Cover Image - Autism & Empathy: Understanding Emotional Experience On The Spectrum

Autism & Empathy: Understanding Emotional Experience on the Spectrum

By Sean Inderbitzen, LCSW

“What’s Wrong With Me?”

The question of emotional experience in the Autistic mind is one which really struggles to be put to words easily. So let’s visit heartbreaking moment from one of my autistic clients:

The young woman, 30, brown hair, looked at him, lips quivering and said, ”I’m sorry I hurt you and the boys so badly. I’m sorry that all of my shit was taken out of you. I’m sorry for all of it. But I’m not sorry for the good we did have. Because there was a lot of good.” The man, looked away from her eyes, for what was the last time, and replied, “Trauma doesn’t give you an excuse to be a shitty human being. And to me and those boys you were. This wasn’t an accident or a trigger. It was something I suspect you had thought through for some time, and a choice you made at my expense not with Me.” (an untold love story)

My client, the young man in the story highlights, what one might constitute as a complete lack of empathy. Her apologizing for all the pain, and anguish she had caused the young gentleman and his young boys, only to be met with complete coldness and emptiness. I’d call what his response was as anger, but its hard to tell from his response what he was experiencing. And as it would come to bear out in session, he didn’t really know either. His pure lack of response might be labeled by any onlooker a lack of empathy.

Perhaps its because this was my client but I tend to look at this lack of empathy, as the oldest part of the nervous system (the dorsal vagal system) shutting down any form of vulnerability to this woman who had caused what feels like irreparable pain. It is this type of experience of lack of any kind of response that often brings autistic clients to me, and the clinicians who work with them. For the clients its often a question of, “Is there something wrong with me?”. A rather deep and haunting question, it is usually some type of quest in search for answers to this underlying sense of being broken and unable to heal.

The Autistic Nervous System

With respect to clinicians who come to develop their skills in working with autistic patients, there is often a true sense of “stuckness” to help their clients experience these emotions. Which is why, more often than not I think it is important to come back to the autistic nervous system, and how it intersects with this question of do people with Autism have empathy or not. As Porges and others suggest, the oldest part of the nervous system (the dorsal vagal system) is responsible for shutting down the human body to avoid threats. Think about a turtle which goes into its shell, its body becomes withdrawn, its body becomes numb, its pain receptors swap off, and all social functions become non-existent. It is in the same way the autistic body responds in response to stressful situations like the one between the gentleman and woman.

While it is likely his nervous system was highly dysregulated, its hard to know not having been in this gut wrenching moment. Several studies consistently find autistic children having cardiac profiles reflecting altered autonomic activity as compared to non-autistic peers (Porges 2004, Patriquin 2009, Porges et al 2013, Parma et al 2021, Owens et al. 2021). Thus it is well established that there is a correlation between the presence of autism and increased levels of cardiac output suggesting that Autism might be a disorder of altered autonomic regulation. And so when I look at autistic individuals like the one who averts his eyes from the woman’s apology, and callousness as someone who cannot withstand the pressure he is experiencing in his body.

Experiencing Emotions

It is with this understanding of the autistic heart, in its high paced beating and numbing of emotions, that I have come to understand the so-called autistic lack of empathy. Not as a human defect, but rather a true numbness often overrode by frequent use of adaptive strategies like rationality. It is often with these left brain solutions, so steeped in logic and reason that clients with autism have to begin to experience safety within. Which often leads me to wonder about myself if I too will ever shake this sense of brokenness. But it is with this same sense of compassion that I approach my clients and the clients of the clinicians I work with that perhaps I need to turn towards myself with.

"Dr. Stephen Porges by Picasso", created by ChatGPT


  • Apel, K. & Vandervelde, S. (1993, November). Facilitated communication: One validation study. Paper presented at the annual convention of the American Speech-Language-Hearing Association, Anaheim, CA. (conference paper)
  • Beck, A.R. & Pirovano, C.M. (1996). Facilitated communicators’ performance on a task of receptive language. Journal of Autism and Developmental Disorders. 26: 497. DOI: 10.1007/BF02172272
  • Beck, B, Warburg, M, Parving, A, Jansen, E, Arendt-Nielsen, Elbro, /C.& Klewe, L. (1992, August). The Copenhegan investigation of assisted communication between severely handicapped persons and their assistants. Paper presented at the World Congress of the International Association for the Scientific Study of Mental Deficiency. Gold Coast, Australia. (conference papers)
  • Owens, A. P., Mathias, C. J., & Iodice, V. (2021). Autonomic Dysfunction in Autism Spectrum Disorder. Frontiers in integrative neuroscience, 15, 787037.
  • Parma, V. Guy, L., McVey, A. J., Rump, K., Worley, J., Maddox, B. B., Bush, J., Bennett, A., Franklin, M., Miller, J. S., & Herrington, J. (2021). Profiles of Autonomic Activity in Autism Spectrum Disorder with and without Anxiety. Journal of autism and developmental disorders, 51(12), 4459–4470.
  • Patriquin, M. A., Hartwig, E. M., Friedman, B. H., Porges, S. W., & Scarpa, A. (2019). Autonomic response in autism spectrum disorder: Relationship to social and cognitive functioning. Biological psychology, 145, 185–197.
  • Porges, S. W., Bazhenova, O. V., Bal, E., Carlson, N., Sorokin, Y., Heilman, K. J., Cook, E. H., & Lewis, G. F. (2014). Reducing auditory hypersensitivities in autistic spectrum disorder: preliminary findings evaluating the listening project protocol. Frontiers in pediatrics, 2, 80.
  • Porges, S.W. (2004). The vagus: A mediator of behavioral and physiologic features associated with autism.
  • Porges, S. W., Macellaio, M., Stanfill, S. D., McCue, K., Lewis, G. F., Harden, E. R.,
  • Handelman, M., Denver, J., Bazhenova, O. V., & Heilman, K. J. (2013). Respiratory sinus arrhythmia and auditory processing in autism: modifiable deficits of an integrated 1800 College Drive Rice Lake, WI 54868 | p: 715-788-6244 |
  • “social engagement system?”. International journal of psychophysiology : official journal of the International Organization of Psychophysiology, 88(3), 261–270.


Sean is a Behavioral Health Therapist, and lives with an Autism Spectrum Disorder. He has a caseload with 33% of his patients that live with ASD and varying comorbid psychiatric conditions. Prior to being a mental health clinician, he was a Vocational Rehabilitation Specialist for Wisconsin Division of Vocational Rehabilitation for 3 years. He was also appointed by Governor Walker to the Statewide Independent Living Council of Wisconsin. He is an incoming member to the Motivational Interviewing Network of Trainers, and provides training on motivational interviewing, ASD and employment, and ASD and comorbid psychiatric conditions. For more info, find him at or on LinkedIn.