Borrowed Legacies: How History Still Shapes Our Understanding of Neurodivergence and the Autism Spectrum

Our understanding of neurodivergence did not emerge in a vacuum; it was inherited. Each generation inherits ideas about what autism, ADHD and other neurodevelopmental differences are supposed to look like, and these ideas are drawn from psychiatry, psychology, medicine, education, research, policy, the media and popular culture. Over time they become so familiar that we began to mistake them for objective reality rather than recognising them as historically shaped ways of understanding human differences. These are our “borrowed legacies”.

When many people hear the term Autism Spectrum, a remarkably consistent image still comes to mind. They imagine someone who is non-speaking, avoids all social interaction and has an intellectual disability, or, alternatively, someone who possesses extraordinary abilities in mathematics, music or memory. These individuals certainly exist and deserve recognition and support, but they simply do not represent the whole spectrum. Autism Spectrum is not defined by being non-speaking, nor by intellectual disability, nor by exceptional or savant abilities. Some autistic people are non-speaking, some have a co-occurring intellectual disability, and some demonstrate remarkable or highly specialised abilities; many others do not. Many speak fluently, complete university degrees, develop careers, raise families and maintain meaningful relationships, while others require substantial daily support, and most people fall somewhere between these extremes. This diversity is not a recent discovery; it has always existed. What has changed is our capacity to recognise it (Lord et al., 2020).

Part of the reason these misconceptions remain so deeply embedded lies in the history of autism itself, and that history is considerably messier, and more troubling, than it is usually told. In 1943, the Austrian-American psychiatrist Leo Kanner published a description of eleven children referred to his clinic at Johns Hopkins (Kanner, 1943). Barely a year later, working independently in Nazi-occupied Vienna, the paediatrician Hans Asperger described a strikingly similar pattern in a group of children he termed “autistic psychopaths” (Asperger, 1944). Neither man was first. Two decades earlier, the Soviet child psychiatrist Grunya Sukhareva had already published a detailed clinical account of the same presentation in the children she treated, work that went almost entirely unrecognised in the West for most of the twentieth century, in part because it was written in Russian and German by a woman working outside the major Western psychiatric centres of the day (Wolff, 1996). Even Kanner's own account rested more heavily on others than his single-authored paper suggested. Georg Frankl and Anni Weiss, two Austrian Jewish clinicians who had worked alongside Asperger in Vienna before fleeing Nazi persecution and joining Kanner at Johns Hopkins, are now understood to have contributed much of the detailed clinical observation behind Kanner's 1943 paper, with Frankl in particular receiving no co-authorship for that contribution (Muratori, Calderoni, & Bizzari, 2021).

The history darkens further from there. Historical research published in 2018 established that Asperger, who remained in Vienna throughout the war, cooperated with the Nazi regime's child “euthanasia” programme, assessing children and referring at least some of those he judged unsuitable to the Am Spiegelgrund clinic, where they were killed (Czech, 2018; Sheffer, 2018). This history complicates the legacy of the Asperger name considerably, and is part of why, alongside clinical reasons, the diagnosis was folded into the single Autism Spectrum Disorder category in DSM-5 rather than retained as a separate eponym. Kanner's own legacy carries a different kind of harm. His early descriptions characterised the parents of the children he studied as emotionally undemonstrative, and this observation was taken up, most forcefully by Bruno Bettelheim, into the widely propagated “refrigerator mother” theory, which held that cold, unaffectionate mothering caused autism (Bettelheim, 1967). For roughly three decades this theory caused enormous, unwarranted guilt and harm to families, before it was discredited by emerging genetic and neurobiological research. None of this erases the real clinical contributions Kanner and Asperger made, or the value of naming a pattern that had, until then, gone largely unnamed in Western medicine. But it is a reminder that the “discovery” of autism was never a clean, neutral origin story. It too is a borrowed legacy, shaped by war, persecution, prejudice, and by whose contributions history chose to remember.

