double empathy problem

{{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 core deficits 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,{{Cite journal |last1=Baron-Cohen |first1=Simon |last2=Leslie |first2=Alan M. |last3=Frith |first3=Uta |date=1985-10-01 |title=Does the autistic child have a "theory of mind" ? |url=https://dx.doi.org/10.1016/0010-0277%2885%2990022-8 |journal=Cognition |language=en |volume=21 |issue=1 |pages=37–46 |doi=10.1016/0010-0277(85)90022-8 |issn=0010-0277 |pmid=2934210 |s2cid=14955234|url-access=subscription }}{{Cite journal |last=Baron-Cohen |first=Simon |date=1988-10-01 |title=Social and pragmatic deficits in autism: Cognitive or affective? |url=https://www.researchgate.net/publication/20105802 |journal=Journal of Autism and Developmental Disorders |volume=18 |issue=3 |pages=379–402 |doi=10.1007/BF02212194 |pmid=3049519 |s2cid=2050249}}{{Cite journal |last1=Baron-Cohen |first1=Simon |last2=Campbell |first2=Ruth |last3=Karmiloff-Smith |first3=Annette |last4=Grant |first4=Julia |last5=Walker |first5=Jane |date=November 1995 |title=Are children with autism blind to the mentalistic significance of the eyes? |url=https://onlinelibrary.wiley.com/doi/10.1111/j.2044-835X.1995.tb00687.x |journal=British Journal of Developmental Psychology |language=en |volume=13 |issue=4 |pages=379–398 |doi=10.1111/j.2044-835X.1995.tb00687.x|s2cid=34341464 |url-access=subscription }} 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.{{Cite journal |last=Baron-Cohen |first=Simon |date=1990-01-01 |title=Autism: A Specific Cognitive Disorder of 'Mind-Blindness' |url=https://doi.org/10.3109/09540269009028274 |journal=International Review of Psychiatry |volume=2 |issue=1 |pages=81–90 |doi=10.3109/09540269009028274 |issn=0954-0261|url-access=subscription }} 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".{{Cite journal |last=Frith |first=Uta |date=2004 |title=Emanuel Miller lecture: Confusions and controversies about Asperger syndrome |journal=Journal of Child Psychology and Psychiatry |language=en |volume=45 |issue=4 |pages=672–686 |doi=10.1111/j.1469-7610.2004.00262.x |issn=0021-9630 |pmid=15056300|doi-access=free }}

