Episode 11: Autism & Intersectionality

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This podcast explores recently published research on a number of different neurodivergent types. This season I am talking about autism, and in this episode I will go over some recent research on autism and intersectionality. Unless otherwise specified, the research I have done for this and all episodes do not include those with intellectual challenges in conjunction with autism characteristics. While I will describe autism characteristics in this episode, I also recognise that every autistic person will experience autism differently, and these are not specific to every person who identifies as autistic.

Suicide comes up in the research here, so if you don’t want to hear about that right now, please wait until the next episode comes out, and mind yourself in the best way that suits you. Some support services will be listed in the show notes.

While researching intersectionality for this podcast, as well as for my own studies, I came across a 2022 article from academics Monique Both and Kristen Gillespie-Lynch, called ‘Come As You Are: examining autistic identity development and the Neurodiversity Movement through an Intersectional lens’. It encapsulates everything I wish to say about this area, and included many enlightening concepts and ideas that hadn’t occurred to me. For that reason, I will read out extracts from this article that will make up the bulk of this episode. The writing is pretty straightforward, and includes wonderfully simple explanations of some complex concepts, making it available for anyone interested in the intersecting identities with autism, not just to academic researchers. I will include some additional reading suggestions at the end for anyone who might want to explore these ideas more fully in their own time.

The following extracts are from ‘Come As You Are: Examining Autistic Identity Development and the Neurodiversity Movement through an Intersectional Lens', by autistic researcher Monique Botha and Kristen Gillespie-Lynch.

(Page 94) Our aim with this paper is to inform an intersectional approach to autism research and advocacy by exploring autistic identity development in relation to the development of other marginalised identities. We do this by integrating literature on intersectionality, neurodiversity, minority stress, and social identity development. Minority stress refers to the additional stress burden which minoritised individuals have to cope with, in addition to the general life stress everyone must process… People with marginalised identities often experience socio-cultural disadvantages which both shape and are shaped by their identities. We aim to explore how oppressions, structural advantage and disadvantage intersect, diverge, and otherwise interact to produce commonalities and differences in the factors that shape identity development for autistic people and people who are marginalised in other ways in order to draw forth strategies for addressing structural inequalities that we can use to improve autism research, practice, and advocacy going forward. By doing this, we hope to highlight that we cannot understand autistic people without recognising their multifaceted identities and the contexts that shape people and communities… It is vital to ensure that the neurodiversity movement does not become another analytical tool for disability and identity that is wrapped up in and reproduces white supremacy, cis-heteronormativity, classism, cisgenderism, or sexism. Emancipation from any system of oppression means working to undo all systems of oppression, because although they are in some ways distinct, they are inseparable, and work to maintain each other.

(Page 95) Psychology has tended to both generalise and universalise experiences, overlooking systemic forms of oppression in general and intersectionality in particular... It has also been responsible for the perpetuation and maintenance of systems of oppression such as racism… homophobia… genderism… and ableism… ; this responsibility necessitates radical change and adjustment. Therefore, in opening this paper, we first want to acknowledge that where we make comparisons, it is not in any way meant to generate false equivalences by overlooking how each identity is shaped by unique social, historical, and cultural factors (i.e., oppressions are not directly comparable, and it is both redundant and unethical to equate the experience of racism and ableism). It is redundant because oppressions, while intertwined in each other, have evolved with unique contexts and historical traumas, meaning that while the surface level outcome from oppression may appear similar (e.g., health disparities), the root of them is not the same because of unique social and cultural contexts. Direct comparisons are unethical because they ignore how one can experience multiple forms of marginalisation… , the unique way marginalised identities compound to create experiences, and lastly, because they can be used to erase the complicity of one minority group subjugating another (racism in the LGBTQI+ community or transphobia in the Disability community), whereby people equate experiencing one form of oppression with another, to silence other minorities. Instead, we aim to highlight the (often-ignored) complexities faced by autistic people who are also additionally disabled, Black, people of colour, gender and/or sexual minorities, or from low-income backgrounds. The literature for autistic people from these communities is sparse… , so it is important to draw from the vast literature that exists elsewhere.

(Page 95-96) We are not the first to point out that exploring intersectionality and neurodiversity in relation to one another can strengthen both while also supporting coalition building... Although Crenshaw’s early work did not explore disability as a dimension of intersectionality, it highlighted a key point that is increasingly recognised in work about autistic identity development… : that marginalised identities are shaped by both domination and collective action to empower those who have been disempowered.

