All diagnosed Terracotta Warrior, all distinctive.
Present autistic theory mimics past psychological theory in producing a unifying theory of autism regardless of intersecting issues of race, gender, class, etc, and omits the mutually constitutive nature of intersecting diagnoses/conditions. The term first-wave neurodiversity has intentional associations with the term first-wave (and 2nd) feminism. The exclusion of intersectionality, and in the case of autistic/neurodivergent people, intersecting diagnoses/condition that affect the majority.
The Neurodiversity Movement (NDM) has been excellent at exposing how a dominant episteme (neuronormative science) renders autistic self-knowledge invisible or subordinate and subjects autistic/neurodivergent people to a ‘less than’, deficit model. Autistic experiential accounts have been classified as ‘anecdotal’ or ‘subjective’. The neurodiversity paradigm rejects this hierarchical knowledge structure that has been imposed upon them.
Understandably, the NDM resists biomedical framing of autism. Biomedical language has been employed for eugenics, conversion therapies such as ABA, institutionalisation, and a cure or eliminate narrative.
Autism, in particular, has attracted interest from psychologists and philosophers due to our social communication dissimilarities from an assumed human standard. The assumption that autistic social communication is flawed, and by detailing internal mechanisms of this assumed flaw this will inform research in social cognition of humans and of autism. An assumption that implies autism is indicative of being less than human and that neurotypical social cognition is evidence of being fully human. Similarly, traditional (non-autistic) autism research into the behavioural and sensory profiles of those diagnosed ‘with autism’ have sought to explain these under a unifying theory of autism such as ‘Weak Central Coherence’ [Frith, 1989] and ‘Extreme Male Brain Theory of Autism’ [Baron-Cohen, 2002]. Autism as definable by reference to a unifying theory – as an abnormality in need of explanation. The assumption that one theory can be applied to all those with a diagnosis of autism, and the further implicit assumption that ‘you are your brain’. Know what autism is and this explain any autistic person. Heterogeneity and diversity can be delimited by route of a common theory. A spectrum is introduced to account for heterogeneity. Here a common theory works in the way graphic equaliser will accentuate some frequencies and attenuate others, but the song will always remain the same.
Some autistic autism researchers have internalised this assumption of a need for a unifying theory of autism. This epistemological assimilation of the medical model’s logic that there must be a coherent underlying mechanism to ‘explain’ autism. (To be fair not all those in psychiatry and psychology subscribe to this logic.) This is somewhat mystifying in its cooptation of The Master’s Tools [Lorde, Conference talk, 1979; publication, 1981] with little discussion of why there is a need to import the medical model’s logic that autistic people’s experiences and behaviours can only be validated if a unifying theory is established. That the only change necessary is to dismiss a deficit logic and produce a non-deficit theory.
The internalisation of psychology’s assumptions is not hugely problematic when it comes to questions of identity. Whether an autistic person identifies as pattern seeking, systemising or monotropic, is a question of personal choice. The problem arises when a unifying theory of autism is then employed as an explainer as to causes of mental ill health and to inform proposed therapies. This is exacerbated by the failure to update what was the dominant cognitive science paradigm (Computational Cognitivism) of the 90s when the NDM arose. Much of early NDM advocacy was based on computational cognitivism’s main metaphor, brain is hardware, mind is software. Declarations of autism being a different operating system were – and in some quarters still are – common. Computational cognitivism of the 90s: input ➔ neural algorithm ➔ output. Computational cognitivist accounts of autism: input ➔ autistic neural algorithm ➔ autistic output. Autistic bodies are eliminated. These days tech bros take this paradigm to its extreme; Artificial “Intelligence” dispenses with bodies in the work place, while the tech bros and venture capitalists dream of a future where ‘error free’ software (minds) are uploaded to ‘defect free’ hardware (brains) and bodies are wholly eliminated.
Another oft-repeated mantra is ‘autism is not a mental illness’, this is technically true, but autistic people are human and to be human is not a mental illness. The ‘autism is not a mental illness’ will not tell you anything about possible causes of mental ill health in the autistic community. Given that co-occurring psychological and physiological are the norm rather than the exception in the autistic/AuHD population, and that many co-occurring conditions – psychological and physiological – are known to cause mental health conditions, this is hugely reductionist. The NDM has done some excellent research into the social determinants of mental health conditions but, like traditional psychiatry, has assumed that a theory of autism/AuHD is all a clinician needs to determine cause of any mental health conditions present in the autistic person requiring care. Whereas, in reality, all other co-occurring conditions have been abstracted and a reductive approach that ignores anything that may be mutually constitutive or causative. There is concomitant risk to this reductive approach – the continued medical negligence of the neurodivergent population due to the implied assumption that we are neurologically neurodivergent but neurotypical in all other biological processes. An assumption carried over from first-wave neurodiversity (1990s) when the notion that ‘you are your brain’ was pervasive in the West. Where the body is reduced to a mechanical system operated by the brain. This is not a criticism of early NDM proponents but a recognition of the historical context in which they were situated.
