3 ms·

Agreed that we should not be too overprotective in this, the world is the world as you said and per the serenity prayer we should have the courage to accept the

Agreed that we should not be too overprotective in this, the world is the world as you said and per the serenity prayer we should have the courage to accept the things we cannot change, but being thick-skinned is not an easy skill for many people with ASD and its comorbidities. One of the behaviors used for diagnosing ASD is a lack of social awareness, people with what used to be called Aspergers have a really hard time detecting sarcasm and humor and often take things more seriously than they are intended. The HN audience is special, it has (in my opinion) an increased incidence for conditions like ASD/ADHD/OCD/gifted, in part that makes us good at what we do. But I also feel that this incidence is biased towards the higher functioning/higher intelligence side of the spectrum. Not every person diagnosed with ASD has the same cognitive skills to reason about and contextualize something they read or hear. And even people on the higher functioning side have days where this is hard or even impossible. I've had days where the walls were closing in on me, totally consumed by my issues and not seeing a way out. If in a moment like that I read someone joking lightheartedly that they "are so autistic" because of one stereotypical trait they zoom in on, I feel like someone is mocking me personally, I feel like a failure for who I am, and that can lead to a depression episode lasting for days or weeks. An environment where everyone is on their toes and faux-polite all the time is not a solution. I think it mostly comes down to increasing awareness about these conditions, what they are and how they affect people so we as a society can all live together in harmony. Which is what this article is trying to do for OCD, which is also why I have spent the last 60 minutes trying to write a 4 paragraph HN comment on a post that is not even on the frontpage anymore. I don't even know where I'm going with this anymore, my attention is shot, my emotions all over the place, I think I need a walk outside.

skissane 6y ago
I understand where you are coming from. But I worry that a lot of people in the "ASD community" – this might not be true of you personally – seem to me to believe in a sort of hard boundary between ASD and non-ASD, ignoring the concept of BAP (subclinical ASD). An oversimplified one-dimensional model might look like this: you have the "neurotypical" at one end, and ASD at the other, and BAP is somewhere in the middle. A lot of people who joke about being "so autistic" may well actually have BAP, and BAP is adjacent to ASD and has an unclear boundary with it. The boundary between the two is in part determined by non-intrinsic factors such as cultural differences between diagnosing clinicians, patient/client differences in cultural awareness of ASD which influence the likelihood of seeking out a diagnosis, and differences in the supportiveness of the person's environment. (Some "borderline" cases may in a supportive life situation have insufficient clinical dysfunction to justify putting them on the ASD side of the BAP-ASD line, but if their life had turned out a bit differently and they'd found themselves in a less supportive environment they might have ended up on the other side of it, even though the extent to which they innately have core autistic traits might be exactly the same in the two cases.) (That model is oversimplified for two reasons: ASD has a lot of overlap with other psychiatric/neurodevelopmental conditions, and ASD itself is not a one-dimensional construct.)
- vbsteven 6y ago
  I'm going to look into BAP as I had not heard from it before but the concept feels very familiar: I have always tried to explain ASD not as a one-dimensional spectrum but as a set of spectra (oversimplified: one spectrum for each trait) that when combined form a picture that describes a persons autistic behavior. A comparable visualization I like is how Leafly (the marijuana strain website) describes each strain as a set of traits with percentages and then shows each trait score as a horizontal bar. I have similar worries about the idea of a hard boundary between ASD/non-ASD, mostly because I believe that the concepts of "neurotypical" and "neurodiversity" are social constructs we have created because the majority of people behave in a similar way, and everyone who does not is an outlier. We gave the majority behavior a name "neurotypical" and that created an "us vs them" polarization. Hence why I'm an advocate of raising awareness about mental health conditions with the ultimate goal of getting rid of this polarization. You seem to have similar goals in mind when I read your comments about BAP.
  - skissane 6y ago
    > I have always tried to explain ASD not as a one-dimensional spectrum but as a set of spectra (oversimplified: one spectrum for each trait) that when combined form a picture that describes a persons autistic behavior. The term "spectrum" gets used in two different senses (1) a a continuum of severity, stretching from "normal" individuals, to the "mild" cases, through to the "severe" ones (2) to refer to the heterogeneity of different symptoms, such that two people might have a very different mix of symptoms despite having "equal severity". I think both ways of understanding the term are legitimate; some people insist that only sense (2) is correct and sense (1) is wrong, but in fact you'll find both senses being used in the research literature. In some ways it is justifiable to view ASD as a two-dimensional construct: DSM-5 ASD is defined in terms of two domains, the social communication domain and the RRBI+sensory domain. And the DSM-5 says that a diagnosis should provide a level number from 1 to 3 for each of those two domains, and in principle you could have a different level in each domain. (That said, my personal impression is few clinicians actually do that in practice.) ASD is not unique in being a "spectrum". There is also the schizophrenia spectrum (DSM-5 has a whole section called "schizophrenia spectrum and other psychotic disorders"), the obsessive-compulsive spectrum (DSM-5 didn't end up including that concept in its main text, although it was being considered for inclusion, a fact which the front-matter of the DSM-5 briefly alludes to), the bipolar spectrum (not mentioned in the DSM-5, but widely discussed in the literature), among others. In fact, for many different psychiatric/neurodevelopmental disorders, you'll find people in the literature adopting a spectrum-approach to them. But in the popular consciousness, the word "spectrum" gets treated as something specific to ASD rather than the much more general psychiatric/psychological concept which it is. > I have similar worries about the idea of a hard boundary between ASD/non-ASD, mostly because I believe that the concepts of "neurotypical" and "neurodiversity" are social constructs we have created because the majority of people behave in a similar way, and everyone who does not is an outlier. We gave the majority behavior a name "neurotypical" and that created an "us vs them" polarization. I agree with you, but I have another concern as well – the evidence for the "neuro" part just isn't there. The distinction between the "neurotypical" and the "neurodiverse" is actually clinical – it is based on the presence or absence of clinically significant dysfunction, in other words it is based on how well you function in contemporary society, not on any individualised study of brain structure. There is actually genuine neurodiversity among "neurotypicals". For example, most right-handed individuals activate left perisylvian regions of the brain during language processing, but a small minority of right-handed individuals activate right perisylvian regions instead. That small minority are an example of genuine biological neurodiversity. But nobody is going to call them "neurodiverse" unless they have some clinically significant problems with functioning in society, and that example of neurodiversity has no known clinical significance. (Indeed, almost nobody in that small minority would know they are in it, because unless you get someone to do language tasks under MRI, you can't tell whether they belong to it.) The "neurotypical"/"neurodiverse" distinction is fundamentally a clinical distinction masquerading as a neuroscience one. Hence I worry that the us-vs-them polarisation that you mention is both socially harmful and scientifically illiterate

skissane 6y ago

I understand where you are coming from. But I worry that a lot of people in the "ASD community" – this might not be true of you personally – seem to me to believe in a sort of hard boundary between ASD and non-ASD, ignoring the concept of BAP (subclinical ASD). An oversimplified one-dimensional model might look like this: you have the "neurotypical" at one end, and ASD at the other, and BAP is somewhere in the middle. A lot of people who joke about being "so autistic" may well actually have BAP, and BAP is adjacent to ASD and has an unclear boundary with it. The boundary between the two is in part determined by non-intrinsic factors such as cultural differences between diagnosing clinicians, patient/client differences in cultural awareness of ASD which influence the likelihood of seeking out a diagnosis, and differences in the supportiveness of the person's environment. (Some "borderline" cases may in a supportive life situation have insufficient clinical dysfunction to justify putting them on the ASD side of the BAP-ASD line, but if their life had turned out a bit differently and they'd found themselves in a less supportive environment they might have ended up on the other side of it, even though the extent to which they innately have core autistic traits might be exactly the same in the two cases.) (That model is oversimplified for two reasons: ASD has a lot of overlap with other psychiatric/neurodevelopmental conditions, and ASD itself is not a one-dimensional construct.)

