Key Points
• Autism is a spectrum, and every individual on it may exhibit different traits.
• Many autistic people do not see autism as a condition to be cured, but as an aspect of identity to be accepted and understood as an inherent part of who they are.
• Autistic people are consistently underserved in the health-care context, with severe implications for their quality of life and life expectancy.
• Integrative health care and massage specifically have shown promising evidence of reducing autistic anxiety, improving sensory integration difficulties, and assisting with developing coping mechanisms and increased quality of life.
When talking about autism in the health-care context, it is often automatically perceived as a condition to be treated or cured. This is a prevalent attitude among the general public and health-care professionals alike; yet, according to many in the autistic community, they do not want to be cured or changed, they simply want awareness of and respect for their differences, and equal access to standard health care.
The place of autistic people in society has been compared to the oppression experienced by other minority groups, so much so that they become “marginalized to the extent of occupying the social position of ‘non-human’ with the staggering consequences for social well-being that this implies.”1 In contrast to many other minority communities, autistic voices remain marginalized, whereby a medicalized, pathological understanding of autism persists in both wider society and health-care settings. This medicalization often serves as the very rationale for this marginalization, with suggestions from non-autistic circles that autistic people are not capable of judging their own situation. Not only is this grossly untrue, but it is actively harming people across the autism spectrum. While autistic self-advocacy is growing, prejudice and confusion regarding this community persists, resulting in poor health care and education options. Though these vary by country, it’s safe to say that beyond specialist disciplines, very little information or guidance is out there for general health, holistic, or manual practitioners encountering autistic patients.
Among a minority of integrative health practitioners, the mistaken perception persists that autism is related to vaccination (it has been exhaustively proven that it is not), and among wider medical circles, the notion that autism can somehow be prevented or “cured” continues to spark considerable controversy. The actual causes of autism are not known, but are considered to be a result of complex, multifactorial interactions between multiple genetic predispositions and environmental factors.2 Many autistic individuals have openly expressed their aversion to the idea that one should even seek to prevent it, given that this suggests the world finds them undesirable and worthless, though disagreement is expressed by some parents of autistic children on the extreme end of the spectrum.
Trying to Act “Normal”
Autism is a spectrum, and every individual on it may exhibit different traits, the most common of which are social communication difficulties (more when speaking than when writing) and rigid/repetitive behaviors to a greater or lesser degree. Though the “Forrest Gump” or more recently “The Good Doctor” stereotype often dominates public views of what autism looks like, in truth, the media attention to these stereotypes has done more harm than good. Not all autistic people are geniuses, not all are blunt or speak in a monotonous way, not all are verbal.3 Some may “pass” as neurotypical (non-autistic) but doing so requires extreme effort on their part. Known as “masking” or “camouflaging,” this means “acting normal” to hide autistic traits; this can cause intense anxiety and other mental health issues.4
Autistic women tend to do this more effectively, and so miss out on earlier diagnosis and support, leading to the impression that autism is more prevalent in boys (it is not, though it does present differently according to sex, as newer research is beginning to discover). That does not mean it is less severe in women, only that the neurological expression is slightly different.5 In the UK, 1 in 50 children currently hold an autism diagnosis, and in the US, the numbers are similar but with a strong gender bias (likely due to the stereotypical traits being observed more quickly by parents of boys): 1 in 69 boys, but 1 in 189 girls. This is likely to change as awareness grows. True prevalence in adults is unknown but growing as some parents of autistic children notice their own autistic traits and seek diagnosis in mid- or even late adulthood.
Autism and Health Care
In the health-care setting, autistic individuals often face severe challenges that are different for children and adults. There is much literature devoted to pediatric autism, and nonverbal autistic individuals do require multidisciplinary specialist support. This article focuses on the verbal autistic adult, many of whom may already have visited your clinic and may or may not have revealed their autistic status. Though this can be little more than a sketch, it is intended to raise awareness of specific issues among health-care professionals in the hope that more accommodations can be made for this community.
