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Autism in Couple Relationships

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Autism in Couple Relationships

Part of the early appeal of dating an autistic person for a person who is not autistic can be a sense that they are different that they have a mind that can grasp astonishing complexity, they are wonderfully attentive, have deep compassion, are fair-minded, are very talented in their field, extremely loyal or different in ways that are intriguing but not yet fully apparent. Indeed the early stages of dating may not indicate the long-term relationship issues that can occur. On both sides, there can be expectations of how a long-term relationship “should” be, each informed by their own culture or way of thinking. We have learned through our vast clinical experience that approaching relationships between autistic and non-autistic individuals can be likened to a cultural exchange programme, where there needs to be understanding and acceptance of each person’s culture for the relationship to succeed. Certainly, this is true in all relationships but it plays out more significantly when one partner in the relationship is autistic.

The early stages of dating may not indicate the long-term relationship issues associated with autism. The autistic partner may have initially camouflaged and suppressed their autistic characteristics to be more attractive to a non-autistic partner. They may have acquired a dating ‘script’ from watching romantic movies and created a ‘mask’ or artificial persona. However, gradually the mask is removed, and it becomes apparent that the autistic partner does not intuitively know long-term relationship skills.

Theory of Mind

Some of the issues in the relationship can be due to aspects of ‘Theory of Mind’, a psychological term that describes the ability to read facial expressions, body language, tone of voice and social context to determine what someone is thinking or feeling. Both partners experience this. We have known for some decades that autism is associated with Theory of Mind difficulties, and these are part of the diagnostic criteria. However, the non-autistic partner can also have difficulty ‘reading’ the inner thoughts and feelings of their autistic partner. This is described as the Double Empathy issue (Milton, 2012). The autistic partner may not express subtle emotions in facial expressions, tone of voice and body language.

In a conversation, the autistic partner can struggle to find the words to express thoughts and feelings due to aspects of interoception and alexithymia. That is the sensory perception of the body signals that indicate emotional states such as heart rate and breathing (interoception) and being able to translate the emotions that you feel or remember into speech (alexithymia). This will affect the ability of the autistic person to disclose their inner world and communicate their feelings. As the relationship progresses, the non-autistic partner will anticipate increasing self-disclosure as a sign of the depth of the relationship and trust. The non-autistic partner must recognise that their autistic partner has genuine difficulty perceiving and communicating their inner world.

Social engagement

Autistic adults can achieve successful social engagement, but this may be by intellect rather than intuition and often with social guidance from the non-autistic partner. Social occasions are mentally exhausting and energy-draining. In contrast, the non-autistic partner may find that social experiences require little mental energy and may create energy. The non-autistic partner may reluctantly agree to reduce the frequency and duration of social contact with family, friends, and colleagues for the sake of the relationship but feel deprived of experiences they enjoy.

The non-autistic partner may also recognise that their autistic partner can engage socially at work but, on returning home, is exhausted and actively seeks solitude or engagement in a hobby or interest as a means of energy recovery. Although the couple lives together, the autistic partner has a diminishing need for social, conversational and leisure time together. An issue for the non-autistic partner is feeling lonely within the relationship.

Communication

One of the consequences of difficulties with Theory of Mind abilities is misinterpreting intentions, such as determining whether a comment or action was deliberately malicious, humorous or benign. This can lead to conflict within the relationship, with either partner being quick to take offence.

Another communication issue is a tendency for the autistic partner to be perceived as overly critical and correcting and rarely providing compliments. They intend to improve their partner’s proficiency and anticipate gratitude for their advice, being unaware of the effect on their partner’s self-esteem. There may also be a reluctance to provide compliments due to not intuitively knowing that in a relationship, the non-autistic partner need for regular approval and admiration and reluctance to give a compliment when their partner is already aware of their achievement.

As the non-autistic partner describes their daily experiences, their autistic partner may not engage in the anticipated degree of eye contact and words, sounds, and gestures of compassion and interest. The autistic partner absorbs the story but does not appear attentive and is eager to provide practical advice rather than non-judgemental listening and empathy. The non-autistic partner can feel they lack emotional support but experience considerable practical advice.

Expressions of love and affection

In a conventional relationship, regular expressions of love and affection are expected. A metaphor for the need and capacity for expressions of love and affection can be that a non-autistic partner has a ‘bucket’ capacity for love and affection that needs to be regularly filled and replenished. In contrast, an autistic partner has an affection ‘cup’ capacity that is quickly filled. The autistic partner may be perceived as not expressing sufficient affection to meet the needs of his or her partner, who feels affection deprived and unloved, which can contribute to low self-esteem and depression.