(Page 96-97) Although the idea of neurodiversity has been adopted to varying degrees by other disability communities, for example, stuttering, dyslexia, mood disorders, anxiety, ADHD, intellectual and learning disabilities, and schizophrenia, who should be included within the neurodiversity movement remains highly contested... Ongoing debates about who the neurodiversity movement represents demonstrate the immense assumptions that go into attempting to make identity categories more homogenous. Attempts at homogeneity are often carried out by naturalising differences or describing them as expressions of biological destiny... Baron-Cohen is not alone in attempting to naturalise autism. Autistic self-advocates often embrace essentialist conceptions of autism, describing autism as arising from biological causes and reflecting shared brain differences... While the idea that autistic people share a “different type of brain” from others is intuitively appealing, attempts to find brain differences that are consistently associated with autism have been far from successful... Inconsistencies in the brain imaging literature are unsurprising given the vast diversity of autistic people and the limited number of people represented in early brain imaging studies. Recent large-scale collaborations suggest that small and individualised differences in the ways that the brains of autistic people are structured may only become apparent when the fact that autistic people are very diverse is accounted for in analyses... The lack of a clear or singular biological basis for autism has led an increasing number of researchers to assert that the diagnostic category autism is, at least partially, socially constructed… ; that is, autistic people are grouped together by very real characteristics which have been assigned meanings that change across time and cultures. Thus, even if the focus on genetic etiology provides a specific set of genes that are predictive of autism (which it has not yet), one still could not understand autism without understanding how it is socially constructed. This emerging recognition that autism is, at least partially, socially constructed moves our understanding of autism closer to intersectionality theory. As Crenshaw… and others have noted, just because categories are socially constructed does not mean that they do not have a powerful impact on people’s lives (e.g., money is a social construct that has a very powerful influence on people’s lives).

(Page 98) Intersectionality takes into account how the complex and multifaceted nature of people’s identities, including other disabilities, race, ethnicity, gender, sexuality, and class, impact experiences and development across the lifespan. Diagnoses and support can hinge upon these intersecting identities to produce unique, intersecting, interactional, and additive spaces of marginalisation. Autistic people of colour, women, trans and/or non-binary people, and people with fewer resources are underdiagnosed, under-served, and underrepresented... Biases contribute to these inequalities. For example, autistic females may be under-identified partially because they express autism differently than males; females may exhibit greater social motivation and/or less obvious “restricted and repetitive” behaviours and interests than autistic males… ; yet this is not suggestive of a “female autism phenotype” necessarily, and instead a failure of research to truly appreciate the vastness of the autistic community across intersections of gender, meaning that when we think of “autism,” we tend to only think of cisgender boys and men. In the United States, where Black children are more likely to be labelled with stigmatised and racially charged diagnoses than white children… , Black children are much more likely to receive a stigmatising diagnosis like conduct disorder prior to receiving an autism diagnosis than white children... Some, but definitely not all, racial/ethnic differences in access to an autism diagnosis in the United States are attributable to differences in socioeconomic status... Similarly, in the United Kingdom, children of ethnic minorities and/or children from less educated families were less likely to receive an autism diagnosis than others.

(Page 99) “Minority stress” refers to the cumulative effect of many types of social stressors relating to the social marginalisation experienced by minority groups, in addition to the everyday stress of life experienced by the general population... This excess stress burden can result in health inequalities due to chronic stress strain… The minority stress model distinguishes between distal and proximal minority stressors... Distal stressors are events such as discrimination, victimisation, or stigmatisation, while proximal stressors are internalising processes involved in processing and responding to these stressful events, including concealment of a minority identity, the expectation of rejection which minorities can become embroiled in, and internalisation of stigma.

(Page 99-100) Importantly, the minority stress model also focuses on coping strategies that minorities and their communities utilise to cope with the additional stress burden... Meyer notes that a focus on individual and collective coping strategies is rooted in social identity theory... Social identity theory starts from an obvious supposition that people want to feel good about who they are, and describes the strategies people use to accomplish this. These include individual strategies aimed at social mobility, which involve separating oneself from the marginalised group so as to realign themselves (like the whitening Black people in Brazil were encouraged to demonstrate) and collective strategies aimed at social change in which one associates more with the marginalised identity, forming a collective or group which reframes an identity to be positive (like the neurodiversity movement). Strategies marginalised groups can use to enhance their collective self-esteem include redefining what is desirable, being selective in which out-groups they compare themselves to, and/or directly advocating for justice.