There is a further phenomenon in autistic autism research that shapes how some theories become dominant.
It is acknowledged in the neurodivergent literature that sampling bias occurs in research. Mainly white, higher educated, digitally-connected, higher socioeconomic status, fewer high support requirement participants. After spending time online one can’t help notice this sampling bias is affiliated to another problem. A theory-resonance problem, a theory-alignment feedback loop.
Sampling bias correction may correct who participates, it does not address why they choose to participate. A perfectly demographically representative sample could still be theoretically biased if recruitment messaging references a specific framework (e.g., “testing monotropism in autistic adults”). The existing literature treats sampling bias as a demographic problem (which certainly exists) it does not acknowledge the epistemological problem (how participation is shaped by theoretical identification).
Those who follow researchers who write about masking or monotropism, for example, are more likely to attract research participants for whom these theories resonate with their own experiences. What is called neurodiversity-affirming therapy is subsequently shaped by theory subject to both sampling bias and the theory-alignment feedback loop. This in turn shapes the perception that the NDM mainly advocates for those autistics generally labelled “high functioning” or Level 1. This looping effect (plus sampling bias) is similar in some respects to Ian Hacking’s looping effects [Hacking, 1995 onward] but here the looping effect works through theory-aligned self-selection rather than when the category and the classified enter a recursive loop, although theory-resonance self-selection will feed into this looping effect. None of the above changes the fact that autistic led research using participatory methods has been a welcome improvement. This looping effect plus the internalisation of the medical model’s assumption that a theory of autism is essential for establishing determinants of mental health. I suggest that neurodivergent research by those who are neurodivergent could be improved by the introduction of an exclusion audit. Constitutive alterity is real – co-occurring conditions, class position, race, gender, and support needs produce genuinely different material situations – any research, or organisational structure, will tend to exclude some people by default. The question is not whether exclusion happens but whether it is visible and addressed.
In 1973 the Boston Women’s Health Book Collective (later known as Our Bodies, Ourselves) published the seminal book Our Bodies, Ourselves. This work became one of the most influential feminist health texts of the 20th century. The book sold over 4 million copies worldwide and was translated into more than 30 languages, laying the groundwork for what modern researchers call “ignorance studies” in women’s lived experience by documenting first hand accounts of pain dismissal. Validating subjective bodily experiences that had been dismissed as “hysteria” or “emotionalism” the book prioritised autonomy and body sovereignty.
Autistic people are more likely to experience physical health conditions across all organ systems [Weir, et al, 2023].
Conditions like endometriosis occur at 2-3 times higher prevalence in the autistic population [Simantov, et al, 2022]. Endometriosis comes with higher prevalence of anxiety and depression [Zippl, et al 2024] and higher levels of suicide ideation than controls [Zarbo, et al, 2025]
There is also an elevated prevalence of connective tissue issues in the autistic population – “The overall prevalence of HSD/EDS in autistic samples was 27.9%, but 39% if HSD/EDS were assessed clinically, [Baeza-Velasco, et al, 2025]. “Suicide and NSSI (non-suicide self-injury) are highly prevalent among individuals seeking assessment for EDS. Dysautonomia was associated with greater odds of reporting a past suicide attempt and joint hypermobility was associated with increased odds of lifetime NSSI” [Slepian, et al, 2026].
A theory of autism that abstracts all co-occurring conditions will not reveal all possible causes of mental ill health. More seriously, given these conditions (and others) mainly occur in the female autistic population it only serves to perpetuate the medical gender bias as detailed in ‘ignorance studies’. For many, autism and co-occurring conditions are mutually constitutive and systemic when speaking of mental and physical health. A theory of autism is not necessarily insightful as an explanatory framework for delineating the causes of mental ill health of an autistic person with co-occurring conditions where social and biological determinants cannot be pulled apart. How different autonomic phenotypes intertwine with the dysautonomia known to occur in some co-occurring conditions is a more than valid subject of study.
Disability studies was founded on the principle that disability is not a medical problem but a social one — that society disables people through exclusion, stigmatisation, and inaccessible design. The mind-body split violates that principle by re-inscribing a boundary that lets neurological difference exit the medical category while leaving physiological conditions trapped in it. Neurodivergent people deserve a non-deficit narrative for all their conditions.