Generally, health care is a fraught experience for autistic people, causing intense anxiety, avoidance, and a much lower life expectancy (as young as 36–40 years in some studies). This is not due to autism itself, but largely due to “medical complexities” that include “limitations in language and communication [leading] to physicians, hospitals, and the health-care system not being capable of providing the best level of care,” and not seeking “help for their ailments because they are overwhelmed by the awkwardness of talking with other people about themselves.”6 Suicidal ideation is much higher among the autistic community than in the general population, as is severe, ongoing bullying—from the classroom to the workplace to cyberspace.7 Bullying and social stigma are key factors leading autistic people to mask and try to compensate, or pass as “normal,” but the effort is exhausting and often fails, only resulting in further exclusion and, critically, increased suicidality for which masking is one of the main predictors along with unmet support needs.8
Among those needs are standard health-care provision and anxiety support. Crucial to both is the ability to access that health care without being forced to camouflage to be taken seriously. A revealing study aiming to “identify and compare barriers to health care experienced by autistic adults” notes that compared to adults without autism or other disabilities, autistic adults encountered “different and greater barriers to health care, particularly in areas related to emotional regulation, patient-provider communication, sensory sensitivity, and health-care navigation. Top barriers were fear or anxiety (35 percent), not being able to process information fast enough to participate in real-time discussions about health care (32 percent), concern about cost (30 percent), facilities causing sensory issues (30 percent), and difficulty communicating with providers (29 percent).”9
It must be emphasized that this does not refer to people seeking treatment for autism, but to autistic people seeking standard health care for anything from a bad back to cancer. The problem ranges from desk staff and pharmacists to senior clinicians. The “limitations in language and communication” is the first point that every health worker, at any level, in any discipline, should have a basic grounding in, because it does not only refer to nonverbal autistic people (who do indeed require additional support). Autistic people who are perfectly capable of expressing themselves in speech frequently display particularities, or quirks in their body language, in how they describe a problem, how they understand the answer, and how far they are able to comply with a therapeutic regimen. Noncompliance is often interpreted as stubborn willfulness, yet may result from anxiety at changing routine, fear of the unknown, unusual anxiety triggers, or a too-literal interpretation of the therapist’s explanation. Depending on their particular combination of autistic traits, they may also demonstrate one or more characteristics including rigidity in thinking and behavior, altered sensory sensitivity and/or a high pain threshold, and differences in emotional regulation.10
Autism and Bodywork
In the massage therapy context, all these characteristics are significant, and all can be managed with awareness and compassion. Since integrative health care and massage specifically have shown promising evidence of reducing autistic anxiety, improving sensory integration difficulties, and assisting with developing coping mechanisms and increased quality of life, it is all the more important that this community is able to provide the care that autistic people need.11 Most of the evidence for the benefits of massage and similar treatments is found in occupational therapy, psychiatry, and autism-specific journals, rather than in bodywork and manual therapy journals (with one notable exception published some years ago).12 Therefore, it is worth doing a keyword search of PubMed using “autism” and “massage” or other massage therapy techniques if exploring this further.
A further important point is that autism is strongly associated with increased comorbidity and heredity of Ehlers-Danlos syndromes (EDS)/hypermobility spectrum disorders (HSD). It has even been suggested that EDS/HSD may represent a subtype of autism, though this is a relatively recent finding and requires further research.13 EDS/HSD affect proprioception and so does autism, and it has been suggested that the neurodevelopmental parameters causing this may also affect executive functioning (if too much attention is being focused on walking in a straight line or not banging into the furniture, the brain can get overwhelmed and present with what look like attention or other cognitive deficits, even seizures. This is common for autistic people).14
Accompanying neurodevelopmental issues may also be responsible for dysregulation of the immune system and autonomic disorders affecting the peripheral nervous system, resulting in overactive sympathetic responses (fight/flight) and underactive parasympathetic functioning (rest/digest). This means that the heightened anxiety and strong reactions to apparently mild sensory stimuli often seen in both autism and EDS/HSD are a result of neurological differences that can also result in a number of other comorbidities (such as gastrointestinal or cardiac problems). This is one of the best examples of where autistic people get shortchanged: A strong expression of anxiety of something a non-autistic person may see as minor (like a strong reaction to an unfamiliar texture, or sound, or change in routine) is the reflection of that hardwired overactive fight/flight response, not the person just being highly strung. This leads to emotional dysregulation: What would be an irritant to most is perceived by the autistic person’s nervous system as a life-threatening event, and they may react accordingly. This cannot be controlled at will, nor can the person be trained out of it, although coping mechanisms can be developed and applied over time with some success—and with a lot of support from the person’s environment. If the reaction is criticized, condemned, or mocked, it will simply intensify the reaction. Criticism of something one cannot change any more than one’s eye color becomes perceived as a threat.
