Autism Evaluations and the Need for Neurodiversity-Affirming Care

When we look at the diagnostic criteria for autism according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, we see a list of traits, decided by a group of professionals, that spells out what it means to be autistic. In particular, we find “deficits,” “inflexibility,” “difficulties,” and behaviors that are “unusual.”

When I review this list, two major concerns spring to mind:

1. All of these traits emphasize how an autistic person is likely to appear to someone who is observing them, but minimal focus is placed on the autistic person’s experience of their own brain. While observation is a key component of assessment, overlooking the client’s first-hand experience is essentially throwing away the evaluator’s main source of information.
2. Descriptions of autism written from a purely deficit-based perspective overlook the variety of ways that autistic people can present. It ignores the opportunity for a strengths-based conceptualization and leads to misdiagnosis for autistic people who mask.

Between my clinical practice and my personal interactions with autistics, I have heard some horrifying stories and experiences regarding the healthcare system. People have been charged thousands of dollars for an autism assessment—just to be told, “You made eye contact, and autistic people can never make eye contact,” “You say you have friends, and autistic people do not have friends,” or “You have a history of trauma, so I cannot determine if these traits are autism or PTSD.”

Imagine spending your life wondering why you feel so different, why certain things create challenges for you that other people don’t seem to deal with, or why things just do not “click” for you the way they do for other people. Imagine finding the autistic community and finally feeling like someone is speaking your language. The ways that you communicate, feel, and perceive the world around you no longer feel weird and wrong.

Imagine you reach out for support, wait months for an appointment, spend hours being tested, and get charged just to get one of the responses above. Unfortunately, this experience is a reality for many autistics who are misdiagnosed under the current medical model.

When we shift to a neurodiversity-affirming approach, we center the individual’s lived experience and recognize them as the expert on their own mind. We truly listen to them and address their experience rather than our perception of their experience. We can hold space for complexity and co-occurring traits, such as autism and trauma, so our clients get a full picture of themselves, unhindered by our clinical limitations.

Let’s move the mental health field forward and do better for our autistic clients. To begin, I encourage you to check out the purposefully selected treatment recommendations and interventions within A Clinician’s Guide to Supporting Autistic Clients. With knowledge and practice, you can learn to work with your autistic and neurodivergent clients, meeting them exactly where they are.