How and Why Neurotypicals Misunderstand and Mistreat Autistic People

Distinct modes of social communication, the privilege problem, and what to do about it.

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Autistic people are often misunderstood, misinterpreted, misrepresented, and mistreated by allistic (non-autistic) peers, researchers, and clinicians.

A number of recent empirical studies have examined how neurotypicals perceive and judge autistics, shedding light on the social barriers faced by autistics in a world built for neurotypicals: Allistic peers are less likely to interact with autistic people because of immediate and unconscious negative judgments that are based purely on social communication style, and not substance. Autistic people are also often perceived by neurotypicals as deceptive or lacking credibility.

It is obvious how this bias and negative judgment can lead to discrimination, exclusion, and bullying, negatively affecting autistic people’s lives and wellbeing. Indeed, autistic people report more victimization than their neurotypical peers.

One green gamepiece facing many black gamepieces

The DSM-5 diagnostic criteria for autism spectrum disorder (ASD) emphasize “persistent deficits in social communication and social interaction.” However, recent studies clearly demonstrate that instead of exhibiting deficiencies, autistic people have a distinct mode of social communication.

A study investigating interpersonal rapport among autistic, mixed, and non-autistic pairs shows that neurotype-matched pairs report higher levels of rapport than mixed autistic-allistic pairs. A further study connects this to specific social signals: autistic people engage in less mutual gaze and backchanneling (e.g., nods and “mmhm”) than allistics, and mutual gaze is connected to ratings of rapport in mixed and non-autistic pairs, but not in autistic pairs. This recapitulates the finding that the negative impression formed by neurotypicals is connected to communication style and not substance.

Moreover, information transfer between autistic people is highly efficient and does not differ from neurotypicals, supporting the model of distinct modes of social communication as opposed to a deficit: just as there are no major communication barriers between most neurotypicals, there are no communication issues between most autistic people.

These studies support the Double Empathy Problem—a framework that describes the mismatch between autistic and allistic social communication. The Double Empathy Problem suggests that “autistic people have difficulty fitting into society not just because they misunderstand others but also because they are misunderstood by others.”

However, in addition to the Double Empathy Problem, there is also a Privilege Problem, a form of cultural hegemony: the (neuro)majority is never forced to see things from the perspective of the (neuro)minority. Autistic traits are pathologized by neurotypical researchers and clinicians, and autistic people are often denied autonomy and self-agency and forced to conform to neurotypical expectations and social norms. The constant camouflaging or “masking” to be more palatable for allistics is often detrimental to the wellbeing of autistic people.

While autistic people are forced to understand and predict neurotypical behavior, allistics are remarkably bad at empathizing with autistic people. Inability to empathize can translate to a lack of compassion towards autistics and contribute to the pathologization of autistic traits. This pathologization has led to interventions that focus solely on suppressing behaviors that are considered odd or aberrant by neurotypicals. In fact, some commonly used autism interventions, such as Applied Behavior Analysis (ABA), have been found to be both ineffective and abusive, inflicting trauma on those subjected to them.

Popularized by Ole Ivar Lovaas in 1987 and widely used as early interventions, ABA and its modern versions, such as The Early Start Denver Model (ESDM) and Pivotal Response Treatment (PRT), are behavioral modification programs that aim to either enforce or diminish behaviors using external rewards and punishments. They rely on the behavioralist framework that assumes that behavior is caused by external stimuli and can thus be either reinforced or discouraged.

The autism treatment market in the US is estimated at $2 billion and is predicted to continue to grow in the future, largely due to the increase in the number of ABA programs across the country. This is despite the lack of evidence of long-term efficacy, lack of research on non-speaking autistics, and the failure of researchers to report adverse events (see, for example, Dawson and Fletcher-Watson, 2021). A number of researchers and autistic advocates have criticized ABA and “modern ABA” for, for example, the intensive conditioning that can lead to dependence, the use of aversives, emphasizing compliance, negatively affecting autistic people’s self-esteem, and inhibiting self-motivation.

Often included in behavioral modification programs, social skills training (SST) curricula aim to teach autistics to imitate neurotypical behavior and social communication style and are based on the flawed view that autistic social communication is disordered. SST approaches have been criticized for their shaky theoretical basis and lack of convincing empirical support, as well as for their harmfulness by inhibiting authenticity and contributing to the stigma associated with autism.

