Recently, autism discussions have become a battleground of competing perspectives. On one side, the medical model frames autism as a disorder requiring treatment; on the other, neurodiversity advocates celebrate it as a natural variation that should be embraced. These differing views deeply affect how autistic individuals are perceived, supported, and valued in society.
The division has real consequences for autistic people’s wellbeing, identity formation, and access to appropriate support. Understanding this divide is essential for moving toward a more nuanced, compassionate approach that honors the full humanity of autistic individuals.
What is the background?
The journey of autism understanding has been long and winding. When it was first described over 80 years ago, it was viewed exclusively as a severe psychiatric condition. For decades, autism was misunderstood, often blamed on “refrigerator mothers” or considered a form of childhood schizophrenia.
By the 1980s, autism began to be recognized as a developmental condition, and research was exploring how it can occur both with and without a learning disability. In 1994, Asperger’s syndrome was added to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) as a separate diagnosis from autism, to encompass those who did not have a learning disability, but who did have the social challenges and restricted interests characteristic of autism at the time. This created a diagnostic separation that would last until 2013, when the DSM-5 controversially folded Asperger’s into the broader “autism spectrum disorder” diagnosis. There were many reasons for this change, not least relating to revelations about Hans Asperger himself.
It’s worth mentioning that how some people view autism has been complicated by the early research and the stereotypes that were perpetuated as a result, as well as its frequent co-occurrence with learning disabilities, epilepsy, and other conditions. Many people understandably struggle to separate autism itself from these co-occurring conditions. While autism and learning disability are distinct things that can exist independently, they do also overlap in some cases. This leads to confusion about which challenges are related to autism specifically versus those stemming from co-occurring conditions.
Since 2013, the diagnostic criteria have continued to expand as knowledge has improved, acknowledging a wider range of presentations, including those often seen in girls and women, and creating what we now call the autism spectrum.
More recently, the idea of neurodiversity has emerged. This framework, first articulated by sociologist Judy Singer in the late 1990s, proposes that neurological differences like autism are natural variations in the human genome rather than disorders to be treated and cured. This view, whilst adopted by many autistic people, is causing controversy amongst those who still support the medical model of autism.
So, what is the medical model, and what are the problems with it, and the benefits?
The diagnostic framework for autism remains rooted in the medical model, focusing on behaviors that diverge from neurotypical norms. Current diagnostic systems like the DSM-5 and ICD-11 characterize autism through deficits in social communication and restricted/repetitive behaviors.
In this approach, autism is fundamentally conceptualized as a disorder—something wrong that needs fixing. Professionals trained in this model often concentrate on reducing “symptoms” and increasing “normal” behaviors.
For decades, mostly neurotypical professionals, researchers, and sometimes parents have dominated autism discourse, speaking for autistic people rather than with them. This dynamic has led to interventions designed around neurotypical standards and comfort rather than autistic well-being.
A particularly harmful consequence of the medical model has been the development of interventions aimed at making autistic people appear less autistic, rather than supporting their wellbeing on their own terms. Applied Behavior Analysis (ABA), for example, is criticized by many autistic adults for focusing on compliance and suppression of autistic traits rather than understanding and accommodation, and has also been linked to PTSD in research.
The medical model has also fueled research focused primarily on identifying causes and potential “cures” for autism, rather than improving the quality of life for autistic people. When we examine funding patterns, a stark imbalance emerges. The Interagency Autism Coordinating Committee (IACC) has repeatedly found that only a small fraction of autism research funding addresses services, supports, and issues that affect autistic people daily.
Those opposed to the medical model of autism say that focusing on the elimination of autism (and therefore autistic people) rather than accommodation has diverted resources from supports that could make meaningful differences in autistic lives.
Yet, the preference for viewing autism as a disorder persists among some caregivers and autistic individuals themselves. For families navigating complex support needs, the medical model can provide access to services, accommodations, and financial assistance that might otherwise be unavailable. What’s more, to them, calling autism a “difference” minimizes the very real difficulties they face day in and day out. Having it diagnosed as a disorder validates the severity of the challenges they face.
So, what is the neurodiversity perspective? What are the problems with it, and what are the benefits?
The neurodiversity framework has offered a radical reframing: autism as a natural expression of human neurological variation rather than pathology. Supporters of it say it doesn’t deny challenges but contextualizes them within a society designed for neurotypical minds.
These people believe that many of the challenges associated with autism are not caused by autism itself, but by society’s obsession with conforming to neurotypical standards. And that if society were more flexible and accepting about what it deems “appropriate” social behaviour, and more accommodating of autistic people’s needs, autism would not be viewed as a disorder that needs “fixing”.
Within this framework, many autistic individuals have reclaimed their narrative from clinical descriptions, asserting their right to define their own experiences. Identity-first language (“autistic person” rather than “person with autism”) has become preferred by many as a statement that autism is inseparable from their identity.
But a tension exists within the community about representation. When articulate autistic self-advocates speak on social media, are all autistic voices being heard? Many who support the medical model worry that those with higher support needs or complex co-occurring conditions may be underrepresented in these neurodiversity conversations, and that agendas are being pushed without their input. What’s more, when they speak out about their concerns, they are often shouted down, leaving them feeling even more isolated than they already do.
Their concerns are real and valid. However, when this concern is also coupled with a narrow view of how autism presents, it often leads people to dismiss those with less obvious or more fluctuating support needs as not requiring any support. The terms “using autism as a fashion statement” or “the cute type of autism” are unhelpfully and unkindly bandied about.
There is also an issue that some people who oppose the neurodiversity movement fail to separate autism from the co-occurring conditions we mentioned earlier. As a result, they sometimes don’t see that other presentations of autism are still autism, they just don’t have the same co-occurring conditions, or they present differently.
