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Neurodiversity Series Part 2 - The Double Empathy Problem

Read our introduction (Part 1) here


In this blog post, we will explore the "traditional mindset" that "social deficits" experienced by autistics are the main reason behind communication breakdowns as well as how the "Double Empathy Problem" challenges this and suggests that it is actually due to the lack of understanding of communication styles from both parties - autistics and neurotypical individuals.


The traditional approach


The Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition (DSM-V) is the main diagnostic tool used in Australia to determine if "an individual fulfils the requirements to be considered autistic". According to the DSM-V, an individual must present with "persistent deficits in three areas of social communication and interaction and at least two out of four types of restricted, repetitive behaviours". Traditionally, it has been taught that communication breakdowns are mainly due to these "deficits"/"difficulties" that autistics experience:


"Autistics are rude because they don't look at you when conversing with you" "Autistics don't understand social situations because they cannot read between the lines"

"Autistics can't make friends because they can't take turns in conversations".


Unfortunately these long-standing perception of "social deficits" have made a negative impact on how neurotypicals perceive/judge autistics and subsequently impact on these how interactions play out. These "social deficits" are also the goals that speech pathologists target and work on with autistic individuals in speech therapy.


The Double Empathy Problem


Back in the 1990s, it was suggested by autistic activities such as Jim Sinclair that the communication style of autistics simply differ from those of neurotypicals. The Double Empathy problem was then first formally suggested in a 2012 paper by Damien Milton.


The Double Empathy Problem, like many other terms and theories, is considered a relatively new theory by some. This is one of many that were suggested as we move towards learning more from autistic individuals themselves and move away from looking at autistic individuals from a deficit model's perspective.


The Double Empathy problem challenges the traditional approach of looking at the reason behind communication breakdowns that occurs when autistics and neurotypicals communicate/interact. It suggests that the problem lies with both parties - the autistic community and the neurotypical population - having a lack of understanding how each party's communication styles which leads to misunderstandings and communication breakdowns.


Many autistic individuals have actually spent a significant amount of time observing and learning the communication styles of neurotypicals so that they can "mask" their differences. This is extremely exhausting and more often than not causes burnouts or shutdowns and serious mental health issues such as anxiety, depression and a loss of identity. Many have spent their lives learning and therefore know more about the neurotypical's communication style more than how much a neurotypical knows and understands about an autistic individual's communication style.


Autistic individuals have reported that they are more comfortable communicating and interacting with fellow autistics. They often are able to build a greater sense of rapport and do not feel the need to mask. This is most likely because they understand each other's communication style and are not bothered by the lack of "typical social norms" in our interactions.


When communicating with autistic adults in my practice, I find it unnecessary to mask because it makes the interaction enjoyable. We are able to have meaningful back and forth conversations without necessarily looking at each other all the time. We understand and allow each other to have longer turns if the other party has a huge chunk of information they need to share, "interrupt" each other's turn if needed, and engage in self-stimulatory (stemming) behaviour without being judged.


I remember a particular incident that happened during my time at university. I was cleaning and preparing the therapy room in a rush as my course mate's previous session went overtime. I was panicking and focusing on cleaning and getting the room ready to see the little girl waiting in the waiting room.


You'll have to understand that eye contact can be very challenging for me. I have worked on my capacity to maintain "appropriate" eye contact during conversations over the years and understand the importance of it from a neurotypical's point of view. I try to do it the best I can in social situations but it doesn't change the fact that engaging in eye contact makes it very challenging for me to process what was said and organise my thoughts in a coherent way fast enough to keep the conversation going.


My clinical educator started talking to me about my course mate's session. I was working on trying to multi-task the best I can and did not have the capacity to engage in eye contact with her. Suddenly, the atmosphere changed and my clinical educator's tone of voice dropped. I vividly remember her saying, "You need to look at me when I talk to you. You are not listening and it's rude". I was so taken aback. I apologised profusely as I felt extremely guilty for "getting caught" and not being able to mask effectively but was I not listening? Absolutely not. I was processing what she was saying and responding to her questions. If you were listening to an audio recording of our conversation, you probably wouldn't be able to pick up that anything was "wrong" or "socially inappropriate". I often wonder if how the situation might have played out differently if my clinical educator had some insight as to how I communicated or whether she understood the impact of her words on my mental health and sense of identity.



Make the switch to be more neurodiversity-affirming when delivering Speech Therapy

  1. Strive to learn more about how autistics and other Neurodivergent individuals communicate and function. Listen to what these neurodivergent individuals are advocating for and learn from their lived experiences. Accept that there isn't a "right way" of doing things, just many different ways. Joining and learning from Facebook groups such as Autism Inclusivity is a fantastic way to start. For health professionals, check out groups such as the "Australian Neurodiversity Affirming health professionals" and websites such as Therapist Neurodiversity Collective

  2. Be an ally! www.guidetoallyship.com

  3. Be aware of the type of language you are using when describing or communicating with neurodivergent individuals. Avoid ableist (discriminatory and negative) language such as "challenging behaviours", "high/low functioning", and "restricted interests". Try using language such as "preferred style", and "focused/passionate interests".

  4. Make the switch to strength-based reporting


Speech Pathologists Adelaide


Speech Pathologists at Nurture Speech Pathology is passionate about learning directly from autistic individuals themselves to educate us on how we can better understand and support them in an empathetic and respectful way. We hope that you join us in our journey to learn more about how to be neurodiversity-affirming and to spark a change in the way we interact and support neurodivergent individuals.


Speech Pathologists Near Me


Looking for neurodiversity-affirming Speech Pathologists near you? Contact us at 0403 118 979 or admin@nurturespeechpathology.com.au to discuss whether we are a right fit for you and your child.

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