(Page 100) Interestingly, both higher outness (disclosure to family, peers, colleagues, and healthcare workers) and higher concealment (masking autistic behaviours) were associated with significantly worse well-being in this cross-sectional analysis––a finding aptly clarified in a qualitative study where an autistic participant said that when you are autistic, you are “damned if you do, or damned if you don’t”... This “double-bind” highlights that autistic people cannot escape minority stress by simply attempting masking, hiding, or withholding disclosure, because that has its own unique cost… Like autism research, early research about sexual and gender minorities did not examine intersectionality... More recent work has revealed some evidence that LGBTQ+ people of colour may face compounded discrimination relative to white LGBTQ+ people and that this is both intersectional and additive... This means that there can be unique interactions between minority stress from different identities, but also overall that increasingly minoritised status confers increasingly higher stress burdens... For example, a qualitative study with 19 Black lesbians showed that they rarely discussed sexism without also addressing racism... A study with 1,093 transgender people in the United States revealed that trans people of colour, younger trans people, and people of lower socioeconomic status reported heightened discrimination based on their gender identity relative to white trans people... Family and peer support and pride in one’s trans identity were all associated with better mental health.

(Page 101) These findings support additive, interactional, and intersectional effects of multiple marginalised identities. Collectively, these findings point to the need for autism research to not only address the (many) identities which autistic people may have individually but also to consider unique intersections that these identities combine to form, including the additive and interactional impacts thereof… Russell and Fish (2019) suggested a “developmental collision” wherein historical improvements in acceptance have encouraged LGBTQ+ youth to come out earlier, which means that young people are now coming out during a developmental stage when the pressure to fit in is particularly intense and coping mechanisms are weak. In his early work, Meyer (2003) pointed to another surprising set of findings which did not align well with his model, known as the Black-white mental health paradox. Despite growing up in a very racist society…and being subject to high levels of minority stress, Black people in the United States experience similar or lower rates of mental health difficulties than white people. For example, a study with 6,688 non-Hispanic white and 4,584 Black participants revealed that Black participants were less likely to be diagnosed with a range of mental health conditions than white participants (e.g., depression, anxiety, and social phobia... However, Black participants, particularly women, were more likely to experience PTSD. Unexpectedly, evidence of fewer mental health diagnoses was apparent among both Black men and women and, adjusting for socioeconomic status, increased the Black mental health advantage. Possible explanations for the advantage include habituation to heightened stress…and increased community support... Perrin et al. (2020) developed a minority strengths model to explore the varied strengths that minority communities may use to withstand stigma, including social support from family and peers, pride in one’s personal identity, and collective identity. Although none of the potential mechanisms put forth to explain the Black-white mental health paradox have adequate evidence to be conclusive, evidence suggests that racial/ethnic socialisation may prepare Black youth to cope with anticipated stressors... This process itself, while protective, is disturbing because white supremacy should not be something families should need to prepare future generations for; in essence, this should not be the world Black people are born into… Perhaps due to a lack of intersectional consideration, the stereotypes associated with autism (as a white, male, cisgender phenomenon), and because of white supremacy, little literature has addressed identity development in Black autistic people or other autistic people of colour. Intersectionality demands understanding that autistic people also have racial/ethnic identities which they are racialised into through social and cultural processes. Racial/ethnic identity is a multidimensional construct that includes one’s attitudes and thoughts about racial/ethnic group memberships and the processes by which one arrives at them... Typically, racial/ethnic minorities are born into a community of others like them, whereas for sexual and/or gender minorities and autistic people, other people in the family might not share their identities. This may have important implications for material outcomes, including for Black and/or other people of colour who are autistic. The communities and networks racial/ethnic minorities are born into may protect youth from some of the effects of oppression, as a collective way of resisting white supremacy... Warm and close relationships with family have been associated with more well-developed racial/ethnic identity.

