Talk:Autism/Archive 11#RFC: Lede Section of Autism

RFC: Lede Section of [[Autism]]

Should the paragraphs of the proposed revised lede shown below replace the current lede section of the Autism article?

Robert McClenon (talk) 15:28, 25 February 2025 (UTC)

Please answer Yes or No (or the equivalent) with a brief statement in the Survey. Please do not reply to other editors in the Survey. That is what the Discussion section is for.

=Comparison=

The current lede of the article is {{tqb|

Autism spectrum disorder{{efn|name=medical term|Medical diagnosis term. See Classification.}} (ASD), or simply autism, is a neurodevelopmental disorder "characterized by persistent deficits in social communication and social interaction across multiple contexts" and "restricted, repetitive patterns of behavior, interests, or activities".{{cite book|title=Diagnostic and Statistical Manual of Mental Disorders|date=2013 |edition=5th|publisher=American Psychiatric Association|page=31|url=https://archive.org/details/diagnosticstatis0005unse}} Sensory abnormalities are also included in the diagnostic manuals. Common associated traits such as motor coordination impairment are typical of the condition but not required for diagnosis. A formal diagnosis requires that symptoms cause significant impairment in multiple functional domains; in addition, the symptoms must be atypical or excessive for the person's age and sociocultural context.(World Health Organization: International Classification of Diseases version 11 (ICD-11)): https://icd.who.int/browse/2024-01/mms/en#437815624{{Cite web |title=IACC Subcommittee Diagnostic Criteria - DSM-5 Planning Group |url=https://iacc.hhs.gov/about-iacc/subcommittees/resources/dsm5-diagnostic-criteria.shtml |access-date=1 August 2024 |website=iacc.hhs.gov}}

Autism is a spectrum, meaning it manifests in various ways, with its severity and support needs varying widely across different autistic people.{{Cite journal |last1=Waizbard-Bartov |first1=Einat |last2=Fein |first2=Deborah |last3=Lord |first3=Catherine |last4=Amaral |first4=David G. |date=2023 |title=Autism severity and its relationship to disability |journal=Autism Research |language=en |volume=16 |issue=4 |pages=685–696 |doi=10.1002/aur.2898 |issn=1939-3806 |pmc=10500663 |pmid=36786314}} For example, some autistic people are nonverbal, while others have proficient spoken language. Furthermore, the spectrum is multi-dimensional and not all dimensions have been identified {{as of|2024|lc=y}}.{{cite journal | pmid=38434761 | date=2024 | title=Autism spectrum disorder: Pathogenesis, biomarker, and intervention therapy | journal=Medcomm | volume=5 | issue=3 | pages=e497 | doi=10.1002/mco2.497 | pmc=10908366 | vauthors = Zhuang H, Liang Z, Ma G, Qureshi A, Ran X, Feng C, Liu X, Yan X, Shen L }}{{cite journal | pmc=7190887 | date=2017 | title=Multidimensional Neuroanatomical Subtyping of Autism Spectrum Disorder | journal=Cerebral Cortex (New York, NY) | volume=28 | issue=10 | pages=3578–3588 | doi=10.1093/cercor/bhx229 | pmid=28968847 | vauthors = Hong SJ, Valk SL, Di Martino A, Milham MP, Bernhardt BC }}

Public health authorities and guideline developers classify autism as a neurodevelopmental disorder,{{Cite web |date=2013-08-28 |title=Overview {{!}} Autism spectrum disorder in under 19s: support and management {{!}} Guidance |url=https://www.nice.org.uk/guidance/cg170 |access-date=2024-11-02 |website=www.nice.org.uk}}{{Cite journal |last1=National Consultation Meeting for Developing IAP Guidelines on Neuro Developmental Disorders under the aegis of IAP Childhood Disability Group and the Committee on Child Development and Neurodevelopmental Disorders |last2=Dalwai |first2=Samir |last3=Ahmed |first3=Shabina |last4=Udani |first4=Vrajesh |last5=Mundkur |first5=Nandini |last6=Kamath |first6=S. S. |last7=C Nair |first7=M. K. |date=2017-05-15 |title=Consensus Statement of the Indian Academy of Pediatrics on Evaluation and Management of Autism Spectrum Disorder |url=https://pubmed.ncbi.nlm.nih.gov/28368272/ |journal=Indian Pediatrics |volume=54 |issue=5 |pages=385–393 |doi=10.1007/s13312-017-1112-4 |issn=0974-7559 |pmid=28368272}}{{Cite journal |last1=Howes |first1=Oliver D |last2=Rogdaki |first2=Maria |last3=Findon |first3=James L |last4=Wichers |first4=Robert H |last5=Charman |first5=Tony |last6=King |first6=Bryan H |last7=Loth |first7=Eva |last8=McAlonan |first8=Gráinne M |last9=McCracken |first9=James T |last10=Parr |first10=Jeremy R |last11=Povey |first11=Carol |last12=Santosh |first12=Paramala |last13=Wallace |first13=Simon |last14=Simonoff |first14=Emily |last15=Murphy |first15=Declan G |date=2018-01-01 |title=Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology |journal=Journal of Psychopharmacology |language=en |volume=32 |issue=1 |pages=3–29 |doi=10.1177/0269881117741766 |issn=0269-8811 |pmc=5805024 |pmid=29237331}} but the autism rights movement (and some researchers) disagree with the classification. From the latter point of view, autistic people may be diagnosed with a disability, but that disability may be rooted in the structures of a society rather than the person.Kapp, Steven K. Autistic community and the neurodiversity movement: Stories from the frontline. Springer Nature, 2020.Jaarsma, Pier, and Stellan Welin. "Autism as a natural human variation: Reflections on the claims of the neurodiversity movement." Health care analysis 20 (2012): 20-30.Dwyer, Patrick, et al. "Community views of neurodiversity, models of disability and autism intervention: Mixed methods reveal shared goals and key tensions." Autism (2024): 13623613241273029. On the contrary, other scientists argue that autism impairs functioning in many ways that are inherent to the disorder itself and unrelated to society.{{cite journal | url=https://onlinelibrary.wiley.com/doi/abs/10.1111/japp.12470 | doi=10.1111/japp.12470 | title=A Critique of the Neurodiversity View | date=2021 | journal=Journal of Applied Philosophy | volume=38 | issue=2 | pages=335–347 | vauthors = Nelson RH }}{{Cite journal |last1=Shields |first1=Kenneth |last2=Beversdorf |first2=David |date=1 July 2021 |title=A Dilemma For Neurodiversity |url=https://link.springer.com/article/10.1007/s12152-020-09431-x |journal=Neuroethics |language=en |volume=14 |issue=2 |pages=125–141 |doi=10.1007/s12152-020-09431-x |issn=1874-5504}} The neurodiversity perspective has led to significant controversy among those who are autistic and advocates, practitioners, and charities.{{cite book |title=Autistic Community and the Neurodiversity Movement: Stories from the Frontline |vauthors=Robison JE |date=2020 |publisher=Springer |isbn=978-981-13-8437-0 |veditors=Kapp SK |place=Singapore |pages=221–232 |chapter=My Time with Autism Speaks |doi=10.1007/978-981-13-8437-0_16 |doi-access=free |s2cid=210496353}}{{cite journal |last=Opar |first=Alisa |date=24 April 2019 |title=In search of truce in the autism wars |url=https://www.spectrumnews.org/features/deep-dive/search-truce-autism-wars |url-status=live |journal=Spectrum |publisher=Simons Foundation |doi=10.53053/VRKL4748 |s2cid=249140855 |archive-url=https://web.archive.org/web/20220708195918/https://www.spectrumnews.org/features/deep-dive/search-truce-autism-wars/ |archive-date=8 July 2022 |access-date=9 July 2022 |doi-access=free}}

The precise causes of autism are unknown in most individual cases. Research shows that the disorder is highly heritable and polygenic, and neurobiological risks from the environment are also relevant.{{Cite journal |last1=Hodges |first1=Holly |last2=Fealko |first2=Casey |last3=Soares |first3=Neelkamal |date=February 2020 |title=Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation |journal=Translational Pediatrics |language=en |volume=9 |issue=Suppl 1 |pages=S55–S5S65 |doi=10.21037/tp.2019.09.09 |doi-access=free |pmid=32206584 |pmc=7082249 |issn=2224-4344}}{{Cite journal |last=Ratajczak |first=Helen V. |date=2011-03-01 |title=Theoretical aspects of autism: Causes—A review |url=https://www.tandfonline.com/doi/full/10.3109/1547691X.2010.545086 |journal=Journal of Immunotoxicology |volume=8 |issue=1 |pages=68–79 |doi=10.3109/1547691X.2010.545086 |issn=1547-691X |pmid=21299355}}{{cite journal |vauthors=Mandy W, Lai MC |title=Annual Research Review: The role of the environment in the developmental psychopathology of autism spectrum condition |journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines |issn=0021-9630 |eissn=1469-7610 |oclc=01307942 |volume=57 |issue=3 |pages=271–292 |date=March 2016 |pmid=26782158 |doi=10.1111/jcpp.12501 |doi-access=free}} Boys are also significantly far more frequently diagnosed than girls.

Autism frequently co-occurs with attention deficit hyperactivity disorder (ADHD), epilepsy, and intellectual disability.{{Citation |last1=Bertelli |first1=Marco O. |title=Autism Spectrum Disorder |date=2022 |work=Textbook of Psychiatry for Intellectual Disability and Autism Spectrum Disorder |pages=391 |editor-last=Bertelli |editor-first=Marco O. |url=https://books.google.com/books?id=4mtvEAAAQBAJ&pg=PA391 |access-date=8 June 2022 |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-319-95720-3_16 |isbn=978-3-319-95720-3 |quote=Persons with autism spectrum disorder and/or other neurodevelopmental problems are more likely than the general population to have transgender identity, non-heterosexual sexual orientation, and other gender non-conformities. |last2=Azeem |first2=Muhammad Waqar |last3=Underwood |first3=Lisa |last4=Scattoni |first4=Maria Luisa |last5=Persico |first5=Antonio M. |last6=Ricciardello |first6=Arianna |last7=Sappok |first7=Tanja |last8=Bergmann |first8=Thomas |last9=Keller |first9=Roberto |editor2-last=Deb |editor2-first=Shoumitro (Shoumi) |editor3-last=Munir |editor3-first=Kerim |editor4-last=Hassiotis |editor4-first=Angela |url-access=subscription}}{{Cite journal |last1=Lord |first1=Catherine |last2=Charman |first2=Tony |last3=Havdahl |first3=Alexandra |last4=Carbone |first4=Paul |last5=Anagnostou |first5=Evdokia |last6=Boyd |first6=Brian |last7=Carr |first7=Themba |last8=de Vries |first8=Petrus J |last9=Dissanayake |first9=Cheryl |author-link9=Cheryl Dissanayake |last10=Divan |first10=Gauri |last11=Freitag |first11=Christine M |display-authors=10 |date=2022 |title=The Lancet Commission on the future of care and clinical research in autism |url=https://fhi.brage.unit.no/fhi-xmlui/bitstream/handle/11250/2975811/Lancet+Commission.pdf?sequence=1 |journal=The Lancet |volume=399 |issue=10321 |pages=299–300 |doi=10.1016/s0140-6736(21)01541-5 |pmid=34883054 |s2cid=244917920 |via=Norwegian Institute of Public Health |hdl=11250/2975811}} Disagreements persist about what should be part of the diagnosis, whether there are meaningful subtypes or stages of autism,{{cite journal |vauthors=Rosen NE, Lord C, Volkmar FR |date=December 2021 |title=The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond |journal=Journal of Autism and Developmental Disorders |volume=51 |issue=12 |pages=4253–4270 |doi=10.1007/s10803-021-04904-1 |pmc=8531066 |pmid=33624215}} and the significance of autism-associated traits in the wider population.{{cite book |vauthors=Losh M, Adolphs R, Piven J |title=Autism Spectrum Disorders |chapter=The Broad Autism Phenotype |year=2011 |pages=457–476 |publisher=Oxford University Press |isbn=978-0-19-996521-2 |language=en-US |doi=10.1093/med/9780195371826.003.0031}}{{cite journal |vauthors=Chapman R, Veit W |title=Correction to: The essence of autism: fact or artefact? |journal=Molecular Psychiatry |volume=26 |issue=11 |page=7069 |date=November 2021 |pmid=34697454 |doi=10.1038/s41380-021-01057-6 |s2cid=239771302 |doi-access=free}}

The combination of broader criteria, increased awareness, and the potential increase of actual prevalence has led to considerably increased estimates of autism prevalence since the 1990s.{{cite journal |vauthors=Wazana A, Bresnahan M, Kline J |title=The autism epidemic: fact or artifact? |language=English |journal=Journal of the American Academy of Child and Adolescent Psychiatry |volume=46 |issue=6 |pages=721–730 |date=June 2007 |pmid=17513984 |doi=10.1097/chi.0b013e31804a7f3b}} The World Health Organization estimates about 1 in 100 children had autism between 2012 and 2021, as that was the average estimate in studies during that period, with a trend of increasing prevalence over time.{{Efn|However, this figure may reflect an underestimate of prevalence in low- and middle-income countries.}}{{cite journal |last1=Zeidan |first1=Jinan |last2=Fombonne |first2=Eric |last3=Scorah |first3=Julie |last4=Ibrahim |first4=Alaa |last5=Durkin |first5=Maureen S. |last6=Saxena |first6=Shekhar |last7=Yusuf |first7=Afiqah |last8=Shih |first8=Andy |last9=Elsabbagh |first9=Mayada |date=15 May 2022 |title=Global prevalence of autism: A systematic review update |journal=Autism Research |volume=15 |issue=5 |pages=778–790 |doi=10.1002/aur.2696 |issn=1939-3806 |pmc=9310578 |pmid=35238171}}{{cite web |date=30 March 2022 |title=Autism |url=https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders |access-date=8 May 2022 |website=World Health Organization |language=en |archive-date=10 April 2020 |archive-url=https://web.archive.org/web/20200410103835/https://www.who.int/news-room/fact-sheets/detail/autism-spectrum-disorders |url-status=live}} This increasing prevalence has contributed to the myth perpetuated by anti-vaccine activists that autism is caused by vaccines.{{cite journal |vauthors=DeStefano F, Shimabukuro TT |date=September 2019 |title=The MMR Vaccine and Autism |journal=Annual Review of Virology |volume=6 |issue=1 |pages=585–600 |doi=10.1146/annurev-virology-092818-015515 |pmc=6768751 |pmid=30986133}}

There is no known cure for autism. Some advocates dispute the need to find one.{{Cite journal |date=2020-08-21 |title=Cure of Autistic Disorders: Mission Impossible is Possible in an Illustrated Pioneering Experience. |journal=SunKrist Journal of Psychiatry and Mental Health |language=en |pages=1–20 |doi=10.46940/sjpmh.01.1003|doi-broken-date=3 December 2024 |s2cid=242289975 }}{{Cite journal |last1=Eric Barnes |first1=R. |last2=McCabe |first2=Helen |date=2012 |title=Should we welcome a cure for autism? A survey of the arguments |url=http://link.springer.com/10.1007/s11019-011-9339-7 |journal=Medicine, Health Care and Philosophy |language=en |volume=15 |issue=3 |pages=255–269 |doi=10.1007/s11019-011-9339-7 |pmid=21837546 |issn=1386-7423}} Interventions such as applied behavior analysis (ABA), speech therapy, and occupational therapy can help these children gain self-care, social, and language skills.{{Cite web |last=CDC |date=2024-07-18 |title=Treatment and Intervention for Autism Spectrum Disorder |url=https://www.cdc.gov/autism/treatment/index.html |access-date=2024-11-28 |website=Autism Spectrum Disorder (ASD) |language=en-us}}{{cite journal|last1=Kasari |first1=Connie |last2=Shire |first2=Stephanie |last3=Shih |first3=Wendy |last4=Landa |first4=Rebecca |last5=Levato |first5=Lynne |last6=Smith |first6=Tristram |title=Spoken language outcomes in limited language preschoolers with autism and global developmental delay: RCT of early intervention approaches|journal=Autism Research|date=June 2023|volume=16|issue=6|pages=1236–1246|doi=10.1002/aur.2932|pmc=10460274|pmid=37070270|doi-access=free }} Guidelines from the US Centers}} for Disease Control and Prevention (CDC) and European Society for Child & Adolescent Psychiatry endorse the use of ABA on the grounds that it reduces symptoms impairing daily functioning and quality of life,{{cite journal|url=https://www.autismeurope.org/wp-content/uploads/2020/09/Fuentes2020_Article_ESCAPPracticeGuidanceForAutism.pdf|title=ESCAP practice guidance for autism: a summary of evidence‑based recommendations for diagnosis and treatment|author=Joaquin Fuentes, Amaia Hervás, Patricia Howlin, ESCAP ASD Working Party|journal=European Child & Adolescent Psychiatry |year=2020|volume=30 |issue=6 |pages=961–984 |doi=10.1007/s00787-020-01587-4|pmid=32666205 |pmc=8140956 }} but the National Institute for Health and Care Excellence cites a lack of high-quality evidence to support its use.{{Cite web |date=2011-09-28 |title=How we made the decision {{!}} Evidence {{!}} Autism spectrum disorder in under 19s: recognition, referral and diagnosis {{!}} Guidance |url=https://www.nice.org.uk/guidance/cg128/resources/surveillance-report-2016-autism-spectrum-disorder-in-under-19s-recognition-referral-and-diagnosis-2011-nice-guideline-cg128-and-autism-spectrum-disorder-in-under-19s-support-and-management-2013-nice--2660567437/chapter/How-we-made-the-decision?tab=evidence#:~:text=Consultees%20felt%20that%20applied%20behavioural,guideline%20development%20or%20surveillance%20review. |access-date=2024-11-28 |website=www.nice.org.uk}} Additionally, some in the autism rights movement oppose its application due to a perception that it emphasizes normalization.{{Cite web |date=2 April 2024 |title=EUCAP Position Statement on ABA |url=https://eucap.eu/2024/04/02/aba-statement/ |access-date=8 August 2024 |website=EUCAP |language=en-GB}}{{multiref2|{{cite web|url=https://www.spectrumnews.org/features/deep-dive/controversy-autisms-common-therapy/|title=The controversy over autism's most common therapy| vauthors = DeVita-Raeburn E |author-link=Elizabeth DeVita-Raeburn|date=10 August 2016|website=Spectrum|access-date=7 April 2019}}; republished in The Atlantic as:|{{cite magazine| vauthors = DeVita-Raeburn E |date=11 August 2016|title=Is the Most Common Therapy for Autism Cruel? |magazine=The Atlantic |url=https://www.theatlantic.com/health/archive/2016/08/aba-autism-controversy/495272/}}}}{{cite journal |vauthors=Kirkham P |date=1 April 2017 |title='The line between intervention and abuse' – autism and applied behaviour analysis |journal=History of the Human Sciences |language=en |volume=30 |issue=2 |pages=107–126 |doi=10.1177/0952695117702571 |issn=0952-6951 |s2cid=152017417}} No medication has been shown to reduce ASD's core symptoms, but some can alleviate comorbid issues.{{cite web |title=Medication Treatment for Autism |url=https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment |access-date=21 February 2023 |website=www.nichd.nih.gov/ |date=19 April 2021 |language=en |archive-date=7 February 2023 |archive-url=https://web.archive.org/web/20230207142659/https://www.nichd.nih.gov/health/topics/autism/conditioninfo/treatments/medication-treatment |url-status=live}}{{Cite journal |last1=Rzepka-Migut |first1=Beata |last2=Paprocka |first2=Justyna |date=2020 |title=Efficacy and Safety of Melatonin Treatment in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder—A Review of the Literature |journal=Brain Sciences |language=en |volume=10 |issue=4 |pages=219 |doi=10.3390/brainsci10040219 |doi-access=free |pmid=32272607 |issn=2076-3425|pmc=7226342 }}{{Cite journal |last1=Peled |first1=Julia |last2=Cassuto |first2=Hanoch |last3=Berger |first3=Itai |date=2 April 2020 |title=Processing speed as a marker to stimulant effect in clinical sample of children with high functioning autism spectrum disorder |url=https://www.tandfonline.com/doi/full/10.1080/08039488.2019.1686063 |journal=Nordic Journal of Psychiatry |language=en |volume=74 |issue=3 |pages=163–167 |doi=10.1080/08039488.2019.1686063 |pmid=31686565 |issn=0803-9488}}

