18 ms·

Metabolism of autism reveals developmental origins

171 points by wglb 2y ago

faeriechangling 2y ago
> The researchers discovered that a small number of biochemical pathways are responsible for the majority of these changes, which could help inform new early detection and prevention strategies for autism. It won’t. Autism is a socioculturally bound diagnosis, not a single disease that exists in biology. It’s a label for those perceived by others in a certain light, defined in such a way that two with the same label can have remarkably little overlap in terms of observed behaviour. You diagnose autism based on how people act, not who they are. Any biological markers for autism are politically suspect as it would imply those without those markers are invalid, while also raising the spectre of eugenics for those with the markers. More likely and productivity it might eventually REPLACE autism as a diagnosis with something scientifically valid and treatable, as if somebody displays no autistic behaviours as a result of treatment of a metabolic disorder, why diagnose them with autism?
- furyofantares 2y ago
  > defined in such a way that two with the same label can have remarkably little overlap in terms of observed behaviour I believed this until my daughter was diagnosed and then I was later diagnosed. My experience with (some) professionals was a surprise to me; a much wider variety of "observed behaviors" than I expected seem to stem from sensory issues for example. And I think it makes sense that humans might adopt a wide variety of ways to deal with for a much smaller variety of processing issues. (Unrelated to the professional experience) Have you looked into monotropism? It's a fairly compact theory that ties a lot of behaviors together that might look like they have no overlap from the outside. Also: > It’s a label for those perceived by others in a certain light Lots of people self-diagnose.
  - faeriechangling 2y ago
    If you ask the majority of people if somebody who they do not perceive as engaging in autisitic behaviours, and was not diagnosed as autistic, but considers themselves autistic, is autistic, they will say no. Scientifically (which how it’s defined in the OP), it’s not defined by psychiatrist appraisal and self-assessment plays no necessary role in the process and alone holds no diagnostic validity. We can also invert this: self-denial doesn’t make one non-autistic if they’re seen as engaging in autistic behaviours and are diagnosed as autistic by a professional. I’ll concede that a minority believe that autism is self-definable though. I’d prefer things that way myself, but the among other things it would make it impossible to gatekeep services for the autistic if self-diagnosis were held in the same esteem as physician diagnosis, so it won’t catch on anytime soon.
    - flatline 2y ago
      I’m not sure what point you are making with this reply. I’m late/adult self-identifying autistic. I’ve done this with some of the standard tests that psychiatrists use, attended workgroups related to the topic, and studied extensively. Self-diagnosis is highly accurate for autism, both for positive and negative evaluations. I am also pursuing a formal diagnosis because so many people downplay it when I tell them I’m autistic. I don’t have the affect at first glance, but it does come out in my behaviors if you get to know me a bit. I’ve also had the luxury of therapy, eduction, etc. I also agree that the categorization is overly broad and your original post resonates. There are various non-overlapping clusters of traits that fall under autism. I do think, however, that at the core of it is a common difference in information and sensory processing.
      - zeroonetwothree 2y ago
        Adults that get diagnosed later typically have developed very good ability to mask so casual acquaintances probably don’t suspect they are autistic. So it’s not surprising they would downplay it.