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.{{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 }}{{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 }} The claim that autistic people lack theory of mind is taught across a wide range of psychology textbooks{{Cite book |last=Kellogg |first=Ronald Thomas |url=https://www.worldcat.org/oclc/77520655 |title=Fundamentals of cognitive psychology |date=2007 |publisher=SAGE Publications |isbn=978-1-4129-3692-7 |location=Los Angeles, CA |oclc=77520655}}{{Cite book |last1=Kirk |first1=Samuel A. |url=https://www.worldcat.org/oclc/276275401 |title=Educating exceptional children |last2=Gallagher |first2=James |last3=Coleman |first3=Mary Ruth |last4=Anastasiow |first4=Nicholas J. |date=2008 |publisher=Houghton Mifflin |isbn=978-0-547-12413-1 |edition=12th |location=Boston, MA |oclc=276275401}}{{Cite book |last=Myers |first=David G. |url=https://www.worldcat.org/oclc/670478661 |title=Myers' psychology for AP |date=2010 |publisher=Worth Publishers |isbn=978-1-4292-4436-7 |edition=1st |location=New York, NY |oclc=670478661}}{{Cite book |last=Myers |first=David G. |url=https://www.worldcat.org/oclc/568677536 |title=Exploring psychology |date=2011 |publisher=Worth Publishers |isbn=978-1-4292-1635-7 |edition=8th |location=New York, NY |oclc=568677536}}{{Cite book |last1=Mash |first1=Eric J. |url=https://www.worldcat.org/oclc/908991427 |title=Abnormal child psychology |last2=Wolfe |first2=David A. |date=2016 |publisher=Cengage Learning |isbn=978-1-305-10542-3 |edition=6th |location=Australia |oclc=908991427}}{{Cite book |last1=Coon |first1=Dennis |url=https://www.worldcat.org/oclc/990766461 |title=Psychology : modules for active learning |last2=Mitterer |first2=John O. |last3=Martini |first3=Tanya |date=2018 |publisher=Cengage Learning |isbn=978-1-305-96411-2 |edition=14th |location=Boston, MA |oclc=990766461}}{{Cite book |last1=Sigelman |first1=Carol K. |url=https://www.worldcat.org/oclc/1100692276 |title=Life-span human development |last2=Rider |first2=Elizabeth A. |date=2018 |publisher=Cengage Learning |isbn=978-1-337-51606-8 |edition=9th |location=Australia |oclc=1100692276}} and promoted by over 75% of the top 500 scholarly articles indexed for "theory of mind" and "autism" on Google Scholar,{{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}}{{Cite journal |last=Gernsbacher |first=Morton Ann |date=2018-02-25 |title=Critical Review of Autism and Theory and Mind: A Tech Report |url=https://osf.io/3r2qy/ |journal=Open Science Framework |doi=10.17605/OSF.IO/3R2QY}} serving as one of psychology's widely promoted topics throughout psychological literature, practice, and instruction.{{Cite journal |last=Gernsbacher |first=Morton Ann |date=February 2007 |title=On Not Being Human |journal=APS Observer |volume=20 |issue=2 |pages=5–32 |issn=1050-4672 |pmc=4266404 |pmid=25520547}}{{Cite journal |last=Yergeau |first=Melanie |date=2013-09-05 |title=Clinically Significant Disturbance: On Theorists Who Theorize Theory of Mind |url=http://dsq-sds.org/article/view/3876 |journal=Disability Studies Quarterly |volume=33 |issue=4 |doi=10.18061/dsq.v33i4.3876 |issn=2159-8371|doi-access=free }}{{Cite journal |last1=Yergeau |first1=Melanie |last2=Huebner |first2=Bryce |date=2017-09-06 |title=Minding Theory of Mind: Minding Theory of Mind |url=https://onlinelibrary.wiley.com/doi/10.1111/josp.12191 |journal=Journal of Social Philosophy |language=en |volume=48 |issue=3 |pages=273–296 |doi=10.1111/josp.12191|url-access=subscription }} Mind-blindness has also been embraced by scholars in other disciplinary areas such as sociology,{{Cite journal |last1=Willey |first1=Angela |last2=Subramaniam |first2=Banu |last3=Hamilton |first3=Jennifer A. |last4=Couperus |first4=Jane |date=2015 |title=The Mating Life of Geeks: Love, Neuroscience, and the New Autistic Subject |url=https://www.journals.uchicago.edu/doi/10.1086/678146 |journal=Signs: Journal of Women in Culture and Society |language=en |volume=40 |issue=2 |pages=369–391 |doi=10.1086/678146 |s2cid=146561474 |issn=0097-9740|url-access=subscription }} philosophy,{{Cite book |last=Barnbaum |first=Deborah R. |url=https://www.worldcat.org/oclc/560616889 |title=The ethics of autism : among them, but not of them |date=2008 |publisher=Indiana University Press |isbn=978-0-253-22013-4 |location=Bloomington, IN |oclc=560616889}} economics,{{Cite journal |last1=Singer |first1=Tania |last2=Fehr |first2=Ernst |date=2005-04-01 |title=The Neuroeconomics of Mind Reading and Empathy |url=https://pubs.aeaweb.org/doi/10.1257/000282805774670103 |journal=American Economic Review |language=en |volume=95 |issue=2 |pages=340–345 |doi=10.1257/000282805774670103 |pmid=29125271 |s2cid=1480492 |issn=0002-8282|hdl=10419/33340 |hdl-access=free }} anthropology,{{Cite journal |last=Boyer |first=Pascal |date=2003-03-31 |title=Functional origins of religious concepts: ontological and strategic selection in evolved minds |url=https://onlinelibrary.wiley.com/doi/10.1111/1467-9655.00012 |journal=Journal of the Royal Anthropological Institute |language=en |volume=6 |issue=2 |pages=195–214 |doi=10.1111/1467-9655.00012|url-access=subscription }} robotics,{{Cite journal |last=Scassellati |first=Brian |date=2002 |title=Theory of mind for a humanoid robot |url=http://link.springer.com/10.1023/A:1013298507114 |journal=Autonomous Robots |volume=12 |issue=1 |pages=13–24 |doi=10.1023/A:1013298507114|s2cid=1979315 |url-access=subscription }} and narratology.{{Cite journal |last=Barnes |first=Jennifer L. |date=2012 |title=Fiction, imagination, and social cognition: Insights from autism |url=https://linkinghub.elsevier.com/retrieve/pii/S0304422X12000368 |journal=Poetics |language=en |volume=40 |issue=4 |pages=299–316 |doi=10.1016/j.poetic.2012.05.001|url-access=subscription }}

The mind-blindness hypothesis, in addition to being questioned shortly after its publication, has faced a great deal of criticism from the scientific community over the years,{{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 }} in response to the replication studies (mostly the false-belief tasks) that have failed to reveal significant differences in theory of mind between autistic and non-autistic participants,{{Cite journal |last1=Ozonoff |first1=Sally |last2=Pennington |first2=Bruce F. |last3=Rogers |first3=Sally J. |date=1991 |title=Executive Function Deficits in High-Functioning Autistic Individuals: Relationship to Theory of Mind |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.1991.tb00351.x |journal=Journal of Child Psychology and Psychiatry |language=en |volume=32 |issue=7 |pages=1081–1105 |doi=10.1111/j.1469-7610.1991.tb00351.x |pmid=1787138 |issn=0021-9630|url-access=subscription }}{{Cite journal |last1=Oswald |first1=Donald P. |last2=Ollendick |first2=Thomas H. |date=1989 |title=Role taking and social competence in autism and mental retardation |url=http://link.springer.com/10.1007/BF02212723 |journal=Journal of Autism and Developmental Disorders |language=en |volume=19 |issue=1 |pages=119–127 |doi=10.1007/BF02212723 |pmid=2708295 |s2cid=46444974 |issn=0162-3257|url-access=subscription }}{{Cite journal |last1=Tager-Flusberg |first1=Helen |last2=Sullivan |first2=Kate |date=1994 |title=A second look at second-order belief attribution in autism |url=http://link.springer.com/10.1007/BF02172139 |journal=Journal of Autism and Developmental Disorders |language=en |volume=24 |issue=5 |pages=577–586 |doi=10.1007/BF02172139 |pmid=7814307 |s2cid=25194344 |issn=0162-3257|url-access=subscription }} as well as the growing body of evidence for the high degree of heterogeneity in autistic brains at a neurobiological level.{{Cite journal |last1=Toal |first1=F. |last2=Daly |first2=E. M. |last3=Page |first3=L. |last4=Deeley |first4=Q. |last5=Hallahan |first5=B. |last6=Bloemen |first6=O. |last7=Cutter |first7=W. J. |last8=Brammer |first8=M. J. |last9=Curran |first9=S. |last10=Robertson |first10=D. |last11=Murphy |first11=C. |last12=Murphy |first12=K. C. |last13=Murphy |first13=D. G. M. |date=July 2010 |title=Clinical and anatomical heterogeneity in autistic spectrum disorder: a structural MRI study |url=https://www.cambridge.org/core/product/identifier/S0033291709991541/type/journal_article |journal=Psychological Medicine |language=en |volume=40 |issue=7 |pages=1171–1181 |doi=10.1017/S0033291709991541 |issn=0033-2917 |pmid=19891805 |s2cid=10216391|url-access=subscription }}{{Cite journal |last1=Lenroot |first1=Rhoshel K. |last2=Yeung |first2=Pui Ka |date=2013 |title=Heterogeneity within Autism Spectrum Disorders: What have We Learned from Neuroimaging Studies? |journal=Frontiers in Human Neuroscience |volume=7 |page=733 |doi=10.3389/fnhum.2013.00733 |issn=1662-5161 |pmc=3812662 |pmid=24198778 |doi-access=free}}{{Cite journal |last=Chapman |first=Robert |date=2020-08-17 |title=The reality of autism: On the metaphysics of disorder and diversity |url=https://www.tandfonline.com/doi/full/10.1080/09515089.2020.1751103 |journal=Philosophical Psychology |language=en |volume=33 |issue=6 |pages=799–819 |doi=10.1080/09515089.2020.1751103 |issn=0951-5089 |s2cid=203059811 |hdl=1983/309dc16c-cfe9-4356-81b8-6d95510b5eb0|hdl-access=free }}

