April is Autism Acceptance month, a shift from what was formerly Autism Awareness month. In recent years, autistic self-advocates worldwide have called for more inclusive language guided by autistic voices. However, we have not seen a universal adoption of Autism Acceptance. Acceptance promotes inclusion and changes in social perceptions of autism and autistic people.

The goals of autism acceptance are to embrace, celebrate, and integrate autistic people as equal members of society deserving of dignity and self-determination. In this, we counter the long history of social stigma and misinformation around autism. We strive to improve outcomes for autistic people in education, employment, housing, health care, and support services. Services for autistic individuals tend to focus on behavioral interventions for children, but these children will grow up to become adults who face significant challenges. Autistic people see unemployment rates between 39 and 73 percent, sexual victimization at 70 percent, inadequate support systems, and up to 13 times more likely to die by suicide than non-autistic people.

Reforming Social Perceptions of Autism

Reforms for autistic people start with changing public attitudes toward autism and increasing support for autistic people. Historically, autistic people have had little say in how we are depicted and perceived. Harmful representations and myths perpetuate false beliefs about autistic individuals, such as the idea that we lack emotions, struggle with communication, have exceptional or below-average intelligence, and tend to engage in obsessive behavior. These false beliefs contribute to the stigmatization of autistic individuals. For example, non-autistic people created the puzzle piece representing autism, which they use to describe us as having a “missing piece.” Non-autistic people also created “Light it Up Blue.”

Perhaps the most harmful myth is that autism needs a cure. When we focus on eliminating autism, we overlook autistic strengths rather than finding solutions to life’s obstacles. The truth is, autistic people don’t need a cure, and we don’t want autism eradicated — most of us like being autistic. Our neurodivergence is part of who we are, and in the neurodiversity movement, we celebrate our differences.

Destigmatization

De-stigmatization also requires improving language around autism (and disability as a whole) to accurately represent who we are and how we are affected by disability. Pathologizing language is rooted in a deficit model of disability, framing autistic people as having an affliction or suffering from symptoms. A significant number of autistic adults prefer identity-first language (he is autistic) over person-first language (he has autism). Identity-first language aligns with the notion that autism is a central part of whom we are rather than something that is happening to us.

Functioning labels are often used to describe autistic people as high or low-functioning. Still, they are non-specific, don’t improve access to support, and may be damaging because they create assumptions about people’s needs and capabilities. Even terms like “high support needs” and “low support needs” can be problematic. Being specific about a person’s needs is a more accurate representation.

Autistic Joy

Autism Acceptance Month is a time for autistic joy, allyship, education, and the de-stigmatization of neurodivergence. It also reminds us that autism is more than a collection of impairments. There is no one way of being autistic. Autistic people deserve autonomy, cultural appreciation, equity, and accommodation. Renaming April as Autism Acceptance month would be a first step.

(…and please stop using the puzzle piece, and don’t “Light it Up Blue.” The autism community prefers the gold infinity symbol and to wear #redinstead)

Some anti-trans bills sweeping the nation target autistic people and other individuals with developmental and mental health disabilities, and these laws are authoritarian, transphobic, and ableist. The language of these laws leaves disabled transgender people powerless and subjected to a paternalistic government that does not understand us or our need for self-determination.

Oppressive laws are further marginalizing vulnerable people.

Georgia Bill SB140 and Missouri Senate Bill 49 (at the time of this writing, SB140 has passed, and SB49 has passed the senate and is on the way to the house) deny gender-affirming health care to autistic people and people with other developmental and mental health disabilities. The law in Georgia points to the fact that transgender people are more likely to be autistic (Pasterski, Gillian, and Curtis, 2013) or to have other developmental disabilities as a reason to ban gender-affirming care for all minors.

Section 1 of Georgia’s SB 140 reads, “gender dysphoria is often comorbid with other mental health and developmental conditions, including autism spectrum disorder.” Lawmakers in Georgia are using autism and other disabilities to justify denying minors access to much-needed trans-affirming care. In Missouri, anti-trans law SB 49 would require clinicians to “ensure that the patient has a comprehensive screening to determine whether or not they have autism” and “treat and resolve existing mental health comorbidities” before gender-affirming care would be permitted. Missouri has created impossible-to-meet benchmarks openly hostile to a historically repressed and underserved population.