Nevertheless, the pain, dysfunction, and neuropathologies accompanying EDS/HSD will often require physical therapeutic intervention, so awareness and sensitivity to autistic needs is particularly significant in this context.
What to Watch For and How to Handle It
Before you read on, a caveat: Not all autistic people display all these behaviors; some may tell you they have a diagnosis yet exhibit none of them. They may make consistent eye contact, communicate perfectly, and not demonstrate any traits described here. Never, ever say to these people “but you don’t look autistic.” If they have a diagnosis, they are autistic, and it is outside your scope of practice to make this call. Someone may have very intense invisible traits, but be very good at masking, or their traits may assert themselves in different circumstances. Telling someone they “don’t look autistic” is saying you don’t believe them, and it also suggests that “not looking autistic” is a good thing, forcing that mask more firmly on and confirming to the autistic person that they will never be socially accepted without masking. Both of these make a bad situation worse for your client, and more importantly, you will never gain their trust. If on the other hand they exhibit some obvious traits, such as visible stimming (self-stimulating behaviors), or speech or body language quirks, don’t comment on these either. It’s as hurtful as commenting on someone’s visible disability.
Also never say “we’re all a little autistic.” No, we’re not. Autism stems from neurological differences that are hardwired into the body. Some of the physical and behavioral challenges can be mitigated with careful, holistic approaches, but navigating everyday life built for a different kind of neurology is full of challenges, threats, and sometimes actual physical pain for autistic people. Being quirky, or introverted, or offbeat, or super-creative is not the same thing, and does not give anyone the right to assume they know what navigating the world with autism is like. Try to imagine saying the same thing (“we’re all a little . . .”) to someone with a different skin color, ethnic background, or gender identity. You wouldn’t. Don’t say it to an autistic person either.
Self-Diagnosis, Formal Diagnosis, and the Autistic Closet
Getting formally diagnosed with autism in adulthood is difficult, sometimes costly, and fraught with the difficulties that come with navigating complex health systems. Autistic advocacy on social media has helped raise awareness, but it has also led to a lot of people “identifying” as autistic when they are not by taking an oversimplified, checklist approach, and this has damaged the actual needs of the autistic community. Adults with diagnosed autistic children or adults with particular educational specializations may well self-diagnose accurately, but it is outside your scope of practice to judge this.
Someone seeing you for a bad knee with a superficial “Tik-Tok” style self-diagnosis is unlikely to bring up autism because they won’t see a need to. Someone who really is autistic—formal diagnosis or not—is already very self-conscious about the difficulties they’re facing, and they may tell you about it to excuse or explain certain quirks you’re bound to observe in the therapeutic encounter. And some autistic people who mask well (or think they do) fear the stigma too much to tell you at all—they may try to “act normal” and focus on the physical complaint. If, in your assessment, you observe traits and physical correlations that make you suspect they are on the spectrum, wait to establish a good, trusting relationship before considering raising it. If they are visibly struggling with something (and if EDS/HSD, gut complaints, or other issues with connective tissue are in the picture), then you might gently check what other evaluations they have undergone, and then probe to see whether they are open to the discussion and whether referral should be considered. They may be grateful to let go of the mask, and this would lead to a constructive, trusting therapeutic alliance. Or they may shut the conversation down. Respect that and focus on dealing with the areas they are open to addressing without judgment.
Communication and Language
Saying that autistic people experience “communication difficulties” does not mean they can’t put together a sentence. Quite often they are extremely articulate, and some will use long words with elaborate explanations. This often leads to them being seen as being sarcastic or patronizing when in fact they may be trying their best to share their thoughts with you in the only way they know how. Facial expressions and body language may not line up with their tone of voice or their words: They may look sad, angry, or happy while expressing something neutral, or speak more loudly or softly than usually considered appropriate. You will need to ignore both tone and facial expression—don’t comment on them (this will be taken as criticism and cause self-consciousness and anxiety).
