension of each other increases, and they become more able to empathize with each other.
* the difficulty neurodivergent people have relating to or understanding the needs of neurotypical people, and
* the difficulty [[urban planners]] and other [[designer]]s, whether of [[Product (business)|product]]s, services, [[technology]], places, [[system]]s or [[process]]es etc., have finding solutions that equitably balance the needs of all community members.
Triple empathy is associated with the concept and principles of [[universal design]], which aims to create environments and services that are accessible and beneficial to everyone, regardless of their neurotype.<ref name=":51" /> Fostering [[neuroinclusive design]] not only accommodates but actively embraces the diverse perspectives and experiences of all individuals.<ref name=":51" />
▲It is important to note that conceptual replications and further studies on double empathy are needed in different groups, including siblings of autistic people, non-autistic pupils in [[school]]s including autistic peers, late-diagnosed autistic adults, parents of autistic children, and autism service providers.<ref name=":18">{{cite journal |last1=Mitchell |first1=Peter |last2=Sheppard |first2=Elizabeth |last3=Cassidy |first3=Sarah |year=2021 |title=Autism and the double empathy problem: Implications for development and mental health |journal=British Journal of Developmental Psychology |volume=39 |issue=1 |pages=1–18 |doi=10.1111/bjdp.12350 |pmid=33393101 |s2cid=230489027 |doi-access=free|url=https://nottingham-repository.worktribe.com/preview/4871894/bjdp.12350.pdf }}</ref><ref name=":21" />
== Quadruple empathy problem ==
▲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>{{Cite journal |last1=Kapp |first1=Steven K. |last2=Gillespie-Lynch |first2=Kristen |last3=Sherman |first3=Lauren E. |last4=Hutman |first4=Ted |date=2013 |title=Deficit, difference, or both? Autism and neurodiversity. |url=https://researchportal.port.ac.uk/files/16869786/Deficit_difference_or_both.pdf |journal=[[Developmental Psychology (journal)|Developmental Psychology]] |language=en |volume=49 |issue=1 |pages=59–71 |doi=10.1037/a0028353 |issn=1939-0599 |pmid=22545843}}</ref><ref>{{Cite journal |last1=Jaarsma |first1=Pier |last2=Welin |first2=Stellan |date=2012 |title=Autism as a Natural Human Variation: Reflections on the Claims of the Neurodiversity Movement |url=http://link.springer.com/10.1007/s10728-011-0169-9 |journal=Health Care Analysis |language=en |volume=20 |issue=1 |pages=20–30 |doi=10.1007/s10728-011-0169-9 |pmid=21311979 |s2cid=18618887 |issn=1065-3058|url-access=subscription }}</ref><ref>{{Cite journal |last1=Chapple |first1=Melissa |last2=Davis |first2=Philip |last3=Billington |first3=Josie |last4=Myrick |first4=Joe Anthony |last5=Ruddock |first5=Cassie |last6=Corcoran |first6=Rhiannon |date=2021-07-27 |title=Overcoming the Double Empathy Problem Within Pairs of Autistic and Non-autistic Adults Through the Contemplation of Serious Literature |journal=Frontiers in Psychology |volume=12 |pages=708375 |doi=10.3389/fpsyg.2021.708375 |issn=1664-1078 |pmc=8354525 |pmid=34385964 |doi-access=free }}</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>{{Cite journal |last1=Milton |first1=Damian E. M. |last2=Bracher |first2=Mike |date=June 2013 |title=Autistics speak but are they heard? |url=https://www.researchgate.net/publication/330875068 |journal=Medical Sociology Online |volume=7 |issue=2 |pages=61–69}}</ref> – should be moved away from due to its approach being too narrow, individualistic, and deficit-based,<ref name=":42">{{Cite journal |last1=Pellicano |first1=Elizabeth |last2=den Houting |first2=Jacquiline |date=November 2021 |title=Annual Research Review: Shifting from 'normal science' to neurodiversity in autism science |journal=Journal of Child Psychology and Psychiatry |language=en |volume=63 |issue=4 |pages=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=":42" /><ref name=":6" /><ref>{{Cite journal |last=Woods |first=Richard |date=2017-08-09 |title=Exploring how the social model of disability can be re-invigorated for autism: in response to Jonathan Levitt |journal=Disability & Society |language=en |volume=32 |issue=7 |pages=1090–1095 |doi=10.1080/09687599.2017.1328157 |s2cid=148783346 |issn=0968-7599|doi-access=free |url=https://openresearch.lsbu.ac.uk/download/03490c9a8af5af864334f6aa9ae6da0f979f174aef504b527b78216d86070699/42457/14%20April%202017%20DS%20Submission%20Author%27s%20copy.docx }}</ref><ref>{{Cite journal |last1=Bottema-Beutel |first1=Kristen |last2=Kapp |first2=Steven K. |last3=Lester |first3=Jessica Nina |last4=Sasson |first4=Noah J. |last5=Hand |first5=Brittany N. |date=2021-03-01 |title=Avoiding Ableist Language: Suggestions for Autism Researchers |journal=Autism in Adulthood |language=en |volume=3 |issue=1 |pages=18–29 |doi=10.1089/aut.2020.0014 |issn=2573-9581 |pmc=8992888 |pmid=36601265}}</ref> further widening this double empathy gap.
