Support for autistic people

‍Neurodivergence Terminology

It’s important to start by acknowledging the debate around the term Autism Spectrum Disorder, and the language many autistic people prefer when talking about neurodivergence.

Many people with mental health conditions prefer person-first language, for example “I have bipolar” rather than “I’m bipolar”. Preferences vary, and the best guide is always the person’s own words.

In contrast, many autistic people prefer identity-first language. For example:

- “I’m autistic” is generally preferred over “I have autism”

- “Jane is autistic”  is generally preferred over “Jane has autism”

- “Autistic people”  is generally preferred over “people with autism”

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Some people find the term Autism Spectrum Disorder, or describing autism as a disability, offensive because of what the words disorder and disability imply. Although autism is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), autism is not a mental health condition. It is a natural variation in how a brain develops and works. Autistic people do experience higher rates of anxiety and depression, which many researchers link to the stress of living in a world that isn’t built for them. 

It is also worth acknowledging that some people prefer ‘Autism Spectrum Disorder’ to ‘autistic’, and welcome the term disability.

On this page we use the term autism rather than Autism Spectrum Disorder, as it is generally preferred in the autistic community, but we acknowledge that it isn’t everyone’s preferred term. As with pronouns, it’s important to use the language a person prefers when talking with them. 

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Autism

Autism describes a brain that develops in its own way, shaping how a person interacts, communicates, feels and behaves. It is referred to as a "spectrum" because it includes a wide range of traits, strengths and support needs, which can vary greatly from one person to another.

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What about Asperger's?

Asperger’s (also known as Asperger’s Syndrome) was removed from the DSM in 2013 because of its overlap with autism. It was previously used to describe autistic people who were seen as needing less support. 

The DSM now includes Asperger’s and autism under the one diagnosis, Autism Spectrum Disorder, which is given at one of three levels based on the support a person needs:

1. Level 1 (requiring support)
2. Level 2 (requiring substantial support)
3. Level 3 (requiring very substantial support)

Many autistic people reject functioning labels like “high functioning” because they can hide some people’s support needs and underestimate others.

The level a person is diagnosed at matters in practice. Under the National Disability Insurance Scheme (NDIS), autism diagnosed at Level 2 or Level 3 is on the list of conditions likely to meet the disability requirements, while people diagnosed at Level 1 need to provide more information about how autism affects their daily life.

Many autistic people (and many health professionals working with the autistic community) see this medical model as inaccurate and oversimplified, and prefer the Autism Wheel to the idea of a spectrum. The Autism Wheel reflects how autistic traits and support needs vary from person to person in a neurotypical world. 

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The Autism Wheel

Image credit @LauraFMcConnel 

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Autistic Characteristics

Autistic characteristics typically become apparent during early childhood, usually before the age of three. The main areas of difference for autistic people are social interaction, communication and behaviour, but autistic traits look very different from person to person, as shown in the image below.

Autism and Women 

Initially, autism was believed to be significantly more common in males than females, with autistic males outnumbering females by a ratio of 4 to 1. However, a growing body of research indicates a diagnostic bias towards males, leading to autistic girls and women being misdiagnosed, underdiagnosed, or diagnosed later in life. In fact, recent research indicates that about 80% of autistic females are undiagnosed by age 18 (footnote 1).

There are a number of factors that could contribute to autism being missed in girls and women. Autistic females tend to engage in a lot of masking (camouflaging/concealing autistic tendencies) and overcompensating (mimicking neurotypical tendencies) behaviours. This has been speculated to be due to:

• The importance of communication skills and social relationships in female friendships
• The modelling of communication skills and social relationships of women in popular culture 
• The mother-daughter relationship, which may model and teach communication and relationship skills 

Some argue that the special interests of autistic girls often fit female gender norms (such as a deep interest in horses or a teen boy band), and may be more socially acceptable in adolescent girls than in boys.

It is also thought that a strong preference for predictability and clear rules may, in girls and women, show up as:

• Perfectionism
• Anxiety
• Depression
• Disordered eating 

and be diagnosed as one of these instead.

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What Causes Neurodivergence?

Autistic scholar Nick Walker describes neurodiversity, “the diversity among minds”, as “a natural, healthy, and valuable form of human diversity” (Walker, 2021).

Viewing neurodiversity this way helps explain why more people are identifying as neurodivergent. As a society we are also getting better at understanding the inner neurodivergent experience, and so are recognising people who mask well and would previously have been missed.

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Assessment and Diagnosis

Identifying an autistic neurotype is a complex process that may take several appointments. Selected psychologists at Exhale Psychology Centre can provide comprehensive diagnostic assessments for neurotype.

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Support for Autistic People

Therapy can support autistic people through:

• Psychoeducation around autism
• Support to identify sensory aversions (strong sensory dislikes) and sensory preferences
• Adjusting environments to reduce sensory overwhelm
• Sensorimotor Psychotherapy skills, using sensory tools to support emotion regulation
• Dialectical Behaviour Therapy skills to support emotional regulation
• Communication skills to help you express your preferences and strengthen relationships

Many autistic people also find support groups helpful, along with connecting with like-minded people through special interest groups, and therapy and/or medication for co-occurring anxiety or depression.

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1. McCrossin, R. (2022). Finding the True Number of Females with Autism Spectrum Disorder by Estimating the Biases in Initial Recognition and Clinical Diagnosis. Children (Basel). Feb 17;9(2):272.