      - faeriechangling 2y ago
        >Self-diagnosis is highly accurate for autism, both for positive and negative evaluations. I've also gone into autism communities before and declared that I had self-undiagnosed myself with autism, which is something I've desired recently, to re-diagnose myself as not being autistic and either having nothing or ADHD. This was totally rejected, and repeatedly brought up was my admittance to a lengthy period of diagnosis, overseen my multiple doctors, from a very young age, which all were seen as evidence of the validity of my diagnosis (conversely, I'd presume, they treat the opposite as more less valid or invalid). Interestingly the same people generally accepted diagnosis, but to reject a diagnosis, well that was beyond the pale and denialism. I brought up the same to a psychiatrist, saying I wanted to be treated by a psychiatrist for ADHD and NOT autism because I believe it will lead to superior outcomes. They blew me off, exasperated, saying that any psychiatrist would simply observe my symptoms and deem me autistic and treat me that way no matter what I did, denying that I even had the capability or possibility to receive treatment which was not based on the premise that I was autistic. Metabolic testing and self-diagnosis be damned. Just this moment I'm in the process of seeking accommodations. I self reported autistic symptoms to my employer. In the past, during interviews they have accepted my diagnosis and pledged to "accommodate" me accordingly, and I was ticked off as a diversity hire. They asked me to verify such symptoms with a doctor. They subsequently said they reserve the right to an independent psychological assessment of myself or my records. This is very pleasing to me, as either I shall receive accommodations and an affirmation that I am autistic, or my undiagnosis, which is truly a win-win. If I was in family court, and it was argued that I was unable to say take care of children because I'm autistic, I could not successfully object on the grounds that "I'm not autistic". Yet my observation is what is considered the true measure of somebodies autisticness, the validity of their diagnosis and their symptoms, is independent psychological assessments by an examiner not beholden to your own self-assessment. I theorise this is both because of a lack of faith in the competence of either of us to assess an autism diagnosis, as well as a lack of faith in our objectivity. I've met a number of self-diagnosed people who are shy about disclosure or asking for accommodation BECAUSE they are self-diagnosed, and while obviously believing in the reality of their autism, are either self-sceptical or believe in others scepticism to a degree not commonly seen in those medically diagnosed. I don't mean to be exclusionary or gatekeeping, just descriptive of what I believe to be social/political/legal/scientific reality. I don't like that things are this way, I'm aware that hilariously I've never seen ANY evidence that suggests physician diagnosis is more accurate than self-diagnosis, I'm aware of the many historical problems with physician diagnosis, I merely believe that they ARE this way.
  - somenameforme 2y ago
    Here [1] is the DSM diagnostic criteria for autism. It's broad to the point of absurdity. The reason many people think autism is a faux disorder is because it includes everything from an individual who simply sits in the corner endlessly flapping his hands, completely unable to function as a human being, to Bill Gates or Elon Musk. The weaker diagnoses, which is an increasingly large chunk of all of them, often seem like an effect to pathologize normal behavioral differences within people. This is, IMO, one of those things people are definitely going to look back at think 'wtf were they even thinking?' [1] - https://a4.org.au/dsm5-asd https://a4.org.au/dsm5-asd
    - zeroonetwothree 2y ago
      Drug users can include people from a homeless addict who can barely stay conscious to Elon Musk. Does that mean the concept is absurd?
    - whimsicalism 2y ago
      frankly, this will continue as long as performance-enhancing drugs and accommodations are gated behind diagnoses
      - pseudalopex 2y ago
        What performance enhancing drugs are prescribed for autism?
        whimsicalism 2y ago
        i thought we prescribed adderall for autism, but i guess cross-diagnoses are just so common nowadays that i didn’t realize what it was being prescribed for among people i know
        ModernMech 2y ago
        You may be under this impression because ADHD and Autism are so frequently comorbid: According to the scientific literature, 50 to 70% of individuals with autism spectrum disorder (ASD) also present with comorbid attention deficit hyperactivity disorder (ADHD). From a clinical perspective, this high rate of comorbidity is intriguing. What is the real significance of this dual diagnosis? Is ADHD in fact always present in such cases? Might the attentional impairment reported among our ASD patients actually be a distinct trait of their ASD—namely, impaired joint attention—rather than an ADHD attention deficit? Could their agitation be the consequence of this joint attention impairment or related to a physical restlessness etiologically very different from the agitation typical of ADHD? The neurobiological reality of ASD-ADHD comorbidity is a subject of debate, and amphetamine-based treatment can have paradoxical or undesirable effects in the ASD population. Consequently, does a dual diagnosis, notwithstanding its currency in the literature, prevent us from shedding sufficient light on major physiopathologic questions raised by the clinical picture of ASD? https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.837424/full https://www.frontiersin.org/journals/psychiatry/articles/10....
