Many in the disability sector argue that a social model of disability should replace the medical model.

A social model of disability might be illustrated through considering a room full of people who all communicate primarily using AUSLAN.  Being deaf or hearing-impaired is not a deficit in this context. But when a new person who knows no AUSLAN enters the room, that person has a communication disability in this setting: their disability is due to the social context. Some aspects of disability generally depend on social context and interpretation.

Social context/interpretation plays a major role in autism. Autism Spectrum Disorder is diagnosed when a person “needs support” in two domains:

A. social communication and social interaction …

B. Restricted, repetitive patterns of behavior, interests, or activities …

The concept of “needs support” in autism is largely a social model construct especially when it relates to deficits in social communication and interaction … not to mention the social judgement of what behaviour is dysfunctionally “restricted” or “repetitive”. 

Social models vary: social norms and social expectations change through time. Back in the 1980s, researchers and clinicians sought to teach autistic children skills so they could participate in mainstream school. At that time, autistic children needed to present as “normal” on a social basis to be eligible for mainstream school.

In the 1990s, at about the same time as the DSM-IV was published with its diagnostic criteria for Autistic Disorder, the international community adopted the Salamanca Statement that sought to make mainstream schools more inclusive. The Statement meant autistic children were no longer required to appear “normal” in order to attend mainstream schools; the aim was a more flexible social model that would accommodate children with disability, including autistic children, in the “least restrictive” setting which often meant a mainstream classroom.

Many autistic children still needed substantial support to be able to learn effectively … but no longer did they need to be “normal” (whatever that meant). Many autistic children also need to be taught to learn effectively even in accommodating settings. And many teachers need to learn to teach children with more divergent learning styles. 

After “inclusive” education comes neuro-affirming or celebrating the benefits of neuro-divergence as a next step. This is about recognising and appreciating non-normal (different) ways of doing things and especially when different is good or better than the normal way of doing things.

I had the benefit of being brought up in a neuro-affirming family before there was a word for it. I recall once that I was asked in a maths test to prove that the two angles at the base of an isosceles triangle ABC were equal. I had been taught the “normal” way to prove it by bisecting the line BC with a midpoint X, then proving ABX and ACX were congruent triangles hence the angles ABX and ACX were equal. Instead, I chose in my answer to prove that the triangles ABC and ACB were congruent hence the angles ABC and ACB were equal. My teacher marked me wrong since that was not the accepted/normal/expected proof. My neuro-affirming mother stepped in to defend my “different” (and simpler) proof arguing that my maths was sound (which it was). The neurotypical teacher did not accept my proof nor my mother’s defence of my proof … so insisted on awarding me no marks for the question. Years later, the proof I’d given was accepted by the maths community especially when the same proof was recognised as the first great triumph of AI theorem proving since it is a simpler, more direct, and better proof than the more complex classical proof (using the X midpoint triangles). This experience was pretty typical of my schooling. 

There are increasing numbers of stories like this as IT companies recognise and appreciate the benefits of neuro-divergent employees. There are signs that other industries are starting to follow. 

The main message here is that not everything that society has traditionally considered an autistic deficit will remain as a deficit. For example, different sensitivities to light or sound can be accommodated with the result that some behaviour that was regarded as problematic or dysfunctional no longer occurs … so a degree of different sensitivity is no longer a functional deficit in an autistic person. If some trait ceases to be considered deficits (because they are readily accommodated through environmental or social adjustment, etc. ) then the need for support is gone and the person no longer needs support for that trait. If their all traits are fully accepted and/or accommodated then they no longer need support; they no longer meet the diagnostic criteria for autism so they lose their autism diagnosis. The person has not changed so it does not make sense to suggest that they were cured. And they remain neuro-divergent … just not autistic (based on the diagnostic criteria). 

I knew from a very early age that my brain worked differently from other people. The terms “neuro-divergent” and “neuro-affirming” describe many in my family and we were mostly proud of our difference even though we did not have a word for it until recently.

I’m lucky. Throughout my life (now in my 70s) I feel like I’ve benefited from my neuro-divergence; it’s been an advantage for me. 

I don’t regard myself as autistic since my differences have not been deficits (except a couple of times lately in my advocacy work NDIS neurotypicals have complained about my (atypical?) communication style). I lived my life without needing support (at least for my “differences”). 