Observe silently, but don’t pay attention to nonverbal cues in a verbal patient if they seem off, and only listen to the words. They may have difficulty with eye contact; respect this and don’t try to “catch” their gaze or comment on their gestures or expressions. If they find it difficult to speak at all, they may be displaying selective mutism. This results from sensory overload that occurs when trying to talk about something they find stressful, or when too many thoughts come at once and they find it difficult to articulate them in the right order. Many autistic people need to rehearse or “script” encounters in unfamiliar situations; their script may have failed, or they may be experiencing stress from an unknown factor. Offer pen and paper if that happens—it will probably break the impasse—and if they ask for pen and paper themselves, do not react any more than you would if they’d asked for some water (and get them some water anyway; it will break the awkwardness and allow time to compose themselves).
Autistic people may also use words strangely; they may use strong language when describing sensations or emotions. They may speak in an angry tone when describing a situation that made them angry: This is not directed at you. Ignore the tone, stick with the words. Try to step into their form of expression—they cannot step into yours, but if they’ve made it as far as your clinic, they’re already trying very hard. Meet them halfway, and if unsure, use encouraging, compassionate wording such as “I wasn’t sure what you meant by . . . could you help me understand?” Or ask for an example or demonstration, then look for patterns that line up with something you do recognize, as you would if speaking with someone for whom English is a second language.
Many autistic people also tend to be extremely direct and honest to the point of bluntness, though they can be exquisitely polite as well, and this is sometimes confusing. This is neither intentional rudeness, nor deceit—autistic people are actually almost incapable of lying. They can be brutally honest but eager to please, and the difficulties inherent in autism make it difficult to balance these. It may be helpful in establishing a line of communication if you set aside “expectations” of how someone “should” speak and accept it for what it is.
Rigidity in Thinking and Behavior
Routines, repetitive or ritualistic behaviors, and adherence to rules tend to be very important to autistic people, often because this is a measure of control for them when life seems so chaotic. Asking them to change or break a routine or habit may cause extreme anxiety (such as starting a new regimen or changing a behavior). The changes need to be introduced in a way that fits in with their existing comfort zone. Ask the client what aspect they find discomfiting, and help frame the change in a way that might work for them. Do not try to “educate” or use arguments such as “but it’s good for you” or “but you’re harming yourself by eating this way.” There may be sensory, psychological, and other issues you cannot tackle outside a multidisciplinary context, and “lecturing” an autistic patient will send them into an anxiety spiral and break trust. Work with them to discover their tolerance levels for additions or changes to a routine, and don’t underestimate their intelligence. They speak a different language; it is up to you to find the balance that will work.
Altered Sensory Sensitivity
Unusual responses to sensory stimuli among autistic individuals are well-documented, whereby the texture of a fabric may be so disturbing they cannot even look at it, or certain sounds, scents, or food textures may be equally upsetting. This is one reason why autistic people sometimes make repetitive gestures such as flapping their hands, playing with a piece of clothing or strand of hair, or picking at their fingers; these are all examples of stimming, which helps defuse the building anxiety they may be feeling.
Depending on the degree of discomfort, the associations the individual has made with the stimulus, and their own coping mechanisms, their reactions may range from displeasure to extreme anxiety or panic. This should not be treated as an overreaction; if they can’t stand the texture of the sheet on your treatment table, find another fabric. If the lights are too bright, dim them or switch them off. The autistic patient may feel too shy to ask this, but if you notice visible discomfort, or an increase in stimming, ask them if there is anything in the room making them feel uncomfortable and give them a cue by asking directly about the lighting or fabrics. They may even refuse to sit down if they don’t like the texture of a chair—always meet them at their comfort level. Check whether oils or creams used (and their scents) are tolerable. This characteristic will also impact how autistic people respond to touch: Begin by discussing it, explain what your treatment involves, talk them through any assessment procedures clearly, and ask them whether they have questions before proceeding. Check if there are any parts of their body (apart from the obvious) where they do not like to be touched (feet and legs for example), and if dealing with a particularly sensitive individual, ask them to demonstrate (on their own arm or on yours) what degree of touch they find tolerable and/or disturbing (they may be fine with firm pressure but disturbed by light stroking, for example). The neck and throat area are often particularly triggering—ask them before touching. Be flexible and be prepared that the same individual may respond differently on different days depending on their anxiety levels. They are not being “difficult”; there will be a context they may not be able to explain depending on the day or week they’ve had.
