Communication About Autism: Terminology Considerations

Some people view autism as a neurological difference and a fundamental part of a person’s identity. Some people view traits of autism, likes social communication differences, as signs of a developmental disorder and seek specific treatment. Both perspectives are valid and important. Both perspectives have implications for speech-language pathology services and reimbursement.

These perspectives have changed the terminology we use about autism, autism spectrum disorder, and autistic individuals; the role of the speech-language pathologist (SLP) and other professionals; and treatment approaches. ASHA shares different perspectives on disability identity and culture, neurodiversity, and ableism to inform members and other stakeholders:

Some ASHA resources emphasize a person-centered approach to services, including co-created treatment goals and family/community involvement.
Other ASHA resources emphasize an identity-centered approach, including neurodiversity-affirming services.

See ASHA’s Practice Portal page on Autism and Autism Spectrum Disorders for detailed information about assessment, interventions, services, and supports.

Identity-First or Person-First Language

Some people choose identity-first language, such as autistic person, because they consider autism an intrinsic part of a person’s identity.
Others choose to use person-first language, such as person with autism, which emphasizes the person rather than the condition.
Families and caregivers may prefer person-first language—particularly when their child has high support needs. This may be related to advocacy for resources and services and the desire that their child be recognized for more than their disabilities.

The Publication Manual of the American Psychological Association (7th ed.; APA, 2020) details using either person-first or identity-first language, depending on the individual’s preference. For more information, see APA’s style guidelines on bias-free language. Note: APA style guidance is not unique to autism.

Resources About Identity-First and Person-First Language

Neurodiversity and Ableism

A strengths-based approach and neurodiversity: A strengths-based perspective is more consistent with a neurodiversity paradigm that “views autism as a form of neurobiological diversity that cannot be separated from the person and does not inherently need to be fixed” (DeThorne & Searsmith, 2020). From this perspective, autism is considered another way of “being”—not a disorder. Treatment focuses on building strengths by providing supports, strategies, and/or accommodations rather than correcting a disorder or seeking a cure. SLPs may work on social skills that may be (or are) impacting education and quality of life—not as a way to change autism.

A disorder-based approach and ableism: Ableism refers to “beliefs and practices that discriminate against people with disabilities . . . . Ableist language assumes disabled people are inferior to nondisabled people” (Bottema-Beutel et al., 2021). A disorder-based perspective, which some people may consider ableist, establishes the ideal standard to be someone without a disability, and treatment may focus on helping a person appear to look or act in a more “typical” way.

Resources About Neurodiversity and Ableism

Learn Neurodiversity Terminology [PDF]
We Don’t Treat Autism: Here’s Why [PDF]

Terminology Considerations

Sometimes, a diagnosis is needed so that a person can access services or so that SLPs can be reimbursed.
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (2022) defines criteria for an autism diagnosis and describes the levels of severity within that formal diagnosis that may have an impact on access and reimbursement of services.
In order to qualify for reimbursement, the service provider needs to document areas of deficit in order to demonstrate that (a) the client requires skilled services that only a licensed professional can provide and (b) the service is medically necessary.
In order to qualify for eligibility for services or accommodations, the clinician needs to document areas of deficit to demonstrate that the student requires skilled services and supports that (a) that only specialized instruction can provide and (b) are necessary in order to access a free appropriate education under the Individuals with Disabilities Education Improvement Act (2004).
Some impairment-based terms (e.g., impairment, deficit, disability, disorder) are required in certain contexts to establish eligibility for services or accommodations in public schools and communities. Examples include access to disability transportation supports, job coaching services, funding for dedicated support staff, access to assistive technology, and community service activities.
The World Health Organization framework is cited in ASHA’s Scope of Practice in Speech-Language Pathology. That framework uses the terms impairment, disability, and activity/participation.

The terms services/supports are alternatives to the terms intervention/treatment. The term intervention is typically used in the school setting; the term treatment is typically used in the medical setting. Some people prefer the terms services/supports and address severity by using the term low support needs or high support needs. Payers and disability service agencies, however, expect to see widely accepted terms for diagnosis and evidence of intervention/treatment.

Alternative Terminology

Discuss terminology preferences directly with students/clients/patients and family members/care partners. Preferences change over time and across settings. Individuals may have different views about what constitutes ableist language. Different preferences may also be influenced by severity along the spectrum of autism. Use inclusive alternatives to ableist language whenever possible. Follow administrative guidelines and mandates for eligibility, reimbursement, or other procedural means of providing services.

Consider the following terminology examples, recognizing that these may change over time based on trends and preferences (see table below; Bottema-Beutel et al., 2021).

Examples of Ableist Terminology to Avoid	Examples of Alternative Terminology That MAY Be Preferred
“at risk for having autism”	“may be autistic”
“high or low functioning”	“high or low support needs”
“deficit” or “impairment”	Use “challenges,” “limitation,” or “disorder.” Some people may acknowledge a “disorder” but not consider it a limitation. Consider describing the communication status rather than using a label.
“nonverbal person,” “nonspeaking person,” or “minimally verbal person”	Describe the communication status and modalities of an individual (e.g., “person who uses gesture and picture symbols”).
“person with neurodiversity”	“neurodivergent person” or “person who is neurodivergent”

Not all individuals and families will have the same preferences regarding terminology or treatment approaches. Some families may want their child to appear “normal” and will want a focus on increasing eye contact, modifying facial expressions, or reducing self-stimulatory behaviors. Others, including many autistic people, may use identity-first language and want to learn about communication effectiveness strategies and training programs to help their communication partners (who may not be neurodivergent) better understand individual differences.

References

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.).

American Psychological Association. (2020). Publication manual of the American Psychological Association (7th ed.). https://apastyle.apa.org/products/publication-manual-7th-edition

Bottema-Beutel, K., Kapp, S. K., Lester, J. N., Sasson, N. J., & Hand, B. N. (2021). Avoiding ableist language: Suggestions for autism researchers. Autism in Adulthood, 3(1), 18–29. https://doi.org/10.1089/aut.2020.0014

DeThorne, L. S., & Searsmith, K. (2020). Autism and neurodiversity: Addressing concerns and offering implications for the school-based speech-language pathologist. Perspectives of the ASHA Special Interest Groups, 6(1), 184–190. https://doi.org/10.1044/2020_PERSP-20-00188

Individuals with Disabilities Education Improvement Act of 2004, 20 U.S.C. § 1400 et seq.