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The double empathy theory and many subsequent findings contest common assumptions about autistic people in the fields of psychology and [[psychiatry]], which are often riddled with outdated information regarding autism and theory of mind.<ref>{{Cite journal |last=Marocchini |first=Eleonora |date=2023-02-01 |title=Impairment or difference? The case of Theory of Mind abilities and pragmatic competence in the Autism Spectrum |url=https://www.cambridge.org/core/product/identifier/S0142716423000024/type/journal_article |journal=Applied Psycholinguistics |language=en |pages=1–19 |doi=10.1017/S0142716423000024 |issn=0142-7164}}</ref>
The double empathy theory and many subsequent findings contest common assumptions about autistic people in the fields of psychology and [[psychiatry]], which are often riddled with outdated information regarding autism and theory of mind.<ref>{{Cite journal |last=Marocchini |first=Eleonora |date=2023-02-01 |title=Impairment or difference? The case of Theory of Mind abilities and pragmatic competence in the Autism Spectrum |url=https://www.cambridge.org/core/product/identifier/S0142716423000024/type/journal_article |journal=Applied Psycholinguistics |language=en |pages=1–19 |doi=10.1017/S0142716423000024 |issn=0142-7164}}</ref>


Studies that have used autistic-autistic pairs to test interpersonal [[rapport]] and communication effectiveness in adults have shown that autistic adults perform better in interpersonal rapport and communication effectiveness when paired with other autistic adults, that higher rapport may be present 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 [[Thought|thoughts]] and [[Motivation|motivations]] better than neurotypical people<ref name=":3" /> as well as possibly autistic close family members.<ref>{{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 |pmid=23174401 |pmc=6345368 |issn=0028-3932}}</ref>
Studies that have used autistic-autistic pairs to test interpersonal [[rapport]] and communication effectiveness in adults have shown that autistic adults perform better in interpersonal rapport and communication effectiveness when paired with other autistic adults, that higher rapport may be present 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 [[Thought|thoughts]] and [[Motivation|motivations]] better than neurotypical people<ref name=":3" /><ref>{{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 |issn=0968-7599}}</ref> as well as possibly autistic close relatives.<ref>{{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 |pmid=23174401 |pmc=6345368 |issn=0028-3932}}</ref> Some autistic people also appear to possess a heightened understanding and sensitivity towards [[Animal|animals]].<ref>{{Cite journal |last=Prothmann |first=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}}</ref>


