By Fatima de Kwant
The Netherlands, June 9, 2026
For decades, autism was described in psychiatric manuals as a severe neurodevelopmental disorder, identified as infantile autism or classic autism. These presentations were characterized by significant and observable impairments in social communication, behavior, and functional autonomy, often accompanied by neurological and psychiatric comorbidities.
In addition to classic autism, the DSM‑IV included Pervasive Developmental Disorder Not Otherwise Specified (PDD‑NOS), intended for individuals with atypical or incomplete manifestations. Asperger’s Syndrome, in turn, described people with similar social and behavioral impairments but with average or above‑average intelligence and no significant language delay. For many researchers, it represented a phenotypic variation within the same autistic continuum.
From fragmentation to spectrum
The publication of the DSM‑5 in 2013 consolidated these categories under the term Autism Spectrum Disorder (ASD), introducing the concept of a spectrum and classifying individuals by levels of support (1, 2, and 3). This shift broadened clinical and social understanding of autism, allowing recognition of profiles previously overlooked — especially adults with subtle manifestations, high masking ability, and a history of unexplained psychological suffering.
Late diagnosis became more frequent, particularly among women and people with high intelligence. Many began sharing their experiences on social media, in lectures, and in qualitative research, contributing to a deeper understanding of autism as lived internally — a dimension that had long remained invisible.
However, the significant rise in diagnoses at Level 1 support generated concern within the very scientific community that shaped the spectrum concept.
Is the spectrum “collapsing”?
International studies show that the prevalence of Level 3 autistic individuals remains relatively stable (20% to 30%), with diagnoses occurring predominantly in childhood. Meanwhile, the number of Level 1 diagnoses continues to grow, especially in adulthood.
This phenomenon has led some researchers to question whether overdiagnosis or excessive broadening of criteria is occurring. Uta Frith, one of the central figures in autism research, recently stated that the spectrum is “collapsing,” reigniting debates about the legitimacy of so‑called “functional autism” and the alleged trivialization of diagnosis.
In Brazil, statements by neuropediatrician Dr. Salomão Schwartzman on national television reinforced this concern. His remarks divided opinions: autistic adults felt invalidated, while some families of autistic individuals with intensive support needs agreed with the criticism.
“Too many diagnoses” or “too little recognition”?
The core controversy is complex:
Should Level 1 autistic individuals, who appear highly functional, be recognized as autistic?
And if they are autistic, are they — or are they not — persons with disabilities?
If they are not considered autistic, how should we name a consistent set of atypical social, behavioral, sensory, and cognitive characteristics that impact daily life and require adaptations and support?
For many adults diagnosed later in life, the diagnostic report is not a privilege but a structuring explanation that grants access to rights, therapies, and minimal conditions for mental health.
“I spent decades being excluded from school, parties, and work. I was called lazy, dramatic, rude, bipolar. At 41, a psychologist suggested an autism assessment. I received the diagnosis a year later. Now they say I’m lying and want to be autistic to profit… profit from what? I’m never going back to the closet that suffocated me for four decades.”
— Isabela M. (43), late‑diagnosed autistic woman
Rights, needs, and equity within the spectrum
ASD is legally recognized as a disability, but the heterogeneity of the spectrum makes this classification challenging when it comes to public policy. The needs of Level 3 autistic individuals — which include intense dependency, multiple comorbidities, and continuous supervision — differ from the needs of Level 1 autistic adults, who struggle with mental health, employability, sensory accessibility, and recognition.
Still, all require support.
Vulnerability may be visible — such as absence of speech, aggression, epilepsy, or intellectual disability — or internal, such as chronic depression, autistic burnout, and suicidal ideation, all highly prevalent among Level 1 autistic adults.
Responsible activism must acknowledge this diversity and avoid hierarchies that weaken rights. Defending the spectrum requires educational inclusion, social inclusion, accessible environments, and comprehensive health care for all autistic people, regardless of support level.
The gap in epidemiological data
Brazil still lacks official statistics that stratify autism by support levels — one of the greatest obstacles to effective public policy.
Likewise, recent international studies indicate that there are no consolidated global estimates by level. The Global Burden of Disease Study 2021, published in The Lancet Psychiatry (2024–2025), provides the most up‑to‑date epidemiological data, but still without this stratification.
Brazilian jounalist living in the Netherlands; autistic; mother of an autistic son.
