ESF

The Evolutionary Stress Framework: A New Perspective on Neurodiversity for Understanding Autism and Co-occurring Conditions

Lori Hogenkamp BA Director, Center for Adaptive Stress

Keywords: Autism, Evolutionary Stress Framework, Neurodiversity, Complexity, Person-Centered Care, Resilience, Adaptive Calibration, Complex Adaptive systems

Lay Summary:

The traditional medical model of autism seeks a single cause and cure for a condition that is complex and heterogeneous. This approach has led to ongoing debates about autism’s definition, causes, and appropriate language. The Evolutionary Stress Framework offers a new perspective that views autism as a natural variation in the human body-mind’s adaptive response to stress. This framework calls for a shift in perspectives towards person-centered care and a focus on understanding how individuals with different neurotypes respond to stress. In this paper, we introduce the Evolutionary Stress Framework and discuss its implications for autism research and care. We emphasize the importance of recognizing the heterogeneity of autism and the need for a neurodiversity approach that supports individual differences. By embracing the Evolutionary Stress Framework, we can improve our understanding of autism and develop more effective interventions and support systems for autistic individuals.

 Abstract:

The neurodiversity movement and medical community have differing views on how to understand and describe autism, with some advocating for neurodiversity-affirming language and focusing on strengths, while others view autism as a “disorder” ranging from “mild to severe.” To bridge this divide, an evolutionary-stress framework has been proposed, which views autism as an amplified and adapted neurotype with varying trade-offs. This approach redefines health as an emergent property of allostasis, providing a more productive platform for creating person-centered, family-centered, and community-centered solutions for autistic people. This shift may help to resolve conflicts between parents, practitioners, advocates, and researchers and lead to more effective, precision approaches that incorporate systemic and systematic changes. This paper explores the evolutionary-stress framework and its potential implications for improving care for autistic individuals.

Introduction:

A recent article by Alison Singer et al. in Autism Research INSAR Journal (Singer et al., 2022) argues that the neurodiversity movement censors the voices of those with profound autism by insisting medical research use neutral and neurodiversity-affirming language (Bottema-Beutel et al., 2021; Dwyer et al., 2022; Monk et al., 2022). As an autistic autism researcher, I suggest the conflicts might be best resolved by shifting to an evolutionary-stress framework. This perspective could help us understand autism as amplified and adapted neurotypes with costs and trade-offs which can have both beneficial and negative consequences for neurodivergent people. Singer et al. would argue that autism is a disorder ranging from “mild to severe”, whereas an ESF perspective suggests autism are neurotypes with varying levels and intensity of trade-offs, including those with medically complicated challenges of regulation we may think of as profound or severe. The shift in language is a new paradigm that may better support disabled people by allowing the redefining of health as an emergent property of allostasis in cooperative ecosystems. This shift may help to resolve the current arguments between parents, practitioners, advocates, and researchers (Leadbitter et al., 2021) and offer a more productive and elevated platform for creating precision and system-wide changes for person, family, and community-centered solutions within a neurodiversity-informed evolutionary stress framework.

The evolutionary-stress framework (ESF) examines how stress impacts developmental paths and well-being, including difficulties related to immune, metabolic, and mitochondrial processes. It also considers how these effects are shaped by the interaction of genetic and environmental factors through various biodynamic interfaces and pathways (Arora et al., 2020).

The evolutionary-stress framework (ESF) views the trade-offs in brain function and development as adaptations to protect and conserve resources, rather than pathologizing them. This approach aligns with the concept of neurodiversity, which acknowledges the diversity in brain function and development and recognizes that it does not have to fit within a typical range or be free of disease or impairment to be considered healthy and stable.

In the ESF, a neurotype is a combination of behavioral, thinking, and cognitive styles that vary in associated strengths paired with stress sensitivity. I hypothesized that neurotypes may be akin to what I call “peripheral minds”. These mind-body’s are peripheral, but complementary cognitive types to the average socially-oriented neurotype (Hogenkamp, 2018, 2021; Taylor et al., 2022). Leo Kanner, who published the first description of early infantile autism, observed that one of the defining features of the parents of autistic children he studied, was that they all were of exceptional intellect in either an artistic, literary or scientific field (Kanner, 1943). Today, rather than assuming intellectual and creative parents were cold to their children, leading to the theory of “refrigerator mothers“, a better hypothesis is that neurotypes with different information and cognitive subtypes create distinct patterns of trade-offs when impacted by stress factors. Neurotypes may reflect behavioral genetics, temperament traits, immune variance, thinking types (Grandin, 2009), and neurotransmitter systems (Fisher et al., 2015). Neurotypes may also reflect the broader autism phenotypes which are traits of autism that do not reach diagnostic levels but are distributed in the general population (Landry & Chouinard, 2016). Research has shown that individual differences in personality and information processing can greatly impact how people respond to stress and manifest chronic mismatch adaptations. Exemplified by research into the “Orchid, Dandelion, and Tulip” theory, where people have varying levels of sensitivity to environmental load challenges. They excel in some situations but are more vulnerable in others (Kennedy, 2013; Lionetti et al., 2018). It’s important to note that within an ESF neurodivergencies are not just diagnostic labels, but are inclusive of the “slippery slopes” of traits as well. Disability or diagnostic criteria are not problems within the individual, but warning systems that our larger ecosystems are in distress.