Non-autistic people tend to have a poor understanding of autistic people, just as autistic people may have a poor understanding of non-autistic people.<ref name=":1" /><ref name=":20" /><ref>{{Cite journal |last=Sasson |first=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 |url=https://www.nature.com/articles/srep40700 |journal=Scientific Reports |language=en |volume=7 |issue=1 |pages=40700 |doi=10.1038/srep40700 |issn=2045-2322 |pmc=5286449 |pmid=28145411}}</ref><ref name=":16" /> Whilst autistic people sometimes have difficulties in understanding non-autistic people and struggle to socialise with non-autistic people, most non-autistic people often hold negative views or [[Bias|biases]] regarding autistic differences and struggle to understand autistic people's communication, emotions, and intentions, resulting in and contributing to this "double empathy problem".<ref name=":20" />
Non-autistic people tend to have a poor understanding of autistic people, just as autistic people may have a poor understanding of non-autistic people.<ref name=":1" /><ref name=":20" /><ref>{{Cite journal |last=Sasson |first=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 |url=https://www.nature.com/articles/srep40700 |journal=Scientific Reports |language=en |volume=7 |issue=1 |pages=40700 |doi=10.1038/srep40700 |issn=2045-2322 |pmc=5286449 |pmid=28145411}}</ref><ref name=":16" /> Whilst autistic people sometimes have difficulties in understanding non-autistic people and struggle to socialise with non-autistic people, most non-autistic people often hold negative views or [[Bias|biases]] regarding autistic differences and struggle to understand autistic people's communication, emotions, and intentions, resulting in and contributing to this "double empathy problem".<ref name=":20" />
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It is likely that autistic people understand non-autistic people to a higher degree than vice versa, due to the frequency of [[Masking (personality)|masking]] – i.e., adopting neurotypical behaviours and diminishing one's autistic traits and/or [[personality]] to better camouflage and [[Passing (sociology)|pass]] within a non-autistic [[society]].<ref name=":1" /><ref>{{Cite journal |last=Pearson |first=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 |url=https://www.liebertpub.com/doi/10.1089/aut.2020.0043 |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> Masking begins at a young age in order to avoid [[bullying]], a common experience for autistic children and adults.<ref>{{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 |pmid=36601572 |pmc=8992843 |s2cid=212921826 |issn=2573-9581}}</ref><ref>{{Cite journal |last=Humphrey |first=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 |url=http://www.tandfonline.com/doi/full/10.1080/13603116.2014.981602 |journal=International Journal of Inclusive Education |language=en |volume=19 |issue=8 |pages=845–862 |doi=10.1080/13603116.2014.981602 |issn=1360-3116}}</ref> The bullying targeted at 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 |url=https://www.frontiersin.org/articles/10.3389/fpsyg.2021.727542/full |journal=Frontiers in Psychology |volume=12 |pages=727542 |doi=10.3389/fpsyg.2021.727542 |issn=1664-1078 |pmc=8506216 |pmid=34650484}}</ref><ref name=":6">{{Cite journal |last=Botha |first=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 |url=https://www.frontiersin.org/articles/10.3389/fpsyg.2022.1050897/full |journal=Frontiers in Psychology |volume=13 |pages=1050897 |doi=10.3389/fpsyg.2022.1050897 |issn=1664-1078 |pmc=9730396 |pmid=36506950}}</ref> further suggests that neurotypical people generally lack empathy towards autistic people, which further supports the double empathy theory.
It is likely that autistic people understand non-autistic people to a higher degree than vice versa, due to the frequency of [[Masking (personality)|masking]] – i.e., adopting neurotypical behaviours and diminishing one's autistic traits and/or [[personality]] to better camouflage and [[Passing (sociology)|pass]] within a non-autistic [[society]].<ref name=":1" /><ref>{{Cite journal |last=Pearson |first=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 |url=https://www.liebertpub.com/doi/10.1089/aut.2020.0043 |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> Masking begins at a young age in order to avoid [[bullying]], a common experience for autistic children and adults.<ref>{{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 |pmid=36601572 |pmc=8992843 |s2cid=212921826 |issn=2573-9581}}</ref><ref>{{Cite journal |last=Humphrey |first=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 |url=http://www.tandfonline.com/doi/full/10.1080/13603116.2014.981602 |journal=International Journal of Inclusive Education |language=en |volume=19 |issue=8 |pages=845–862 |doi=10.1080/13603116.2014.981602 |issn=1360-3116}}</ref> The bullying targeted at 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 |url=https://www.frontiersin.org/articles/10.3389/fpsyg.2021.727542/full |journal=Frontiers in Psychology |volume=12 |pages=727542 |doi=10.3389/fpsyg.2021.727542 |issn=1664-1078 |pmc=8506216 |pmid=34650484}}</ref><ref name=":6">{{Cite journal |last=Botha |first=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 |url=https://www.frontiersin.org/articles/10.3389/fpsyg.2022.1050897/full |journal=Frontiers in Psychology |volume=13 |pages=1050897 |doi=10.3389/fpsyg.2022.1050897 |issn=1664-1078 |pmc=9730396 |pmid=36506950}}</ref> further suggests that neurotypical people generally lack empathy towards autistic people, which further supports the double empathy theory.