Interventions should be safe and evidence-based, and the fact that approaches such as ABA and SST are still considered the gold standard reflects a wider problem and lack of accountability in psychiatry and clinical psychology. Behavioralist interventions and neuronormative SST erode autistic people’s self-esteem and identities. Behavioral modification programs focus on compliance and the suppression of behaviors that are visible to and considered undesirable by neurotypicals, inhibiting behaviors that are intrinsic and regulating to the autistic person (e.g., self-stimulatory behaviors) while simultaneously forcing them to tolerate stimulation that is dysregulating (e.g., sensory stress and forced eye contact).

The world punishes autistic people for displaying their autistic traits, leading to masking even without interventions. Being rejected, marginalized, and receiving the constant message that everything that is intrinsic to them is wrong or unacceptable is a continuous source of trauma: society rarely produces non-traumatized autistics. Chronic stress, masking, and having to constantly conform to neurotypical social expectations are often cited by autistic people as a major contributor to autistic burnout—a devastating and, for many autistics, recurring condition with substantial negative effects on functioning, wellbeing, and quality of life.

The pathologization of and the disdain towards autistic traits and people has led to the development of flawed and harmful theories, many of which have since been debunked but still continue to cause harm by contributing to stigma and dehumanization. Most notably, the idea that autistic people lack theory of mind, meaning that autistics fail to understand that other people have a mind or that they themselves have a mind, has been heavily criticized, and previous empirical studies claiming to support the hypothesis do not survive a critical examination.

This “mind-blindness” hypothesis and other misguided ideas have long been used to justify mistreatment and to deny autonomy. Furthermore, neurotypical-led charities and programs focus largely on autistic children, centering advocacy around neurotypical parents of autistic children, often without any input from actually autistic people. At the same time, autistic adults are marginalized, infantilized, discredited, and not adequately included in autism research, decision-making, and planning of support programs, and autistic advocates raising concerns are easily dismissed and perceived as lacking credibility.

All these issues contribute to the disenfranchisement of and health disparities affecting autistic people: autistics are at an increased risk of mental health problems and report difficulties in getting support, lack of understanding and knowledge, and lack of appropriate treatments contributing to their wellbeing. This highlights the urgent need to increase knowledge, understanding, and acceptance of autism, which entails the depathologization, destigmatization, and normalization of autistic traits.

One of the biggest barriers on our way towards this goal is making the neuromajority aware of and accepting of the fact that there are two distinct and valid modes of social communication. This requires making allistic people more aware of their cognitive biases: While autistic people are deliberative decision-makers and exhibit enhanced rational thinking, neurotypicals rely on intuitive decision-making and are prone to cognitive biases.

After forming an immediate negative impression of an autistic person due to the differences in social communication, an allistic person is likely to react negatively based on intuition. It is clear how this can contribute to the mistreatment of autistic people and is particularly dangerous in situations where there is a power imbalance, such as in mental health care.

As autistic people are often misunderstood and misinterpreted by neurotypicals, it is crucial that the mental health care of autistic individuals is neurodiversity-affirming, patient-led, anti-authoritarian, respects patient autonomy, and allows the autistic person to live as their authentic self. Key steps towards this goal include adopting trauma-informed, strength-based approaches that prioritize safety, empowerment, accountability, and transparency.

Many autistic people consider that autistics have a unique perspective that can only be fully understood by other autistics, emphasizing the importance of the autistic community and peer support. Studies on autistics and other marginalized groups highlight the importance of peer support and mentoring in empowering the members of the community and contributing to their wellbeing: the community provides social support, facilitates collective action and advocacy, and can provide an environment free of neuronormative expectations.

Peer support and mentoring can be particularly helpful for newly diagnosed autistics: in a recent study, newly identified autistics attending a peer-led program were particularly appreciative of the autistic-led nature of the program, the diversity within the program, and reported that the program helped them develop a more positive outlook on autism. Moreover, loneliness and lack of social support are associated with a greater negative impact of stress on mental wellbeing, further emphasizing the importance of the community.