}}

The proposed revised lede of the article is {{tqb|

Autism, referred to in clinical contexts as autism spectrum disorder (ASD), is a neurodevelopmental condition characterized by difficulties in social interaction, verbal and nonverbal communication; the presence of repetitive behavior and restricted interests; and uncommon responses to sensory stimuli. Being a spectrum, autism manifests in various ways, and support needs vary widely between different autistic people. For example, some are nonspeaking, while others have proficient spoken language.

Health authorities classify autism as a neurodevelopmental disorder, characterised by deficits.(World Health Organization: International Classification of Diseases version 11 (ICD-11)): https://icd.who.int/browse/2024-01/mms/en#437815624{{Cite web |date=2013-08-28 |title=Overview {{!}} Autism spectrum disorder in under 19s: support and management {{!}} Guidance |url=https://www.nice.org.uk/guidance/cg170 |access-date=2024-11-02 |website=www.nice.org.uk}}{{Cite web |title=IACC Subcommittee Diagnostic Criteria - DSM-5 Planning Group |url=https://iacc.hhs.gov/about-iacc/subcommittees/resources/dsm5-diagnostic-criteria.shtml |access-date=1 August 2024 |website=iacc.hhs.gov}}{{Cite journal |last1=National Consultation Meeting for Developing IAP Guidelines on Neuro Developmental Disorders under the aegis of IAP Childhood Disability Group and the Committee on Child Development and Neurodevelopmental Disorders |last2=Dalwai |first2=Samir |last3=Ahmed |first3=Shabina |last4=Udani |first4=Vrajesh |last5=Mundkur |first5=Nandini |last6=Kamath |first6=S. S. |last7=C Nair |first7=M. K. |date=2017-05-15 |title=Consensus Statement of the Indian Academy of Pediatrics on Evaluation and Management of Autism Spectrum Disorder |url=https://pubmed.ncbi.nlm.nih.gov/28368272/ |journal=Indian Pediatrics |volume=54 |issue=5 |pages=385–393 |doi=10.1007/s13312-017-1112-4 |issn=0974-7559 |pmid=28368272}}{{Cite journal |last1=Howes |first1=Oliver D |last2=Rogdaki |first2=Maria |last3=Findon |first3=James L |last4=Wichers |first4=Robert H |last5=Charman |first5=Tony |last6=King |first6=Bryan H |last7=Loth |first7=Eva |last8=McAlonan |first8=Gráinne M |last9=McCracken |first9=James T |last10=Parr |first10=Jeremy R |last11=Povey |first11=Carol |last12=Santosh |first12=Paramala |last13=Wallace |first13=Simon |last14=Simonoff |first14=Emily |last15=Murphy |first15=Declan G |date=2018-01-01 |title=Autism spectrum disorder: Consensus guidelines on assessment, treatment and research from the British Association for Psychopharmacology |journal=Journal of Psychopharmacology |language=en |volume=32 |issue=1 |pages=3–29 |doi=10.1177/0269881117741766 |issn=0269-8811 |pmc=5805024 |pmid=29237331}} An alternative perspective, arising out of autistic communities,{{Cite journal |date=2020 |editor-last=Kapp |editor-first=Steven K. |title=Autistic Community and the Neurodiversity Movement |url=https://link.springer.com/book/10.1007/978-981-13-8437-0 |journal=SpringerLink |language=en |doi=10.1007/978-981-13-8437-0}} is neurodiversity, which positions autism as a healthy part of the diversity of humankind, rather than a disorder {{Em dash}} with advantages, as well as disadvantages. This is usually associated with some version of the social model of disability,{{Cite journal |last=Dwyer |first=Patrick |last2=Gurba |first2=Ava N |last3=Kapp |first3=Steven K |last4=Kilgallon |first4=Elizabeth |last5=Hersh |first5=Lynnette H |last6=Chang |first6=David S |last7=Rivera |first7=Susan M |last8=Gillespie-Lynch |first8=Kristen |date=2024-09-18 |title=Community views of neurodiversity, models of disability and autism intervention: Mixed methods reveal shared goals and key tensions |url=https://journals.sagepub.com/doi/10.1177/13623613241273029 |journal=Autism |language=en |pages=13623613241273029 |doi=10.1177/13623613241273029 |issn=1362-3613}} suggesting that disability generally arises when a person's environment does not accommodate their needs.{{Cite book |last=Shakespeare |first=Tom |url=http://thedigitalcommons.org/docs/shakespeare_social-model-of-disability.pdf |title=The disability studies reader |date=1997 |publisher=Routledge |year=1997 |isbn=978-0-415-91470-3 |editor-last=Davis |editor-first=Lennard J. |location=New York |chapter=The Social Model of Disability}} It can also be argued that autism can be inherently disabling.{{cite journal |vauthors=Nelson RH |date=2021 |title=A Critique of the Neurodiversity View |url=https://onlinelibrary.wiley.com/doi/abs/10.1111/japp.12470 |journal=Journal of Applied Philosophy |volume=38 |issue=2 |pages=335–347 |doi=10.1111/japp.12470}}{{Cite journal |last1=Shields |first1=Kenneth |last2=Beversdorf |first2=David |date=1 July 2021 |title=A Dilemma For Neurodiversity |url=https://link.springer.com/article/10.1007/s12152-020-09431-x |journal=Neuroethics |language=en |volume=14 |issue=2 |pages=125–141 |doi=10.1007/s12152-020-09431-x |issn=1874-5504}} There is a significant controversy between the neurodiversity perspective and the medical model of disability among autistic people, practitioners, researchers and charities.{{cite book |title=Autistic Community and the Neurodiversity Movement: Stories from the Frontline |vauthors=Robison JE |date=2020 |publisher=Springer |isbn=978-981-13-8437-0 |veditors=Kapp SK |place=Singapore |pages=221–232 |chapter=My Time with Autism Speaks |doi=10.1007/978-981-13-8437-0_16 |doi-access=free |s2cid=210496353}}{{cite journal |last=Opar |first=Alisa |date=24 April 2019 |title=In search of truce in the autism wars |url=https://www.spectrumnews.org/features/deep-dive/search-truce-autism-wars |url-status=live |journal=Spectrum |publisher=Simons Foundation |doi=10.53053/VRKL4748 |s2cid=249140855 |archive-url=https://web.archive.org/web/20220708195918/https://www.spectrumnews.org/features/deep-dive/search-truce-autism-wars/ |archive-date=8 July 2022 |access-date=9 July 2022 |doi-access=free}} Support for the neurodiversity approach has increased substantially in recent years among all of these groups.{{Cite journal |title=Moving from Disorder to Difference: A Systematic Review of Recent Language Use in Autism Research |url=https://www.liebertpub.com/doi/10.1089/aut.2023.0030 |journal=Autism in Adulthood}}{{Cite journal |title=Annual Research Review: Shifting from ‘normal science’ to neurodiversity in autism science |url=https://acamh.onlinelibrary.wiley.com/doi/full/10.1111/jcpp.13534 |journal=Journal of Child Psychology and Psychiatry}}

The causes of autism are unknown in most individual cases. Research shows that autism is highly heritable and polygenic. Environmental factors are also relevant.{{Cite journal |last1=Hodges |first1=Holly |last2=Fealko |first2=Casey |last3=Soares |first3=Neelkamal |date=February 2020 |title=Autism spectrum disorder: definition, epidemiology, causes, and clinical evaluation |journal=Translational Pediatrics |language=en |volume=9 |issue=Suppl 1 |pages=S55–S5S65 |doi=10.21037/tp.2019.09.09 |issn=2224-4344 |pmc=7082249 |pmid=32206584 |doi-access=free}}{{Cite journal |last=Ratajczak |first=Helen V. |date=2011-03-01 |title=Theoretical aspects of autism: Causes—A review |url=https://www.tandfonline.com/doi/full/10.3109/1547691X.2010.545086 |journal=Journal of Immunotoxicology |volume=8 |issue=1 |pages=68–79 |doi=10.3109/1547691X.2010.545086 |issn=1547-691X |pmid=21299355}}{{cite journal |vauthors=Mandy W, Lai MC |date=March 2016 |title=Annual Research Review: The role of the environment in the developmental psychopathology of autism spectrum condition |journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines |volume=57 |issue=3 |pages=271–292 |doi=10.1111/jcpp.12501 |issn=0021-9630 |eissn=1469-7610 |oclc=01307942 |pmid=26782158 |doi-access=free}} Autism frequently co-occurs with attention deficit hyperactivity disorder (ADHD), epilepsy, intellectual disability, hypermobility{{Cite journal |last=Donaghy |first=Bethany |last2=Moore |first2=David |last3=Green |first3=Jane |date=2023-01-02 |title=Co-Occurring Physical Health Challenges in Neurodivergent Children and Young People: A Topical Review and Recommendation |url=https://www.tandfonline.com/doi/full/10.1080/13575279.2022.2149471 |journal=Child Care in Practice |volume=29 |issue=1 |pages=3–21 |doi=10.1080/13575279.2022.2149471 |issn=1357-5279}} and gastrointestinal problems.{{Cite journal |last=Leader |first=Geraldine |last2=Abberton |first2=Cathal |last3=Cunningham |first3=Stephen |last4=Gilmartin |first4=Katie |last5=Grudzien |first5=Margo |last6=Higgins |first6=Emily |last7=Joshi |first7=Lokesh |last8=Whelan |first8=Sally |last9=Mannion |first9=Arlene |date=January 2022 |title=Gastrointestinal Symptoms in Autism Spectrum Disorder: A Systematic Review |url=https://www.mdpi.com/2072-6643/14/7/1471 |journal=Nutrients |language=en |volume=14 |issue=7 |pages=1471 |doi=10.3390/nu14071471 |issn=2072-6643}} Research indicates that autistic people have significantly higher rates of LGBTQ+ identities and feelings than the general population.{{Citation |last1=Bertelli |first1=Marco O. |title=Autism Spectrum Disorder |date=2022 |work=Textbook of Psychiatry for Intellectual Disability and Autism Spectrum Disorder |pages=391 |editor-last=Bertelli |editor-first=Marco O. |url=https://books.google.com/books?id=4mtvEAAAQBAJ&pg=PA391 |access-date=8 June 2022 |place=Cham |publisher=Springer International Publishing |language=en |doi=10.1007/978-3-319-95720-3_16 |isbn=978-3-319-95720-3 |quote=Persons with autism spectrum disorder and/or other neurodevelopmental problems are more likely than the general population to have transgender identity, non-heterosexual sexual orientation, and other gender non-conformities. |last2=Azeem |first2=Muhammad Waqar |last3=Underwood |first3=Lisa |last4=Scattoni |first4=Maria Luisa |last5=Persico |first5=Antonio M. |last6=Ricciardello |first6=Arianna |last7=Sappok |first7=Tanja |last8=Bergmann |first8=Thomas |last9=Keller |first9=Roberto |editor2-last=Deb |editor2-first=Shoumitro (Shoumi) |editor3-last=Munir |editor3-first=Kerim |editor4-last=Hassiotis |editor4-first=Angela |url-access=subscription}}{{Cite journal |last1=Lord |first1=Catherine |last2=Charman |first2=Tony |last3=Havdahl |first3=Alexandra |last4=Carbone |first4=Paul |last5=Anagnostou |first5=Evdokia |last6=Boyd |first6=Brian |last7=Carr |first7=Themba |last8=de Vries |first8=Petrus J |last9=Dissanayake |first9=Cheryl |author-link9=Cheryl Dissanayake |last10=Divan |first10=Gauri |last11=Freitag |first11=Christine M |display-authors=10 |date=2022 |title=The Lancet Commission on the future of care and clinical research in autism |url=https://fhi.brage.unit.no/fhi-xmlui/bitstream/handle/11250/2975811/Lancet+Commission.pdf?sequence=1 |journal=The Lancet |volume=399 |issue=10321 |pages=299–300 |doi=10.1016/s0140-6736(21)01541-5 |pmid=34883054 |s2cid=244917920 |via=Norwegian Institute of Public Health |hdl=11250/2975811}}{{cite journal |last1=Graham Holmes |first1=Laura |last2=Ames |first2=Jennifer L. |last3=Massolo |first3=Maria L. |last4=Nunez |first4=Denise M. |last5=Croen |first5=Lisa A. |date=1 April 2022 |title=Improving the Sexual and Reproductive Health and Health Care of Autistic People |journal=Pediatrics |publisher=American Academy of Pediatrics |volume=149 |issue=Supplement 4 |pages=e2020049437J |doi=10.1542/peds.2020-049437J |issn=0031-4005 |pmid=35363286 |quote=A substantial proportion of autistic adolescents and adults are LGBTQIA+. Autistic people are more likely to be transgender or gender nonconforming compared with non-autistic people, and findings from a recent autism registry study suggest that among autistic people able to self-report on a survey, up to 18% of men and 43% of women may be sexual minorities. |doi-access=free}} Autistic people are also significantly more likely to experience anxiety and depression, especially if they feel the need to mask their autism.{{Cite journal |title=Camouflaging in autism: A systematic review |url=https://www.sciencedirect.com/science/article/abs/pii/S0272735821001239 |journal=Clinical Psychology Review}}