Traits can be composites of different biological/psychological processes. One cannot isolate autistic traits from the whole psycho-physical unity and treat concomitant diagnoses as inert (or neurotypical) plug-ins that can be abstracted to reveal a ‘pure autism’ which can then be defined and employed to uncover all causes of perturbation.
The social model recognises impediment while placing what is disabling in socio-political structures that fail to provide accommodations and discriminate against disabled people when they are measured, and placed in hierarchical framework, defining worth as to Capitalism’s ability to extract value by as frictionless means as possible.
It is possible to reject a narrative of biological inferiority and all that flows from this narrative without introducing a form of dualism that resides within autistic individuals and the autistic ensemble. As more women are being diagnosed as neurodivergent, and a substantial percentage are recognised to have co-occurring physiological conditions such as connective tissue issues at considerably higher rates than the non-neurodivergent population, any proposed account of therapeutic practice via a theory of autism that abstracts co-occurring conditions perpetuates the gender bias of dismissal, diagnostic overshadowing, and gatekeeping, documented in feminist accounts of gender bias in medicine and disability studies. One cannot ignore the concrete reality of intersecting diagnoses any more than one can ignore the intersectionality of social and political identities/ensembles. To be fair some neurodiversity advocates do recognise this and advocate accordingly.
There is a preponderance of research output that is accordant with social psychology’s preoccupation with issues of assigned personal identity and relational autonomy. This output needs to placed in context with the real, material concerns that effect many neurodivergent people; class/socioeconomic status, physical health and its concomitant consequences for mental health – including the gender bias inherent in its denial, repeated onslaught of austerity measures, the corrosive effect on neurodivergent parents (often women) who are carers for their neurodivergent children – often resulting in poor housing and financial impoverishment, the effects of competing in a job market where capitalism demands extraction of value with no concessions, the effects of documented elevated levels of domestic and interpersonal violence. Neurodivergent people should be accorded the same consideration as neurotypical people, not approached with a predetermined theory of a single diagnosis that reifies a psychiatric classification and ossifies it within a specific diagnostic time frame, or resorting to an internalisation of “the misconception that complex social and political identities are fixed biological realities simplistically determined by DNA” [Diaz-Papkovich, Ramachandran, et al, 2026].
As an older autistic person one becomes to realise that concomitant diagnoses cannot be separated out, they are mutually constitutive. The literature should reflect and acknowledge that. Some in the neurodivergent population have recognised this and many of us are realising the systemic nature of all diagnoses/conditions need to be taken into account. All concomitant issues need to be placed within disability studies non-deficit narrative and given equal status within that narrative.
First-wave neurodiversity in its mission to destigmatise (as necessary as this was) has continued psychiatry’s/psychology’s convention of viewing autism as an invariant cloning mechanism, producing a unifying theory with issues of intersectionality and intersecting diagnoses/conditions rendered inert.
In the autistic literature these co-occurring diagnoses/conditions are relegated to a subsidiary status when, in reality, they can often be the source of much perturbation and ill-health. Neurodivergent discourse and politics is still burdened by autistic exceptionalism and its internalisation of the imperiousness of past psychological theoretical assumptions – that one can know the minds of millions of people on the planet by reference to a unifying theory.
References
Frith, U., 1989. Autism: Explaining the Enigma.
Baron-Cohen S., 2002, The extreme male brain theory of autism
Lorde A., Audre Lorde The Master’s Tools Will Never Dismantle the Master’s House, Conference talk, 1979; publication, 1981
Hacking, I., 1995. The looping effects of human kinds.
Weir E., et al, 2023, Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults
Simantov T., et al, 2021, Medical symptoms and conditions in autistic women
Zippl A. L., et al, 2023, Endometriosis and mental health disorders: identification and treatment as part of a multimodal approach
Zarbo C., et al, 2025, Stopping suffering: An exploration of suicidal ideation and its clinical, cognitive and relational correlates among women with a diagnosis of endometriosis
Baeza-Velasco, et al, 2025, Autism in the context of joint hypermobility, hypermobility spectrum disorders, and Ehlers-Danlos syndromes: A systematic review and prevalence meta-analyses
Slepian M. P., et al, 2026, Non-suicidal self-injury and suicide attempts among individuals seeking assessment for Ehlers-Danlos Syndromes
Diaz-Papkovich, Ramachandran, et al, 2026, From Wikipedia to AI: Measuring 25 years of synthesis of human genetics research in the public-facing information ecosystem
