There has been a movement afoot to have clinicians and scientists reconsider the use of pathologizing terms to refer to those manifesting autism spectrum disorder (ASD) and replace the term with the likes of “autistic people” with the reference being not ASD as a developmental delay but rather a developmental difference. The claim is that ASD is not a disorder to be ‘cured’ or prevented. These terms are ableist and supposedly highly offensive [1, 2, 3, 4].

We need to object to such thinking vociferously. Each of us is “neurodiverse” and that has been the basis of the psychological concept of individual differences that has been with us for well over 100 years. But that concept does not eradicate “intellectual disability” nor cast aside the clinical, educational, and management services necessary to grant the individuals demonstrating such conditions the right of support.

By any standard, it is counterproductive for those with ASD to simply be “different” rather than “impaired”. If one were to ask most psychologists, social workers, or other members of various social service/education professions what the principal problem would be of those individuals “suffering” from autism or being on the autism spectrum, one would likely hear the definition based on problems in social connectivity, eye contact, and other behavioral indices of the “condition”. We will, however, need to explain the currently equivocal evidence of an association that exists between coeliac disease and ASD, with that connection being less likely to be investigated [5].

There may be a connection between ASD and autoimmune dysfunction. Several immunological indicators point to a relationship between ASD and the immune system, including serum cytokines, brain antibodies, immunogenetics, and family history. Numerous studies have concentrated on a single kind of immunological data alone, and some lack strong controls. Studies of immunological aspects of ASD with appropriate controls are necessary and they will be less likely to be supported within the framework of “difference” rather than “disorder” [6].

Simultaneously, rare genetic heterogeneity and high heritability define ASD. Like ASD, the majority of autoimmune diseases (AID) are marked by significant genetic variability and inheritance. Some have proposed that rather than being a large collection of dissimilar disorders, both a portion of ASD and AID are related sets of disorders that share a common faulty route (mechanistic target of rapamycin (mTOR) signaling). Additionally, an immunological variant of autism spectrum disorder may be a particular type of autoimmune disease that presents early in life with a distinct set of primarily behavioral characteristics [6, 7]. Besides autoimmunity issues, numerous molecular mechanisms are involved allowing this line of research to blossom [8, 9].

We might also want to delve into the controversy of Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS)/pediatric acute-onset neuropsychiatric syndrome (PANS) with ASD being nominally related in some cases to post-streptococcal infection in some children and the resolution, in some cases, possibly with antibody (Immunoglobulin G/Immunoglobulin A (IgG/IgA)) treatment [10, 11].

One can be assured that “difference” does not even begin to describe the developmental difficulties that growing children with ASD need to overcome in the health care and educational systems let alone in social engagement and decision-making. We should not be obfuscating our ability to truly advance our knowledge base. We should understand that soon there will be no such thing as “disorders” only differences! How can one “normalize” and speak for a whole section of individuals who cannot speak or communicate? Is that supposed to be a normal variant of humans that we eventually lose the ability to communicate or socialize with one another?

Taking this issue further one additional step, while providing a single definition of “abnormal” or “pathological” behavior, these terms refer to behavior outside of the norms of a particular culture or society. This can include behavior that is, “harmful, dangerous, or otherwise disruptive”. A person acting in a way that harms himself or others, or feeling so uncomfortable that they are unable to function, is said to be engaging in abnormal behavior. Abnormal behavior can then lead to a psychological disorder, and “harmful dysfunction”. Abnormal behavior involves responses judged or evaluated to be: atypical, disturbing, maladaptive, and harmful. ASD is all of that relative to the society in which the individual with that condition finds him or herself.

Statistically, abnormality should be based on rarity; if it happens seldom, it is abnormal. The definition’s mathematical component deals with the notion that human characteristics are distributed normally across the population. Sixty-eight percent of the population will fall within one standard deviation of the mean for a trait or attribute that fits into a normal distribution, such as in the construct of IQ; 98% of the population will fall within two standard deviations of the mean. Ninety-eight percent of the population would score between 70 and 130 on an IQ test, and 68% of the population would score between 85 and 115 if the mean IQ was 100 and the standard deviation was 15. According to this definition, abnormality occurs in 2% of the population when they deviate more than two standard deviations from the mean. Accordingly, those with IQ scores between 70 and 130 are abnormal in the given case.

We currently have variability in the incidence reporting of ASD in the population, however the range is limited. A recent large-scale register-based cohort study in Denmark with 6,989,627 residents revealed a 400 per 100,000 or 0.004 prevalence of ASD. That is abnormal by definition [12]. According to estimates, there were 52 million suspected instances of ASD globally in 2010 (corresponding to a prevalence of 760 per 100,000, or 0.0076 percent) [13]. Additionally, the estimated global prevalence of ASD in children under the age of five, across all nations, in 2016 was 723 per 100,000, or 0.00723% [14].

With statistical infrequency assumptions, an aberrant behavior deviates from the “average”. This method is based on the notion that behavior is more likely to be abnormal when it occurs less frequently in people. Therefore, number, not quality, distinguishes between normal and abnormal. A small percentage of people are abnormal, while the majority of people are normal. The mathematical concept of the normal distribution serves as the foundation for the determination of whether a behavior is statistically infrequent.

The possibility of having precise criteria for differentiating between normal and abnormal behaviors is one of the strengths of the statistical infrequency definition of abnormality. For many professions to view ASD uniformly and provide a more scientifically suitable method of evaluating abnormality, the definition adds an element of objectivity to the process of defining abnormality, lowering subjectivity, and resulting in a more precise definition of abnormality. It may be a productive exercise to examine Foorthuis’s [15] thorough analysis of the subject of anomaly.

So, anyway one slices it, if we are dealing with statistical rather than qualitative models, ASD is an abnormality. In a country where 98 percent of the population is autistic, then there it would not be. One cannot have it both ways, the choice is clear—science or political correctness.

GL—Writing, Conceptualization, Original draft.

Not applicable.

Not applicable.

This research received no external funding.

The author declares no conflict of interest. Gerry Leisman is serving as one of the Editorial Board members of this journal. We declare that Gerry Leisman had no involvement in the peer review of this article and has no access to information regarding its peer review. Full responsibility for the editorial process for this article was delegated to Gernot Riedel.