As diagnostic systems developed, these early clinical observations became integrated into successive classification systems, educational practices, research priorities and public understanding. Popular media further reinforced relatively narrow portrayals of autism, often depicting either individuals with very high support needs or those with extraordinary intellectual or memory abilities, a pattern traced in detail through the twentieth century by science writer Steve Silberman (2015). Gradually, one presentation became mistaken for the condition itself, and today, despite substantial advances in research, many of these historical assumptions continue to shape public understanding.

This reminds us that diagnostic concepts are never merely scientific; they also shape culture. The language used by psychiatry, psychology, medicine and education does more than describe people. It shapes who is recognised, who receives support, who is believed, who gains access to services and, perhaps most importantly, how people come to understand themselves. Even a choice as seemingly small as identity-first versus person-first language carries real weight for how autistic people experience their own diagnosis (Botha et al., 2023). Mental health concepts therefore carry profound clinical, social and political consequences.

This is not a criticism of diagnosis. Diagnostic systems such as the DSM and ICD remain valuable: they can facilitate communication, research and service provision, but the categorical systems of care built around them do not automatically translate into advocacy or access to care. In practice, they can just as easily become exclusionary, gatekeeping the very support they are meant to enable. Like all scientific frameworks, they evolve, reflecting the best available knowledge of their time while remaining open to revision as our understanding grows. Autism Spectrum itself demonstrates this evolution remarkably well. When the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders was published in 2013, it consolidated what had previously been four separate diagnoses: autistic disorder, Asperger's disorder, childhood disintegrative disorder, and pervasive developmental disorder not otherwise specified, into a single diagnosis of Autism Spectrum Disorder, framed explicitly as a continuous spectrum rather than a set of discrete types (American Psychiatric Association, 2013). The World Health Organization's eleventh revision of the International Classification of Diseases made a comparable shift, aligning its own classification with this same dimensional understanding (World Health Organization, 2022).

Over the past four decades our understanding has expanded dramatically. We now recognise far greater heterogeneity across communication styles, sensory experiences, cognition, emotional regulation, masking, gender, culture and developmental trajectories than earlier models could adequately account for, a shift well documented in the clinical and research literature (Happé & Frith, 2020; Lord et al., 2020).

The concept of neurodivergence has similarly broadened our perspective. First, I think, it was articulated by sociologist Judy Singer as a way of naming what she called “a problem with no name,” and it reminds us that neurological diversity is a natural part of human variation, and it encourages us to consider strengths alongside challenges, adaptation alongside impairment, and context alongside diagnosis (Singer, 1999). Understood this way, neurodivergence is not simply a trait located inside an individual but something that emerges through the interaction between a person and the environments, the expectations and social systems they move through (Chapman, 2021).

This distinction is one I find myself repeating often, because it is also where much of the resistance to the term comes from. I regularly meet colleagues, fellow psychologists and psychiatrists among them, who are sceptical of “neurodivergence” itself: sometimes because “everyone is neurodiverse” gets used, almost reflexively, to dissolve the concept altogether, and sometimes because it is not a diagnostic entity and does not sit easily within the categorical, formulaic thinking many of us were trained in. Both objections deserve to be taken seriously, and both rest on the same conflation. Neurodiversity describes a population-level fact: human neurocognitive functioning varies, and that variation is a natural feature of our species, true for everyone. Neurodivergent describes something narrower and more specific: an individual whose neurocognitive functioning diverges from dominant social norms. Being in the world in various contexts is not consistent with what is often socially expected, what has sometimes been termed “neurotypical”. It is not a diagnosis, and I would caution against treating it as one, since neurodivergence is not a disorder or a disease; it is a different lens for understanding difference, one that sits alongside diagnosis rather than replacing it. This distinction matters especially in areas such as ADHD, Autism Spectrum and learning differences (a term I much prefer to “learning disorders,” since it better reflects a different way of learning rather than a defect), where our diagnostic categories, however clinically useful, still struggle to tease out the full complexity of what is actually going on for a given person. Understood this way, it becomes easier to see why parts of the mental health community, though certainly not all of it, struggle to fully acknowledge or integrate the concept: it asks us to hold a way of thinking that does not reduce neatly to a category.

