"I'm Human After All": Autism, Trauma, and Affective Empathy.

Academic literature has long associated autism with empathy deficits. Although this view has been attenuated over time to include only cognitive empathy, earlier perceptions continue to influence popular representations of autism and screening/diagnostic tools. As a result, empathetic autistics may be prevented from accessing diagnosis, and those with a diagnosis may experience internalized stigma or violence under the guise of therapy. There are, however, some autistics who do self-identify as having empathy difficulties. The purpose of this perspective piece was to first trouble the view of empathy "deficit" as intrinsic within autism and consider alternative explanations and, second, to more deeply consider post-traumatic stress disorder (PTSD) as a factor for autistic people who self-identify as having empathy difficulties. Using both literature and author narrative, we argue that autistics are more likely to experience trauma and more vulnerable to developing PTSD, but less likely to receive a diagnosis of PTSD than nonautistics, as their PTSD-related symptoms, such as a lack of affective empathy, may be conflated with autism traits. Our main recommendations are: (1) future studies should investigate the possible interactions between autism, trauma, PTSD, and affective empathy, determining whether autistic adults with PTSD may recover affective empathy following therapy; (2) clinicians should look beyond autism if their client identifies a lack of affective empathy as part of their challenges; (3) and clinicians should adapt diagnostic procedures for PTSD in autistic adults to accommodate those with alexithymia, and exercise caution when using screening tools for autism, allowing empathic autistic adults to access diagnosis. Lay summary: