Self-diagnosis in psychiatry is where individuals diagnose themselves rather than rely upon official diagnosticians to supply a psychiatric diagnosis. The accuracy of self-diagnosis is a contested topic. In this paper, I outline what arguments are needed to see self-diagnosis as accurate and how different approaches to self-diagnosis require different arguments. I show how different arguments are required to justify accuracy for an autistic individual judging they are autistic compared to non-autistic individuals judging they are not autistic. Different arguments are required (...) if a self-diagnosing individual accepts or rejects official diagnostic criteria. Finally, different arguments are required depending upon whether diagnoses are seen as objective entities, the product of theoretical virtues or practically useful groupings. All these approaches require unique arguments to justify the accuracy of self-diagnosis. Identifying the required arguments for different approaches is a stepping stone toward establishing whether those arguments and which of those arguments can be successfully justified. (shrink)

BackgroundIdentifying biomarkers for autism can improve outcomes for those affected by autism. Engaging the diverse stakeholders in the research process using community-based participatory research can accelerate biomarker discovery into clinical applications. However, there are limited examples of stakeholder involvement in autism research, possibly due to conceptual and practical concerns. We evaluate the applicability of CBPR principles to biomarker discovery in autism and critically review empirical studies adopting these principles.MethodsUsing a scoping review methodology, we identified and evaluated seven studies using CBPR (...) principles in biomarker discovery.Results and conclusionsThe limited number of studies in biomarker discovery adopting CBPR principles coupled with their methodological limitations suggests that such applications are feasible but challenging. These studies illustrate three CBPR themes: community assessment, setting global priorities, and collaboration in research design. We propose that further research using participatory principles would be useful in accelerating the pace of discovery and the development of clinically meaningful biomarkers. For this goal to be successful we advocate for increased attention to previously identified conceptual and methodological challenges to participatory approaches in health research, including improving scientific rigor and developing long-term partnerships among stakeholders. (shrink)

Autism spectrum disorder (ASD) is a neuro-developmental condition, which requires a multi-disciplinary matrix of treatments, including functional, educational, and emotional interventions. The latter mode of treatment entails particular difficulties, inasmuch as the core deficits of this condition seem to challenge the very premises of traditional psychotherapy. Reciprocity, verbal, and symbolic expression and inter-subjective dynamics are often difficult to attain with clients diagnosed with ASD, and emotional treatment thus often turns out to be a frustrating process, which may well elicit questions (...) as to the efficacy of psychotherapeutic emotional interventions. These core challenges, described in the literature, become particularly acute in view of the increasing number of clients diagnosed on the autistic spectrum in recent years, and the growing need for qualified therapists who have trained for working specifically with this condition. It seems, therefore, that it is high time for systematic research into the lived experience of therapists working with these clients in order to attain a better clinical and theoretical understanding of the condition itself and broaden the range of effective interventions. This study, informed by a phenomenological-hermeneutic approach which guided both the collection of data and its subsequent analysis, aims to address these issues by exploring the particular challenges faced by therapists in this field, the questions that come up in the process, modes of personal and professional coping, and the insights elicited by the therapeutic encounter. The research consisted of in-depth interviews with 28 practicing therapists from a broad range of clinical orientations, including dance/movement, arts, music, and drama therapists, clinical psychologists, and clinical social workers. The essential themes that emerged from the participants’ responses and the analysis of the findings lend support to theoretical and developmental approaches, which focus on the primacy and the foundational role of the concrete body in inter-subjective relationships and in the therapeutic process, and indicate the potential efficacy of somatic and kinetic interventions. The clinical implications of this study are thus highly relevant to the training and support of therapists working with ASD, who should be encouraged to develop greater receptivity to non-verbal modes of interaction in the therapeutic process. (shrink)

In their attempt to connect the workings of the human mind with their neural realizers, cognitive neuroscientists often bracket out individual differences to build a single, abstract model that purportedly represents (almost) every human being’s brain. In this paper I first examine the rationale behind this model, which I call ‘Platonic Brain Model’. Then I argue that it is to be surpassed in favor of multiple models allowing for patterned inter-individual differences. I introduce the debate on legitimate (and illegitimate) ways (...) of mapping neural structures and cognitive functions, endorsing a view according to which function-structure mapping is context-sensitive. Building on the discussion of the ongoing debate on the function(s) of the so-called Fusiform “Face” Area, I show the necessity of indexing function-structure mappings to some populations of subjects, clustered on the basis of factors such as their expertise in a given domain. (shrink)