When the autistic partner recognises the value of expressions of love and affection in the relationship, there can be the issue of the frequency, type, intensity and duration of expressions of love and affection. As an autistic partner said: ‘We feel and show affection but not enough and at the wrong intensity’ and “I know I am not meeting her needs, but I don’t see them, will I ever be able to make my partner happy”. A non-autistic partner gradually realised that “…he can’t give me my needs because he doesn’t see them, he doesn’t perceive them and doesn’t ask about them… I often feel alone in our relationship because he’s not quite with me” (Smith et al., 2021)

Emotion repair

During personal distress, when expressions of empathy and words and gestures of affection would be expected as an emotional restorative, the autistic partner may not read the signals to elicit emotion repair (Theory of Mind) or know and have confidence in what to do. Their emotional repair mechanisms may be solitude and engaging in their interests and hobbies as a thought blocker. Affection may not be perceived as an emotion repair mechanism, with a hug perceived as an uncomfortable squeeze which does not automatically make them feel better. A typical comment of the non-autistic partner is that hugging their autistic partner is like ‘hugging a piece of wood’. The person does not relax and enjoy such close physical proximity and touch.

Being alone is often the primary emotional repair mechanism for an autistic partner, and they may assume that is also the case for their non-autistic partner, with the thought that if I leave her alone, she will get over it quicker. They may also not know how to respond or fear making the situation worse, as in the relationship counselling session where an autistic partner sat next to his wife, who was in tears. He remained still and offered no words or gestures of affection for emotional repair. When asked if he knew his wife was crying, he replied, “Yes, but I didn’t want to do the wrong thing.”

The autistic partner can be accused of being callous, emotionally cold and lacking empathy due to a genuine difficulty reading interpersonal signals and knowing how to respond. The non-autistic partner gradually realises that they need to be very clear and direct in expressing their feelings and suggesting to their partner what they need to do for emotion repair.

Intimacy

There may be issues associated with verbal, emotional and physical intimacy. The effects of alexithymia will inhibit verbal and emotional intimacy, that is, converting thoughts and feelings into speech. However, an autistic partner may be able to express their thoughts and feelings indirectly using music, poetry, a scene from a movie, a passage in a book or typing rather than speaking their thoughts and feelings.

Sensory sensitivity may affect physical intimacy, leading to confusion, distress, and frustration with sexual experiences for an autistic partner (Gray et al., 2021). Autism is associated with a low or high threshold for sensory experiences, especially tactile experiences. A low threshold can lead to experiencing discomfort or pain when lightly touched during moments of intimacy. A high threshold can lead to requiring greater physical stimulation, as in the comment from the Gray et al. research paper, “I am not particularly sensitive, so I need more friction to achieve orgasm”. There may also be the issue of the use of drugs and alcohol, as in another comment from the same research study. Only when I am drunk do I feel comfortable being touched or touching others.

There can be issues with the frequency and quality of physical intimacy, which influences sexual satisfaction (Boling, 2016). Sex can become an intellectual interest for an autistic partner in acquiring information on sexual diversity and activities, often from pornography, and sex may function as a means of self-calming and emotion regulation. This was described by one of the participants in the Gray et al. (2021) study “I went through this highly sexualised phase because I just loved the way orgasms made me feel and connected me to myself and centred me. It was like the best self-regulation strategy I had found” The desire for and frequency of sexual activities and experiences may not be reciprocated by the non-autistic partner.

However, from our extensive clinical experience, the non-autistic partner is more likely to be concerned about the lack of sexual desire rather than an excess. The autistic partner may become asexual once he or she has children. In a relationship counselling session, the partner of an autistic man was visibly distressed when announcing that she and her husband had not had sex for over a year. Her autistic husband appeared confused and asked, “Why would you want sex when we have enough children?”

Partnership

In modern Western society, we have replaced the word husband or wife with the word partner. This reflects changing attitudes towards long-term relationships. There is an expectation of sharing the workload at home, for domestic chores and caring for the children, and being each other’s best friend regarding the disclosure of thoughts and feelings, reciprocal conversation, sharing experiences and emotional support. Taking on the role of a best friend is not easy for an autistic partner to achieve due to having lifelong difficulties making and maintaining friendships.

For those autistic adults who have problems with executive function, that is, organisational and time management abilities, distractibility and prioritisation, procrastination and completing tasks, the non-autistic partner often takes responsibility for the family finances, ensuring jobs are completed and resolving the organisational and interpersonal problems that have developed in their partner’s work situation. The non-autistic partner takes on the executive secretary/ mother role, frequently prompting their partner on what to do (Wilson et al., 2014). This aspect of the relationship adds to the stress and responsibility of the non-autistic partner and can be a source of conflict in the relationship.