Perhaps neuro-divergence can be seen in parts:

1. The part that is highly functional and a positive advantage;
2. Elements that are judged to be deficits because they are outside social norms that disappear when social norms are extended/expanded and difference is accepted/respected
3. A part that is only dysfunctional in the wrong social or environmental contexts - the part where difference can be accepted, accommodated or is environmental hence can be avoided; and
4. impairments that need distinct effort to support as they are beyond what most communities can adjust for.

Some people want to believe only the first and to some extent the second categories exist. If they choose to deny parts 3 & 4, I really can’t help them.

The boundaries between these categories are very variable: basically, there are major aspects of disability that are socially determined. Some aspects of disability and autism as part of neuro-divergence are decreased through fixing society. And technology extends the range of impairment that can be accommodated, for example AAC diminishes communications disability for many. 

I agree that substantially improved outcomes for autistic Australians will/can be achieved through better acceptance of neuro-divergence and respect for neurodiversity. A more inclusive/accepting/flexible/tolerant community/society reduces support needs. More effort is needed in the area of active and explicit neuro-affirming community building. Note that this is not the role of the NDIS; the test here is whether the bureaucrats now writing the imminent National Autism Strategy recognise this and include plans to act accordingly (a very unlikely outcome). 

I love that times for wheelchair marathons are faster than for runners. On the other hand, I’m not aware of many wheelchair orienteering or rogaining events. Are there any urban orienteering events? The choice of venue for these events is a social construct that determines “disability” (or advantage) in these cases.

Some people dispute that the last of the above neuro-divergence categories exists. Their ideology expects society to expand the second and third categories to fully include the last category … so that the last category is empty and goes away. I dispute that this ideal state will happen in my or my son’s lifetimes. 

I don’t accept the argument that all autistic impairment would not exist in a fully inclusive society. Some severely/profoundly autistic people need to learn/develop functional skills through therapy (or autism-specific education). Some autistic children need intensive behavioural intervention to realise their potential. Everything/everyone who is toilet trained had their behaviour modified. It is prejudice and discrimination for NDIS planners to deny ABA to autistic children who need to learn skills like toilet training, communication, personal hygiene, learning to learn, tolerance of medical and dental procedures, etc. … when that is what families and clinicians both believe is best for a young autistic child. They also need to fully understand and respect the child’s preferences and communication. And the intervention must focus on learning/developing functional skills; intervention is not about becoming “normal”. 

My severely autistic adult son needs very substantial support. No amount of social change will render him independent, self-sufficient, or fully functional. Of course, he also has many positive differences that we celebrate. He seems to be enjoying his life especially when he chooses how he lives it - though he rarely articulates any of this. 

I don’t expect everyone will agree with how I see autism and neuro-divergence as different, that 

• autism is a part of the deficits side of neuro-divergence, where supports for communication, social interaction, and behaviour are needed, and 
• neuro-divergence is much bigger,  including positives/benefits, deficits (or needing support), and neutral (equally functional) differences. 

Another issue is that there is more to the social model of disability that just goes unrecognised.  Some autistic people are just excluded because they are too different; they do not fit in socially. They do not maintain successful friendships or relationships. Or their difference may deny them employment. Our society does not recognise the social support that they need. For these people their disability is purely social. 

It does not make sense to me when I hear someone say “I’m autistic but I don’t need support … just just need awareness and accommodations”^[1]. I don’t understand what they mean by “autistic” when they say this - what definition/description of “autistic” are they using (not one that says autistic people need support)? It seems to me that if their difference is successfully accommodated then they may be neuro-divergent but not autistic (at least according to the autism criteria^[2] that I am aware of). 

As parts of society change, becoming more inclusive or accepting of autistic differences, autistic people can lose their autism diagnosis without being “cured”. The autistic person has not changed: instead society changed to accept or accommodate their differences or they avoid environments where they need support for their difference. 

Autistic people can also learn/develop functional skills thereby losing aspects of their disability/deficits without their neurology changing. 

Maybe, if we had a term for just the positive side of neuro-divergence, it would be easier to talk about. Maybe the term “gifted & talented” is a step in that direction. 

Autism is a largely social model disability: it is not (yet?) determined by genetics, biochemistry, neurology or any other more medical characteristic(s). The impact of autism on an individual depends on their social context and social environment in relation to how the autistic person interacts with their social environment. Support for individual autistic people can usually improve both their environment and their social & communication capacity. And many need accommodations or substantial support with their executive function and self-regulation. 

Governments in Australia need to better understand their autistic citizens, to recognise and address the full range of autism-related support needs, and to develop effective policy and programs that improve the well-being of all autistic Australians. 

Bob Buckley
Dec 2024