There is ongoing debate within the autism community and among researchers regarding diagnostic criteria, whether there are meaningful subtypes or stages of autism,{{cite journal |vauthors=Rosen NE, Lord C, Volkmar FR |date=December 2021 |title=The Diagnosis of Autism: From Kanner to DSM-III to DSM-5 and Beyond |journal=Journal of Autism and Developmental Disorders |volume=51 |issue=12 |pages=4253–4270 |doi=10.1007/s10803-021-04904-1 |pmc=8531066 |pmid=33624215}}fix this citation and the significance of autism-associated traits in the wider population.{{cite book |title=Autism Spectrum Disorders |vauthors=Losh M, Adolphs R, Piven J |publisher=Oxford University Press |year=2011 |isbn=978-0-19-996521-2 |pages=457–476 |language=en-US |chapter=The Broad Autism Phenotype |doi=10.1093/med/9780195371826.003.0031}}{{cite journal |vauthors=Chapman R, Veit W |date=November 2021 |title=Correction to: The essence of autism: fact or artefact? |journal=Molecular Psychiatry |volume=26 |issue=11 |page=7069 |doi=10.1038/s41380-021-01057-6 |pmid=34697454 |s2cid=239771302 |doi-access=free}} Estimates of autism prevalence have increased considerably since the 1990s, mainly due to the combination of broader criteria and increased awareness; there is disagreement on whether the actual prevalence has increased.{{cite journal |vauthors=Wazana A, Bresnahan M, Kline J |date=June 2007 |title=The autism epidemic: fact or artifact? |journal=Journal of the American Academy of Child and Adolescent Psychiatry |language=English |volume=46 |issue=6 |pages=721–730 |doi=10.1097/chi.0b013e31804a7f3b |pmid=17513984}}{{cite journal |display-authors=6 |vauthors=Russell G, Stapley S, Newlove-Delgado T, Salmon A, White R, Warren F, Pearson A, Ford T |date=August 2021 |title=Time trends in autism diagnosis over 20 years: a UK population-based cohort study |journal=Journal of Child Psychology and Psychiatry, and Allied Disciplines |volume=63 |issue=6 |pages=674–682 |doi=10.1111/jcpp.13505 |issn=0021-9630 |eissn=1469-7610 |oclc=01307942 |pmid=34414570 |s2cid=237242123 |quote=The figure starkly illustrates an overall 787% increase in recorded incidence of autism diagnosis over 20 years. |doi-access=free |hdl-access=free |hdl=10871/126929}}{{Cite journal |title=Autism phenotype versus registered diagnosis in Swedish children: prevalence trends over 10 years in general population samples |url=https://www.bmj.com/content/350/bmj.h1961 |journal=The BMJ}} The increase in reported prevalence has reinforced the completely debunked pseudo-scientific conspiracy theory perpetuated by anti-vaccine activists that autism is caused by vaccines.{{cite journal |vauthors=DeStefano F, Shimabukuro TT |date=September 2019 |title=The MMR Vaccine and Autism |journal=Annual Review of Virology |volume=6 |issue=1 |pages=585–600 |doi=10.1146/annurev-virology-092818-015515 |pmc=6768751 |pmid=30986133}} Boys are more frequently diagnosed than girls,{{cite journal |display-authors=6 |vauthors=Maenner MJ, Shaw KA, Baio J, Washington A, Patrick M, DiRienzo M, Christensen DL, Wiggins LD, Pettygrove S, Andrews JG, Lopez M, Hudson A, Baroud T, Schwenk Y, White T, Rosenberg CR, Lee LC, Harrington RA, Huston M, Hewitt A, Esler A, Hall-Lande J, Poynter JN, Hallas-Muchow L, Constantino JN, Fitzgerald RT, Zahorodny W, Shenouda J, Daniels JL, Warren Z, Vehorn A, Salinas A, Durkin MS, Dietz PM |date=March 2020 |title=Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2016 |journal=MMWR. Surveillance Summaries |language=en-us |volume=69 |issue=4 |pages=1–12 |doi=10.15585/mmwr.ss6904a1 |pmc=7119644 |pmid=32214087}} although this gap has been narrowing.{{Cite journal |title=What Is the Male-to-Female Ratio in Autism Spectrum Disorder? A Systematic Review and Meta-Analysis |url=https://www.jaacap.org/article/S0890-8567(17)30152-1/abstract |journal=Journal of the American Academy of Child and Adolescent Psychiatry}}

}}

=Survey (on lede replacement RFC)=

No. The clear shift from spending time covering symptom matters to talk of discussions around that is sufficient, and the proposed version comes across more clearly as non-neutral.Abbi043 (talk) 21:37, 25 February 2025 (UTC)

:In connection to my reply in the other recent RFC opened by Robert McClenon, I think I may be out of my depth and hadn't realized it. I no longer feel confident in my ability to judge the exact text difference. Abbi043 (talk) 06:25, 26 February 2025 (UTC)

Yes. There are three main changes that we have proposed. Two are related to the balancing and the third is related to reducing the number of words.

The first is that we do not use Wikipedia’s voice anymore for the assertion that autism is a disorder. The neutral point of view policy (WP:WIKIVOICE) says that opinions must not be stated as facts. Only in cases where something is either objective or uncontroversial is it appropriate to write something like „Autism is a disorder.“ instead of „Health authorities X, Y, ... classify autism as a disorder.“ This consensus existed until a few years ago but it does not exist anymore, as has been shown by many reliable sources that different editors have cited here on the talk page and on the dispute resolution pages. [https://en.wikipedia.org/wiki/Wikipedia:Dispute_resolution_noticeboard/Autism][https://en.wikipedia.org/wiki/Wikipedia:Dispute_resolution_noticeboard/Autism_discussion] and in my comment to the other RfC.[https://en.wikipedia.org/wiki/Talk:Autism#c-LogicalLens-20250226044700-Survey_(on_RFC_on_focus)]

The second point is that we have clarified the section on the controversy about the autism classification as it is wrong and contradicts the given sources to say that the neurodiversity viewpoint means not viewing autism as a disability (it is only not a disorder to be treated according to this perspective, but can still be disabling).

Thirdly, the last paragraph has been omitted mainly because the lede is too long. The old lede has 524 words and the new has 366 words (if my text program counted them correctly). The Manual of Style ([https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Lead_section|Manual of Style]) considers 250 to 400 words optimal. We thought the other parts in the lede are more important and especially the controversy about ABA is so intricate that it is very challenging to summarize in a few sentences. LogicalLens (talk) 04:52, 26 February 2025 (UTC)

Yes. The existing lead is far too long, poorly-focused, and comes off as dismissive of - and muddled about - the neurodiversity perspective.

Given the well-evidenced popularity of this perspective among stakeholders (especially autistic people, but also families and relevant professionals[https://journals.sagepub.com/doi/full/10.1177/13623613241273029]) and its position as (at least) a very substantial minority view among researchers in the field[https://www.liebertpub.com/doi/10.1089/aut.2023.0030], it is important that this should be reflected fairly in the lead, as well as in the body of the entry.

Speaking as someone involved in drafting it, the proposed replacement lead represents an attempt at a careful compromise between two fundamentally differing understandings of autism, each well-represented in reliable sources. It continues to give the medical perspective substantially more space than the neurodiversity approach - which, to be transparent, is not my personal preference, but is the result of a sincere effort to assign weight to viewpoints 'in proportion to their prominence in reliable sources'.

- Oolong (talk) 12:29, 27 February 2025 (UTC)

:I just want to emphasise here that there is not a scientific consensus that autism is a disorder, and there is certainly no scientific consensus that neurodiversity is an incorrect or unhelpful perspective.

:I keep hoping to get to a point where we can work towards some kind of Wikipedia consensus based on a shared understanding of basic facts, but any responses made on the basis of a 'scientific consensus' against the neurodiversity approach are, I'm afraid, unambiguously incorrect.

:@LogicalLens has carefully laid out plentiful references directly addressing these questions above, as well evidence that shows the large number of relevant scientists and other researchers who take a neuro-affirming view, and the much higher proportion of other stakeholders who do so. Wikipedia rightly demands a high standard of evidence for claims of academic consensus for articles, and I would suggest that it would be appropriate to hold out for something similar before making such claims in a discussion of this sort: "A statement that all or most scientists or scholars hold a certain view requires reliable sourcing that directly says that all or most scientists or scholars hold that view."

:I understand that this is a demanding discussion in many ways, but I would strongly encourage anybody contributing to it to ensure they are at least familiar with the overall trends in the academic literature[https://www.liebertpub.com/doi/10.1089/aut.2023.0030]. Oolong (talk) 17:43, 16 March 2025 (UTC)

Yes. The existing version is unbalanced. It emphasises the purely medical viewpoint of autism to the detriment, and frankly marginalisation, of other valid approaches to autism, to be found in recent research in genetics, neurology, psychology and sociology, and in disability rights, autism advocacy and the neurodiversity paradigm. Urselius (talk) 19:58, 28 February 2025 (UTC)

No The current version is excellent because it accurately reflects current mainstream medical opinion. It appropriately includes concerns from advocacy organizations. The proposed version is not acceptable because it does not adequately address severe forms of autism.T g7 (talk) 05:58, 2 March 2025 (UTC)

No The current lede is stronger in terms of neutrality, balance, and accuracy. While the proposed lede introduces some valuable refinements, it leans heavily into advocacy for neurodiversity perspective, misrepresenting the current scientific and clinical consensus. The medical model remains the dominant framework in diagnosis, intervention, policy, and research, and should therefore be presented as the default and baseline perspective in the lede. Discussion here on this talk page fail to sufficiently acknowledge that the majority of autism research is still conducted within the medical paradigm and the revised lede creates the misleading impression that the medical model is being broadly challenged or replaced, when in fact - despite claims to the contrary also here on this talk page - no country has discarded the medical diagnostic framework for autism in favor of any other model. While some countries have embraced neurodiversity principles in their autism strategies and programs (primarily in education, social support, and advocacy contexts), the medical model remains the dominant and official paradigm globally. The neurodiversity perspective is influential in advocacy and social discussions and that should influence where in the article we afford more discussion to it, but it is not a wholesale replacement or alternative to the medical model and care should be taken to avoid presenting it as such intentionally or accidentally. The original lead correctly frames neurodiversity as a perspective originating from autistic communities and advocacy movements.

A close analysis of the proposed changes reveals a significant shift that compromises neutrality:

Subtle undermining of the medical model, introducing doubt and uncertainty only in relation to it.
Complete removal of discussion on treatment, aligning with neurodiversity perspective that shifts the burden away from clinical intervention and onto broader societal accommodations.
Omission of the formal diagnostic requirement that symptoms cause “significant impairment” in multiple functional domains - a critical omission, as diagnosis requires functional impairment, distinguishing autism from personality traits that resemble it.
Introduction of vague reference to prevalence of LGBTQ+ identity and "feelings" - while some research suggests a link between autism and gender diversity (not necessarily same-sex orientation), this is not a core trait of autism nor central to its definition. Its inclusion notably strengthens the neurodiversity framing without sufficient justification for inclusion in lede or sufficiently strong sourcing.
Escalation of language in reference to the vaccine myth, which is not part of medical model, shifting from neutral fact to polemical tone not appropriate for encyclopedia. "This increasing prevalence has contributed to the myth perpetuated by anti-vaccine activists that autism is caused by vaccines." -> "The increase in reported prevalence has reinforced the completely debunked pseudo-scientific conspiracy theory perpetuated by anti-vaccine activists that autism is caused by vaccines." (emphasis added to highlight problematic language). This change was entirely unnecessary and unrelated to creating a more balanced lede. It is a great example of why advocacy editing is as problematic as COI.
Creating unnecessary ambiguity about whether autism rates have increased or simply been recognized more and subtle attempts to separate autism from medical risk factors and reject the idea that autism prevalence is influenced by environmental or genetic causes. "neurobiological risks from the environment are also relevant." -> "Environmental factors are also relevant." On the surface, the edit may not seem inherently problematic, but when examined in context we see there is sufficient reason to believe its an attempt to subtly shift the article’s framing.

These changes, taken together, fundamentally alter the framing of the article, shifting it away from a neutral, fact-based summary toward a viewpoint-driven narrative. The current lede is far better at maintaining the appropriate balance between the scientific consensus and alternative perspectives, and should not be replaced with a version that overstates the prominence of neurodiversity at the expense of accuracy. The medical model should retain primacy in the lede with acknowledgement of the existence of the neurodiversity perspective but discussion beyond that should be reserved for appropriate sections in the body. Someone who reads just the lede should understand the broad strokes of the medical model and be aware that there is a sufficiently prominent movement to warrant acknowledgement in the lede who believe that autism is a natural part of human neurodiversity and resist pathologizing their difficulties and differences. The lede must not become a summary of the controversy/dispute/difference between the models as this isn't an article about that even if it is one of the important parts of it. Tacitusmd (talk) 11:15, 2 March 2025 (UTC)

:I agree it may be useful to include some discussion on supports and accommodations, but if so, surely this would need to be a balanced discussion meaning accommodations would need to be discussed as well as interventions aiming to change the individual. The original article's intervention section is notably unbalanced and covers only the latter.

:I agree it may be useful to note in paragraph 2 something like "Health authorities classify autism as a neurodevelopmental disorder, characterised by deficits. In this approach, a diagnosis of autism requires identifying impairments internal to the individual." However this is a minor addition and can easily be made within the context of the proposed new text.

:The LGBTQ+ mention seems very relevant since there is plenty of research now documenting it, and why mention co-occurring neurodevelopmental disabilities and mental and physical health conditions but selectively leave out other things co-occurring with autism? That seems unbalanced and odd.

:I would assume since the various scientific authorities have totally debunked the vaccine myth that we all agree it should not be endorsed. I think the specific language used to reject it can be discussed separately from the global changes here.

:As for shifting the framing of environmental factors influencing likelihood, the previous version's use of the subjective word "risk" was notably unbalanced and aligned only with a controversial medical perspective, whereas the term "likelihood" is neutral, compatible with either medical or neurodiversity perspectives, and more reflective of a Wikipedia-appropriate balance.

:So it seems like rather than proposing a balanced view, you are proposing again to provide unbalanced coverage in favour of the medical model, which you actually call the "scientific consensus" even though it is not - as I noted in other posts, even a few years ago 30% of the peer-reviewed literature used neurodiversity-aligned language - 70% vs 30% is not a consensus. Somewhere like the International Society for Autism Research one sees a mixture of medicalized and neurodiversity-affirming approaches - not a consensus in favour of medicalized - for example as one crude metric, of the keynotes this year, 2 are medicalized and 1 is neuro-affirming. Meanwhile the Australasian Society for Autism Research is almost exclusively neuro-affirming. The neurodiversity perspective is far from marginal, and there is definitely no scientific consensus in favour of the medical view these days. Ó.Dubhuir.of.Vulcan (talk) 00:31, 7 March 2025 (UTC)

No I agree with Tacitusmd. Lova Falk (talk) 18:41, 3 March 2025 (UTC)

Yes. The existing lead is unbalanced. Ó.Dubhuir.of.Vulcan (talk) 00:32, 7 March 2025 (UTC)

No As per Tacitusmd. As an autistic, this seems to be far less nuanced despite how much I was under the assumption that the intent was to provide far more nuance, though in practice seems to merely wants to replace suspected "bias" the article because it goes against the own personal bias of certain activist editors. I think there is potential to show a rise in different perspectives, but how it's introduced here goes against the overwhelming medical consensus of current medical authorities, which IMO seems to prefer writing based more on vague and subjective "autistic lived experience" to depict pro-neurodiversity views as deserving of more weight against the viewpoints of mainstream medical authorities, even despite such being the rules for writing about medical conditions on wikipedia. [[User:GigaMigaDigaChad|

GigaMigaDigaChad]] 04:14, 7 March 2025 (UTC)

No. The revised proposal gives undue weight to the opinions of the Neurodiversity Movement and discounts the mountains of references demonstrating a global scientific consensus on the validity of ASD as a neurodevelopmental disorder (cited in prior discussions) and of the application of other terminology. Furthermore, it's biased against the perspective of scientists about how ASD impairs functioning inherently in ways unrelated to society. It reduces this statement to just "inherently impairing", while leaving the opposing statement with far more elaboration. The proposal also erroneously suggests there has been a "substantial increase" in support for the aforementioned movement's assertions, and redacts key details regarding the treatment of ASD with interventions approved by various guideline developers. Overall, the proposal should not be admissible and lacks careful consideration. Димитрий Улянов Иванов (talk) 15:10, 8 March 2025 (UTC)

No As indicated below, this badly fails WP:RFCBRIEF. If successful it would only provide an avenue to lock the lead on the Right Version™, and provide an avenue for proponents to discourage any further changes. This runs counter to the spirit of Wikipedia and part of why we do not generally have RfCs on sweeping rewrites to several paragraphs. If the proposal is rejected, it's not abundantly clear that everyone will reject it for the same reasons, rendering it effectively a non-con result where anyone could come back in a while with a largely cosmetic rewrite and try again with an equally broad proposal.{{pb}}Narrow this down to something specific and concise and try again. GMG ^talk 15:04, 10 March 2025 (UTC)

Yes because, although I would personally write the lede with more emphasis on the medical model, this revised lede resulted from a long, detailed discussion by many editors with different perspectives. In addition, adopting the revised (new) lede does not mean that its exact text must persist forever. In other words, we can (and should) continue to debate the issues and revise as needed according to the usual Wikipedia guidelines, policies, and procedures. Mark D Worthen PsyD (talk) [he/him] 17:45, 14 March 2025 (UTC)

Procedural oppose this use of an RfC - I am not averse to shortening the lede or to the gist of the suggested changes, including bringing the mention of neurodevelopmental disorder down to the second paragraph. However, I feel we are losing important context by removing reference to age, sociocultural context, interventions and the evidence-base behind interventions. I realize we do not want to speak of there not being a "cure" for autism, however I think a non-negligible proportion of readers may need this context. Imagine someone who has a child recently diagnosed with autism, or someone who has recently been diagnosed - and at a point where they may be quite distressed - they go to the lede of this page as a first point of reference. I think they need that information. Maybe it could be put in different words, and it is not entirely true to say that "autism doesn't go away" - but I don't think throwing this out of the lede is helpful.

Anyway, I commend this effort, but I believe what would be best is to use parts of this discussion to iteratively rewrite the existing lede. I'm quite against the idea of an RfC for the whole lede, because that cements it in a way that it shouldn't be cemented. CFCF (talk) 18:56, 15 March 2025 (UTC)

:P.S. I'm also not sure we have support to say "especially" regarding vulnerability due to masking. I think we can say that it contributes, but especially makes it sound like the exact degree of increased depression etc. caused by masking is known. We don't know it, and we certainly can't say it is the major part based off of this lack of evidence. CFCF (talk) 19:01, 15 March 2025 (UTC)

::@CFCF – Thanks for engaging in good faith. But I want to challenge a few core assumptions here—because what you’re describing as “context” often reflects a specific worldview, not a neutral baseline.

::Your point about readers coming to the article in distress is valid. But what exactly do we think comforts them? A framing that subtly reinforces deficit models? Or one that situates autism within a broader landscape of diversity, possibility, and grounded support?

::You mentioned that the proposed lede “throws out” references to age, intervention, or evidence. But those are still in the article—just not in the opening. That’s not omission; it’s structural clarity. The job of the lede is to lay out the conceptual frame. Not to front-load clinical messaging or offer emotional hand-holding via deficit language.

::Regarding your “procedural oppose” to the RfC: it’s a tool, not a verdict. Community input isn’t “cement.” It’s calibration. The current lede has resisted major revision for years precisely because these informal, incremental rewrites haven’t led to durable consensus. An RfC—properly framed—can clarify what the community is actually aligned on.

