4/09 The Double Empathy Problem

For decades, the dominant explanation for why autistic people struggle socially has pointed in one direction: something is wrong with the autistic person. Impaired theory of mind. Deficits in empathy. Poor social communication.

In 2012, Damian Milton, an autistic academic and father of an autistic child, published a five-page paper in Disability & Society that challenged the entire framing. His argument was simple and quietly radical: the social difficulties autistic people experience aren't a deficit located inside one person. They're a breakdown in mutual understanding between two people with fundamentally different ways of experiencing and moving through the world. And crucially, that breakdown runs both ways.

This session also functions as a thread that ties together everything DNA has discussed this year. Masking, burnout, interoception, minority stress: a lot of it looks different once you take the deficit out of the autistic person and put it back where Milton argues it belongs, in the interaction.

Reading Questions:

• What is the double empathy problem, and why does it matter that an autistic researcher named it? Milton argues that the double empathy problem refers to a breakdown in mutual understanding that can happen between any two people, but is more likely to occur when people of very differing dispositions attempt to interact. Within exchanges between autistic and non-autistic people, the locus of the problem has traditionally been seen to reside in the brain of the autistic person, resulting in autism being framed primarily as a social communication disorder rather than as a mutual and interpersonal issue. We'll ask what it means that this reframe came from inside the autistic community rather than from clinical research. (Milton, 2012) Sage Journals

• What does "theory of mind" actually measure, and whose mind does it test for? The theory of mind framework, the idea that autistic people can't read others' mental states, is the foundation of the deficit model Milton is critiquing. Milton argues that the theory of mind so lauded in normative psychological models refers to the ability a neurotypical individual has to assume understandings of the mental states of other people, and that when such empathy is applied toward an autistic person it is often wildly inaccurate. In other words, neurotypical people fail the autistic theory of mind test too. They just don't get tested on it. (Milton, 2012) Kent Academic Repository

• What happens when autistic people talk to each other? Crompton et al. tested the double empathy theory directly using an information transfer task, a structured version of the telephone game, across all-autistic, all-non-autistic, and mixed groups. They found that autistic peer-to-peer information transfer was highly effective, consistent with prior research indicating that autistic people experience close social bonds and empathy with other autistic people, though may experience specific difficulty interacting with non-autistic people. The social deficit doesn't show up when autistic people are talking to each other. That's a striking finding. (Crompton et al., 2020) Sage Journals

• What does this mean for how we interpret masking? If social difficulties are a product of cross-neurotype mismatch rather than autistic deficit, then masking isn't compensation for a broken social brain. It's the work autistic people do to bridge a gap that runs in both directions but whose burden falls entirely on one side. Connect this back to what Botha and Frost found about minority stress, and to Raymaker et al.'s findings on burnout. Who is being asked to do the translation work, and what does that cost? (Milton, 2012; Crompton et al., 2020)

• Does the double empathy problem extend to ADHD? Milton's original paper focused on autism, but the logic applies more broadly. We'll ask whether cross-neurotype communication difficulties show up between ADHD and non-ADHD people in similar ways, and whether the research supports extending the framework. This is relatively underexplored in the literature and is a good place to think critically about the limits of a theory. (Milton, 2012)

• If the problem is mutual, why is the solution always placed on autistic people? A double empathy approach emphasizes that social interactions are bidirectional with both parties equally contributing to poor outcomes, in contrast to a deficit model that attributes poor cross-neurotype interactions exclusively to the autistic person and places the onus on them to change. We'll close by asking what it would look like for institutions, classrooms, and workplaces to take that seriously. What would Duke look like if non-autistic people were equally responsible for bridging the gap? PubMed Central

• Design a study: how would you test the double empathy problem in a college environment? Crompton's telephone game paradigm is clever but controlled. What would a study look like that tested cross-neurotype communication in a realistic college setting, lectures, group projects, office hours? What would you measure and how?

Papers we're reading

• Milton, D. E. M. (2012). On the ontological status of autism: The 'double empathy problem.' Disability & Society, 27(6), 883–887.

• Crompton, C. J., Ropar, D., Evans-Williams, C. V. M., Flynn, E. G., & Fletcher-Watson, S. (2020). Autistic peer-to-peer information transfer is highly effective. Autism, 24(7), 1704–1712.

• Milton, D. E. M., Gurbuz, E., & López, B. (2022). The 'double empathy problem': Ten years on. Autism, 26(8), 1901–1903.

Why this matters

Everything DNA has discussed this year, the circadian mismatch between neurodivergent bodies and institutional schedules, the immune cost of chronic stress, the interoceptive differences that make burnout hard to catch before it lands, the minority stress of navigating spaces not built for you: all of it sits differently once you accept Milton's premise. The problem was never located inside neurodivergent people. It was always in the gap between two different ways of being human, and in who gets asked to close it.