An area of social-cognitive strength in autistic people centres upon [[anthropomorphism]].<ref>{{Cite journal |last=Atherton |first=Gray |last2=Cross |first2=Liam |date=2018-04-17 |title=Seeing More Than Human: Autism and Anthropomorphic Theory of Mind |url=http://journal.frontiersin.org/article/10.3389/fpsyg.2018.00528/full |journal=Frontiers in Psychology |volume=9 |pages=528 |doi=10.3389/fpsyg.2018.00528 |issn=1664-1078 |pmc=5932358 |pmid=29755383}}</ref> A 2018 study has shown that autistic people are 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=http://journals.sagepub.com/doi/10.1177/1362361318793408 |journal=Autism |language=en |volume=23 |issue=4 |pages=1042–1045 |doi=10.1177/1362361318793408 |pmid=30101594 |s2cid=51969215 |issn=1362-3613}}</ref> suggesting that autistic empathy may be not only more complex but also more 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">{{Cite journal |last=Baron‐Cohen |first=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 |issn=0021-9630}}</ref> autistic participants have outperformed neurotypical participants in a [[cartoon]] version of said test in a 2022 study,<ref>{{Cite journal |last=Cross |first=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 |url=https://onlinelibrary.wiley.com/doi/10.1002/aur.2782 |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.
An area of social-cognitive strength in autistic people centres upon [[anthropomorphism]].<ref>{{Cite journal |last=Atherton |first=Gray |last2=Cross |first2=Liam |date=2018-04-17 |title=Seeing More Than Human: Autism and Anthropomorphic Theory of Mind |url=http://journal.frontiersin.org/article/10.3389/fpsyg.2018.00528/full |journal=Frontiers in Psychology |volume=9 |pages=528 |doi=10.3389/fpsyg.2018.00528 |issn=1664-1078 |pmc=5932358 |pmid=29755383}}</ref> A 2018 study has shown that autistic people are 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=http://journals.sagepub.com/doi/10.1177/1362361318793408 |journal=Autism |language=en |volume=23 |issue=4 |pages=1042–1045 |doi=10.1177/1362361318793408 |pmid=30101594 |s2cid=51969215 |issn=1362-3613}}</ref> suggesting that autistic empathy may be not only more complex but also more 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">{{Cite journal |last=Baron‐Cohen |first=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 |issn=0021-9630}}</ref> autistic participants have outperformed neurotypical participants in a [[cartoon]] version of said test in a 2022 study,<ref>{{Cite journal |last=Cross |first=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 |url=https://onlinelibrary.wiley.com/doi/10.1002/aur.2782 |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> one again supporting the view of social-cognitive differences rather than deficits in the autistic population.


== Autistic perspectives ==
== Autistic perspectives ==
Autistic theory of mind 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}}</ref> If autistic people were inherently poor at social communication, an interaction between a pair of autistic people would logically be more of a struggle than one between an autistic and neurotypical person.<ref name=":2" /><ref name=":3" />
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}}</ref><ref>{{Cite journal |last=Hadjikhani |first=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 |url=https://www.nature.com/articles/tp2013113 |journal=Translational Psychiatry |language=en |volume=4 |issue=1 |pages=e343–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" />