::Lastly, on the “especially due to masking” phrase: you’re right to be cautious about weighting. But the literature does support a significant association between camouflaging and mental health distress in autistic people, particularly women and gender minorities. If the word “especially” feels too strong, we can amend that. But the entire point is to reflect what autistic people themselves report—not just what external observers feel confident quantifying.

::Let’s not confuse “comfort” with “familiar framing.” Readers in distress don’t need autism described as a tragedy—they need to not feel alone. And that starts with language that doesn’t flatten their identity into pathology.

::Recursiva (talk) 10:41, 7 May 2025 (UTC)

No - I think that the proposal is well written, but it is an advocacy statement that does not reflect the article content and is a bad match per WP:LEAD. The first paragraph seems an improvement to readability, but the rest just seems too much like soapboxing. At the end it’s getting a bit ranting with side topic content and sensationalized phrasing “completely debunked pseudo-scientific conspiracy theory perpetuated by anti-vaccine activists “ Cheers Markbassett (talk) 10:17, 19 March 2025 (UTC)

Bad RfC. Per WP:RFCBRIEF: {{tq|"The initial RfC statement (and heading) should be neutrally worded and brief."}} There's an RfC on the scope and wording of the article right now. I don't think it makes sense to have what are essentially the same discussion in two places at the same time. TurboSuperA+ (☏) 10:47, 20 March 2025 (UTC)

Yes overall but there are some ways in which the first section is better. For example, the statement "mainly due to the combination of broader criteria and increased awareness" looks like it should be sourced. I concur with Turbo that this RfC is not as well structured as it ought to be but not because of lack of neutrality. It would be more efficient to say what the main upshot of the intent behind the change is. Darkfrog24 (talk) 14:54, 20 March 2025 (UTC)

No. The above comments rejecting this explain this in detail and I don't have much to add; it gives far too much WP:WEIGHT to the neurodiversity movement over the still-mainstream medical view, creating a false balance. Crossroads ^-talk- 21:24, 9 April 2025 (UTC)

Yes Per my comments on the other RfC, the lead doesn't mention the "neurodiversity" view at all. I don't know the details of all this, but I do think that Wikipedia shouldn't be talking about a "cure" for autism any more than it should be talking about a "cure" for ADHD, despite the fact that both conditions can cause problems. Mrfoogles (talk) 18:50, 27 April 2025 (UTC)

=Discussion (about lede replacement RFC)=

:@Robert McClenon why has the cure part been ommitted. “It can also be argued that autism is inherently disabling” is pretty damaging since majority of the autistic population can function similarly to others and saying “it can be argued” is basically saying its a valid arguement and simply underminds the fact that autism is a spectrum this should be changed to “some argue…”. I also in my opinion the lgbtq correlation should be ommited from the opening paragraph as i feel it could add fuel to the already blazing fire that is the current world we live in today it should be relegated to an different section until further research solidifies more about the correlation •Cyberwolf•. talk? 19:19, 25 February 2025 (UTC)

::The cure part has been omitted mainly because the lede is too long. The old lede has 524 words and the new has 366 words (if my text program counted them correctly). The Manual of Style ([https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Lead_section]) considers 250 to 400 words optimal. We thought the other parts in the lede are more important and especially the controversy about ABA is so intricate that it is very challenging to summarize in a few sentences. LogicalLens (talk) 03:05, 26 February 2025 (UTC)

::The previous version was "on the contrary, other scientists argue..." which was misleading because there are many pro-neurodiversity researchers who acknowledge that there can be aspects of autism that are inherently disabling (for example, not being able to communicate basic needs, not even trough alternative means of communication). That part of the lead section is not optimal and we agreed on refining it further. LogicalLens (talk) 04:31, 27 February 2025 (UTC)

:::I agree that’s my stance with those scientists and imo the right approach. This approach should be documented in the article if it isn’t already. I was concerned with the lack of the word “can” and who said it
{{tq|1= there are many pro-neurodiversity researchers who acknowledge that there can be aspects of autism that are inherently disabling (for example, not being able to communicate basic needs, not even through alternative means of communication)}}
is a perfect solution •Cyberwolf•. talk? 16:51, 27 February 2025 (UTC)

::::This is a very complicated section of the article. Your phrasing is factually more accurate and I personally would normally agree with that. But then sources by actual pro-neurodiversity researchers would have to be used and before that, it should be stated that other researchers have criticized neurodiversity on the grounds of the assumption that neurodiversity would say there cannot be inherently disabling features. This would then be a back-and-forth juxtaposition that is very suboptimal in an encyclopedia. I think this paragraph will require a lot of work to provide a neutral, accurate, and encyclopedic summary of the models. LogicalLens (talk) 05:04, 28 February 2025 (UTC)

:::::I agree •Cyberwolf•. talk? 05:17, 28 February 2025 (UTC)

::::::Realistically, there is no way to convey the nuance of this debate (or several others) within the kind of word-count that is appropriate for a lead. There are researchers and non-researchers on all sides of this particular debate, for example, and we should not be reporting only the views of researchers, as if they are the only ones that matter.

::::::There are many subtle distictions to be made within the social model of disability, and the neurodiversity approach(es). Our goal for the lead should, I think, be to summarise only the most important points about all of this. Meanwhile, we probably ought to start thinking about how best to give an encyclopaedic account of these disagreements (and indeed disagreements) within the body of the article... Oolong (talk) 15:42, 1 March 2025 (UTC)

:::::::I am currently working on a re-draft for this paragraph of the lede. The current body mischaracterizes the neurodiversity paradigm by, for example, stating that critics object to it because they think autism is a disability, as if any serious pro-neurodiversity researcher had said the opposite. LogicalLens (talk) 23:21, 1 March 2025 (UTC)

::::::::Thank you for all your work on this LogicalLens, including your current work to improve that paragraph. I had stated earlier (although I cannot find it now) that we should omit or revise that sentence (“It can also be argued that autism is inherently disabling”) because of its ambiguity. I agree that it is a challenge to find concise, accurate phrasing to explain the issue. Mark D Worthen PsyD (talk) [he/him] 17:53, 14 March 2025 (UTC)

Pretty sure this fails WP:RFCBRIEF. You can't really expect uninvolved editors to spend an hour trying to figure out exactly what changed between these two versions. GMG ^talk 19:39, 25 February 2025 (UTC)
:Which is what i did lol •Cyberwolf•. talk? 20:30, 25 February 2025 (UTC)
:The topic we are discussing here is very complicated and it does not lead anywhere to resort to oversimplifications. The RfC runs for 30 days so there is enough time. LogicalLens (talk) 03:07, 26 February 2025 (UTC)
::RFCBRIEF is concerned about the part that appears on Wikipedia:Requests for comment/All, which is only 19 words long ("Should the paragraphs of the proposed revised lede shown below replace the current lede section of the Autism article?"). WhatamIdoing (talk) 23:32, 26 February 2025 (UTC)
:::Where in the world did you get that idea? GMG ^talk 15:19, 4 March 2025 (UTC)
::::These statistics will probably answer your current question. WhatamIdoing (talk) 01:42, 6 March 2025 (UTC)
:::::Congratulations I guess. But no. The point of brevity and specificity is to hopefully arrive at an actionable outcome. Suggesting 50 different changes in one go is just offering 50 different ways for people to disagree. GMG ^talk 13:42, 9 March 2025 (UTC)
::::::And having 50 different RFCs is just offering 50 different times for people to disagree. WhatamIdoing (talk) 19:10, 9 March 2025 (UTC)
:::::::To disagree on something specific. If an overly broad RfC fails, it doesn't really establish an underlying consensus if participants are dissenting for vastly different reasons. GMG ^talk 12:55, 10 March 2025 (UTC)
::::::::GMG: Since you chose to not participate in the Dispute Resolution Process, I'm having a hard time giving a lot of credence to your arguments now that we have an RfC. Mark D Worthen PsyD (talk) [he/him] 18:03, 14 March 2025 (UTC)
:::::::::If the price for entry is wading through 250k+ of meandering text that results in...one clearly malformed RfC and another that's so broad that it at best justifies more RfCs, then think what you will. DRN is a bad format that pretends to be pseudo ArbCom. I have not and will not be a party to it. GMG ^talk 19:31, 14 March 2025 (UTC)
::::::::::There is clearly a significant dispute here about this article's content, and editors have not been able to make progress despite expending a lot of time and energy. Do you have a suggestion for making progress? For example, can you identify what you think would be a more effective RfC? FactOrOpinion (talk) 20:28, 14 March 2025 (UTC)
:::::::::::That would require those involved to focus on a specific change rather than debating autism writ large. At this point in this war of attrition, it's a small victory if someone posts a response that's less than a half page long. GMG ^talk 21:02, 14 March 2025 (UTC)

@Abbi043, it would be productive to hear what exactly you perceive as non-neutral. There are two major changes influencing the balancing between the viewpoints that we made to this proposed lead section.

:So, firstly, the proposed lede spends a lot of time on the neurodiversity position, which is not really the topic of the article - since neurodiversity does not just refer to autism, such belongs in articles on neurodiversity and/or the neurodiversity movement.

:Secondly, the proposed lede has removed the quotation from the symptomology part of the lede, and as near as I can tell that has only really served to remove a citation from there.

:Thirdly, the mention of the positions of various health organizations has been removed from the new lede, implying a greater level of unification in their positions than the old lede did.

:Fourthly, "It can also be argued that autism can be inherently disabling", as the sum of the coverage of that issue, in combination with the time spent on the neurodiversity position, is rather clearly dismissive of that position; while I haven't encountered a great deal of material over the years regarding it, what I have seen has suggested that it's more popular amongst the most severely disabled autistics. I'll see if I can get back to you with a source on this last one, since it feels like it should have one - I've been hovering nearer the sections of neurodiversity advocates focusing on DID, Psychosis and PDs lately, so that may take me a bit, and I feel you deserve a quicker reply than that. Abbi043 (talk) 03:42, 26 February 2025 (UTC)

::There is much more to autism than can be found in any diagnostic manual. The existing lead gives too much emphasis to the medical diagnosis manuals and their definitions. Plus, speaking as an autistic biomedical researcher (retired), it does so using unnecessarily insulting language. It is not fit for purpose as it marginalises all the many perfectly valid non-medical approaches to defining and studying autism, these being supported by many high quality academic sources.

::Your first point. Autism falls within neurodiversity, so neurodiversity is relevant. There are two competing models of autism operating at present, the medical model and the neurodiversity model. Both need to have as close to equal treatment in anything claiming to be encyclopedic.

::Your second point makes little sense to me. If a quotation is removed its supporting citation should be removed. Of course the quotation may be incorporated in a section outside of the lead later, when the body of the article is overhauled.

::Your third point. Again the material can be reinstated in the body of the article. Your implication of medical unity due to a lack of information is rather strained.

::Your fourth point. The most important word in the quote is 'CAN', which is not 'inevitably, or 'always'. I think that the social disability model, inherent in the neurodiversity paradigm for autism, does not claim that all disability, at all times, is wholly caused by the environment. A person with quadriplegia is never going to play table tennis.Urselius (talk) 20:09, 28 February 2025 (UTC)

:::I believe that Abbi043 was emphasizing the "It can also be argued that" part of that sentence, whereas you seem to be focused on the "autism can be inherently disabling" part. Perhaps it should be shortened to "autism can be inherently disabling"? Or "Sometimes autism is inherently disabling, and sometimes it is not"? WhatamIdoing (talk) 20:59, 28 February 2025 (UTC)

::::"Autism can be inherently disabling" can sound either out-of-context and confusing or a bit dismissive of the neurodiversity position because it could be interpreted in a way that neurodiversity supporters deny this and then critics come along and point out the obvious dismissal. As I have written already in these discussions, it is very hard to phrase this paragraph in a way that is both balanced and accurate because the debate between the models is very intricate. LogicalLens (talk) 03:39, 1 March 2025 (UTC)

@T_g7, @WhatamIdoing said that it can put editors who provide valuable contributions off to involve them in long arguments. I still have a question and would appreciate an answer although I do not expect you to take part in lengthy discussions. Do you think that information could be included to our proposed lede to reflect autistic people with higher support needs better or do you disagree entirely with our proposed changes? LogicalLens (talk) 06:22, 2 March 2025 (UTC)

:Thank you. I would not remove any of the information in the existing lead section. However, the definition of autism has been shifting in recent years, so I think it would be reasonable to add text taking into account this shift. That text can include much of the proposed text. I would advocate that instead of deleting the existing lead section and replacing it with a new section, you might wish to identify the important points you wish to communicate, and add them in to the existing lead. T g7 (talk) 06:47, 2 March 2025 (UTC)

::There are different legitimate positions on this topic. The main reason why some content in this proposed lead section was removed is that the current lead section is already far longer than what is recommended in MOS:LEADLENGTH and adding more content makes it even longer. Both the current and the proposed new lead section mention that support needs vary widely between autistic people, that some autistic people are nonverbal and that autism frequently co-occurs with intellectual disability. So, it would be helpful for our efforts to improve the article if you clarified in which ways you think the proposal addresses autistic people with higher supports needs in a less adequate way than the current lead section. LogicalLens (talk) 00:37, 3 March 2025 (UTC)

::There are two competing, but overlapping, models of autism in the real world at present, the pathologising 'medical model' and the non-pathologising 'neurodiversity model'. Any encyclopedic treatment HAS to cover both and, in my opinion, should cover them equally. There has been a tendency by editors here to treat the medical model as sacrosanct and the neurodiversity model as fringe and merely an expression of autistic community activism. This is entirely biased and wrong. There are plenty of academic publications that have accepted the validity of the neurodiversity model. Even Sir Simon Baron-Cohen (originator of the 'extreme male brain' and 'systematising' theories of autism), a world expert on autism research, has accepted the validity of some aspects of the neurodiversity model in his more recent works. Urselius (talk) 10:31, 3 March 2025 (UTC)

:::@Urselius, there are two RfCs on this page, and this comment strikes me as relevant to the RfC on the overall focus of the article, where you haven't !voted or otherwise commented. Just a heads up in case you missed that. FactOrOpinion (talk) 23:46, 4 March 2025 (UTC)

::::Thanks. Urselius (talk) 11:36, 5 March 2025 (UTC)

::There is some preliminary genetic evidence that autism is caused in two differing ways. Is it really one condition? For most autistics autism is caused by a higher than average incidence of a plethora of small variants in DNA (such as point mutations - single nucleotide changes) found within the general population, that have been associated with autism. Some of these variants are also associated with higher than average academic attainment. For a smaller, though still significant, number of autistic people, autism is caused by much larger changes in DNA (deletions, transpositions and duplications). These are often de novo mutation events, not inherited, occurring during ovum and sperm development. The former is associated with autism without intellectual disability, the latter associated with autism with intellectual disability and more 'profound' autism. Urselius (talk) 22:39, 4 March 2025 (UTC)

:::Yes, but probably it would be better to say these are two classes of differing ways. After all there are many different specific variants that have influences on autism likelihood (and on the likelihood of many other things!!) within each of these two categories. And leading to different things - autism in Fragile X syndrome is quite different from CHD8 autism... There's also some blurry boundaries here since the "common variants" still influence outcomes in those with the genetic syndromes, modulating likelihood that the person with the genetic syndrome will be autistic - since for a given syndrome it might often be say 30%, or 70% - higher than average but not deterministic. Ultimately the genetics is such a mess that autism just isn't a genetically defined category, or even one defined on the basis of biology. It's a socially constructed category referring to real phenomena but with fuzzy boundaries. Clinicians define it behaviourally, though arguably people in the neurodiversity movement might tend to conceptualize it as more of a mental/cognitive experience. Ó.Dubhuir.of.Vulcan (talk) 00:12, 7 March 2025 (UTC)

:::A comment here to {{U|Ó.Dubhuir.of.Vulcan}} - I think this is what you're saying, but I also think we need to be more clear when we are discussing this. We can not say that autism is caused by SNPs in DNA or Fragile X or CHD8. We are unsure what precise mechanism underlies the increase in autism among these individuals, but even among those with these diagnoses, autism is not universal or even present in the majority of cases - and other factors must therefore also be in play - meaning we can't say they "cause autism". CFCF (talk) 15:01, 16 March 2025 (UTC)

This is a small point in the scheme of things, perhaps, but {{User|Ó.Dubhuir.of.Vulcan}} in a reply to {{User|Tacitusmd}} [https://en.wikipedia.org/wiki/Talk:Autism#c-%C3%93.Dubhuir.of.Vulcan-20250307003100-Tacitusmd-20250302111500 suggested adding something like] "Health authorities classify autism as a neurodevelopmental disorder, characterised by deficits. In this approach, a diagnosis of autism requires identifying impairments internal to the individual."

I don't think this is an accurate reflection of what is required by diagnostic manuals like the DSM - am I missing something? The characteristics needed for a diagnosis are mainly determined by behaviour, and are largely social. In the DSM, as I understand it, impairment is used only to talk about functioning, in contexts which are primarily social in nature: "Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning". There is, as far as I can see, nothing about whether "impairments internal to the individual" are present at all; indeed, the kind of impairment referred to is, by definition, contextual.

The USA's CDC [https://www.cdc.gov/autism/hcp/diagnosis/index.html follows the DSM], of course (and helpfully lists its full criteria) and I can't see any sign that they deviate from its apparent agnosticism about where any impairment is located.

It may well be the case that clinicians widely assume that some impairment is present in the individual, but if this view is going to be attributed to health authorities, or as any kind of requirement, I would appreciate a more specific reference to back that up. Thanks!

--Oolong (talk) 18:29, 9 March 2025 (UTC)

:{{U|Oolong}} - This is precisely right. For autism to be diagnosed there much be a) a persistant deficit present from a young age, and b) some degree of symptoms causing clinically significant impairment in social, occupational, or other important areas of current functioning.

