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How are Autistic People Perceived? A Reply to Chown, Hughes and Baker-Rogers (2019)

We welcome the Letter to the Editor by Chown et al. (2019) that addresses some of the points raised in our recent article (Alkhaldi et al. 2019). The Double Empathy Problem (DEP) is a major new perspective on autism that appropriately contextualises this condition in society—a society that is perhaps not well-adapted for accommodating people who are different from the majority. Since the DEP was first introduced by Milton (2012) it is likely that the concept has evolved as researchers endeavour to understand and engage with the idea as a researchable topic. Recent empirical articles have paved the way (Alkhaldi et al. 2019; Edey et al. 2016; Sheppard et al. 2016) and Chown et al.’s Letter offers a timely reflection on where we stand. Here, we take the opportunity to respond to some of the key points (appearing as bullet points below) raised by Chown et al. with the aim of advancing thinking on this topic even further.

  • Is it appropriate that Alkhaldi et al. (2019) focus “solely on the difficulties faced by autistic people whereas double empathy posits that NT people have the same difficulties?”

Alkhaldi et al. (2019) state on several occasions that autistic targets are difficult to read by non-autistic/ neurotypical perceivers, but in doing so they do not focus solely on “difficulties faced by autistic people” ; rather the data are interpreted as strongly showing that NT individuals have difficulty perceiving autistic people. Indeed, this is the key message of the article. Possibly, Chown et al. feel the difficulty is attributed to autistic people because Alkhaldi et al. code data at the level of the ‘target,’ which naturally leads to conclusions about the relative readability of different target groups (autistic and NT, in this case).

To expand, in research that implies that one group of individuals is not easy for another group of individuals to read, one can ask the question: “which individual—the perceiver or the target—has the difficulty?” The answer almost certainly is that the difficulty arises due to the interaction of the two (which is, as we understand it, exactly the point that the DEP is making). This simple fact is not changed by the phrasing used to describe the issue. If we say “Neurotypical individuals find it difficult to read autistic people” the difficulty is attributed by implication to the perceiver, whereas if we say “Autistic people are difficult for NT people to read” then the difficulty is implied to reside in the target. But these both actually describe the same findings.

In Sheppard et al. (2016), analyses were conducted at the level of the perceiver and accordingly, results were reported in the format of “NT perceivers have difficulty reading autistic targets”. Sheppard et al. continued by making the point that this mirrors the well-known finding that autistic perceivers find it difficult to read NT targets (the so-called Theory of Mind deficit!). Alkhaldi et al. (2019) report the same effect but have carried out analysis at the level of the target. Consistent with this, the article reports, “Autistic targets are difficult for NT perceivers to read”. This is a rewording, but one that refers to the same phenomenon reported in Sheppard et al. In short, these two articles collectively make a key point that is entirely consistent with DEP, namely that NT people have difficulty perceiving autistic people and autistic people have difficulty perceiving NT people. The articles most certainly do not place the burden of responsibility with autistic people for this problem.

If NT people have difficulty reading autistic people (as they seem to do), probably this really does create a difficulty for autistic people. If being difficult for NT people to read is associated with being disliked then this could be highly problematic for the autistic person. Indeed, the aim of the research by Alkhaldi et al. (2019) was to explore this possible relationship. The fact that NT people are difficult for autistic people to read probably does not have such negative consequences simply because NT individuals are the majority of society and autistic in the minority. Therefore, within the context of this particular piece of research we suggest that it is appropriate to refer to this effect as a difficulty faced by autistic people (due to the negative consequences), but fully acknowledge that the difficulty is the result of the interaction between both parties and is not the fault of autistic people.

  • Should Alkhaldi et al. (2019) have included autistic perceivers to determine whether they fare better than NT perceivers in reading autistic targets?

If the aim had been to investigate how accurately autistic people read other autistic people, relative to how NT people perform in these activities, then it would have been essential to include autistic perceivers as well as autistic targets, NT perceivers and NT targets. The primary aim, though, was to investigate how NT people perceive autistic targets and whether or not they perceive autistic targets differently than NT targets. This is the primary objective in investigating DEP: Are autistic people misperceived by NT people. An interesting additional question concerns whether or not autistic people are relatively accurate and favorably disposed in how they perceive other autistic people but the answer to that question is not key to DEP. Irrespective of how autistic people perceive other autistic people, a problem will arise if different groups misperceive each other. That problem is not mitigated by members of one group proving to be relatively accurate in perceiving other members of their own group. Hence, the aim of Alkhaldi et al. was to explore the relationship between whether a person is easy or difficult to read by NT perceivers, and how socially favorably they are perceived by NT perceivers.