Specific approaches can aid in facilitating successful interactions and increase autistic people’s confidence in neurotypical social situations. For example, instead of neurotypical-led SST, conversations and mentoring can focus on critically examining real-life situations and unpacking social interactions in ways that help participants understand the norms, motivations, and power structures at play.

Additionally, training programs targeted at neurotypicals can help increase knowledge of and reduce the stigma surrounding autism, speaking to the importance of, for example, workplace training in creating and cultivating a healthy, neuroaffirming environment. For any kind of behavioral intervention, particularly early interventions, to be compatible with the neurodiversity paradigm, substantial reform is needed.

Despite all the recent advances in understanding the two distinct modes of social communication, nearly all autism studies, particularly in biomedicine, psychiatry, and genetics, still frame the work around the deficiency model. Unfortunately, most mental health practitioners do not know how to differentiate between neurological differences, psychiatric states, personality traits, and trauma, and have a poor understanding of the complex interactions within and between these distinct layers of complexity and the environment, emotions, and behavior. When researchers and clinicians try to understand autism and autistic behavior in the context of neurotypical psychology, they will inevitably make incorrect assumptions, leading to ineffective and even harmful interventions.

Moreover, the DSM-5 criteria for ASD and the diagnostic assessment are based purely on behavior, and trying to infer neurological variation from behavior is an approach that is deeply flawed and unreliable. Indeed, many autistic people, particularly women and people of color, often go undiagnosed or misdiagnosed; some common misdiagnoses include mood and anxiety disorders, personality disorders, obsessive-compulsive disorder, and even psychosis.

As autism knowledge in the field is lacking, and autistics are often remarkably good at masking, many live their lives unidentified, without a clear understanding of themselves, and without support. Autistic people can often easily identify each other based on shared experiences, and only an autistic person can accurately describe the autistic experience.

Allowing autistic people to openly share their experiences is crucial for reaching unidentified autistics: many late-identified autistics have decided to seek an assessment after discovering and relating to other autistic people’s stories. Autistic people must take control of the narrative in autism research, assessment, advocacy, and in the treatment of autistic people—only then can efforts be fully directed towards goals that improve the lives of autistic people and help more autistics thrive and reach self-actualization. In particular, more research and effort should be directed towards, e.g., understanding and preventing autistic burnout, accommodating for sensory differences, and tackling social stigma and exclusion.

Allistic allies, particularly mental health professionals and researchers, have an important role in facilitating this process and furthering the understanding and acceptance of autism and autistic people. Acceptance begets confidence, and eventually, this will lead to the empowerment and better wellbeing of all neurominorities.

Acknowledgments

I want to thank Rachel Zanoni for originating the idea of The Privilege Problem and for comments on a previous version of this essay.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

21 COMMENTS

  1. I’m autistic and nothing in this article speaks for me. The only time Neurodiversity groups ever cite any source tht they want acceptence is from the mainstream woke media and themselves, and this is never the right way to do any research. Nothing is ever accomplished from movements that are paid to do what the bought social justice studies that are run by dangerious individuals influanced by woke companies. Please don’t act like this represents who I am, because I myself as i’ve said am autistic and I hate when i’m told what to believe by the mainstream media.

  2. I hope these descriptions of people become laughable one day.
    I mean they already are, but Psychiatry sees EVERYONE else as different in an ill way, apart from themselves.

    They act out what most of us think and feel. About those “other people” It’s a pity that we as humans are not just a tad brighter, than we think we are.

    Because I see all animals “othering”, so I guess our brains are really sick, because some of us believe we should oust these others.

  3. https://youtu.be/ItEkpJpixHI

    Im with the previous commenter about woke. Its not at all that I do not see the joys of woke. I do. But I also see discrepancies. Minorities do need protected and supported and cared for. Absolutely. So I am all for that. But sometimes the ability to listen to the individuals in that minority get overlooked precesely because a consensus agreement has corralled all the individuals into that minority in a way that can “only” protect them or support them if they parrot everyone else.