  - neom 2y ago
    I mean I was diagnosed with a salad of things. And then different doctors tell me different things about how they're all related or unrelated. It was honestly a very amusing situation. The only sense I got out of the whole long ass process was: neurological sensory difference "combo" in the roll of the dice, some of it given hereditarily, some this that and the other. I really see why this stuff is so frustrating for people. I'm super lucky circumstances are such for me that I can give less shits about the social issues my autism causes, allowing me to explore it.I actually just started a blog last week to share as I explore this stuff, I'm a bit shy to share it as I've never blogged in earnest before, so I have no sense of if this is good, bad, silly, lame, boring, etc: https://b.h4x.zip/autism-thinking-and-whiteboards/ https://b.h4x.zip/autism-thinking-and-whiteboards/
    - ntxy 2y ago
      Please keep writing. I'm hooked!
- ninininino 2y ago
  FTA: "only 10–20% of children diagnosed before 5 years of age able to live independently as adults" ^ the article and the medical treatment is aimed at those so severely impacted/compromised that they cannot live independently.
  - Der_Einzige 2y ago
    People with high functioning autism make up a majority of the “people who died at 25 and didn’t know it until they were 80” crowd.
    - giantg2 2y ago
      I'm not sure I understand the quote.
      - normaler 2y ago
        There is an increased comorbidity with neuro divergence and harmful behaviour.
      - IggleSniggle 2y ago
        I think they meant "people who didnt die before 25." I don't know much about autism, but I had three friends who died before 30 in accidents that were almost certainly related to ADHD. Two of them were doing behavioral therapy but didn't believe in pharmaceutical treatment. One of them was generally medicated but wasn't taking their medication on the day they died (due to medication shortages for ADHD drugs). That last one rear-ended a semi-truck at high speed. Probably after getting lost in thought after reading a "You shouldn't text and drive. If you text and drive, it may be the last text you ever read. Remember, don't read superfluous text; pay attention to the road, for your own safety and the safety of those around you." Obviously I don't know that last part; I am just bitter.
        giantg2 2y ago
        I knew someone in high school that had ADHD. He totaled many cars when he wasn't on meds for things like game day for sports (not sure if that's a performance or health thing). What baffles me, is how someone diagnosed with a condition that affects driving is allowed to drive without the condition being treated - especially if they are under a prescription and just not taking it, and also if they have multiple accidents attributed to the condition. We already require this for people with seizures, for people needing glasses to wear them, etc.
- RobotToaster 2y ago
  IMO, it will probably end up like Ehlers Danlos, where you have 20 or so subtypes defined by certain genes.
  - Perenti 2y ago
    EDS is also highly associated with ADHD and ASD.
- deleted 2y ago
  [deleted]
- 2four2 2y ago
  I think most people understand that disease nomenclature changes rapidly. Even if the word "autism" is deprecated in the future and replaced by a litany of other terms for conditions, the research is still useful and interesting.
- jncfhnb 2y ago
  Because it’s fully possible and commonly understood that a medical condition can arise from multiple different circumstances
- m00x 2y ago
  That's completely incorrect. Autism has clear physiological differences in the brain. It's not just a personality difference. People like to call themselves autistic when it's just social awkwardness, and some doctors might even improperly diagnose them, but these are separate from the condition. https://www.healthcentral.com/condition/autism/autism-brain-differences https://www.healthcentral.com/condition/autism/autism-brain-... This could help us prevent autism completely.
