5 ms·

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

by 323 5y ago

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).

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

by 323 5y ago

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

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).