    In order to care for a minority it must be defined as a miniority or a thing that needs protecting. That sounds good. But then there has to be societal consensus on treating the minority as a special category. That is good too. But then in treating that minority as special, which is great, other minorities have to take a back seat unless they too can assert their wish for society to treat them as special. Soon everyone in society figures they too are in a miniority that needs special regard. So soon everyone wants treated as special. That is good. But to some people the act of plumping the cushions for one minority group makes them feel unspecial. So they then ask for their own specialness to include not having to make anyone else feel special, since that gets tiresome. But the response to this is not agreeable. Other minorities then blame the tired for whatever it was that led to their feeling unspecial to begin with. They go after the blamed, who in turn feel unspecial for that reason and so they blame the blamers until the whole world is full of everyone blaming everyone for them not feeling special. It becomes so awful in the world that soon everyone thinks the only way to ever feel special is to commit genocide on whoever causes them to feel unspecial.

    Sometimes Great God shows up and tells everyone not to worry and tells everyone they are special, all eight billion are uniquely different special people.

    But some dont feel the love enough and so they may say that Great God says only certain people are special. They may even start to sound a bit like Great God, to lend an air of authority. But this makes those who feel dismissed as not special feel rankled at what they think is a false deity. They may commit genocide on anyone who is of a faith and is not an atheist, since atheists say atheists are special and everyone is special. Everyone except maybe the people who listen to Great God telling them they are special.

    Maybe the problem is with how each individual doubts their specialness so much that all it takes is the slightest nudge to make them part company with this knowledge.

    Children are born knowing they are special. No baby thinks it is not pretty special already.

    So the dilemma may be why we are not more like children.

    Maybe the guy in this video is being a child. A child telling everyone in the world who is focussed on consensus, consensus, consensus to leave him alone.

  4. If diagnosing autism through the DSM is unreliable because it entails “trying to infer neurological variation from behavior”, then how is it any more reliable to diagnose on the basis of just relating to someone else’s experience? Wouldn’t an actual physiological analysis like a brain scan be a much more reliable way of diagnosis, if it is entirely neurological? Autism itself is entirely defined in the DSM (and ICD) to begin with, so if we throw that out, then what criteria does someone need to fulfill for a proper diagnosis? If it just requires relating to diagnosed people’s experiences, then almost anyone is going to be potentially liable for a diagnosis depending on what is mentioned and how it is presented.

    I find it absolutely disheartening how the neurodiversity paradigm has managed to gain so much influence within the broader anti-psychiatry movement that they are now somehow tolerated trying to actually legitimize psychiatry, saying that MORE people need to be diagnosed, as long as it is the diagnoses that ND approves of. I was diagnosed myself so mind you I am not speaking from a “neurotypical” perspective, and I can safely say that diagnosis has done nothing but harm me.

    • This. So much this. I do not support Autism speaks at all, as they’re not respectful of autistic people and their experiences. But I’ve found no relief in the neurodiversity moment either, and that’s speaking as someone who has been diagnosed as a child. It’s interesting how you’re expected to really, really identify with your diagnosis when it’s “neurodiverse”… seems like other psychiatry survivors are more allowed to challenge theirs.
      If you’re a)unhappy with being diagnosed b) truly unhappy with your symptoms and wish you were rid of them or c) don’t see your diagnosis as the core of your identity, there seems to be little room for you in “neurodiverse” spaces. But you’ll still be lumped in by others and treated like you should be part of a monolith perspective… Fun!

  5. “The world punishes autistic people for displaying their autistic traits, leading to masking even without interventions. Being rejected, marginalized, and receiving the constant message that everything that is intrinsic to them is wrong or unacceptable is a continuous source of trauma: society rarely produces non-traumatized autistics. Chronic stress, masking, and having to constantly conform to neurotypical social expectations are often cited by autistic people as a major contributor to autistic burnout—a devastating and, for many autistics, recurring condition with substantial negative effects on functioning, wellbeing, and quality of life.”

    Very interesting. Truly.
    A question occured to me as I read your through your thoughtful concerns. Could you make the same observations about other groups of people who are marginalized, rejected, and told repeatedly they are intrinsically wrong? But, what if they agree? What if they view themselves with disdain and contempt, yet long to be “okay” one day, who crave change?
    What if medical intervention could set them free? What if psychiatrists could relieve their suffering, from lives never lived, from potential never realized?

