Should you say ‘autistic person’ or ‘person with autism’? Here’s how language has changed

How should we refer to people with mental ill health, disability, or neurodivergence?

Terminology should be respectful, apt and avoid carrying stigma. It’s also important to listen to people’s preferences about how they refer to their condition. But how much consensus is there and how has terminology changed?

Our new study – the largest of its kind – explores how this language has evolved over the past 45 years to reflect our shifting views of mental illness and disability.

We found preferences can depend on the condition, and whether we are talking about individuals or groups.

Remind me, what’s person-first language?

In the 1980s, disability activists argued common expressions such as “disabled person” equated the person with their disability.

Instead they proposed “person-first” language. Referring to someone as a “person with disability” puts their personhood in the foreground and doesn’t define them by their impairment.

Professional organisation soon adopted person-first language as preferred terminology. Guidelines for academic publishing and media reporting followed.

The move to identity-first language

More recently there has been a backlash. Critics argue person-first language presents disability or mental illness as a devalued and peripheral aspect of the person.

US psychologist Louis Sass expresses this beautifully:

Is schizophrenia best conceptualized as a disease entity that comes, as it were, from outside, and with which the sufferer must contend, as with a burden or an enemy? Or is it better seen as a more intimate factor: something that emerges from within, permeates the very core of one’s being, and must, perhaps, be understood as an aspect of the sufferer’s very soul?

Proponents of “identity-first” language say expressions such as “autistic person” recognise that some conditions are not external visitations but integral aspects of the individual.

The American Psychological Association endorsed identity-first language in 2020, and surveys show many neurodivergent people prefer it.

But more broadly, is person-first or identity-first language preferred?

We studied how preferences changed

In our new study, we assessed the relative popularity of person-first and identity-first expressions for 15 mental health, disability and other conditions over 45 years.

We examined two vast English-language databases: the Google Books database (1980–2019) and the 23-billion-word global News on the Web collection of newspapers and magazines (2010–2025).

For each condition and year, we counted the frequency of four expressions: person-first or identity-first terms for individuals or groups of people.

For autism, for example, we counted “person with autism”, “autistic person”, “people with autism” and “autistic people”.

We then computed the relative popularity of person-first versus identity-first language when referring to individuals or groups.

What did we find?

This graph summarises the key findings, averaged over the 15 conditions.

It shows identity-first language was dominant in the 1980s but steadily declined. The decline begins to slow in the 1990s. There have been no meaningful shifts in preferences since 2010.

Despite increasing advocacy, there is currently no widespread preference for identity-first language.

At most, advocacy has slowed the rise in person-first language promoted by an earlier generation of advocates.

Whether terms refer to individuals or groups also matters

When describing individuals, identity-first expressions have generally been more common. But person-first expressions are now equally popular.

When describing groups, person-first expressions now more common.

Mental health problems and disabilities are typically understood as aspects of personal identity rather than group identity. So it’s not surprising identity-first language is preferred when referring to individuals.

It makes sense to use “psychotic person” rather than “person with psychosis” but also use “people with psychosis” rather than “psychotic people” if we see psychosis as a personal experience, not a basis for shared identity.

Differences among conditions

These findings, based on averages, conceal large variations across our 15 conditions.

Identity-first language was consistently preferred for some conditions, such as alcoholism, anxiety and obesity.

Person-first language was consistently preferred for others, such as anorexia, bipolar, diabetes and epilepsy.

The conditions also show diverse patterns of change. In recent years, identity-first terminology has risen for autism and dyslexia, but person-first terminology has risen for bipolar, anorexia and obesity.

These findings indicate that terminological trends are quite specific to the condition.

Why might it depend on the condition?

Some conditions have become the focus of identity claims more than others.

The neurodiversity movement, for example, has promoted the view that neurodevelopmental conditions are inherent and valued aspects of the person. The rise in identity-first language for autism and dyslexia supports this possibility.

More broadly, whether we favour identity-first or person-first language for different conditions may depend on our beliefs about them. Do they represent identities or attributes: who we are or what we have?

Conditions that people see as biologically caused and enduring are more likely to be viewed as part of someone’s “true self”. We might expect identity-first language will be preferred for these conditions.

The language we use in this domain is not a collection of inert labels. It’s contentious and ever-evolving.

Read more: Diagnostic labels may increase our empathy for people in distress. But there are downsides too