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Lucas was 26 years old when he finally managed to name what he had felt since childhood. A brilliant software engineer, he never understood why work social gatherings exhausted him so much. Why he needed to memorise mental scripts before any meeting. Why last-minute changes to a project triggered an anguish that his colleagues simply did not share. For years, he called himself anxious, antisocial, difficult. The diagnosis of Autism Spectrum Disorder came at age 26 and, according to him, "it was like receiving an instruction manual for my own life".

Lucas's story is not an isolated case. It is the portrait of millions of Brazilians living with Autism Spectrum Disorder (ASD) without ever having received a formal diagnosis, or who received it too late to avoid years of unnecessary self-blame. And it is precisely for this reason that a law approved this year deserves more than a date on the calendar: it deserves an honest conversation about what autism really is, how it manifests itself, and how medicine needs to treat it.

The law that debuts today: what changed?

On 31 March 2026, the president signed Law 15.365, which officially established National Autistic Pride Day, to be celebrated every 18 June. Today is, therefore, the first time this date is commemorated in Brazil.

The project originated from PL 3.391/2020, proposed by former senator Romário, and was approved in the Senate with a report by senator Mara Gabrilli (PSD-SP). The rule did not replace the National Day of Awareness about Autism, celebrated on 2 April and already provided for by Law 13.652/2018. The two dates now coexist with distinct purposes: April for awareness, June for pride.

But what exactly does "autistic pride" mean? And why does this have clinical relevance? This answer begins by understanding what the ASD diagnosis really represents.

Autism is not a disease to be cured. It is a different way of existing.

Before talking about pride, it is necessary to dispel a misconception that still persists in surgeries, schools and even in family conversations: autism is not a disease in the traditional sense of the term. There is no infection, tumour, or lesion that causes it. Autism Spectrum Disorder is a neurodevelopmental condition, that is, a different way in which the brain organises itself and processes the world from birth.

The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th revised edition), the primary diagnostic reference used in Brazil, defines ASD as a pattern of characteristics involving two main axes:

1. Persistent deficits in communication and social interaction. This includes difficulties in initiating or maintaining conversations, in understanding non-verbal language (facial expressions, tone of voice, gestures), in building and maintaining relationships appropriate to the developmental stage, and in adapting behaviour to different social contexts.

2. Restricted and repetitive patterns of behaviour, interests or activities. This encompasses repetitive motor movements (such as body swaying or hand movements, spinning objects), insistence on routines and great resistance to change, highly focused and intense interests in specific themes, and uncommon reactivity to sensory stimuli (hypersensitivity to sounds, textures, light or temperature, or, conversely, intense seeking of sensory stimulation).

For the diagnosis to be confirmed, these symptoms need to be present from the initial stages of development, cause clinically significant impairment in social, professional or other important areas of life, and not be better explained by isolated intellectual disability or global developmental delay.

Why "spectrum"? Because autism has a thousand faces.

The word "spectrum" exists for a precise reason: autism does not have a single format. Two people with the same diagnosis can have radically different life experiences. One may speak fluently, work independently and be diagnosed only in adult life. The other may have very limited verbal communication, require intensive support for basic activities and be diagnosed in the early years of life.

To organise this diversity within clinical practice, the DSM-5 introduced the concept of support levels, which replaced the old subcategories (Asperger's Syndrome, High-Functioning Autism, etc.). There are three levels, which describe the intensity of support the person needs, not the degree of severity as a condemnation.

This distinction matters greatly: support level is not a hierarchy of human worth. It is a clinical tool to guide interventions.

Level 1: Requires support

What it means

At Level 1, the person can function relatively independently in most everyday contexts. Without specialised support available, deficits in social communication cause perceptible impairment, but do not prevent functional life. Behavioural inflexibility, however, interferes significantly in at least one context, compromising independence.

Frequent characteristics:

  • Difficulty in initiating spontaneous social interactions
  • Inadequate or disconcerting responses in informal social situations
  • Apparent little interest in social relationships (which often actually conceals intense desire to connect, but difficulty in knowing how)
  • Inflexibility that generates real suffering in changes to routine
  • Difficulty with organisation and planning that impairs autonomy in complex tasks
  • Verbal communication preserved, but with difficulties in implicit social language (irony, innuendo, insinuation)

This is the level frequently associated with late diagnosis, especially in women, who learn from an early age to "mask" differences to fit in socially.

