How important are conceptual boundaries?

Recently, a couple of interesting items about autism were posted. One was a NYT podcast, and the other was an opinion piece in STAT.

Specifically, the unintended consequences of the movement from a categorical diagnostic model (Autistic Disorder and Asperger’s Disorder) to a spectrum model (Autism Spectrum Disorder, aka ASD).

---

In the NY Times podcast episode, I saw interesting parallels with the conflation of addiction with Substance Use Disorder (SUD) and alcohol and other drug problems.

The definition of autism is expanding, and the whole tent basically is getting bigger. And it’s being recognized as a single tent. You know, before, I think there was recognition like these things are related to each other. Now it’s being viewed as one thing, one group of people. And sort of in parallel to the changes that we’ve been talking about, there was also the growth of what became known as the neurodiversity movement. This movement was really about beginning to view autism through a different lens and rejecting the idea that it was a disease in need of a cure.

Abrams, R. (Host). (2025, November 24). The Autism Diagnosis Problem [Audio podcast episode]. In The Daily. New York Times.

We’ve seen similar patterns in recovery and SUD advocacy, rejecting the idea that addiction is a disease, sometimes with overlap between neurodiversity advocacy and SUD advocacy.

---

The movement toward a spectrum has been good for some and less good for others. It’s expanded services and research for the mild and moderate forms, but limited access for people with more severe forms:

while broadening the tent did expand access to help for a huge number of people, it also brought in many different kinds of people with many different kinds of needs. And that has raised these tensions over which of those needs get prioritized in a world where there’s a really limited pile of resources to help. And there’s two really big areas where we see this, and the first is schools. I spoke with a lot of families who had kids with severe autism who said that as the number of kids with less severe disabilities has increased so much over the years, it’s made it harder to access school services that are actually geared towards their kids, their kids needing a lot more help and a lot more support to get through the day.

. . . We’ve seen a really similar thing play out in terms of autism research. Even as the amount of money that has gone towards researching autism has grown substantially year-over-year, we’ve actually seen a decrease in studies that are focused on people with the most severe impairments.

Abrams, R. (Host). (2025, November 24). The Autism Diagnosis Problem [Audio podcast episode]. In The Daily. New York Times.

We’ve seen an explosion in lower intensity SUD services over the last decade that has probably greatly benefited people with mild to moderate SUD, but it’s hard to know because a lot of published research fails to differentiate between addiction and other SUDs and often focuses on problems related to a single class of drugs (like opioids), where addiction often involves multiple drugs.

---

It has also led to an advocacy movement where people with milder forms (and, probably, other forms of neurodiversity) advocate on behalf of the whole spectrum, challenging the parents and caregivers of people with severe forms.

parents of the kids with severe autism who are now at odds with activists who are self-advocates—who are autistic people themselves—who say, “You know, we have a shared experience as members of the autistic community that you can’t understand.” And I think that is a really difficult dynamic that has played out in this community: who gets to speak for the community when there are such broad needs, and the people on the most severe end of the spectrum often cannot speak for themselves.

Abrams, R. (Host). (2025, November 24). The Autism Diagnosis Problem [Audio podcast episode]. In The Daily. New York Times.

We see similar patterns in recovery and SUD advocacy, where the movement initially sought to make recovery from addiction visible and promote people in recovery as community assets. Over the past decade, large segments of the movement have evolved into allies and people who use drugs advocating on behalf of people who use drugs.

---

An article in STAT points to the amorphous boundaries of neurodiversity as a problem for the category as a useful social movement, because it risks being too inclusive, and social movements require exclusionary boundaries to differentiate those within the social identity from those outside it.

The movement also relies on there being others, in this case neurotypicals. Therefore, neurodiversity has to be defined by those who have been diagnosed as or self-identify with conditions such as autism, ADHD, Tourette’s syndrome, bipolar disorder — anything considered a neurological variation resulting in behavioral differences outside of society’s norm — precisely so those who have not been diagnosed as or self-identify with these conditions can be the other.

All social movements need an other because it helps to reinforce one’s own identity — if the other is X, Y, and Z, then I know I am not X, Y, and Z. And if the other is seen as responsible for doing things that make your own life difficult, then they become the target of your frustration (which though just at times, can also become problematic). It’s this opposition that cements neurodiversity as a social movement.

Pemment, J. (2025, November 24). The definitional problems at the heart of the neurodiversity movement. STAT.

‌Overly broad boundaries that creep into “normalcy” risk undermining the connective cement that coheres groups of people in a movement. We’ve previously written about the problems with SUD as a category and that recovery definitions like NIAAA’s produce “recoveries” that have little in common with reference to the problem or its resolution.

---

Finally, what happens when the very inclusive movement achieves critical mass?

Once it dawns on everyone that there is an infinity of neurodiversity within neurotypicals, the movement will lose its other and so will no longer be a social movement. Likewise, if by showing people through social media what neurodiversity looks like, more people realize that they have these traits, the neurodiverse will move from being a minority to a majority, which itself might be a logical ending for the movement, because the other has to be seen as the majority. The natural ending for any critical social movement should be that equality has been achieved.

Pemment, J. (2025, November 24). The definitional problems at the heart of the neurodiversity movement. STAT.

The salient question is, has equality been achieved?

For who?

Have those on the severe end of the spectrum achieved equality under these circumstances?