On a typical school morning, seven-year-old Jayden (not his real name) sits quietly at his desk, smiling at classmates who greet him as they stream into the classroom. As soon as his best friend sits down beside him, they start talking about their favourite topic – Pokemon.
Everyone in class knows that Jayden loves Pokemon – conversations with him often revolve around this interest. They have also learnt to navigate his preferences carefully and understand that he may become distressed when he loses games or when events do not unfold according to his expectations. To his teachers, he is academically capable and expressive, though he sometimes tends to interrupt lessons with his questions and needs reminders to wait for his turn.
Beneath this outwardly cheerful and competent appearance lies a daily struggle that is less visible to others. Jayden works hard to regulate himself, particularly when he becomes overwhelmed with rules he thought had been broken. During group work, he makes a conscious effort to avoid dominating conversations or redirecting discussions towards his own interests. His current primary school teachers began to understand his behavioural patterns more fully only after his parents shared his diagnosis of autism and the support he had received during his pre-school years.
Jayden was diagnosed with autism at the age of six, after his parents noticed that he seemed different from other children of his age. Initially, they attributed his frequent tantrums to his temperament. His outbursts, when he thought that rules had been broken, were a daily occurrence, until he started receiving behavioural help from his psychologist.
Jayden did not fit the image of autism that many people hold: a child who wanders aimlessly in public or withdraws entirely from others. Further evaluation was pursued only after teachers observed persistent behavioural challenges during kindergarten. In addition, Jayden also received behavioural and occupational therapy as well as social skills training, helping him regulate emotions and better understand friendships.
Stories like Jayden’s reflect how autism awareness in Singapore has expanded, particularly with improvements in early recognition and access to therapy or intervention. Yet they also raise an important question: Has understanding truly kept pace with awareness? Looking closely at Jayden’s journey, one might note that his parents’ initial concerns were not centred on autism itself, but on what seemed like a short temper. Public recognition of autism certainly exists, but it is often shaped by narrow and incomplete stereotypes. When societal perceptions remain limited, do we risk leaving some individuals undiagnosed, unsupported and unseen?
What is autism?
Autism is a neurodevelopmental condition characterised by differences in how autistic individuals communicate and interact with others, as well as by restricted interests and/or repetitive patterns of behaviour. At first glance, autism may seem straightforward to define. In reality, its definition has evolved considerably over the past few decades, reflecting advances in scientific understanding and clinical practice.
Historically, autism was classified into several related diagnoses – such as Asperger’s syndrome, pervasive developmental disorder-not otherwise specified, and so-called “classic” autism – each intended to reflect differing patterns of language, social and cognitive development. A major shift occurred in 2013 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. These previously separate diagnoses were consolidated into one umbrella term: autism spectrum disorder (ASD). Beyond simplifying diagnostic categories, this change acknowledged that autistic traits exist along a continuum rather than within discrete boxes.
Clinically, these changes have offered clear advantages. Professionals can now recognise individuals who might have fallen between categories previously, and inconsistencies in the use of older labels have reduced. However, the umbrella approach has also introduced new complexities. A single diagnosis now encompasses individuals with widely differing profiles – from those who require intensive daily support to those who function independently in academic or professional environments.
Some clinicians and educators have raised concerns that the broad autism spectrum framework may mask meaningful differences. Individuals with very different needs, for example, can share the same diagnosis, potentially obscuring both challenges and strengths. Parents may also struggle to interpret the significance of an ASD diagnosis when it spans a wide range of abilities, particularly when autism is associated mainly with more visible impairments, leading to subtler differences dismissed as normal variation.
Although more specific descriptors have been proposed to enhance our understanding of autism, we need to keep in mind that every diagnostic model has its boundaries and carefully consider the clinical and practical usefulness of the umbrella model moving forward.
Beyond a straight line: Rethinking the spectrum
Public discourse often portrays autism as a straight line stretching from “mild” to “severe”, a metaphor that is simple but potentially misleading. Rather than a single sliding scale, autism is better understood as a constellation of traits, with characteristics varying in intensity and expression across individuals, contexts and stages of life. As a result, the type and level of support an individual requires may change over time.
This diversity is reflected in how traits present across different individuals. One person may have strong verbal abilities yet struggle with sensory sensitivities, while another may communicate minimally but display exceptional visual or analytical strengths. Some individuals function effectively in structured settings but become overwhelmed in unpredictable social environments, illustrating that abilities and challenges often coexist in complex ways.
