What is wrong with the biomedical approach to Autism assessment?

Historically, to establish itself as a respected discipline within the medical community, the study of human psychology described psychological differences as “mental disorders”. The underlying premise being a “disorder” could be defined and measured by comparison with a norm, and research could strive towards treatment or a “cure” in a scientifically measurable way. The result of this approach was that for Autism, once identified, it too was described as a “mental disorder”, focusing on what a person couldn’t do, and driven by a list of ‘challenging behaviours’ and deficits. This approach is still very much the basis of the biomedical model today and much of the clinical terminology relating to Autism takes this perspective.

Ongoing, environments and whole cultures already tailored to Neurotypical needs and preferences, are validated by the biomedical model. This leaves the Autistic person marginalised, dis-enabled, and misunderstood. A clue is in the acronyms used – ASD versus ASC – there is no difference between the two in terms of clinical criteria. However, there is a very big difference in terms of how it can feel to the person being given the label. This hinges primarily on the use of the word “disorder”. Many people who identify as Autistic dislike it as it pathologizes their neurology.

While ASD is still commonly used by medical professionals and is often found in research literature, ASC is increasingly being preferred by the non-medical community and within the education setting.

“Autism spectrum conditions is the preferred term because it highlights the spectrum nature of symptoms and biomedical bases and allows for the idea of being differently wired neurologically, leading to both cognitive strengths and difficulties. The word disorder implies that something is broken or dysfunctional, whereas condition is viewed as more neutral, less stigmatising, and more respectful.” Meng-Chuan Lai

But what this biomedical model means for the individual is that for many, the diagnostic process starts from the perspective of being a “disorder” and while your positive qualities and strengths may be discussed during your assessment, this is not guaranteed and is at the discretion of your clinician. Some clinicians will view these as equally important, but an alarming number still focus purely on the things you can’t do to make the diagnosis. This extends to many settings, an Autistic person’s behaviours often given negative labels, when the equivalent behaviour in a Neurotypical person is described totally differently. For example:

Increasingly the biomedical model is being challenged not only by self-advocacy groups, but by a community of researchers and clinicians who view Autism as a difference and not as something lesser.

“From a biomedical perspective, autism is seen as a disability or a disease. Autistic people are seen as having impairments that prevent them from participating ‘normally’ in society, from leading happy and productive lives. Thus, biomedical goals include early detection, prevention, and improved treatments and ultimately a cure for autism. From this perspective, autism is seen as a tragedy, a mystery, or a puzzle needing to be solved.” Bagatell

As a direct challenge to this the Neurodiversity model views neurological differences as simply that – difference. And it goes further:

“Conditions like autism, dyslexia, and attention-deficit/ hyperactivity disorder (ADHD) should be regarded as naturally occurring cognitive variations with distinctive strengths that have contributed to the evolution of technology and culture rather than mere checklists of deficits and dysfunctions.” Silberman

In fact, the thinking around this has moved on since the publication of The Undercover Autistic such that people with late onset brain difference, and acquired brain difference (i.e. following a brain injury) are also now included in the definition ‘neurodivergent’ – I will correct this in the book text on next issue.

Thinking differently is a huge strength, one only need look at the success of many of the big tech companies in Silicon Valley for a really stereotypical illustration of this. On an individual level our unique interests and skills can bring great enjoyment and lead to creative opportunities and employment if we are only able to live as our authentic selves unhindered by a society mired in the biomedical model.