  - faeriechangling 2y ago
    >People like to call themselves autistic when it's just social awkwardness, and some doctors might even improperly diagnose them, but these are separate from the condition. What makes such a diagnosis incorrect when various forms of social awkwardness satisfy criteria A and D of the diagnostic criteria [1], and all of the criteria for social pragmatic disorder[2]? In the DSM-V-TR era psychiatrists are instructed to not just judge somebody to not be autistic if they do not appear socially awkward, and to additionally ask if they find social interactions distressing, and observe them for longer in more naturalistic settings to find the deficit in social functioning[3] as part of a thus far continuously lowering diagnostic bar as to what is considered sufficient social awkwardness to be diagnosable. >Autism has clear physiological differences in the brain. Which physiological changes in the brain make you autistic, or put another way, which physiological changes in the brain must you lack to NOT be autistic? I've heard of any autism diagnosis's and self-diagnosis's and I've never heard of any of them being based on a brain scan and yet people go around calling others and themselves autistic. I've never heard of a diagnosis being lost or gained due to a brain scan. I've heard this insistence that we can infer the territory, the neurological conditions of peoples brains, from the map, the behaviourist diagnosis, and there may be a correlation but it can't be said that any given person with an autism diagnosis has any given specific neurological change. The only thing we test for IS behaviour, and infer biology from it. [1] https://www.cdc.gov/ncbddd/autism/hcp-dsm.html https://www.cdc.gov/ncbddd/autism/hcp-dsm.html [2] https://en.wikipedia.org/wiki/Social_(pragmatic)_communication_disorder#Diagnosis https://en.wikipedia.org/wiki/Social_(pragmatic)_communicati... [3] https://www.reddit.com/r/aspergirls/comments/th9hku/dsm5tr_new_diagnostic_criteria_for_autism/ https://www.reddit.com/r/aspergirls/comments/th9hku/dsm5tr_n...
- mewpmewp2 2y ago
  It's gross to hear that they want to prevent it.
- ants_everywhere 2y ago
  > Autism is a socioculturally bound diagnosis This is untrue and unsupported by evidence > It's a label for those perceived by others in a certain light This is untrue and unsupported by evidence > defined in such a way that two with the same label can have remarkably little overlap in terms of observed behaviour This is untrue and unsupported by evidence > You diagnose autism based on how people act, not who they are You diagnose all disorders based on observable phenomena, not some sort of metaphysical essence. > Any biological markers for autism are politically suspect What is this, Lysenkoism? > as it would imply those without those markers are invalid Are you saying that in your view biology has some ability to mark people as valid or invalid? That's an extremist view and I wonder how you arrived at it. If your ideology requires you divide the world into "valid" and "invalid" people, then it's probably a good time to rethink your approach.
  - zer00eyz 2y ago
    >> defined in such a way that two with the same label can have remarkably little overlap in terms of observed behaviour > This is untrue and unsupported by evidence Here is the diagnostic criteria for ASD: https://www.cdc.gov/ncbddd/autism/hcp-dsm.html https://www.cdc.gov/ncbddd/autism/hcp-dsm.html ... It literally lays out a path that can generate a non overlapping diagnosis. It sort of has to because we lummped what were previously two disorders together because people are sensitive to nazi's having existed. Now go to the UK where there is strong advocacy for a whole other set of diagnostic criteria for women. The DSM begins to look barbaric and/or sexist if not misinformed. The moment there is a biological underpinning to something like ASD it gets interesting because what do you do with all the folks with a diagnosis who DONT fit that label. They have something that looks the same but isnt... and the whole psychiatry/psychology community looks like quacks. DO note that im not opposed to these fields but they need to get their shit together on reproducibility.
    - ants_everywhere 2y ago
      Thanks I'm thoroughly familiar with the DSM criteria, the ICD criteria, and the research literature. > It literally lays out a path that can generate a non overlapping diagnosis. It does not. If you believe there are exist two autistic people who have no overlapping symptoms please present an example. > The moment there is a biological underpinning to something like ASD it gets interesting because what do you do with all the folks with a diagnosis who DONT fit that label. Compare this to, "The moment there is a biological underpinning to something like cancer it gets interesting because what do you do with all the folks with a diagnosis who DONT fit that label." To which the answer is "that's a red herring, the current understanding of cancer doesn't require all cancers share the same biological origins, so why should finding one marker call that into question?" Or "The moment you locate the code line with a buffer overflow it gets interesting because some programs that seem like they have a buffer overflow don't have that line of code."
