Abstract

Over the past decade, two approaches have substantially influenced the direction of autism research: precision medicine in psychiatry and the neurodiversity paradigm. Precision medicine aims to improve early detection, diagnosis and prognosis, as well as develop mechanism-based therapies tailored to individual needs/ characteristics using biomarkers. EU-AIMS and AIMS -2-TRIALS are two linked European consortia that have been at the forefront of this global effort. In this talk, I will share some reflections on progress and challenges. Significant advancements include larger, comprehensively characterised cohorts from infancy to adulthood, new methods to make predictions about individuals and identify subgroups and increased methodological rigour. However, in our studies, we did not identify single modality markers that have sufficient accuracy for any clinical application. This may be due to both methodological factors, including granularity and reliability of measures, and conceptual factors, such as the predominant reductionist approach, which seeks to parse complex issues into simpler, more tractable units. By studying particular processes in isolation (e.g., social or sensory processes) we often neglect their interactions, while the focus on individual-level markers has led us to divorce the (autistic) person from their social environment.

In parallel, the neurodiversity paradigm has highlighted the need to shift away from deficit models to understanding diversity in perception, cognition and experiences. It emphasised the role of social and contextual factors in strengths and disabilities and advocated for active involvement of autistic people as research collaborators in defining priorities and conduct of research.

Drawing upon insights from system biology, developmental psychology and social sciences I outline an integrative approach. It aims to understand the dynamic interaction between biological (brain, body) and social mechanisms (stress, stigma, protective factors) to gain a fuller understanding of strengths and difficulties of neurodivergent people in different conditions and contexts.