There have been developments of new theory-of-mind measures when existing measures were perceived by some researchers as inadequate. There have been some successful replications demonstrating differences in theory of mind and empathy with some measures such as the Frith–Happé Animations Test,{{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 }} Baron-Cohen's "Reading the Mind in the Eyes" task,{{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 }}{{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 |pages=104518 |doi=10.1016/j.neubiorev.2021.104518 |issn=0149-7634 |pmid=34974069 |s2cid=245591561|url-access=subscription }} 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.{{Cite journal |last1=Fletcher-Watson |first1=Sue |last2=Bird |first2=Geoffrey |date=2019-11-01 |title=Autism and empathy: What are the real links? |journal=Autism |language=en |volume=24 |issue=1 |pages=3–6 |doi=10.1177/1362361319883506 |pmid=31674189 |s2cid=207816582 |issn=1362-3613|doi-access=free |url=https://ora.ox.ac.uk/objects/uuid:0c3b8997-4cf5-4cbe-bf22-2342224ad339/files/m57e45de0ffd9ced828baef10959baf65 }} 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. Such mixed and inconsistent findings with many different measures have raised doubts regarding the generalizability and validity of the mind-blindness theory of autism.{{Cite journal |last1=Rajendran |first1=Gnanathusharan |last2=Mitchell |first2=Peter |date=2007 |title=Cognitive theories of autism |url=https://strathprints.strath.ac.uk/5154/7/strathprints008124.pdf |journal=Developmental Review |language=en |volume=27 |issue=2 |pages=224–260 |doi=10.1016/j.dr.2007.02.001|s2cid=34448439 }}