Conflict management

In any relationship, there will inevitably be areas of disagreement and conflict, such as having different parenting styles. Unfortunately, autism is associated with a developmental history of limited ability to manage conflict successfully. The autistic partner may not be skilled in negotiation, accepting alternative perspectives, agreeing to compromise, and the art of apology and may tend to hold and ruminate over grudges. This can be due to difficulty with understanding the thoughts, feelings and perspectives of others, a central characteristic of autism and limited experiences of childhood and adolescent friendships where these abilities are practised. Effectiveness in resolving conflict is a factor in relationship satisfaction for both the autistic and non-autistic partner (Bolling, 2016).

Emotion management

Autism is associated with experiencing strong emotions, especially anxiety, anger and despair and difficulty coping with stress at work and home. (Attwood 2006). There may be issues in the relationship regarding anxiety because the autistic partner can be very controlling, and life for the whole family is based on rigid routines and predictable events. There may be concerns regarding anger management and the risk of physical and psychological abuse (Arad et al., 2022), and both partners may be vulnerable to being depressed (Arad et al., 2022; Gotham et al., 2015). The relationship may benefit from assessing specific mood disorders and appropriate treatment and professional support.

Mental and physical health

Surveys of the mental and physical health of couples where one partner is autistic indicate that the relationship has very different health effects for each partner (Arad et al., 2022; Aston, 2003). Most autistic male partners considered that their mental and physical health had significantly improved due to the relationship. They stated they felt less stressed and would prefer to be in the relationship than alone.

In contrast, most non-autistic partners stated that their mental health had significantly deteriorated due to the relationship. They felt emotionally exhausted and neglected, and many reported signs of clinical depression (Lewis, 2017). A sense of grief may be associated with losing the hoped-for relationship, as illustrated by the comment, “It’s not only what I’ve lost, it’s what I’ve never had… (Millar-Powell & Warburton, 2020). Most non-autistic survey respondents also stated that the stress associated with the relationship had contributed to a deterioration in physical health.

Thus, we increasingly recognise the potential benefits of couples engaging in relationship support and counselling, which focuses on assisting their clients in identifying each other’s needs and how best to meet them (Yew et al., 2023).

References

Arad, Schectman and Attwood (2022). Journal of Psychology and Psychotherapy 12

Aston (2003) Asperger’s in Love: Couple Relationships and Family Affairs London, Jessica Kingsley Publishers.

Attwood, T. (2006). The Complete Guide to Asperger’s Syndrome London, Jessica Kingsley Publishers.

Bolling (2026) Asperger’s Syndrome/Autism Spectrum Disorder and marital satisfaction: a quantitative study Antioch University, New England.

Gotham, Unruh and Lord (2015). Autism 19

Gray, Kirby & Holmes (2021). Autism in Adulthood 3

Lewis (2017) Journal of Marital and Family Therapy 43

Millar-Powell and Warburton (2020). Journal of Relationship Research 11

Milton, D. (2012.) Disability and Society 27

Smith et al., (2021) Journal of Autism and Developmental Disorders 51

Wilson, Beamish, Hay & Attwood (2014). Journal of Relationship Research 5

Yew, Hooley & Stokes (2023). Autism in press.

Autism and bullying: new developments in research and support

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Autism and bullying: new developments in research and support

Why are autistic students so frequently the victims of bullying? From our extensive clinical experience, the answer is that they are perceived as easy victims due to often being alone and not having a group of friends for protection, having the posture and body language of someone insecure and vulnerable, and having low self-esteem and social status, as well as being perceived as a relatively ‘soft target’, i.e., someone unlikely to be assertive or able to retaliate in a way that could cause discomfort to the ‘predator’.

Due to difficulties with social reasoning and Theory of Mind abilities, they may also lack the ability to determine if an action or suggestion was deliberate or accidental, whether teasing is friendly or malicious and the difference between humour and insult. Bullying can occur for autistic students of all ability levels, including children attending a special school (van Roekel, Scholte and Didden 2010). The study found that autistic adolescents who were frequently bullied sometimes misinterpreted non-bullying situations as bullying. They had become over-sensitised and quick to react without analysing intentions.

They may also lack conflict-resolution skills and be a source of entertainment when distressed. Recent research has added two more reasons: not being optimally tuned to social situations and resisting change (Forrest, Kroeger and Stroope (2020). The resistance to change means that the autistic student’s reaction and response are predictable, with difficulty acquiring more effective responses. Their intense emotional reaction also encourages the child who engages in bullying (Cappadocia et al, 2012).

