Rethinking Autism in Clinical Practice: Key Insights from Jonathan Green

Driven by the fact that last month marked Autism Awareness Day, we would like to take this opportunity to expand on the topic by sharing key insights from Jonathan Green’s recent article on the evolving understanding of autism and its implications for clinical practice.

The growing demand for neurodevelopmental assessments is becoming overwhelming — not only in the UK, as Green highlights, but globally. This pressure affects both service providers and families. For individuals aged 18 and over, access through public systems often feels entirely out of reach, leaving private services as the only viable option. Yet, the private sector is expected to absorb this unmet need without additional support or infrastructure. Meanwhile, people are left feeling even more burdened — not only emotionally, but financially — as they must pay out of pocket for services that should have been available to them through public healthcare, supported by their tax contributions.

This dynamic is creating a two-tier system of autism care, where timely support is accessible only to those who can afford it. It deepens health inequities, delays intervention, and contributes to poorer outcomes for those without financial means. At the same time, private providers are placed under growing pressure to compensate for systemic gaps. Without coordinated reform, the legitimacy and sustainability of autism-related healthcare — both public and private — are at risk. Further, as Green highlights, different uses of the term ‘autism’ pose a potential risk of fragmentation in care. Certain subgroups of individuals and their families are at risk of being  severely under-represented in how autism is defined and understood, further compounding diagnostic inequities and limiting access to appropriate support. Placing this burden on the private sector risks reinforcing existing disparities and undermining the integrity of autism-related healthcare as a whole.

These inequities highlight not only a crisis in service delivery, but also a deeper need to rethink how we conceptualise autism — to move away from rigid diagnostic pathways toward a more inclusive, developmental, and needs-based approach that can better inform both policy and practice.

Key Takeaways (Green, 2023):

• Conceptual Shifts:

Autism is increasingly understood not as a fixed pathology, but as an emergent developmental response within the broader framework of neurodiversity. This challenges conventional diagnostic and intervention models.

• A New Model – Emergent and Transactional Autism:

Green proposes that autistic traits emerge through interactions between neurobiological differences and early environmental experience. This dynamic model accommodates both neurodiverse identity and clinical need.

• Bridging Neurodiversity and Clinical Practice:

This model enables clinicians to support families in ways that respect neurodivergent identities, shifting the goal from 'normalising' autism to enhancing developmental environments through tailored support.

• Clarifying the Role of Intellectual Disability (ID):

Greater conceptual clarity is needed around autism/ID co-occurrence. Clinicians should assess and describe ID separately to improve representation and service access for those with higher support needs.

• Phenomenology and Lived Experience Matter:

Incorporating autistic individuals’ subjective experience in the assessment and service design can enrich understanding and help redefine care pathways.

Link to paper: https://acamh.onlinelibrary.wiley.com/doi/epdf/10.1111/camh.12663

and more: https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.988755/full