While further study is still needed, the hypothesis of peripheral minds and neurotypes aligns with research conducted by the Hidden Talents in Harsh Environments Lab, Utah, USA, led by Bruce Ellis and Willem Frankenhuis and guided by the Adaptive Calibration Model developed by Ellis, Marco DelGuidice, and Elizabeth Shirtcliff (Del Giudice et al., 2011). This Model posits that people who grow up in harsh environments tend to score lower on tests of social and cognitive abilities. Still, instead of impairing development, these people adapt their skills and abilities to solve problems that are ecologically relevant in those environments. These adaptations potentially result in enhanced performance and diminished functional trade-offs in cognitive and metabolic interconnected systems (Aiello & Wheeler, 1995; Barrett et al., 2016; Barrett, 2017; Ellis et al., 2017, 2017, 2022; Frankenhuis & de Weerth, 2013; Friston, 2010; Jacqueline et al., 2017). This perspective challenges the traditional deficit-based approach. According to Ellis et al., functional trade-offs in traits and abilities lead to the hypothesis that stress should not be viewed solely as a negative phenomenon, but rather as a natural part of the human experience. Similarly, Baron-Cohen ( 2017) has argued that the evidence does not support the idea that autism is a disorder and that re-conceptualizing autism as a form of neurodiversity would significantly impact the field of psychiatry for over 300 currently classified disorders in the DSM-V. Bölte et al. (2021) have expressed that advocates and neurodiversity language must find their place in new models of medicine from the DSM to a more inclusive biopsychosocial like changes already happening in the ICF. Therefore, I refer back to the approach of an ESF.  

An Evolutionary-Stress Framework:

The Evolutionary-Stress Framework views health as emergent allostasis requiring an understanding of initial conditions and the allocation of energy in interdependent systems. Communication channels between these systems play a critical role in maintaining health and well-being. This framework highlights the importance of considering the interplay between genetic, environmental, and social, cultural and nutritional (biopsychosocial-nutritional) factors in shaping health outcomes (See figure 1). Effective communication between the body’s systems is necessary for the proper allocation of energy and for maintaining health.

An increasing number of interdisciplinary studies are creating the foundation for the Evolutionary-Stress Framework. Including the field of Environmental Biodynamics. This conjecture suggests the existence of “biodynamic interfaces” act as intermediaries between genes and the environment in complex interacting systems (Arora, 2021), instead of analyzing the interaction between the environment and humans separately, these interfaces act like leverage points in systems where small changes create large impacts (Abson et al., 2017; Sturmberg et al., 2019). Biological systems are complex systems that adapt to their environment and interact with other systems (Sturmberg, 2022; Uversky & Giuliani, 2021). The hormones, like estrogen (Melino & Mormone, 2022), and the microbiome might be considered examples of biodynamic interfaces. For example, The microbiome in the sense that it is a complex system that interacts with and influences the body’s systems and functions, and vice versa. Just as the microbiome can influence the body’s immune system, metabolism, and other physiological processes, factors such as diet, stress, and personality can, in return, influence the microbiome’s composition and interaction with the body and its systems in various ways (Ortega et al., 2021; Vernice et al., 2020).

The ESF posits that stress can impact the body in various ways, such as influencing the HPA axis and epigenetics (Lu et al., 2021; Meaney & Szyf, 2005) due to the trade-off between protective mechanisms and resource allocation. The ESF emphasizes that the effects of stress and stressors are not predetermined, but rather depend on the individual’s sensitivity and recalibration strategies to stress, the overall load of stressors, and the specific interactions between different stressors which results in both equifinality and multifinality. The theory highlights that the outcome of stress is not a fixed result, but rather a dimensional and overlapping range of possibilities, similar to the concept of a “PLINKO! board” where the same impact can create different outcomes and different impacts can create the same outcome (Cicchetti & Rogosch, 1996).