The prevalence of being bullied

A study of over 1200 parents of autistic children explored the prevalence of their child being bullied over a one-month period. 38% of the children were bullied occasionally, with a further 28% being bullied frequently. Thus, most autistic children experienced some form of bullying over the month (Zablotsky et al., 2013). A study by Schroeder et al. (2014) confirmed high rates of bullying for autistic students, with 40% of their autistic research participants experiencing daily victimisation and a further 33% experiencing victimisation two to three times a week. A study by Fisher and Taylor (2016) of autistic adolescents found a prevalence of peer victimisation of 73%, with a prevalence of only 10% in non-autistic adolescents.

The signs of being bullied

The signs of being bullied can be very subtle, such as peer rejection, fewer birthday party invitations, or being picked last for team sports (Kloosterman et al., 2013; Schroeder et al., 2014) Other subtle expression of bullying are poking and having shoe laces tied together (Fisher & Taylor, 2016).

There may be physical evidence, such as lost or damaged possessions, or torn clothing, and medical evidence, such as bruising, injuries, stomachache, headaches and difficulty getting to sleep. Psychological evidence includes increased anxiety, especially before school, depression, school refusal and responding violently to bullying leading to suspension. There can also be signs of a lack of trust in peers, even paranoia, and a change in the special interest to a fascination with weapons and violent films with drawings of retribution and retaliation.

When parents ask about experiences of bullying at school, there may be a reluctance to disclose those experiences as disclosure means re-experiencing the emotions. There may also be aspects of alexithymia such that the autistic child or adolescent has considerable difficulty describing their thoughts and feelings about being bullied using conversational speech.

Assessment of being bullied

A new bullying experiences assessment instrument has been designed for autistic children and adolescents (Morton et al., 2022). The 22-item Assessment of Bullying Experiences (ABE) assesses verbal, physical, relational, and cyber victimisation using examples of bullying experiences that include:

  • Name-calling
  • Taunting
  • Teasing
  • Mocking or mimicking
  • Direct: hit, push, shove
  • Indirect: hit, push, shove
  • Damage possessions
  • Group exclusion
  • Ignored
  • Exclusion from an online group
  • Online impersonation
  • Social media insults
  • Spreading rumours
  • Held down or restraint
  • Physically take an object
  • Knock food/item from hands
  • Teased for joining a group
  • Provoked to have an outburst
  • Hurtful digital messages
  • Hurtful post online
  • Embarrassing photo/video

The assessment includes direct interpersonal bullying experiences at school and on social media. Home may not be a sanctuary from bullying in terms of cyberbullying and bullying from siblings.

We now have a new web-based touchscreen app to assess self-reported trauma exposure and symptoms in autistic children aged 8-14 (Hoover & Romero, 2019). The app has eight trauma exposure items, including bullying and teasing.

Disclosure of being bullied and support

A range of potential responses to bullying includes seeking help from teachers, friends, classmates, and parents and coping alone (Humphrey & Symes, 2010). When telling a teacher, the question can arise of which teacher or teacher assistant to tell and whether the teacher can or wants to rectify the situation. We have found that there can also be the issue of peer disapproval for disclosing bullying to teachers. Class peers may consider ‘dobbing’ a fellow student as a greater social ‘crime’ than reporting the bullying. Autistic students are more likely to confide in a friend if the friend is perceived as being able to do something about the situation or has some social influence over the bully.

Parents are often the last resort in terms of support, sometimes due to feeling uncomfortable having their parents involved in their school life and parents being perceived as unable to provide support during and immediately after being bullied. Research suggests that parenting stress also affects the likelihood of disclosing bullying to parents (Weis et al, 2015). When parents had low levels of stress, and there was open communication on problems at school, bullying could more easily be disclosed. In families that experienced high levels of stress, disclosure is less likely.

Coping alone often occurs with responses varying from ignoring the bullying and just walking away to acts of violence being seen as the only course of action to stop the bullying. Intervention strategies must include exploring and using a more comprehensive range of responses when violence has proved effective.

The effects of being bullied

As clinicians, we know the psychological effects of bullying are devastating, contributing to a range of mental health problems. It is a major cause of school refusal and suspension, often because the victim has become angry and reluctantly retaliated (Bitsika, Heyne and Sharpley 2021). It can contribute to developing an anxiety disorder due to constant fear of a bullying ‘attack’ or ambush each day and knowing there is no way to prevent such painful emotional experiences. The derogatory and provocative comments and actions may be internalised and believed by the victim, contributing to low self-esteem and clinical depression (Kim & Lecavalier, 2021; Ung et al., 2016) and suicidality (Halloran, Coey and Wilson, 2022). As so many interactions with peers are associated with being bullied, and so few positive social interactions are experienced, a sense of paranoia can develop based on the reality of their interactions with peers at school.

We increasingly recognise that one of the reasons for camouflaging or masking autism is to avoid being bullied (Cage & Troxell-Williams, 2019; Chapman et al., 2022). We also recognise a link between bullying and the development of Anorexia Nervosa (Brede et al., 2020) and gender dysphoria (Chang et al., 2021).