The adverse consequences of outlawed care.

These authoritarian, transphobic, ableist laws will bar autistic people and those with other developmental and mental health disabilities from receiving gender-affirming healthcare. The same care saves trans lives (Tordoff et al., 2022). Studies have also shown that access to gender-affirming healthcare reduces anxiety, depression, and dysphoria. Legislative attempts to limit, ban, or criminalize access to transgender medical and psychosocial healthcare endangers the health and well-being of transgender and nonbinary youth (Olson et al., 2016; Olson-Kennedy et al., 2018))

Autism is not “resolvable” and does not need a cure. It is ableist to expect autistic people to magically change their neurology to receive life-saving care. Paternalistic attitudes toward autistic people that assume our understanding of gender is dubious because we are autistic are well documented and harmful (Brown, 2016; Dale, 2019; Yergeau, 2018; Jackson-Perry, 2020; Walker, 2022).

What we know about ourselves is not debatable.

I am transgender and autistic, and I knew I was not my gender assigned at birth from early childhood. I experienced debilitating gender dysphoria as soon as I was aware of my body in relation to others. My challenges came from not having access to free self-expression in a cis-and-neurotypically centric society. I and all other autistic people are autonomous, capable, and cognizant of who we are and how we identify. It is no one’s place to undermine our self-determination and self-understanding. We deserve better from society and our legislators. Anti-trans laws directly attack our identities, independence, and safety.

The truth is that autistic people are more likely to be LGBTQ+ than non-autistic people (Weir, Alison, & Baron-Cohen, 2021). Transgender and autistic people have higher rates of mental health issues, such as depression, anxiety, and suicidality (Bockting et al., 2013; Hedley & Uljarević, 2018; Hirvikoski et al., 2016; Murphy, Prentice, Walsh, Catmur, & Bird, 2019). Research has shown that transphobia, ableism, and other forms of discrimination cause trauma, resulting in adverse mental health outcomes (Hendricks & Testa, 2012).

Autism and trans-affirming mental health care are challenging to find, especially for those living outside of urban, progressive areas (Safer et al., 2016; Rodriguez, 2022). Anti-trans laws make it even harder for us to get the care we need to survive and allow clinicians to learn better how to serve us. When gender-affirming health care is contingent on being able-bodied and free of common mental health disabilities, we create an untenable landscape for already vulnerable children and the future of healthcare in America.

Work Cited

Bockting, W. O., Miner, M. H., Swinburne Romine, R. E., Hamilton, A., & Coleman, E. (2013). Stigma, mental health, and resilience in an online sample of the US transgender population. American journal of public health, 103(5), 943–951.

Brown, L. X. (2016). Gendervague: at the intersection of autistic and trans experiences. Asperger/Autism Network.

Dale, L. K. (2019). Uncomfortable labels. Jessica Kingsley Publishers.

Hedley, D., Hayward, S. H., Clarke, A., Uljarević, M., & Stokes, M. A. (2022). Suicide and autism: A lifespan perspective. In End of Life and People with Intellectual and Developmental Disability (pp. 59–94). Palgrave Macmillan, Cham.

Hirvikoski, Tatja, Ellenor, Mittendorfer-Rutz, Boman, Larsson, Lichtenstein, & Bölte. 2016. Premature mortality in autism spectrum disorder. British journal of psychiatry 208(3):232–38.

Murphy, J., Prentice, F., Walsh, R., Catmur, C. & Bird, G. (2020). Autism and transgender identity: Implications for depression and anxiety. Research in autism spectrum disorders. 69:101466.

