The fight between those who define autism as a medical condition and those who see it as a mere difference has reached vitriolic levels. Can the two sides come together to support all autistic people?
Is autism a difference, a diagnosis, a disorder, a disease or a disability? These are the ‘D-words’ that really matter in the autism community, according to academics such as healthcare ethicist Kenneth A. Richman and researcher Simon Baron-Cohen.
Those in the neurodiversity camp see autism primarily as the first D-word: difference. Viewing autism as a disease is harmful, Ne’eman says. “In lots of cases, the way that you make an autistic person successful and happy and as independent as possible for them to be, is by leaning into the autism, not trying to correct it,” he says. Those who describe autism as a disease, he and others say, are reflecting back society’s intolerance of difference.
Supporters of the NCSA and others argue that the ‘difference’ from neurotypicals looks vastly different across the spectrum and cannot be so easily recapitulated. For some autistic people, for example, repetitive behaviors may serve to calm them or offer a means to express great discomfort, or even great joy — and need only acceptance, not treatment. But that’s not always the case, Casanova says. “It’s not a blessing to have head-banging, eye-gouging or self-biting; those have serious side effects, including retinal detachment, cauliflower ears, they can get brain trauma, contusions,” he says. “Those people need to be treated.”