vbsteven 6y ago
I'm going to look into BAP as I had not heard from it before but the concept feels very familiar: I have always tried to explain ASD not as a one-dimensional spectrum but as a set of spectra (oversimplified: one spectrum for each trait) that when combined form a picture that describes a persons autistic behavior. A comparable visualization I like is how Leafly (the marijuana strain website) describes each strain as a set of traits with percentages and then shows each trait score as a horizontal bar. I have similar worries about the idea of a hard boundary between ASD/non-ASD, mostly because I believe that the concepts of "neurotypical" and "neurodiversity" are social constructs we have created because the majority of people behave in a similar way, and everyone who does not is an outlier. We gave the majority behavior a name "neurotypical" and that created an "us vs them" polarization. Hence why I'm an advocate of raising awareness about mental health conditions with the ultimate goal of getting rid of this polarization. You seem to have similar goals in mind when I read your comments about BAP.
- skissane 6y ago
  > I have always tried to explain ASD not as a one-dimensional spectrum but as a set of spectra (oversimplified: one spectrum for each trait) that when combined form a picture that describes a persons autistic behavior. The term "spectrum" gets used in two different senses (1) a a continuum of severity, stretching from "normal" individuals, to the "mild" cases, through to the "severe" ones (2) to refer to the heterogeneity of different symptoms, such that two people might have a very different mix of symptoms despite having "equal severity". I think both ways of understanding the term are legitimate; some people insist that only sense (2) is correct and sense (1) is wrong, but in fact you'll find both senses being used in the research literature. In some ways it is justifiable to view ASD as a two-dimensional construct: DSM-5 ASD is defined in terms of two domains, the social communication domain and the RRBI+sensory domain. And the DSM-5 says that a diagnosis should provide a level number from 1 to 3 for each of those two domains, and in principle you could have a different level in each domain. (That said, my personal impression is few clinicians actually do that in practice.) ASD is not unique in being a "spectrum". There is also the schizophrenia spectrum (DSM-5 has a whole section called "schizophrenia spectrum and other psychotic disorders"), the obsessive-compulsive spectrum (DSM-5 didn't end up including that concept in its main text, although it was being considered for inclusion, a fact which the front-matter of the DSM-5 briefly alludes to), the bipolar spectrum (not mentioned in the DSM-5, but widely discussed in the literature), among others. In fact, for many different psychiatric/neurodevelopmental disorders, you'll find people in the literature adopting a spectrum-approach to them. But in the popular consciousness, the word "spectrum" gets treated as something specific to ASD rather than the much more general psychiatric/psychological concept which it is. > I have similar worries about the idea of a hard boundary between ASD/non-ASD, mostly because I believe that the concepts of "neurotypical" and "neurodiversity" are social constructs we have created because the majority of people behave in a similar way, and everyone who does not is an outlier. We gave the majority behavior a name "neurotypical" and that created an "us vs them" polarization. I agree with you, but I have another concern as well – the evidence for the "neuro" part just isn't there. The distinction between the "neurotypical" and the "neurodiverse" is actually clinical – it is based on the presence or absence of clinically significant dysfunction, in other words it is based on how well you function in contemporary society, not on any individualised study of brain structure. There is actually genuine neurodiversity among "neurotypicals". For example, most right-handed individuals activate left perisylvian regions of the brain during language processing, but a small minority of right-handed individuals activate right perisylvian regions instead. That small minority are an example of genuine biological neurodiversity. But nobody is going to call them "neurodiverse" unless they have some clinically significant problems with functioning in society, and that example of neurodiversity has no known clinical significance. (Indeed, almost nobody in that small minority would know they are in it, because unless you get someone to do language tasks under MRI, you can't tell whether they belong to it.) The "neurotypical"/"neurodiverse" distinction is fundamentally a clinical distinction masquerading as a neuroscience one. Hence I worry that the us-vs-them polarisation that you mention is both socially harmful and scientifically illiterate