Opinion
Laura Kennedy: We need a more nuanced conversation about autism
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Even by the bizarre standards of our political era, witnessing Robert F Kennedy jnr and Donald Trump citing paracetamol as a potential risk factor in autism spectrum disorder last week was surreal. Autism has always been a concept that evades attempts to rigidly classify or understand it – the diagnostic manuals that guide clinicians have repeatedly redrawn and expanded the boundaries of what constitutes autism.
In the mid-1980s, researchers at the University of Utah and UCLA conducted an autism epidemiology study among children and reported its prevalence as four in 10,000 using contemporary diagnostic criteria. Now, an estimated one in 31 US children has received an autism diagnosis. The rate of diagnosis of schoolchildren in Ireland is one in 20. The definition and diagnostic criteria have shifted so much since the 1980s that functionally speaking, with the exception of severe cases, the average diagnosed autistic person then may bear little resemblance to someone diagnosed in 2025.
In the past 30 years, it has moved from what was seen as a rare and severe condition diagnosed in childhood to an umbrella term encompassing a broad range of traits, behaviours and experiences. This expansion has altered how autism is considered in the public sphere, and crucially, which voices are elevated and acknowledged in public discourse.
Once the remit of doctors, teachers and parents, autism is now claimed as an identity by many adults, including those with public profiles and access to experts, and speculated on by politicians.
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The diagnosis can liberate people – providing new language and conceptual framing to understand their experience. It can also present challenges or feel limiting – a prescriptive rather than a descriptive label.
Canadian philosopher Ian Hacking wrote about the “looping effect” of classification. When we invent categories and place people within them based on relevant shared characteristics, people change in response, and therefore so does the category itself. Hacking is interested in “how names interact with the named”. He suggests that in the act of creating classifications to help us understand complex clusters of concepts and how they relate to one another, we seek to capture and describe the thing we classify, but necessarily end up changing it too.
The autism conversation exhibits the looping effect in real time. The more we describe it, dispute what it is,and debate the criteria for entry to the category, and the more people who identify with the term, the more that category shifts. Eventually it ceases to resemble what it once sought to name. What was at one time a narrow, strictly medical diagnosis has shifted to become a much debated talking point. When the conversation is most awkward and sensitive, as it is now, it is all the more important to ask what has been gained or lost.
One very clear loss is nuance in public discourse. The quality of conversation about autism this last week in particular has been abysmal – it is either a frightening pathology inflicted by mysterious causes and being speciously linked to paracetamol, or a brittle, exaggerated, chosen identity to be mocked.
In reality, autistic people with the greatest and most complex need for care and support are unheard in these debates. Families with profoundly disabled children or adults struggling without support and resources tend to be busy, and therefore farther from the public conversation about autism, where comparatively successful adults talk about how diagnosis changed their lives or discuss the challenges they navigate.
The new way of talking about autism is siloed and unsatisfactory. It under-serves us all, but especially those with the greatest need. A more philosophical approach to the conversation demands that instead of shirking complexity, we simply tolerate it.
Our relatively recent realisation that there are different, neurodivergent kinds of minds is valuable. Difference should be treated not as a defect to be “fixed” but a fact of human variation that should challenge how we think about people who don’t necessarily conform, or who evade strict categorisation.
The stakes are high. If autism is exclusively considered a pathology, then the appropriate response is medical: management through medication, therapeutic intervention and support, and efforts at solving what is seen exclusively as a deficit. If it is seen purely as an identity, people whose needs cannot be met merely with recognition and the comfort of a label feel invisible.
Blaming paracetamol or vaccines is simple. Valuing difference rather than seeing it as a failure or a deviation is hard. So too is prioritising those with the greatest need. But that is what must be done.