By being so sensitive to frequent bullying and having difficulty reading the intentions of others, an autistic child or adolescent may not be able to differentiate between friendly and unfriendly teasing, which can inhibit the development of a true friendship. Also, others may create a distance between themselves and the autistic student to avoid becoming targets themselves. This adds to a sense of loneliness and rejection. The autistic student may have few friends to provide protection and safety in numbers and have friends to calm the anguish and dissolve the despair, with no words or actions of support and compassion to create greater self-esteem and put the event in perspective. Thus, the effects of bullying go deeper and last longer for autistic students than non-autistic students.

Strategies to reduce experiences of being bullied

Research has confirmed our clinical experience that if peers intervene, over 50% of bullying episodes will stop (Cappadocia et al., 2012). Peers need to be educated about the effects of bullying on autistic students and actively encouraged to intervene. There will also be benefits in extending an autistic student’s social network to be less isolated and a more identifiable target and being able to call on the support of their friends (Hebron & Humphrey, 2014).

A study by Etherington (2007) evaluated the creation of a team of peer supporters for an autistic year eight student. The school chose six students, including two boys who were notorious for bullying the autistic student and two girls who had previously been socially supportive. A six-session training programme in support techniques and mentoring was held on a weekly basis during lesson time. A plan was agreed upon to provide support during break times. The team members recognised that sometimes the autistic student wanted to be alone during the breaks, and he could opt into or decline companionship. The peer supporters set up a rota to take turns to be ‘on call’ at each break. There was a significant reduction in the number of reported incidents with the following comments from the autistic student:

“Now I’ve got my peer supporters, I don’t feel alone anymore. I don’t keep thinking I’m going to get into trouble or do the wrong thing. I’m not frightened or anxious about coming to school anymore.

My peer supporters have really helped me. I can talk to them, and they will help me to know if what I am doing is appropriate. Sometimes I don’t know if people are trying to be unkind to me but I can ask one of my support group and they can tell me.

Once, this girl asked me to stand on a bench and sing a song. I did it, but I think she wanted to humiliate me. I asked one of my supporters. He said I shouldn’t do what people tell me to do if it makes me feel bad inside. I should just say no and walk away. I think he is right. I think I can trust him.”

Carol Gray (2010) has explored bullying using Social Stories on themes such as:

What is bullying?

Bullying: What to think, say and do

My team

Learning to respond to bullying

We have also found that her strategy of Comic Strip Conversations can help teachers and parents explore the autistic child’s perspective of events and explain the thoughts and motivations of those who engage in bullying. Parents and teachers can access literature and resources on bullying and autism, such as No Fishing Allowed: Reel in Bullying (Gray & Williams, 2006) and the books on bullying published by Jessica Kingsley publishers www.jkp.com

We now have social skills video games such as the Secret Agent Society specifically designed for autistic students, which includes components on managing bullying (Beaumont et al, 2021). We also have resources to improve online safety for autistic children and teenagers (Lonie, 2015).

Bullying can result in signs of trauma, and Eye Movement Desensitization and Reprocessing (EMDR) has been confirmed as an effective treatment for trauma in autistic adults (Lobregt-van Burren et al 2019).  The study found that 50% of participants had flashbacks of school bullying. EMDR could be considered for an autistic child or adolescent who has been traumatised by bullying.  

 

References

Beaumont et al. (2021). Journal of Autism and Developmental Disorders 51, 3637–3650.

Bitsika, H. & Sharpley (2021). Journal of Autism and Developmental Disorders 51, 1081–1092.

Brede et al. (2020). Journal of Autism and Developmental Disorders 50, 4280-4296

Cage & Troxell-Williams (2019). Journal of Autism and Developmental Disorders 49, 1899-1911

Cappadocia et al. (2012). Journal of Autism and Developmental Disorders 42.

Chang et al (2021) Autism 26 1-14.

Chapman et al (2022) Research in Autism Spectrum Disorders 99 102069

Etherington (2007) Good Autism Practice 8, 37-44.

Fisher and Taylor (2016) Autism 20, 402–411.

Forrest, Kroeger and Stroope (2020). Journal of Autism and Developmental Disorders 50, 560-571

Halloran, Coey and Wilson (2022) Clinical Psychology Review 93.

Hebron & Humphrey (2014). Autism 18.

Hoover & Romero (2019). Journal of Autism and Developmental Disorders 49, 1686-1692

Humphrey & Symes (2010). Journal of Research in Special Educational Needs 10, 82–90.

