Debate: Neurodiversity, autism and healthcare

Abstract

We are at a time of unparalleled flux in our understanding of what autism is and now to respond to it, including our understanding of the role of clinical services. For any clinician working in the context of child development and child mental health services, the majority experience is probably of overwhelming demand, and then perhaps confusion. Referrals for neurodevelopmental conditions, and particularly autism, have become an increasing proportion of UK CAMHS referrals in recent years—with the consequent lengthening of wait times extending to years, sometimes equivalent to the whole length of a child's life up until that point. Services are struggling to develop response strategies to meet user frustration, a task not helped by the fact that most interventions in current use have no good evidence of effectiveness. Consequently, a plethora of local approaches and initiatives have developed. In this article I address these clinical and related issues. I discuss current different uses of the term autism, the relation to intellectual disability, and introduce a conceptualisation of autism as emergent and transactional, which is consistent with current developmental and intervention science. This could bridge between neurodiversity and clinical perspectives and implies a framing of early intervention support that has strong clinical trials evidence and provides the basis for a rational and pre‐emptive evidenced care pathway, which I describe.

Commentary: Reviewing neurodiversity, autism, and healthcare by Jonathan Green (2023) from an autistic perspective

“…I fundamentally agree with Green (2023) and glad his paper addresses these issues. However, Green (2023) needed to be more forceful in reiterating how healthcare professionals can make progress, to better understand and integrate the neurodiversity movement into healthcare surrounding autistic identity. Identity is the interaction with spaces, people and objects to form an understanding of the self (Hollweck, Netolicky, & Campbell, 2022).…”

“…Even though healthcare researchers as illustrated by Green (2023) have attempted to include autistic perspectives, such as ICD11, I believe healthcare professionals and other disciplines, such as the social sciences, continue to pathologize and infantilise both autistic adults and children. This continues the suppression of my community (Zeidan et al, 2022).…”

“…Furthermore, Green (2023) discusses the emergence of neurodiversity as a key player in forming knowledge concerning autism, such as including neurodiversity in his model portraying autism to be emergent and transactional. Thus, as a strong proponent surrounding autism rights, I also agree with this argument.…”

“…I am pleased that Green's (2023) paper addressed this issue as I find coproduction a vital and empowering tool in creating healthcare systems that cater to our needs. This was important for me when he highlighted the need to conduct further research on intellectual disability (ID), as ID is often tied to autism, despite the fact IDs are separate conditions from autism.…”

“…To reflect upon the perspectives of autism and neurodiversity and how these two terms have influenced health care, this article aims to respond to Green (2023). I shall respond by analysing two themes outlined by Green (2023), which I believe as an autistic person requires further analysis. This would help support healthcare provision for autistic people in the future.…”