:The only possible way to diagnose this is based off of behavior, and thus the diagnosis is a behavioral diagnosis.

:You are also entirely correct that this impairment is always contextual - that is why I believe it is important to describe the sociocultural environment in the lede. A theory that has some traction in explaining part of the increase in autism (beyond increased awareness), is that: modern society is structured in such a way that certain situations - that individuals with autism tend to struggle with - are becoming more common.

:Just for a very gratuitous example - just 50 years ago - factory jobs were more common and might have meant limited need for social interaction in the workplace. Whereas today, with collaborative work and taking in social nuances to clarify what needs to be done, is more common. Taken at the population level - this might just tip some individuals over to the side that fulfills clinically significant impairment - when they would previously have not. I neither think we should speak about deficits being "inherent" - nor is this strictly the medical view. Rather, the relevant question is whether deficits are persistent. CFCF (talk) 15:01, 16 March 2025 (UTC)

Note that the established definition of lede is the first sentence in a news article. https://en.m.wiktionary.org/wiki/lede#English (apologies for the pedantry Dw31415 (talk) 12:31, 15 March 2025 (UTC)
:The source you linked to defines it as "The introductory paragraph or paragraphs of a newspaper, or a news or other type of article; the lead or lead-in."
:I personally much prefer the standard English spelling of 'lead', and Wikipedia guidelines mainly only use 'lede' by way of contrast with news articles, but there's nothing wrong with the way it's been used here - certainly not according to your own source! Oolong (talk) 17:49, 16 March 2025 (UTC)

:I feel emboldened to pile pedantry atop pedantry. 'Lede' as a spelling was introduced to the printing of newspapers and other periodicals to avoid confusion with 'lead', which could refer to metallic lead used in type setting. Now that printing no longer uses metallic lead, the spelling 'lede' is redundant (it only dates the the late 1940's anyway). Urselius (talk) 14:30, 15 March 2025 (UTC)

::Lede has been used on Wikipedia for the past 20 years to describe the text that precedes the TOC. CFCF (talk) 15:01, 16 March 2025 (UTC)

:::Wikipedia usage should follow, not lead usage in the real world. If something is archaic and no longer relevant it should go. Urselius (talk) 06:53, 19 March 2025 (UTC)

{{User|CFCF}}, regarding your procedural objection, I don't know if you're aware that this RfC has come out of a long dispute resolution process.

I am more and more thinking I should have lodged a conduct complaint instead (a combination of dismissing good sources and going well beyond what other sources say, adding up to status quo stonewalling) but I thought maybe dispute resolution might help lead us towards some kind of consensus. 😐

I wonder what your preferred approach would have been?

For what it's worth, my biggest problem with the page is essentially that it seems to have been written with no regard at all for likely readers such as "someone who has a child recently diagnosed with autism, or someone who has recently been diagnosed". We should be thinking carefully about what information might be valuable for such readers (and what is likely to be actively unhelpful), as they are likely to constitute a large and important fraction of visitors to this page (along with people who are just at the stage of considering seeking such a diagnosis). The existing entry reads as if it's aimed at someone taking a first-year undergraduate course on autism, or something - tonnes of stuff on (mostly outdated) scientific research and technical details, with a systematic failure to cover essential information of general interest. It's bizarre.

I'm a little bit surprised by your comments about masking and mental health, by the way; you don't think [https://www.sciencedirect.com/science/article/abs/pii/S0272735821001239 this review paper] and [https://www.mdpi.com/2076-3425/13/3/469 this one] for example confirm what is written in the draft?

--Oolong (talk) 18:11, 16 March 2025 (UTC)

:I was not aware, and I would prefer to remain neutral.

:To elaborate on my objection, it stems from how damaging it is when an RfC decides what an entire lede should read, or even just part of a lede. It discourages editing, and articles tend to get stale. I believe it runs counter to the iterative refinement process that Wikipedia excels at. For instance COVID-19 pandemic ran into these issues, perhaps by necessity (due to massive trolling), but it was very detrimental to editing of the article, and much of it is still in bad shape and not up to snuff with WP:MEDRS. However controversial autism may be, it is not that controversial, and we should avoid putting unnecessary barriers against improvement. Because what do we do when we want to change the lede after an RfC sets it in stone? Well we need a new RfC, and then a new one, and then one whether we want to overturn the need for RfCs.

:Instead, I think one could have a pretty broad discussion on what the current gripes are, and lower the stakes. I think the table above by DependableProportion is interesting, even though I don't agree with all of it (in part not with the need to replace all of it - in part because it is useful to distinguish and clarify both perspectives). I think by rewriting the entire lede in one go, we are trying to do too much. I like the first two sentences of the new suggestions, but then you lose me when so much relevant information is removed, and the part about deficits (in italics) is not very good. It does not explain what they are, which the old lede does better.

:Some parts of the old lede are however really bad, like the part about "not all dimensions have been identified". I think something actionable would be try to agree on: 1) what is superfluous in the current lede, 2) what is missing, 3) should be move the mention of neurodevelopmental disorder and diagnostic criteria to the second paragraph.

:If I were to start:

:1) a. I think mention of dimensions is entirely redundant - that is not lede-material. Perhaps it is for the body, perhaps it is too in-depth for an encyclopedic entry all-together. b. I don't think we should write the autism "frequently" co-occurs with those other conditions - as if you remove ADHD from the list - it more frequently does not co-occur. I don't like the word frequently and find it a WP:WEASEL, and we would to better to replace with "can co-occur", and then get into the exact numbers in the article. c. We should probably not link to causes of autism in the lede. It is sufficient to say it is largely hereditary. d. The current read leads almost as if there were an antagonism between the autism community and researchers/clinicians. This isn't really the case - I think this is overemphasizing a quite limited debate on the internet.

:2) I think the new lede is missing quite a few things, relating to sociocultural context, prognosis, and what is meant by deficits.

:3) I think it could be moved down. We aren't going to get away with not mentioning it, but there isn't any need to have it in the first sentence.

:CFCF (talk) 20:18, 16 March 2025 (UTC)

::P.S. Forgot to explain on masking. I don't think it is incorrect to say that masking contributes - but both of those studies fail to quantify the size of any relationship. This is the problem, not the mention itself. I think the problem is the word "especially", which would be better if replace with "including". CFCF (talk) 21:23, 16 March 2025 (UTC)

:::The statement is that "Autistic people are also significantly more likely to experience anxiety and depression, especially if they feel the need to mask their autism."

:::That is surely literally true if masking contributes to anxiety and depression, which we agree the studies demonstrate? I guess your position is that it makes it sound like their contribution is known to be large...? Oolong (talk) 07:50, 19 March 2025 (UTC)

::::My position is that the word "especially" makes it sound like the contribution is known to be large. CFCF (talk) 19:46, 20 March 2025 (UTC)

:I am following this developing story closely and may have more to say about the accusations of misconduct being made here. For now, despite the repeated accusations, the most worrying things I have seen out of our discussions is the occasional innuendo a user or two have directed towards holders of a particular position, which I don't think persisted to compromise the discussion process.

:As one of the people to which Oolong's accusations have been directed towards, to give my own perspective, we have not been "dismissing good sources" nor "going well beyond what other sources say", or other sych assertions. In actuality, we have been showing how the Neurodiversity Movement has contributed very little to the scientific understanding of neurodevelopmental disorders, which is why its claims (e.g., that ASD is not a neurodevelopmental disorder, doesn't have symptoms or impairments, isn't subject to varying severity, etc) are contradicted in virtually all national and international guidelines, diagnostic criteria, scientific consensus statements, systematic reviews, and other secondary sources on the topic of ASD. I have pointed out that the quality of such sources far outweighs the references to (some) of the primary literature, advocacy papers, and editorials, that may claim otherwise. These sources have been individually accounted for in replies, and so haven't been dismissed. In contrast, I have seen one publication from the NHS repeatedly presented as an authority on the matter to not use specific terminology. However, it's been pointed out that its not scientific in nature, and is contradicted by its own guidelines elsewhere, including by NICE which supersedes the NHS.

:In this case, citing references to substantiate a scientific consensus is just that, a review of the literature, and not signs of some attack worthy of censorship. I do not think there has been any intentional misrepresentations of people's viewpoints, though I do think the draft proposed here is misrepresenting the literature and is strongly biased towards inaccurate viewpoints. Nonetheless, I wouldn't want to pursue misconduct accusations against the people who contributed to or support the proposal. Not only would that be unfounded, as the discussion process has not been compromised, but also because you're supposed to challenge what you think is wrong speech through more speech, not by trying to silence the authors. Димитрий Улянов Иванов (talk) 15:41, 17 March 2025 (UTC)

::@Димитрий Улянов Иванов, there are two RfCs on this page; the other one is an RfC on the overall focus of the article, where you haven't !voted or otherwise commented. Just a heads up in case you missed that. FactOrOpinion (talk) 15:49, 17 March 2025 (UTC)

:::Thank you! Димитрий Улянов Иванов (talk) 15:52, 17 March 2025 (UTC)

::I stand by my description of status quo stonewalling, and I am prepared to shift this to Wikipedia:Arbitration if necessary. I have put enormous effort into challenging wrong speech through more speech, and there are good reasons why this is not the only avenue available. Procedurally, Wikipedia maintains a division between disputes over content and conduct, but in practical terms it is understood that many disagreements involve both.

::As I described above, I entered into a dispute resolution process - in good faith - in the hopes of bringing us towards some kind of consensus.

::I remain sure that we have significant common ground, despite our substantial disagreements about a number of basic facts as well as genuinely contentious questions, but so far we have made little to no progress in establishing that.

::I am strongly disinclined to enter into further discussion with you without strong mediation in place - we have spent enough time going in circles around this - so I will not get into your claims about the relationship between neurodiversity and science here, but I will direct interested readers to [https://oolong.medium.com/neurodiversity-and-science-41fc303a1782 a piece I wrote about this in January,] sparked by earlier discussions on these pages. Oolong (talk) 08:18, 19 March 2025 (UTC)

:::Disagreements aside, I don't mean to imply that you haven't been engaging diplomatically. I agree that the discussions were getting circular, though I do not see that as a reason to pursue misconduct hearings, unless there is something I have missed. The subject is ultimately always going to be contentious. Disagreements will likely persist, and people's views on things do get misrepresented or misinterpreted at times, but with the involvement of other editors, I believe that in due time, debate and discussion will be the path of achieving more of a common ground. Димитрий Улянов Иванов (talk) 13:00, 20 March 2025 (UTC)

::::Of course circular discussions in themselves are not grounds for misconduct hearings. Circularity is not the fundamental issue here: as you say, 'things do get misrepresented or misinterpreted at times'.

::::I had hoped that Dispute Resolution would allow us to move on from persistent misrepresentations and misinterpretations, but that has not, so far, happened. Oolong (talk) 15:26, 24 March 2025 (UTC)

Comment. I have not yet !voted in the Survey. I agree with editors who say the RfC is too long. This isn't an RfC on the lede, this is an RfC on the whole article.

:First of all, there isn't consensus among MEDRS that autism should be called a "disorder" [https://www.science.org/content/article/disorder-or-difference-autism-researchers-face-over-field-s-terminology], so rather than take sides, the article needs to explain the debate in prose.

:I understand that some people might have a desire to classify and categorise. It would be nice if we could say "Autism is " and be done with it, but the world is a messy place and not everything fits neatly into boxes.

:Autism isn't any one thing. That's why the first sentence of the lede should start with {{tq|"Autism describes..."}} or even {{tq|"Autism is the word for..."}} because that's what "autism" really is -- it is a label/descriptor of certain behaviours and traits (or symptoms, depending how you look at it).

:Stop thinking about Wikipedia as a textbook and think of it as a store of knowledge (yes, there is a difference between the two). Are we trying to impart knowledge humans have so far accumulated about autism or are we simply giving people the textbook definition from DSM-V? If the latter, then there's no point to Wikipedia, people can just go look at the DSM-V. TurboSuperA+ (☏) 10:41, 20 March 2025 (UTC)

::{{tqq|the first sentence of the lede should start with "Autism describes..." or even "Autism is the word for..." }} {{mdash}} MOS:REFERS says No. If you are correct in that autism {{tqq|is a label/descriptor of certain behaviours and traits }}, then the first sentence should be (for example) "Autism is a set of certain behaviours and traits ...". All words are labels; this article is about the subject, not the word/label. Mitch Ames (talk) 01:46, 21 March 2025 (UTC)

Autism ≠ Autism Spectrum Disorder

{{closed|text=Hi all—starting a new thread to raise a concern about structural framing.

At present, the article titled Autism immediately redirects to Autism Spectrum Disorder in the lead sentence. This conflates two distinct concepts:

“Autism” is widely used across advocacy, education, and lived-experience communities to describe a neurodevelopmental identity.
“Autism Spectrum Disorder (ASD)” is the clinical diagnosis as defined by DSM-5 and ICD-11.

Conflating the two introduces a factual inaccuracy and creates a policy inconsistency:

1. Per WP:TITLE, article titles should reflect common usage—not just clinical definitions. “Autism” is used broadly beyond the scope of ASD.

2. Per WP:NPOV and WP:DUE, we are required to represent all significant perspectives in proportion. That includes both the clinical and neurodiversity framings—especially when the article’s title uses the broader term.

Redirecting the reader from “autism” directly to “disorder” erases this plurality and introduces bias at the structural level.

Proposal: Reframe the lead so that Autism is introduced as a broader concept, with ASD as a diagnostic classification within that spectrum—not the sole or default definition.

Would welcome views on how best to align structure with policy and source plurality.

Recursiva (talk) 16:24, 7 May 2025 (UTC)

:Autism and ASD are widely used synonymously. GMG ^talk 16:33, 7 May 2025 (UTC)

::This has been discussed ad nauseum, there is consensus, and there are even open threads that discuss this consensus. This thread is not conducive to improvement. Closing - please engage, if you must, in the appropriate threads above. CFCF (talk) 19:02, 7 May 2025 (UTC)}}

Parents and siblings

This book chapter:

{{cite book |last=Van Bourgondien |first=Mary E. |title=Adolescents and Adults with Autism Spectrum Disorders |last2=Dawkins |first2=Tamara |last3=Feldman |first3=Melanie |last4=Marcus |first4=Lee |date=2024 |publisher=Springer International Publishing |isbn=978-3-031-46462-1 |editor-last=Volkmar |editor-first=Fred R. |place=Cham |pages=19–54 |language=en |chapter=Families of Autistic Adults |doi=10.1007/978-3-031-46463-8_2 |editor2-last=Reichow |editor2-first=Brian |editor3-last=McPartland |editor3-first=James C.}} (WP:TWL link: [https://link-springer-com.wikipedialibrary.idm.oclc.org/chapter/10.1007/978-3-031-46463-8_2])

looks like it could be useful for describing family relationships in this or a related article. It mentions factors affecting how close adults siblings are, the expectations on neurotypical adults to care for their autistic siblings, estate planning in the US (ABLE accounts), coping strategies (problem solving is better than avoidance), and even something about spouses (an under-researched area).

Based on what I've seen in the popular press, I think this is an area of interest to readers. WhatamIdoing (talk) 21:40, 12 May 2025 (UTC)

Severity

Just a note on a late debate that I noticed - on whether to use severity in the lede. I am cautiously pro omitting severity from the lede, but insist it must remain in some part of the article, if nothing else in the classification section. However, it does not make sense to replace severity with presentation or something that misses the range, degree, or spectrum of difficulties. That says something entirely different, and that is not neurodiversity-affirming, that is being euphemistic. CFCF (talk) 15:33, 25 April 2025 (UTC)

:I think the thing about "severity" is fundamentally about a POV. I realize I've been harping on this point for a year now, but the problem is that we don't have a shared understanding of what autism is.

:If autism is an atypical wiring pattern in the brain, then of course you could have "mild autism" or "severe autism" or whatever; that would just be a description of how close to the middle it is, and no different from saying that today's weather is ordinary, but last week's was severe.

:But if autism is a normal human variation, then how could it be "severe"? We don't usually say that a person is "severely normal".

:Of course, all of this assumes that the person is literally interpreting the words. We know that medical language shouldn't be interpreted literally (cf. Chronic Fatigue Syndrome, which isn't being tired all the time; Polycystic ovary syndrome, which doesn't require polycystic ovaries). However, we also know that autistic people are more likely than neurotypical people to interpret words literally, and I think we can safely assume that autistic people make up both a high proportion of editors of this article and a somewhat higher proportion of readers of this article. In this case, "severe autism" doesn't mean "a lot of autism"; it means that the person is severely impaired (non-verbal, abnormally low IQ, unable to care for self) due to autism. It is not literal wording. WhatamIdoing (talk) 18:01, 25 April 2025 (UTC)

::Is it not as simple as being clear that the deficits/difficulties are severe, just as you say? CFCF (talk) 18:08, 25 April 2025 (UTC)

:::I think that "severe" and "severity" are words that some Wikipedia editors would like to excise from any sentence about autism, regardless of context. Some autistic people seem to react to it as if it is automatically a slur. WhatamIdoing (talk) 20:14, 25 April 2025 (UTC)

:I think the lede should certainly include coverage of severity, including a broadening of the definition of autism. For example, diagnoses of 'severe' autism have apparently not been increasing, while more autism cases under a broader definition have increased. This is an important detail in refuting the claim that autism is 'on the rise' (made by the likes of RFK Jr). Zenomonoz (talk) 23:58, 25 April 2025 (UTC)

:"Varying support needs" is a non-euphemistic alternative to "varying levels of severity". LogicalLens (talk) 00:06, 26 April 2025 (UTC)

::I don't think these are the same.