This further aligns with the research and outreach of Sturmberg (2021), who argues that health and disease are dynamics of complex adaptive systems where the outcome is not determined by an external force, but rather by the nonlinear dynamics of interactions. This would expand upon the work of McEwen (2013), who theorized that the effects of stress on the body are determined by how the body adapts to stressors, rather than by the stressors themselves. In systems science, this is often phrased as there are no causes as the system is its own cause or produces its own pattern of behavior over time (Meadows, 2008)

When rethinking evolution, it is essential to broaden the traditional emphasis on competitive natural selection and reproductive success to include the nuanced cooperative effects of nutrition (Wrangham, 2013), culture (Taylor et al., 2022), energy constraints (Barrett, 2017), and stress. Stress is a significant evolutionary force (Kim et al., 2016; Steinberg, 2012), and developing models and frameworks such as the ESF, therefore, merits priority in autism research. A collaborative effort among researchers from different fields is necessary to comprehend the intricate connections between stress sensitivity, stress buffers, and stressors.

The Benefits of an Evolutionary-Stress Framework:

The traditional medical paradigm often focuses on identifying a single cause or treatment for a specific condition or illness, which can lead to a narrow focus on one aspect of an individual’s health and neglect other important factors such as social, cultural and nutritional factors. This approach can disproportionately impact marginalized groups. Within this framework, neurodivergent needs will differ from neurotypical needs and have different reasons for manifesting similar medical conditions such as heart disease, depression, anxiety or cancer. If we only take the average or look for single cause-outcome we miss that stressors are interchangeable, variable, and depend on the person, timing and context. The benefits of a stress model is we can flesh out these nuances and hold more flexible and fuzzy logic as to the what, why, who, when, where and how mismatched adapted states are created.

Although often looked at through a reductionistic lens and stress as a variable, instead of a framework. a growing body of work examples stress mechanisms and pathways creating and reversing autistic trade-off symptoms. Such as oxidative stress, inflammation, mitochondria, and neurotransmitter channels (Abbarin et al., 2023; Malaguarnera et al., 2020; Morais et al., 2021; Ornoy et al., 2019; Singh et al., 2014; Wu et al., 2022). However, as a variable, we often mistake stress as the cause and anti-stress measures as “cures”. Understanding stress as a framework instead would give us a better grasp of the dynamics involved. By considering trade-off adaptations in neurodivergent neurotypes we could get a clearer understanding of stress pathways and hubs as biodynamic interfaces as opposed to direct cause-effect. Shifting out of the disease model is therefore imperative. While trade-offs can manifest difficulties related to immune, metabolic, and mitochondrial processes (Gevezova et al., 2020; Pangrazzi et al., 2020) they are often misattributed to autism severity instead of the severity of trade-offs (Daniels et al., 2020; Marchi et al., 2022; Ronald, 2019).

These relationships are complex and we need better language to describe multi-finalities and transdiagnostic (Caspi and Moffitt, 2018; Dalgleish et al., 2020; Skou et al., 2022). It’s important to differentiate between deeper-level adaptations in neurodivergencies and more fluid adaptations (or mis-adaptations) such as anxiety and depression when considering neurotypes and trade-offs in quality-of-life research and protocols, as neurodivergents may manifest differently and for different reasons than neurotypicals.

In conclusion, it’s important that we look beyond to realize the full potential of “evidence-based medicine” by expanding into systems and complexity approaches (Fernandez et al., 2015; Picard, 2021). By considering complex interactions and no boundary between genetics and environment through biodynamic interfaces such as functional exposomes (Price et al., 2022), hormones, microbiome, and nutrition-energy-oxidant (Kaplan et al., 2015) relationships, we have a greater potential for more effective and personalized interventions and support for autistic people, including those with severe trade-offs and complex care needs.

Example Application of the Evolutionary Stress Framework:

As we move into a new framework to make more purposeful and self-determined choices about lifestyle factors that can impact the quality of life and health outcomes.  It is important to acknowledge that various lifestyle factors, such as systemic racism, food deserts, microbiome influences, and intergenerational trauma, may be outside of an individual’s direct control. However, synergistic lifestyle factors can still impact stress regulation and overall health and can be incorporated into personalized, comprehensive programs. This approach can scientifically validate the inclusion of therapies such as exercise, animal therapy, music, and social support. The effectiveness of these strategies, serving as stress buffers, antioxidants, and anti-inflammatories, must be tailored to the person, timing, environment, and regulation goals. Overgeneralization and the “one-size-fits-all” approach should be avoided, and ESF can aid in the integration of these methods into practice.