Furthermore, autism intervention research based on theory of mind has shown little efficacy,{{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}}{{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}} 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.{{Cite book |last=Bogdashina |first=Olga |url=https://www.worldcat.org/oclc/922835761 |title=Sensory perceptual issues in autism and asperger syndrome : different sensory experiences – different perceptual worlds |date=2016 |publisher=Jessica Kingsley Publishers |isbn=978-1-84905-673-1 |edition=2nd |location=London |oclc=922835761}} 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{{Cite journal |last=Baron-Cohen |first=Simon |date=2008 |title=Theories of the autistic mind |url=https://thepsychologist.bps.org.uk/volume-21/edition-2/theories-autistic-mind |journal=The Psychologist |volume=21 |pages=112–116}}{{Cite journal |last=Baron-Cohen |first=Simon |date=2009 |title=Autism: The Empathizing-Systemizing (E-S) Theory |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1749-6632.2009.04467.x |journal=Annals of the New York Academy of Sciences |language=en |volume=1156 |issue=1 |pages=68–80 |bibcode=2009NYASA1156...68B |doi=10.1111/j.1749-6632.2009.04467.x |pmid=19338503 |s2cid=1440395|url-access=subscription }}{{Citation |last=Baron-Cohen |first=Simon |title=Empathizing, systemizing, and the extreme male brain theory of autism |date=2010-11-20 |url=https://www.sciencedirect.com/science/article/pii/B9780444536303000117 |journal=Progress in Brain Research |volume=186 |pages=167–175 |editor-last=Savic |editor-first=Ivanka |access-date= |series=Sex Differences in the Human Brain, their Underpinnings and Implications |publisher=Elsevier |language=en |doi=10.1016/b978-0-444-53630-3.00011-7 |isbn=9780444536303 |pmid=21094892|url-access=subscription }} has also been called into question by other researchers since the 1990s.{{Cite journal |last1=Bailey |first1=Anthony |last2=Phillips |first2=Wendy |last3=Rutter |first3=Michael |date=1996 |title=Autism: Towards an Integration of Clinical, Genetic, Neuropsychological, and Neurobiological Perspectives |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.1996.tb01381.x |journal=Journal of Child Psychology and Psychiatry |language=en |volume=37 |issue=1 |pages=89–126 |doi=10.1111/j.1469-7610.1996.tb01381.x |pmid=8655659 |issn=0021-9630|url-access=subscription }}{{Cite journal |last1=Bauminger |first1=Nirit |last2=Kasari |first2=Connie |date=1999 |title=Brief report: Theory of mind in high-functioning children with autism |url=http://link.springer.com/10.1023/A:1025974701090 |journal=Journal of Autism and Developmental Disorders |volume=29 |issue=1 |pages=81–86 |doi=10.1023/A:1025974701090|pmid=10097997 |s2cid=42761063 |url-access=subscription }}{{Cite journal |last1=Beversdorf |first1=D. Q. |last2=Anderson |first2=J. M. |last3=Manning |first3=S. E. |last4=Anderson |first4=S. L. |last5=Nordgren |first5=R. E. |last6=Felopulos |first6=G. J. |last7=Nadeau |first7=S. E. |last8=Heilman |first8=K. M. |last9=Bauman |first9=M. L. |date=1998-11-01 |title=The effect of semantic and emotional context on written recall for verbal language in high functioning adults with autism spectrum disorder |journal=Journal of Neurology, Neurosurgery & Psychiatry |language=en |volume=65 |issue=5 |pages=685–692 |doi=10.1136/jnnp.65.5.685 |issn=0022-3050 |pmc=2170365 |pmid=9810938}}{{Cite journal |last1=Buitelaar |first1=Jan K. |last2=Wees |first2=Marleen van der |last3=Swaab-Barneveld |first3=Hanna |last4=Gaag |first4=Rutger Jan van der |date=1999 |title=Verbal Memory and Performance IQ Predict Theory of Mind and Emotion Recognition Ability in Children with Autistic Spectrum Disorders and in Psychiatric Control Children |url=https://onlinelibrary.wiley.com/doi/10.1111/1469-7610.00505 |journal=Journal of Child Psychology and Psychiatry |language=en |volume=40 |issue=6 |pages=869–881 |doi=10.1111/1469-7610.00505 |pmid=10509882 |issn=0021-9630|url-access=subscription }}{{Cite journal |last1=Ozonoff |first1=Sally |last2=Rogers |first2=Sally J. |last3=Pennington |first3=Bruce F. |date=1991 |title=Asperger's Syndrome: Evidence of an Empirical Distinction from High-Functioning Autism |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1469-7610.1991.tb00352.x |journal=Journal of Child Psychology and Psychiatry |language=en |volume=32 |issue=7 |pages=1107–1122 |doi=10.1111/j.1469-7610.1991.tb00352.x |pmid=1787139 |issn=0021-9630|url-access=subscription }} While Baron-Cohen has revised his understanding, his well-powered and large-sample 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.{{Cite journal |last1=Baksh |first1=R. Asaad |last2=Abrahams |first2=Sharon |last3=Bertlich |first3=Maya |last4=Cameron |first4=Rebecca |last5=Jany |first5=Sharon |last6=Dorrian |first6=Terin |last7=Baron-Cohen |first7=Simon |last8=Allison |first8=Carrie |last9=Smith |first9=Paula |last10=MacPherson |first10=Sarah E. |last11=Auyeung |first11=Bonnie |date=2021-10-03 |title=Social cognition in adults with autism spectrum disorders: Validation of the Edinburgh Social Cognition Test (ESCoT) |journal=The Clinical Neuropsychologist |language=en |volume=35 |issue=7 |pages=1275–1293 |doi=10.1080/13854046.2020.1737236 |pmid=32189564 |s2cid=151487088 |issn=1385-4046|doi-access=free |hdl=20.500.11820/ea02ab9c-73be-4e85-916a-7612aa640013 |hdl-access=free }}{{Cite journal |last1=Greenberg |first1=David M. |last2=Warrier |first2=Varun |last3=Allison |first3=Carrie |last4=Baron-Cohen |first4=Simon |date=2018-11-27 |title=Testing the Empathizing–Systemizing theory of sex differences and the Extreme Male Brain theory of autism in half a million people |journal=Proceedings of the National Academy of Sciences |language=en |volume=115 |issue=48 |pages=12152–12157 |doi=10.1073/pnas.1811032115 |issn=0027-8424 |pmc=6275492 |pmid=30420503 |bibcode=2018PNAS..11512152G |doi-access=free }}{{Cite journal |last1=Lombardo |first1=Michael V. |last2=Lai |first2=Meng-Chuan |last3=Auyeung |first3=Bonnie |last4=Holt |first4=Rosemary J. |last5=Allison |first5=Carrie |last6=Smith |first6=Paula |last7=Chakrabarti |first7=Bhismadev |last8=Ruigrok |first8=Amber N. V. |last9=Suckling |first9=John |last10=Bullmore |first10=Edward T. |last11=MRC AIMS Consortium |last12=Bailey |first12=Anthony J. |last13=Baron-Cohen |first13=Simon |last14=Bolton |first14=Patrick F. |last15=Bullmore |first15=Edward T. |date=2016-10-18 |title=Unsupervised data-driven stratification of mentalizing heterogeneity in autism |journal=Scientific Reports |language=en |volume=6 |issue=1 |pages=35333 |doi=10.1038/srep35333 |issn=2045-2322 |pmc=5067562 |pmid=27752054|bibcode=2016NatSR...635333. }} Similar results have been consistently demonstrated by other research teams.{{Cite journal |last1=Brett |first1=Jack D. |last2=Preece |first2=David A. |last3=Becerra |first3=Rodrigo |last4=Whitehouse |first4=Andrew |last5=Maybery |first5=Murray T. |date=2024-08-08 |title=Empathy and Autism: Establishing the Structure and Different Manifestations of Empathy in Autistic Individuals Using the Perth Empathy Scale |journal=Journal of Autism and Developmental Disorders |language=en |doi=10.1007/s10803-024-06491-3 |pmid=39115741 |issn=0162-3257|doi-access=free }}{{Cite journal |last1=Hajdúk |first1=Michal |last2=Pinkham |first2=Amy E. |last3=Penn |first3=David L. |last4=Harvey |first4=Philip D. |last5=Sasson |first5=Noah J. |date=April 2022 |title=Heterogeneity of social cognitive performance in autism and schizophrenia |url=https://onlinelibrary.wiley.com/doi/10.1002/aur.2730 |journal=Autism Research |language=en |volume=15 |issue=8 |pages=1522–1534 |doi=10.1002/aur.2730 |pmid=35460541 |s2cid=248345497 |issn=1939-3792|url-access=subscription }}{{Cite journal |last1=Bird |first1=G. |last2=Cook |first2=R. |date=2013-07-23 |title=Mixed emotions: the contribution of alexithymia to the emotional symptoms of autism |journal=Translational Psychiatry |language=en |volume=3 |issue=7 |pages=e285 |doi=10.1038/tp.2013.61 |issn=2158-3188 |pmc=3731793 |pmid=23880881}}