Kim and Lecavalier, (2021) Research in Autism Spectrum Disorders 88

Kloosterman et al (2013) Research in Autism Spectrum Disorder 7, 824-832

Lobregt-van Burren et al (2019). Journal of Autism and Developmental Disorders 49, 151–164.

Schroeder et al (2014) Journal of Autism and Developmental Disorders 44

Ung et al (2016) Research in Autism Spectrum Disorders 32, 70-79

van Roekel, Scholte and Didden (2010) Journal of Autism and Developmental Disorders 40, 63-73

Weis et al (2015) Autism Research 8, 727-737.

Zablotsky et al (2013). Journal of Developmental and Behavioral Pediatrics 34, 1-8

 

Resources

Gray C. and Williams (2006) No Fishing Allowed: Reel in Bullying Student workbook and teacher manual. Arlington, Future Horizons

Gray C. (2010) The New Social Story Book Arlington, Future Horizons

Lonie, N. (2015) Online Safety for Children and Teens on the Autism Spectrum: A Parent’s and Carer’s Guide London Jessica Kingsley Publishers

Secret Agent Society www.sst-institute.net

The dating game and Autistic adolescents

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The Dating Game and Autistic Adolescents

Typical teenagers are usually enthusiastic about going beyond friendship and experiencing the dating game. They are exploring their new sexual awareness, who they find attractive, and who is attracted to them. Their romantic and sensual experiences become a major topic of conversation with peer advice on the ‘rules’ of the dating game. Our clinical experience suggests this may not be the case for autistic teenagers. They may be delayed by several years in being interested in a romantic relationship and have difficulty resonating with their peers’ interest in dating. They are also often socially isolated and may not have a circle of friends who discuss and disclose information on dating and sexuality.

In order to participate in the dating game, it is important to read subtle non-verbal communication that indicates mutual attraction and explore one another’s expectations in a romantic relationship. Typical teenagers understand dating conventions from intuition, observation and discussion with their peers. When dating, both partners progress along the relationship continuum at a reciprocally agreed and mutually enjoyed pace. Typical adolescents have considerable experience with many friendships, developing conflict management strategies and the art of compromise. They also know how much time to spend together and communicate through social media.

Autistic adolescents often need guidance and support in each of these dimensions.

Reading body language

There are many subtle ways that body language can indicate an interest in someone, such as the head tilted to one side, which means I am listening, nodding to indicate agreement or approval, smiling to indicate feeling happy with the conversation and looking at the other person’s face, especially the eyes to read the person’s feelings. There are other ways to tell that someone is interested in or likes someone, such as going out of their way to engage in a conversation, wanting to sit together and often giving compliments to the person they like. It is also important to know when body language expresses not interested such as frequently looking away, avoiding eye contact and a ‘closed’ body posture and flat facial expression.

A characteristic of autistic adolescents is difficulty accurately reading the intentions and personalities of their peers. Someone’s act of kindness may be interpreted as meaning more than was intended. Some personalities frequently engage in touch during a conversation due to their culture which may not be a sign of seeking a romantic attachment. Typical teenagers often have friends they can consult regarding the intentions of a potential dating partner.

Attraction

It is important to explore what aspects of personality, abilities, and appearance are attractive when seeking someone to date. There are differences in what adolescent girls and boys may seek. There is a general convention that girls may have a greater emphasis on personality and ability attributes and boys on physical attributes. When we have discussed attraction with autistic teenagers this convention can be maintained, but we have found that attributes such as intellect, being accepted and understood, sense of humour, and similar interests have been rated as more important for autistic than typical adolescents.

Asking someone for a date

An autistic adolescent may rehearse and need guidance on asking someone on a date or responding to an invitation for a date. They need to consider where the date will be and who may also be there. Autistic adolescents may be naïve, trusting, and unaware of being in a potentially risky situation.

There are also aspects of what to wear on a date, topics of conversation and knowing if the date is mutually enjoyable.

The development of a romantic relationship

A romantic relationship may evolve into disclosing deeper and more personal inner thoughts, emotions, and experiences. Some autistic adolescents may have alexithymia which is difficulty disclosing and explaining inner thoughts and emotions through speech. Their romantic partner may be concerned that self-disclosure may not have the same degree of depth and reciprocity.

The agreed ‘balance’ of touch, affection, and sensual experiences can be an issue. An autistic adolescent may need guidance on these aspects of a romantic relationship as a characteristic of autism can be a sensitivity to tactile experiences, especially those that may occur with gestures of affection and may extend to sensual and sexual experiences (Gray, Kirby and Holmes 2021) There is also the potential issue of reading the signals and context when the typical partner anticipates gestures and words of affection and compassion. There will need to be open communication and mutual understanding.

