John Harris’s recent exploration of the autism spectrum (‘The term is becoming unrecognisable’, 1 November) covers the central debates, yet readers argue it falls short of capturing the full breadth of autistic experience, particularly for those without a learning disability.
Louise King, London
From childhood, I sensed a fundamental difference in how I experienced the world. Bullying forced me to mask intensively to fit in, a strategy supported by a stable upbringing. However, adulthood brought mounting difficulties. Since my mid-twenties, I have endured recurrent depression, anxiety, and what I now recognize as autistic burnout, leading to repeated career disruption and relationship strain. Despite a postgraduate education, I struggled to maintain employment and faced persistent fatigue and sleep issues.
A diagnosis at age 53 finally provided a framework for my life history. The greater challenge remains helping others—including health professionals—grasp the daily reality of these challenges. Moving beyond stereotypes of special interests or eye contact would foster a more accurate understanding of autism’s varied presentation, enabling appropriate support and classification.
Salli Ward, Market Harborough, Leicestershire
Having worked alongside mental health services, I witnessed the shift from Asperger’s syndrome to the broader “autism spectrum disorder” label. I initially misinterpreted “spectrum” as a universal continuum of social traits. While clinically inaccurate, this view hints at a social truth: a distribution of social comfort where classic autism sits at one extreme, former Asperger’s profiles nearby, and the general population spread across the middle.
I identify with traits—aversion to phones, dislike of crowds, need for solitude—that align with introversion, yet that term has also morphed into an identity label rather than a clinical category. As clinicians taught me, diagnoses are essentially descriptions of lasting functional impairment. However, this framework overlooks that almost everyone finds specific aspects of life functionally difficult. Rather than endlessly expanding diagnostic categories to validate struggle, society should build systems where anyone can declare their needs and receive flexible, understanding support.
Dr Louise Legg, Counselling Psychologist, London; Dr Emma Bede, Clinical Psychologist, London
Mr. Harris cites Professor Uta Frith describing masking as “completely unfalsifiable,” implying a scientific dead end. In reality, researchers are actively testing the construct. Professor Will Mandy’s group at University College London developed the standard masking questionnaire and has spent years publishing its limitations—exemplifying rigorous science. Dr Meng-Chuan Lai and colleagues have quantified masking by comparing clinical presentation against social-cognition test performance, an objective gap no self-report can fabricate.
At Birkbeck, University of London, Jagdeep Wadhwa-Brown is recording neural activity during social tasks alongside subjective masking accounts, directly addressing the empirical challenge Professor Frith posed. Professor Francesca Happé has documented observable instances of the “mask slipping” in real-world settings.
Clinically, we regularly assess adults with “internalised” autism—individuals who make eye contact, sustain demanding careers, and have spent decades dismissed with the assertion they “can’t possibly be autistic,” much like Abigail Stow in your article. The measurement tools require refinement, and researchers openly acknowledge this. However, “the measure needs work” and “the phenomenon does not exist” are distinct claims; only the latter was presented to your readers.