Additionally, it has been argued that many professionals and, likewise, parents seem to have neglected that reciprocity needs to be mutual and symmetrical. For example, John Constantino's Social Responsiveness Scale,{{Cite book |last=Constantino |first=John N. |title=The social responsiveness scale |publisher=Western Psychological Services |year=2002 |location=Los Angeles, CA}} a 2002 quantitative measure of social reciprocity in children which has since been used extensively in autism research,{{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 }}{{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 }}{{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}}{{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}}{{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}} consisted of the item that asks whether the child "is regarded by other children as odd or weird", which, although seeming 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. 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.

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 cognition between the two groups.{{Cite journal |last=Jackson-Perry |first=David |date=2017-09-14 |title=Autism and Asperger syndrome in adults |journal=Disability & Society |volume=32 |issue=8 |pages=1280–1282 |doi=10.1080/09687599.2017.1362181 |s2cid=149435804 |issn=0968-7599|doi-access=free }}{{Cite journal |last1=Rogers |first1=Kimberley |last2=Dziobek |first2=Isabel |last3=Hassenstab |first3=Jason |last4=Wolf |first4=Oliver T. |last5=Convit |first5=Antonio |date=2007-04-01 |title=Who Cares? Revisiting Empathy in Asperger Syndrome |url=https://doi.org/10.1007/s10803-006-0197-8 |journal=Journal of Autism and Developmental Disorders |language=en |volume=37 |issue=4 |pages=709–715 |doi=10.1007/s10803-006-0197-8 |issn=1573-3432 |pmid=16906462 |s2cid=13999363|url-access=subscription }} 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".

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.{{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}} 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".

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, that interpersonal rapport may be stronger in autistic-autistic interactions than in those between autistic and neurotypical people, and that autistic people may be able to understand and predict each other's thoughts and motivations better than neurotypical people{{Cite journal |last=Chown |first=Nicholas |date=2014-11-26 |title=More on the ontological status of autism and double empathy |url=http://www.tandfonline.com/doi/abs/10.1080/09687599.2014.949625 |journal=Disability & Society |language=en |volume=29 |issue=10 |pages=1672–1676 |doi=10.1080/09687599.2014.949625 |s2cid=143826899 |issn=0968-7599|url-access=subscription }} as well as possibly autistic close relatives.{{Cite journal |last1=Sucksmith |first1=E. |last2=Allison |first2=C. |last3=Baron-Cohen |first3=S. |last4=Chakrabarti |first4=B. |last5=Hoekstra |first5=R. A. |date=2013-01-01 |title=Empathy and emotion recognition in people with autism, first-degree relatives, and controls |journal=Neuropsychologia |language=en |volume=51 |issue=1 |pages=98–105 |doi=10.1016/j.neuropsychologia.2012.11.013 |issn=0028-3932 |pmc=6345368 |pmid=23174401}}

One major factor influencing communication effectiveness is social reciprocity. 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.{{Cite journal |last1=Odom |first1=S. L. |last2=Strain |first2=P. S. |date=1986 |title=A comparison of peer-initiation and teacher-antecedent interventions for promoting reciprocal social interaction of autistic preschoolers. |journal=Journal of Applied Behavior Analysis |volume=19 |issue=1 |pages=59–71 |doi=10.1901/jaba.1986.19-59 |pmc=1308041 |pmid=3710949}}{{Cite journal |last1=McEvoy |first1=Mary A. |last2=Nordquist |first2=Vey M. |last3=Twardosz |first3=Sandra |last4=Heckaman |first4=Kelly A. |last5=Wehby |first5=Joseph H. |last6=Denny |first6=R. Kenton |date=1988 |title=Promoting autistic children's peer interaction in an integrated early childhood setting using affection activities |journal=Journal of Applied Behavior Analysis |language=en |volume=21 |issue=2 |pages=193–200 |doi=10.1901/jaba.1988.21-193 |pmc=1286111 |pmid=3417581}} 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.{{Cite journal |last1=Dawson |first1=Geraldine |last2=Adams |first2=Alexandra |date=June 1984 |title=Imitation and social responsiveness in autistic children |url=http://link.springer.com/10.1007/BF00910664 |journal=Journal of Abnormal Child Psychology |language=en |volume=12 |issue=2 |pages=209–226 |doi=10.1007/BF00910664 |issn=0091-0627 |pmid=6725782 |s2cid=36581183|url-access=subscription }}{{Cite journal |last1=Tiegerman |first1=Ellenmorris |last2=Primavera |first2=Louis H. |date=March 1984 |title=Imitating the autistic child: Facilitating communicative gaze behavior |url=http://link.springer.com/10.1007/BF02408553 |journal=Journal of Autism and Developmental Disorders |language=en |volume=14 |issue=1 |pages=27–38 |doi=10.1007/BF02408553 |issn=0162-3257 |pmid=6706896|s2cid=38198496 |url-access=subscription }} 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.{{Cite journal |last1=Dawson |first1=Geraldine |last2=Galpert |first2=Larry |date=April 1990 |title=Mothers' use of imitative play for facilitating social responsiveness and toy play in young autistic children |url=https://www.cambridge.org/core/product/identifier/S0954579400000675/type/journal_article |journal=Development and Psychopathology |language=en |volume=2 |issue=2 |pages=151–162 |doi=10.1017/S0954579400000675 |issn=0954-5794 |s2cid=145739085|url-access=subscription }}

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".{{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}} 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. 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.

