3 ms·

there was a trend in neuropsychiatry to study "neuroendophenotypes" - the smallest behavioral changes linked to gene expression - rather than treat macro-level

there was a trend in neuropsychiatry to study "neuroendophenotypes" - the smallest behavioral changes linked to gene expression - rather than treat macro-level diagnoses like autism as monoliths. autism probably covers hundreds of discrete genetic disorders that share similar pathology. for instance, Rett syndrome is sometimes considered part of ASD, but only explains a small number of ASD diagnoses. I don't think that precludes ASD from being a useful diagnostic category, though. behavioral therapists don't need to know your genotype to help you cope with sensory overload. schizophrenia probably works the same way, but you still prescribe antipsychotics regardless.

skissane 4y ago
> I don't think that precludes ASD from being a useful diagnostic category, though. behavioral therapists don't need to know your genotype to help you cope with sensory overload. It is possible to have "sensory overload" – even severe problems with it – yet not have enough of the other symptoms of ASD to meet its diagnostic criteria. How do behavioural therapists treat sensory overload in a person without ASD? Pretty much in the same way that they treat sensory overload in people with ASD! Conversely, it is possible to meet the ASD diagnostic criteria, and yet have no sensory issues needing treatment – such people exist too. That's the thing – received wisdom justifies the clinical use of diagnoses as useful in treatment planning - but if you subject that received wisdom to scrutiny (too rarely done), it doesn't hold up very well. Almost all treatments in psychology/psychiatry/etc are (at best) symptom-specific not diagnosis-specific – almost all symptoms occur in multiple diagnoses, and many diagnoses have no one essential symptom. If person A has diagnosis B with symptom C – their treatment for symptom C will often be very similar, even identical, to the treatment of that same symptom in some other person who has completely different diagnoses instead. > schizophrenia probably works the same way, but you still prescribe antipsychotics regardless The same point applies to medications – medications don't really treat disorders, they treat symptoms. Antipsychotics are used to treat psychosis – which is a symptom which occurs not only in schizophrenia spectrum disorders, but very commonly seen in mood disorders as well (bipolar disorder with psychotic features, depressive psychosis), and (less commonly) can occur as a symptom of many more. Yet, whatever their diagnosis may be, a person with psychotic symptoms is highly likely to be prescribed an antipsychotic. Added to that, you can also be prescribed an antipsychotic without having any psychotic symptoms, since various antipsychotics are FDA-approved for treating non-psychotic conditions, including anxiety, behavioural issues in children with autism/ASD, bipolar disorder, depression and Tourette's syndrome, along with various non-specific symptoms such as "agitation", "behavioural problems" (ADHD, ODD, DMDD, conduct disorder, personality disorders), and "hyperactivity" [0] – to say nothing of their very widespread off-label use. [0] https://www.ncbi.nlm.nih.gov/books/NBK84656/ https://www.ncbi.nlm.nih.gov/books/NBK84656/

skissane 4y ago

> I don't think that precludes ASD from being a useful diagnostic category, though. behavioral therapists don't need to know your genotype to help you cope with sensory overload. It is possible to have "sensory overload" – even severe problems with it – yet not have enough of the other symptoms of ASD to meet its diagnostic criteria. How do behavioural therapists treat sensory overload in a person without ASD? Pretty much in the same way that they treat sensory overload in people with ASD! Conversely, it is possible to meet the ASD diagnostic criteria, and yet have no sensory issues needing treatment – such people exist too. That's the thing – received wisdom justifies the clinical use of diagnoses as useful in treatment planning - but if you subject that received wisdom to scrutiny (too rarely done), it doesn't hold up very well. Almost all treatments in psychology/psychiatry/etc are (at best) symptom-specific not diagnosis-specific – almost all symptoms occur in multiple diagnoses, and many diagnoses have no one essential symptom. If person A has diagnosis B with symptom C – their treatment for symptom C will often be very similar, even identical, to the treatment of that same symptom in some other person who has completely different diagnoses instead. > schizophrenia probably works the same way, but you still prescribe antipsychotics regardless The same point applies to medications – medications don't really treat disorders, they treat symptoms. Antipsychotics are used to treat psychosis – which is a symptom which occurs not only in schizophrenia spectrum disorders, but very commonly seen in mood disorders as well (bipolar disorder with psychotic features, depressive psychosis), and (less commonly) can occur as a symptom of many more. Yet, whatever their diagnosis may be, a person with psychotic symptoms is highly likely to be prescribed an antipsychotic. Added to that, you can also be prescribed an antipsychotic without having any psychotic symptoms, since various antipsychotics are FDA-approved for treating non-psychotic conditions, including anxiety, behavioural issues in children with autism/ASD, bipolar disorder, depression and Tourette's syndrome, along with various non-specific symptoms such as "agitation", "behavioural problems" (ADHD, ODD, DMDD, conduct disorder, personality disorders), and "hyperactivity" [0] – to say nothing of their very widespread off-label use. [0] https://www.ncbi.nlm.nih.gov/books/NBK84656/ https://www.ncbi.nlm.nih.gov/books/NBK84656/