Clinical case: Lucas, 26 years old

Lucas sought medical care complaining of "severe social anxiety" and insomnia. He was a software engineer at a technology company. He described himself as someone who "did not know how to talk to people" and who needed, literally, to mentally prepare what he was going to say before any unstructured social interaction.

In the surgery, he spoke with precise vocabulary, maintained adequate eye contact when the subject was technical, but demonstrated noticeable rigidity when interrupted in his reasoning. He said that he relied on fixed routines to organise himself, that any change to his schedule left him profoundly uncomfortable, and that he had an intense interest in medieval history, a subject he spoke about with depth and enthusiasm rarely seen in other subjects.

Referred for neuropsychological assessment, he received a diagnosis of ASD Level 1. Upon learning of the diagnosis, his first reaction was relief: "I'm not lazy or arrogant. My brain works differently."

The approach included psychoeducation about ASD, cognitive-behavioural therapy adapted for autism, guidance on sensory management strategies in the work environment, and, fundamentally, communication with the company's HR department for reasonable workplace adjustments. There was no indication for medication specific to ASD, but there was follow-up of the associated anxiety condition.

Level 2: Requires substantial support

What it means

At Level 2, deficits in social communication are marked, visible even to untrained observers, and persist even when the person receives some support. Social interactions are limited, responses to openings from others are reduced or atypical, and restricted and repetitive behaviours appear with sufficient frequency to be evident in everyday life.

Frequent characteristics:

  • Verbal language present, but with significant functional limitations (simple sentences, vocabulary restricted to subjects of interest, difficulty maintaining reciprocal dialogues)
  • Marked difficulty in adapting to new or unexpected routines
  • Visible repetitive behaviours (motor stereotypies, rigid rituals before activities)
  • Social interest present, but with great difficulty in knowing how to establish it
  • Sensory hypersensitivity or hyposensitivity that interferes in daily life
  • Need for support with schoolwork, social and self-care tasks

Children at this level typically attend mainstream school with the support of a therapeutic aide and need continuous multidisciplinary interventions.

Clinical case: Marina, 9 years old

Marina's mother brought her to the surgery worried about her daughter's difficulties at school. Marina had functional language, but responded mainly when directly asked. She rarely initiated conversations with peers. When she tried to approach other children, she did so in a way that others considered "strange": she would stand beside the group without integrating, repeating phrases from cartoons out of context.

At home, any change in routine triggered intense crises. A change of route to school due to roadworks caused a week of great distress. Marina lined up objects before sleep every day, in the same order, and any change to this ritual prevented sleep.

On examination, she demonstrated echolalia (repetition of phrases heard in other contexts), body-swaying stereotypy when anxious, and clear hypersensitivity to noise (she covered her ears in any environment with more than three people speaking at the same time).

The diagnosis was ASD Level 2. The approach involved a multidisciplinary team: speech and language therapist focusing on functional communication and social skills, occupational therapist for sensory management, psychologist specialising in ASD, and a therapeutic aide at school. The family received guidance on the Berenice Piana Law (Law 12.764/2012), which guarantees the right to a specialised aide in public and private schools.

Level 3: Requires very substantial support

What it means

Level 3 represents the greatest degree of functional impairment within the spectrum. Deficits in verbal and non-verbal social communication are severe, causing serious impairment in functioning in virtually all areas of life. Initiation of social interactions is very limited, and responses to attempts at interaction by others are minimal.

Frequent characteristics:

  • Very limited or absent verbal communication (functional use of few words or communication mainly non-verbal and by images)
  • Need for augmentative and alternative communication (communication boards, AAC apps, PECS)
  • Repetitive behaviours that markedly interfere in all areas of functioning
  • Extreme difficulty in dealing with any change, however small
  • Need for constant supervision for safety and self-care
  • Frequent presence of comorbidities such as epilepsy, intellectual disability and sleep disorders
  • Self-injurious behaviours in some cases, associated with sensory distress or communication of unmet needs

It is the level that requires the broadest support network: family, specialist school, complete multidisciplinary team and, often, lifelong support.

