A groundbreaking study from Princeton & the Simons Foundation—published July 9 in Nature Genetics—used a “person-centered” analysis of 230+ traits across 5,000+ children. It revealed four distinct subtypes of autism, each with unique developmental, behavioral, and genetic profiles. So what might this mean for clinicians?
We’ve all sat across from a parent hearing the word autism for the first time. Sometimes it lands with quiet relief. Other times, it arrives like an earthquake—rattling their assumptions, identity, and understanding of their child.
One of the most common responses we hear is: “But they make eye contact,” “they’re verbal,” “they’re so smart,” “they are so affectionate with me,” or even “they don’t do that with us” (implying that other informants must be looking at a different child).
And the truth is—yes, we are sure. We never want to assign a label unless we’re truly confident it fits—and even then, no label is ever given lightly. But that doesn’t mean their child fits into society’s narrow image of autism. This is exactly why the new study from Princeton and the Simons Foundation is so significant. It finally gives language to something many of us have sensed clinically for years: there is no single path into autism—and the biology backs that up.
Why This Matters for Therapists & Families
Recognizing that there are four distinct subtypes of autism isn’t just a research milestone—it’s a clinical and relational pivot point. For years, many of us—both therapists and parents—have sensed that the term “autism” was trying to hold too many truths at once. Some children present with early, global delays and obvious needs; others seem highly verbal, deeply sensitive, even gifted—yet they struggle quietly in ways that are often misunderstood or dismissed. Having language to distinguish these subtypes offers more than diagnostic clarity—it brings emotional coherence. It helps us explain why one child’s rigidity shows up as perfectionism and anxiety, while another’s appears as sensory defensiveness or social withdrawal. It reframes those hard-to-articulate moments where a child “doesn’t quite fit the mold” and reminds us that autism is not one thing. It is many things, unfolding in different patterns, at different times, and requiring different types of support.
For therapists, this framework invites us to consider nuance before reaching for a standard protocol and ask: What inner world is this behavior expressing or protecting? For families, it can reduce the inner conflict that often follows a diagnosis—especially when their lived experience doesn’t match what they were told to expect. And for those of us doing diagnostic evaluations, it helps us tell the child’s story with more dimension, more accuracy, and more respect for the nuances that matter. It’s a step toward precision care, yes—but more importantly, it’s a step toward being deeply present with each child’s unique developmental trajectory.
Rethinking Intervention Pathways
Now that we can conceptualize autism through the lens of these four subtypes, it’s time to ask: What kinds of support align best with each child’s unique neurodevelopmental fingerprint?
This doesn’t mean building specific or rigid service menus. It means allowing the ‘why’ behind a diagnosis to inform what interventions are needed. Many ABA programs—and even psychotherapy plans—operate with standardized protocols that assume uniformity. But precision care asks:
“Which parts of this child’s presentation are calling for behavioral tools?”
“Which are asking for emotional attunement, relational depth, or adaptive scaffolding?”
We’re not saying ABA is inappropriate for certain subtypes—but rather, that how it’s delivered and what’s emphasized must be subtype-sensitive.
Below is a living, evolving map to guide treatment alignment—not a checklist, but a conversation starter for clinicians and caregivers alike.
| Subtype | Key Traits | Primary Interventions | Supplemental Supports | Expressive Strategies (Art & Music Therapy) | Cautions |
| 1. Social & Behavioral Challenges | On-time milestones; strong verbal or academic skills; high rigidity, internalizing symptoms (anxiety, OCD, depression) | CBT-informed ABA, Flexibility training, Executive function coaching, Parent guidance for masking and emotional burnout | Individual therapy for anxiety/OCD, Group therapy, Sensory support as needed | Art therapy for perfectionism and nonverbal emotional processing, Music improvisation for co-regulation and expression | Risk of overestimating coping due to masking; ABA should be gentle and trauma-informed |
| 2. Mixed Autism with Developmental Delay | Language or motor delays; variable autism features; few mental health issues; inherited traits | NDBI, Floortime or DIR-based therapies, Parent-implemented coaching, ST/OT integration | Play therapy, Social play groups, Routines-based intervention at home or daycare | Sensory-based art therapy, Music routines and turn-taking games to support joint attention and language | Don’t dismiss needs due to ‘milder’ social features; early relational approaches are key |
| 3. Moderate Presentation | Mild or ‘invisible’ traits; average milestones; subtle deficits in reciprocity, perspective-taking | Social thinking interventions, Cognitive-behavioral coaching, Narrative therapy or video modeling | Psychotherapy for identity/masking/self-esteem, School consultation | Comic strip art narratives, Group music therapy for social reciprocity, Improvisational role-play | Often misjudged as oppositional or immature; interventions must be validating and skills-focused |
| 4. Broadly Affected | Global delays; high support needs; intense behavioral/emotional dysregulation; significant psychiatric overlay | Multidisciplinary ABA, Structured teaching, AAC or alternative communication, Functional behavioral assessment | Medication management, Crisis planning & case management, Attachment-based approaches | Rhythmic entrainment, Sensory art work, Vibroacoustic interventions for regulation and connection | Over-reliance on behaviorism without trauma lens can lead to power struggles and caregiver burnout |
Toward a More Human Diagnostic Future
This new framework doesn’t replace our clinical judgment—it refines it. It invites us to move beyond diagnostic binaries and honor the wide arc of what autism can look like across development, context, and identity.
As we integrate these subtypes into our work, the challenge is not to sort children into categories, but to listen more closely. To ask not just “Do they meet criteria?” but “How does this child move through the world? What’s hard for them—and what’s beautiful about them?”
This study offers us a mirror and a map. And if we’re thoughtful, we can begin to craft a future where autism diagnoses are not just accurate, but meaningful—where they lead to support that fits, language that heals, and care that honors the personhood beneath the profile.
I’ll be following up with a companion article exploring how each subtype may benefit from distinct therapeutic approaches—including ABA, psychotherapy, and expressive modalities like art, play, and music therapy.
For now, may this work help you—whether clinician, caregiver, or advocate—stand more firmly in the complexity, clarity, and compassion that every autistic child deserves.
Citation:
Krishnan, A., Yoon, S., Rubeis, S. D., et al. (2025, July 9). Major autism study uncovers biologically distinct subtypes, paving the way for precision diagnosis and care. Princeton University News. https://www.princeton.edu/news/2025/07/09/major-autism-study-uncovers-biologically-distinct-subtypes-paving-way-precision
