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From autism to the plural ‘autisms’: evidence from differing aetiologies, developmental trajectories and symptom intensity combinations

Published online by Cambridge University Press:  21 March 2025

Paul Whiteley Open the ORCID record for Paul Whiteley [Opens in a new window] ,
Kevin Carr ,
Paul Shattock ,
Malcolm Hooper ,
Carol Stott Open the ORCID record for Carol Stott [Opens in a new window] ,
Karl Hardy  and
Ben Marlow
Paul Whiteley*
Affiliation:
ESPA Research, Sunderland, UK
Kevin Carr
Affiliation:
ESPA Research, Sunderland, UK
Paul Shattock
Affiliation:
ESPA (Education and Services for People with Autism), Sunderland, UK
Malcolm Hooper
Affiliation:
ESPA Research, Sunderland, UK ESPA (Education and Services for People with Autism), Sunderland, UK
Carol Stott
Affiliation:
ESPA Research, Sunderland, UK BeginningwithA, Cambridge, UK
Karl Hardy
Affiliation:
ESPA (Education and Services for People with Autism), Sunderland, UK
Ben Marlow
Affiliation:
Synapse Centre for Neurodevelopment, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
*
Correspondence: Paul Whiteley. Email: [email protected]
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Abstract

Autism spectrum disorder is defined by the presence of sustained problems in areas of social cognition and social understanding alongside repetitive and/or restricted patterns of behaviour. Behavioural presentations and developmental trajectories in autism are highly heterogeneous. For most, characteristics variably continue across the lifespan, and, for many, they overlap with numerous overrepresented comorbid combinations spanning behavioural, psychiatric and somatic domains. The current autism diagnostic systems (DSM-5, ICD-11) reflect this heterogeneity, focusing on discerning different assistance needs and symptom severity combinations. An emerging view on the pluralisation of autism – ‘the autisms’ – based on different severity levels and different developmental trajectories is gaining popularity, bolstered by the introduction of the grouping ‘profound autism’ and observations of non-persistence of autism for some. We advance the case for expanding the definition of the plural autisms based also on the numerous different aetiological routes that can lead to autism. Various genetic conditions, susceptibility to infectious agents, non-infectious environmental exposures and immune-mediated occurrences have all been observed to culminate in a diagnosis of autism. As a triad, aetiology, presentation intensity and developmental trajectory offer new ways to classify the autisms, with potentially important implications for research and practice.

Keywords

Autism spectrum disorderenvironmentgeneticsheterogeneitythe autisms
Type
Feature
Information
The British Journal of Psychiatry , First View , pp. 1 - 7
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Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Royal College of Psychiatrists

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