Olson, K., Durwood, L., DeMeules, M., McLaughlin, K.A., (2016). Mental Health of Transgender Children Who Are Supported in Their Identities. Pediatrics. 137 (3): e20153223. 10.1542/peds.2015–3223

Olson-Kennedy, J., Warus, J., Okonta, V., Belzer, M., Clark, L.F., (2018). Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults: Comparisons of Nonsurgical and Postsurgical Cohorts. JAMA Pediatr.;172(5):431–436. doi:10.1001/jamapediatrics.2017.5440

Rodriguez, O. (2022). Autistic transgender people face intersecting healthcare hurdles. Prism. Retrieved March 23, 2023, from https://prismreports.org/2022/05/09/autistic-transgender-people-intersecting-health-care-hurdles/.

Safer, J.D., Coleman, E., Feldman, J., Garofalo, R., Hembree, W., Radix, A., Sevelius, J. (2016) Barriers to healthcare for transgender individuals. Curr Opin Endocrinol Diabetes Obes. 23(2):168–71. doi 10.1097/MED.0000000000000227. PMID: 26910276; PMCID: PMC4802845.

Tordoff, D.M., Wanta, J.W., Collin, A., Stepney, C., Inwards-Breland, D.J., Ahrens, K. (2022) Mental Health Outcomes in Transgender and Nonbinary Youths Receiving Gender-Affirming Care. JAMA Netw Open. 5(2): e220978. doi:10.1001/jamanetworkopen.2022.0978

Weir, E., Allison, C., & Baron-Cohen, S. (2021). The sexual health, orientation, and activity of autistic adolescents and adults. Autism Research. DOI: 10.1002/aur.2604

Autistic people deserve accurate representation.

Autistic people are often categorized as high or low functioning to locate them along the “spectrum” of autism, which denies that the spectrum is not linear and high and low-functioning are inaccurate classifications. The linear autism spectrum is perceived as a gradation of “can” and “can’t” and lacks the de facto specificity of abilities or challenges. Additionally, the notion of can and can’t is subjective and relies on normative expectations for the execution of tasks or ways of living.

The linear spectrum defies nuance, which is problematic because it formats autism compared to non-autism neurotypicality. Instead, we should focus on each person’s needs and strengths and recognize autism as a valid and culturally relevant way of being.

To enable autistic people and help them reach their potential, consider their individual circumstances. Society often makes things more challenging for people with disabilities by not meeting their needs, so identifying them is the first step toward making things more equitable. And how do we figure out what people need? Simple — ask them! Never make assumptions about what someone can or can’t do.

Easy examples of how to replace functioning labels with specificity:

Annie (she/her), an autistic person, is non-speaking and uses an AAC (augmentative and alternative communication) device to communicate. She drives herself to work for her job as a software engineer, where she wears noise-canceling headphones to silence in-office noise.

Rashad (he/him) writes for a primary news source and does not use a computer keyboard because of dexterity limitations. Instead, he types on the phone or uses voice-to-text.

Avery (they/them) lives in an apartment with two roommates and has a carer who helps them prepare meals and get ready for school in the morning. They are an ethnic studies student at a college several states away from their parents. They play clarinet in the marching band.

As you can see, Annie may appear “high functioning” because she has a job in STEM, but functioning labels would ignore her communication and environmental needs. Rashad doesn’t use one form of the keyboard but does use another. Avery is independent in some ways but needs in-home support in other ways.

To know us is to respect us.

Vague descriptors like “high or low functioning” would tell us nothing useful about Annie, Rashad, or Avery. Functioning labels are reductive terms that undermine one’s humanity, struggles, and individuality. Accurate identifiers can help others understand the nature of individual disabilities and adequately accommodate someone’s needs.

We can acknowledge that individuals encounter diverse challenges that we cannot generalize, and these challenges do not imply that the person is flawed or defective.

Companies today find that robust diversity, equity, inclusion, and accessibility programs are ethical as well as guarantors of success, but how does an organization get started on designing and implementing a DEIA program that is successful and sustainable?

Beginning with a vision and defined purpose, the organization starts by setting company goals that build a framework for its DEIA plan. I suggest developing the DEIA framework around four main areas: (1) diversity, which includes company structure, systems, and leadership; (2) equity, which includes recruiting, hiring, wages, advancement, and retention; (3) inclusion, which the company culture defines; and (4) accessibility, which focuses on disability, health, and accountability. Through these four mainstays, a company can tackle common diversity issues that, unaddressed, limit talent, performance, profitability, and worker satisfaction.