- ModernMech 2y ago
  > the same label can have remarkably little overlap in terms of observed behaviour.... You diagnose autism based on how people act, not who they are. I'm able to mask until I'm alone. My meltdowns look exactly like the observed behavior you see in other people, I just hide it better. I'm also verbal mostly, until I'm not and I'm dissociating. Then I look a lot what you're used to seeing, except i don't let you see that. I don't let you see me rocking and stimming. I can talk for an hour in front of 100 people about my special interests at any depth, but I can't complete simple tasks that others can do every day like going to the grocery store and restaurants without extreme difficulty. Some people are "high functioning" autists, meaning that they are able to suppress their negative autistic expressions for the benefit and comfort of people around them. This doesn't make them "not autistic" -- they still are even if you personally can't tell. It just means they're putting on an act for you, to make you happy, so that you don't respond in the negative way they are used to being received. You are witnessing a performance. That suppression is not a constant, and it can't go on forever. Someone doing this long enough will go into autistic burnout, which is like an extended depression and comes with skill loss and an inability to function in society. If you were to see this person at that point, you'd "see" the autism then. Is this all there is to being autistic though? No! Being autistic comes with a great capacity for curiosity, creativity, artistic expression, innovation, and excellence associated with committing fully (as in actually 100%, eschewing loved ones and society) to an endeavor. These are things we don't want to "cure". Most of the problems I face related to my autism have to do with interfacing with society, and not understanding people or not being able to do things everyone else seems to be able to, without any compassion for my inability to do so. As far as I can tell they come from being dysregulated, and being dysregulated comes from extreme sensory overload. If we can fix the sensory overload a lot of other things are fixed. But that doesn't mean we should be "curing" or "preventing" autism, and it doesn't mean people who aren't melting down and who can live by themselves aren't autistic -- they're just well regulated.,
  - faeriechangling 2y ago
    From the DSM-V-TR: "Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)." "Core diagnostic features are evident in the developmental period, but intervention, compensation, and current supports may mask difficulties in at least some contexts." "Individuals who have developed compensation strategies for some social challenges still struggle in novel or unsupported situations and suffer from the effort and anxiety of consciously calculating what is socially intuitive for most individuals. This behavior may contribute to lower ascertainment of autism spectrum disorder in these individuals, perhaps especially in adult women. Thus, longer assessments, observation in naturalistic settings, and inquiring about any tolls of social interaction may be needed(Cage and Troxell-Whitman 2019; Hull et al. 2017). If asked about the costs of social interaction, for example, these individuals might respond that social interactions are exhausting for them, that they are unable to concentrate because of the mental effort in monitoring social conventions, that their self-esteem is adversely affected by being unable to be themselves, and so forth." Observation is STILL actually essential to a diagnosis, you can't merely just claim to be masking, but it's not technically considered disqualifying for symptoms to only appear in certain contexts. >Some people are "high functioning" autists, meaning that they are able to suppress their negative autistic expressions for the benefit and comfort of people around them. This doesn't make them "not autistic" -- they still are even if you personally can't tell. It just means they're putting on an act for you, to make you happy, so that you don't respond in the negative way they are used to being received. You are witnessing a performance. The research I've seen on the cat-q shows that [1]: - Neurotypicals men mask a statistically insignificant amount more than autistic men - Autistic women mask a statistically insignificant more than neurotypical women - Autistic women mask a statistically significant amount more than autistic men - Autistics "Compensate" more, copy others behaviour, copy behaviour they learned from movies - Autistics "Assimilate" more, they will force themselves unwillingly more than others to be social or not be social. We should also get over what gets somebody defined as having "high functioning" or "level 1" autism. It's a lack of severity of social impairments AND restricted & repetitive behaviours. With autistic men specifically, the evidence points to the "high functioning" as simply naturally exhibiting less autistic social interactions and behaviours than the "low functioning" without any exceptional effort beyond what the everyday non-disabled person