Hashtag who's missing? Lessons for genomic databases

Genomic databases support research intended to advance understanding, diagnosis, and treatment of disease. Utility is linked to diversity, and initiatives are seeking to enroll traditionally underrepresented groups such as people with disabilities. Commentators have called for adoption of a participant-centric approach to build trust and address barriers to inclusion. Complexities emerge, however, when minors are enrolled and whose perspective on their condition may with time diverge from their parents' perspective. Public response to MSSNG, a genomic database focused on autism, and public discourse regarding neurodiversity reveal division regarding autism as a difference or identity versus a disease. We explore what it means for genomic databases enrolling individuals, particularly minors, with disabilities to be participant-centric when affected individuals disagree about the nature of their condition and research priorities, offering recommendations for participant engagement and measures when enrolling minors with conditions that are the subject of difference-disease debates.