5 ms·

> She simply argues that the symptoms are caused by numerous unknown diverse causes in the brain, and the concept of a single disorder (ASD), or even a spectrum

> She simply argues that the symptoms are caused by numerous unknown diverse causes in the brain, and the concept of a single disorder (ASD), or even a spectrum of related disorders (ASDs, the DSM-IV PDDs, and more recent ASD sub-typing proposals), isn't helpful in understanding those causes. I think this is a dangerous misunderstanding of the reason for the grouping of autism-spectrum disorders under a common umbrella. The danger lies in the (all-too-common) tendency of people to think that the rejection of autism's categories means "autism doesn't exist" or something similar. The purpose of such categories is not to help understand the causes, but to help cement the reality that autism is a group of very serious disorders with similar traits. As an analogy, many cancers that are grouped under a single name -- such as breast cancer -- are actually caused by very different genetic alterations. To use these differences as a justification to reject the concept of breast cancer would be ludicrous.

abellerose 6y ago
> The danger lies in the (all-too-common) tendency of people to think that the rejection of autism's categories means "autism doesn't exist" or something similar. Serious question, do you actually have any evidence for that postulation? Even with the analogy you have listed doesn't show evidence that people would consider non-existence or reject care from individuals suffering what we today characterize as autism.
skissane 6y ago
> I think this is a dangerous misunderstanding of the reason for the grouping of autism-spectrum disorders under a common umbrella Who are you accusing of a "dangerous misunderstanding" here – her, or me? If you haven't read her work, I don't know how you can fairly accuse her of misunderstanding anything; likewise, I think having read at least some of her work is a prerequisite to be able to fairly accuse me of having misunderstood her If your accusation is that she doesn't understand "the reason for the grouping" may I point out that she played a central role in the drafting of the PDDs section in the DSM-III-R [1]. As a former member of the DSM working group on autism, Waterhouse has a very good knowledge of the reasons and history behind the development of the "ASD" diagnostic label. Waterhouse may or may not be right, but her argument cannot be dismissed anywhere near as easily as you seem to think it can. [1] https://link.springer.com/article/10.1007/BF01046326 https://link.springer.com/article/10.1007/BF01046326
- gwerbret 6y ago
  > Who are you accusing of a "dangerous misunderstanding" here – her, or me? I wasn't accusing anyone specifically, merely commenting on the idea you shared. However, since you asked, I would say that the misunderstanding is on both your parts -- yours, for interpreting her arguments to mean "ASD doesn't exist" (as far as I can tell, she makes no such claim); and hers, for arguing that the formal definitions and categorizations of ASD need to be biologically valid (which they can't be, as we don't understand enough about the biology for that to be possible). It's common for many fields of research to start with "stamp-collecting", where people just identify and group diseases and conditions and birds based on shared characteristics; and later, as the field becomes more mature, to develop more meaningful categories. I think this same concept applies to ASD.
  - skissane 6y ago
    > yours, for interpreting her arguments to mean "ASD doesn't exist" (as far as I can tell, she makes no such claim); To quote page 431 of her book Rethinking Autism (my emphasis): > Taken together, these three claims and associated lines of evidence argue against the existence of autism as a single disorder, spectrum, or set of autism subgroups. If autism symptoms are not one disorder, and are not many disorders, what are they? The most parsimonious and least speculative view is that autism symptoms must be symptoms. Her book is quite explicit in its claim that autism spectrum disorder does not exist. Her conclusion (p. 433) is given under the heading "AUTISM SYMPTOMS WITHOUT A DISORDER". The whole point of her book is to argue that the disorder "Autism Spectrum Disorder" does not exist, but the symptoms do. You might say she rejects the "Spectrum" and the "Disorder" in "ASD", but keeps the "Autism" as a reference to a set of symptoms – however, her "autism" is narrower than the DSM-5's "autism", since it only includes social impairment, and considers repetitive behaviours/restricted interests and sensory issues, to be distinct symptom sets coequal with attention-deficit/hyperactive-impulsive symptoms, intellectual disability, functional language impairment, seizures, see p.434-435 To quote the blurb on the back cover "Rethinking Autism... draws the potentially shocking conclusion that 'Autism' does not exist as a single disorder. The conglomeration of symptoms exists, but like fever, those symptoms aren't a disease in themselves..." (But, the book actually goes further than the blurb says it does, because it not only rejects the idea that autism exists as a single disorder, it also rejects the idea that autism exists as multiple disorders or a spectrum of disorders, as my quote above demonstrates.) > and hers, for arguing that the formal definitions and categorizations of ASD need to be biologically valid Biologically valid categories would be a lot more useful than biologically invalid categories, and one of her major points is that the research community's fixation on the later is getting in the way of actually discovering the former ([1], [2]). She argues that, in place of the current widespread practice of doing research with ASD-defined samples (a confirmed ASD diagnosis as a study inclusion criteria), samples should be based on all individuals showing neurodevelopmental symptoms (mixing together ASD, ADHD, epilepsy, intellectual disability, etc, into a single sample) and then trying to study the variation in the sample in order to derive biologically valid categories to replace the existing biologically invalid ones such as ASD. [3] is an example of a study along the lines of what she recommends (indeed, they've obviously read [1] since they reference it) [1] https://link.springer.com/article/10.1007/s40489-016-0085-x https://link.springer.com/article/10.1007/s40489-016-0085-x [2] https://pubmed.ncbi.nlm.nih.gov/28714261/ https://pubmed.ncbi.nlm.nih.gov/28714261/ [3] https://www.nature.com/articles/s41398-019-0631-2 https://www.nature.com/articles/s41398-019-0631-2

