One paper from 2005 likened autistic children to great apes, and another from 2016 stated that language problems in autistic people stem from “a failed domestication of the human brain.” Linguist Steven Pinker famously compared autistic people to robots.
As Monique Botha read these descriptions, they felt their stomach drop and thought they might throw up. Botha — whose preferred pronouns are they and them — had dug up these papers several years ago as background for their master’s thesis at the University of Surrey in the United Kingdom. They were investigating why people with autism have a high incidence of mental health problems — and hypothesized that stigma had something to do with it. Botha was diagnosed with autism at age 19 and thought they had an important perspective as a member of the group they studied. But when they dove into the scientific literature on the topic, they realized the field suffered from some fundamental problems.
The slights went beyond ugly parallels to apes and robots. Some reports said autistic individuals are incapable of having moral selves or that they are inherently selfish and egocentric. Several described them as economic burdens to communities. And one posited that people with moderate to severe forms of autism are unable to experience features of a “good life,” including close relationships. Most of the articles had been published within the past decade. “Imagine waking up one day and reading a book dedicated to arguing why you, and someone like you, doesn’t actually count as a person,” Botha says. “It was all this really horrific stuff.”
Far from discouraging Botha, these ignorant statements only solidified their resolve to change the scientific conversation about autistic people. Now associate lecturer in psychology at the University of Surrey, Botha studies the effects of stigma and discrimination on autistic people. The importance of Botha’s mission goes beyond principle. Autistic people are at risk for numerous mental health issues and suicide — much of it likely propelled by prejudice. Amid the coronavirus outbreak, some doctors in the U.K. have pushed for blanket ‘do not resuscitate’ orders for autistic adults without their or their family’s consent. As long as the scientific literature casts autistic people as less than human, “it facilitates maltreatment of autistic people,” Botha says. “It legitimizes violence.”
Botha is part of a growing community of autistic scientists who are studying the condition, swapping stories and sharing opportunities. These scientists do so through two closed Facebook groups, each of which has more than 150 members; and on Twitter, using the hashtags #AutisticsinAcademia and #ActuallyAutistic. They meet over drinks at conferences and mentor students between talk sessions. “I get a very clear sense that there is this big — I wouldn’t say a big family, but a big connection,” Botha says. “It’s like being connected to all these other people who are doing the same thing as you.”
These connections were practically nonexistent 10 years ago, when few researchers were open about being autistic, and even fewer made efforts to recruit autistic scientists to the field. “There’s a growing voice,” says autism researcher Damian Milton, chair of the Participatory Autism Research Collective, which promotes autistic people’s involvement in science. “I think in the future, there will be a lot more of us coming through — or trying to.”
Already, autistic academics are making a significant contribution to discoveries about autism. They regularly publish papers in leading academic journals, and they serve as editors of at least four autism journals and as board members and reviewers. Last year, they spearheaded the founding of an autistic researchers’ committee at the International Society for Autism Research, the professional group that organizes the world’s largest annual autism conference. And they have established groups such as the Academic Autism Spectrum Partnership in Research and Education to help autistic people partner with scientists on research projects.
These autistic scientists hope they will eventually become a major force in autism research. But obstacles to their academic success abound, from sensory overload at conferences to difficulties communicating with colleagues. Researchers may dismiss autistic scientists as ‘too autistic’ to produce quality science or, conversely, ‘not autistic enough’ for their insights to be useful. Slowly, though, these biases are fading, Botha says: “For every high-quality piece of work an autistic researcher puts out on autism, the more the autistic perspective will be valued or recognized.”
The idea of autistic researchers leading studies on autism is a natural extension of ‘participatory research,’ an approach first developed in the 1940s to ensure that studies of minority communities were not harmful, offensive or inaccurate, and that they were in line with that community’s needs. Researchers who practice this approach collaborate directly with individuals who are part of the community. They work together to define all phases of a research project, starting with which questions are asked and how to ask them, to interpreting and applying the results. In the past decade, the nonprofit Patient-Centered Outcomes Research Institute has helped lead the charge in funding participatory health science. The work it supports, which includes two dozen studies related to autism, puts communities in charge of setting research agendas and determining how research is conducted, says Lisa Stewart, a senior engagement officer at the institute.
Involving the community in research goals is important because the types of autism research that get funded often differ from what autistic people want. For example, more than half of all autism research in the U.K. focuses on the underlying biology of autism — yet most of the 125 autistic people surveyed in a 2013 study said greater priority should go to research on public services, and almost half called for more research on improving life skills among autistic people. A 2015 survey of nearly 300 autistic individuals in the U.K. identified mental health as the most pressing research issue. And in a 2018 study conducted in the United States, 485 autistic individuals and their family members said they value research on health and well-being, the transition to adulthood and lifespan issues more than basic science research. “The outcomes that matter most [to people with autism] tie to improved quality of life,” Stewart says. Participatory research can give these preferences sway.
“For every high-quality piece of work an autistic researcher puts out on autism, the more the autistic perspective will be valued or recognized.” Monique Botha
Autistic partners have been crucial to prioritizing research in these areas. They were essential, for example, in the development of an online healthcare tool kit for autistic adults and primary-care providers. Surveys and interviews with autistic adults revealed the main barriers to care. But the autistic partners were important for insuring that the tool kit would be as useful as possible for them and others like them. “As a physician and autism researcher, I certainly had plenty of ideas of my own, but I never would have been able to create a tool anywhere near as useful as we did as a team,” says Christina Nicolaidis, a health services researcher at Portland State University in Oregon who helped develop the tool kit. The contributions of one autistic partner in particular, the late Mel Baggs, “are infused through every aspect of the tool kit and are a big part of why it’s accessible, respectful and useful,” Nicolaidis says.
Community involvement may also help eradicate hurtful descriptions of autistic people in the scientific literature. “I can’t count the number of times I’ve had to read papers that are talking about how much I cost society, how much of a burden I am, how difficult I am for the people around me, how awful life is for my parents and siblings — all those things,” says Jac den Houting, a postdoctoral researcher in education at Macquarie University in Sydney, Australia. “There’s still a lot of research coming out that unfortunately doesn’t take into account the fact that autistic people are going to read what you’re writing.”
Sometimes these offensive views come up in person. Years ago, at a meeting at Oregon Health and Sciences University in Portland, one senior researcher lamented that girls with Rett syndrome have no soul and said it was his deep passion to restore their souls, recalls Dora Raymaker, assistant professor of social work at Portland State University, who was at the meeting. “He had no idea what he said was in any way offensive,” says Raymaker, who is autistic. Participatory research helps prevent such situations by requiring scientists to interact directly with the people they are studying and get their input, or even their sign-off, on the research.