![](https://assets.reachrx.ai/images/10.1192%E2%98%8Dbjp.2025.10478/_page_0_Picture_2.jpeg) ## Letter # Autism diagnosis and the double empathy problem Catherine J. Crompton ### Keywords Autism; autism spectrum disorder; post-diagnostic support; autism spectrum condition. #### Copyright and usage © The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists. Rates of autism diagnosis continue to rise, with an increasing number of diagnoses made in adulthood.¹ Although many report receiving a diagnosis as a positive milestone, the diagnostic process can be challenging owing to the pathologising and deficit-based language of diagnostic criteria, including 'deficits in socialemotional reciprocity', 'abnormal social approaches' and an 'absence of interest in peers'. Psychology, linguistics, neuroscience and philosophy have led a recent shift in autism research. Instead of autistic communication being studied at the individual level, interactions are examined at the dyadic level within a 'double empathy' framework,, which refers to the 'disjuncture in reciprocity between two differently disposed social actors who hold different norms and expectations of each other,' such as autistic and non-autistic people.³ By comparing how autistic and non-autistic people interact with people of the same (i.e. autistic pairs, non-autistic pairs) and different (i.e. one autistic person, one non-autistic person) diagnostic statuses, we can learn more about how the diagnostic status of an interaction partner shapes the way that people communicate. Research shows two key findings. First, communication difficulties are not exclusive to autistic people; non-autistic individuals also struggle to understand autistic social behaviours, leading to a 'double' problem in mixed-neurotype interactions.4 Second, autistic people prefer interacting with other autistic people and share information just as effectively with other autistic people as do non-autistic people with other non-autistic people.⁵ However, information-sharing breaks down in mixed-neurotype interactions.⁵ Autistic people disclose more to, feel closer to and empathise more with other autistic individuals than with non-autistic people.[6](#page-1-0) What does this mean for autism, as clinically defined by deficits in social and communicative behaviours? The current research shows that many social difficulties experienced by autistic people are not due to an individual deficit or an intrinsic autistic failure of social behaviours, but rather a mismatch between the way that autistic people behave, experience the world and communicate and the way that the non-autistic majority do. Autistic people can interact very well with autistic others, and, during autistic interactions with non-autistic people, both parties experience similar difficulties.⁵ Understanding autism social difficulties contextually rather than individually is important for three reasons. First, for autistic self-understanding: the way autistic people interact is not deficient, it is different to that of the non-autistic majority. This understanding can reduce self-stigma and help autistic people find ways to communicate that work for them, without resorting to masking their autistic behaviours to adhere to non-autistic norms, which can be damaging to their mental health. Second, for designing support systems for autistic people: encouraging ways to communicate that support autistic communicative styles and provide opportunities to engage with other autistic people. Finally, for non-autistic people: to understand that the non-autistic way is one way of communicating, but it has limitations. It is not superior to autistic ways of communication (as indicated by studies of how autistic people share information and build rapport with other autistic people just as well as nonautistic people do with non-autistic people5 ), merely different. Rather than the myriad 'social skills' interventions that encourage autistic people to learn non-autistic social norms, it is time to consider how non-autistic people can meet autistic people half-way. How can these findings be embedded into clinical practice? First, it is important to consider the pathologising nature of language used in diagnosis[7](#page-1-0) and understand that although autistic and non-autistic communication styles may be different, that does not mean one is superior to the other. Second, given the relative ease with which some autistic people interact with other autistic people, peer support has been suggested as a promising model for post-diagnostic support[.8](#page-1-0) Although postdiagnostic peer support pilots have shown promising results, provision is geographically inequitable[.8](#page-1-0) However, encouragement to engage with an autistic community after diagnosis may be beneficial for autistic adults[9](#page-1-0) in the absence of formal peer support. Catherine J. Crompton , PhD, Senior Research Fellow, Usher Institution of Population Health Sciences, University of Edinburgh, Edinburgh, UK; and Institute for Neuroscience and Cardiovascular Research, University of Edinburgh, Edinburgh, UK Email: [catherine.crompton@ed.ac.uk](mailto:catherine.crompton@ed.ac.uk) First received 23 Sep 2025, final revision 20 Oct 2025, accepted 22 Oct 2025 ## Funding This study received no specific grant from any funding agency, commercial or not-for-profit sectors. ## Declaration of interest None. ## References - 1 Russell G, Stapley S, Newlove-Delgado T, Salmon A, White R, Warren F, et al. Time trends in autism diagnosis over 20 years: a UK population-based cohort study. J Child Psychol Psychiatry 2022; 63: 674–82. - 2 Kiehl I, Pease R, Hackmann C. The adult experience of being diagnosed with autism spectrum disorder: a qualitative meta-synthesis. Autism 2024; 28: 1060–74. - 3 Milton D, Heasman B, Sheppard E. Double empathy. In Encyclopedia of Autism Spectrum Disorders (ed F Volkmar). Springer, 2018. - 4 Edey R, Cook J, Brewer R, Johnson MH, Bird G, Press C. Interaction takes two: typical adults exhibit mind-blindness towards those with autism spectrum disorder. J Abnorm Psychol 2016; 125: 879. - 5 Crompton CJ, Ropar D, Evans-Williams CV, Flynn EG, Fletcher-Watson S. Autistic peer-to-peer information transfer is highly effective. Autism 2020; 24: 1704–12. - 6 Komeda H, Kosaka H, Fujioka T, Jung M, Okazawa H. Do individuals with autism spectrum disorders help other people with autism spectrum disorders? An investigation of empathy and helping motivation in adults with autism spectrum disorder. Front Psychiatry 2019; 10: 376. - 7 Bottema-Beutel K, Kapp SK, Lester JN, Sasson NJ, Hand BN. Avoiding ableist language: suggestions for autism researchers. Autism Adulthood 2021; 3: 18–29. - 8 Crompton CJ, Hallett S, McAuliffe C, Stanfield AC, Fletcher-Watson S. "A group of fellow travellers who understand": interviews with autistic people about postdiagnostic peer support in adulthood. Front Psychol 2022; 13: 831628. - 9 Watts G, Crompton C, Grainger C, Long J, Botha M, Somerville M, et al. 'A certain magic' – autistic adults' experiences of interacting with other autistic people and its relation to quality of life: a systematic review and thematic meta-synthesis. Autism 2025; 29: 2239–53.