8 ms·

Genuine question and not a dismissal - what makes this a form of autism, of all things? Plenty of people who are generally considered NT are indeed anxious, som

Genuine question and not a dismissal - what makes this a form of autism, of all things? Plenty of people who are generally considered NT are indeed anxious, sometimes to an extreme and pathological extent. And it's only natural for anxiety to center on demands of some sort that may have been placed on the individual.

joejerryronnie 8y ago
I have two daughters on the spectrum and this profile of Pathological Demand Avoidance describes their challenges very accurately. There are many factors that go into an autism diagnosis, but to your specific question of how this autism profile differs from an NT with anxiety challenges - I think it's the degree to which the extreme avoidance occurs and the downstream effects. For instance, a request to brush teeth can result in a 3 hour violent meltdown. Attempting to get a 60-pound child from the car into school can result in an injury and visit to the ER for a para-trained, full grown adult. And it's not just once in a while, it is every single demand asked of the child every single day.
nicoburns 8y ago
A very reasonable question, and there is still some controversy over that in the medical community. For me, it's because it comes with a whole host of classically autistic symptoms like struggling with eye contact, overload from sensory processing, difficulty understanding social norms, etc, but only at times when I'm stressed or otherwise in a low energy mood. I also had to put a lot of effort into learning other people's social norms - my intuitive ones were different in ways which seem similar to other people on the autism spectrum - but unlike some forms of autism, I have been able to learn the rules of neurotypical people to the point that you probably wouldn't be able to tell I was autistic if you met me. I still find a lot of these rules utterly bizarre.
- wpietri 8y ago
  When I read their official description of it, it strikes me as a pretty reasonable response for a not-as-social person forced by social context to engage with much-more-social people on an ongoing basis. Of course they'd be anxious and avoidant. Of course they'd become skilled at getting out of things that are unpleasant and unrewarding for them. I should read more, but at first blush I'd see this not as a disease, but a coping strategy.
  - nicoburns 8y ago
    The trigger for the avoidant behaviour in PDA people isn't socialising, many of them including me very much enjoy socialising (although there may be stressed around social expectations). It's anything that's perceived as a demand (i.e. something that must be done, or is expected). For many people with PDA (esp. children) this can be things as simple as putting their shoes on or brushing their teeth. It may also include activities that they otherwise enjoy. (Side note: if you're from the US, then you may see much more forced socialisation. In europe, quiet people are allowed to be quiet to a much greater degree. It's not seen as rude to be quiet here)
    - MichaelMoser123 8y ago
      Wow, we don't quite know what autism is (don't know if it is a spectrum or a set of separate conditions) therefore it becomes possible to assign the label to almost every condition. I think that's amazing.
      - Nomentatus 8y ago
        And I was unaware that children with foot infections, say, stubbornly refuse to brush their teeth as a result as you seem to suggest. (Sarcasm for Sarcasm.) Many children would rather avoid brushing their teeth. Few children are radically opposed to tooth-brushing, say to the point where they'll skip a meal to avoid it. I don't think you understand how unusual the behavior being discussed, is.
        wpietri 8y ago
        I'm totally open to this being a diagnosis. But I think the point is more that a kid with a foot infection who refuses demands would probably be called "independent". Stubborn, even. But it wouldn't necessarily be medicalized. There was a recent study on ADHD and birthdates; the upshot was that kids on the younger end of the age spectrum are medicated for ADHD more if they're young for their grade. Which implies that some number of kids are medicated more for "teacher inconvenience syndrome" than any real disease. There's a long history of medicine treating different as bad. (The formal academic term is "medicalization of deviance".) So I think it's worth being a bit skeptical that traits that teachers and parents might inconvenient are diseases on the order of foot infections. Rather than, say, how homosexuality was medicalized for decades.
