Autism and Society – Clinical Psychology 1/8
1. WHAT IS AUTISM?
Currently understood as a common, diverse, lifelong condition which Critical point on rising diagnoses: The increase does not necessarily
affects communication and social interaction. The concept has changed over mean autism itself has become more common. It may reflect increased
time. awareness, broader diagnostic criteria, better recognition of autistic adults,
Usually described as a neurodevelopmental condition — differences are and improved access to assessment.
present from early development and persist throughout life. Highly Important: Traditional autism diagnosis may have been biased toward male
heterogeneous: autistic people vary widely in communication, sensory presentations. This links to the idea that diagnosis is shaped by social,
experience, intellectual ability and support needs. medical and historical context, not just biology. However, rising diagnoses
also increase pressure on assessment and post-diagnostic services.
Prevalence:
1/100 people — National Autistic Society Diversity within autism: "Autistic people have their own strengths and
700,000 autistic adults and children in the UK weaknesses" (NAS). Can use fluent, minimal or no verbal communication;
787% increase in diagnoses between 1998 and 2018 (Russell et al., academic abilities vary greatly. Some autistic people may need high levels of
daily support; others may live independently but still experience significant
2021)
challenges (e.g., employment, mental health, social relationships).
Due to: changes in environmental factors, improved awareness, widened
diagnostic criteria (Bullimer, 2008; Mandell, 2018)
Russell et al. (2021): diagnoses increased exponentially among adults,
females and people deemed "higher functioning"
Loomes et al. (2017) meta-analysis: girls less likely to be diagnosed —
female autism may be misidentified or missed
2. CORE FEATURES OF AUTISM
Social interaction and communication: difficulties reading social cues DSM-5 (APA, 2013) — Criteria overview:
and maintaining conversations
A) Social communication and interaction (all 3 required):
Repetitive or restricted behaviours: strong need for routine, intense
Deficits in social-emotional reciprocity
interests, repetitive movements
Deficits in nonverbal communicative behaviours
Over/under-stimulation by the sensory environment: hypersensitive to
Deficits in maintaining/developing relationships
noise/lights or hyposensitive and seeking stimulation
B) Restricted/repetitive behaviours (at least 2 required):
Anxiety: often due to unpredictability and social demands
Stereotyped or repetitive movements/speech
Meltdowns and shutdowns: outward or inward responses to overwhelm
Insistence on sameness
Key framing: These features are best understood as differences in
Highly restricted, fixated interests
communication, predictability, sensory processing and regulation — not
Sensory differences
simply deficits or failures. Autism should not be reduced to stereotypes.
C–E criteria: Symptoms present in early developmental period · Cause
clinically significant impairment · Not better explained by intellectual disability
, Autism and Society – Clinical Psychology 2/8
3. AUTISM AS A CHANGING DIAGNOSTIC CATEGORY — VERHOEFF (2013)
Verhoeff (2013) — key arguments: Evaluation and exam use:
Critiques the idea that autism has always meant the same thing Verhoeff supports the argument that diagnosis is a social and historical
"Practitioner-historians" have written histories that suggest a stable process, not just a biological discovery. Useful for evaluating whether DSM-5
continuous concept of autism — Verhoeff challenges this criteria represent objective truth or reflect current consensus. Links to
Argues autism has been "in flux", with major shifts in which symptoms broader questions about nosology.
and impairments are treated as essential DSM-5 limitation (exam point): The requirement for "clinically significant
Shows that psychiatric criteria are historical and constructed impairment" reflects a medical/disorder framework. This can be criticised
Challenges the idea that autism is a fixed, timeless category because impairment may partly depend on whether social environments
accommodate autistic differences — the same person may be more or less
Clarification: This does not mean autism is "not real" — it means that the
"impaired" depending on context.
way autism is defined, recognised and diagnosed has shifted over time and
continues to evolve.
4. INTERVENTIONS AND ETHICAL ISSUES — HENS ET AL. (2018)
Examples of interventions: Hens et al. (2018) — Disorder vs identity debate:
Speech and language therapy Raises the key question: should we be trying to change autistic people,
Occupational therapy or accept them?