Even within the same person, traits can shift across life stages, and stereotypical portrayals capture only a narrow range of experiences. A child who manages well in early schooling may face increasing demands during adolescence, while adults who appear socially confident may still experience profound anxiety beneath the surface. Viewing autism as a constellation rather than a linear spectrum, therefore, encourages a more nuanced perspective – one that moves beyond simplistic labels and focuses on individual strengths, needs and lived experiences.
Autism in the Singapore context
Singapore has made notable progress in raising awareness of autism. Public campaigns, educational initiatives and community programmes have increased visibility and encouraged conversations that were once uncommon.
The Department of Child Development (DCD) at KK Women’s and Children’s Hospital is recognised as a local tertiary centre for developmental assessment of pre-school children with suspected neurodevelopmental conditions, including autism. A local study led by Dr Wong Chui Mae, senior consultant at the DCD, analysed more than 2,000 children born between 2008 and 2011 who were evaluated or diagnosed with autism through the service. The findings revealed that on average, children were diagnosed with autism at about 3½ years old. This study shows varied developmental outcomes, highlighting the importance of early assessment and timely intervention.
Indeed, schools and healthcare services have expanded autism support, with mainstream and special education programmes reflecting broader efforts to meet diverse needs.
Despite ongoing advancements, significant challenges remain, particularly the continued reliance on highly visible or stereotypical signs as indicators of autism. Children who are verbal, academically capable, or outwardly sociable may not raise concern, allowing subtler differences – such as rigid thinking, social difficulties, or sensory sensitivities – to be overlooked by parents, teachers and primary care providers. Cultural influences can further delay identification, meaning underlying difficulties may be recognised only when more pronounced emotional or behavioural challenges emerge.
The consequences are real. Later identification can mean delayed access to interventions, educational accommodations and emotional support. Children or individuals may internalise repeated social failures as personal inadequacies rather than differences in neurodevelopment. Families, too, may endure prolonged uncertainty, navigating years of confusion before receiving clarity.
The neurodiversity debate
Contemporary discussions on autism are shaped by two main frameworks: the medical model and the neurodiversity model.
The medical model frames autism as a condition involving differences that may require structured support, with diagnosis enabling access to interventions such as speech, occupational and behavioural therapies, which are often essential for individuals and families. While autism has been defined by severity levels based on the degree of support required, these severity levels change over time as an individual’s needs evolve along with the support they receive.
In contrast, the neurodiversity model views autism as a natural variation in neurocognitive functioning, highlighting strengths such as attention to detail, persistence and creative problem-solving, while emphasising that difficulties arise from environmental barriers.
The tension between these models influences policy, education, and societal attitudes. Should interventions focus on reducing autistic behaviours, or should environments adapt to accommodate diverse ways of thinking and interacting?
In practice, the two perspectives often overlap rather than oppose each other. Autism can be understood as both a form of neurocognitive diversity and a condition that may require clinical support in specific contexts. One must carefully consider some individuals on the spectrum with impairments, who would benefit from a medical-model lens, both for assessment and intervention. How this balance is interpreted has direct implications for how resources to support are allocated, how schools design accommodations, and how workplaces foster inclusivity for people with autism.
Singapore is at a pivotal moment in autism understanding, where growing awareness has brought greater visibility to the condition. A local study in 2025 led by KKH DCD highlights this effort, where 2 per cent of over 4,000 young children were screened positive for autism. While screening does not confirm a diagnosis, catching these signs early helps families better understand the developmental and behavioural needs of children on the spectrum.
Yet, awareness alone is insufficient if understanding remains superficial. Clearer conceptualisation enables earlier diagnosis, timely intervention, improved independence for individuals and families, and more tailored strategies in practical terms. True inclusion comes from understanding autism beyond textbook or media stereotypes.
As Singapore continues to refine its educational systems, healthcare pathways and community support, a deeper understanding of autism must accompany rising awareness. Only then can individuals like Jayden move through classrooms, workplaces and communities not as anomalies to be managed, but as valued members of society whose diverse ways of thinking enrich the world around them.
Dr Kenneth Li is a consultant at the Department of Child Development at KK Women’s and Children’s Hospital.