    • Sounds a lot like “blaming the victim” to me. Of course, people don’t want to feel marginalized. But why is it their job to carve off parts of their personality in order to “fit in?” Why is it not the job of society in general to help people feel more welcome and accepted, even if their behavior is unusual or confusing, yet does no harm to anyone? Isn’t a lot of “mental illness” simply the consequence of society’s narrow view of what is “normal” or “acceptable” behavior?

  6. Sounds a lot like “blaming the victim” to me.

    They are legally blind or nearly deaf, but no one understands these things including themselves. Blindness and deafness are not acceptable problems. They are excuses in this analogy. No one needs glasses or hearing aids or sign language. That’s what they run up against when they say they can’t see the blackboard or hear the teacher. They want to engage in life just like others do, but they can’t. They are held back by physical limitations. (But no one knows about this stuff.) They are bad and they hate themselves and they should. They are good for nothing spoiled bums. If they wanted to do well in class and have friends, they would straighten out. That’s what they are taught every where they go. “Try. Quit screwing around. You’re lazy. You just want to sit around all day and do nothing but watch t.v. and fart around with your loser friends.”

    No one understands, including themselves. They buy into what others say about them and soon they hate. They hate themselves and everyone else. They are called stupid and excluded, all the while they long to participate, they long to engage in life.

    One day mom takes her to what they call an “eye doctor”. She’s transformed over night, even though some don’t believe in eye doctors or hearing specialists or speech therapists.

    • This is a nice story, but does not reflect reality in the vast number of cases I see, nor does the research support the “transformed overnight” meme, except in the most mundane of aspects, namely that many kids behave more acceptably to the teacher’s (or parents’ or professionals’) eye on stimulants. Long term studies and literature reviews have repeated ad nauseum that long-term stimulant use does not improve outcomes in academic, social, behavioral, or emotional areas. I’ve listed some of these in another post. Try googling “long-term outcomes stimulants ADHD” and read through the results. There will be a few individual articles claiming positive benefits, but the reviews of the literature and the long-term outcome studies, including the Montreal, Raine, the Finnish study, and the highly touted MTA study, all show “disappointing” results.

      I would also submit that your characterization of how adults treat these hypothetical “ADHD” children amounts to verbal and emotional abuse. Giving drugs to avoid verbal and emotional abuse by adults seems a little ass-backwards to me. Perhaps the parents need to learn how to treat a child who doesn’t naturally fit into the largely arbitrary social expectations foisted on them by schools and often by the parents themselves?

      As I’ve said before, I speak from direct experience in this case. It is VERY possible to create a positive environment that is both nurturing and sets reasonable and attainable expectations for kids based on their personalities. It’s just that very few children ever experience these conditions, because parents are expected to send their kids to schools that are not suited to their needs.

        • My children functioned without medical intervention, but with a HELL of a lot of non-medical intervention. We EARNED their positive behavior through YEARS of hard work. You are trivializing it by trying to pretend that “they functioned without medical intervention,” as if what we did had NOTHING to do with their success! You are building a strawman argument to bolster your own case, rather than listening to the story and trying to find the core of meaning behind it.

          What if lots of children could function without medical intervention, and nobody ever tried? What then? What if we are exposing children to years of drug side effects without really addressing their issues? What if 90% of those children COULD “function without medical intervention,” yet never had the chance to because people like you insisted it was impossible? Are we not cheating them out of an opportunity to grow and learn by telling them and their parents it is impossible?

          • After re-checking my post, I find your diminishment of the accomplishments described to be even more offensive. Did you even bother to read what I wrote? Do you have any comments or thoughts on the idea that using of rewards of intense stimulation to help kids learn new behavior? Do you have ANY experience in behavior change theories? Do you even understand the point I’m making, or are you just choosing to ignore it because it doesn’t fit your narrative?