::"Varying support needs" could mean the type of support ("Alice uses ear defenders in noisy environments, and Bob needs clothes that don't itch") or the amount of support ("Alice lives by herself in a one-bedroom apartment and drives herself to work each morning, but Bob needs round-the-clock supervision").

::"Varying levels of severity" is more obviously about the amount of support. WhatamIdoing (talk) 02:09, 26 April 2025 (UTC)

:::Terms, such as "profound autism" and "severe autism," are not standardized or widely accepted medical terms. They're chiefly pushed by organizations that go out of their way to be as pathologizing as possible, such as the Autism Science Foundation and the National Council on Severe Autism. It's not appropriate to treat those labels as if they are standardized or widely accepted here on Wikipedia. They should only be mentioned in direct quotes with explanatory context. I agree with LogicalLens' suggested verbiage for the lede. DoItFastDoItUrgent (talk) 02:29, 26 April 2025 (UTC)

::::I disagree. Words do not have to be "standardized" to be useful. The color blue, for example, is not standardized, and yet people manage to use them.

::::I agree that you have removed references to severe autism on Wikipedia, but I do not think that your removals or your addition of scare quotes around it ([https://en.wikipedia.org/w/index.php?title=National_Council_on_Severe_Autism&diff=prev&oldid=1283246772 example]) are always appropriate. WhatamIdoing (talk) 06:06, 26 April 2025 (UTC)

:::::They're not scare quotes. They're quotes designed to make it clear that the terms are unofficial, and you can't make a legitimate argument that editors on Wikipedia should use terms, like "severe autism" or "profound autism" (or use derivative phrases, like "severely autistic" or "profoundly autistic"), without quotes or explanatory context. If, in a few years time, ableist hate groups and savior organizations win the language war and those terms become medically standardized or put into wide usage, then you might have a point. We are not at that point yet (and hopefully never will be). And, if you want to discuss one another's edit histories, maybe you'd like to explain what motivated you to create the article for the National Council on Severe Autism. Did you really think the organization was noteworthy and that it made Wikipedia a more comprehensive repository of information, or did you do it solely to promote the organization and its ideology? DoItFastDoItUrgent (talk) 21:28, 26 April 2025 (UTC)

::::::They're scare quotes. They're quotes designed to make it clear that you disapprove of these terms, and I can make a legitimate argument that editors on Wikipedia should use terms without quotes or explanatory context. Specifically, that argument is: Almost everything we write, including your comment above, is neither "quotes" nor "explanatory context".

::::::If you think that an organization of parents caring for severely disabled people is best described as "ableist hate groups and savior organizations", and you think there is a "language war" underway, then I suggest you not edit articles about those subjects.

::::::What motivated me to create the article National Council on Severe Autism is that I (a) read about them in a newspaper, (b) realized that they met the WP:NORG requirements to have an article, and (c) had time to work on it at that moment. I see that you haven't ever created an article, so perhaps you think it's a difficult task that requires external motivation, but I've created well over a hundred, and it's easy for me. WhatamIdoing (talk) 21:43, 26 April 2025 (UTC)

:::::::I am done engaging with you in any way and will ignore any further replies or pings that originate from your user name. During our interactions over the past several months, you have made it abundantly clear that you are outright hostile toward members of the Autistic community (particularly those who subscribe to the neurodiversity paradigm) and have explicitly expressed your opinion that using forcible electric shocks to punish autistic residents at the Judge Rotenberg Center is not necessarily torture (despite overwhelming evidence and expert consensus that it is) and that you view the autistic neurotype as akin to a "genetic disease." It is unfortunate that, seemingly because of your long history here on Wikipedia, that such outright bigotry is largely ignored and tolerated (which seems to be a systemic problem on this site, rather than just a problem involving you). Good luck in your future endeavors here on Wikipedia. DoItFastDoItUrgent (talk) 22:08, 26 April 2025 (UTC)

:::::::::{{U|DoItFastDoItUrgent}}—this latest comment is deeply WP:TENDITIOUS and outright describes a WP:BADFAITH argument. You are entitled to not engage on Wikipedia, and are entitled not to engage with specific editors—but you are not entitled to say that very neutral comments from an editor in high standing (that is trying to be compassionate, while still abiding by Wikipedia's principles and a scientific view)—are "outright hostile" or "bigotry". This is far across the line, and not true. I hope you can refrain from saying such things again. CFCF (talk) 12:31, 27 April 2025 (UTC)

::::::::You are rather asserting baseless accusations, which unfortunately has happened several times on this page. I have kept up with the conversations here extensively and do not recall any instance of them saying such things. The global scientific consensus, as has been referenced elsewhere above, concludes that autism is a neurodevelopmental disorder with varying severity levels. That is what we are trying to reflect on the article, not that it’s a “disease”. It meets the definition of a disorder based on (1) the presence of neurological variation in a trait universal to humans and (2) accruing impairment in major life domains, as well as increased risks for morbidity, injury, and even early mortality. The diagnostic contingency on impairment facilitates the varying severity levels and the use of other terms. Димитрий Улянов Иванов (talk) 00:16, 27 April 2025 (UTC)

:::::::::No 'scientific consensus' exists (global or not) in regard to autism. Please refrain from using this phrase when describing the medical or pathological model of autism. As many academic scientists adhere, wholly or in part, to the neurodiversity paradigm of autism (this can be substantiated by a cursory look at scientific papers and books written in the last decade) describing the medical model as a scientific consensus is provably wrong. Urselius (talk) 07:27, 1 May 2025 (UTC)

:::The phrase "support needs vary widely in both type and amount" would be better and also more informative than "severity" LogicalLens (talk) 02:39, 26 April 2025 (UTC)

::::Assuming that's the point of the sentence/paragraph in question, then I agree that the more specific description is helpful. (Of course, if the point were to communicate that Levels 1-2-3 are actually called things like "severity levels" (as in [https://www.google.com/books/edition/Introducing_Autism/HZ4LEQAAQBAJ?hl=en&gbpv=1&dq=%22autism%22+%22levels%22+%22severity%22&pg=PT45&printsec=frontcover this book]) or "levels of severity" (as [https://www.google.com/books/edition/Handbook_of_Quality_of_Life_for_Individu/ndJyEAAAQBAJ?hl=en&gbpv=1&dq=%22autism%22+%22level+of+severity%22&pg=PA436&printsec=frontcover in this book]), we'd actually have use the word severity.) WhatamIdoing (talk) 06:12, 26 April 2025 (UTC)

:::::@WhatamIdoing, I agree with @CFCF to use "severity" only in the DSM/ICD section. LogicalLens (talk) 06:18, 26 April 2025 (UTC)

:Yes, the situation is that DSM-5 uses the term 'severity' but then makes it clear that what they are actually talking about is varying levels of support needs (in two categories). As such, the term 'severity' is highly misleading in contexts where it might be assumed to carry its everyday meaning.

:The ICD doesn't talk in terms of severity at all. As [https://www.nature.com/articles/s41380-023-02354-y one paper in Nature put it]:

:"ICD-11 retains a multi-categorical system to differentiate individuals with varying levels of developmental history (i.e., regression) and intellectual and language abilities by offering eight subcategories of ASD diagnoses. In contrast to DSM-5, ICD-11 has no specifier for severity that could provide additional information about the degree of support needed in identified areas of deficits. Maybe the reason for this was that the severity metric has shown questionable validity https://pmc.ncbi.nlm.nih.gov/articles/PMC10071646/ 22 or that in the conceptualization of ASD in ICD-11 severity in sense of impairments in functionality do not need to be present as implied in the previous statement that some individuals with Autism Spectrum Disorder are able to function adequately in many contexts through exceptional effort, such that their deficits may not be apparent to others." Oolong (talk) 08:17, 27 April 2025 (UTC)

::The ICD-11 does talk in terms of severity for autism. For example, it states:

::"Persistent deficits in initiating and sustaining social communication and reciprocal social interactions that are outside the expected range of typical functioning given the individual’s age and level of intellectual development. Specific manifestations of these deficits vary according to chronological age, verbal and intellectual ability, and disorder severity."

::As do many other guidelines, expert consensus statements, and reputable sources that we've been citing. So it is not merely the DSM. Димитрий Улянов Иванов (talk) 12:07, 27 April 2025 (UTC)

:::I am still on the fence on what level we need to express severity, but {{U|Oolong}}, what {{U|Димитрий Улянов Иванов}} writes is correct. Severity is very well defined, and very well accepted—and there is really no constructive debate to be had if the premise is that severity is misleading or not validated.

:::An argument can be made that prominent mention of severity is not neurodiversity-affirming, and that is the one I am leaning on in my hesitancy. However, if this argument is found insufficient even by those who want to keep mention of severity out of the lede/article—I will be easily convinced that it should be prominently displayed per WP:DUE. CFCF (talk) 12:40, 27 April 2025 (UTC)

::::Perhaps a concrete example would help. Oolong, consider a statement like this:

::::"There are different severity levels of autism. For example, two autistic brothers might have very different behaviors and very different support needs. One might benefit from a quiet place to take a break and be slower at certain tasks, and be classified as having 'Level 1' support needs. The other might be unable to communicate problems like feeling pain or hunger and need lifelong 24x7 supervision, and be classified as having 'Level 3' support needs."

::::How might people misunderstand or be misled by the use of the word "severity" in that passage? WhatamIdoing (talk) 21:18, 27 April 2025 (UTC)

::::Being less pathologizing is the main reason for the removal, while the questioned validity is an additional argument. LogicalLens (talk) 04:18, 28 April 2025 (UTC)

:::::The questioned validity is a false argument. CFCF (talk) 13:30, 29 April 2025 (UTC)

::::::Yes, I understand that Wikipedia reproduces what reliable sources say and that therefore, our discussion about the validity of severity scales is not a sufficient reason not to include it. But my position on removing it from the lead section does not stand or fall with this argument, it is based on the intention of being less pathologizing. LogicalLens (talk) 04:50, 30 April 2025 (UTC)

:::::::If you were to read a random selection of reliable sources, what approximate percentage of them would you expect to find are meeting the goal of "being less pathologizing"? WhatamIdoing (talk) 17:20, 30 April 2025 (UTC)

::::::::Scientists are experts within their perspective on autism, but they are not experts on ableism and the effects words have on people. Also, this article is not written for scientists but for the general public. For this, the style guides by the US' NIH and by the UK's NHS have been cited multiple times in these debates. WP:SUFFER instructs us to use appropriate language and if we find words that say essentially the same while being less stigmatizing, we should use them. This also solves large parts of our dispute that is ongoing here for months. LogicalLens (talk) 03:31, 1 May 2025 (UTC)

::::::::::This is very false. CFCF (talk) 02:31, 2 May 2025 (UTC)

:::::::::::Why? LogicalLens (talk) 03:15, 2 May 2025 (UTC)

:::::::::I said "a random selection of reliable sources", not "a random selection of sources written by and for scientists". WhatamIdoing (talk) 03:49, 1 May 2025 (UTC)

::::::::::As not all sources use neurodiversity-affirming language, we also should not replace all medical model words by neurodiversity words, for example, we still use "difficulties" and not only "differences" for social interaction and do not currently mention any positive aspects of being autistic in the opening paragraph. The word "severity" is used in the classification section multiple times and I think this is sufficient. LogicalLens (talk) 06:06, 2 May 2025 (UTC)

:::::::::Both the NHS and NIMH contradict themselves in other guidelines of theirs regarding this. We have to be careful to not rely on selective citing. This context has been pointed out repeatedly but keeps being omitted. Димитрий Улянов Иванов (talk) 06:26, 1 May 2025 (UTC)

::::::::::This an argument to use not only neurodiversity-affirming language (as I wrote above), but not one to block all attempts to insert less pathologizing language. LogicalLens (talk) 06:41, 2 May 2025 (UTC)

:::::::::If I am allowed to play armchair psychologist here to prove a point, I believe this post in particular unintentionally and subtly confirms a very noticeable trend with a lot of pro-neurodiversity users here, that being the subjective feelings of being seen as "inferior", or "lesser" in terms of being seen as "disabled" and that because of it, make such edits seeks to promote a greater distrust against or outright hostility towards the consensus of current medical authorities as a whole as ableist for considering the condition they identify with as "disability" or attributes the condition with aspects considered undesirable or even harmful even if it's perfectly objective and factual, and that I worry that treating these subjective and vague feelings of discontent as an objective argument to radically shift the article will risk setting an incredibly bad precedent for dealing with many mental conditions on wikipedia down the line, to where it's far more significantly difficult for average users to distinguish between mental disabilities and perfectly acceptable and normal behaviors because many "problematic" traits associated with various mental disorders could be seen as socially constructed or otherwise relativized, when (with a few exceptions) current diagnosis standards and current understandings of the condition by the research community at large have not changed and ignores many of these traits often are inherently disabling and are not automatically a by-product of the treatment by wider society. 172.97.217.147 (talk) 06:09, 4 May 2025 (UTC)

::::::::::Because you are new to this discussion, I do not know how much of the context you are aware of. Therefore, I summarize a few things:

::::::::::1) The sources that I cited recommend neurodiversity-affirming language and in response, another user cited other sources that do not. So I argued that some parts of neurodiversity-affirming language should be used while others should not, for example, writing "difficulties" in social interaction instead of only differences, and we currently do not mention positive aspects of being autistic.

::::::::::2) Neurodiversity proponents argue that autism is not a disorder but not that it is not in a significant fraction of cases a disability. There are certainly aspects for which it would be absurd to claim that they are not disabling, for example a complete lack of any communication ability.

::::::::::3) I complied a list of sources supporting neurodiversity 2-3 months ago.[https://en.wikipedia.org/wiki/Talk:Autism#c-LogicalLens-20250226044700-Survey_(on_RFC_on_focus)] LogicalLens (talk) 04:17, 5 May 2025 (UTC)

:::::::We don't change article content based on larger societal implications. GMG ^talk 12:17, 1 May 2025 (UTC)

::::::::@GreenMeansGo See WP:SUFFER. Also, severity is mentioned in the classification section which is appropriate. LogicalLens (talk) 12:29, 1 May 2025 (UTC)

::::Ah, apologies, I should have re-read the ICD-11 entry itself before posting. Yes, it mentions severity, it just doesn't classify autism by severity.

::::You suggest that severity "is very well defined, and very well accepted". The definition provided by, for example, Wiktionary, is as follows:

::::# The state of being severe (i.e. Very bad or intense; Strict or harsh; Sober, plain in appearance, austere)

::::# The degree of something undesirable; badness or seriousness.

::::I would suggest that this is quite different from the sense used in the DSM, which specifically refers to level of support required, and emphasises that "severity may vary by context and fluctuate over time" and "social communication difficulties and restricted, repetitive behaviors should be separately rated."

::::I don't believe that the average lay reader would get any of that from seeing the term 'severity' used without clarification. It doesn't sound like a contextual, varying or multidimensional thing at all.

::::The term 'severe autism' comes with many common misconceptions (as does the near-synonymous term 'profound autism' which is sometimes suggested; see e.g. [https://pmc.ncbi.nlm.nih.gov/articles/PMC10576471/ Rachel Kripke-Ludwig 2023]) - failing to recognise that support needs vary hugely with context and over time, for example, and that 'symptom severity' in one domain tells you little about another. Oolong (talk) 10:01, 1 May 2025 (UTC)

:::::The article currently contradicts itself in the spectrum model section: "DSM-5 uses a "level" system, which specifies the level of support needed by the person. In this system, level 1 is the mildest form and level 3 the most severe." and later: "The spectrum model should not be understood as a continuum running from mild to severe, but instead means that autism can present very differently in each person, with support needs depending on context and changing over time." LogicalLens (talk) 10:20, 1 May 2025 (UTC)

::::::I don't think that's a contradiction. They're talking about different things. WhatamIdoing (talk) 17:48, 1 May 2025 (UTC)

:::::::The problem seems to be that the DSM workgroup was obliged to use a severity scale by the APA when what they really meant was support needs: [https://link.springer.com/chapter/10.1007/978-981-13-8437-0_13] LogicalLens (talk) 06:42, 2 May 2025 (UTC)

::::::::Don't most things in the DSM-V have a severity scale? The ICD-11 also uses severity scales (sometimes called "specifiers") widely. Autism is not being singled out in this regard. WhatamIdoing (talk) 19:25, 2 May 2025 (UTC)

:::::::::This is what I meant. The American Psychiatric Association required the workgroup for autism to use a severity scale, although they opposed it, for example because a lower "severity" estimate because an autistic person looks thriving (due to supports) could then lead to the very supports that were necessary for this to be reduced. LogicalLens (talk) 02:11, 3 May 2025 (UTC)

:::::Oolong, I think that "support needs vary hugely with context and over time" is only true in a limited way. It seems most applicable for the less-impaired majority. For example, an autistic person might be happy with no particular support needed when they can work from home and largely interact with people by typing text on a computer screen. That same person might need support to attend a large in-person meeting (access to a quiet room, sitting where no one is likely to touch them accidentally, noise-cancelling headphones, being able to skip social events).

:::::At the other end of the spectrum, the support needs are always huge. There isn't a "context" or a "time" in which a minimally verbal autistic person becomes a fluent communicator. I read about one autistic adult whose support needs included boarding up the windows in their house, because if he could see the windows, he would break the glass. This did not change "over time", and there was no "context" in which he understood that windows should not be broken, or even what the natural consequences of broken windows would be (e.g., if it rained or snowed).