In this article, I argue that the history and philosophy of autism need to account for two kinds of autism. Contemporary autism research and practice is structured, directed and connected by an ‘ontological understanding of disease’. This implies that autism is understood as a disease like any other medical disease, existing independently of its particular manifestations in individual patients. In contrast, autism in the 1950s and 1960s was structured by a psychoanalytical framework and an ‘individual understanding of disease’. This implied (...) that autism was not a distinct disease but an idiosyncratic and meaningful response of the child to a disturbed development of the ego. These two kinds of autism are embedded in and reveal two very different ‘styles of psychiatric thought’. (shrink)

One of the central aims of autism research is to identify specific neurodevelopmental mechanisms that cause and explain the visible autistic signs and symptoms. In this short paper, I argue that the persistent search for autism-specific pathophysiologies has two fundamental difficulties. The first regards the growing gap between basic autism science and clinical practice. The second regards the difficulties with demarcating autism as a psychiatric condition. Instead of the unremitting search for the neurobiological basis of autism, I suggest that basic (...) autism research should focus on experiences of impairment and distress, and on how these experiences relate to particular behaviors in particular circumstances, regardless of whether we are dealing with an autism diagnosis or not. (shrink)

Recurrent, unvarying, and seemingly purposeless patterns of action and cognition are part of normal development, but also feature prominently in several neuropsychiatric conditions. Repetitive stereotyped behaviors can be viewed as exaggerated forms of learned habits and frequently correlate with alterations in motor, limbic, and associative basal ganglia circuits. However, it is still unclear how altered basal ganglia feedback signals actually relate to the phenomenological variability of RSBs. Why do behaviorally overlapping phenomena sometimes require different treatment approaches−for example, sensory shielding strategies (...) versus exposure therapy for autism and obsessive-compulsive disorder, respectively? Certain clues may be found in recent models of basal ganglia function that extend well beyond action selection and motivational control, and have implications for sensorimotor integration, prediction, learning under uncertainty, as well as aesthetic learning. In this paper, we systematically compare three exemplary conditions with basal ganglia involvement, obsessive-compulsive disorder, Parkinson’s disease, and autism spectrum conditions, to gain a new understanding of RSBs. We integrate clinical observations and neuroanatomical and neurophysiological alterations with accounts employing the predictive processing framework. Based on this review, we suggest that basal ganglia feedback plays a central role in preconditioning cortical networks to anticipate self-generated, movement-related perception. In this way, basal ganglia feedback appears ideally situated to adjust the salience of sensory signals through precision weighting of new sensory information, relative to the precision of predictions based on prior generated models. Accordingly, behavioral policies may preferentially rely on new data versus existing knowledge, in a spectrum spanning between novelty and stability. RSBs may then represent compensatory or reactive responses, respectively, at the opposite ends of this spectrum. This view places an important role of aesthetic learning on basal ganglia feedback, may account for observed changes in creativity and aesthetic experience in basal ganglia disorders, is empirically testable, and may inform creative art therapies in conditions characterized by stereotyped behaviors. (shrink)

One way to determine whether a mental condition should be considered a disorder is to first give necessary and sufficient conditions for something to be a disorder and then see if it meets these conditions. But this approach has been criticized for begging normative questions. Concerning autism (and other conditions), a neurodiversity movement has arisen with essentially two aims: (1) advocate for the rights and interests of individuals with autism, and (2) de-pathologize autism. We argue that denying autism’s disorder status (...) could undermine autism’s exculpatory role in cases where individuals with autism are charged with a crime. Our argument raises a dilemma for the neurodiversity movement: advocating for the rights and interests of individuals with autism may require viewing autism as a condition that can be inherently disabling (at least for some individuals). If this is right, autism’s disorder status might be maintained (again, at least for some individuals) without deriving this result from any general account of disorder. (shrink)

Neurodiversity, the advocacy position that autism and related conditions are natural variants of human neurological outcomes that should be neither cured nor normalized, is based on the assertion that autistic people have unique neurological differences. Membership in this community as an autistic person largely results from clinical identification, or biocertification. However, there are many autistic individuals who diagnose themselves. This practice is contentious among autistic communities. Using data gathered from Wrong Planet, an online autism community forum, this article describes the (...) debate about self-diagnosis amongst autistic self-advocates and argues for the acceptance of the practice in light of the difficulties in verifying autism as a ‘natural kind.’ This practice can counteract discriminatory practices towards and within the autistic community and also work to verfiy autistic self-knowledge and self-expertise. This discussion also has important implications for other neurocommunities, neuroethical issues such as identity and privacy, and the emerging field of critical autism studies. (shrink)

