Autism is not a puzzle to be solved, a pathology to be corrected, or a checklist of deficits to be managed. It is a neurocognitive style that is a part of us across the entire lifespan; a way of sensing, processing, relating, and existing in the world.
For too long, healthcare systems have approached autism through a narrow medical lens; diagnosis as destination, behaviour as symptom, distress as disorder. This approach has failed Autistic people and it has actively harmed many of us.
This article offers a different starting point. One grounded in lived experience, and neurodivergent-led knowledge. Not a “soft” alternative, but a more accurate one.
Autism Is a Neurocognitive Style, Not a Disease
Autism is a naturally occurring form of human diversity (hence “neurodiversity”). It shapes perception, attention, communication, sensory processing, emotional regulation, and cognition from birth onward.
Autistic people do not “have” autism in the way one has an illness. Autism is not separable from the self. Attempts to treat autism as something external, something to remove, reduce, or normalise away, inevitably end up treating Autistic people themselves as the problem.
This framing matters clinically. When autism is misunderstood as pathology, healthcare interactions become sites of correction rather than care.
Autism Is Heterogeneous
The saying goes “If you have met one Autistic person, you have met exactly one Autistic person”.
Autism is not a linear spectrum from “mild” to “severe”. It is better understood as a multidimensional constellation of traits that show up differently depending on context, environment, stress, safety, and support.
An Autistic person may:
- Communicate fluently in writing but struggle with speech
- Mask competently in short clinical interactions while collapsing afterwards
- Appear “high functioning” until cumulative burnout removes access to skills
- Move between apparent capability and profound difficulty across time
Static assessments miss dynamic realities.
Communication Differences Are Not Deficits
Autistic communication is often framed as impaired because it differs from dominant neurotypical norms. In reality, many communication breakdowns arise from mutual misunderstanding, not unilateral failure.
The double empathy problem describes how Autistic and non-Autistic people struggle to intuit one another’s perspectives equally. Yet only Autistic people are pathologised for this gap. We have fundamentally different experiences of the world, so it follows that our empathy, emotional response, and subsequent communication styles would differ from one another.
Healthcare settings amplify this mismatch:
- Time pressure penalises processing differences
- Indirect language creates ambiguity
- Sensory overload impairs comprehension
- Power dynamics discourage clarification
Clear, literal, respectful communication is not an accommodation; it is good clinical practice.
Sensory Processing Is Central, Not Peripheral
Sensory differences are core parts of the overall Autistic experience.
Lights, sounds, textures, smells, temperature, clothing, pain, internal bodily signals; all may be experienced more intensely, more diffusely, or less predictably.
Healthcare environments are often sensory minefields:
- Fluorescent lighting
- Overlapping noises
- Strong chemical smells
- Unexpected touch
- Unclear procedures
Distress in these settings is frequently misread as anxiety, non-compliance, or behavioural challenge, rather than a rational nervous system response to overload.
Masking Is Not Coping, It Is Costly
Many Autistic people learn to suppress natural behaviours, responses, and communication styles to survive in a world not built for us. This is known as masking. Rather than being a conscious choice, it becomes an innate reflex to manage our embodied identity dependant on the situation.
Masking can look like:
- Forced eye contact
- Scripted speech
- Suppressed stimming
- Downplayed pain or confusion
- Apparent emotional regulation
Masking often leads clinicians to underestimate need; over time, it contributes to exhaustion, burnout, identity fragmentation, and mental health crises. Masking has been linked to increased suicidality in Autistic people.
If someone “seems fine” in a brief appointment, that tells you very little about the cost of getting there.
Autistic Burnout Is Not Depression or Laziness
Autistic burnout is a state of profound exhaustion caused by chronic mismatch between an Autistic person and their environment.
It often involves:
- Loss of skills
- Reduced tolerance to sensory input
- Increased shutdown or withdrawal
- Cognitive fog
- Physical illness
- Heightened vulnerability to crisis
Burnout is a predictable outcome of sustained system-level pressure. Burnout is frequently misdiagnosed as depression, personality disorder, or treatment resistance. Traditional interventions often fail because they target the individual rather than the conditions that caused collapse.
Pain Is Experienced and Expressed Differently
Autistic experiences of pain often do not align with clinical expectations; either in intensity, expression, or timing.
Some Autistic people experience hypersensitivity to pain, where sensations are amplified and overwhelming. Others experience hyposensitivity, where significant injury or illness may register as muted, delayed, or difficult to localise. Many experience both at different times or in different body systems.
Just as important as how pain is felt is how it is expressed.
Autistic people may:
- Show minimal outward reaction to severe pain
- React intensely to sensations clinicians perceive as minor
- Struggle to identify, locate, or describe pain verbally
- Experience delayed pain responses after an event or procedure
- Communicate pain through behaviour, shutdown, agitation, or withdrawal rather than speech
These differences are frequently misinterpreted as exaggeration, attention-seeking, anxiety, or poor insight. In reality, they reflect genuine differences in interoception; the sense that allows us to perceive internal bodily states. It can also be affected by the double empathy problem, with language we are taught to understand and describe pain not aligning with our lived experience of it.
Distress Is Often Ecosystemic, Not Intrinsic
Autistic distress is commonly framed as arising from the brain alone. Even Autistic people themselves iften approach meltdowns as neurological events. Whil meltdowns and distress in Autistic people absolutely erupt as neurological events, we can’t ignore the wider ecosystem shaping wellbeing.
Distress emerges at the intersections of:
- Sensory environments
- Relationships
- Expectations
- Institutional demands
- Economic precarity
- Diagnostic gatekeeping
- Social exclusion
This is a non-exhaustive list.
Understanding mental health and distress through an ecosystemic lens contextualises it. It asks not “What is wrong with this person?” but “What is happening around them, and how is their nervous system responding?”
An ecosystemic model of distress acknowledges that neurology is changed by our relationship with the world, and helps us frame not just Autistic Mental Health, but all mental health, through a neurodivergence-competent lens.
Diagnosis Is a Tool, Not a Measure of Worth
Diagnosis can provide access to understanding, community, language, and support. It can also be inaccessible, delayed, traumatising, or denied altogether.
Healthcare professionals should be cautious not to:
- Treat diagnosis as the start of autism
- Gatekeep validation behind formal assessment
- Use diagnostic status to determine credibility
- Ignore self-knowledge and lived experience
Autism does not begin at diagnosis. Neither should care.
Neurodivergent-Competent Practice Changes Outcomes
Supporting Autistic people well does not require becoming an autism “expert”. It requires shifting orientation.
Neurodivergent-competent healthcare:
- Assumes difference, not deficit
- Centres lived expertise
- Adjusts environments, not just expectations
- Communicates clearly and collaboratively
- Recognises masking and burnout
- Understands distress as relational and contextual
This approach improves outcomes not only for Autistic people, but for many others whose needs fall outside normative assumptions.
A Final Note
Autistic people do not represent broken versions of non-Autistic people. We are whole people navigating systems that were never designed with us in mind.
Healthcare has immense power to either deepen harm or foster safety, dignity, and trust. The difference lies not in intention, but in understanding.
Getting autism right is not about learning a checklist.
It is about listening; and being willing to rethink what you thought you already knew.