Exercise, as highlighted in studies by Silverman and Deuster (2014) and Toscano et al. (2021), is particularly effective in recalibrating stress responses, but depends on the person and situation (Smith & Merwin, 2021). Similarly, animal therapy, as explored in research by Wijker et al. (2020), has the potential to provide social support, enhance mood, and foster a sense of calmness and relaxation. Social cohesion, identity groups, and community connection can be a crucial foundation for stress regulation. Building opportunities for much-needed interdependence provides buffers against stress impacts and negative calibrations by creating a sense of safety and belonging (Breedvelt et al., 2022; Jennings & Bamkole, 2019; Uchino, 2004). This makes it important to encourage the integration of community-based programs in order to create more supportive environments of acceptance and radical love for autistic people and other marginalized groups beyond neurotypical expectations and methods.

Shaping health outcomes emphasizes the importance of incorporating multidimensional lifestyle factors to improve an individual’s stress responses and lower or balance inflammation (Gusev & Zhuravleva, 2022; Pinhasov & Kirby, 2022).

The Challenges of Adopting the Evolutionary-Stress Framework:

The adoption of the evolutionary-stress framework in autism research calls for significant shifts in medical paradigms and language. Researchers will need to move away from traditional deficit-based models that focus on assumptions of disorder and instead consider autism and other health conditions as complex adaptive systems with multiple dimensions and trade-offs (Sturmberg, 2022). This will necessitate the development of new terminology and fields of study that more accurately describe the complexity of autism and recognize the unique strengths and needs of each individual (Mancilla et al., 2020; Monk et al., 2022).

Integrating an evolutionary-stress framework into healthcare practices for autism poses several challenges, similar to those encountered in Precision Medicine. Both approaches involve understanding the complex and dynamic nature and the interplay of genetic and environmental factors that contribute to diagnostic emergence. A key challenge is a need for a multidisciplinary and integrated approach, requiring collaboration between researchers and healthcare practitioners from various fields, such as genetics, epigenetics, psychoneuroendocrinology, environmental health, nutrition, psychology, critical psychiatry, critical disability studies, and neurodiversity grassroots efforts. Additionally, a systems biology approach that takes into account the complex interactions between different biological and environmental factors is essential, utilizing advanced analytical tools and methods, such as big data analytics, systems biology, and network analysis. Personalized and individualized interventions are also critical, utilizing precision medicine approaches that incorporate genetic and environmental data to inform development.

In addition, the use of accurate, precise, and respectful language that describes the autism spectrum and the people it affects is crucial, in order to avoid harmful stereotypes and to ensure respect for neurodivergent people. In order to achieve all of these, self-determination is a potentially important principle that can be incorporated into the development of respectful language and personalized interventions and supporting them in developing their own skills and abilities. By involving autistic, neurodivergent people and their families as advocates in the development of language and communication guidelines for autism research and practice, it ensures that the language is respectful, accurate, and inclusive.

The ESF provides a unique perspective on how to approach personalized medicine, and how to address the limitations of the traditional medical paradigm that can be oppressive and discriminatory. However, this model is a relatively new framework in the field of healthcare, and while it has shown promise in addressing the limitations of the traditional medical paradigm, it is important to note that more research and study are needed to fully understand its potential for accomplishing the goals of acceptance, respect, and social justice for marginalized groups.

Conclusion:

In conclusion, the Evolutionary-Stress Framework offers a fresh and multidimensional perspective on autism, recognizing the unique strengths and needs of each individual. This framework can help resolve conflicts in our systems of oppression and discrimination by shifting the focus from competition to cooperation and resilience, and by promoting social acceptance and positive regard as equally important as dietary, cognitive-behavioral and pharmaceutical solutions in creating personalized, person-centered, family-center, and community-centered solutions. The ESF highlights the role of inflammation in medical dimensional and overlapping conditions interconnected with autism and the importance of neurodiversity-affirmative language in creating an inclusive global community that values and nurtures diversity. Adopting the ESF will require significant change and collaboration, but the potential benefits for autistic and neurodivergent people, their families, and their communities make it a worthwhile effort.

The author cites no conflicts of interest.  

The author generated this text in part with GPT-3, OpenAI’s large-scale language-generation model. Upon generating draft language, the author reviewed, edited, and revised the language to their own liking and takes ultimate responsibility for the content of this publication.