(Page 102) Although evidence remains insufficient, racial/ethnic socialisation may be a key factor contributing to the Black-white mental health paradox––the collective agency and resistance of communities who have been combating white supremacy and imperialism for centuries… The First Nations communities of Canada are diverse, with radically different languages and belief systems and histories of interactions with neighbours and colonisers. Chandler and Lalonde (2009) hypothesised that a pattern was hidden under apparently random differences in suicide rates across communities, or that suicide rates were lower among First Nations communities that had developed strategies to promote cultural continuity in the face of change (e.g., cultural centres and self-governance). This was based on the insight that identity development involves both a series of ruptures with the past and a desire to believe in a continuous sense of self. To be able to envision a future after these ruptures, he believed that young people need something stable to return to, or community traditions. Data from 29 tribal councils revealed that First Nations communities that had lost touch with their cultural traditions had much higher rates of youth suicide than communities that had maintained an empowered collective identity, and that differences were not attributable to variations in poverty.

(Page 103) Like autism, homosexuality and transsexuality were once considered diagnostic categories. Homosexuality was removed from the DSM in 1973, seven years before autism and gender identity disorder (or incongruence between one’s assigned sex at birth and one’s gender) joined the DSM as their own diagnostic categories... Also, like autism (and unlike race-ethnicity), identities as sexual and gender minorities are not necessarily visible (further they are made invisible by societal structures); this puts them on a spectrum of concealability (which as discussed earlier has implications for health and well-being). Goffman (1963) asserted that people with visible stigmas manage situations, while people with invisible stigmas manage information about themselves.

(Page 103-104) Research about autistic identity development is relatively new; for so long autism was categorised as antithetical to having rich social worlds. Thus far, it has generally ignored intersectionality. Samples are usually predominantly white... Particularly in earlier work, race/ethnicity was often not even reported... Autistic people face challenges making meaning of their diagnosis or neurology within a neurotypically-oriented world; this often involves balancing how one sees themselves versus how they believe society as a whole sees them, which are often at odds with one another.

(Page 104) Support from others is often associated with more positive perspectives about being autistic… The primary benefit of learning one is autistic is the potential to connect: to the self, to people, to support, and to the world. Learning one is autistic provides the chance to understand the self as autistic and not as a broken neurotypical, which can empower people to explore and nourish their own self-identities. Knowing one is autistic can open opportunities for connections with other autistic people…who might share similar norms and values with regard to sociality. This knowledge can help people understand the different needs they might have. Self-understanding is often the first step toward seeking the support needed to fully experience society and life. By recognising oneself as autistic and as having autistic needs, one can connect with communities that can help guide one towards ways of fulfilling these needs. Realising one is autistic can provide connection to autistic communities, or invisible autistic infrastructures full of knowledge about navigating neurotypical society and systems to achieve desired outcomes... Autistic people often feel more comfortable expressing themselves around other autistic people... Autistic people find community by sharing experiences with other autistics… Autistic identity development is also often made difficult in that it may already be happening prior to autistic people having words for it; parents might withhold the information, the person might not have a diagnosis or enough information to know that they are autistic, and yet they may still internalise societal messages about their behaviour. Indeed, autistic people have described an enduring sensation of being bad, wrong, or out of place before having the words to be able to describe their autistic-ness... Many autistic people do not receive their autism diagnosis until adulthood... The experience of receiving an autism diagnosis as an adult often has a strong and complex emotional impact, which can include both relief and shock... By providing a new interpretive lens, an autism diagnosis can confer self-understanding, self-compassion, and coping strategies, yet also involves a complete overhaul of the more silent processes of identity building, which have been happening in the background through the imposition of prevalent social and cultural norms. Many people diagnosed as adults interpret autism as a positive difference. However, people also describe difficulty adjusting to their new identity, increased susceptibility to discrimination, feelings of low self-worth, and grief for their pre-diagnosis self...

(Page 105) While the stereotype of autism is one of social withdrawal, the vibrant history of autistic people coming together to support one another defies this notion... While there is a dearth of literature focusing on autistic community or autistic culture, what does exist points to a network of like-minded people who are determined to secure a better future for autistic people... Ryan Idriss (2021) describes what they observed in an ethnographic project investigating an autistic community group as an enduring “autistic sociality” of people coming together to build an “invisible autistic infrastructure” of support. This is something that confounds deficit-based, reduced Theory of Mind understandings of autism which construct autistic people as inherently socially disordered or withdrawn. Like any other minority community, regardless of how little it is acknowledged in formal systems, the autistic community has created cultures and “invisible” infrastructure which works constantly to meet the needs of this minority group.