            BTW, I have used these same approaches professionally with lots of kids, and also with adults, with some modifications. They WORK. It’s not because “my kids didn’t need medical interventions.” It’s because these interventions are smart and on target and very, very effective. But they require analysis, creativity, and months or even YEARS of HARD WORK! Maybe most people just don’t know how or don’t want to do that kind of work, and stimulants give them an “easy answer.” But one thing you have NEVER responded to is decades of research showing that long-term outcomes are NOT improved by stimulant treatment. My way DOES appear to affect long-term outcomes, at least in my kids’ cases. No learning problems, no delinquency, no school dropouts, continued high academic test scores, academic honors, and for one, a complete college education, again with academic honors. Stimulants can make no such claims. If you’re so interested in science, why not look for better solutions? Why spend all your time railing about genetics when it’s the one thing in the equation that can’t be changed?

            I assume you’re aware of the research on brain plasticity, that the environment molds and changes the brain based on how it needs to be used to survived. What if our approach altered the epigenetic conditions in the brain by teaching our kids to use their brains differently? Would that not be a great outcome, and exciting outcome? Why is that not of interest to you?

          • “After re-checking my post, I find your diminishment of the accomplishments described to be even more offensive.”

            I was making a comment or two here, on this thread, and I’ve done so elsewhere, and then you show up out of the blue and demand that I interact with you. Why does it bother you what I think?

            Would you mind ignoring me? Please?

    • Enrico, I’m not sure how you can compare eye glasses with everything DSM. Being told from a young age that it is YOU who is damaged, disordered, broken, defective is garbage. And then getting a youngster to swallow chemicals to change him is huge garbage.

      No doubt some youngsters might grow up and believe that their lives might have been better IF they had been given these miraculous chemicals for their broken brains. And of course they might because that is the messages given to the public.
      But no one knows do they.
      Why not offer a different view of all those millions of defective brains? Why call them defective just because on some crude scan you can see differences and yet have no clue what it all means?

      Amazing how far your neurology has come to be able to wonderfully transform the lives of millions of children. All those defective brains popping up in schools and shrinks offices.

      Must be something in the air to create short legs, lack of looks, lack of sporting ability, weak hands, wrists, broken defective brains that are so untypical of the normal people. Do you see the whole being of a person as defective if they need glasses?

      Their very nature and character. WHO they are is boxed into ridiculous labels.

      Stop doing this to kids, families, parents.

  7. I have met countless people over the years labelled ‘autistic’ or ‘asd’ and they are all individuals with little recognisable similarities in terms of what determined the label. Except for some folks i’d say shyness can be a present but not always. Look at the long list of celebrities whose lives are often all about clear communication and interaction. Consider Elon Musk although I must say I wonder if his ‘autism’ label was more a marketing tool for selling his neuralink tech.

    I always wonder what is meant by neuorotypical or neurodiverse – surely EVERYONE is the latter and the former an illusion?

    The DSM mindset is saturated right through our cultures.

    • Trained, experienced professional health care workers can spot illness that may be hidden to others. People work tirelessly to build defense mechanisms to mask their raw selves.
      I would would offer instead that our world is filled with people who have serious issues and there is much more awareness about these kinds of things today. So much more information is available today compared to 10, 20, 30, 40, 50 years ago.

      I think most of us are pretty good at mistreating others as a rule.

      • There are NO people without “issues”. Often those “issues” hurt the person themselves or those issues are used to hurt others, even if coming from being indoctrinated into belief systems. Being indoctrinated into belief systems is as well as being blind.
        Never will your eyes and nature be opened to the wide world of differences.

  8. I don’t see how dividing the world into “neurotypicals” (non-autistic people) and the “neurodiverse” (autistic people) is an improvement over dividing the world into “normals” (“mentally healthy” people) and the “biologically-based mentally ill.” Both promote a biological essentialist view of humanity that is pseudoscientific, stigmatizing, and more likely to divide and harm than unite and help.

    The science is clear: characterizing a psychological problem as a biologically-based mental illness, a “thing” a person “has” that normal people don’t have and is caused by a brain/genetic abnormality, worsens stigma among both sufferers and everyone else. We know this. Yet, this large and consistent scientific literature is consistently ignored by those like this author who claim a desire to “promote acceptance” and “reduce stigma.” Why would those who wish to reduce stigma totally ignore research showing that labeling a psychological problem as a “biologically-based mental illness” worsens stigma? Obviously, they have a different agenda. This agenda is usually to “educate” others that the “mental illness” is “real” and “treatable.” Why would they do this? Follow the money and guild interests and you’ll usually find the answer.

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