Future Directions:

Potential challenges of implementing the Evo-stress framework in practice include:

• Resistance from healthcare practitioners and researchers who are used to traditional deficit-based models and may need to become more familiar with the ESF.
• Difficulty to develop new language and terminology that accurately describes the complexity of autism and acknowledges the unique strengths and needs of each individual.
• Difficulty in involving the public, self-advocates and professionals in developing personalized interventions and language guidelines.
• Difficulty to obtain funding and resources for research and implementation of the ESF.
• Lack of consensus among researchers and healthcare practitioners on the best way to incorporate the ESF into existing medical models and practices.

To overcome these potential obstacles, researchers could:

• Develop and provide training and education programs for healthcare practitioners and researchers on the ESF and how it can be applied in practice.
• Collaborate with self-advocates and autistic professionals to develop language and communication guidelines and personalized interventions.
• Seek funding from sources that support interdisciplinary and innovative research.
• Form consortia of researchers and healthcare practitioners to work together to develop and implement the ESF.
• Continuously evaluate and refine the framework based on feedback and new research findings.
• Encourage open dialogue and discussion among researchers, healthcare practitioners, and the autism community to address any challenges or concerns that may arise during implementation.

To support the implementation of the Evo-stress framework in practice, researchers from a variety of fields would be needed. These fields include, but are not limited to:

• Genetics and Epigenetics – To contribute to understanding the genetic and epigenetic factors that play a role in the emergence of autism and how these factors interact with environmental factors.
• Environmental Health, Environmental Biodynamics & Social Epigenomics – To contribute to understanding the environmental factors that play a role in the emergence of autism, such as exposure to toxins or other environmental stressors.
• Psychology and Psychiatry – To contribute to understanding the cognitive, emotional, and behavioral aspects of autism, as well as the development of interventions and support for autistic people.
• Systems Biology – To contribute to understanding the complex interactions between different biological and environmental factors that contribute to the emergence of autism, using advanced analytical tools and methods such as big data analytics, systems biology, and network analysis.
• Complex Adaptive Systems – To contribute to understanding the complex interactions between different biological and environmental factors that play a role in the emergence of autism and how these interactions are influenced by the person, timing, and context of stress resilience factors and stressor loads.
• Neurodiversity and Disability studies – To contribute to understanding the social and cultural aspects relating to autism, including the use of inclusive and respectful language and the development of person-centered and family-centered interventions.
• Stress and Stress resilience – To contribute to understanding the effects of stress on developmental trajectories, and mental and physical health, and how these effects are influenced by the interaction of genetic and environmental factors through biodynamic interfaces.
• Precision medicine – To contribute to the development of personalized and individualized interventions for autism based on genetic and environmental data.
• Public health – To contribute to understanding the impact of autism on society and the healthcare system, and the development of interventions and support for autistic people, as well as their families.
• Educational and neuropsychology – To contribute to understanding the neuropsychological aspects of autism and the development of interventions and support for autistic people in educational settings.

Reaching out to researchers in these fields and collaborating on interdisciplinary research projects would be essential in implementing the Evo-stress framework in practice and overcoming potential obstacles. Additionally, involving autistic people and their families in the research process and in the development of interventions would be important in ensuring that the framework is person-centered and inclusive.

Additional specific types of study needed might include:

• Longitudinal studies to track the development and outcomes of autistic people over time. These studies can help to identify specific environmental factors that may be contributing to maladaptive or detrimental trade-offs in autistic neurotypes.
• Studies that investigate the complex interactions between genetic, environmental, and epigenetic factors contribute to the emergence of excessive trade-offs associated with autistic phenotypes. This could include research on gene-environment interactions, epigenetics, and the role of the microbiome in autism.
• Studies that investigate the role of inflammation in autism. Studies that identify the specific inflammatory pathways that are activated in autistic people could help to inform the development of personalized interventions.
• Studies that investigate the impact of stress on the development and outcomes of autistic people. Studies that identify the specific stressors that are associated with maladaptive or detrimental trade-offs in autistic neurotypes could help to inform the development of interventions to mitigate these effects.
• Studies that investigate the role of self-determination in the care of autistic people. Studies that investigate how autistic people and their families can be involved in the decision-making process and in the development of personalized interventions could help to improve the quality of life for people and families.
• Studies that investigate the impact of language and communication on the lives of autistic people and their families. Studies explore the ways in which language and communication can be used to promote understanding, reduce stereotypes and increase the overall well-being of autistic people.
• Studies that investigate the impact of the evolutionary-stress framework on healthcare practices for autism. Studies that compare the outcomes of autistic people who receive care under an evolutionary-stress framework to those who receive care under traditional models could help to determine the effectiveness of this approach.

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