The company vision is the driving force behind any organizational change. With DEIA in mind, I encourage a company vision prioritizing recruitment, engagement, and sustainability. The purpose of a new DEIA program will be multi-pronged: the organization should establish a culture aligned with its values by building a multicultural workplace, diversifying leadership, securing the best talent, and improving client relationships factor into this goal.

The Oxford Dictionary defines diversity as “the practice or quality of including or involving people from a range of different social and ethnic backgrounds and of different genders, sexual orientations, religions, and ages.” In part, diversity is achieved by adapting company structure, systems, and leadership to align with the organization’s vision. A company begins the diversity process by analyzing company demographics to determine the breakdown of workers’ race, religion, gender, sexual orientation, disability, and age. Next, the company will identify systemic barriers to inclusion through employee interviews and feedback. Ideally, the company will employ outside auditors and consultants who review policies, practices, and employee assessment tools, conduct qualitative research, and identify systemic issues. Consultants can also provide advice and training to workers to reduce bias and communicate clearly defined company values and expectations to all workers.

Equity, which is the act of being equitable and unbiased, is addressed through recruiting, hiring, wages, advancement, and employee retention. Equity can be a challenging concept to implement and requires adapting recruiting methods to reach a proportionately diverse pool of talent that reflects the area’s demographics. Equity goals are purposeful, however, to introduce new people, bring new skills, and incorporate new perspectives into the company. Equity initiatives will prioritize recruiting people with POC and people with disabilities. Improving recruitment through direct efforts can reach prospects through disability programs and organizations, HBCUs and colleges, social media, trade journals, referrals, and diversifying recruiters.

Requiring a diverse pool of candidates at the pre-interview stage will ensure that job candidates meet company diversity goals. The company should adopt new interview processes to be more inclusive. An organization cannot address equity without emphasizing equitable promotion processes and assessments. A review of existing employee assessment tools is necessary to find gaps in advancement opportunities. Revising company policies to accommodate a diverse workforce by not giving preferential treatment to cis, white, male workers. Establishing an equal pay protocol will address wage inequality, and transparency will improve company accountability.

An inclusion policy ensures equal access to opportunities and resources for marginalized groups, such as people with disabilities and members of other minority groups — embedding inclusion into company culture often requires cultural shifts. Inclusion enables employees to reach their potential in an environment that fosters cooperation, adaptability, and equity. Individualize support for workers. A company’s support will improve by offering flexible hours that are remote or in-person based on individual needs, family support, including access to good childcare and family leave, and workplace accommodations. Factors that serve employee needs will improve employee satisfaction and require flexibility to respond to employee feedback by reviewing and revising practices, then developing solutions to provide necessary resources.

Integral to inclusion practices is robust leadership vetting and training programming. Leadership must not only be diverse but have multicultural knowledge and proven methods. One way to achieve more diverse leadership is to steer clear of meritocracy vs. diversity narratives that privilege those socially positioned to have opportunities over those who may have been denied opportunities because of class, race, ethnic background, age, or disability. Interview existing employees to gather data about their understanding of diversity and provide training to those who require improving their knowledge.

Employee advocacy and mentorship programs can bridge the gaps between supervisors and employees. Recruits benefit from mentors who can help them navigate the job and highlight their talents for others to see. Pairing mentors with protégés based on shared work interests can help those flying under the radar by nominating them for awards, new teams, or projects. Mentoring programs support inclusion by aiding the visibility of workers who may historically have been overlooked. A company should establish mentors/protege partnerships and create an employee advocate position independent of HR. Give all employees explicit, detailed communication about company goals, processes, and their place in the process. It helps to establish a company-wide lexicon so all team members can communicate effectively on these topics.