In the philosophy of well-being, there is hardly anything written on the lives of people with autism or on the question whether existing philosophical theories of well-being are suited for understanding how well the lives of autistic persons are going. This paper tries to make some progress towards filling this gap. I start by giving a concise account of autism, which highlights the huge heterogeneity among autistics. I discuss some basic features of autism, ask whether there are good reasons why (...) we would need an account of well-being specifically for autistics and what philosophical well-being research could learn from being informed by autistic experiences and phenomenology. I then investigate to what extent the capability approach gives us a helpful theory of well-being for autistics, and what looking through an autism-lens can contribute to the further development of the capabilitarian well-being. In particular, I show that some capabilities that are crucially relevant for autistics are also relevant for the lives of non-autistic people. The final part of the paper looks at an important difficulty in using the capabilitarian account of well-being for autistics, namely: should the normative focus be on achievements (functionings) or real opportunities (capabilities)? (shrink)

It often seems incorrect to say that psychiatric conditions are diseases, and equally incorrect to say that they are not. This results in what would seem to be an unsatisfactory stalemate. The present essay examines the considerations that have brought us to such a stalemate in our discussions of autism. It argues that the stalemate in this particular case is a reflection of the fact that we need to find the logical space for a position that rejects both positive and (...) negative answers. It then suggests one way in which we might find such space, by applying Michael Dummett’s notion of semantic disharmony. (shrink)

The Heythrop Journal, Volume 63, Issue 4, Page 757-769, July 2022.

The growth of autistic self-advocacy and the neurodiversity movement has brought about new ethical, theoretical and ideological debates within autism theory, research and practice. These debates have had genuine impact within some areas of autism research but their influence is less evident within early intervention research. In this paper, we argue that all autism intervention stakeholders need to understand and actively engage with the views of autistic people and with neurodiversity as a concept and movement. In so doing, intervention researchers (...) and practitioners are required to move away from a normative agenda and pay diligence to environmental goodness-of-fit, autistic developmental trajectories, internal drivers and experiences, and autistic prioritized intervention targets. Autism intervention researchers must respond to these debates by reframing effectiveness, developing tools to measure autistic prioritized outcomes, and forming partnerships with autistic people. There is a pressing need for increased reflection and articulation around how intervention practices align with a neurodiversity framework and greater emphasis within intervention programmes on natural developmental processes, coping strategies, autonomy, and well-being. (shrink)

How we ought to diagnose, categorise and respond to spectrum disabilities such as autism and Attention Deficit/Hyperactivity Disorder (ADHD) is a topic of lively debate. The heterogeneity associated with ADHD and autism is described as falling on various continua of behavioural, neural, and genetic difference. These continua are varyingly described either as extending into the general population, or as being continua within a given disorder demarcation. Moreover, the interrelationships of these continua are likewise often vague and subject to diverse interpretations. (...) -/- In this paper, I explore geneticists' and self-advocates’ perspectives concerning autism and ADHD as continua. These diagnoses are overwhelmingly analysed as falling on a continuum or continua of underlying traits, which supports the notion of “the neurodiversity spectrum”, i.e., a broader swath of human neural and behavioural diversity on which some concentrations of different functioning are diagnosed. I offer a taxonomy of conceptions of the genetic, phenotypic, and endophenotypic dimensionality within and beyond these diagnostic categories, and suggest that the spectrum of neurodiversity is characteristically endophenotypic. (shrink)