Emotional Regulation
As noted earlier, this can be expressed in the form of strong or underwhelmed reactions to situations and stimuli. You may encounter autistic individuals who express large emotions (it is a myth that they don’t), both positive and negative, or others who come across as entirely “flat,” but who in fact may experience emotions so strongly that they have subconsciously—or very deliberately—shut them down in order to cope or out of fear of being judged (this may well have somatic manifestations).
In non-autistic people, stressors tend to be experienced as a peak after which their emotional state returns to baseline; in autistic people, it is often more of a staircase—a peak followed by a plateau, rising further each time rather than returning to baseline. That means stress becomes compounded until they reach a state of such intense overwhelm that it results in a meltdown or shutdown. Those more experienced in coping with these issues may display avoidant behavior when they know they’re approaching that point of no return, and that avoidance may also manifest in hesitancy to adopt a regimen, allow certain sensory experiences, and so on. Great care is needed not to try to force that avoidance—if they can’t, find a way around but don’t push them past their anxiety threshold. Take things slowly, ask permission for everything you do, and if they express discomfort, stop and ask whether they want to explain to you what is happening (take care this doesn’t sound like you’re interrogating or patronizing them—let them know you want to understand so they will feel comfortable with you).
In the unlikely event the client does experience a shutdown in your presence, they are likely to go silent and refuse further communication or communicate nonverbally. If this occurs, tell them you are going to step out of the room for a few minutes, and that you’ll come and see how they feel in a little while. Give them 10 minutes, then if they are still uncommunicative when you return, reassure them that you understand they may not feel up to carrying on, end the session without embarrassing them, and offer a new appointment if their condition warrants it.
Alternatively, end the session and tell them to take the time they need to come and meet you outside the treatment room—and allow them at least 10 minutes. Don’t leave it to them to get in touch—they probably won’t out of embarrassment. If they don’t rebook that day, call them a few days later to show that the incident is forgotten, and gently inquire whether they would like to try another session; they will most likely be grateful for the second chance. Preserve their dignity and give them a way out of that situation by offering them options. In the even more unlikely event that the client experiences a meltdown in your presence (only likely to occur under extreme, cumulative anxiety), you need to be even more careful. A meltdown can look like a temper tantrum, but is actually sensory overload tipping the person into a state of emotional dysregulation that feels like extreme fear. If this happens, don’t attempt to talk back to them, don’t touch them or invade their personal space, and don’t verbally attack or shame them. It is not about you, and they are not a threat. They are already ashamed of losing control, and it is themselves they are upset with. Follow the same steps as for a shutdown, speaking softly and gently. Again, give them space and a graceful way out by reassuring them that you understand what is happening, and you are not judging them for it.
Pain Threshold
Autistic people display both reduced and overactive responses to pain, with some demonstrating a very high pain threshold under some conditions. Two points to note include history taking and assessment procedures: Asking “does this hurt” or using a pain scale may be very misleading with these clients. Due to the often overly literal interpretation of speech, using the word “pain” or asking, “Does this hurt?” may be counterproductive (if they don’t perceive it as pain, they won’t know what to say even if they do feel distressed). Help them evaluate their pain by asking, “What do you feel?” and ask for the quality of the sensation instead (heat; texture, e.g., hard/soft/tight; or ask them to compare it to something, e.g., rock, velvet, needles, insects walking). Never correct their wording; work with what they give you. They may respond with “tingling, discomfort, pressure,” or similar, in which case you can gently probe for more detail. They may even respond with something that doesn’t make sense at first, such as “elephant” or “tombstone.” Think laterally if this happens: Both suggest a sense of heaviness or pressure. Ask where the elephant is, what it’s doing. If they say, “sitting on my chest,” you have an answer. In a manual therapy scenario, autistic people may well prefer or request “deep massage” because of this characteristic of altered sensory perception. This is not the time to correct their terminology; they are asking for it either because deeper pressure is felt to be comforting, or because they can’t actually feel you at all. Adapt your technique within safe boundaries if possible, or attempt a different approach. Assisting an autistic client to articulate (find the words for) their interoceptive state may be one of the greatest gifts you can give them.
Takeaway
Though these issues may sound daunting to practitioners, they are still more daunting to the autistic person seeking, and not receiving, help. From the practitioner or educator perspective, they should not be any more trouble than handling clients with other sensitivities. This is a vibrant, often gifted, and certainly widespread community that deserves the same opportunities for support and respect as all other communities—and it is particularly bad for members of ethnic minority and LGBTQ+ communities who are also autistic.
