Autism spectrum disorder (ASD) continues to spark debate—not only among clinicians but also within the autistic community. Is autism a disorder requiring treatment, a disability that calls for accommodations, or simply a different way of being in the world? This question touches on more than just labels. It affects how we understand the lived experiences of autistic individuals and how we approach the medical challenges they face.
Autism is characterized by difficulties in social interaction, communication, and repetitive behaviors, but these are only part of the picture. Autistic individuals often face a range of co-occurring conditions, including mental health disorders like anxiety and depression, attention-deficit/hyperactivity disorder (ADHD), epilepsy, and metabolic disorders such as obesity, diabetes, and cardiovascular disease. These health challenges, which significantly contribute to higher rates of premature mortality, demand attention—but not in a way that shames or pathologizes autistic people. Instead, we need to understand these medical issues holistically and explore innovative ways to treat them while respecting the autonomy, dignity, and rights of autistic individuals.
The Debate: Disorder, Disability, or Difference?
For some, autism is seen primarily as a disorder that needs treatment. From this perspective, the challenges it presents—especially in more severe forms—can severely limit communication, social engagement, and independence. In these cases, medical interventions and therapies are often necessary to improve quality of life and reduce difficulties.
Others view autism as a disability that requires societal adjustments and accommodations. The focus here is on supporting individuals by creating an inclusive environment, whether through specialized education programs, workplace accommodations, or social services. This perspective acknowledges the challenges of autism while emphasizing that autistic people can thrive when provided with the right support.
Others advocate for seeing autism not as a disorder or disability but as a natural variation in human neurobiology. Proponents argue that society should focus on celebrating and accommodating neurodivergence, emphasizing the strengths of autistic individuals, such as creativity, attention to detail, and problem-solving abilities. This view pushes back against medicalizing autism and instead encourages an embrace of neurological diversity.
Mitochondrial Dysfunction: A Key to Understanding Autism?
One area of research that offers new insights into autism and its related health conditions is mitochondrial dysfunction. Mitochondria, often referred to as the “powerhouses” of cells, are essential for energy production, particularly in energy-demanding organs like the brain. Many scientists now believe that mitochondrial dysfunction plays a key role in autism, affecting brain function and contributing to the range of co-occurring conditions seen in autistic individuals.
Mitochondrial dysfunction can lead to impaired energy production in the brain, which may help explain the neurological and psychiatric symptoms that often accompany autism. For instance, conditions like anxiety, depression, and cognitive challenges can arise when the brain’s cells do not function optimally. Mitochondrial dysfunction is also implicated in epilepsy, a condition that affects up to one-third of autistic individuals. Understanding this underlying issue offers a new way to think about how these diverse conditions are connected, helping to unify the seemingly disparate symptoms seen in many autistic individuals.
Metabolic conditions, such as obesity, diabetes, and cardiovascular disease, are also thought to be linked to mitochondrial dysfunction. When the body’s energy systems are disrupted, metabolic regulation suffers, leading to the development of these chronic health issues. This connection helps us understand why autistic individuals are at higher risk for metabolic disorders and why they experience premature mortality at higher rates.
Person-First vs. Identity-First Language
The language we use to describe autism is also a matter of debate. Some advocate for “person-first” language, such as “person with autism,” to emphasize that autism does not define the individual. Others prefer “identity-first” language, such as “autistic person,” asserting that autism is an integral part of who they are. Both perspectives have merit, and it’s important to respect individual preferences. What matters most is listening to people and allowing them to express their experiences in the language that feels right to them.
The Hidden Burden of Mental and Physical Health Conditions
While some argue that autism is simply a difference rather than a disorder, the co-occurring health conditions that often accompany it present significant challenges. In addition to mental health disorders such as anxiety and depression, autistic individuals are at increased risk for ADHD, epilepsy, and other neurological conditions. These challenges often go untreated or misdiagnosed, partly because the complexities of autism can mask underlying issues.
But the burden doesn’t end with neuropsychiatric disorders. Metabolic conditions like obesity, diabetes, and cardiovascular disease are also common among autistic individuals. Mitochondrial dysfunction may help explain this higher prevalence, but these issues complicate healthcare for autistic people. Unfortunately, many healthcare providers are not adequately trained to recognize the unique needs of autistic patients, leading to inadequate treatment and missed diagnoses.
These combined physical and mental health challenges are a major contributor to the higher rates of premature mortality in autistic individuals. Studies show that autistic people are more likely to die from conditions like heart disease or suicide, and addressing these risks requires a concerted effort to improve both healthcare and social support systems.
A Call to Action: Addressing Health While Respecting Dignity
How do we navigate the balance between addressing these health concerns and respecting the rights and autonomy of autistic individuals? We need a holistic approach that treats the medical issues autistic individuals face without reducing them to a diagnosis. This means creating more accessible healthcare environments, improving provider training, and offering treatments tailored to both mental and physical health.
At the same time, we must always respect the independence, autonomy, dignity, and preferences of individuals. Whether someone views autism as a disorder, disability, or simply a difference, their perspective matters. Healthcare and social services must be designed in a way that supports individuals without stigmatizing them or imposing unwanted interventions.
Understanding Autism in All Its Complexity
Autism is a complex condition that cannot be easily categorized. Whether we view it as a disorder, disability, or difference, the health challenges faced by many autistic individuals are real and demand attention. The growing recognition of mitochondrial dysfunction as a key player in autism offers hope for better understanding and treatment of the many co-occurring conditions that affect this population.
By addressing the medical challenges while respecting the dignity and autonomy of individuals, we can create a healthcare system that supports everyone in thriving—whether they are neurotypical or neurodivergent.
