Is Autism a Disability or Neurodivergence?

The text I’ll reference throughout this entry to help answer the question posed in the title of this entry is Neurotypical Spectrum Disorder, written by Autism advocate and licensed pastoral therapist Matt Lowry. The linked version contains a small addition by licensed marriage and family therapist Stephanie Winn. It’s written in the style of a Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5) diagnosis. It classifies being neurotypical as a disorder, listing the disadvantages and differences of being neurotypical relative to autism.

I’d like to start by addressing the apparent deficits in autistic social communication.

The DSM-5 says that autistic people have “Persistent deficits in social communication and social interaction across multiple contexts”. However, at least in autistic people who are verbal, a “substantial number of studies in recent years” consistently support the double empathy problem, the hypothesis that “This lack of understanding may stem from bidirectional differences in communication style, social-cognitive characteristics, and experiences between autistic and non-autistic individuals, but not necessarily an inherent deficiency.”

The DSM-5 criteria for autism doesn’t reflect this at all. It essentially places all the blame on autistic people for failing to communicate with neurotypicals.

The Neurotypical Spectrum Disorder text mentions multiple ways that neurotypical socialization might be considered abnormal and pathologized as a “disorder” by a hypothetical majority autistic society. It can be read as a critique of the old theory of Mind Blindness which posits that autistic people lack theory of mind.

Neurotypical Spectrum Disorder seems to support the Neurodiversity-based view of autism, which asserts that:

“…there is intrinsic diversity in human brain function and cognition, and that certain things currently classified as neurodevelopmental disorders are differences and disabilities but are not necessarily pathological.”

and that

“…disability partly arises from societal barriers, rather than attributing disability purely to inherent deficits.”

The diversity model sits in contrast to the dominant Medical Model of Disability, which asserts that:

“…disability may reduce the individual’s quality of life and aims to diminish or correct this disability with medical intervention.”

I think both frameworks have a point.

The Neurodiversity Framework

The DSM-5 classifies the ways autistic people differ as symptoms of a disorder even though not all those differences are deficits and even when they are disadvantageous, that’s often only because society has made them so, not because of anything inherent about autism. As Neurotypical Spectrum Disorder points out, many traits of neurotypicals would probably be classified as deficits in an autistic society and the only reason they’re not is because the majority of people are neurotypicals.

Saying that all autism is nothing more than a “disorder” ignores that it can actually be a mixed blessing. Without the autistic “deficits” such as noise sensitivity due to a hyperconnected brain, one might lose certain “autistic superpowers” that neurotypicals lack. For example, a much larger fraction of autistic people are savants than neurotypicals. So autism is perhaps better thought of as a trade-off. Let me give an analogy.

Imagine spending skill points on a skill tree for your character in a video game. Neurodiversity is like spending your skill points on atypical strengths while negating commonly taken branches of the skill tree. Your atypical skill tree doesn’t necessarily make you better or worse than the other players overall. If the strengths your character possesses balance out the weaknesses, it just makes you different.

The Medical Framework

On the other hand, I do think the medical model has its place. Something like 25% to 30% of children diagnosed with autism never develop spoken language beyond a few words. For many high-support-needs autistic people, there simply is no “trade-off” being made. They’re worse off than the average person by every metric, they have an impossibly difficult life prone to suffering, and others’ lives are ruined because they require constant care and supervision.

If there were a cure for autism, what possible reason would there be for not treating these individuals? I suppose one could argue that curing these individuals would be akin to killing them and replacing them with a neurotypical since there would be significant psychological discontinuity. However, I don’t find this objection convincing because I place no value on personal identity, only well being.

As far as terminology goes, I think it’s fine to refer to people that have severe debilitating autism with no advantages as people with “disorders” and “disabilities”. Since diversity is normally seen as a good thing, the word “neurodiverse” gives the false impression that their condition doesn’t need to be cured. It does need to be cured and we need medical terminology to talk about it.

To return to the video game analogy, it’s less like they spent their skill points atypically and more like they just started out with less points overall than everybody else. It’s pure disadvantage.

Neurodiversity + Medicine

By creating this distinction between autistic people who should be treated primarily as neurodiverse versus primarily as having a disorder, I’m not saying the neurodiverse can’t benefit from treatment. It’s often the case that the skills autistic people lack, although counterbalanced by “autistic superpowers”, are still important for living in neurotypical society and can actually be learned by autistics. If one can treat or cure what’s bad about being autistic while retaining everything good, I see no reason not to do that.

If you still want to take the hardline position that neurodiversity is a complete load of horseshit and autism should always be classified as a medical disorder, I have one question for you:

How do you justify that position?

If it’s because autism carries deficits compared to being neurotypical, so does being neurotypical carry deficits compared to being autistic, as Neurotypical Spectrum Disorder demonstrates. So both would be disorders under that logic. If it’s because autism carries deficits compared to being neurotypical and differs from the majority neurotype, then in order to be consistent you’d have to concede that neurotypicals living in a majority autistic society should also be considered disabled and ought to be cured.

Also, are you counting autistic deficits that only exist because of an inability to conform to neurotypical society? If so, you also have to count neurotypical deficits that would arise from being forced to conform to an autistic society as symptoms of Neurotypical Spectrum Disorder.

Conclusion

For the relatively small number of people who have exceptional abilities compared to the average, we call them gifted. For the relatively small number of people who have exceptional deficits compared to the average, we call them disabled or say they have a disorder. But what should we call people who have a mixed bag of both exceptional abilities and exceptional deficits compared to the average? Should we just call them disabled too?

I don’t think so. Firstly, we don’t treat all deficits as diseases that need to be cured, at least not in a medical sense. Secondly, calling all autistic people disabled ignores the inherent advantages of autism. That’s why I’m in favor of using the word “neurodiverse” over “disability” or “disorder” in autism with counterbalancing inherent advantages. We need terminology that acknowledges that the categories of disabled, normal, and gifted aren’t mutually exclusive. There are shades of gray.

Autistic people are disabled in the sense that it’s hard for us to function in society, but that doesn’t necessarily mean autism is a disease to be cured. Maybe society needs to be cured instead.

To give the medical framework its due, I think it’s possible to flip around any definition found in the DSM-5, but not to the same effect that the Neurotypical Spectrum Disorder text creates. That’s because some conditions are better off being labeled as disorders and cured, despite however having that disorder might be incidentally beneficial and despite any social good that might come of having people in society with disorders.