If you ask a medical or mental health professional what autism is, they will likely tell you that autism is a neurodevelopmental disorder with two primary components. First, problems with social communication and relating to others. Second, restricted, repetitive patterns of behaviors, interests, or activities. This definition is pulled directly from the Diagnostics and Statistical Manual (DSM-5) which is used to diagnose disorders. It’s based on the medical model that sees autism as a disorder. If you want a good example of someone explaining autism in this way, you can watch the video ADHD vs Autism by psychiatrist Dr. Marks.
My conceptualization of autism varies starkly from the medical model.
First, I do not see autism as a disorder. I see it as a different neurotype. It is not something that needs to be changed, fixed, or cured. This is in line with the neurodiversity movement.
Second, I do not see the two primary categories of Autism Spectrum Disorder as a sufficient explanation of autism. These categories simply identify external behaviors that the medical community deems “abnormal.” They do not actually explain what is happening in the brain or what the lived interior experience of autism is.
Current theories of autism suggest that an autistic brain has more neural pathways that fire more frequently and in conjunction with other pathways. This causes an autistic person to perceive, feel, and think differently than neurotypical people. Autistic people typically have an enhanced sensory system, as well as a nervous system that is more frequently activated. Furthermore, autistic people tend to feel and think more - they experience a greater quantity and frequency of emotions and thoughts.
All of the above can be positive things. It can lead us to feel things deeply and connect with the world around us in profound ways. It can also lead us to feel overwhelmed at times. We’re constantly dealing with a lot of incoming information, as well as intense emotions and thoughts. It’s a lot to manage, and controlling our environment and the amount of incoming information can help with that. Consistency, clarity, and reliability feel extremely good to an autistic because it limits the amount of excess incoming information. We don’t have to experience and process something new when we stay in our routines.
When the DSM-5 classifies autistics as “disordered” due to our love of routine and order, they miss WHY those things are helpful to us.
They also miss the “why” when it comes to repetitive behaviors. We often stim or throw ourselves into our interests to regulate our nervous systems. These things feel good to us and help us to calm down. To frame these behaviors as “disordered” pathologizes something beneficial to us.
The DSM-5 category of “problems with social communication and relating to others” also misses what is happening on a deeper level for autistics. If an autistic person perceives, feels, and thinks differently than the average person, of course there will be difficulty when socializing with others. Furthermore, the DSM-5 also doesn’t take into account the impact of neurotypical social norms, such as “lying” to be polite. Instead of questioning our cultural norms, they deem autistics as “disordered” because we want clear, direct, and truthful information. We come off as “blunt” or “inappropriate” because we do not want to engage in social norms that do not align with our values.
When you place an autistic person with an individual who understands autism, they communicate perfectly well. This can also be seen when autistics communicate with other autistics. If you would like to explore this topic more, you can see my essay “Autism Does Not Directly Cause Difficulty Socializing.”
The DSM-5 needs to provide consistent “symptoms” to define a disorder. Unfortunately, these symptoms focus solely on external behaviors and miss what is central to autism. When we set the medical model aside, we can stop focusing on external behaviors. We can actually understand what autism is and how it impacts people internally.