Many [[autistic activists]] have shown support for the double empathy concept, and have argued that past studies done on theory of mind in autism have served to [[Social stigma|stigmatise]] autistic people,<ref name=":0" /><ref name=":23" /> blame autistic-neurotypical misunderstandings solely on autistic people,<ref name=":16">{{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}}</ref> and [[dehumanise]] autistic people by portraying them as unempathetic.<ref name=":6" /> This lack of understanding and resultant stigma and [[marginalisation]] felt by autistic people in social settings may negatively impact upon their [[mental health]], [[employment]], accessibility to education and services, and experiences with the [[criminal justice system]].<ref name=":5" /><ref>{{Cite web |date= |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}}</ref><ref>{{Cite journal |last=Camus |first=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://osf.io/5mysh |journal=PsyArXiv |doi=10.31234/osf.io/5mysh}}</ref>
Many [[autistic activists]] have shown support for the double empathy concept, and have argued that past studies done on theory of mind in autism have served to [[Social stigma|stigmatise]] autistic people,<ref name=":0" /><ref name=":23" /> blame autistic-neurotypical misunderstandings solely on autistic people,<ref name=":16">{{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}}</ref> and [[dehumanise]] autistic people by portraying them as unempathetic.<ref name=":6" /> This lack of understanding and resultant stigma and [[marginalisation]] felt by autistic people in social settings may negatively impact upon their [[mental health]], [[employment]], accessibility to education and services, and experiences with the [[criminal justice system]].<ref name=":5" /><ref>{{Cite web |date= |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}}</ref><ref>{{Cite journal |last=Camus |first=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://osf.io/5mysh |journal=PsyArXiv |doi=10.31234/osf.io/5mysh}}</ref>
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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 disputes their [[autonomy]], devalues their [[self-determination]], and discredits their [[credibility]].<ref>{{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}}</ref> In addition, research has shown that autistic people are more likely to be dehumanised by non-autistic people,<ref>{{Cite journal |last=Cage |first=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}}</ref> and first-hand accounts of autism research, including [[autoethnographies]],<ref name=":30" /> [[Blog|blogs]],<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 |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? |url=https://www.liebertpub.com/doi/10.1089/aut.2021.0019 |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|editorials]],<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 that autism research is often dehumanising to autistic people.<ref name=":6" /> Milton has also 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>{{Cite journal |last=Milton |first=Damian |date=2014 |title=Autistic expertise: A critical reflection on the production of knowledge in autism studies |url=http://journals.sagepub.com/doi/10.1177/1362361314525281 |journal=Autism |language=en |volume=18 |issue=7 |pages=794–802 |doi=10.1177/1362361314525281 |pmid=24637428 |s2cid=206715678 |issn=1362-3613}}</ref>
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 disputes their [[autonomy]], devalues their [[self-determination]], and discredits their [[credibility]].<ref>{{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}}</ref> In addition, research has shown that autistic people are more likely to be dehumanised by non-autistic people,<ref>{{Cite journal |last=Cage |first=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}}</ref> and first-hand accounts of autism research, including [[autoethnographies]],<ref name=":30" /> [[Blog|blogs]],<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 |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? |url=https://www.liebertpub.com/doi/10.1089/aut.2021.0019 |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|editorials]],<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 that autism research is often dehumanising to autistic people.<ref name=":6" /> Milton has also 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>{{Cite journal |last=Milton |first=Damian |date=2014 |title=Autistic expertise: A critical reflection on the production of knowledge in autism studies |url=http://journals.sagepub.com/doi/10.1177/1362361314525281 |journal=Autism |language=en |volume=18 |issue=7 |pages=794–802 |doi=10.1177/1362361314525281 |pmid=24637428 |s2cid=206715678 |issn=1362-3613}}</ref>


== Limitations, criticisms, and future directions ==
== Limitations and future directions ==
As the literature on double empathy is still relatively young, the generalisability of double empathy findings to younger autistic children as well as autistic people with an [[intellectual disability]], [[Speech and language impairment|speech-language impairment]], and/or [[Low-functioning autism|higher support needs]] is unknown, may be confounding, and will require further research.<ref name=":2" /><ref name=":21">{{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://osf.io/xzkjh |journal=PsyArXiv |doi=10.31234/osf.io/xzkjh}}</ref>
As the literature on double empathy is still relatively young, the generalisability of double empathy findings to younger autistic children as well as autistic people with an [[intellectual disability]], [[Speech and language impairment|speech-language impairment]], and/or [[Low-functioning autism|higher support needs]] is unknown, may be confounding, and will require further research.<ref name=":2" /><ref name=":21">{{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://osf.io/xzkjh |journal=PsyArXiv |doi=10.31234/osf.io/xzkjh}}</ref>