:::::The letter to the editor from the high school student makes the point that being non-speaking is not the same as having no receptive or other expressive language skills, and that accurate IQ testing of someone with limited or no communication skills is difficult. It also makes extraordinary unsupported assertions ("autistics with intellectual disabilities would have pointed out the problems with the study before it was conducted" – if you can point out difficulties with a study design, you're not intellectually disabled. For context, the middle third of people with ID can read and understand children's picture books – Dr. Seuss, not scientific study designs). Overall, it leaves me wondering if this is another case of Augmentative and alternative communication (the student uses a letterboard) that turns out to be her mother 'writing' for her. (Her mother has the professional qualifications you would expect from someone who evaluates study designs.) But it doesn't actually say that people with "profound" problems have huge variations in the amount of support they need. It tends to confirm that the support needs are constantly high. WhatamIdoing (talk) 18:37, 1 May 2025 (UTC)

::::::This is true. While the ability to speak can fluctuate by stress level or other circumstances, autistic people who do not speak at all or who are intellectually disabled will always need much support. I do not think that any relevant academic says that all autistic people can be at all support need levels. The reality is very complicated, both an oversimplifying interpretation and denying the fixed nature of some support needs is false.

::::::Regarding the second part: what you mean is facilitated communication. Augmentative and alternative communication is valid. While it is important to keep in mind the risks, I am very skeptical about attempts to discredit what autistic people with high support needs communicate without clear evidence. If I were such an autistic person, wrongly not being listened to on the grounds of such arguments would be one of the most painful things I could imagine. LogicalLens (talk) 03:36, 2 May 2025 (UTC)

:::::::I agree that there are valid forms of AAC. The problem is that "uses a letterboard" could mean either FC or AAC. WhatamIdoing (talk) 05:41, 2 May 2025 (UTC)

::::::::As you provided no link to a letter to the editor but only to the Wikipedia article for "letter to the editor", I cannot form my own opinion on this particular case, but as I said, I hesitate to silence these people without a proof. Of course, it seems like there are autistic people who will never communicate with words neither in spoken nor in written or typed form and are intellectually disabled regardless of which test is used. LogicalLens (talk) 06:35, 2 May 2025 (UTC)

:::::::::It is the only external link in the comment I was replying to. He labeled it "[https://pmc.ncbi.nlm.nih.gov/articles/PMC10576471/ Rachel Kripke-Ludwig 2023]", as if it were a research paper. It's just a letter to the editor, expressing someone's opinion, some parts of which (such as what I quoted) are obviously unreasonable.

:::::::::On the broader question of ID, about 15 years ago, activists made a push to emphasize adaptive skills (e.g., if you can buy food at a grocery store, including paying the correct amount of money) in the ID diagnosis. If you have a low IQ according to any test, but you also have cognitive flexibility that allows you to function in ordinary daily life, then you don't have ID. It is not enough to "fail" an IQ test; you have to also fail daily living skills. The unintended consequence of this definition is that autistic people who score 65 on an IQ test have a higher chance of being diagnosed with ID than people with Down syndrome who got the same score. This is because cognitive inflexibility is a core feature of autism, but not of Down syndrome, and cognitive flexibility is now half the ID diagnosis. WhatamIdoing (talk) 19:46, 2 May 2025 (UTC)

::::::::::This paper is a journal article, it would not have been published if it contained obviously wrong or unreasonable information. The important question is to how many autistic people this applies. For example, Jordyn Zimmerman is a prominent example of an autistic person who is non-speaking but communicates via AAC. LogicalLens (talk) 03:35, 3 May 2025 (UTC)

:::::::::::This "paper" is [https://pubmed.ncbi.nlm.nih.gov/37732335/#publication-types a letter to the editor]. It is neither peer-reviewed nor fact-checked. Letters to the editor get published if the editor thinks that they have something interesting or controversial to say, including if part of the letter contains known-wrong or fringe-y information. WhatamIdoing (talk) 06:08, 3 May 2025 (UTC)

::::::::::::You are right. The journal says its letters-to-the-editor are not peer-reviewed but the authors of the original paper the letter referred to can respond. This is the response[https://journals.sagepub.com/doi/full/10.1177/00333549231201820], it does not refute the claim that being non-speaking does not automatically mean having no receptive language skills. Different studies show that a significant fraction of non-speaking autistic people understands language at least to some degree.[https://journals.sagepub.com/doi/10.1177/13623613241230709][https://onlinelibrary.wiley.com/doi/abs/10.1002/aur.3079][https://www.nature.com/articles/s44184-024-00062-1] LogicalLens (talk) 02:40, 4 May 2025 (UTC)

:::::::::::::Of course nonspeaking doesn't automatically mean having no receptive language skills. Nonspeaking doesn't even mean having no expressive language skills. The problem isn't that many nonspeaking people can communicate.

:::::::::::::The problem is that the high school student thinks that people with intellectual disability can realistically evaluate a scientific study's design. Adults with moderate intellectual disability, even if they have no speaking problems, have the intellectual ability you would expect from an average child around age 7 to 9. That's the age when kids are reading Dog Man and Magic Tree House books. They're learning basic fractions and multiplication facts. Does that sound like a description of the intellectual talent you'd want to seek for evaluating a scientific study design?

:::::::::::::The high school student also falsely claims that no autistic people were involved. The authors' response directly corrects that mistake. WhatamIdoing (talk) 03:06, 4 May 2025 (UTC)

::::::::::::::This sentence where the author says people with intellectual disability would have pointed out problems in the study design is indeed awkward. Nevertheless, the critique that autistic people have not been involved in an appropriate way is valid, because including some autistic people without giving them equal power is not meaningful participation, see Arnstein ladder of participation. LogicalLens (talk) 03:50, 4 May 2025 (UTC)

:::::::::::::::How do you know that they did not have equal power? Is there a document somewhere that says "By the way, autistic people on this committee only get half a vote"? WhatamIdoing (talk) 04:03, 4 May 2025 (UTC)

::::::::::::::::I was referring to the paper the proposed term "profound autism" emerged from,[https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01541-5/abstract] which included only some autistic people and was heavily criticized.[https://www.liebertpub.com/doi/10.1089/aut.2022.0017]. The letter-to-the-editor discussed here is indeed not a perfect source.

::::::::::::::::To go back to what this discussion was originally about: You criticized @Oolong's statement that support needs fluctuate and that the term "severity" is therefore invalid. As some support needs in autistic people do not fluctuate, this argument is weakened to some extent, which I admit. Still, this term creates an impression that the support needs are more fixed and linear than they actually are. It is a common problem that people look at an autistic person and try to determine how “severely” autistic they are and try to generalize from this observation to support needs in other contexts. Autistic people can require support in very different areas of life and someone who appears independent in one domain can need surprisingly much support in other areas. Autistic people deemed to be at the same level of “severity” can also have very different support needs. This is all obfuscated and oversimplified by the term “severity”. LogicalLens (talk) 04:24, 5 May 2025 (UTC)

:::::::::::::::::My impression is that the point of the "profound" category is to identify the small subset of people whose support needs do not include moments in which the autistic person "appears independent in one domain". That is, it is meant to include autistic people whose support needs are always very high – 24x365, in all settings, under all circumstances, and to exclude people whose support needs are sometimes or always less than that. WhatamIdoing (talk) 06:35, 5 May 2025 (UTC)

::::::::::::::::::Having worked with such patients, I also don't think we should overinterpret "appearing independent in one domain" either. Someone with profound autism who has support needs that mean 24/7 monitoring is needed in order to ensure their personal safety, might reasonably spend an hour doing a puzzle or playing with a toy - during which it could be argued that they probably would seem alright and not in need of monitoring or help. However, the problem is not that they can not do things at all independently, but that in stringing together multiple parts of their day, or even shifting from doing a puzzle to eating lunch is entirely impossible on their own. CFCF (talk) 10:26, 6 May 2025 (UTC)

:::::::::::::::::First you say that autistic people weren't given equal power on that committee. Now you say the problem is that it included "only some" autistic people. Is the complaint that autistic activists did not hold a majority position on the committee? Choosing sources because professional activists with the Right™ POV wrote them or rejecting them because professional activists disagreed with them sounds like POV pushing to me. WhatamIdoing (talk) 06:43, 5 May 2025 (UTC)

::::::::::::::::::I agree fully with WhatamIdoing here - and will also state that criticism of something does not necessarily weaken it at all. If the criticism isn't headed with the appropriate authority of WP:MEDRS it isn't even WP:DUE to consider it on Wikipedia. Further, it seems to me a very dark view to state that because support needs are not ever present, that this would invalidate the presence of a support need. If an autistic person were to need some form of support 1/10 times to go to the supermarket in order to get food, that is a very real and present need, even if 9/10 times they are doing entirely all-right. To suggest that they don't have that support need is basically invalidating their needs, just because "they most often get it right", and is a view brought forth by some penny-pinching lawmakers to remove support from autistic people. To me this speaks less of neurodiversity, and more of being intentionally obtuse in order to invalidate the needs of others.

::::::::::::::::::Further, it is quite common to change the severity classification of a patient over time, and this is certainly not something that invalidates the construct - just a fact of life. CFCF (talk) 10:32, 6 May 2025 (UTC)

:::::::::::::::::::The activist fear about levels, as described in something linked on this page, was that the levels would be used to exclude people from getting support.

:::::::::::::::::::AIUI the DSM committee originally suggested four levels:

:::::::::::::::::::* Level 0 (no support needs)

:::::::::::::::::::* Level 1 (what we have now)

:::::::::::::::::::* Level 2 (what we have now)

:::::::::::::::::::* Level 3 (what we have now)

:::::::::::::::::::But the activists killed the Level 0, so at least one government briefly thought that Level 1 must be the "no support needs" category. The activists should have supported Level 0 and then made sure that nobody was rated that way. WhatamIdoing (talk) 14:44, 6 May 2025 (UTC)

::::::It is of course true, to a point, 'that "support needs vary hugely with context and over time" is only true in a limited way.' I never suggested that every autistic person could run the entire gamut of support needs depending on context!

::::::However, what I wrote remains literally true, and it is true throughout the autistic spectrum. Autistic people generally cope much, much better in some environments than others, and in some cases, have high support needs because of unaddressed health issues, or sensory problems.

::::::See for example [https://www.tandfonline.com/doi/full/10.1080/13575279.2022.2126437#abstract this paper]: "the sensory environments of NHS England-funded in-patient facilities were found to present sometimes extreme challenges for autistic young people that at best hinder wellbeing and at worst exacerbate existing mental health problems: instigating a cycle of progressing upwards through increasingly restrictive settings for some."

::::::As Luke Beardon famously puts it - and he is not just talking about those with relatively low support needs - [https://www.bps.org.uk/psychologist/putting-autistic-children-centre autism + enviornment = outcome]. Oolong (talk) 17:48, 11 May 2025 (UTC)

:::::::While traits + environment = outcome is generally true in biological senses, I'm not sure that it's really showing "support needs vary hugely with context".

:::::::If you have a person who needs:

:::::::* a quiet place, or

:::::::* help coping with a noisy place

:::::::then you don't have "needs vary hugely"; you have a person whose needs are constant (i.e., to not be overwhelmed by noise) and the only thing that differs is how those needs are met. WhatamIdoing (talk) 20:36, 11 May 2025 (UTC)

::::::::But unmet sensory or other needs, distress etc. can lead to autistic people needing more support in other areas, for example, they might lose certain daily living skills. It is a problem if people look at an autistic person, see that this person can do X and then assume the person can always do X and deny them their needed supports. LogicalLens (talk) 01:19, 12 May 2025 (UTC)

:::::::::It's still a person whose needs are the fairly constant.

:::::::::With something like an autoimmune disease, you can have a person who actually has no (disease-related) needs at some points but has differing amounts of symptoms later. For example, lupus is pretty common in women in their 30s. But if a woman with lupus gets pregnant, it usually goes into temporary remission. After giving birth, it typically comes at least as bad. This means that her lupus-related needs could be "3 out of 10" before she gets pregnant, "0" while she is pregnant, and "6" in the months after the baby is born. For example: Before getting pregnant, she could spend time outside in the sun if she wore sunscreen and a hat; while pregnant, she could spend time outside in the sun like anyone else; after giving birth, she gets a painful rash if she's outside for 15 minutes. Or before she was pregnant, she could walk for an hour; while she was pregnant, she could run pain-free; after giving birth, her joints hurt too much to walk for more than a few minutes. The actual needs vary in this case.

:::::::::With autism, it seems that the needs are like "5" all the time. If the needs are met, then everything's okay. If the needs are not met, then that failure becomes visible. But the needs themselves don't change.

:::::::::With lupus, the person is actually able to do different things at different times because the illness itself waxes and wanes. The popular metaphor for lupus is that if you do too much, you're "run out of spoons". That is, you wake up in the morning with a certain amount of energy and other internal resources that you can use. When you use up all your energy, you can't do anything else. However, you might wake up one day with "5 spoons" of energy. Another day, you might have "15 spoons" of energy. It is unpredictable.

:::::::::With autism, the person's problems aren't waxing and waning. Every day, that person wakes up with "10 spoons" of energy, and every day, the cost of the speaking is the same amount of energy for that individual. If they can't do something, it's because they've already experienced so many stressors that day that they've run out of energy and other internal resources. Speaking (or not) isn't because their autism "got better" or "got worse" today; the autism is constant.

:::::::::For example, someone who finds speaking to be a complex and exhausting task is always someone who finds speaking complex and exhausting. If that person still has plenty of "spoons", then they'll be able to speak. If they had to use up their energy on something else, they won't. But they begin each day in basically the same place, and the cost of speaking will always be basically the same. WhatamIdoing (talk) 01:59, 12 May 2025 (UTC)

::::::::::There is an interesting aspect in this however, that the psychological conceptualization of energy as finite, or that specific activities "cost" a pre-specified amount of "spoons"—if one ascribes to it—is more likely to increase the risk of energy "running out". So it might be a good analogy by which to view other people, but not for oneself—likely applying both to autism and lupus (despite etiological differences).

::::::::::The keeping track of "spoons" in turn is not beneficial for all, where it can simplify things such as "How many spoons one wakes up with", beyond what is reasonable or helpful. For instance, so many other things may play in, to how many spoons ones has at onset, like: sleep, being sick, having had a bad week, etc.

::::::::::I think most professionals discourage this specific use of spoon theory, beyond promoting a general awareness that energy is finite, because you can get into issues of "Why am I feeling this bad, I should have at least 5 spoons left?", or "Why am I feeling this energetic? I've already run out of spoons—something must be wrong.".

::::::::::From the perspective of autism support needs, I think the better conceptualization is—"What is the risk of needing support in a specific task?" If one has a 1% risk of needing support to accomplish something, that can be sufficient to receive significant support, if that is a day-to-day essential task that needs to be completed. If for instance paying taxes, grocery shopping, or getting to school/work has a 10% risk of failing, that is quite a significant support need despite outwardly looking as if the person has got everything covered most of the time. What matters is also the consequences of failing at a specific task. If it means not saying "Hi" to the bus-driver when you are low in energy, then it might be very insignificant. (Crude examples, can be replaced but I needed something to illustrate conceptually). CFCF (talk) 07:06, 12 May 2025 (UTC)

:::::::::::I wonder if we should be thinking about "needing support" as specifically "needing external support". For example, if bright lights bother you, bu you are living alone and you turn off the lights yourself, you don't "need support" for that. You are meeting your own needs yourself for that.

:::::::::::(Thanks for long comment; I thought it was interesting.) WhatamIdoing (talk) 15:37, 12 May 2025 (UTC)

::::::::::::Yes. Needing lights turned down at home is not needing support.

::::::::::::Being too low on spoons to prepare food is.

::::::::::::People in environments where they are constantly pushed towards their sensory, social and emotional limits are likely to require external support, potentially for extended periods even once they are free of that environment.

::::::::::::People in burnout find their support needs increase, often dramatically - and actually, that's still true even in the very broad interpretation of 'support' that includes things like removal of sensory stressors. Oolong (talk) 15:28, 13 May 2025 (UTC)

:::::::::::::To communicate this concept more clearly, and to differentiate it from other meanings of support (like "the neurodiversity movement supports this idea" or "scientific evidence supports this"), perhaps we can find places in the article to say "needs support from other people" or "needs practical support" or "the level of external support". Or even changing some of them from support to assistance or help. WhatamIdoing (talk) 15:57, 13 May 2025 (UTC)

::::::::::::::We can make these edits. Is this the reason why people here hesitate using "support needs" or is it just a marginal point? LogicalLens (talk) 01:22, 14 May 2025 (UTC)

:::::::::::::::I don't know. WhatamIdoing (talk) 05:12, 14 May 2025 (UTC)

= Severity II =

As the severity topic has no reply buttons anymore, I start a new thread here.

First, we should distinguish between severity labels and the debate about the proposed category "profound autism". If the latter concept becomes widely adopted in the future and is recognized as scientifically valid (which it is not currently), then we must address it in the article. We can then of course also include the criticism from reliable sources in a proportionate manner but it would not be a reason to remove the concept. What this discussion was initially about is the word choice between severity and other, similar terms like support needs or presentation. @CFCF, I did not argue that the fact that support needs fluctuate invalidate support needs. Not at all. I think you conflated "severity" with "support needs". It is only about the word choice. LogicalLens (talk) 04:44, 7 May 2025 (UTC)

:It's not conflating, severity is measured by the same metrics as support needs and is synonymous. In most jurisdictions support is given based on severity of diagnosis.

:Also, if the reply button doesn't work, you can edit in source, making a new section is confusing. CFCF (talk) 16:50, 7 May 2025 (UTC)

::That the two expressions are synonymous is why I want to write "support needs" instead of "severity". LogicalLens (talk) 23:14, 7 May 2025 (UTC)

::Again, they may well be synonymous in this technical context, but they are not synonymous in ordinary speech, and should not be treated as such on Wikipedia. This is specifically addressed in WP:MEDLANG. Oolong (talk) 09:40, 10 May 2025 (UTC)

:::I must be honest and admit that I do not see what is being discussed here. Only that we should not use profound? Or are we simply agreeing with eachother in an antagonistic way - that yes we can use support needs throughout, but must also define precisely that severity is synonymous in the classification section?

