Typical pain experience but underestimation of others' pain: Emotion perception in self and others in autism spectrum disorder.

Thaler et al. (2018) asked adults with and without autism to rate pain. They looked at photos of hands in mild, medium, and strong painful situations. Each adult first said how much the pain would hurt them. Then they said how much it would hurt the person in the photo.

The study used a simple 0-10 scale. The team compared self-ratings to other-ratings in both groups.

Adults with autism gave the same pain scores for themselves as typical adults did. Yet they gave lower scores for the person in every photo. Typical adults matched their own score to the other person’s score. The gap stayed the same at every pain level.

In short, clients with autism feel pain normally but judge others’ pain as milder.

Mulder et al. (2020) later tested pain control in older adults with autism. They found no group difference in pain thresholds, but wide individual scores. This widens the lens: pain feeling is typical, yet pain response is highly variable.

Petrovic et al. (2016) looked at toddlers who self-injure. Those kids showed more pain cues, not less. This seems to clash with Hanna’s finding, but age and behavior type explain it. Toddlers may express pain strongly while still misreading others’ pain later in life.

Gallo et al. (2026) used brain scans and showed that low activity in the primary sensory cortex drives the emotion gap. This gives a neural reason for the low other-pain ratings Hanna saw.

If a client says “that doesn’t hurt” when a peer scrapes a knee, it may not be coldness. It may be a real perceptual gap. You can teach pain recognition like any other skill. Use photos, videos, and labeled scales to practice matching self to other. Over time this can boost empathy and reduce social errors.