Misunderstood, Minimised, Misrepresented: Autistic Young Adults' Experiences of Epistemic Injustices in Healthcare Interactions Around Autism

This article explores autistic young adults' experiences of epistemic injustice in healthcare interactions where autism is invoked and a subject of misaligned sensemakings. We take a particular focus on hermeneutical injustice, which refers to the difficulty of understanding and communicating one's experiences due to gaps and biases in sensemaking resources. Earlier research concerning autistic individuals from this perspective is sparse and mostly theoretical. Our study addresses this gap by conducting abductive thematic analysis on interview and questionnaire data from Finnish autistic young adults. This approach enabled us to recognise biases and hierarchies, such as neuronormativity and epistemic hierarchies, while also describing a new, paradoxical kind of hermeneutical injustice not covered by earlier research. Our results indicate how the often-intertwined forms of epistemic injustices are related to a lack of representativeness in how autism is understood as well as to how the exclusion of certain kinds of knowledge and knowers, along with the devaluations of expressive styles, impact autistic people's epistemic agency, identities and access to care. We argue for more inclusive epistemic approaches in healthcare that appreciate autistic contributions, recognise the diversity of autistic experience and expression, and challenge the reductive assumptions embedded in diagnostic and professional practices.