- pseudoanonymity 8y ago
  > I still find a lot of these rules utterly bizarre. Like what?
  - ericabiz 8y ago
    Not the person you replied to, but his description resonates with me too, so I can help explain. One of the ones that bothers me constantly is the "buffer" of small talk that (particularly American) culture forces on us. For instance: We work together. You have a pencil sharpener. I need to sharpen my pencil. My preferred way of handling this situation: Hey Mike, can I borrow your pencil sharpener for a minute? Now, this is OK in American culture, but ONLY IF you've spoken to each other recently. (I had to learn this the hard way.) If you haven't, the conversation has to go like this: Me: Hey Mike. Got a minute? You: Sure. What's up? Me: I was wondering, could I borrow your pencil sharpener really quick? I have this pencil I need to sharpen. (And you should always insert a reason there; see https://www.psychologytoday.com/us/blog/brain-wise/201310/the-power-the-word-because-get-people-do-stuff https://www.psychologytoday.com/us/blog/brain-wise/201310/th...) If you don't insert this social "fluff", you come across as rude. Where this social buffer comes naturally to most people, I get frustrated and annoyed by it. I just want to borrow the dang pencil sharpener and get back to work! I have come to understand I don't resemble neurotypicals when it comes to this interaction (and it is likely that many others here on HN are not neurotypical either.) NTs enjoy this fluff, and it helps them feel connected to each other. When I don't play by their rules, I'm viewed as cold and callous. So...I play by their rules, because even though I'm not NT in this way, I still have basic human needs of wanting to feel loved and desired, and I don't want to upset other people.
    - zozbot123 8y ago
      > If you don't insert this social "fluff", you come across as rude. Isn't this a bit overstated? I'm pretty sure that you could also use bog-standard politeness markers (like, "could you please", "I would really appreciate it", "sorry about asking") and so on and so forth. (You might then come across as being a bit formal and old-fashioned, but certainly not rude!) The underlying motivation in both cases is that you need to make it very clear that you're not issuing an outright demand - and you do this by making it easy for Mike to say no (for any reason or no reason!) and providing plausible deniability. There are things that are closer to "fluff" in other contexts, but even they have their own explanation.
mr_overalls 8y ago
From the article: "Demand avoidance can be seen in the development of children, including those on the autism spectrum. It’s the extent and extreme nature of this avoidance, together with displays of socially shocking behaviour that leads to it being described as 'pathological'."
chongli 8y ago
what makes this a form of autism, of all things? Autism isn't a fact about the world, it's a category we use to group traits we think belong together. What's actually going on may be varied and rather complex. We do this with a lot of words over time. The word atom, for example, means indivisible. For a long time we believed atoms were the fundamental units of matter. To say to a pre-nuclear physicist that we can now "split the atom" is to speak nonsense; to utter a contradiction. The same goes for universe. Centuries ago, people thought the earth was the centre of the universe and that the stars and other heavenly bodies were fixed upon spheres. Then came the sun-centred model of the solar system, and the universe grew a little bit larger. More recently, the Hubble ultra-deep field dramatically expanded our view of the universe yet again. But now there are physicists who speak very seriously about about the idea of a multiverse. What the heck does that even mean? It means we decided, after a certain point, to stop changing the meaning of the word universe.
QuantumGood 8y ago
I was classically autistic, but identified eventually that if I was supposed to do something (use green fingerpaint) it created a strong anxiety response, but if I was simply allowed to do something (fingerpaint however I wanted to) there was no anxiety. I learned to put dishes away by just putting one away, or moving a group from one spot to another, then making another move, but never saying "I'll put them all away" as that created anxiety.