abellerose 6y ago

> The danger lies in the (all-too-common) tendency of people to think that the rejection of autism's categories means "autism doesn't exist" or something similar. Serious question, do you actually have any evidence for that postulation? Even with the analogy you have listed doesn't show evidence that people would consider non-existence or reject care from individuals suffering what we today characterize as autism.

skissane 6y ago

> I think this is a dangerous misunderstanding of the reason for the grouping of autism-spectrum disorders under a common umbrella Who are you accusing of a "dangerous misunderstanding" here – her, or me? If you haven't read her work, I don't know how you can fairly accuse her of misunderstanding anything; likewise, I think having read at least some of her work is a prerequisite to be able to fairly accuse me of having misunderstood her If your accusation is that she doesn't understand "the reason for the grouping" may I point out that she played a central role in the drafting of the PDDs section in the DSM-III-R [1]. As a former member of the DSM working group on autism, Waterhouse has a very good knowledge of the reasons and history behind the development of the "ASD" diagnostic label. Waterhouse may or may not be right, but her argument cannot be dismissed anywhere near as easily as you seem to think it can. [1] https://link.springer.com/article/10.1007/BF01046326 https://link.springer.com/article/10.1007/BF01046326

gwerbret 6y ago
> Who are you accusing of a "dangerous misunderstanding" here – her, or me? I wasn't accusing anyone specifically, merely commenting on the idea you shared. However, since you asked, I would say that the misunderstanding is on both your parts -- yours, for interpreting her arguments to mean "ASD doesn't exist" (as far as I can tell, she makes no such claim); and hers, for arguing that the formal definitions and categorizations of ASD need to be biologically valid (which they can't be, as we don't understand enough about the biology for that to be possible). It's common for many fields of research to start with "stamp-collecting", where people just identify and group diseases and conditions and birds based on shared characteristics; and later, as the field becomes more mature, to develop more meaningful categories. I think this same concept applies to ASD.
- skissane 6y ago
  > yours, for interpreting her arguments to mean "ASD doesn't exist" (as far as I can tell, she makes no such claim); To quote page 431 of her book Rethinking Autism (my emphasis): > Taken together, these three claims and associated lines of evidence argue against the existence of autism as a single disorder, spectrum, or set of autism subgroups. If autism symptoms are not one disorder, and are not many disorders, what are they? The most parsimonious and least speculative view is that autism symptoms must be symptoms. Her book is quite explicit in its claim that autism spectrum disorder does not exist. Her conclusion (p. 433) is given under the heading "AUTISM SYMPTOMS WITHOUT A DISORDER". The whole point of her book is to argue that the disorder "Autism Spectrum Disorder" does not exist, but the symptoms do. You might say she rejects the "Spectrum" and the "Disorder" in "ASD", but keeps the "Autism" as a reference to a set of symptoms – however, her "autism" is narrower than the DSM-5's "autism", since it only includes social impairment, and considers repetitive behaviours/restricted interests and sensory issues, to be distinct symptom sets coequal with attention-deficit/hyperactive-impulsive symptoms, intellectual disability, functional language impairment, seizures, see p.434-435 To quote the blurb on the back cover "Rethinking Autism... draws the potentially shocking conclusion that 'Autism' does not exist as a single disorder. The conglomeration of symptoms exists, but like fever, those symptoms aren't a disease in themselves..." (But, the book actually goes further than the blurb says it does, because it not only rejects the idea that autism exists as a single disorder, it also rejects the idea that autism exists as multiple disorders or a spectrum of disorders, as my quote above demonstrates.) > and hers, for arguing that the formal definitions and categorizations of ASD need to be biologically valid Biologically valid categories would be a lot more useful than biologically invalid categories, and one of her major points is that the research community's fixation on the later is getting in the way of actually discovering the former ([1], [2]). She argues that, in place of the current widespread practice of doing research with ASD-defined samples (a confirmed ASD diagnosis as a study inclusion criteria), samples should be based on all individuals showing neurodevelopmental symptoms (mixing together ASD, ADHD, epilepsy, intellectual disability, etc, into a single sample) and then trying to study the variation in the sample in order to derive biologically valid categories to replace the existing biologically invalid ones such as ASD. [3] is an example of a study along the lines of what she recommends (indeed, they've obviously read [1] since they reference it) [1] https://link.springer.com/article/10.1007/s40489-016-0085-x https://link.springer.com/article/10.1007/s40489-016-0085-x [2] https://pubmed.ncbi.nlm.nih.gov/28714261/ https://pubmed.ncbi.nlm.nih.gov/28714261/ [3] https://www.nature.com/articles/s41398-019-0631-2 https://www.nature.com/articles/s41398-019-0631-2