How (Not) to Talk About Autism
About Person-First Language
In recent years, person-first language has become standard among researchers and therapists who seek to end the depersonalization that can occur when we identify an individual in terms of their diagnosis and the harmful psychological impact this can have on patients. In many recent research studies, you might observe the use of “people with diabetes” rather than “diabetics,” or “people with cancer” rather than “cancer patients,” for this reason.
With autistic people, the situation is different and remains controversial. Most professionals tend toward person-first wording such as “people with autism,” following the reasoning in the above example. However, a large movement within the autistic community argues that autism is an integral part of one’s identity, and they strongly advocate for identity-first language. Many autistic people do not see autism as a condition to be cured, but as an aspect of identity to be accepted and understood as an inherent part of who they are. They frequently call themselves “autistic” or “neurodivergent” and many resent person-first language.15 This isn’t true of all autistic people, and currently the most appropriate way to handle this is to ask the individual what they prefer, or take your cue from their own use of language, but never correct an autistic person if they have chosen a form of self-description you haven’t heard before. Do not try to override their opinion using medical or other reasoning; this invalidates their voice and makes a therapeutic alliance impossible to build. Autism is indeed a spectrum, and each autistic individual will have their preferences, dislikes, and triggers. Respect them as you would any other individual—if you respect people’s pronouns, you need to respect this equally. Autistic views on this should take precedence over medical or “professional” opinion.16 Rule of thumb: The plural term “autistics” is never acceptable under any circumstances, as it carries strongly negative connotations. “Autistic people/person,” or “he/she/they is/are autistic” is the most prevalent wording. A few still prefer “person with autism” and “he/she/they have autism,” but this is problematic and increasingly rare.
Asperger’s Syndrome
This term is outdated and controversial. It used to be used to refer to “high-functioning autism,” essentially meaning autistic people who are verbal and highly capable, but with distinct behavioral and socially awkward traits. The name comes from Hans Asperger, a Nazi doctor who identified the syndrome, and the term has fallen out of favor because of his Nazi associations, eugenicist views, and participation in Aktion T4, a program that selected patients for involuntary euthanasia if they did not conform to the Nazi ideal of people “worthy of life” (also known as racial hygiene).17
High-Functioning
Often defined as “without intellectual disability,” some professionals and members of the public use this to refer to autistic people who generally have high levels of executive functioning, are verbal, often gifted, and able to function within society to a fair degree. However, it is also controversial, firstly because of the distinction and potential for ableist discrimination against nonverbal (but equally intelligent) autistic people, or those with greater learning deficits.
Autism Spectrum Disorder
This is the current term used to describe all individuals diagnosed with autism. It emphasizes that although certain traits are common in autism, not all individuals will exhibit all the traits, nor do they express them to the same degree. A common phrase in the autistic community is “When you’ve met one autistic person, you’ve met one autistic person.” Stereotyping should be avoided in all cases. There are further concerns surrounding the use of “disorder” for the same reason as the dislike of person-first language; many autistic people feel their autism is part of who they are and not a pathology to overcome. Aside from being upsetting, the “pathology paradigm” has also been seen as resulting in autistic people “being stigmatized, misrepresented, dehumanized, abused, harmed, and traumatized by professionals and by their own families,” and autism research has until recently been exclusively informed by this paradigm. Some studies have now begun to produce evidence for the harmful effects of the “pathology” model on neurodiverse individuals.18 There are other nuances in the “depathologizing” movement worth exploring.19
Neurodivergent/Neurotypical
The term neurodiversity is attributed to Judy Singer in 1999,20 and neurodivergent/neurodivergence were coined by Kassiane Asasumasu around 2000. Nick Walker, PhD, a professor at California Institute of Integral Studies and influential autism self-advocate, explains: “Neurodiversity is the diversity of human brains and minds—the infinite variation in neurocognitive functioning within our species . . . Neurodiversity is a biological fact. It’s not a perspective, an approach, a belief, a political position, or a paradigm . . . When an individual diverges from the dominant societal standards of ‘normal’ [neurotypical] neurocognitive functioning, they don’t ‘have neurodiversity,’ they’re neurodivergent.”21 In short, autism starts with brain neurology, should not be pathologized, and cannot be “cured.” Many autistic individuals do require support with coping mechanisms, socialization, and other practical matters, but not at the expense of their identity—which is not one they have chosen, but one that is hardwired into their brains.