Mental health support · CBT (adapted) Autism is heterogeneous and a natural variation in human cognition
Music and play therapy Interventions become ethically problematic if they aim to suppress
Relationship Development Intervention (parents/carers as therapists) harmless autistic behaviours simply because they differ from neurotypical
Applied Behaviour Analysis (ABA) norms
Ethical issues: whose goals are being prioritised — the autistic person's,
ABA controversy: ABA focuses on changing behaviours to seem "normal". parents', school's or society's?
Criticised when it prioritises compliance or masking over autistic wellbeing.
Suppressing harmless behaviours (e.g., stimming) may ignore their Balanced position: Interventions can be valuable when they reduce
regulatory function and increase pressure to camouflage. Most ethically distress, improve access, support communication, build skills and increase
problematic when "success" is measured by neurotypical appearance rather wellbeing — with the autistic person's needs and consent at the centre.
than the autistic person's actual wellbeing. Support should reduce barriers while respecting autistic identity, autonomy
and dignity.
Exam conclusion: Autism interventions are ethical when person-centred,
consent-based and focused on reducing distress or improving
communication/function. They become problematic when they prioritise
conformity over autonomy.
5. THEORY OF MIND VS DOUBLE EMPATHY PROBLEM
Theory of Mind — Baron-Cohen et al. (1985): Double Empathy Problem — Milton:
Autistic people have an impaired theory of mind — difficulty Alternative theory: misunderstanding between autistic and non-autistic
understanding or predicting the thoughts, feelings and intentions of others people goes both ways
Also called "mindblindness" Non-autistic people may also struggle to understand autistic
Historically influential in autism research and widely cited communication and experiences
Limitation: can oversimplify autism and imply that autistic people lack The "problem" is located in neurotype mismatch, not solely in the
empathy. Locates the communication problem mainly within the autistic autistic person
person. Crompton et al. (2020): autistic people shared information effectively
with other autistic people and experienced fewer miscommunications —
supports double empathy
Fits with social model thinking: locates difficulty in interaction and social
expectations, not individual deficit
Exam use: The double empathy problem challenges stereotypes that autistic people lack empathy and supports a more interactional understanding. It argues
that communication difficulties arise from neurotype mismatch rather than autistic deficit — shifting focus from "fixing" autistic people to improving mutual
understanding and accommodation.
1. WHAT IS AUTISM?
Currently understood as a common, diverse, lifelong condition which Critical point on rising diagnoses: The increase does not necessarily
affects communication and social interaction. The concept has changed over mean autism itself has become more common. It may reflect increased
time. awareness, broader diagnostic criteria, better recognition of autistic adults,
Usually described as a neurodevelopmental condition — differences are and improved access to assessment.
present from early development and persist throughout life. Highly Important: Traditional autism diagnosis may have been biased toward male
heterogeneous: autistic people vary widely in communication, sensory presentations. This links to the idea that diagnosis is shaped by social,
experience, intellectual ability and support needs. medical and historical context, not just biology. However, rising diagnoses
also increase pressure on assessment and post-diagnostic services.
Prevalence:
1/100 people — National Autistic Society Diversity within autism: "Autistic people have their own strengths and
700,000 autistic adults and children in the UK weaknesses" (NAS). Can use fluent, minimal or no verbal communication;
787% increase in diagnoses between 1998 and 2018 (Russell et al., academic abilities vary greatly. Some autistic people may need high levels of
daily support; others may live independently but still experience significant
2021)
challenges (e.g., employment, mental health, social relationships).
Due to: changes in environmental factors, improved awareness, widened
diagnostic criteria (Bullimer, 2008; Mandell, 2018)
Russell et al. (2021): diagnoses increased exponentially among adults,
females and people deemed "higher functioning"
Loomes et al. (2017) meta-analysis: girls less likely to be diagnosed —
female autism may be misidentified or missed
2. CORE FEATURES OF AUTISM
Social interaction and communication: difficulties reading social cues DSM-5 (APA, 2013) — Criteria overview:
and maintaining conversations
A) Social communication and interaction (all 3 required):
Repetitive or restricted behaviours: strong need for routine, intense
Deficits in social-emotional reciprocity
interests, repetitive movements
Deficits in nonverbal communicative behaviours
Over/under-stimulation by the sensory environment: hypersensitive to
Deficits in maintaining/developing relationships
noise/lights or hyposensitive and seeking stimulation
B) Restricted/repetitive behaviours (at least 2 required):
Anxiety: often due to unpredictability and social demands
Stereotyped or repetitive movements/speech
Meltdowns and shutdowns: outward or inward responses to overwhelm
Insistence on sameness
Key framing: These features are best understood as differences in
Highly restricted, fixated interests
communication, predictability, sensory processing and regulation — not
Sensory differences
simply deficits or failures. Autism should not be reduced to stereotypes.