Clinical case: Pedro, 5 years old

Pedro was brought by his family to the child neurologist with a referral from the primary health care centre after his kindergarten teacher reported that he "did not respond to his own name" and "did not play with other children". His mother said that she knew something was different from 18 months, when Pedro stopped saying the few words he had learned.

On assessment, Pedro did not maintain consistent eye contact. His verbal communication was limited to four functional words ("water", "no", "mum" and the name of his favourite cartoon). He communicated his needs mainly by pulling his mother's hand and leading her to the desired object. He presented frequent motor stereotypies (spinning objects, hand flapping), strong resistance to any environmental change, and episodes of intense distress at unexpected sounds, such as car horns or hair dryers.

The family reported that Pedro bit his own hands during moments of sensory overload and that his sleep was fragmented, with frequent nocturnal awakenings.

The diagnosis was ASD Level 3. The additional investigation included EEG (ruling out comorbid epilepsy in this case) and genetic assessment (karyotype with microarray), which did not identify associated genetic alteration. The approach was structured with a special education school with trained professionals, introduction of an augmentative communication system (PECS and AAC app on tablet), occupational therapy focusing on sensory issues, intensive speech and language therapy, and detailed family guidance on crisis management. The team also discussed with the family realistic expectations for development, without underestimating Pedro's potential, but without creating unrealistic expectations that would generate additional suffering.

What does Autistic Pride Day change in medical practice?

Autistic pride is not a denial of challenges. It is the recognition that autistic people have value, identity and rights, regardless of the level of support they need. And this has direct impact on the way doctors should approach diagnosis and treatment.

1. The diagnosis is not a sentence. Receiving an ASD diagnosis does not define what a person can or cannot achieve. It defines the type of support they need to achieve what they desire. Communicating the diagnosis should be done with care, clarity and realistic hope.

2. Treatment is not synonymous with "cure". There is no medication to treat autism itself. What exist are interventions for associated conditions (anxiety, comorbid ADHD, sleep disorders, epilepsy) and therapies that expand functional abilities and quality of life. The goal is not to make the autistic person appear neurotypical. It is to support them to live well being who they are.

3. The approach changes according to the level of support. A patient at Level 1 may primarily need psychoeducation, environmental adjustments and cognitive-behavioural therapy. A patient at Level 3 needs a much more robust support network, which includes family, specialist school, AAC and medical follow-up for comorbidities. Treating everyone with the same approach is treating the diagnosis, not the person.

4. Masking is suffering, not adaptation. Especially in autistic women and girls, the phenomenon of "masking" (camouflaging autistic characteristics to fit in socially) is frequent and intensely exhausting. Recognising this clinically means not interpreting absence of visible symptoms as absence of suffering.

5. Family also needs care. Mothers, fathers and carers of autistic people, especially at higher support levels, present high rates of burnout, anxiety and depression. Including the family in the therapeutic plan is not optional: it is part of the approach.

Misinformation kills opportunities. Information changes lives.

Brazil has more than 2 million people diagnosed with autism, according to the Brazilian Institute of Geography and Statistics. The actual prevalence, considering underdiagnosis, is probably much greater. Nevertheless, access to early diagnosis and adequate interventions remains unequal: children from families with more resources reach the specialist sooner, and poor children often arrive late, or never arrive.

Autistic Pride Day does not solve this inequality by itself. But dates like this broaden public debate, increase recognition of the diagnosis by the community itself, and reduce the stigma that still makes many families hide the diagnosis in shame instead of seeking help.

When a doctor understands the spectrum in all its diversity, when a school knows the difference between a "difficult" student and a student who needs different support, and when a family receives the diagnosis as a beginning instead of an end, more people live with dignity.

This is what autistic pride has to do with medicine.

This article is exclusively informative and educational in character. It does not replace individualised clinical assessment by a qualified healthcare professional. The clinical cases described are fictional, created for educational purposes, and do not correspond to real patients. If you or someone in your family presents with characteristics described in this text, seek guidance from a specialist medical professional.

Dr. Rebeca Soares Andrade CRM-GO 39335