Milton agrees that there currently remain large gaps in this area of research.<ref name=":9" /> Bidirectional communication and socialisation studies so far have seemingly only included autistic people who are not [[Nonverbal autism|nonverbal]] and do not have an intellectual disability,<ref name=":25" /><ref name=":2" /> which is a limitation of the double empathy studies considering the high degree of [[comorbidity]] between autism and intellectual disability; roughly 30% of autistic people have an intellectual disability,<ref>{{Cite journal |last=Bilder |first=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 |url=http://link.springer.com/10.1007/s10803-012-1664-z |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 |last=Polyak |first=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://onlinelibrary.wiley.com/doi/10.1002/ajmg.b.32338 |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}}</ref><ref> {{Cite journal |last=Katusic |first=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 |issn=0031-4005}} </ref><ref>{{Cite journal |last=Shenouda |first=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 |issn=0031-4005}}</ref> while just roughly 1–3% of the global population or lower has an intellectual disability.<ref>{{Cite journal |last=McKenzie |first=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 |url=http://link.springer.com/10.1007/s40474-016-0085-7 |journal=Current Developmental Disorders Reports |language=en |volume=3 |issue=2 |pages=104–115 |doi=10.1007/s40474-016-0085-7 |issn=2196-2987}}</ref><ref>{{Cite journal |last=McBride |first=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 |doi=10.23889/ijpds.v6i1.1342 |issn=2399-4908 |pmc=8188522 |pmid=34164584}}</ref> Moreover, double empathy and bidirectional communication studies typically fail to take into account the vast differences in autism and factors like masking, which may interfere with autistic people's ability to communicate and empathise with one another. The [[Jon Entine#Genetic Literacy Project|Genetic Literacy Project]] has criticised Milton's work to improve communication between autistic and neurotypical people by claiming it oversimplifies the ways different autistic people process information and communicate.<ref>{{Cite web |last=Williams |first=Bill |date=2021-11-01 |title=Viewpoint: Advocacy or orthodoxy? How the neurodiversity movement that has sought to normalize autism is changing, and not always for the best |url=https://geneticliteracyproject.org/2021/11/01/viewpoint-advocacy-or-orthodoxy-how-the-neurodiversity-movement-that-has-sought-to-normalize-autism-is-changing-and-not-always-for-the-best/ |access-date=2023-03-31 |website=Genetic Literacy Project |language=en-US}}</ref>
Milton agrees that there currently remain large gaps in this area of research.<ref name=":9" /> Bidirectional communication and socialisation studies so far have seemingly only included autistic people who are not [[Nonverbal autism|nonverbal]] and do not have an intellectual disability,<ref name=":25" /><ref name=":2" /> which is a limitation of the double empathy studies considering the high degree of [[comorbidity]] between autism and intellectual disability; roughly 30% of autistic people have an intellectual disability,<ref>{{Cite journal |last=Bilder |first=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 |url=http://link.springer.com/10.1007/s10803-012-1664-z |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 |last=Polyak |first=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://onlinelibrary.wiley.com/doi/10.1002/ajmg.b.32338 |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}}</ref><ref> {{Cite journal |last=Katusic |first=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 |issn=0031-4005}} </ref><ref>{{Cite journal |last=Shenouda |first=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 |issn=0031-4005}}</ref> while just roughly 1–3% of the global population or lower has an intellectual disability.<ref>{{Cite journal |last=McKenzie |first=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 |url=http://link.springer.com/10.1007/s40474-016-0085-7 |journal=Current Developmental Disorders Reports |language=en |volume=3 |issue=2 |pages=104–115 |doi=10.1007/s40474-016-0085-7 |issn=2196-2987}}</ref><ref>{{Cite journal |last=McBride |first=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 |doi=10.23889/ijpds.v6i1.1342 |issn=2399-4908 |pmc=8188522 |pmid=34164584}}</ref> Moreover, double empathy and bidirectional communication studies typically fail to take into account the vast differences in autism and factors like masking, which may interfere with autistic people's ability to communicate and empathise with one another. The [[Jon Entine#Genetic Literacy Project|Genetic Literacy Project]] has criticised Milton's work to improve communication between autistic and neurotypical people by claiming it oversimplifies the ways different autistic people process information and communicate.<ref>{{Cite web |last=Williams |first=Bill |date=2021-11-01 |title=Viewpoint: Advocacy or orthodoxy? How the neurodiversity movement that has sought to normalize autism is changing, and not always for the best |url=https://geneticliteracyproject.org/2021/11/01/viewpoint-advocacy-or-orthodoxy-how-the-neurodiversity-movement-that-has-sought-to-normalize-autism-is-changing-and-not-always-for-the-best/ |access-date=2023-03-31 |website=Genetic Literacy Project |language=en-US}}</ref>


