MELBOURNE: There seems to be much debate over the diagnosis and assessment of autism. Historically, autism diagnoses were often reserved for very young children who had severe communication difficulties that frequently overlapped with intellectual disability. This became the stereotypical presentation of autism. With the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), several diagnoses that had previously existed within the pervasive developmental disorders category were combined under the diagnosis of autism spectrum disorder (ASD). This change, together with increased self-advocacy among autistic adults, greater professional awareness, and growing access to information about autism beyond traditional stereotypes, contributed to a substantial increase in autism diagnoses.
Yet a broad segment of clinical and popular culture believes this increase in diagnoses is due to overdiagnosis. Those of us who are late-diagnosed autistic people deal with this perspective regularly. People frequently tell us that we “don’t seem autistic.” If you are autistic and well-spoken, intelligent, or gifted in a particular area, this group of people will argue that you are not representative of the “real” autistic population. In The Independent, Dame Uta Frith recently argued that “today, anyone of any age or intelligence level can be diagnosed with autism if they meet certain criteria” (Frith, as cited in Newton, 2026). Although this statement is literally consistent with current diagnostic criteria, the article’s headline—“anyone can have autism now”—invites a much broader and more dismissive interpretation.
Research reviewed by Uddin (2022) offers several possible explanations for differences in how autism presents. Some research suggests that autistic cognitive traits—such as heightened perception, detail-focused processing, and strong systemizing—may contribute to gifted or savant-like abilities, creating a twice-exceptional profile of significant strengths alongside genuine disabilities. These strengths may mask support needs, while challenges with processing speed, executive functioning, sensory regulation, or communication may hide the person’s giftedness.
This framework does not divide autism into separate “types,” but describes several cognitive patterns that may produce different combinations of strengths and disabilities. Enhanced perceptual functioning may contribute to exceptional visual, auditory, musical, spatial, or pattern-recognition abilities; hyper-systemizing may support advanced skills in mathematics, technology, language, calendars, classification, or any subject governed by rules; and detail-focused processing may help someone detect small differences and achieve extraordinary accuracy, even when integrating information into a broader context is difficult. These patterns may contribute to savant abilities, meaning an exceptionally developed skill in one narrow area; intellectual giftedness, meaning unusually high general reasoning ability; or twice-exceptionality, in which autism and giftedness coexist alongside sensory, communication, executive-function, adaptive, or emotional difficulties.
Because autistic cognition is often uneven or “spiky,” a person may be profoundly talented in one domain while needing substantial support in another. Giftedness can therefore conceal disability, and visible disability can prevent others from recognizing giftedness. Importantly, this framework does not claim that every autistic person is gifted or that autistic people with high support needs possess hidden genius. It proposes that certain autistic processing styles may contribute to exceptional abilities in some individuals and that strengths and disabilities must be assessed separately.
Much research provides support for many of the cognitive patterns reviewed by Uddin. The stereotypical autistic child represents only one possible presentation: a child whose disability and communication differences are highly visible. That child may or may not possess exceptional abilities, just as a speaking or intellectually gifted autistic adult may still have substantial disabilities and support needs.
Every day I see articles, stories, and posts about autism being overdiagnosed and about people using neurodivergence or autism as a crutch or an excuse to escape personal responsibility in some way. Yet this assumption is often based on the belief that people who have exceptional abilities, whether cognitive gifts or savant-like skills, cannot possibly be autistic because of those abilities alone. It does not acknowledge that twice-exceptional autistic people are still autistic. These people still experience autistic sensory, social, communication, and daily struggles, although those experiences and support needs vary from person to person. Along with those struggles, they also carry the burden of expectation. They are expected to live up to their gifts. They are expected to thrive and live the exceptional lives that the ordinary world wants from their savant-like skills. This pressure can be crushing when they are still haunted by sensory, social, communication, and other forms of overload.
I know many twice-exceptional autistic adults. I have known engineers, musicians, artists, and writers who are twice-exceptional. They are remarkable. The outside world does not think they seem autistic, but they still struggle. One artist I know was so exceptional that she skipped a grade. She was always ahead of everyone academically, and her intelligence and exceptional gifts were all anyone could see. Her giftedness obfuscated all the issues she struggled with every day. When she finally melted down and collapsed under the pressure of all the labels, she could never paint again. Her gifts were lost in the avalanche of neurotypical expectations.
Uddin says that twice-exceptional autistic people may possess specialized skills that allow them to make important contributions in education and the workforce while simultaneously experiencing substantial difficulties with social functioning, daily living, and the transition to independence. Their intelligence can cause others to underestimate their disabilities, leaving them without appropriate services, while public misconceptions can contribute to isolation, underemployment, mental-health difficulties, and unmet support needs.
As a twice-exceptional adult, I am always walking a tightrope. I know that people do not see me as struggling. They just see the gifts. They also do not see all the ways I am not exceptional — the ways I am well below the norm, and the ways I struggle daily to live up to even basic expectations. It is easy to see that I can write and create new things, but it is hard to see the many things I hide: my inability to keep up with basic tasks, the way I forget daily responsibilities, and the way I become overwhelmed under pressure. They do not see me meltdown in the grocery store or my inability to read a room or understand things that are not concrete.
Claims that autism is overdiagnosed, used to excuse bad behavior, or something that “anyone can be these days” are dangerous because, as Uddin’s discussion of twice-exceptionality demonstrates, autistic strengths can conceal significant disabilities and support needs; recognizing why someone struggles is not the same as removing personal responsibility.