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October 12, 2023

Language and Neuro-Divergence

The use of person-first language, such as “person with autism,” to describe neurodivergent individuals has been a topic of debate in recent years. While some may argue that it is a respectful way to refer to neurodivergent people, I would argue that it pathologizes perfectly natural neurology, and is responsible for stealing autonomy away from the neurodivergent individual.

Historically neurodivergent people have been ostracized, and institutionalized, and their differences viewed as disordered. However, with a better understanding of neurology and changes in diagnostic criteria, we are now able to perceive divergent characteristics with more clarity and accept divergence as a naturally occurring part of human diversity. The continued use of person-first language, particularly in medical and clinical settings, has pathologized neurodivergence and has led to discriminatory stereotypes and ableist language. Autistic people (in general) prefer identity first language as one cannot separate oneself from their neurology. The “with (insert neuro type)” implies something to be cured. Equality starts with language, and therefore unless one uses the phrase “person with neuro-typicalism’’ then, for the sake of equality, one should not do it for any other neuro-type.

The impact that pathologizing language has had on the neurodivergent community is profound, and it has led to discriminatory stereotypes and ableist language and slurs. Using person-first language to describe neurology automatically leads to bias, even if the bias is unconscious, and impacts how neurodivergent individuals are treated in schools, workplaces, health care, and society at large.

We’ve all heard the phrase “Words Matter.” However, people rarely fully understand just how inequitable the language they use is, and the impact it can have on others.  When we talk about autism in the sense that someone “has it,” we make the “it” sound as though it is a removable item, an accessory, or a deficit which a person needs to overcome. When we say “person with autism” we are, without realizing it, describing how that person’s neurology may impact us, and not how it impacts them. The continued use of person-first language also takes autonomy away from the autistic community as they reject that phrase time and time again but are spoken over and ignored because others see them as a person “with something” and therefore they are not taken seriously. Autistic people are trying to lead the change on this, but allyship from institutions is going to be necessary. The desire for progress in the way in which neuro-divergence is spoken about is completely ignored when the desire to celebrate diversity as intrinsic to existence and use the logic that you cannot separate a person from their neurology is disregarded.

Unfortunately, this pathologizing of neuro-divergence, rather than embracing the array of neuro-types that humans come with, leads to ableist discrimination. Person-first language impacts how autistic people are treated in schools, workplaces, health care and society, as though a person “with” a neuro-divergent brain is less than a neurotypical peer, and not equal to their peer. The autistic community is beyond awareness campaigns and is fighting daily for an equitable life, and to celebrate their autistic traits with pride. Yet still, people in educational institutions and clinicians are trained to refer to autistics as people with autism, and rarely ask autistic people how they would like to be described.  Much has been written on this topic by many autistic people, but still, the preference for identity first language is being ignored as allistic people push against it.

Imagine being perfectly capable of making your own decisions, of being bright, smart, funny, intelligent, and competent, but being repeatedly told that you do not have a say in how you are identified, and ultimately how you are treated by society at large. This is essentially what the autistic community faces when their desire to celebrate their existence and use the logic that you cannot separate a person from their neurology. Therefore, the desire for progress in the way in which neuro-divergence is spoken about is completely ignored. The argument for person-first language prevails, particularly in medical/clinical professions.  Autism does indeed need to be diagnosed, and so it has slipped into the category of a condition. Therefore, clinicians use and teach person-first language. We would, of course, say “a person with cancer” after a cancer diagnosis, however, cancer is something that needs to be cured and overcome, and autism does not fit into this category.

Being autistic is an identity, in the same way, that being neurotypical is. You cannot remove a person’s neurology, yet we are still overlooking, and ignoring the autistic experience, perspective, and preferred choices, in favour of the allistic, neuro-typical choice of person-first language. If we use person-first language, solely on the basis that autism needs a diagnosis, then society will always see neurodivergence as something in need of curing or overcoming. It is time for a societal shift, and hopefully, with more autistic people entering the medical and clinical professions, this will come with time, but for many autistic children and adults, this shift towards celebrating neurodiversity and who they are cannot come soon enough.

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Lisa Spencer Cook  |  Contribution: 675