{{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.{{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}}{{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 |pages=100992 |doi=10.1016/j.newideapsych.2022.100992|hdl=10810/59712 |s2cid=253316582 |doi-access=free |hdl-access=free }} Masking begins at a young age as a coping strategy, partly to avoid harassment and bullying,{{Cite journal |last1=Cage |first1=Eilidh |last2=Cranney |first2=Rebekah |last3=Botha |first3=Monique |date=2022-09-01 |title=Brief Report: Does Autistic Community Connectedness Moderate the Relationship Between Masking and Wellbeing? |journal=Autism in Adulthood |language=en |volume=4 |issue=3 |pages=247–253 |doi=10.1089/aut.2021.0096 |issn=2573-9581 |pmc=9645674 |pmid=36606159 }}{{Cite web |last=Drake |first=Kimberly |date=2022-04-19 |title=Masking in Autism: The 'Why' Matters |url=https://psychcentral.com/autism/autism-masking-why |access-date=2023-04-15 |website=Psych Central |language=en}}{{Cite journal |last1=Botha |first1=Monique |last2=Dibb |first2=Bridget |last3=Frost |first3=David M. |date=2022-03-16 |title="Autism is me": an investigation of how autistic individuals make sense of autism and stigma |journal=Disability & Society |language=en |volume=37 |issue=3 |pages=427–453 |doi=10.1080/09687599.2020.1822782 |s2cid=225116488 |issn=0968-7599|doi-access=free |hdl=1893/32042 |hdl-access=free }} which are highly common experiences for autistic children and adults.{{Cite journal |last1=Dickter |first1=Cheryl L. |last2=Burk |first2=Joshua A. |last3=Zeman |first3=Janice L. |last4=Taylor |first4=Sara C. |date=2020-06-01 |title=Implicit and Explicit Attitudes Toward Autistic Adults |journal=Autism in Adulthood |volume=2 |issue=2 |pages=144–151 |doi=10.1089/aut.2019.0023 |issn=2573-9581 |pmc=8992843 |pmid=36601572 |s2cid=212921826}}{{Cite journal |last1=Humphrey |first1=Neil |last2=Hebron |first2=Judith |date=2015-08-03 |title=Bullying of children and adolescents with autism spectrum conditions: a 'state of the field' review |journal=International Journal of Inclusive Education |language=en |volume=19 |issue=8 |pages=845–862 |doi=10.1080/13603116.2014.981602 |issn=1360-3116 |s2cid=12261937|doi-access=free |url=http://eprints.whiterose.ac.uk/119988/1/IJIE%20ASC%20Bullying%20Review%20%28AAM%29.pdf }}{{Cite journal |last1=Weiss |first1=Jonathan A. |last2=Fardella |first2=Michelle A. |date=2018-05-25 |title=Victimization and Perpetration Experiences of Adults With Autism |journal=Frontiers in Psychiatry |volume=9 |pages=203 |doi=10.3389/fpsyt.2018.00203 |issn=1664-0640 |pmc=5980973 |pmid=29887806 |doi-access=free }}{{Cite journal |last1=Schroeder |first1=Jessica H. |last2=Cappadocia |first2=M. Catherine |last3=Bebko |first3=James M. |last4=Pepler |first4=Debra J. |last5=Weiss |first5=Jonathan A. |date=July 2014 |title=Shedding Light on a Pervasive Problem: A Review of Research on Bullying Experiences Among Children with Autism Spectrum Disorders |url=http://link.springer.com/10.1007/s10803-013-2011-8 |journal=Journal of Autism and Developmental Disorders |language=en |volume=44 |issue=7 |pages=1520–1534 |doi=10.1007/s10803-013-2011-8 |issn=0162-3257 |pmid=24464616|s2cid=254567709 |url-access=subscription }} High rates of peer victimization are also seen in autistic children and adults.{{Cite journal |last=Shtayermman |first=Oren |date=2007 |title=Peer Victimization in Adolescents and Young Adults Diagnosed with Asperger's Syndrome: A Link to Depressive Symptomatology, Anxiety Symptomatology and Suicidal Ideation |url=http://www.tandfonline.com/doi/full/10.1080/01460860701525089 |journal=Issues in Comprehensive Pediatric Nursing |language=en |volume=30 |issue=3 |pages=87–107 |doi=10.1080/01460860701525089 |issn=0146-0862 |pmid=17885828|s2cid=38242770 |url-access=subscription }}{{Cite journal |last1=Fisher |first1=Marisa H. |last2=Taylor |first2=Julie Lounds |date=May 2016 |title=Let's talk about it: Peer victimization experiences as reported by adolescents with autism spectrum disorder |journal=Autism |language=en |volume=20 |issue=4 |pages=402–411 |doi=10.1177/1362361315585948 |issn=1362-3613 |pmc=4662636 |pmid=26019304}}

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,{{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}}{{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}}{{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}} has been viewed as a demonstration of non-autistic people's lack of social or emotional reciprocity towards autistic people, 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.