C–E criteria: Symptoms present in early developmental period · Cause
clinically significant impairment · Not better explained by intellectual disability
, Autism and Society – Clinical Psychology 2/8
3. AUTISM AS A CHANGING DIAGNOSTIC CATEGORY — VERHOEFF (2013)
Verhoeff (2013) — key arguments: Evaluation and exam use:
Critiques the idea that autism has always meant the same thing Verhoeff supports the argument that diagnosis is a social and historical
"Practitioner-historians" have written histories that suggest a stable process, not just a biological discovery. Useful for evaluating whether DSM-5
continuous concept of autism — Verhoeff challenges this criteria represent objective truth or reflect current consensus. Links to
Argues autism has been "in flux", with major shifts in which symptoms broader questions about nosology.
and impairments are treated as essential DSM-5 limitation (exam point): The requirement for "clinically significant
Shows that psychiatric criteria are historical and constructed impairment" reflects a medical/disorder framework. This can be criticised
Challenges the idea that autism is a fixed, timeless category because impairment may partly depend on whether social environments
accommodate autistic differences — the same person may be more or less
Clarification: This does not mean autism is "not real" — it means that the
"impaired" depending on context.
way autism is defined, recognised and diagnosed has shifted over time and
continues to evolve.
4. INTERVENTIONS AND ETHICAL ISSUES — HENS ET AL. (2018)
Examples of interventions: Hens et al. (2018) — Disorder vs identity debate:
Speech and language therapy Raises the key question: should we be trying to change autistic people,
Occupational therapy or accept them?
Mental health support · CBT (adapted) Autism is heterogeneous and a natural variation in human cognition
Music and play therapy Interventions become ethically problematic if they aim to suppress
Relationship Development Intervention (parents/carers as therapists) harmless autistic behaviours simply because they differ from neurotypical
Applied Behaviour Analysis (ABA) norms
Ethical issues: whose goals are being prioritised — the autistic person's,
ABA controversy: ABA focuses on changing behaviours to seem "normal". parents', school's or society's?
Criticised when it prioritises compliance or masking over autistic wellbeing.
Suppressing harmless behaviours (e.g., stimming) may ignore their Balanced position: Interventions can be valuable when they reduce
regulatory function and increase pressure to camouflage. Most ethically distress, improve access, support communication, build skills and increase
problematic when "success" is measured by neurotypical appearance rather wellbeing — with the autistic person's needs and consent at the centre.
than the autistic person's actual wellbeing. Support should reduce barriers while respecting autistic identity, autonomy
and dignity.
Exam conclusion: Autism interventions are ethical when person-centred,
consent-based and focused on reducing distress or improving
communication/function. They become problematic when they prioritise
conformity over autonomy.
5. THEORY OF MIND VS DOUBLE EMPATHY PROBLEM
Theory of Mind — Baron-Cohen et al. (1985): Double Empathy Problem — Milton:
Autistic people have an impaired theory of mind — difficulty Alternative theory: misunderstanding between autistic and non-autistic
understanding or predicting the thoughts, feelings and intentions of others people goes both ways
Also called "mindblindness" Non-autistic people may also struggle to understand autistic
Historically influential in autism research and widely cited communication and experiences
Limitation: can oversimplify autism and imply that autistic people lack The "problem" is located in neurotype mismatch, not solely in the
empathy. Locates the communication problem mainly within the autistic autistic person
person. Crompton et al. (2020): autistic people shared information effectively
with other autistic people and experienced fewer miscommunications —
supports double empathy
Fits with social model thinking: locates difficulty in interaction and social
expectations, not individual deficit
Exam use: The double empathy problem challenges stereotypes that autistic people lack empathy and supports a more interactional understanding. It argues
that communication difficulties arise from neurotype mismatch rather than autistic deficit — shifting focus from "fixing" autistic people to improving mutual
understanding and accommodation.
