Abstract

As diagnoses of autism spectrum disorder (ASD) rise, the neurodiversity and autistic self-advocacy movements have challenged traditional deficit-based clinical models and called for more inclusive, affirming approaches to care. Recent research disputes the long-held belief that autistic individuals have deficits in perspective-taking, revealing that miscommunication between autistic and neurotypical individuals results from mutual misunderstanding, a concept known as the double empathy problem (DEP; Milton, 2012), with the triple empathy problem (TEP) extending this framework to healthcare settings. Our study investigates the consequences of the DEP and TEP within clinical environments, focusing on interactions between neurotypical speech-language pathologists (SLPs) and adult autistic clients. Through the use of multiperspectival interpretive phenomenological analysis (MIPA) we analyze in-depth interviews with both adult autistic clients and neurotypical SLPs. We then compared and contrasted perspectives to explore the DEP and TEP, as well as barriers and facilitators to neuroinclusive care. Findings reveal two themes that converged between clinician and autistic participants: the foundational role of authentic, mutual relationships in fostering positive clinical experiences, and the significant impact of power dynamics on clinical trajectories. We also found that, while autistic clients valued speech therapy as a tool for societal integration, they often experienced heteronomy in the clinical environment and rarely advocated for changes, even when therapy misaligned with their needs. Neurotypical clinicians reported barriers to the provision of neuroinclusive care including inadequate educational preparation, inadequate professional support and environmental constraints, yet expressed a strong sense of responsibility to optimize client outcomes. We propose the Neuroinclusive Implementation of Clinical Empathy (NICE) model, a new theoretical framework that extends triple empathy theory to clinical practice, with mutual understanding and shared decision-making as foundational prerequisites for neuroinclusive clinical environments. Our findings and proposed model highlight the need for clinicians to move beyond deficit-based models, prioritize authentic relationships, and empower autistic clients as equitable stakeholders in their care.

Degree

MS

College and Department

David O. McKay School of Education; Communication Disorders

Rights

https://lib.byu.edu/about/copyright/

Date Submitted

2025-08-05

Document Type

Thesis

Keywords

double empathy problem, triple empathy problem, autism, speech-language pathology, consequences, qualitative research

Language

english

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