joejerryronnie 8y ago

I have two daughters on the spectrum and this profile of Pathological Demand Avoidance describes their challenges very accurately. There are many factors that go into an autism diagnosis, but to your specific question of how this autism profile differs from an NT with anxiety challenges - I think it's the degree to which the extreme avoidance occurs and the downstream effects. For instance, a request to brush teeth can result in a 3 hour violent meltdown. Attempting to get a 60-pound child from the car into school can result in an injury and visit to the ER for a para-trained, full grown adult. And it's not just once in a while, it is every single demand asked of the child every single day.

nicoburns 8y ago

A very reasonable question, and there is still some controversy over that in the medical community. For me, it's because it comes with a whole host of classically autistic symptoms like struggling with eye contact, overload from sensory processing, difficulty understanding social norms, etc, but only at times when I'm stressed or otherwise in a low energy mood. I also had to put a lot of effort into learning other people's social norms - my intuitive ones were different in ways which seem similar to other people on the autism spectrum - but unlike some forms of autism, I have been able to learn the rules of neurotypical people to the point that you probably wouldn't be able to tell I was autistic if you met me. I still find a lot of these rules utterly bizarre.

wpietri 8y ago
When I read their official description of it, it strikes me as a pretty reasonable response for a not-as-social person forced by social context to engage with much-more-social people on an ongoing basis. Of course they'd be anxious and avoidant. Of course they'd become skilled at getting out of things that are unpleasant and unrewarding for them. I should read more, but at first blush I'd see this not as a disease, but a coping strategy.
- nicoburns 8y ago
  The trigger for the avoidant behaviour in PDA people isn't socialising, many of them including me very much enjoy socialising (although there may be stressed around social expectations). It's anything that's perceived as a demand (i.e. something that must be done, or is expected). For many people with PDA (esp. children) this can be things as simple as putting their shoes on or brushing their teeth. It may also include activities that they otherwise enjoy. (Side note: if you're from the US, then you may see much more forced socialisation. In europe, quiet people are allowed to be quiet to a much greater degree. It's not seen as rude to be quiet here)
  - MichaelMoser123 8y ago
    Wow, we don't quite know what autism is (don't know if it is a spectrum or a set of separate conditions) therefore it becomes possible to assign the label to almost every condition. I think that's amazing.
    - Nomentatus 8y ago
      And I was unaware that children with foot infections, say, stubbornly refuse to brush their teeth as a result as you seem to suggest. (Sarcasm for Sarcasm.) Many children would rather avoid brushing their teeth. Few children are radically opposed to tooth-brushing, say to the point where they'll skip a meal to avoid it. I don't think you understand how unusual the behavior being discussed, is.
      - wpietri 8y ago
        I'm totally open to this being a diagnosis. But I think the point is more that a kid with a foot infection who refuses demands would probably be called "independent". Stubborn, even. But it wouldn't necessarily be medicalized. There was a recent study on ADHD and birthdates; the upshot was that kids on the younger end of the age spectrum are medicated for ADHD more if they're young for their grade. Which implies that some number of kids are medicated more for "teacher inconvenience syndrome" than any real disease. There's a long history of medicine treating different as bad. (The formal academic term is "medicalization of deviance".) So I think it's worth being a bit skeptical that traits that teachers and parents might inconvenient are diseases on the order of foot infections. Rather than, say, how homosexuality was medicalized for decades.
pseudoanonymity 8y ago
> I still find a lot of these rules utterly bizarre. Like what?
- ericabiz 8y ago
  Not the person you replied to, but his description resonates with me too, so I can help explain. One of the ones that bothers me constantly is the "buffer" of small talk that (particularly American) culture forces on us. For instance: We work together. You have a pencil sharpener. I need to sharpen my pencil. My preferred way of handling this situation: Hey Mike, can I borrow your pencil sharpener for a minute? Now, this is OK in American culture, but ONLY IF you've spoken to each other recently. (I had to learn this the hard way.) If you haven't, the conversation has to go like this: Me: Hey Mike. Got a minute? You: Sure. What's up? Me: I was wondering, could I borrow your pencil sharpener really quick? I have this pencil I need to sharpen. (And you should always insert a reason there; see https://www.psychologytoday.com/us/blog/brain-wise/201310/the-power-the-word-because-get-people-do-stuff https://www.psychologytoday.com/us/blog/brain-wise/201310/th...) If you don't insert this social "fluff", you come across as rude. Where this social buffer comes naturally to most people, I get frustrated and annoyed by it. I just want to borrow the dang pencil sharpener and get back to work! I have come to understand I don't resemble neurotypicals when it comes to this interaction (and it is likely that many others here on HN are not neurotypical either.) NTs enjoy this fluff, and it helps them feel connected to each other. When I don't play by their rules, I'm viewed as cold and callous. So...I play by their rules, because even though I'm not NT in this way, I still have basic human needs of wanting to feel loved and desired, and I don't want to upset other people.
  - zozbot123 8y ago
    > If you don't insert this social "fluff", you come across as rude. Isn't this a bit overstated? I'm pretty sure that you could also use bog-standard politeness markers (like, "could you please", "I would really appreciate it", "sorry about asking") and so on and so forth. (You might then come across as being a bit formal and old-fashioned, but certainly not rude!) The underlying motivation in both cases is that you need to make it very clear that you're not issuing an outright demand - and you do this by making it easy for Mike to say no (for any reason or no reason!) and providing plausible deniability. There are things that are closer to "fluff" in other contexts, but even they have their own explanation.

mr_overalls 8y ago

From the article: "Demand avoidance can be seen in the development of children, including those on the autism spectrum. It’s the extent and extreme nature of this avoidance, together with displays of socially shocking behaviour that leads to it being described as 'pathological'."

chongli 8y ago

what makes this a form of autism, of all things? Autism isn't a fact about the world, it's a category we use to group traits we think belong together. What's actually going on may be varied and rather complex. We do this with a lot of words over time. The word atom, for example, means indivisible. For a long time we believed atoms were the fundamental units of matter. To say to a pre-nuclear physicist that we can now "split the atom" is to speak nonsense; to utter a contradiction. The same goes for universe. Centuries ago, people thought the earth was the centre of the universe and that the stars and other heavenly bodies were fixed upon spheres. Then came the sun-centred model of the solar system, and the universe grew a little bit larger. More recently, the Hubble ultra-deep field dramatically expanded our view of the universe yet again. But now there are physicists who speak very seriously about about the idea of a multiverse. What the heck does that even mean? It means we decided, after a certain point, to stop changing the meaning of the word universe.

QuantumGood 8y ago

I was classically autistic, but identified eventually that if I was supposed to do something (use green fingerpaint) it created a strong anxiety response, but if I was simply allowed to do something (fingerpaint however I wanted to) there was no anxiety. I learned to put dishes away by just putting one away, or moving a group from one spot to another, then making another move, but never saying "I'll put them all away" as that created anxiety.