Nuances of double empathy in autistic and non-autistic people: examination using the empathic accuracy paradigm

Social communication difficulties in autism were traditionally attributed to deficits in empathy, that is, understanding others' mental states and responding to these with a similar or appropriate emotion, within autistic individuals. The double empathy problem theory proposes that difficulties with cross-neurotype empathy are bidirectional. This study examines predictions from the double empathy problem theory, mainly whether autistic and non-autistic individuals differ in their empathy towards autistic versus non-autistic social targets, using an empathic accuracy paradigm alongside self-report measures of empathy and empathic interest.

A novel empathic accuracy stimulus featuring video-recorded autobiographical stories from five autistic and five non-autistic adult storytellers was used. Participants [141 autistic, 94 non-autistic; mean age: 49.09 years (SD = 16.41)] were recruited through the Cambridge Autism Research Database. Each participant viewed two stories (one autistic, one non-autistic storyteller) in a randomized design, continuously rated storytellers' emotional valence, and globally rated the degree to which they believed the storytellers felt each of 12 discrete emotions. Accuracy was computed as concordance with storytellers' own ratings. Participants also self-reported empathy and empathic interest toward the storyteller in the target videos. Mixed linear models examined the effects of rater neurotype, target neurotype, and their interaction. Participants' text responses were qualitatively analyzed using an inductive, data-driven approach to identify patterns within the data, which converged into subthemes and themes.

No significant main effects emerged for rater or target neurotype on continuous valence or specific emotions' empathic accuracy. A trend-level interaction (p=.059, d = 0.13) suggested that autistic raters showed relatively higher continuous valence empathic accuracy toward autistic targets than non-autistic raters. Non-autistic raters reported significantly higher self-reported empathy (p<.001, d=-0.67) and empathic interest (p<.001, d=-0.43) regardless of target neurotype. Qualitative analysis revealed that autistic participants described difficulties in identifying emotions and in performing the EA task, and engaged in metacognitive introspection, while non-autistic participants focused more on task design feedback.

The use of video-based experimental design may not fully capture the complexity of spontaneous social encounters. The self-selected sample of autistic participants may not represent the full autism spectrum or include individuals requiring greater support, potentially affecting generalizability.

Findings suggest partial support for the double empathy problem theory and potential underestimation of autistic participants of their own empathic abilities. Individual variability patterns caution against treating neurotypes as homogeneous categories that alone determine double empathy processes. Future research should examine real-world interactions and include measures of autistic traits across participants.