:::Also, @LogicalLens, I never suggested that anyone here was saying that fluctuating support needs invalidates support needs, merely that such arguments are a strategy that is used elsewhere, and that we must be mindful not to open the door too wide as even if we don't think so - it can be interpreted as such by readers. CFCF (talk) 00:41, 11 May 2025 (UTC)

::::The discussion is about replacing "severity"/"severe"/"mild" by "support needs". The classification section already makes it clear that the DSM-5 views these terms as synonymous: "DSM-5 uses a "level" system, which specifies the level of support the person needs. In this system, level 1 is the mildest form and level 3 the most severe." LogicalLens (talk) 03:27, 11 May 2025 (UTC)

Too much summary and links to subarticles

I made some adjustments to the lede to simplify the language - and to give neurodiversity more prominence (and to remove the WP:WEASEL wording "some researchers"). I do not think that any of the actual message is changed, I have focused on making what is there more readable and less repetitive.

However, a broader criticism of the entire scope of articles about autism, and which has been touched upon by others - but that I see being unrecognized - is not so much that this article isn't summarizing all the other articles. But rather, that there are far too many sub-articles to summarize. We need to get rid of quite many of the See also Main article and other links. This article has turned into a monster that can not be maintained. The problem is not that we aren't summarizing the sub-articles, but that there are too many sub-articles. We need to cut and just have the subarticles as wikilinks, not prominently displayed banners stating that there is a main article on the topic. CFCF (talk) 11:42, 13 April 2025 (UTC)

:This is something @Oolong and I have previously said multiple times. We are overwhelmed by this article and cannot maintain it. What we are proposing is not inserting additional summaries but replacing very long sections in the article that have separate articles (causes, for example) by summaries. Removing unnecessary summaries and "See also"/"Main article" are both ways to make the article shorter. LogicalLens (talk) 03:46, 14 April 2025 (UTC)

::I would recommend going for concise and not just short. It's a pretty high level article and so it's going to have some meat on the bones. It's going to have a lot of articles beneath it because we're writing an encyclopedia article and not a book.

::If nothing else, I've yet to meet the article that couldn't be trimmed down ~20% just by getting rid of words that make no difference in meaning. But I would agree that we could probably trim more substantively in a lot of places. And any way, we have to fix the article before we fix the lead. The tail doesn't wag the dog. GMG ^talk 23:55, 14 April 2025 (UTC)

:::Do you have concrete suggestions what we can make shorter or more concise? LogicalLens (talk) 06:27, 15 April 2025 (UTC)

::::Well for starters:

::::* I think we have to drop the use of any use of the {{Excerpt|}}, realizing that even this is far to extensive and that the language used is often to technical in nature - and actively makes editing and abiding by MOS/MEDMOS difficult. Just for instance - the Assessment/Diagnosis section links to Diagnosis of autism three times in short succession - and relinks both the WHO and ICD-10, despite these being mentioned before.

::::* The section on History and Culture is cluttered with images of flags and is essentially a WP:GALLERY - which should not be used. The aim is to get the general message across, what this is about, not indiscriminately list the flag of every supportive movement.

::::* What ought perhaps be a single line or half a paragraph on Digital media use is now a long excerpt that is WP:UNDUE at this high-level article.

::::* The "Pre-diagnosis" sections is a bullet list that is not useful. Further, I don't see how the prominent link to the Outline article serves any purpose here. There is also no general narrative overview of what assessment/diagnosis is, just a long list of steps.

::::And that is just spending 3 minutes looking for objective stylistic issues. CFCF (talk) 07:45, 15 April 2025 (UTC)

:If I'm reading Wikipedia:Summary style correctly (and this is not, itself, well-structured - so I'm finding it hard to be sure of the details) we are supposed to have summaries for subtopics. I think we're supposed to treat these summaries like leads, so probably 250 or at most 400 words each?

:We currently have well over 4000 words of duplicated content on subtopics that already have separate entries, as described under heading #The article as it stands. We should lose at least three quarters of that, I think, and likely reduce a couple more subtopics to summaries as well. Oolong (talk) 16:21, 21 April 2025 (UTC)

::I don't think that it's helpful to think of the local summary as a WP:LEAD, because the local summary should contain somewhat different information. Some material that's normal for leads (e.g., pronunciation, other names, related concepts) should be omitted and other material should be expanded. For example, the lead for Applied behavior analysis should contain information about its use in non-autism situations and the history of its development, but if we decided to add a Main-type summary for that article in Autism#Non-pharmacological interventions, then it should not include any information about those two points. (NB: I'm not advocating for including such a summary; this is only example.)

::Back in the day, we recommended that the local summaries be longer than a typical lead. That recommendation was removed years ago. The local summary should be as long, or as short, as makes sense for the local article. In some cases, that will be only a few sentences. In others, it will be a thousand words. WhatamIdoing (talk) 17:19, 21 April 2025 (UTC)

:::Fair enough. I feel like clearer guidance could be helpful here, but I guess we just improvise. Oolong (talk) 15:39, 23 April 2025 (UTC)

= Assessment =

Within the field of autism, the generally used term when undergoing evaluation is Assessment, and there has been considerable discussion here to improve use of non-pathologizing language. Because we are writing to a broad audience and the intent is to provide an introduction about autism to a broad public, which to a significant degree will include those we are either thinking about assessment or introduced to the process - it makes sense to structure the article around this, with the process itself being described rather than the formal criteria, which are defined under the first section on classification. WP:MEDORDER, part of WP:MEDMOS clearly describes a list of {{tq|suggested}} headings which may or may not be appropriate for all articles. I wrote this on my phone, so I was unable to provide the full nuance - but I would think this is in line with the consensus to avoid overt pathologizing language - without being imprecise, incorrect, or by avoiding mentioning what we are talking about. There is a real need to clarify what assessment really entails, not just repeating information from the classification. CFCF (talk) 07:37, 18 April 2025 (UTC)

:This section is more intended for official diagnostic criteria, which other sections do not mention and shouldn’t. Since there is a move to slightly de-pathologize the article, I can see how adding broader autism identification criteria in a non-pathological sense is possible, in which “Assesment” would be the appropriate name. However, I am not aware of the existence of such and am worried it may cause more confusion. If this section remains exclusively for diagnostic criteria, then “Assessment” would be a broad term possibly related to symptoms and classification, which is why I lean towards naming it “Diagnosis”. I am open to moving this section above “Causes”, but not “Signs and symptoms” as the characteristics of autism are of greater importance for the reader. Let me know your input into this, thank you. Slothwizard (talk) 08:12, 18 April 2025 (UTC)

::There is an additional reason why it shouldn't be called diagnosis, which is inherent to the condition and definitions described in the classifications section. Since the classification is so central to formal diagnosis, they really make up the diagnosis - and nothing is helped by reiterating them first in a definition, then in diagnosis. I placed the section before signs and symptoms, because I think in this case it is a far more logical flow, and more directly relevant to readers who are learning about autism (also not helped by how the signs and symptoms section is in quite a sorry state).

::Autism is, even more so, than other psychiatric conditions synonymous with the diagnosis. All psychiatric diagnoses are pretty much constructed (I don't want so say socially), and are therefore not objective in the sense that say a cancer diagnosis is. Yet, autism also differs from quite a few other psychiatric diagnoses, where one does not speak of a spectrum or persistant findings since childhood, i.e. bipolar disorder, depression etc. - but instead mainly about severity or on occasion type. In autism the specific difficulties define how to manage it, whereas in many other conditions management is, at the very least, less influenced by specific symptoms. CFCF (talk) 09:37, 18 April 2025 (UTC)

:::I think that a description of the process, regardless of whether it's called ==Diagnosis== or ==Assessment==, would be appropriate. For example, if someone suspects Breast cancer, then most readers expect the process looks like a mammogram and a biopsy, and this is what Breast cancer#Diagnosis starts with.

:::So what's the equivalent for autism? Adults will fill out a lot of questionnaires. (We should list some popular ones.) Parents will fill out a lot of questionnaires. Very young children will be observed directly. What do you do for a non-speaking child? Do you need an appointment with a pediatrician, a psychiatrist, a psychologist, a therapist, someone else? WhatamIdoing (talk) 22:39, 19 April 2025 (UTC)

:I suspect that there's a US-oriented legal consideration underlying the field's preference. Only certain healthcare providers are allowed to "diagnose" people, but a lot more people are allowed to "assess" them. For example, a school nurse can call a child's parent and say "Your child needs to leave school; they have a cough and a temperature of {{convert|40|C|F}}" but they aren't supposed to say "Your child needs to leave school; they have a cough and a fever of {{convert|40|C|F}}", because attributing the elevated temperature to fever (instead of, e.g., heat illness) is a "diagnosis", and school nurses can't legally make a diagnosis (except for a Nursing diagnosis). WhatamIdoing (talk) 22:30, 19 April 2025 (UTC)

::Interesting point, but I don't think when it comes to autism that it is US-centric. Formal diagnosis is only made by a psychiatrist in most countries, whereas some allow for psychologist diagnosis. Rather, the reason for talking about assessment is that it is a) quite an intricate process requiring the collection of data from several different people; and b) the joint assessment of direct observation and reports from individuals who know the person; c) cases are often not clear-cut, where there is a lot of subjectivity - which deviates from many other diagnoses; d) intentional attempt to avoid pathologizing. As far as I'm aware this, or similar, distinctions are made in most countries. CFCF (talk) 15:22, 20 April 2025 (UTC)

:The section should not be renamed. It is the the term used in authoritative sources including the ones in the article, the term found in Wikipedia’s own style guide, is consistent with similar and sister articles, and the title readers will expect. “Diagnosis” also covers the section’s full scope: referral and screening pathways, gold‑standard instruments, diagnostic criteria, and differential diagnosis. By contrast, “Assessment” would invite material about post‑diagnostic support‑needs evaluations and other data‑gathering exercises that belong elsewhere, blurring the line between identifying autism and managing it. Renaming would therefore sacrifice precision, consistency, and alignment with both sources and policy. Arguments found for other language changes do not apply here. Tacitusmd (talk) 06:04, 20 April 2025 (UTC)

::Where do "post‑diagnostic support‑needs evaluations" belong? WhatamIdoing (talk) 19:14, 20 April 2025 (UTC)

:::Most of these are also performed from the perspective of more in-depth diagnosis, which in turn is what guides support-needs both from a care-giver and insurer perspective. That the term is suggested in WP:MEDMOS implies it is a good start, but with a clear rationale why we should not use it (which I think is given here and in literature) - there is no reason not to choose a more appropriate in-field term. CFCF (talk) 11:13, 21 April 2025 (UTC)

:::Wading into this after skimming this entire discussion - I would place the detailed information about post-diagnostic support and the related assessments in the Management section, if the current article structure is to be kept, with a brief mention in the Diagnosis/Assessment section. Regardless of whether Diagnosis or Assessment is a better header for the section on the process and criteria for diagnosis, I would argue that, while an autism diagnosis can include some amount of support needs assessment, the majority of support needs assessments (eg. those performed by a speech pathologist, occupational therapist, physiotherapist, etc) don't really belong in the same section as the autism diagnosis process itself. Ethmostigmus 🌿 (talk | contribs) 12:46, 22 April 2025 (UTC)

::Many authoritative sources do prefer 'assessment' over 'diagnosis'. The NHS [https://www.nhs.uk/conditions/autism/getting-diagnosed/how-to-get-diagnosed/ 'how to get an autism assessment'] page is one obvious example, although the use of the term 'diagnosis' in the URL and a couple of times on the page suggests that they have only partially transitioned away from the 'diagnosis' framing, so far. See also [https://www.england.nhs.uk/publication/autism-diagnosis-and-operational-guidance/ this national framework]. [https://www.autismcrc.com.au/best-practice/assessment-and-diagnosis These Australian guidelines] use both, as do [https://www.nice.org.uk/guidance/cg142/chapter/Recommendations#identification-and-assessment-2 the NICE guidelines].

::See also [https://uk.jkp.com/products/the-adult-autism-assessment-handbook The Adult Autism Assessment Handbook] and [https://uk.jkp.com/products/the-neurodiversity-affirmative-child-autism-assessment-handbook The Neurodiversity Affirmative Child Autism Assessment Handbook], both handbooks for clinicians.

::I accept that to some degree the two terms refer to separate but overlapping concepts, but I'm not sure that needs assessments can or should be neatly separated from the diagnostic process? In fact, doesn't the DSM-5 explicitly require them? Or am I being confused by terminology here? Oolong (talk) 16:36, 21 April 2025 (UTC)

:::{{tq|I'm not sure that needs assessments can or should be neatly separated from the diagnostic process? In fact, doesn't the DSM-5 explicitly require them? Or am I being confused by terminology here?}} To clarify, when you say that the DSM-5 requires support needs assessments, are you referring to the "severity levels" (ie. level one "requires support", level two "requires substantial support", level three "requires very substantial support")? If so, I would not classify that alone as a support needs assessment.

:::How much detail is given to an autistic individual's support needs during the initial diagnosis process depends on the diagnostic team/their resources and the request of the individual/their guardian, but in my personal experience, it is largely separate. Again, just from my experience (take it with a grain of salt, things may be done very differently elsewhere!), the diagnostic team does not themselves conduct a dedicated support needs assessment but rather refers the autistic person to support services they think may be of use (eg. speech or occupational therapy) for more detailed assessment and support. Certainly, there are support needs assessments that can occur long after a person was initially diagnosed, eg. to access programs like the National Disability Insurance Scheme or Meals on Wheels. It can occur as part of the diagnosis process, but it doesn't always, and mentions of it shouldn't be restricted to within the context of diagnosis. Ethmostigmus 🌿 (talk | contribs) 13:11, 22 April 2025 (UTC)

::::That makes sense - and yes, I was referring to the DSM-5's requirement for an assessment of support needs for what they call "severity level".

::::It still seems like it's going to be tough to delineate what is (or should be) part of the diagnostic process, and what is or should be part of a broader or later assessment. I wonder how much this distinction varies between countries, practices etc - from what I know, the answer is, I think, quite a lot. Oolong (talk) 15:44, 23 April 2025 (UTC)

:::::I think you are coming at this with some confusion over what the diagnostic process is. It is not only the formal process of ascertaining the presence of a condition, but also the type/character/subtype/degree/severity of the condition. One can diagnose a condition, and then more precisely diagnose the type or degree - while still engaging in diagnosis. CFCF (talk) 13:37, 29 April 2025 (UTC)

::::::I'm not sure why you think you're disagreeing with me. My point is that diagnosis routinely includes broader assessment than simply naming a condition.

::::::Given this, I'm unconvinced that 'assessment' is in any sense an incorrect or inappropriate term for the process we're talking about. Oolong (talk) 10:12, 1 May 2025 (UTC)

Right now the assessment and characteristics sections are a hot mess. They lack any clear focus or sense of narrative. GMG ^talk 16:27, 20 April 2025 (UTC)
:You're absolutely right, but it's not just those sections.
:Hence the persistent efforts to address the many outstanding problems with the article in at least a semi-systematic way.
:Would you be up for making a start on redrafting either of these sections? Oolong (talk) 09:49, 10 May 2025 (UTC)
::I do not think the article is a mess anymore, at least not to the extent of one month ago. It can be argued that it is a bit confusing and possibly redundant that there is a pre-diagnosis section that distinguishes between social and behavior characteristics, followed by another section that does the same. Maybe, a distinction could be made between signs and characteristics, with the signs being moved into the assessment section. That section is redundant in part because the pre-diagnosis signs section also has a paragraph that starts with "Clinicians often consider assessment..." and the assessment section explains the DSM-V criteria in its second paragraph which belongs into the DSM subsection in the classification section. LogicalLens (talk) 03:08, 11 May 2025 (UTC)
:::Thanks, @LogicalLens! I've been pretty busy the last month or so (mostly with writing chapters about autism, ha) and have gotten so used to this process being intensely stressful that I only stop in when I am feeling particularly resilient - so I haven't fully kept up with improvements to the article!
:::I see that the physiology section is gone, which is sensible, but Autism#Causes is still way longer than it should be, and @Slothwizard has restored the inappropriate title of the 'Management' section, without making a positive argument for why it would be better.
:::It's definitely good to see some progress starting to be made! Oolong (talk) 18:03, 11 May 2025 (UTC)
::::Regarding the "Management" section, "therapies" itself implies there is an issue that may need to be resolved. The "supports" are literally medications. They are managing symptoms (which I guess we are not supposed to use that term?) that cause complications, if they occur. Unlike "Treatment", "Management" does not imply that therapies and supports are absolutely required, given that some characteristics of autism are not inherently pathological (e.g., special interests), and instead are just signs. Would it be appropriate for Homosexuality to have a "Therapies and supports" section due to discrimination from society? No, obviously not, because homosexuality is not pathological, a different name would be required. This article is about autism when clinically diagnosed. I do not understand what most of these name changes are supposed to accomplish. Slothwizard (talk) 19:07, 11 May 2025 (UTC)
:::::I wrote this above under #Next steps:
:::::"I would suggest fully replacing 'management' with 'support', and moving this immediately after 'common characteristics'. Symptoms might be managed; people need support. This is a huge topic, taking in parenting, education, workplaces, community and healthcare, as well as therapies of various sorts and also disability aids. We will therefore want numerous subsections."
:::::Leaving out descriptions of support which fall outwith the heading 'management' means omitting a huge amount of highly pertinent information. The intention of the name change was chiefly to ensure we have somewhere it makes sense to include this information.
:::::Why would 'management' be better? I'm still not seeing a positive argument for this. Oolong (talk) 14:03, 14 May 2025 (UTC)
::::::I wonder whether "support" could be split between ==Management== (e.g., he needs to wear a helmet to prevent concussions) and ==Accommodations== (e.g., this dev needs to be able to work from home). WhatamIdoing (talk) 17:36, 14 May 2025 (UTC)