Conceptual replications and further studies on double empathy are needed in different groups, including siblings of autistic people, non-autistic pupils in [[School|schools]] including autistic peers, late-diagnosed autistic adults, parents of autistic children, and autism service providers.<ref name=":18" /><ref name=":21" /> Emphasising that empathy is a "two-way street",<ref name=":1" /> Milton, along with other researchers, proposes 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 |last=Chapple |first=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 |url=https://www.frontiersin.org/articles/10.3389/fpsyg.2021.708375/full |journal=Frontiers in Psychology |volume=12 |pages=708375 |doi=10.3389/fpsyg.2021.708375 |issn=1664-1078 |pmc=8354525 |pmid=34385964}}</ref> It has also been suggested that the [[medical model of autism]] should be moved away from due to how its messaging could contribute to [[prejudice]] and stigma towards autistic people,<ref name=":6" /><ref>{{Cite journal |last=Milton |first=Damian |date=2014-06-06 |title=Autism: a social and medical history |url=http://www.tandfonline.com/doi/abs/10.1080/09687599.2014.905281 |journal=Disability & Society |language=en |volume=29 |issue=6 |pages=991–992 |doi=10.1080/09687599.2014.905281 |issn=0968-7599}}</ref><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 |url=https://www.tandfonline.com/doi/full/10.1080/09687599.2017.1328157 |journal=Disability & Society |language=en |volume=32 |issue=7 |pages=1090–1095 |doi=10.1080/09687599.2017.1328157 |issn=0968-7599}}</ref><ref>{{Cite journal |last=Bottema-Beutel |first=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 |url=https://www.liebertpub.com/doi/10.1089/aut.2020.0014 |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><ref>{{Cite journal |last=Pellicano |first=Elizabeth |last2=Houting |first2=Jacquiline |date=November 2021 |title=Annual Research Review: Shifting from ‘normal science’ to neurodiversity in autism science |url=https://onlinelibrary.wiley.com/doi/10.1111/jcpp.13534 |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> further widening this double empathy gap.
Conceptual replications and further studies on double empathy are needed in different groups, including siblings of autistic people, non-autistic pupils in [[School|schools]] including autistic peers, late-diagnosed autistic adults, parents of autistic children, and autism service providers.<ref name=":18" /><ref name=":21" /> Emphasising that empathy is a "two-way street",<ref name=":1" /> Milton, along with other researchers, proposes 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 |last=Jaarsma |first=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 |issn=1065-3058}}</ref><ref>{{Cite journal |last=Chapple |first=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 |url=https://www.frontiersin.org/articles/10.3389/fpsyg.2021.708375/full |journal=Frontiers in Psychology |volume=12 |pages=708375 |doi=10.3389/fpsyg.2021.708375 |issn=1664-1078 |pmc=8354525 |pmid=34385964}}</ref> It has also been suggested that the [[medical model of autism]] should be moved away from due to how its messaging could contribute to [[prejudice]] and stigma towards autistic people,<ref name=":6" /><ref>{{Cite journal |last=Milton |first=Damian |date=2014-06-06 |title=Autism: a social and medical history |url=http://www.tandfonline.com/doi/abs/10.1080/09687599.2014.905281 |journal=Disability & Society |language=en |volume=29 |issue=6 |pages=991–992 |doi=10.1080/09687599.2014.905281 |issn=0968-7599}}</ref><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 |url=https://www.tandfonline.com/doi/full/10.1080/09687599.2017.1328157 |journal=Disability & Society |language=en |volume=32 |issue=7 |pages=1090–1095 |doi=10.1080/09687599.2017.1328157 |issn=0968-7599}}</ref><ref>{{Cite journal |last=Bottema-Beutel |first=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 |url=https://www.liebertpub.com/doi/10.1089/aut.2020.0014 |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><ref>{{Cite journal |last=Pellicano |first=Elizabeth |last2=Houting |first2=Jacquiline |date=November 2021 |title=Annual Research Review: Shifting from ‘normal science’ to neurodiversity in autism science |url=https://onlinelibrary.wiley.com/doi/10.1111/jcpp.13534 |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> further widening this double empathy gap.


== See also ==
== See also ==

Revision as of 18:39, 11 April 2023

Autistic and non-autistic people can find it difficult to understand each other. The fact that both people in the interaction have trouble with understanding is why the theory is called the double empathy problem.[1]
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The double empathy problem is a theory in psychology and sociology, coined in 2012 by autistic autism researcher Damian Milton,[2] which proposes that the social and communication difficulties present in autistic people when socialising with non-autistic people are due to a reciprocal lack of understanding and bidirectional differences in communication style, social-cognitive characteristics, and experiences between autistic people and non-autistic people, but not necessarily an inherent deficiency as most autistic people are able to socialise, communicate,[3] empathise well,[4][5] and display good social reciprocity[6] with most other autistic people.[2][7]

Having the potential to radically shift goals of interventions, public psychoeducation, and how autism is seen in the public and diagnosed, the theory of the double empathy problem fundamentally challenges both the common notion that the social skills of autistic people are inherently impaired, as well as the theory of "mind-blindness", developed by Professor Simon Baron-Cohen, which proposes that empathy and theory of mind are generally impaired in autistic people.[8][9][10] The idea that autistic people lack empathy is empirically questionable and has since been disputed due to many failed replications and mixed findings with many different operationalisations and measures.[11][12][13][14][15][16]

The double empathy concept has now been consistently supported by a substantial number of studies over the last few years.[17] In a podcast in December 2020[18] and in two research articles in 2018[19] and 2022,[20] Baron-Cohen positively recognised the theory of the double empathy problem and recent findings that support it.

