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Moving forwards not backwards: heterogeneity in autism spectrum disorders

Molecular Psychiatry volume 26, pages 7100–7101 (2021)Cite this article

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The article by Mottron and Bzdok [1] argues that heterogeneity in autism is artefactual, and that returning to a ‘prototypical’ autism would benefit clinical practice and research endeavours. We note that the authors do not define what they mean by ‘prototypical’ autism and thus it is left for the reader to interpret who would and would not be included under the authors’ revised definition. However, from our reading, we argue that, though perhaps unintended, the suggestion is for a return to a rather stereotyped understanding of autism, one which is no longer fit for purpose and that research does not support: we offer our insights from both clinical and academic practice.

A move away from the (assumed) prototypical approach to autism proposed by Mottron and Bzdok [1] has, in fact, only recently taken place. One familiar autistic presentation—that of young males of mid-intellect without neurodevelopmental or mental health comorbidities—has been consistently favoured and has repeated from the original clinical observations of autism [2] to contemporary research sampling; for example, individuals with comorbid intellectual disability, who have mental health comorbidities or who are female, are consistently left out of research samples [3, 4]. This approach maintains a narrow lens of what autism looks like. It may offer a simpler scientific case, but it is biased, only examining a subsection of the autistic population, and is ultimately invalid. Indeed, the authors’ suggestions, if ever implemented, would likely lead to even poorer rates of identification for women and adults who did not have the opportunity to be diagnosed in childhood. A definition that incorporates data from females [5, 6], adults, people with mental health comorbidities and comorbidity with conditions such as ADHD would contribute to an updated description, and not a less accurate description. Importantly, these updated definitions [7] provide the basis for better clinical care through the design and refinement of updated interventions, such as for anxiety and depression [8].

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  1. Department of Psychology, University of York, York, UK

    H. Hobson & S. Petty

  2. North Yorkshire NHS Adult Autism and ADHD Assessment Service, The Retreat York, York, UK

    S. Petty

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  1. H. Hobson
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Correspondence to H. Hobson.

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Hobson, H., Petty, S. Moving forwards not backwards: heterogeneity in autism spectrum disorders. Mol Psychiatry 26, 7100–7101 (2021). https://doi.org/10.1038/s41380-021-01226-7

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