Yet here too we should proceed thoughtfully. Neurodivergence is not one thing. Autism Spectrum is not one thing. ADHD is not one thing. Every neurodevelopmental condition represents considerable diversity within itself, and while these conditions often overlap and frequently co-occur, each possesses its own developmental pathways, behavioural profiles, lived experiences and support needs. If we begin treating neurodivergence as a single, homogeneous identity, we risk creating a new oversimplification while attempting to move beyond the old one.

The challenge, then, is not choosing between categories and individuality; it is learning to hold multiple perspectives simultaneously. We can appreciate the value of diagnostic categories while recognising that no diagnosis fully captures the complexity of an individual person. We can acknowledge common experiences across neurodivergent communities while respecting the unique characteristics of Autism Spectrum, ADHD, dyslexia, dyspraxia, Tourette syndrome, intellectual disability and many other forms of neurodevelopmental diversity. Both perspectives are necessary. This ability to shift our focus from diagnosis, to person, to context, to behaviour, to lived experience is one of the greatest strengths of contemporary psychological science, and it echoes what functional contextual approaches such as Acceptance and Commitment Therapy have long argued: that behaviour can only be understood in relation to the context in which it occurs, not as a fixed property of the individual alone (Hayes, Strosahl, & Wilson, 2012; Hayes, Barnes-Holmes, & Wilson, 2012).

I write about this, too, from personal experience. Acknowledging my own neurodivergence took me far longer than I would like to admit, in part because of my own learning history and the masking I developed, first in childhood and later across my professional life. I became skilled at adapting to social demands and expectations, skilled enough that, for a long time, I did not fully recognise what I was adapting to, or why it required so much effort. That experience has shaped how closely I listen to the people I work with.

Perhaps one of the most painful consequences of these borrowed legacies is something I encounter repeatedly, in clinical practice, within neurodivergent communities, and among colleagues. Family members, partners, friends, and even fellow professionals often struggle to accept an Autism Spectrum diagnosis when it does not match the narrow image of autism they inherited, an image built on exactly the historical models described earlier in this piece. Many individuals spend years attempting not to understand themselves, but to convince others. They hear comments such as “You don't look autistic,” “You're too articulate,” “You make eye contact,” “You're too empathic,” “You're too successful,” and “You can't be autistic.” Often these statements are not intended to be dismissive; they reflect comparisons with inherited stereotypes. In many ways they echo what researchers have described as a double empathy problem, a mutual breakdown in understanding between autistic and non-autistic people, rather than a deficit located in the autistic person alone (Milton, 2012). This is worth an entire blog on its own, hopefully I can write that soon.

For many individuals, the greatest source of distress is not their neurodevelopmental differences themselves, but repeatedly having those differences questioned, minimised or denied. Recognition becomes an ongoing process of explanation, and acceptance becomes conditional upon fitting someone else's expectations.

This is precisely why advocacy matters. Advocacy is not about broadening labels indiscriminately, nor is it about suggesting that every individual difference reflects neurodivergence. Rather, advocacy seeks to improve understanding of the extraordinary diversity that has always existed, informed by what autistic spectrum folk and their communities themselves identify as priorities for research, support and services (Pellicano, Dinsmore, & Charman, 2014), and by strengths-based approaches to education and support that build on what autistic spectrum individuals can do rather than focusing solely on deficit (Mottron, 2017). It invites society to move beyond stereotypes towards curiosity, from certainty towards humility, and from narrow assumptions towards richer and more nuanced understanding.

History teaches us that scientific concepts evolve. The challenge is ensuring that our inherited ideas continue to evolve alongside them. Perhaps the greatest lesson Autism Spectrum offers us is that no single description can ever capture the complexity of human neurodevelopment. The labels we use are valuable, but the perspectives we hold should always remain broader than the labels themselves. If we can do this, we honour not only scientific progress but the remarkable diversity of the people these concepts were always intended to serve.

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