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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 memorize mental scripts before any meeting. Why last-minute project changes 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, "was like receiving an instruction manual for life itself."

Lucas's story is not an isolated case. It is a portrait of millions of Brazilians who live 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, and how medicine needs to treat it.

The law that debuts today: what changed?

On March 31, 2026, the president signed Law 15,365, which officially established the National Day of Autism Pride, to be celebrated every June 18. Today is, therefore, the first time this date is being commemorated in Brazil.

The project originated from Bill 3,391/2020, proposed by former senator Romário, and was approved in the Senate with rapporteurship by senator Mara Gabrilli (PSD-SP). The rule did not replace the National Day of Awareness About Autism, celebrated on April 2 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 "autism 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 undo a misconception that still persists in offices, schools, and even in family conversations: autism is not a disease in the traditional sense of the term. There is no infection, tumor, or lesion that causes it. Autism Spectrum Disorder is a neurodevelopmental condition, that is, a different way in which the brain organizes itself and processes the world from birth.

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

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

2. Restricted and repetitive patterns of behavior, interests, or activities. This encompasses repetitive motor movements (such as swaying the body or hands, spinning objects), insistence on routines and great resistance to change, highly focused and intense interests in specific topics, and unusual 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 must be present from the initial phases of development, cause clinically significant impairment in social, professional, or other important areas of functioning, 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 adulthood. Another may have very limited verbal communication, require intensive support for basic activities, and be diagnosed in the first years of life.

To organize 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, and 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 is able to function relatively independently in most everyday contexts. Without specialized support available, social communication deficits cause noticeable impairments, but do not prevent functional living. Behavioral inflexibility, however, interferes significantly in at least one context, compromising independence.

Frequent characteristics:

  • Difficulty initiating spontaneous social interactions
  • Inadequate or bewildering 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 routine changes
  • Difficulty with organization and planning that impairs autonomy in complex tasks
  • Speech preserved, but with difficulties in implicit social language (irony, insinuation, hints)

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 with people" and who literally needed to mentally prepare what he would say before any unstructured social interaction.

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

Referred for neuropsychological evaluation, he received the 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 management included psychoeducation about ASD, cognitive-behavioral therapy adapted for autism, guidance on sensory management strategies in the work environment and, fundamentally, communication with the company's HR for reasonable accommodations in the workplace. There was no indication for medication specific to ASD, but monitoring of the associated anxiety condition was undertaken.

Level 2: Requires substantial support

What it means

At Level 2, social communication deficits 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 behaviors appear with sufficient frequency to be evident in daily life.

Frequent characteristics:

  • Verbal language present, but with significant functional limitations (simple phrases, vocabulary restricted to topics of interest, difficulty maintaining reciprocal dialogues)
  • Marked difficulty adapting to new or unexpected routines
  • Visible repetitive behaviors (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 for school, social, and self-care tasks

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

Clinical case: Marina, 9 years old

Marina's mother brought her to the office concerned about her daughter's difficulties at school. Marina had functional language, but responded primarily when asked directly. She rarely initiated conversations with classmates. 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. The change of route to school due to road work caused a week of great suffering. Marina would line up objects before sleeping every day, in the same order, and any alteration in 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 (covered her ears in any environment with more than three people speaking at the same time).

The diagnosis was ASD Level 2. The management involved a multidisciplinary team: a speech-language pathologist with focus on functional communication and social skills, an occupational therapist for sensory management, a psychologist specialized in ASD, and a therapeutic aide at school. The family received guidance about Berenice Piana Law (Law 12,764/2012), which guarantees the right to specialized accompaniment in public and private schools.

Level 3: Requires very substantial support

What it means

Level 3 represents the highest degree of functional impairment within the spectrum. Deficits in verbal and nonverbal social communication are severe, causing serious impairments in functioning in practically all domains of life. Initiation of social interactions is very limited, and responses to attempts at interaction from others are minimal.

Frequent characteristics:

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

It is the level that requires the broadest support network: family, specialized school, complete multidisciplinary team, and often support for life.

Clinical case: Pedro, 5 years old

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

On evaluation, Pedro did not make consistent eye contact. His verbal communication was limited to four functional words ("water," "no," "mom," and the name of his favorite cartoon). He communicated his needs mainly by pulling his mother's hand and taking her to the desired object. He presented frequent motor stereotypies (spinning objects, waving hands), strong resistance to any change in environment, and episodes of intense distress with unexpected sounds, such as car horns or hair dryers.

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

The diagnosis was ASD Level 3. Supplementary investigation included EEG (ruling out comorbid epilepsy in this case) and genetic evaluation (karyotype with microarray), which identified no associated genetic alteration. The management was structured with special education school with trained professionals, introduction of augmentative communication system (PECS and AAC application on tablet), occupational therapy with sensory focus, intensive speech-language pathology, 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 Autism Pride Day change in medical practice?

Autism 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 how doctors should approach diagnosis and treatment.

1. Diagnosis is not a sentence. Receiving the ASD diagnosis does not define what a person can or cannot achieve. It defines the type of support they need to achieve what they want. Communication of 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. Management changes according to the support level. A patient at Level 1 may mainly need psychoeducation, environmental adaptations, and cognitive-behavioral therapy. A patient at Level 3 needs a much more robust support network, which includes family, specialized school, AAC, and medical monitoring 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. Recognizing this clinically means not interpreting absence of visible symptoms as absence of suffering.

5. Family also needs care. Mothers, fathers, and caregivers 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 management.

Misinformation kills opportunities. Information changes lives.

Brazil has more than 2 million people diagnosed with autism, according to IBGE. The actual prevalence, considering underdiagnosis, is probably much greater. Yet access to early diagnosis and appropriate interventions remains unequal: children from families with more resources reach the specialist sooner, and poor children usually arrive late, or never arrive.

Autism 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 causes many families to 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 rather than an end, more people live with dignity.

This is what autism pride has to do with medicine.

This article is exclusively informative and educational in nature. It does not replace individual clinical evaluation by a qualified health professional. The clinical cases described are fictional, created for teaching purposes, and do not correspond to real patients. If you or someone in your family exhibits characteristics described in this text, seek guidance from a specialized medical professional.

Dr. Rebeca Soares Andrade CRM-GO 39335