A preimplantation genetic test to discriminate between severe and mild autism spectrum disorder might be developed in the foreseeable future. Recently, the philosophers Julian Savulescu and Guy Kahane claimed that there are strong reasons for prospective parents to make use of such a test to prevent the birth of children who are disposed to autism or Asperger’s disorder. In this paper we will criticize this claim. We will discuss the morality of selection for mild autism in embryo selection in a (...) hypothetical in vitro fertilization (IVF) situation where preimplantation genetic diagnosis is performed and compare this with a similar selection for congenital deafness. To do this we first discuss relevant human differences. We then introduce the principle of human capabilities (PC) and compare this principle with the principle of procreative beneficence (PB) introduced by Savulescu and Kahane. We apply the two principles to selection for mild autism and selection for congenital deafness. We argue that PC allows for the selection for mild autism but rules out selection for congenital deafness. PB will not give clear answers; the ruling of PB depends to a large extent on expected social, cultural and political developments. We will argue that PC is preferable to PB. We will discuss arguments for the value of mild autism for individuals who have this condition and argue that they are able to lead a life with human dignity provided autism-friendly social circumstances are present. Neither PC nor PB yields strong reasons for prospective parents to seek to prevent the birth of children who are disposed to mild autism spectrum disorder. (shrink)

The diagnosis of autism is on the rise. Autistic people, parents, professionals, and policy makers alike face important questions about the right approach toward autism. For example, there are questions about the desirability of early detection, the role and consequences of underlying cognitive theories, and whether autism is a disorder to be treated or an identity to be respected. How does the fact that autism is a heterogeneous concept affect the answers to these questions? Who has the authority or knowledge (...) to speak on behalf of people with autism? In this paper, we describe a cluster of research topics which should be on the agenda of the emerging field of autism ethics. These topics include the very concept of autism itself, the question whether autism is primarily an identity or a disorder, the ethical questions that parents of autistic children face, metaethical questions, the ethical consequences of epistemological questions, and a cluster of questions related to social justice, stigma, and paternalism. (shrink)

Autism as a polysemic and dynamic phenomenonIn this paper we demonstrate how the dominant discourse about autism, that stresses biological explanations, has certain ethical implications. On the one hand, such discourse is exculpating. In autism’s history, genetic explanations helped removing the blame from so-called refrigerator mothers. In present-day diagnostic practice, the idea of having a biological diagnosis helps people and their parents see beyond blame and guilt. On the other hand, a simplistic approach to biology risks neglecting the experiences and (...) stories of autistic people in favour of finding causes and cures. In our own research we have noticed that narratives of autistic people explore an alternative autism discourse, one that demonstrate multiple meanings and dynamics of autism. We demonstrate, using the theories of Georges Canguilhem and the science of epigenetics, how dynamic models of life and mind offer the possibility to look at autism differently. Rather than seeing autistic people as people with fundamental flaws in their genes or software faults in their brains that have to be explained, autism appears as a phenomenon that exists in interaction with the context, as a meaningful reaction to the environment. (shrink)

Jonathan Beever and Nicolae Morar’s article “The Porosity of Autonomy: Social and Biological Constitution of the Patient in Biomedicine” and its accompanying commentaries in the American Journal of Bioethics—though insightful, innovative, and provocative—overlook key interlocutors necessary for any discussion of whether the mid-twentieth-century biomedical principle of autonomy should be revised or revoked. The conversation sparked by “The Porosity of Autonomy” will remain both incomplete and politically untenable so long as there is no meaningful engagement with persons/communities who appeal to the (...) principle of patient autonomy in order to articulate and challenge the conditions of their oppression. (shrink)

BackgroundResearch with cerebral organoids is beginning to make significant progress in understanding the etiology of autism spectrum disorder (ASD). Brain organoid models can be grown from the cells of donors with ASD. Researchers can explore the genetic, developmental, and other factors that may give rise to the varieties of autism. Researchers could study all of these factors together with brain organoids grown from cells originating from ASD individuals. This makes brain organoids unique from other forms of ASD research. They are (...) like a multi-tool, one with significant versatility for the scope of ASD research and clinical applications. There is hope that brain organoids could one day be used for precision medicine, like developing tailored ASD drug treatments.Main bodyBrain organoid researchers often incorporate the medical model of disability when researching the origins of ASD, especially when the research has the specific aim of potentially finding tailored clinical treatments for ASD individuals. The neurodiversity movement—a developmental disability movement and paradigm that understands autism as a form of natural human diversity—will potentially disagree with approaches or aims of cerebral organoid research on ASD. Neurodiversity advocates incorporate a social model of disability into their movement, which focuses more on the social, attitudinal, and environmental barriers rather than biophysical or psychological deficits. Therefore, a potential conflict may arise between these perspectives on how to proceed with cerebral organoid research regarding neurodevelopmental conditions, especially ASD.ConclusionsHere, we present these perspectives and give at least three initial recommendations to achieve a more holistic and inclusive approach to cerebral organoid research on ASD. These three initial starting points can build bridges between researchers and the neurodiversity movement. First, neurodiverse individuals should be included as co-creators in both the scientific process and research communication. Second, clinicians and neurodiverse communities should have open and respectful communication. Finally, we suggest a continual reconceptualization of illness, impairment, disability, behavior, and person. (shrink)

