There's a lot of minor things that the show gets stunningly right, but they're mostly in terms of how neurotypicals react to people with autism. One example: the support group for parents of autistic children polices the language people use. Other examples are more personal and I'm not sure I want to get into them right now (though I probably would were I in a better state of mind). However there's a few issues that stand out as glaringly unrealistic:
- Sam is lower functioning than I am, but somehow holds down a job while still in high school. Most autistic people I know have trouble getting, much less holding, jobs as adults. Considering how much his mother coddles him, this seems particularly unlikely.
- Sam is remarkably self-aware. He's lower-functioning that I was at his age, but more self-aware. High-functioning autistic people with little-to-no self-awareness is common, but self-awareness to the degree he shows is very rare even among high-functioning autistic people.
- Sam cannot understand figurative speech as an adult. This is something that's drawn a lot of commentary, and for good reason. Understanding metaphors is linked to first-order theory of mind (I know that people have different beliefs than I do), and once autistic people attain it, we're just as good at getting metaphors as neurotypical people. It's just that we develop first-order TOM later, but Sam clearly has it.
- Sam's melt-down after a long time without meltdowns seems unrealistic to me. Once I learned how to handle meltdowns, I never melted down in that way again, no matter how stressful the situation. I don't know if that sort of regression is possible, but I think that this is just another thing that is delayed in autism, and once we learn to control it it's unlikely to regress.
- For someone who is as high-functioning as Sam is, he does a lot of socially inappropriate things (like breaking into his therapist's house and barging in on his girlfriend's French class), which it seems unfathomable that he wouldn't understand are socially inappropriate.
- He describes four penguin species as "subspecies." It is unlikely that an autistic person would get something so simple wrong about something that interests them.