History

The development and spread of mind-blindness theory

Main article: Mind-blindness

Earlier studies on autism regarding theory of mind and empathy had concluded that a lack of theory of mind was one of the primary symptoms of autism. The most popular of these studies were those led by Simon Baron-Cohen in the 1980s and 1990s, who used the term "mind-blindness" to describe his theory in an attempt to empirically explain the tendency of autistic people to avoid eye contact,[8][9][21] 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.[10]

Mind-blindness implies an inability to make sense of and predict another person's behaviour, and to attribute mental states such as knowledge, beliefs, desires, emotions, and intentions to oneself and others.[22][23] The claim that autistic people lack theory of mind is taught across a wide range of psychology textbooks[24][25][26][27][28][29][30] and promoted by over 75% of the top 500 scholarly articles indexed for "theory of mind" and "autism" on Google Scholar,[12][31] serving as one of psychology's widely promoted topics throughout psychological literature, practice, and instruction.[32][33][34] Mind-blindness has also been embraced by scholars in other disciplinary areas such as sociology,[35] philosophy,[36] economics,[37] anthropology,[38] robotics,[39] and narratology.[40]

Problems with mind-blindness theory

The mind-blindness hypothesis, in addition to being questioned shortly after its publication,[11] has faced a great deal of criticism from the scientific community over the years,[12][14][15][16][41] in response to the many failed replications of classic theory-of-mind studies[42][43][44] and the growing body of evidence for the heterogeneity of autism.[45]

Researchers were found creating new measures in an attempt to support the mind-blindness hypothesis when existing measures were not adequate.[12] There have been some successful replications with some measures such as Baron-Cohen's "Reading the Mind in the Eyes" task[46][47] and self-report empathy questionnaires – which have been criticised for not considering social interaction contexts, reference groups, and substantially lowered social-desirability bias of autistic individuals.[48] However, several independent teams have repetitively failed to replicate highly cited and widely taught findings with false-belief tasks such as the Sally–Anne test.[12] Such mixed and inconsistent findings with many different measures have raised doubts regarding the generalisability and validity of the empathy-deficit model of autism.[12][49]

Furthermore, 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.[50] 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[51][52][53] has also been called into question by other researchers since the 1990s.[54][55][56][57][58][59]

Counter-theory to mind-blindness

Around the early 2010s, academics began to suggest that some studies of theory-of-mind tests may have misinterpreted autistic people having difficulty understanding non-autistic or neurotypical people as being an intrinsic social difficulty present in autistic individuals. It seems more likely that autistic people are specifically having trouble understanding neurotypical people in some contexts, due to the neurological differences between the two groups.[2][60][61] 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, 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".[2]

Whilst the concept of double empathy had existed in prior publications,[62] Milton named and significantly expanded on it.[2][13][17][63] Since 2015, there has been an increasing number of research studies, including experimental studies, qualitative research, and real-life social interaction studies supporting the double empathy theory and the findings appear consistent.[3][4][5][6][64][65][66][67][68][69][70][71] Supported by many researchers including Baron-Cohen himself,[18][19][20] the double empathy theory has also been approached by research projects in various disciplinary areas,[17] including but not limited to psychology, sociology,[72] philosophy,[73] neuroscience,[65][74] linguistics,[70] film studies,[75] and design.[76]

Neurologically-aligned studies

The double empathy theory and many subsequent findings contest common assumptions about autistic people in the fields of psychology and psychiatry, which are often riddled with outdated information regarding autism and theory of mind.[77]

