5 ms·

Autism is still wildly misunderstood. It’s a big label on a very very big bag of diverse symptoms. I don’t know how any reasonable scientist could gatekeep som

Autism is still wildly misunderstood. It’s a big label on a very very big bag of diverse symptoms. I don’t know how any reasonable scientist could gatekeep something so amorphous and loosely defined. You can take a child to 4 different doctors and they will all diagnose “autism” differently. It stands to reason no one knows the truth. We are all just making this up as we go along.

323 5y ago
Maybe they should split it into more specific categories. Like we don't just say "you have heart disease".
- netizen-936824 5y ago
  Personally, I like the idea of reclassifying things based on biochemical mechanism. Not that this is any small undertaking, as we need to understand the mechanism that leads to the symptom(s) and develop some sort of reliable test for them. This goes for all psychological issues though, beyond just ASD
  - whatshisface 5y ago
    That's a good idea but nobody knows the mechanism for most brain diseases. When they know they say something like "you have a lesion in your right parietal lobe."
    - netizen-936824 5y ago
      Yes but that is why researchers are actively working to change this. We are aware of the problems, but the system we're dealing with is large and complex. It takes time and effort to learn about the mechanisms, just because we don't know right now doesn't mean we never will.
  - caddemon 5y ago
    It's sort of a self reinforcing problem though - a lot of studies trying to understand biochemical mechanisms are taking our existing subpar labels at face value. They generally don't have the sample size to get remotely close to detection of the probably double digit distinct disorders that are making up the "Autism" group. And that is further complicated by natural heterogeneity found even in control groups. Personally I think coming up with better behavioral characterizations will be an important intermediate step to identifying bio mechanisms, because it leads to much more tractable lines of questioning. For example, we could be quantifying symptoms like rigidity and repetitiveness of movement, sleep quality, sensitivity in different sensory domains, etc. - which should be increasingly feasible to do at scale these days.
  - shakna 5y ago
    How would you go about treatment for illnesses that have no known cause? There are illnesses where we have a known set of symptoms, a known progression, and known treatment options, but have yet to discover the underlying set of causes. You may be able to reliably diagnose, and treat, without understanding the mechanisms at play. You're not going to be able to work with the bureaucratic side of the healthcare system without being able to say what they're being treated for. Those treatment options can be approved for one illness and not another, even when they share symptoms, because of known efficacies. Having a name to call something helps, even when you have no idea about the mechanism at play.
- Fnoord 5y ago
  In DSM-V they did the contrary. In DSM-IV, things like Asperger's, PDD-NOS, etc existed. Now, with V, it is all under the same umbrella: ASD ('Autism Spectrum Disorder' in short 'autism' or ASD). I'm not sure why, but I know there was discrimination going on. People looking to e.g. headhunt idiot savants or high functioning autistics with Asperger's.
  - pas 5y ago
    The DSM is ... well, it's a many-purpose compendium, but one of them is diagnosing people to get them a starting point. For insurance claims, for looking for specialists, etc. But it's certainly not in itself an expert manual. (While yes it is, but it's really not. Because it necessarily has to exclude the outlier cases, so it intentionally limits its own scope, focusing on the most common symptoms, and general descriptions of them. Which is very hard for psychological phenomena.) And it was because it seems those are all caused by the same underlying biology, so they are the same disorder with differing levels of severity in their symptom categories. (Social/language and restricted repetitive behaviors.)
    - oaktrout 5y ago
      To add to the above, my understanding is that classifying autism spectrum disorders into subcategories (eg aspergers) didn't seem to provide much benefit and it made things more difficult to understand. At this point all of our limited interventions are similar and are focused on strengthening social skills, which applies whether you have aspergers or pervasive developmental disorder. This may change again if we find benefit in subclassification (e.g. a treatment that benefits aspergers patients only).
netizen-936824 5y ago
Honestly this is a massive problem in the psychological sciences. Most of the disorders are just collections of symptoms without any solid research tying those symptom collections to concrete issues in neurological circuits or biochemical signaling pathways. Work is being done to fix this, but its currently an absolute shit show in my opinion
- guerrilla 5y ago
  > Most of the disorders are just collections of symptoms without any solid research tying those symptom collections to concrete issues in neurological circuits or biochemical signaling pathways. This isn't true for autism, ADHD, bipolar or schizophrenia since some biological mechanisms are understood (even if these labels aren't perfect), so what are you talking about and what do you base it on?
  - whalesalad 5y ago
    The illnesses you mentioned are misdiagnosed all the time. DSM-V is a joke and so are most mental health professionals. They’re just fitting a list of symptoms to another list of symptoms based on what amounts to Levenshtein distance. Anyone can be diagnosed with ADHD these days. And for all intents and purposes the patient might have 9/10 symptoms. But do they really have ADHD or is it something else? We don’t even have the capacity to figure that out right now because our understanding is so limited.
    - DarylZero 5y ago
      And if you think diagnoses are bad, wait 'til you see what passes for treatments.
    - bratwurst3000 5y ago
      True. A friend of mine got diagnosed with adhd and it was like 15 questions( mostly the same kind) et voila adhd. I got adhd since a kid and i the test was the same. Only they asked the parents and not me. But i think i rly got it… Its like the south park episode where kids got diagnosed because the bible bored them…

