The evidence is evolving - So our practise should evolve too!

In recent years, our understanding of autism has changed significantly. Not so long ago, autism was often approached through a deficit-focused lens - centred on what a person "couldn't do" or needed to change. Today we have a much richer understanding of the diversity within the spectrum, and of the many different ways autistic people perceive, feel, learn and relate to the world around them.

From my perspective, Coni - Speech Pathologist, I want to share what's changed, what the evidence says, and how that's reshaping the goals I set in therapy along with the whole team at Playful Paediatrics.

What's changed?

We recognise far greater diversity of profiles within the spectrum, rather than a single "type" of autistic person.

More people who were historically under-diagnosed are now being identified, including girls, women and adults - partly because diagnostic criteria were originally built around observations of young boys.

We've moved towards more respectful, person-centred practice, rather than interventions designed to "correct" behaviour.

And perhaps one of the most important shifts: the goal should no longer be for an autistic person to "appear less autistic." The focus is on supporting participation, wellbeing, autonomy and quality of life - by adapting the environment so families, schools and the broader community can support participation and build on strengths. Educating parents and carers is central to understanding these differences and supporting learning and development from there.

And thank goodness for these changes!

What does the evidence say?

This shift isn't a trend or an opinion - it's backed by research.

The double empathy problem. For decades, autistic social difficulty was explained as an individual deficit. Autistic researcher Damian Milton proposed a different view: when autistic and non-autistic people interact, both parties can struggle to understand one another [1]. It isn't a one-sided problem - it's a mismatch between two equally valid ways of communicating.

Autistic-to-autistic communication works well. When two autistic people interact with each other, information transfer is just as effective as it is between two non-autistic people [2]. Difficulty tends to arise specifically across neurotypes, which reinforces that this isn't an inherent deficit in the autistic person.

Masking comes at a cost. Suppressing or hiding autistic traits to fit in is linked to higher levels of stress, anxiety and burnout [3]. Teaching a child to "appear less autistic" can, without meaning to, be teaching them to mask.

From a speech pathology lens: rethinking our goals

Much of our profession's traditional practice was built around goals designed to "normalise" communicative behaviour. Evidence - and the voice of the autistic community -  is inviting us to rethink these.

✨ Instead of increasing eye contact - forced eye contact can increase sensory load and anxiety, without improving genuine communication.

Try this instead: support authentic communication, respecting each child's own sensory-communicative style.

✨ Instead of reducing self-stimulatory behaviour ("stimming") - stimming serves a genuine regulatory function for the nervous system; suppressing it doesn't remove the need, it just hides it.

Try this instead: support self-regulation, allowing stimming unless it poses a genuine safety risk.

✨ Instead of social skills training aimed at "fitting in" - social difficulty is bidirectional, not a one-sided deficit (double empathy).

Try this instead: build self-awareness, self-determination and reciprocal communication strategies - for the child and the people around them.

✨Instead of eliminating echolalia or "gestalt" language - gestalt language acquisition (whole phrases and scripts) is a legitimate pathway of language development [4].

Try this instead: recognise and support gestalt language as a functional bridge towards a child's own generative language.

✨ Instead of measuring therapeutic "success" by how well a child masks - sustained masking is linked to greater stress and burnout [3].

Try this instead: reduce the pressure to mask, and validate autistic identity both in and outside of therapy.

✨ Instead of "social deficits" or "social disorder" - framing social communication purely as a deficit overlooks that it's a difference, shaped by the double empathy problem rather than a one-sided impairment.

Try this instead: talk about social differences - different, not less than.

✨ Instead of "non-compliant" - this framing places the difficulty entirely with the child, without asking why a request might be hard to meet in that moment.

Try this instead: talk about difficulty with a task or expectation, and get curious about the underlying reason (sensory, communication, capacity).

✨ Instead of "obsession" or "restricted interest" - these terms carry a negative undertone for something that's often a genuine source of joy, motivation and expertise.

Try this instead: talk about passionate interests or areas of high focus — and use them as a way in for engagement, connection and learning.

In summary

The scientific evidence keeps evolving. Clinical recommendations get updated. And so do people's needs. That's why staying current isn't just an option - it’s part of ethical, evidence-based practice, as well as part of our learning journey together and how we can continue to grow as better professionals and humans.

If you'd like to chat about a neuroaffirming approach for your child, please get in touch.

With playfulness,

Constanza Penaloza Johnson,  Speech Pathologist, Playful Paediatrics

References:

[1]: Milton, D. E. M. (2012). On the ontological status of autism: The 'double empathy problem'. Disability & Society, 27(6), 883–887.

[2]: Crompton, C. J., Ropar, D., Evans-Williams, C. V., Flynn, E. G., & Fletcher-Watson, S. (2020). Autistic peer-to-peer information transfer is highly effective. Autism, 24(7), 1704–1712.

[3]: Cage, E., & Troxell-Whitman, Z. (2019). Understanding the reasons, contexts and costs of camouflaging for autistic adults. Journal of Autism and Developmental Disorders, 49(5), 1899–1911.

[4]: Blanc, M. Natural Language Acquisition and Gestalt Language Processing (referenced in ongoing discussion within Perspectives of the ASHA Special Interest Groups, 2023–2026).