There may also be an issue of recognising the human sexual response for both partners and education with regard to sexuality (Attwood, 2008; Dekker et al 2017; Hartman 2014; Henault 2006 Visser 2017)

As the relationship progresses there could be concerns with regard to the amount of time spent together and communication on social media. There is potential for the enthusiasm of one partner to be perceived as too intrusive and intense, with a risk of them ‘wearing out their welcome’. Guidance from peers and parents can be very helpful.

The experience of love

A characteristic of autism is having difficulty perceiving and regulating emotions. Clinically we tend to focus on feelings of anxiety, sadness and anger, but love is a feeling. We have developed a programme From Like to Love to help young autistic children understand, express and enjoy love and affection with family and friends (Attwood and Garnett 2013). Many strategies apply to autistic adolescents embarking on the dating game, with age-appropriate adaptation, which includes expressions of love that are perceived as inappropriate or too intense, such as accusations of stalking (Post et al 2017)

An autistic teenager may also experience high levels of anxiety when meeting and being with a person towards whom they have strong feelings of affection and ruminate on their social/romantic performance. They may need guidance in coping with the emotion of love and anxiety.

Knowing the relationship is going well or not well

There are signs that the relationship is going well, such as both partners being happy to see each other, having a genuine interest in each other’s experiences, thoughts and feelings, smiling, laughing and having fun together with each feeling free to be their natural self and feeling safe and relaxed.

There is also the question of knowing the signs that the relationship is not going well. These negative signs may be the opposite of the positive signs described above, such as being critical and finding fault. We have found that another sign is one of the partners being possessive or controlling.

Adolescent romantic relationships often have a ‘use by date’ and may last from days to months and occasionally years. Adolescents may experience the ending of a relationship several times; sometimes, it is their choice, and sometimes not. There are many ways of ending a relationship; if an autistic person makes that decision, they will need guidance on how to do that appropriately. If the decision is from their romantic partner, they will experience rejection which may be reminiscent of rejection from previous friendships or romantic relationships. There will need to be time and support for recovery, to move on and not ruminate on the relationship, and to acknowledge what has been learned about the dating game from the relationship.

Long-term relationships

The focus has been on the dating game in adolescence, when romantic relationships may have a limited duration. However, many characteristics of autism contribute to a successful long-term relationship. These include kindness and a sense of social justice, loyalty and integrity, ability in a chosen career in science, technology, the arts and caring professions, passion for knowledge, and maternal and paternal abilities.

References and resources

Attwood S. (2008) Making Sense of Sex: A Forthright Guide to Puberty, Sex and Relationships for People with Asperger’s Syndrome. Jessica Kingsley Publishers

Attwood and Garnett (2013) From Like to Love Jessica Kingsley Publishers

Dekker et al (2015) Journal of Autism and Developmental Disorders 45 (6)

Gray, Kirby and Holmes (2021) Autism in Adulthood

Hartman D. (2014) Sexuality and Relationship Education for Children and Adolescents with Autism Spectrum Disorders Jessica Kingsley Publishers

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Understanding empathy and autism

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Empathy

We know that there are three forms of empathy, cognitive, affective, and behavioural and that the expression of each is underpinned by similar and different neurological structures in the prefrontal cortex. Cognitive empathy is the ability to determine what someone is feeling or thinking by ‘reading’ their facial expressions, gestures, vocal tone, and social context. An autistic person may need to use intellect rather than intuitive abilities to identify and process nonverbal communication that they see and hear. Affective or emotional empathy is the ability to ‘feel’ the emotions of others. A recurring theme from our clinical experience of talking to autistic teenagers and adults and reading autobiographies is an over-sensitivity to the negative feelings of other people. Behavioural empathy is knowing how to respond to someone’s feelings. Autism is associated with uncertainty in identifying what is expected to be said or done to alleviate or respond to someone’s feelings.

Emotional empathy

A central characteristic of autism is difficulty knowing how to read and respond to the emotions of others (Schwenck et al 2012). However, clinical experience indicates that there is a hypersensitivity to feeling another person’s negative emotions such as disappointment, anxiety or agitation. Autistic individuals have a remarkable capacity to mirror, or amplify within themselves, how another person feels (Fletcher-Watson and Bird 2020). As one of the participants in that study said, “We express empathy differently.” This capacity has been described as empathy over-arousal (Smith 2009) and occurs in both autistic males and females (Schwenck et al 2012).

We have yet to determine how this capacity is achieved but quotations from autistic adults may provide some indication.

I am able to distinguish very subtle cues that others would not see, or it might be a feeling I pick up from them.

There’s a kind of instant subconscious reaction to the emotional states of other people that I have understood better in myself over the years.