323 5y ago

Maybe they should split it into more specific categories. Like we don't just say "you have heart disease".

netizen-936824 5y ago
Personally, I like the idea of reclassifying things based on biochemical mechanism. Not that this is any small undertaking, as we need to understand the mechanism that leads to the symptom(s) and develop some sort of reliable test for them. This goes for all psychological issues though, beyond just ASD
- whatshisface 5y ago
  That's a good idea but nobody knows the mechanism for most brain diseases. When they know they say something like "you have a lesion in your right parietal lobe."
  - netizen-936824 5y ago
    Yes but that is why researchers are actively working to change this. We are aware of the problems, but the system we're dealing with is large and complex. It takes time and effort to learn about the mechanisms, just because we don't know right now doesn't mean we never will.
- caddemon 5y ago
  It's sort of a self reinforcing problem though - a lot of studies trying to understand biochemical mechanisms are taking our existing subpar labels at face value. They generally don't have the sample size to get remotely close to detection of the probably double digit distinct disorders that are making up the "Autism" group. And that is further complicated by natural heterogeneity found even in control groups. Personally I think coming up with better behavioral characterizations will be an important intermediate step to identifying bio mechanisms, because it leads to much more tractable lines of questioning. For example, we could be quantifying symptoms like rigidity and repetitiveness of movement, sleep quality, sensitivity in different sensory domains, etc. - which should be increasingly feasible to do at scale these days.
- shakna 5y ago
  How would you go about treatment for illnesses that have no known cause? There are illnesses where we have a known set of symptoms, a known progression, and known treatment options, but have yet to discover the underlying set of causes. You may be able to reliably diagnose, and treat, without understanding the mechanisms at play. You're not going to be able to work with the bureaucratic side of the healthcare system without being able to say what they're being treated for. Those treatment options can be approved for one illness and not another, even when they share symptoms, because of known efficacies. Having a name to call something helps, even when you have no idea about the mechanism at play.
Fnoord 5y ago
In DSM-V they did the contrary. In DSM-IV, things like Asperger's, PDD-NOS, etc existed. Now, with V, it is all under the same umbrella: ASD ('Autism Spectrum Disorder' in short 'autism' or ASD). I'm not sure why, but I know there was discrimination going on. People looking to e.g. headhunt idiot savants or high functioning autistics with Asperger's.
- pas 5y ago
  The DSM is ... well, it's a many-purpose compendium, but one of them is diagnosing people to get them a starting point. For insurance claims, for looking for specialists, etc. But it's certainly not in itself an expert manual. (While yes it is, but it's really not. Because it necessarily has to exclude the outlier cases, so it intentionally limits its own scope, focusing on the most common symptoms, and general descriptions of them. Which is very hard for psychological phenomena.) And it was because it seems those are all caused by the same underlying biology, so they are the same disorder with differing levels of severity in their symptom categories. (Social/language and restricted repetitive behaviors.)
  - oaktrout 5y ago
    To add to the above, my understanding is that classifying autism spectrum disorders into subcategories (eg aspergers) didn't seem to provide much benefit and it made things more difficult to understand. At this point all of our limited interventions are similar and are focused on strengthening social skills, which applies whether you have aspergers or pervasive developmental disorder. This may change again if we find benefit in subclassification (e.g. a treatment that benefits aspergers patients only).

netizen-936824 5y ago

Honestly this is a massive problem in the psychological sciences. Most of the disorders are just collections of symptoms without any solid research tying those symptom collections to concrete issues in neurological circuits or biochemical signaling pathways. Work is being done to fix this, but its currently an absolute shit show in my opinion

guerrilla 5y ago
> Most of the disorders are just collections of symptoms without any solid research tying those symptom collections to concrete issues in neurological circuits or biochemical signaling pathways. This isn't true for autism, ADHD, bipolar or schizophrenia since some biological mechanisms are understood (even if these labels aren't perfect), so what are you talking about and what do you base it on?
- whalesalad 5y ago
  The illnesses you mentioned are misdiagnosed all the time. DSM-V is a joke and so are most mental health professionals. They’re just fitting a list of symptoms to another list of symptoms based on what amounts to Levenshtein distance. Anyone can be diagnosed with ADHD these days. And for all intents and purposes the patient might have 9/10 symptoms. But do they really have ADHD or is it something else? We don’t even have the capacity to figure that out right now because our understanding is so limited.
  - DarylZero 5y ago
    And if you think diagnoses are bad, wait 'til you see what passes for treatments.
  - bratwurst3000 5y ago
    True. A friend of mine got diagnosed with adhd and it was like 15 questions( mostly the same kind) et voila adhd. I got adhd since a kid and i the test was the same. Only they asked the parents and not me. But i think i rly got it… Its like the south park episode where kids got diagnosed because the bible bored them…