Here are five of the major areas of debate.
Disorder or Difference?
The diagnostic criteria for autism have changed radically over time, making it hard to define who actually qualifies (or once qualified) for an autism diagnosis.
In the early 20th century, autism was considered to be a rare and severe form of schizophrenia marked by a nearly complete separation from reality. It wasn’t until 1980 that autism was described as a separate disorder not related to schizophrenia; at that point, it was considered a developmental disorder rather than a mental illness.
In 1994, Asperger’s syndrome was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The diagnosis was typically given to those with high IQs and strong verbal skills who had difficulties with social skills as well as narrow interests and repetitive behaviors.
Hence, ASD now includes a large range of people, some of whom are severely intellectually challenged, and others who are brilliant and accomplished. The evolution of the criteria has led to disagreements among parents, self-advocates, and practitioners about what autism really means.
When the DSM-5 was published in 2013, these five disorders were eliminated and folded into the single diagnosis of “autism spectrum disorder.”
Some people believe autism should be celebrated as a normal neurological variation (sometimes called “neurodiversity”) that can lead to extraordinary insights, and often claim that people such as Einstein and Mozart would have been diagnosable with autism today. Others think autism should be considered a disorder that should be treated, or even cured.
Causes of Autism
Rates of autism have been increasing dramatically in recent decades, but it is not clear whether this is due to more people being diagnosed, environmental factors, or some combination of both. This increase has led to an increase in research on autism. Scientists believe that both genetics and environmental factors likely play a role, and some researchers have found differences in the brains of those with autism.
The fact that there is no known cause of ASD has given rise to fringe theories, none of which have solid research to support them. Among these are the belief that vaccines (and trace amounts of mercury in one particular vaccine) cause the onset of autism in children. This is untrue. In fact, one study found that higher rates of autism occurred in children who were un- or under-vaccinated.
Others believe that autism is caused by airplane contrails, anti-flea powders, or cell phones. All of these theories have been debunked, yet some persist.
Best Autism Treatments
There is no treatment that reliably treats or alleviates core symptoms in everyone with autism. Some therapies are carefully researched, others are fly-by-night, and still others are somewhere in-between. There are tremendous disagreements about which treatments are most effective, most appropriate, most humane, most respectful, and safest.
One of the most significant splits in treatment theory occurred during the 1990s with the belief that vaccines caused autism. This myth resulted in the emergence of treatments intended to “chelate” or remove heavy metals from the body. These treatments, usually used for lead poisoning, are typically provided in a clinical setting—but parents did and do provide chelation at home, with some risk of injury.
In addition to these more extreme approaches, there are legitimate differences of opinion as to whether applied behavioral therapy (ABA) is more appropriate than developmental therapies such as Floortime or Play Therapy. While behavioral therapy has been extensively researched, some self-advocates and parents feel that it is at worst cruel and at best inappropriate. In fact, the two camps have come much closer over the years: Some forms of behavioral therapy are now very similar to developmental approaches.
There is also significant controversy over dietary therapies. Some research suggests that children with autism are, indeed, more susceptible to gastrointestinal issues, which can lead to pain and discomfort. Putting autistic children on special diets, however, is controversial.
Education and Autism
The Individuals with Disabilities Education Act (IDEA) guarantees a public education to eligible children with disabilities, along with special education and related services. Parents and educators sometimes disagree, however, as to whether it’s a good idea to include a child with autism in a typical educational setting if they are academically capable but exhibit behavioral challenges—or vice versa. Often, the controversy about inclusion escalates into mediation and even lawsuits as parents and school district officials battle it out.
Other disagreements relate to what autistic children should be taught. If a child is capable of learning academically, should their primary educational focus be on academics or on the social/communication skills they will need to navigate the community?
Similarly, some parents and schools believe that autism-only educational settings are ideal. These settings are physically set up to lessen sensory challenges and are staffed by autism experts who can provide autism-specific programs. On the other hand, such settings deny autistic children the opportunity to participate in their own communities and engage with neurotypical peers.
Support as Adults
Even well-educated adults on the autism spectrum have challenges that can make full-time employment, household management, and daily interactions extremely difficult. Those on the low-functioning end are rarely capable of living completely on their own without any form of financial or personal support.
Since ASD encompasses such a wide range of abilities, it is not always clear which autistic adults should live in the general community, and which in group settings, as well as who should pay for their sometimes-extensive needs. It’s hard to make the case outside the autism community that a college graduate can’t cope with the demands of daily life, even though in many cases it’s simply a statement of fact.
All of these issues are addressed on an individual and state-by-state basis. While some states provide liberal resources for autistic adults, offering funds for a variety of housing options and supports, others provide almost nothing. Political disagreements over funding for adults leads to inequities in what’s available at what quality for which individuals.