While several scholars have argued that the rise of the internet has allowed an autistic culture to emerge over the past two decades, the question of whether people with autism or, as some members of this group refer to themselves, ‘autists’, are legally entitled to their own cultural rights has not been investigated. This article fills part of this lacuna by considering whether such entitlements exist from the perspective of human rights law. I start by showing that, insofar as autists (...) have their own culture, they are likely to be entitled to cultural rights under existing human rights treaties, before arguing that the absence of evidence that their beliefs, values, and behaviors are significantly shaped by distinct social norms renders it unclear whether they do in fact have their own culture. However, I end by arguing that, in terms of autists’ entitlements from a human rights perspective, little seems to depend on this. (shrink)

Many individuals on the autism spectrum are hypersensitive to certain sensory stimuli. For this group, as well as for non-autistic individuals with sensory processing disorders, being exposed to e.g. fluorescent lights, perfume odours, and various sounds and noises can be real torment. In this article, I consider the normative implications of such offence for the design of office spaces, which is a topic that has not received any attention from philosophers. After identifying different ways in which the senses of hypersensitive (...) workers might be protected within these spaces, I show that many of such accommodations can be made at reasonable cost, before arguing that doing so ought to be a legal requirement. (shrink)

Volume 20, Issue 4, May 2020, Page 35-37.

Typically, although it’s notoriously hard to define, autism has been represented as a biologically-based mental disorder that can be usefully investigated by biomedical science. In recent years, ho...

Journal of Social Philosophy, EarlyView.

Autobiographical stories do not merely offer insights into someone’s experience but can constitute evidence or even serve as self-standing arguments for a given viewpoint in the context of public debates. Such stories are likely to exercise considerable influence on debate participants’ views and behaviour due to their being more vivid, engaging, and accessible than other forms of evidence or argument. In this paper we are interested in whether there are epistemic and moral duties associated with the use of autobiographical stories (...) in mental health debates. We argue that debate participants have a responsibility to assess a story as evidence or as an argument when the story is put forward to support a given viewpoint. We also make some preliminary suggestions about what can be done to ensure that the use of stories contributes to the variety of the resources available to debate participants without compromising the quality of the argumentation or increasing polarisation. (shrink)

Psychiatric diagnoses such as Autism Spectrum Disorder (ASD) are primarily attributed on the basis of behavioral criteria. The aim of most of the biomedical research on ASD is to uncover the underlying mechanisms that lead to or even cause pathological behavior. However, in the philosophical and sociological literature, it has been suggested that autism is also to some extent a ‘social construct’ that cannot merely be reduced to its biological explanation. We show that a one-sided adherence to either a biological (...) or a social explanation leads to a moral dilemma, a Catch-22, for autistics and for those living with them. Such explanations close the space for self-identifying as autistic and at the same time being considered to be in good mental health. They foreclose the possibility of making sense of the lived experience of (and with) autistics. In this paper we argue that such lack of space for moral imagination inherently leads to scientific stalemate. We propose that one can only go beyond this stalemate by taking an ethical stance in theorizing, one that enables better intersubjective understanding. Only on such a view can behavior and biology be linked without either disconnecting them or reducing the one to the other. (shrink)

This paper proposes a novel method for identifying the public evaluative standards that contribute to the classification of certain conditions as mental disabilities. Public evaluative standards could contribute to ascertaining disabilities by outlining characteristics whose presence beyond a threshold is fundamentally important for the life of a person and whose absence or reduced occurrence constitutes a disability. Additionally, they can participate in determining disabilities by delineating particularly grave difficulties, impairments, or incapacities. Our method relies on a model of public justification (...) of evaluative standards that is inspired by Gerald Gaus’s theory of public reason. Thus, our approach recommends the justification of evaluative standards through sound deliberative routes from reasons accessible to all persons who participate in the process of justification and the convergence of what is justified in this way to each of them. We deem that disabilities could be caused both by problems in the internal characteristics of a person as well as by unfairness or a lack of hospitality in external circumstances. This is why the method of justification is applied to the assessment of those circumstances as well. If social or environmental circumstances cannot be justified through the convergence of reasons accessible to all persons involved in the process of justification, we have reasons to exclude the presence of a disability and ascertain the presence of inadequate external conditions. (shrink)