Studies that have used autistic-autistic pairs to test interpersonal rapport and communication effectiveness in adults have shown that autistic adults perform better in interpersonal rapport and communication effectiveness when paired with other autistic adults, that higher rapport may be present 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[5][78] as well as possibly autistic close relatives.[79] Some autistic people also appear to possess a heightened understanding and sensitivity towards animals.[80]

Non-autistic people tend to have a poor understanding of autistic people, just as autistic people may have a poor understanding of non-autistic people.[2][64][81][82] Whilst autistic people sometimes have difficulties in understanding non-autistic people and struggle to socialise with non-autistic people, most non-autistic people often hold negative views or biases regarding autistic differences and struggle to understand autistic people's communication, emotions, and intentions, resulting in and contributing to this "double empathy problem".[64]

It is likely that autistic people understand non-autistic people to a higher degree than vice versa, due to the frequency of masking – i.e., adopting neurotypical behaviours and diminishing one's autistic traits and/or personality to better camouflage and pass within a non-autistic society.[2][83] Masking begins at a young age in order to avoid bullying, a common experience for autistic children and adults.[84][85] The bullying targeted at autistic people, along with the problem of ableism in autism research,[86][87] further suggests that neurotypical people generally lack empathy towards autistic people, which further supports the double empathy theory.

An area of social-cognitive strength in autistic people centres upon anthropomorphism.[88] A 2018 study has shown that autistic people are more prone to object personification,[89] suggesting that autistic empathy may be not only more complex but also more 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,[46] autistic participants have outperformed neurotypical participants in a cartoon version of said test in a 2022 study,[90] one again supporting the view of social-cognitive differences rather than deficits in the autistic population.

Autistic perspectives

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.[91][92] 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.[3][5]

Many autistic activists have shown support for the double empathy concept, and have argued that past studies done on theory of mind in autism have served to stigmatise autistic people,[7][41] blame autistic-neurotypical misunderstandings solely on autistic people,[82] and dehumanise autistic people by portraying them as unempathetic.[87] This lack of understanding and resultant stigma and marginalisation 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.[13][93][94]

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 disputes their autonomy, devalues their self-determination, and discredits their credibility.[95] In addition, research has shown that autistic people are more likely to be dehumanised by non-autistic people,[96] and first-hand accounts of autism research, including autoethnographies,[86] blogs,[97][98] commentaries,[99] and editorials,[32][100] have described that autism research is often dehumanising to autistic people.[87] Milton has also described the belief that autistic people lack theory of mind as a myth analogous to the now-discredited theory that vaccines cause autism.[101]

Limitations and future directions

As the literature on double empathy is still relatively young, the generalisability of double empathy findings to younger autistic children as well as autistic people with an intellectual disability, speech-language impairment, and/or higher support needs is unknown, may be confounding, and will require further research.[3][102]

Milton agrees that there currently remain large gaps in this area of research.[17] Bidirectional communication and socialisation studies so far have seemingly only included autistic people who are not nonverbal and do not have an intellectual disability,[1][3] which is a limitation of the double empathy studies considering the high degree of comorbidity between autism and intellectual disability; roughly 30% of autistic people have an intellectual disability,[103][104][105][106] while just roughly 1–3% of the global population or lower has an intellectual disability.[107][108] Moreover, double empathy and bidirectional communication studies typically fail to take into account the vast differences in autism and factors like masking, which may interfere with autistic people's ability to communicate and empathise with one another. The Genetic Literacy Project has criticised Milton's work to improve communication between autistic and neurotypical people by claiming it oversimplifies the ways different autistic people process information and communicate.[109]

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.[69][102] Emphasising that empathy is a "two-way street",[2] Milton, along with other researchers, proposes 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.[13][17][64][110][111] It has also been suggested that the medical model of autism should be moved away from due to how its messaging could contribute to prejudice and stigma towards autistic people,[87][112][113][114][115] further widening this double empathy gap.

See also

References

  1. ^ a b Crompton, Catherine J.; DeBrabander, Kilee; Heasman, Brett; Milton, Damian; Sasson, Noah J. (2021-05-11). "Double Empathy: Why Autistic People Are Often Misunderstood". Frontiers for Young Minds. 9: 554875. doi:10.3389/frym.2021.554875. ISSN 2296-6846.{{cite journal}}: CS1 maint: unflagged free DOI (link)
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Further reading

External links

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