Unsupported autism is living in a constant and chronic state of survival. A detailed explanation. 

Understanding autism through the lens of survival (aka nervous system activation) is absolutely crucial for understanding autism... because autism isn't just a condition that causes "social deficits," rigidity, demand avoidance, and sensory sensitivities...

It's a perpetual state of survival when an autistic person is not appropriately supported. (Requiring support is part of what makes it a disability, which is explicitly included in the diagnostic criteria).

So let's talk about what I mean by all of this. 

(If you've heard people referencing the Medical and Social models of disability and haven't been sure what that means in the context of autism, this post is for you 🙂)

Autism as a disability can be understood in a variety of different ways, but the two most widely applied lenses in autism awareness and advocacy are the Medical Model of Disability and the Social Model of Disability. (I'll define the two models in a second)

Typically it's...

Autism Awareness (allies attempting to spread awareness but not fully understanding the internal autistic experience) → Medical Model

Autistic Advocacy (autistic advocates educating others on the internal autistic experience) → Social Model

But I think both miss something extremely important, and over the past few years, I've developed a model that I believe gets to the heart of disability advocacy in a way the other two haven't. 

I call it the Survival Model of Disability. (I'll define this model after briefly describing the core premises of the other two models first.)

The Medical Model of Disability says a person is disabled by their own brain and body...

The Social Model of Disability says a person is disabled by their environment (societal-level systems, structures, programs, etc).

Now for the Survival Model of Disability (my model)...

The Survival Model of Disability says there are often devastating consequences in the brain and body when a person is...

1. Disabled by their environment

2. Unsupported or not sufficiently supported, and 

3. Their needs go unmet for extended periods of time (if not indefinitely)

The Survival Model agrees with the premise of the Social Model, that a person is disabled by their environment (not by their brain/body like the Medical Model suggests), but takes the observation to another level by asking...

- What is the impact of the disability on the individual when supports are not put in place?

- What is happening inside the nervous system when a person is unable to get their own needs met due to their disability?

- What is the downstream impact on a person's brain and body long-term if supports are never provided and needs are never met?

The Social Model explains why disabilities occur...

The Survival Model explains what happens to a person mentally, physically, and emotionally when their needs are not supported in the immediate... medium-term... and long-term.

It proposes that there is an increasing and compounding decline to a person's physical and mental health that can become catastrophic if proper intervention and supports are not provided...

And proposes that the increasing and compounding nature of this decline is all rooted in nervous system activation (which many people refer to as "Survival Mode")...

The activation occurring when a person is thrust into a state of self-protection / self-preservation because their nervous system detects an urgent threat to their safety.

So that's the Survival Model of *Disability.*

Now let's apply it to autism. 

The Autistic Survival Model:

(Note that this model represents what happens when disability supports are not provided. The trajectory can change at any point with proper intervention and effective supports.)

Autistic brain wiring

↓

Disabling environment 

↓

Lack of support / insufficient support 

↓

Increasing and compounding impact of disabling environment with no / insufficient support 

↓

Long-term health consequences

↓

Catastrophic physical / mental health outcomes 

Now, I will illustrate how the impact increases and compounds the longer the autistic person's needs remain unmet. 

*Immediate impact*

- Destabilization / Dysregulation / Distress

- Fight / Flight / Freeze responses (e.g. meltdowns/shutdowns)

- Maladaptive coping behaviors (e.g. shouting at others, punching walls, kicking/throwing things)

*Medium-term impact*

- Burnout 

- Cognitive/skill regression

- Physical and mental health decline (worsening health conditions)

- Increased maladaptive coping behaviors (e.g. substance use)

- cPTSD

- "Personality" disorders (I call them "survival disorders" for this very reason)

- Other acquired neurodivergence 

*Long-term impact*

- Full System Collapse

- Catastrophic health consequences (e.g. severe cardiac events)

- Catastrophic mental health consequences (e.g. attempted suicide/suicide/homicide)

- Implosion (premature death)

(Note that this progression is meant to illustrate the increasing nature and dangers of unmet needs over time, not one specific pathway that every autistic person with unmet needs will definitely experience in the exact same way.)

In sum... the Survival Model of Disability orients around what's happening in a person's brain and body when their nervous system detects a threat to safety due to a disabling environment.

The Autistic Survival Model orients around what happens inside the autistic brain and body when needs go unmet for extended periods of time.

And once you put autistic and disability needs in general into that larger frame, you start to understand how and why there are so many (countless) interconnected and co-occurring physical and mental health disabilities... 

And why so. many. co-occur with autism, specifically. 

- Clinical depression and anxiety

- Sleep disorders 

- Substance use disorders 

- cPTSD

- "Personality" disorders

- Severe digestive conditions

- Severe cardiac conditions 

- (The list is endless)

Because the correlations are far from random, yet science has yet to offer a coherent explanation for why these correlations exist.

And I believe the Survival Model of Disability and the Autistic Survival Model start putting the correlations into a meaningful unified framework so the correlations start actually making sense.