{{See also|Anthropomorphism|Personification}}

An area of social-cognitive strength in autistic people centers upon anthropomorphism.{{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}} A 2018 study has shown that autistic people are likely more prone to object personification,{{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}} 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, autistic participants have outperformed neurotypical participants in a cartoon version of the said test in a 2022 study,{{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}} 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,{{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 }}{{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 }}{{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 }} once again suggesting social-cognitive differences in autistic people, but not global deficits.

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.{{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 }}{{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}} 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. 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.{{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}}

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 stigmatize autistic people,{{Cite journal |last=Gernsbacher |first=Morton Ann |date=2017-08-06 |title=Editorial Perspective: The use of person-first language in scholarly writing may accentuate stigma |journal=Journal of Child Psychology and Psychiatry |language=en |volume=58 |issue=7 |pages=859–861 |doi=10.1111/jcpp.12706 |pmc=5545113 |pmid=28621486}} place the responsibility for autistic-neurotypical misunderstandings solely on autistic people,{{Cite journal |last1=Heasman |first1=Brett |last2=Gillespie |first2=Alex |date=2018 |title=Perspective-taking is two-sided: Misunderstandings between people with Asperger's syndrome and their family members |journal=Autism |language=en |volume=22 |issue=6 |pages=740–750 |doi=10.1177/1362361317708287 |issn=1362-3613 |pmc=6055325 |pmid=28683569}} and dehumanize autistic people by portraying them as unempathetic. Many autistic activists have advocated for the inclusion of autistic people in autism research, promoting the slogan "nothing about us without us".{{Cite book |last=Charlton |first=James I. |url=https://www.worldcat.org/oclc/42417786 |title=Nothing about us without us : disability oppression and empowerment |date=1998 |publisher=University of California Press |isbn=978-0-520-92544-1 |location=Berkeley, CA |oclc=42417786}}{{Cite book |last1=Bertilsdotter Rosqvist |first1=Hanna |url=https://www.worldcat.org/oclc/1150829242 |title=Neurodiversity studies : a new critical paradigm |last2=Chown |first2=Nick |last3=Stenning |first3=Anna |date=2020 |publisher=Routledge |isbn=978-0-429-32229-7 |location=Abingdon, Oxon |oclc=1150829242}} In addition, autistic individuals may tend to have a reliable and scientific understanding of autism that is also less stigmatizing,{{Cite journal |last1=Gillespie-Lynch |first1=Kristen |last2=Kapp |first2=Steven K. |last3=Brooks |first3=Patricia J. |last4=Pickens |first4=Jonathan |last5=Schwartzman |first5=Ben |date=2017 |title=Whose Expertise Is It? Evidence for Autistic Adults as Critical Autism Experts |journal=Frontiers in Psychology |volume=8 |page=438 |doi=10.3389/fpsyg.2017.00438 |issn=1664-1078 |pmc=5368186 |pmid=28400742 |doi-access=free }} 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,{{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 }} and first-hand accounts of autism research, including autoethnographies, blogs,{{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}}{{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}} commentaries,{{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}} and editorials,{{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}} 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. Autism has been described as an epidemic,{{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}} and in some cases, lack of empathy is used to link autism with terrorism. 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.

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.{{Cite journal |last1=Camus |first1=Lorna |last2=Macmillan |first2=Kirsty |last3=Rajendran |first3=Gnanathusharan |last4=Stewart |first4=Mary |date=2022-05-10 |title='I too, need to belong': Autistic adults' perspectives on misunderstandings and well-being |url=https://psyarxiv.com/5mysh/ |journal=PsyArXiv |doi=10.31234/osf.io/5mysh}}{{Cite book |last1=Redman |first1=S. |title=Don't write me off : make the system fair for people with autism |last2=Downie |first2=M. |last3=Rennison |first3=R. |last4=Batten |first4=A. |publisher=National Autistic Society |year=2009 |location=London}}{{Cite journal |last1=Baldwin |first1=Susanna |last2=Costley |first2=Debra |last3=Warren |first3=Anthony |date=October 2014 |title=Employment Activities and Experiences of Adults with High-Functioning Autism and Asperger's Disorder |url=http://link.springer.com/10.1007/s10803-014-2112-z |journal=Journal of Autism and Developmental Disorders |language=en |volume=44 |issue=10 |pages=2440–2449 |doi=10.1007/s10803-014-2112-z |issn=0162-3257 |pmid=24715257|s2cid=254569665 |url-access= }}{{Cite web |date=3 November 2022 |title=Criminal Legal System - Autistic Self Advocacy Network |url=https://autisticadvocacy.org/criminal-legal-system/ |access-date=2023-03-26 |website=Autistic Self Advocacy Network |language=en-US}} Autistic people have increased premature mortality rates and one of the leading causes of death in autistic people is suicide,{{Cite journal |last1=Hirvikoski |first1=Tatja |last2=Mittendorfer-Rutz |first2=Ellenor |last3=Boman |first3=Marcus |last4=Larsson |first4=Henrik |last5=Lichtenstein |first5=Paul |last6=Bölte |first6=Sven |date=March 2016 |title=Premature mortality in autism spectrum disorder |journal=British Journal of Psychiatry |language=en |volume=208 |issue=3 |pages=232–238 |doi=10.1192/bjp.bp.114.160192 |issn=0007-1250 |pmid=26541693 |s2cid=25884060|doi-access=free }} which is likely exacerbated by this stigma and marginalization. Additionally, many autistic people often feel trapped by the stereotypes this largely non-autistic society has of autism,{{Cite journal |last1=Treweek |first1=Caroline |last2=Wood |first2=Chantelle |last3=Martin |first3=Jilly |last4=Freeth |first4=Megan |date=April 2019 |title=Autistic people's perspectives on stereotypes: An interpretative phenomenological analysis |url=https://eprints.whiterose.ac.uk/130341/3/Treweek%252C%20Wood%252C%20Martin%252C%20Freeth%20Autism%202018.pdf |journal=Autism |language=en |volume=23 |issue=3 |pages=759–769 |doi=10.1177/1362361318778286 |issn=1362-3613 |pmid=29848001|s2cid=44086997 }} and have reported changing their behavior (i.e., masking) as a result of those stereotypes. 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.{{Cite book |last=Yergeau |first=Melanie |url=https://www.worldcat.org/oclc/982501293 |title=Authoring autism : on rhetoric and neurological queerness |date=2018 |publisher=Duke University Press |isbn=978-0-8223-7218-9 |location=North Carolina, NC |doi=10.1215/9780822372189 |oclc=982501293}}