An overarching theme of a DEIA initiative should be accessibility, defined as the quality of being appreciated and accepted, providing ease of use and obtainability. Regarding disability accessibility, ADA requirements are often the floor, not the ceiling. A proper DEIA-focused company will go above and beyond legal requirements to provide workers with attentive, specific, individualized accommodations. Much company accessibility centers on comprehensive accountability practices, including transparency, by offering yearly qualitative and quantitative data reports, consistent bias-reduction practices, and regular employee/leadership feedback exchange. In addition, the company must establish mechanisms for employee reporting of harassment or discrimination while shielding them from retaliation and reducing timelines for these processes. Disability accommodations will include neurodiversity awareness, attention to physical disability and the built environment, provisions for those with low vision and deafness, and access to quality mental health care.

DEIA programming is put in place partially to improve employee retention, which requires gathering and analyzing demographic and employee turnover factors. Including qualitative metrics are the only way to understand successes and failures because quantitative analyses can be superficial when addressing employee needs. Metrics that measure success beyond retention are essential for a company’s success. An increase in representation within the company, for example. All supervisors and HR managers have completed DEIA training, policies and processes have been reviewed and revised, and the company is assessing employees with adapted and trackable tools. Not to be forgotten, a company will gather documentation of success stories.

The sustainability of a DEIA program and happy employees necessitates that companies do not rely on marginalized groups to do the work. Allies should step up and do the job, of which secondary benefits include value systems, actionable experiences, and understanding. Anticipating company-wide, lasting, adaptable change is a positive, vision-forward method to keeping DEIA initiatives at the forefront. By improving diversity, equity, inclusion, and accessibility, a company is better positioned to become an industry leader.

Unemployment and underemployment of autistic people are as high as 80%, despite the vast benefits of hiring from this mostly untapped talent pool. Fortunately, the inclusion tide seems to be shifting as many prominent companies recognize the benefits and opportunities of adding neurodiversity to their organizations (shout out to HP, Microsoft, IBM, JP Morgan Chase, et al.).

Overcoming systemic barriers to engaging autistic recruits and employees is easier than it seems — there is a growing body of DEI professionals who specialize in neurodivergence who can assist. Revising company practices can increase your productivity, innovation, and quality.

Benefits and Opportunities to Hiring Autistic Employees

Research has shown that DEI has the potential to increase sales revenue, expand a customer base, and in turn, boost profits. DEI is not just best practice but also makes logical business sense. Hiring autistic people demonstrates your company’s commitment to diversity and inclusion. Neurodivergence is an asset, and a diverse workforce positions an organization as an industry leader that is more likely to acquire and retain quality workers.

Companies embracing neurodiversity initiatives have found that working with autistic people can improve communication within the workforce and across projects. Autistic people’s unique neurology allows them to think outside the box, which can introduce unique perspectives. Other autistic assets are:

• A high degree of concentration
• Reliability and tenacity
• A focus on accuracy and attention to detail
• Pattern recognition
• Technical and other specialized abilities

Improving Company Access to Autistic Talent

Employer recruiting methods may hinder the organization’s ability to reach neurodivergent populations. Difficulty in reaching this innovative pool can happen for several reasons. For instance, adherence to traditional approaches to recruiting and interviewing may screen out autistic hires.

Requiring attributes like “soft skills” such as communication, team-building, and persuasion can eliminate autistic applicants from the start, who feel that they don’t fit the job despite their skillset and accomplishments. This is because systemic attitudes on what makes a good employee can conflict with autistic workers.

Autistic employees may not demonstrate:

• Typical communication
• Interest in or proclivity to working in groups
• Networking skills
• Work culture conformity
• Relatability

Interviewing practices may not be conducive to neurodiversity because conventional expectations of interviewees aren’t designed with autistic people in mind. Autistic people may display inconsistent eye contact, overt bluntness, atypical connections between subjects, and conversational digressions. But, updating hiring practices and adjusting the interview process to accommodate autistic people is easy if companies can demonstrate flexibility.

Furthermore, adjusting work environments to accommodate neurodivergence in small ways, such as allowing noise-canceling headphones, adjustments to bright lighting, or eliminating distractions. Most importantly, company leadership should be open to discussing employee needs with their workers. Developing pathways for an open feedback exchange between neurodivergent and neurotypical workers benefits everyone.