Double empathy problem

This lack of mutual understanding may stem from bidirectional differences in dispositions (e.g., communication style, social-cognitive characteristics), and experiences between autistic and non-autistic individuals, as opposed to always being an inherent deficit.

[14][19] The theory and related concepts have the potential to shift goals of interventions and public psychoeducation or stigma reduction regarding autism.

[16] 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".

[35] 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.

[55] The mind-blindness hypothesis, in addition to being questioned shortly after its publication,[18] has faced a great deal of criticism from the scientific community over the years,[45][56] 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,[57][58][59] as well as the growing body of evidence for the high degree of heterogeneity in autistic brains at a neurobiological level.

[45] There have been some successful replications demonstrating differences in theory of mind and empathy with some measures such as the Frith–Happé Animations Test,[63] Baron-Cohen's "Reading the Mind in the Eyes" task,[64][65] 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.

[45] Such mixed and inconsistent findings with many different measures have raised doubts regarding the generalizability and validity of the mind-blindness theory of autism.

[2][92][93] 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".

[5][11][66][97][101] The theory has also been approached by research projects in various disciplinary areas,[26] including but not limited to psychology, sociology,[110] philosophy,[111] neuroscience,[4][112] linguistics,[102] film studies,[113] and design.

[2][125][126] Masking begins at a young age as a coping strategy, partly to avoid harassment and bullying,[127][128][129] which are highly common experiences for autistic children and adults.

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.

Acknowledging these differences which may affect communication within and between autistic and non-autistic groups, Gillespie-Smith et al. (2024)[172] 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.

[164][173] Emphasizing that empathy and reciprocity are a "two-way street",[2][85] 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.

[27][181][182] Shaw et al. (2023)[182] 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.

Shaw et al. (2023)[182] constructed a model illustrating a chronological journey that outlines how barriers to healthcare access can lead to detrimental health outcomes for autistic individuals.

[182] This expanded framework, further elaborated by Josefson (2024),[184] encompasses: 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.

[184] The transition through menopause can be particularly difficult for autistic people,[185][186] exacerbating existing communication barriers and experiences of misunderstanding in medical contexts.

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.