Note that Pillai et al. (2014) have already shown that autistic people have trouble reading the behavior of NTs in these exact same scenarios, consistent with many previous studies that report autistic people having difficulty reading the minds of NT targets (e.g. Baron-Cohen et al. 2001 etc.). These findings are of central relevance to DEP, for they reveal that members of one group are relatively inaccurate in reading another group, but in the opposite direction than reported in Sheppard et al. (2016). In terms of social favorability, DeBrabander et al. (2019) report that autistic perceivers rate non-autistic targets more favorably on several traits, but expressed greater interest in interacting with the autistic targets than non-autistic targets.

  • Does the study by Edey et al. imply that autistic people are difficult for autistic perceivers to read?

In the article by Edey et al. (2016), autistic targets were relatively difficult to interpret by autistic perceivers as well as NT perceivers; it was not the case that autistic perceivers were more accurate in interpreting the behavior of autistic targets compared with NT perceivers. In short, autistic people do not have greater difficulty reading autistic targets than they have in reading NT targets, but being autistic does not confer any advantage to an autistic perceiver in interpreting the behavior of an autistic target. This seems like a fair summary of an aspect of results reported by Edey et al. and it is echoed in Alkhaldi et al. when referring to Edey et al.

  • Did the “waiting scenario” (Alkhaldi et al. 2019; Pillai et al. 2012, 2014; Sheppard et al. 2016), cause autistic targets to feel anxious due to previous experiences of having been ignored?

Sheppard et al. (2016) discuss the possibility that autistic people experience different mental states in the scenarios, compared with NT targets, and that this might potentially account for difficulty NT individuals have in reading their behavior—although no speculation was offered on what these different mental states might be. At present we cannot be sure whether this is the case, or whether, for example, autistic people experience the same states but express them differently. This a challenging but important issue to clarify for future research.

In relation to the general question of what scenarios to use in research on this topic, these should indeed be designed in partnership with autistic people to ensure that the scenarios do not cause undue distress to any targets participating in the study. Hence it is valuable and indeed appropriate to recognize expertise by experience in the autism community. Obviously, there are many considerations when designing the scenarios as they need to be plausible within the context, and easy enough for a researcher to be able to deliver in convincing fashion.

In summing up, we warmly welcome the comments articulated in the Letter by Chown et al., which make a valuable contribution to the ongoing discussion of DEP. The concepts of DEP are not fixed in stone but evolve thanks to the kinds of intellectual contribution from Chown et al., thanks to efforts to operationalise elements of DEP into researchable questions (which presents a formidable challenge) and thanks to emerging data that provide vital clarification in the matter. We hope this reply to Chown et al. will also contribute to the progress in this new and highly productive perspective on autism in society.

References

  1. Alkhaldi, R. S., Sheppard, E., & Mitchell, P. (2019). Is there a link between autistic people being perceived unfavorably and having a mind that is difficult to read? Journal of Autism and Developmental Disorders,49(10), 3973–3982.

  2. Baron-Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The “Reading the Mind in the Eyes” Test revised version: A study with normal adults, and adults with Asperger syndrome or high-functioning autism. Journal of Child Psychology and Psychiatry and Allied Disciplines,42(2), 241–251.

  3. Chown, N., Hughes, L., & Baker-Rogers, J. (2019). What about the other side of double empathy? A response to Alkhaldi, Sheppard and Mitchell’s JADD article concerning mind-reading difficulties in autism. Journal of Autism and Developmental Disorders,50(2), 683–684.

  4. DeBrabander, K. M., Morrison, K. E., Jones, D. R., Faso, D. J., Chmielewski, M., & Sasson, N. J. (2019). Do first impressions of autistic adults differ between autistic and nonautistic observers? Autism in Adulthood,1(4), 250–257.

  5. Edey, R., Cook, J., Brewer, R., Johnson, M. H., Bird, G., & Press, C. (2016). Interaction takes two: Typical adults exhibit mind-blindness towards those with autism spectrum disorder. Journal of Abnormal Psychology,125(7), 879–885.

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

  7. Pillai, D., Sheppard, E., & Mitchell, P. (2012). Can people guess what happened to others from their reactions? PLoS ONE,7(11), e49859.

  8. Pillai, D., Sheppard, E., Ropar, D., Marsh, L., Pearson, A., & Mitchell, P. (2014). Using other minds as a window onto the world: Guessing what happened from clues in behaviour. Journal of Autism and Developmental Disorders,44(10), 2430–2439.

  9. Sheppard, E., Pillai, D., Wong, G. T. L., Ropar, D., & Mitchell, P. (2016). How easy is it to read the minds of people with autism spectrum disorder? Journal of Autism and Developmental Disorders,46(4), 1247–1254.

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Acknowledgments

Rabi Samil Alkhaldi is funded by a Saudi Government Scholarship from the Saudi Arabian Cultural Bureau (SACB).

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Correspondence to Elizabeth Sheppard.

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Sheppard, E., Mitchell, P. & Alkhaldi, R.S. How are Autistic People Perceived? A Reply to Chown, Hughes and Baker-Rogers (2019). J Autism Dev Disord (2020). https://doi.org/10.1007/s10803-020-04401-x

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