(Page 106) This reflects what Sinclair (2010) referred to as the overwhelming heterogeneity of autistic people even in autistic spaces; friendship is about more than simply a collective identity, but collective identity can build a bridge towards it. One participant described how, while specific autistic people are his friends, all autistic people are his comrades because autistic people share a collective struggle to advance the rights of all autistic people to ensure they have access to basic human rights... Furthermore, autistic individuals specifically mentioned the intersectionality of this struggle, including the constant fight to have non-cisgender people, women, Black autistic people, indigenous people, and other minorities recognised as autistic, as well as the solidarity that the neurodiversity movement can provide by uniting with other minority movements... This intersectional focus reflects that people do not have a single identity, or a single community, and instead embody, juggle, and experience multiple ones, often at the same time. Autistic spaces, identities, and communities often intersect with LGBTQ+ spaces, identities, and communities. While clinical literature seeks to problematise autistic expression of gender as manifestations of “restrictive and repetitive behaviour, “going as far as to seek to restrict autistic people’s access to gender affirmation-based care, autistic people often have a much more “radical” stance to gender, which is inseparable from their autistic identity... Some autistic people who are non-cisgender, specifically understand their gender through their autistic identity, which is how the term “AutGender” was conceived; it is not that autism is necessarily their gender, but rather that being autistic relates heavily to their conceptualisation of their own gender and wider constructs of gender. This is the case even for some cisgender autistic women who do not consider themselves to be women in neurotypical ways, but identify heavily with autistic expressions of womanhood. This is highlighted in the work of Pyne (2021) who asserts that, in contrast to the clinical literature which constantly tries to separate (and dismiss or deny) interrelations of autism and gender, autistic people often understand them as inseparable and co-constitutive. Autistic identities provide an opportunity for radicalising traditional notions of gender and sexuality, and while neurotypical clinicians may put this down to “social confusion” or a failure to “get” social norms, instead it may point to the arbitrary nature of such dichotomising norms. Autistic communities and cultures thus become a way of disrupting the culture of “normality.”

(Page 106-107) Much like other minority communities, the autistic community can perpetuate the same oppressions; white supremacy… , discrimination against Black autistic people or autistic people of colour, including by tokenising them or asking them to ignore their other identities to prioritise autism-focused advocacy priorities… , ableism, cis-heteronormativity… , sexism… , jockeying for status, infighting and “purity policing”… are all still apparent. Worse, the idea of autism has, in some cases, become a shield to hide behind in perpetration of such white supremacy and wider bigotries, from defence of micro-aggressions against minorities, including other Black, gender minority, or sexual minority autistic people… , to full blown legal defences in cases of extreme violence such as the Charleston shooting, that white autistic people do not know better by virtue of their autism... Furthermore, the idea that autistic people lack empathy facilitates the conflation of autistic people with violence or aggression (a stereotype which generates great danger for autistic people of colour, especially for Black autistic boys and men when in interaction with police). Autistic people have pointed out that this sort of violence is blamed on autism to prevent society having to deal with white supremacy and toxic masculinity... While social, cultural, and historical structures both in policy and research have facilitated and created an environment where autistic people are regularly (in)fighting for a single seat at the table of the Establishment in order to be listened to, instead, we should act jointly to abolish the status quo and Establishment in its entirety. You cannot challenge neuronormative without working to undo cisheteronormativity or white supremacy, and ignoring the many identities of autistic people will result in neurodiversity being a tool for upholding other systems of oppressions. This means acknowledging, accounting for, celebrating, and appreciating the vastness of autistic people and their identities when creating research or policy.

