Double empathy problem
The theory of the double empathy problem is a psychological and sociological theory first coined in 2012 by Damian Milton, an autistic autism researcher. This theory proposes that many of the difficulties autistic individuals face when socializing with non-autistic individuals are due, in part, to mismatch and a lack of mutual understanding between the two groups, meaning that most autistic people struggle to understand and empathize with non-autistic people, whereas most non-autistic people also struggle to understand and empathize with autistic people. This lack of mutual understanding may stem from bidirectional differences in dispositions, and experiences between autistic and non-autistic individuals, as opposed to always being an inherent deficit. It has been suggested that it is the mutual responsibility of autistic and non-autistic individuals to overcome the two-way empathy and communication challenges.
Apart from findings that generally demonstrated mismatch effects, some studies have provided evidence for matching effects between autistic individuals, although findings for matching effects with experimental methods are more mixed with both supportive and non-supportive findings. Some studies from the 2010s and 2020s have shown that most autistic individuals are able to socialize and communicate effectively, empathize adequately or effectively, build better rapport, and display social reciprocity with most other autistic individuals. A 2025 systematic review of 52 papers found that most autistic people have generally positive interpersonal relations and communication experiences when interacting with most autistic people, and autistic-autistic interactions were generally associated with better quality of life across various domains. This theory and subsequent findings challenge the commonly held belief that the social skills of all autistic individuals are inherently and universally impaired across contexts, as well as the theory of "mind-blindness" proposed by prominent autism researcher Simon Baron-Cohen in the mid-1990s, which suggested that empathy and theory of mind are universally impaired in autistic individuals.
In recognition of the findings that support the double empathy theory, Baron-Cohen positively acknowledged the theory and related findings in multiple autism research articles, including a 2025 paper on the impact of self-disclosure on improving empathy of non-autistic people towards autistic people to bridge the "double empathy gap", as well as on podcasts and a documentary since the late 2010s. In a 2017 research paper partly co-authored by Milton and Baron-Cohen, the problem of mutual incomprehension between autistic people and non-autistic people was mentioned.
The double empathy concept and related concepts such as bidirectional social interaction have been supported by or partially supported by a substantial number of studies in the 2010s and 2020s, with mostly consistent findings in mismatch effects as well as some supportive but also mixed findings in matching effects between autistic people. The theory and related concepts have the potential to shift goals of interventions and public psychoeducation or stigma reduction regarding autism.
History
Development and spread of mind-blindness theory
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, 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. 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".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. The claim that autistic people lack theory of mind is taught across a wide range of psychology textbooks and promoted by over 75% of the top 500 scholarly articles indexed for "theory of mind" and "autism" on Google Scholar, serving as one of psychology's widely promoted topics throughout psychological literature, practice, and instruction. Mind-blindness has also been embraced by scholars in other disciplinary areas such as sociology, philosophy, economics, anthropology, robotics, and narratology.
Problems with earlier studies on theory of mind and empathy in autism
The mind-blindness hypothesis, in addition to being questioned shortly after its publication, has faced a great deal of criticism from the scientific community over the years, in response to the replication studies that have failed to reveal significant differences in theory of mind between autistic and non-autistic participants, as well as the growing body of evidence for the high degree of heterogeneity in autistic brains at a neurobiological level.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, Baron-Cohen's "Reading the Mind in the Eyes" task, 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. 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.
Furthermore, autism intervention research based on theory of mind has shown little efficacy, 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. 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 has also been called into question by other researchers since the 1990s. 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 of autistic people showing "unimpaired" or even above-average performances in some rather controversial theory-of-mind and empathy measures. Similar results have been consistently demonstrated by other research teams.
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, a 2002 quantitative measure of social reciprocity in children which has since been used extensively in autism research, 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.
Counter-theory to mind-blindness
Around the early 2010s, academics began to suggest that some studies of theory-of-mind and empathy tests may have misinterpreted autistic people having difficulty understanding non-autistic or neurotypical people as being an intrinsic social-cognitive deficit present in autistic individuals. They argued that it seemed more likely that autistic people were specifically having trouble understanding neurotypical people in some contexts, due to differences in experiences, interaction/communication style, and social cognition between the two groups. 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".The claim that autism is characterized by a lack of social or emotional reciprocity has become a truism in academia; for instance, in a 2004 research article examining a hypothesized autism susceptibility gene, the opening line simply stated, without any scientific citations or supporting data, that "impaired reciprocal social interaction is one of the core features of autism". The double empathy theory, subsequent findings, and findings in the broader theory of mind and empathy literature in the 21st century contest common assumptions about autistic people in the fields of psychology and psychiatry, which are often riddled with information regarding autism and theory of mind that is outdated, overgeneralized, empirically questionable with inconsistent findings, and potentially societally harmful, but still often assumed by some researchers, educators, students, and practitioners as factual.
While concepts or ideas similar to double empathy had existed in prior publications, Milton named and significantly expanded on it. Since 2015, there has been an increasing number of research studies, including experimental studies, qualitative research, and real-life social interaction studies, many of which are emerging under the banner of critical autism studies and neurodiversity paradigm, supporting or partially supporting the double empathy theory.
The double empathy theory has been supported or positively recognized by various autism researchers, including Catherine Crompton, Morton Ann Gernsbacher, Baron-Cohen himself, Elizabeth Pellicano, and Sue Fletcher-Watson, the editor-in-chief of the academic journal Autism. The theory has also been approached by research projects in various disciplinary areas, including but not limited to psychology, sociology, philosophy, neuroscience, linguistics, film studies, and design.