Empathy in Autism and the Art of Asking

I have always felt empathetic, at times almost overly empathetic. By this, I mean how deeply I am affected, not that I necessarily understand more than other people do. I can feel other people’s pain in my own body. Their emotions evoke strong reactions in me, while understanding what they feel and need can be difficult. In practice, I have learned to ask directly. I would argue that uncertainty about what another person needs can be part of caring when it prompts me to listen and explore.

When Strong Feelings Meet Difficulties in Interpretation

I am on the autism spectrum. In the article by Wood and colleagues (2026), I find a possible explanation for the combination of strong emotional reactions and difficulty interpreting emotions. Their model, the Emotion Regulation and Recognition Account, or ERRA, proposes that emotional overwhelm can shift attention away from the person evoking the reaction. As a result, cues needed to understand that person may be missed.

The researchers studied 103 autistic and 40 non-autistic children aged six to thirteen. The children watched five videos depicting different emotional expressions. On average, autistic children reported stronger emotional reactions than the comparison group, while recognising the emotions less accurately.

One specific finding concerned variation across videos within the same child: In videos where a child looked away more than their own average across the videos, emotion recognition was less accurate. This association was stronger in the autistic group. Similarly, physiological reactivity above a child’s own average was associated with more gaze aversion in both groups. Reactivity was measured through changes in electrical skin responses compared with periods showing neutral videos.

However, the study provides preliminary support for an explanation, rather than proof of the proposed causal sequence. The children were verbally fluent, the autistic group had an eligibility requirement of an IQ above 85, and missing measurements reduced the sample in several analyses. The researchers also measured what the children said they would want to do, rather than actual comforting or helping behaviour. The main article reports no measurement of alexithymia, which may be relevant to emotion interpretation. The model therefore cannot simply be used to explain how autistic people generally react and behave.

Difficulties interpreting emotions may have several explanations. Alexithymia refers to difficulty identifying and describing one’s own emotions and is also associated with difficulty recognising emotions in others. In two experiments, Cook and colleagues (2013) found that alexithymia, rather than the degree of autism, was associated with less precise interpretation of emotional facial expressions. Alexithymia and autism are distinct concepts; not all autistic people have alexithymia (Bird & Cook, 2013). This adds relevant nuance to what may underlie difficulties in interpretation, but I cannot tell from the research whether it applies to me.

Recognising myself in the ERRA model nevertheless matters to me. It gives me language for an experience that can otherwise be difficult to explain: I can be deeply affected without knowing how to respond to someone’s pain. This essay takes my own experience as its starting point; it does not describe how all autistic people experience empathy.

Feeling Does Not Always Mean Understanding

I can imagine a situation in which a friend is sitting in front of me, upset. My body reacts strongly, but I do not know what my friend needs. I ask: “Would you like me just to stay here, or is there something I can help with?” If they want to talk, I can ask more about what is hurting them. Understanding can then develop without requiring the person to explain everything at once.

Researchers often distinguish between affective empathy, sharing or feeling with another person’s emotions, and cognitive empathy, understanding their emotional state and perspective. These concepts make it easier to see that emotional closeness and accurate understanding do not always go together. Wood and colleagues (2026) also examined emotional synchrony: whether the child’s reaction was similar or complementary to the emotion depicted in the video, such as concern for a child who was crying. The intensity of the child’s reaction and how that reaction related to the other person’s emotion were therefore separate measures.

Here lies a philosophical challenge concerning empathy. Feeling pain does not mean that I know your pain as you know it. My reaction is real, but it does not give me certain knowledge of your experience. Strong emotional involvement can create confidence that I have understood when I have insufficient grounds for that confidence. Caring therefore also requires a willingness to be corrected.

Understanding Must Work Both Ways

Interaction between people also plays a role. Damian Milton (2012) describes the double empathy problem: Misunderstandings between autistic and non-autistic people can occur in both directions. This perspective shifts attention from a deficit within one individual to difficulties in mutual understanding within an interaction.

When others interpret my questions as a lack of motivation, this may be just such a mutual misunderstanding. I struggle to understand their needs; they struggle to understand why I am asking. I can make my intention clear: “I would like to help, but I need you to tell me what would be helpful for you.” They can meet me halfway by expressing their needs directly, rather than waiting for me to read them from their face or the situation.

Asking as an Act of Care

Asking also has ethical significance. The person in pain gains a say in the help they receive. I give their account more weight than my initial interpretation. But questions must be asked thoughtfully. Someone in considerable pain may not have the energy to explain much. I can then offer simple options or begin by being present. Responsibility for understanding must be shared, without placing the entire burden on the person who is struggling.

This makes it necessary to consider how we judge care. A quick, intuitive response may help, but it may also miss the mark. A question may appear hesitant while opening the way to more appropriate help. We should consider both the desire to help and what the help actually means to the person receiving it.

I do not need to be certain that I understand in order to show that I care. Uncertainty can serve a practical and ethical purpose: It keeps my understanding open to the person I want to connect with.

When I ask how I can help, I am trying to give the strong feeling a direction that the other person can benefit from.

References

Bird, G., & Cook, R. (2013). Mixed emotions: The contribution of alexithymia to the emotional symptoms of autism. Translational Psychiatry, 3(7), Article e285. https://doi.org/10.1038/tp.2013.61

Cook, R., Brewer, R., Shah, P., & Bird, G. (2013). Alexithymia, not autism, predicts poor recognition of emotional facial expressions. Psychological Science, 24(5), 723–732. https://doi.org/10.1177/0956797612463582

Milton, D. E. M. (2012). On the ontological status of autism: The ‘double empathy problem’. Disability & Society, 27(6), 883–887. https://doi.org/10.1080/09687599.2012.710008

Wood, J. J., Orm, S., Wood, K. S., Straus, J., Wolpe, S., Morrissey, A., Cornejo Guevara, M., & Crowell, S. E. (2026). The emotion regulation and recognition account of empathy-related processes in autism: A multimodal, multilevel case–control study. Journal of Child Psychology and Psychiatry. Advance online publication. https://doi.org/10.1111/jcpp.70249