Epigenetics – the study of mechanisms that influence and modify gene expression – is providing unique insights into how an individual’s social and physical environment impact the body at a molecular level, particularly in populations that experience stigmatization and trauma. Researchers are employing epigenetic studies to illuminate how epigenetic modifications lead to imbalances in health outcomes for vulnerable populations. However, the investigation of factors that render a population epigenetically vulnerable present particular ethical and methodological challenges. Here we are concerned with (...) demonstrating how, in targeting certain populations for epigenetic research, this research may be pathologizing socio-cultural and medical practices in those populations in a way that increases their vulnerability. Using a case study approach, this article examines three vulnerable populations currently of interest to epigenetic researchers – Indigenous, autistic, and transgender populations – in order to highlight some of the challenges of conducting non-stigmatizing research in epigenetics. (shrink)

In this chapter, our focus is the role played by notions of rationality in the diagnosis of mental disorders, and in the practice of overriding patient autonomy in psychiatry. We describe and evaluate different hypotheses concerning the relationship between rationality and diagnosis, raising questions about what features underpin psychiatric categories. These questions reinforce widely held concerns about the use of diagnosis as a justification for overriding autonomy, which have motivated a shift to mental incapacity as an alternative justification. However, this (...) approach too has recently been criticized from a mental disability rights perspective. Our analysis of the relationship between mental capacity and rationality is used to illuminate these concerns, and to investigate further the relationship between rationality and psychiatric diagnosis. (shrink)

This dissertation explores philosophical issues in autism and defends a new version of the enactive approach to autism and social cognition. The discussion in this dissertation centres around the question “why do autistics encounter social interaction problems?”, addressing this question in ways that raise broader philosophical issues. Within the philosophy of mind, these include the problem of other minds, the nature of emotions, and narratives and their role in understanding the self. Beyond cognition, such issues are intertwined with questions in (...) metaphysics, philosophy of science, sociopolitical and moral philosophy, and disability studies. In responding to the question “why do autistics encounter social interaction problems?”, I argue that autistic social interaction problems result from the sensorimotor differences between autistics and non-autistics. This contrasts with the response to this question given by widely-endorsed views that emphasize instead the cognitive deficits that autistic people have. Such cognitivist views, such as the theory theory and simulation theory, are the focus of my first two critical chapters. I go on to offer a critique of two approaches that go beyond the focus on mindreading in appealing to sensorimotor problems as lying at the heart of the problem. These views, interaction theory and the original enactive approach, are the focus of the next two chapters. I then turn to defend a novel form of the enactive approach in the last part of the dissertation by emphasizing the role of emotions as the capacity for us to make sense of the world and to construct the sense of self from narratives. My new approach shifts the explanatory focus from perception and motion to emotion. This maintains the advantage of the original enactive approach, while avoiding its behaviouristically limited descriptions. My account thus expands the theory’s capacity to describe and explain internal states important to self-understanding and self-expression. This allows one to approach autistic social difficulties by attending to the first-person perspective, cohering with my reliance on first-person autistic narratives as a major source of evidence that supplements traditional scientific research on autism. (shrink)

The traditional paradigm of equality combines a focus on the goals of democratic institutions with the equality of resources position. The goal of distributive justice in this picture is to put citizens on equal footing in mutually accountable relationships by ensuring each has access to the kinds of things that serve as all-purpose means for pursuing their interests, like money. This approach, with its overt focus on providing citizens all-purpose means, however, pays insufficient attention to our neuro-psychological differences. In many (...) ways, the capabilities approach to equality is designed to incorporate issues of diversity, including neurodiversity. The capabilities approach gives issues of diversity a pride of place by starting from the fact of individual’s variable capability to develop a sense of the good or use resources. For the capabilities approach, however, the question of limits looms large. In what sense can we attain equality on a functioning approach when the fact of neurodiversity highlights a wide range of neurological difference, both in kind and degree? How many resources can justly be spent on the project? I suggest the best current approach to equality brings together elements from the capabilities framework, which better accounts for what to equalize in light of neurodiversity, and an institutional framework more readily aligned with the traditional paradigm, which provides a more principled basis for establishing limits on the demands of justice. (shrink)