This failure to see and truly comprehend the diverse ways in which autism can present is one of the main driving forces behind the disorder-difference argument on both sides.
One final thing to note is that many who support the idea of neurodiversity do believe that autism is a disability. But a disability is not the same as a disorder. Vanderbilt Kennedy Center tells us that a disability is something that makes it harder for the person with the disability to take part in certain activities and engage with the world around them, particularly if the world doesn’t accommodate them. A disorder is a condition that affects “normal” functioning. So, even to those who view autism as a difference, not a disorder, it can still be considered a disability that requires support.
Why does the language and our perception of autism even matter?
You might be questioning whether the language of autism even matters. It’s just words after all. Well, psychologists have long known how words can harm or help. What we tell ourselves, and what others tell us, we internalize. We believe.
What’s more, our thoughts and perceptions directly impact our actions. If we believe autism is a disorder to be treated or cured, we will treat autistic people differently than if we think it’s a difference to be supported and accommodated.
So, yes, language and perception are very important, which is why people get so impassioned about it one way or the other. Speaking personally, as someone with experience of autism with a variety of different support needs and co-occurring conditions, I can see both perspectives.
I can see that using “difference” to describe autism might seem trivializing to some, particularly to those with high support needs who require round-the-clock care, and their carers. However, I think the word “disorder” is also very problematic when it comes to autism. Unlike disorders that only affect certain parts of you (for example, a blood disorder), autism is all-encompassing. It affects your thoughts, your behaviour, your nervous system, your body. And, unlike disorders that develop over time and can be treated, such as anxiety disorders, autism is present from birth and will last a lifetime. It is largely inherited. It’s not something that can be “fixed” with treatment, and treatments that do purport to reduce autistic behaviors mostly just encourage masking, which we know is extremely harmful.
So considered that way, many people view it as saying an autistic person’s entire way of being is disordered, or basically wrong. And that it always has been and always will be. When young autistic people hear autism described in this way, or are treated in a way that makes them feel like this, they may internalize the message that their natural way of being is fundamentally flawed, and this can stay with them throughout their lives.
What’s more, by this logic, viewing autism as a disorder to be eradicated would also mean eliminating the autistic person themselves, since the two are intrinsically linked. Yes, curing autism might eradicate their significant challenges, but it also erases all the wonderful things that make them who they are.
When you think of it like that, it’s easy to see why many people are so opposed to it.
There is also the troubling issue of how some people in society view those with disabilities. In a society obsessed with output and productivity, people with disabilities are often viewed as less worthy or deserving of life by those in power, particularly if they cannot contribute significantly to the economy or if they require financial support. They aren’t viewed as being inherently and equally worthy simply because they exist. This can have direct implications for whether you view something as a disorder to be cured or a difference to be accommodated in an inclusive society.
To be clear, I’m not talking about parents and carers (or autistic individuals themselves) who desperately wish they could relieve their children’s anguish (or their own), but rather those with power and influence who hold the purse strings and control the narrative about what does and doesn’t constitute a valuable member of society.
Moving forward together…
So, what is the solution? Well, it doesn’t seem there is one right now. But the path toward reconciliation begins with respect. We must respect individual preferences in how people identify and talk about their own experiences. Some prefer identity-first language (“autistic person”), others person-first (“person with autism”), and still others use different terminology entirely. How they choose to identify is up to them.
It also requires empathy and compassion. In navigating these complexities, you cannot know what shaped someone else’s perspective until you listen. And even then, you will never truly understand what they are going through. The parent (or autistic individual) who favors medical language may experience 24/7 challenges you cannot conceive of. The seemingly “fine” autistic adult who is outspoken about neurodiversity may have experienced horrific abuse and trauma because of their differences, and lifelong mental health crises from trying to mask them.
When we center empathy and humanness in these discussions, we recognize that behind every position stands a person with valid experiences and concerns. This doesn’t mean all approaches are equally beneficial, or that we have to agree with them, but it does mean treating each perspective, and the person behind it, with basic dignity.
By building bridges between different perspectives, we create space for more nuanced approaches that acknowledge both the value of support and the importance of acceptance. These needn’t be mutually exclusive positions.
It’s important to remember that although no two autistic people are the same, and their presentation and support needs may differ significantly, they are all autistic. That means they all share the same cluster of neurological differences in the way that they communicate, behave, and think. And that these neurological differences “deviate” significantly from those of neurotypical people.
As such, autistic people are usually better placed than even the most well-meaning neurotypical person to truly understand the reasons behind the behaviors and challenges of other autistic people, even those with higher support needs than they have.
Dr Joanna Grace, founder of The Sensory Projects, who has worked for many years with autistic people with profound and multiple learning disabilities and who is also autistic herself, makes this point beautifully on the podcast episode “The stories we tell about autism.”
It’s therefore crucial to center autistic voices in the future of autism discourse. But we must be sure to ensure this happens across diverse presentations, including those who communicate in non-traditional ways. This requires moving beyond tokenism to genuine power-sharing in research, policy, and program development.
For those supporting autistic individuals, it’s important that the care and support that’s provided respects autonomy. That means recognizing that support should honor the individual’s needs rather than impose neurotypical conformity.
When we lead with compassion and a willingness to learn from each other, we take meaningful steps toward a world that values autistic lives on their terms.
You may also like:
- 8 Revealing Reasons Why Everyone Seems To Be Autistic These Days
- If you still believe these 15 things about autism, you’re doing more harm than you realize
- Why are so many adult women suddenly discovering they’re autistic, and what are the signs to look out for?
- Autism in girls: why is it missed, why does it look so different, and what are the signs?
- Here’s What Every “ADHD Is Overdiagnosed” Article Gets Dangerously Wrong
- The emergence of AuDHD: how autism and ADHD commonly combine and cause missed or misdiagnosis