Emotional empathy can occur with all expressions of autism. Robert Hughes (2003) wrote about his non-speaking autistic son, Walker whom he described as being a “supersensitive emotional barometer who registered the true emotional pressure in the air, no matter how hard we tried to mask it”.

Exteroception

We have long recognized that a characteristic of autism is an extraordinary perception of sensory experiences from the external world which we describe as exteroception sensitivity. This can be a heightened sensitivity to sounds, light intensity, tactile experiences, aromas, and tastes. We speculate that exteroception may include a sensitivity to the emotions of other people. An extraordinary ‘sixth’ sense can be a response to being with someone who is experiencing negative emotions, but also responding to suffering on television news and in documentaries far more than is typical.

In contrast to heightened exteroception, an autistic person can have difficulty with interoception, that is perceiving their own internal sensory experiences, such as not being consciously aware of increasing heart rate and breathing that indicate rising anxiety or agitation. In his autobiography, Aaron Wahl (2019) wrote “I perceived the feelings of others often overly clear but could not find access to my own”.

Negative and positive emotions

Our clinical experience indicates that there is an extraordinary perception and sensitivity to another person’s negative emotions, as in the comment If someone approaches me for a conversation and they are full of worry, fear or anger, I find myself suddenly in the same state of emotion. Negative emotions in others are ‘infectious’ to an autistic person. One of our clients’ said Emotions are contagious for me. Emotional empathy may be one of the reasons why autistic individuals avoid crowds due to the risk of proximity to someone who is experiencing a negative mood and being ‘infected’ by that mood.

As psychologists, we often try to determine why an autistic person experiences a negative emotion, and one of the reasons may not be due to a specific event or thought but being ‘infected’ by someone’s negative feelings. This may also contribute to a characteristic of autism of avoiding eye contact since the eyes convey feelings (Smith 2009).

Social withdrawal for an autistic person is not exclusively due to social expectations and sensitivity to auditory, visual, and tactile experiences. Lilian said We don’t have emotional skin for protection. We are exposed, and that is why we hide. The sensitivity to the negative mood of others can lead to wanting everyone to be happy.

While we have found that someone’s negative mood can be contagious for an autistic person, they may not be equally ‘infected’ by someone’s positive mood. They can seem impervious to someone trying to ‘jolly them up’. Happy and exuberant positive emotions in others may sometimes cause an autistic person to be confused and uncomfortable and not know how to respond or resonate with others, for example, at a family celebration or reunion or when someone receives exciting news.

There seems to be a preference for a middle to a neutral range of emotions in others, both negative and positive emotions. If there is any greater intensity, the autistic person may become confused, overwhelmed and unsure of what they are expected to do or say.

Strategies for coping with empathic over-arousal

As clinicians, we help the person create a mental barrier using the metaphor of protection by putting on armour and using a shield or putting up an umbrella for protection from a downpour of emotions. We also use advice from autistic adults who share the same emotional empathy such as an autistic mother who said: We have lots and lots of empathy, but if it’s too much to deal with you have to just shut it off because it’s so overwhelming (Dugdale et al 2021).

We also advise family members and teachers to be aware of how their negative mood can be contagious to an autistic person and we teach strategies to stay calm and neutral to assist their loved one through difficult emotions. Sometimes parents and partners may try to temporarily suppress their feelings, although an autistic person may be able to sense the emotions behind their mask of neutrality.

We encourage autistic people to explain their sensitivity to someone’s mood and that the reason for their temporary withdrawal or avoidance of them is a coping mechanism due to emotional empathy and not a rejection of them as a person.

When an autistic person has difficulties with behavioural empathy, that is knowing how they are expected to respond to the distress of another person, they may need clear guidance and encouragement on what to do or say. This could be to suggest that the autistic person gives you a hug that is within their zone of tolerance or makes a reassuring comment.

We now have programmes to help autistic adults read nonverbal communication (cognitive empathy) and develop verbal empathic comments (behavioural empathy) (e.g., Koegel et al 2016).

We also recognize that increased emotional empathy may be an advantage when being with autistic children and adults by being aware of an autistic person’s tolerance of emotional states in others and adjusting their interactions accordingly. We know of many autistic individuals who thrive in the helping professions due to their high levels of emotional empathy.

References

Dugdale et al (2021) Autism 25, 1973-1984

Fletcher-Watson and Bird (2020) Autism 24 3-6

Hughes R (2003) Running with Walker Jessica Kingsley Publishers

Koegel et al (2016) Improving Verbal Empathetic Communication for Adults with Autism Spectrum Disorder Journal of Autism and Developmental Disorders 46, 921-933

Schwenck et al 2012 Jr Child Psychology and Psychiatry 53:6

Smith, A. (2009) The Psychological Record 59 489-510

Wahl A. (2019) Ein tor zu eurer welt KNAUR