The transition through [[menopause]] can be particularly difficult for autistic people,<ref>{{Cite journal |last1=Groenman |first1=Annabeth P. |last2=Torenvliet |first2=Carolien |last3=Radhoe |first3=Tulsi A. |last4=Agelink van Rentergem |first4=Joost A. |last5=Geurts |first5=Hilde M. |date=2021-11-26 |title=Menstruation and menopause in autistic adults: Periods of importance? |journal=Autism |language=en |volume=26 |issue=6 |pages=1563–1572 |doi=10.1177/13623613211059721 |issn=1362-3613 |pmc=9344571 |pmid=34825585}}</ref><ref>{{Cite journal |last1=Moseley |first1=Rachel L. |last2=Druce |first2=Tanya |last3=Turner-Cobb |first3=Julie M. |date=2020-01-31 |title='When my autism broke': A qualitative study spotlighting autistic voices on menopause |journal=Autism |language=en |volume=24 |issue=6 |pages=1423–1437 |doi=10.1177/1362361319901184 |issn=1362-3613 |pmc=7376624 |pmid=32003226}}</ref> exacerbating existing communication barriers and experiences of misunderstanding in medical contexts. Participants from a study by Brady et al. (2024)<ref name=":55">{{Cite journal |last1=Brady |first1=Miranda J. |last2=Jenkins |first2=Christine A. |last3=Gamble-Turner |first3=Julie M. |last4=Moseley |first4=Rachel L. |last5=Janse van Rensburg |first5=Margaret |last6=Matthews |first6=Rose J. |date=2024-04-15 |title="A perfect storm": Autistic experiences of menopause and midlife |journal=Autism |language=en |volume=28 |issue=6 |pages=1405–1418 |doi=10.1177/13623613241244548 |issn=1362-3613 |pmc=11135000 |pmid=38622794}}</ref> described profound communication challenges that echoed their earlier experiences during [[puberty]] and [[menarche]], periods in which they also struggled to articulate their needs and experiences due to their neurodivergent perspectives. Brady et al. (2024)<ref name=":55" /> coined the term "quadruple empathy problem" to not only reflect the challenges autistic individuals face in communicating their needs but also emphasize the impact of [[medical misogyny]] – i.e., systemic biases in healthcare that may dismiss or undermine the experiences of neurodivergent women, who may find themselves navigating a healthcare landscape lacking in appropriate levels of support and understanding, further leading to feelings of desperation and the need for [[self-advocacy]], such as seeking private healthcare or educating [[medical personnel]] about their unique experiences.<ref name=":55" />
== See also ==
Line 79 ⟶ 99:
* [[Discrimination against autistic people]]
* [[Empathy gap]]
* [[Epistemic injustice]]
* [[Inclusion (disability rights)]]
* [[Intercultural communication]]
* [[Medical model of disability]]
* [[Perspective-taking]]
* [[Social model of disability]]
* [[The Fox and the Stork]]
Line 89 ⟶ 112:
== Further reading ==
* {{Cite book |last=Milton |first=Damian
* {{Cite book |last1=Milton |first1=Damian Elgin Maclean |title=Encyclopedia of Autism Spectrum Disorders |pages= 1–9|editor-last=Volkmar |editor-first=Fred R. |editor-link=Fred Volkmar |place=New York, NY |publisher=Springer |chapter=Double Empathy |doi=10.1007/978-1-4614-6435-8_102273-2 |year=2020 |isbn=978-1-4614-6435-8 |last2=Heasman |first2=Brett |last3=Sheppard |first3=Elizabeth}}
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