Toward a Clinically Relevant Epistemology of Autism: Moving from Correlation to Causation and Intervention

Causal knowledge is what is needed to advance policy and care for autistic individuals and their families—to understand how to remove challenges while maintaining desirable human variability. Ultimately, trials of clinical and policy interventions will be needed to confirm their effect, but we can place the most informed and safest bets on interventions by making the greatest use of observational data. This use of observational data is not merely of the form that “autistic individuals are different in XYZ construct,” but rather observational data that is explicitly interpreted to evaluate causal models. The use of theory is critical to this process. Theory is the method for synthesizing a vast corpus of prior data, whether to plan the most parsimonious and influential novel data collection or to assess the state of affairs at the current time, so as to inform interventions. We suspect that LLMs will be used to tackle the synthesis of vast amounts of prior empirical knowledge (Sourati and Evans, 2023, Bzdok et al., 2024), but we have used examples in the history of the autism literature to show how taking contemporaneous interpretations of the data would lead to the persistence of causal ideas that have been overturned by subsequent literature. Restated, the integration of the 80,000 papers’ worth of results will need to operate over the data spanning 80 years of autism research—and a far greater literature setting the foundation for Psychology and Cognitive Neuroscience. There will also have to be substantial nuance in integrating results over multiple sub-fields of Psychology and Cognitive Neuroscience. Such a program of knowledge integration is likely to converge toward a unified model of what we call “autism,” while at the same time expanding trans-diagnostically, resulting not only in a more comprehensive view of human variation in general, but also a reorganized nosology that is more based on causally informed notion of validity and therefore better able to inform interventions that alleviate suffering while protecting positive diversity.