Other terms and nuances related to the language of autism and neurodiversity are explained in Walker’s article “Neurodiversity: Some Basic Terms and Definitions” (see note 21).
Notes
1. Damian E. M. Milton, “Disposable Dispositions: Reflections upon the Work of Iris Marion Young in Relation to the Social Oppression of Autistic People,” Disability and Society 31, no. 10 (2016): 1403–7, https://doi.org/10.1080/09687599.2016.1263468; Damian Milton and Mike Bracher, “Autistics Speak But are They Heard?,” Medical Sociology 7, no. 2 (June 2013): 61–9. https://kar.kent.ac.uk/62635.
2. Daniel J. Weiner et al., “Polygenic Transmission Disequilibrium Confirms that Common and Rare Variation Act Additively to Create Risk for Autism Spectrum Disorders,” Nature Genetics 49, no. 7 (July 2017): 978–85. https://doi.org/10.1038/ng.3863; Lambertus Klei et al., “Common Genetic Variants, Acting Additively, are a Major Source of Risk for Autism,” Molecular Autism 3, no. 1 (October 2012): 1–13. https://doi.org/10.1186/2040-2392-3-9; Martha R. Herbert, “Contributions of the Environment and Environmentally Vulnerable Physiology to Autism Spectrum Disorders,” Current Opinion in Neurology 23, no. 2 (April 2010): 103–10. https://doi.org/10.1097/WCO.0b013e328336a01f; Sylvie Tordjman et al., “Gene X Environment Interactions in Autism Spectrum Disorders: Role of Epigenetic Mechanisms,” Frontiers in Psychiatry 5 (August 2014): 53, https://doi.org/10.3389/fpsyt.2014.00053.
3. Laura Crane et al., “Supporting Newly Identified or Diagnosed Autistic Adults: An Initial Evaluation of an Autistic-Led Programme,” Journal of Autism and Developmental Disorders 51, no. 3 (March 2021): 892–905, https://doi.org/10.1007/s10803-020-04486-4.
4. Laura Hull et al., “Is Social Camouflaging Associated with Anxiety and Depression in Autistic Adults?,” Molecular Autism 12, no. 1 (February 2021): 13, https://doi.org/10.1186/s13229-021-00421-1; Eilidh Cage and Zoe Troxell-Whitman, “Understanding the Reasons, Contexts and Costs of Camouflaging for Autistic Adults,” Journal of Autism and Developmental Disorders 49, no. 5 (May 2019): 1899–1911, https://doi.org/10.1007/s10803-018-03878-x; Meng-Chuan Lai et al., “Quantifying and Exploring Camouflaging in Men and Women with Autism,” Autism 21, no. 6 (August 2017): 690–702, https://doi.org/10.1177/1362361316671012.
5. Meng-Chuan La et al., “Neural Self-Representation in Autistic Women and Association with ‘Compensatory Camouflaging,’” Autism 23, no. 5 (July 2019): 1210–23, https://doi.org/10.1177/1362361318807159; Allison B. Ratto et al., “What About the Girls? Sex-Based Differences in Autistic Traits and Adaptive Skills,” Journal of Autism and Developmental Disorders 48, no. 5 (May 2018): 1698–1711, https://doi.org/10.1007/s10803-017-3413-9; Judith Gould and Jacqui Ashton-Smith, “Missed Diagnosis or Misdiagnosis? Girls and Women on the Autism Spectrum,” Good Autism Practice 12, no. 1 (May 2011): 34–41; Renée M. Green et al., “Women and Autism Spectrum Disorder: Diagnosis and Implications for Treatment of Adolescents and Adults,” Current Psychiatry Reports 21, no. 4 (March 2019): 22, https://doi.org/10.1007/s11920-019-1006-3.
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With 20 years in teaching and more than a decade in journalism and academic publishing, Sasha Chaitow, PhD, is series editor for Elsevier’s Leon Chaitow Library of Bodywork and Movement Therapies and former managing editor of the Journal of Bodywork & Movement Therapies. Based between the UK and Greece, she teaches research literacy and science reporting at the University of Patras, Greece. She is also a professional artist, gallerist, and educator who exhibits and teaches internationally.