Redefining Autism

Written by Georgie Makary, 2026 - All rights reserved

Autism Spectrum Disorder (ASD), or simply autism, is a highly genetic neurodevelopmental profile with considerable variation in how it presents. Although there are common underlying features, autistic individuals often show unique patterns in cognition, behaviour and day-to-day functioning. In general, these features involve differences in social communication and interaction, sensory experiences, and cognitive and behavioural patterns that may be repetitive or restrictive (American Psychiatric Association, 2013).

Autism is a heterogeneous neurotype, meaning that it presents in vastly different ways between individuals.  This diversity of presentation has informed the use of the term “spectrum,” reflecting a move away from earlier, more rigid pathology (Wing et al., 2011). The spectrum is not a linear, sliding scale but a complex wheel of overlapping characteristics including sensory processing, unique language skills, tics and repetitive behaviours, social differences, special interests and differences in executive functioning and learning (Pender et al., 2020). 

Earlier understandings framed autism in categorical terms based on observable behaviours like avoiding eye contact or a flat, monotone voice. More recent neuroaffirming frameworks adopt a dimensional approach, recognising that while individuals may share core autistic traits, the way these manifest vary widely (Lord et al., 2020). 

Eye contact is a good example, often experienced as uncomfortable or physically painful for the autistic community. This may lead one individual to avoid making eye contact due to discomfort, while another individual may force prolonged eye contact for fear of being perceived as rude or not paying attention. This variability shows how adaptive functioning alters the way a core characteristic is expressed between individuals. Autism is understood both as a clinical diagnosis and a broad range of lived experiences, abilities, personality characteristics and adaptations (American Psychiatric Association, 2013; Lord et al., 2020; Pender et al., 2020).

Autism was first defined as a disorder in the early 20th century by specialists including Kanner and Asperger, however it has long existed as a natural variation of human neurology. Historically, neurodiversity has been viewed by some cultures as spiritual or communicating with the divine;  while in other cultures individuals were labeled eccentric or odd, and cared for by the community (Silberman, 2015). 

Modern concepts of health and disability evolved as societies moved from feudalism into industrialisation, imperialism, capitalism and colonisation (Chapman, 2023). The human mind and body needed to be assessed on its functional capacity and value to systems of labor and production, as well as social hierarchy. The pathology paradigm became the key medical framework for categorising biology as either working or broken when compared to a statistical mean of 'normal' health (Chapman, 2023). Human differences were viewed as dysfunctions, deficits and disorders to be correctly diagnosed, treated and cured. This pathology paradigm continues to be a key foundation of contemporary medicine and neuropathology; however, for many in the disability community it is a reductionist, disempowering framework that perpetuates stigma and prejudice (Silberman, 2015).  

The rising rate of autism diagnoses can be partly attributed to the global disability activism of the 1990's, which conceptualised disability rights not as a medical issue, but a human rights issue (Fleischer & Zames, 2011). The movement achieved anti-discrimination laws, accessibility rights, Disability Pride and encouraged the autistic community to reidentify as neurodivergent. The 90's neurodiversity movement argued that challenges faced by the autistic community were no due to broken or dysfunctional neurobiology, but due to systemic failures of society to accommodate their unique needs (Chapman, 2023).      

This neurodiversity activism has contributed to expanding the diagnostic criteria, specifically for the differing presentation in girls and women (the first explicit studies dedicated to the female phenotype of autism began in to 2010s). There are also important holistic advances in diagnostic screening tools to better identifying autistic neurotypes from broader language and behavioural diagnoses (Happé & Frith, 2020; Wing et al., 2011). As the community grows, advances in research fields such as genetics, neuroscience, and behavioural science continue to explore the epidemiology of autism. Other evidence-based hypotheses include sociobiological factors like advanced parental age and genetic mutations or prenatal factors, however these are more likely to be factors and not directly causational (Happé & Frith, 2020). 

Lilly Pilly approaches autism not as a condition to be fixed, but as a valid neurotype and meaningful way of experiencing and interacting with the world. The focus is on supporting individuals to better understand their own strengths, adaptive needs and communication styles, rather than attempting to retrain or suppress autistic traits. Therapy is guided by this neuroaffirming framework that prioritises acceptance, self-understanding and identity. 

References 

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Chapman, R. (2023). Empire of normality: Neurodiversity and capitalism. Pluto Press.

Fleischer, D. Z., & Zames, F. (2011). The disability rights movement: From charity to confrontation (2nd ed.). Temple University Press.  

Happé, F., & Frith, U. (2020). Annual research review: Looking back to look forward—Changes in the concept of autism and implications for future research. Journal of Child Psychology and Psychiatry, 61(3), 218–232. 

Lord, C., Brugha, T. S., Charman, T., Cusack, J., Dumas, G., Frazier, T., Jones, E. J. H., Jones, R. M., Pickles, A., State, M. W., Taylor, J. L., & Veenstra-VanderWeele, J. (2020). Autism spectrum disorder. Nature Reviews Disease Primers, 6(1), 5. 

Pender, R., Fearon, P., Heron, J., & Mandy, W. (2020). The longitudinal heterogeneity of autistic traits: A systematic review. Research in Autism Spectrum Disorders, 79, 101671. 

Silberman, S. (2015). NeuroTribes: The legacy of autism and the future of neurodiversity. Avery. 

Wing, L., Gould, J., & Gillberg, C. (2011). Autism spectrum disorders in the DSM-V: Better or worse than the DSM-IV? Research in Developmental Disabilities, 32(2), 768–773.