(Page 107) Intersectionality teaches us that we must understand differences within the autistic community if we wish to help all autistic people experience the dignity they deserve. Dekker (2020), who founded InLv, where the idea of neurodiversity emerged, wrote that the neurodiversity movement was never intended to exclude or shame autistic people who view autism negatively and/or wish they are not autistic. As Chapman (2021) suggested, the neurodiversity movement should embrace autistic diversity while seeking empirical support for its central premise that diversity improves functioning (e.g., stronger evidence that more diverse groups are more creative but also experience more conflict…) To understand autistic identity development, including potential impacts of the neurodiversity movement, we must study individual and group successes and struggles in relation to shifting social contexts. Research should examine socialisation and cultural factors that could explain unexpected relationships between minority stress and outcomes, ideally with longitudinal mixed-methods design. Such work should assess structural and everyday stigma, family socialisation practices and autistic cultural traditions in relation to mental health outcomes, but also positive characteristics we know to be important for development, like authenticity, pride, belonging, and collective advocacy. To honour the cultural traditions of the neurodiversity movement, we must use an intersectional lens to become more flexible in our understanding of positive autistic identity development and strategies to promote it.

Thank you for listening. This concludes the first season of The Neurogender Podcast. Next season will examine academic research on the gendered aspects of ADHD, the extremely medicalised name for Attention-deficit/hyperactivity disorder. I look forward to tackling this with you and hearing your thoughts on the topics that come up.

If you haven’t already, please review the podcast on the platform you listen from and share it with someone you think might be interested. The research I have used in this episode can be found cited in the show notes, and a full transcript will be available at www.theneurogenderpodcast.com. To receive updates on the podcast, and be the first to hear when the next season launches, please join the mailing list in the show notes. I am Alexa and this has been The Neurogender Podcast.

Show Notes:

Samaritans Ireland and UK – 116 123

Papyrus (people under 35) – 0800 068 4141

Autistica suicide help page - https://www.autistica.org.uk/what-is-autism/signs-and-symptoms/suicide-and-autism

BelongTo Ireland: https://www.belongto.org/

LGBT.IE Ireland: https://lgbt.ie/

National Autistic Society (LBGTQ Branch): https://www.autism.org.uk/what-we-do/branches/lgbtq-online-branch

Podcast Mailing List: https://mailchi.mp/e1e4c4603d1c/sign-up-for-new-episode-email-alerts

TENI - Transgender Equality Network Ireland: https://teni.ie/

The Transgender Issue: An Argument for Justice by Shon Faye: https://www.amason.co.uk/Transgender-Issue-Argument-Justice/dp/0241423147

Twainbow (US): https://www.twainbow.org/

Webinar – ‘Neurodivergent & LGBTQIA+: The ‘double-rainbow’ intersection’: https://www.youtube.com/watch?v=Jny3KPoxXIc&ab_channel=NeurodiversityWeek

References:

Botha, M. and Gillespie-Lynch, K. (2022) 'Come as You Are: Examining Autistic Identity Development and the Neurodiversity Movement through an Intersectional Lens', Human Development, 66(2), pp. 93-112.

Additional Reading Suggestions:

Ahmed, S. (2017) Living a feminist life. 1 edn. Durham, [North Carolina];London, [England];: Duke University Press.

Annamma, S. A., Connor, D. and Ferri, B. (2013) 'Dis/ability critical race studies (DisCrit): theorising at the intersections of race and dis/ability', Race, ethnicity and education, 16(1), pp. 1-31.

Iwasa, M. et al. (2022) 'Twenty‐year longitudinal birth cohort study of individuals diagnosed with autism spectrum disorder before seven years of age', Journal of child psychology and psychiatry, 63(12), pp. 1563-1573.

Lewis, C. J. and Arday, J. (2023) 'We’ll see things they’ll never see: Sociological reflections on race, neurodiversity and higher education', The Sociological review (Keele), 71(6), pp. 1299-1321.

Lovelace, T. S. et al. (2022) 'Missing from the Narrative: A Seven-Decade Scoping Review of the Inclusion of Black Autistic Women and Girls in Autism Research', Behavior analysis in practice, 15(4), pp. 1093-1105.

Shamieh Law (2024) ADHD and Driving. Available at: https://shamiehlaw.com/adhd-and-driving/ (Accessed: 10/09/2024).

Smith, J. et al. (2022) 'They were Saying that I was a 'typical Chinese mum': Chinese Parents' Experiences of Parent-Teacher Partnerships for Their Autistic Children', Journal of autism and developmental disorders, pp. 1-13.

Steinbrenner, J. R. et al. (2022) 'Patterns in reporting and participant inclusion related to race and ethnicity in autism intervention literature: Data from a large-scale systematic review of evidence-based practices', Autism : the international journal of research and practice, 26(8), pp. 2026-2040.