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-language impairment, and/or higher support needs is very uncertain, may be confounding, and will require further research.{{Cite journal |last=Yeung |first=Siu Kit |date=2022-07-21 |title=Directions for Open Scholarship in Autism – Embracing Open Scholarship to Meaningfully Improve Lives of Autistic People Together |url=https://psyarxiv.com/xzkjh/ |journal=PsyArXiv |doi=10.31234/osf.io/xzkjh}} Another limitation is most studies on double empathy and bidirectional social interaction are based on western samples, and studies with non-western samples will be worthwhile.

Milton agrees that there currently remain large gaps in this area of research. The vast majority of studies on double empathy, bidirectional communication, and socialization so far have not included autistic children and autistic people who are nonspeaking or have an intellectual disability. There exists a high degree of comorbidity between autism and intellectual disability; roughly 30% of autistic people have an intellectual disability,{{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}}{{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}}{{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|url-access=subscription }}{{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 }} while just roughly 1–3% of the global population or lower has an intellectual disability.{{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 }}{{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}} In addition, roughly 20–30% of autistic children are either nonspeaking or minimally speaking.{{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}} Glass & Yuill (2023) 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 nonspeaking or minimally speaking.

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, Gillespie-Smith et al. (2024){{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}} 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.

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.{{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 }}

Emphasizing that empathy and reciprocity are a "two-way street", 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.{{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 |language=en |volume=49 |issue=1 |pages=59–71 |doi=10.1037/a0028353 |issn=1939-0599 |pmid=22545843}}{{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= }} 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{{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}} – is problematic due to its approach being too narrow, individualistic, and deficit-based,{{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}} as well as how its messaging could contribute to ableism, prejudice, and stigma towards autistic people,{{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 }}{{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}} further widening this double empathy gap.

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,{{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}}{{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}}{{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}} and thus are more likely to use emergency services.{{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}} Despite increased awareness of these health inequities, many autistic people encounter substantial barriers when accessing healthcare services. Shaw et al. (2023) 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) 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".

This expanded framework, further elaborated by Josefson (2024),{{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 }} encompasses:

• the difficulty neurotypical people have relating to or understanding the needs of neurodivergent people,
• the difficulty neurodivergent people have relating to or understanding the needs of neurotypical people, and
• the difficulty urban planners and other designers, whether of products, services, technology, places, systems or processes 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. Fostering neuroinclusive design not only accommodates but actively embraces the diverse perspectives and experiences of all individuals.

The transition through menopause can be particularly difficult for autistic people,{{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}}{{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}} exacerbating existing communication barriers and experiences of misunderstanding in medical contexts. Participants from a study by Brady et al. (2024){{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}} 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) 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. This research underscores the necessity for healthcare professionals to adopt a person-centered, autism-informed approach that respects the unique communication styles of autistic individuals and acknowledges the often-misunderstood symptoms associated with menopause.

{{Portal|Psychology|Society}}

• 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

{{reflist}}

• {{Cite book |last=Milton |first=Damian |url=https://www.worldcat.org/oclc/1019482019 |title=A Mismatch of Salience: Explorations from the Nature of Autism from Theory to Practice |date=2017 |publisher=Pavilion |isbn=978-1-911028-76-5 |location=Hove, East Sussex |oclc=1019482019}}
• {{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}}

• {{Wiktionary-inline|double empathy problem}}
• {{Cite journal |last=Zamzow |first=Rachel |date=2021-07-22 |title=Double empathy, explained |url=https://www.spectrumnews.org/news/double-empathy-explained/ |journal=Spectrum |publisher=Simons Foundation |doi=10.53053/MMNL2849|s2cid=243309008 |doi-access=free }}
• {{Cite journal |last1=Crompton |first1=Catherine J. |date=2021-05-11 |title=Double Empathy: Why Autistic People Are Often Misunderstood |journal=Frontiers for Young Minds |publisher=Frontiers Media |doi=10.3389/frym.2021.554875|issue=|volume=9|first2=Kilee|last2=DeBrabander|last3=Heasman|first3=Brett|last4=Milton|first4=Damian|last5=Sasson|first5=Noah|pages=554875 |doi-access=free |hdl=20.500.11820/94ee032a-6103-470a-bc06-08337dd6b512|hdl-access=free}}
• {{Cite web |last= |date=2020-12-17 |title=Milton's 'double empathy problem': A summary for non-academics |url=https://reframingautism.org.au/miltons-double-empathy-problem-a-summary-for-non-academics/ |publisher=Reframing Autism }}

{{Autism spectrum}}

{{Autism resources}}

Category:Communication

Category:Empathy

Category:Human communication

Category:Neurodiversity

Category:Psychological theories

Category:Sociological theories

Category:Theory of mind