does. Some of them may be tortured actors, but said people are no more prevalent than they are in the general population. It's things like imitation, and being in unwanted social situations, which is more characteristic of autism. >Being autistic comes with a great capacity for curiosity, creativity, artistic expression, innovation, and excellence associated with committing fully (as in actually 100%, eschewing loved ones and society) to an endeavor. Those may correlate with autism, but aren't definitional of it. The DSM-V-TR's 1891 word diagnostic criteria briefly mentions "Special interests may be a source of pleasure and motivation and provide avenues for education and employment later in life" as the sole positive trait of autistics. I don't mean to be a dick here - more activist. If these are qualities of autistics, they should either be part of the criteria for "Autism spectrum disorder" or autism should be conceptualised as being distinct from disorder similar to how we distinguish between being transgender and having gender dysphoria. Otherwise, one can say that all they wish, but they'll face negative stigmatisation from those who see autism as a definitionally negative mental disorder with no upside other than employability. "Autism" is quite the stigmatised word today and I blame psychiatry and The DSM for that more than anything else as they treat negatives associated with autism as definitional but not positives. [1] ctrl-f "What it tests" "Average Scores" https://embrace-autism.com/cat-q/ https://embrace-autism.com/cat-q/
squigz 2y ago
Actual paper: https://www.nature.com/articles/s42003-024-06102-y https://www.nature.com/articles/s42003-024-06102-y
- m00x 2y ago
  ^^^^ Better to read the paper instead of the pop journals. Most writers don't understand the issues fully and make mistakes, or sensationalize the discovery.
  - cwillu 2y ago
    “This ^” style comments work very poorly on a site that doesn't maintain temporal ordering of comments.
    - rexer 2y ago
      I’ve only ever seen “this ^” refer to the parent comment, not the one directly above it as you mention. So as long as the comment hierarchy is maintained (which it is on HN) then the reference is clear
- quodestabsurdum 2y ago
  The paper is a super fascinating read, and lines up with several key features I've noticed in both of my professionally diagnosed autistic children (good luck getting access to a competent diagnostician who understands how the ASD criteria manifest in passing adults). It's really enlightening to see the association between Xanthine, one of the end-stage products of eATP metabolization, and the anxiety that is so prevalent within my own family. From the Discussion[1] section of the paper: > These self-calming connections in metabolism failed to develop in ASD. The natural consequence of the loss of these metabolic safeguards to overexcitation is for children with ASD to seek sameness to avoid the anxiety produced by change91, and to be more sensitive to environmental changes across many sensory domains. And a bit further on: > In the current study, xanthine was the purine that gained the most stimulatory (+r) correlations in 5-year-olds with ASD. Xanthine is one of the end-products of eATP metabolism97. Xanthine is known to trigger a cascade of events that leads to mitochondrial network fragmentation, reactive oxygen species and reactive nitrogen species (ROS and RNS), eicosanoid (e.g., leukotriene, HETE, and prostaglandin) signaling, immune activation, anxiety-associated behaviors, and consolidates long-term aversive memories that make the animal hypersensitive to future environmental changes that warn of environmental danger, cause fear, and trigger anxiety in mice, and is elevated in the blood of adults with anxiety disorders98. Anxiety is a common but under-recognized problem in autism99. Another really important observation: > A major result of this research was that the developmental differences observed in ASD were not the result of an increase or decrease of one causal metabolite, or an isolated change in the gut-brain axis, or neuroendocrine, autonomic, cytokine, or immunologic circuits. Instead, it was the interconnectedness and developmental state of the metabolic network that underlies all these systems that was fundamentally changed. In the last year, the All Brains Belong VT organization has been working on a collection of information they call "All The Things" [2], which lines up with the paper's observation that there is an underlying metabolic network at play. As a side note, All Brains Belong VT is a fantastic organization that focuses heavily on validation and support in a healthcare industry which often feels incredibly invalidating for individuals who have been reporting symptoms across a wide variety of siloed physician specialties. [1]: https://www.nature.com/articles/s42003-024-06102-y#Sec25 https://www.nature.com/articles/s42003-024-06102-y#Sec25 [2]: https://allbrainsbelong.org/all-the-things/ https://allbrainsbelong.org/all-the-things/
AnEro 2y ago
I feel like this is going to be used by pseudo-science influencers to push trendy diets to prevent autism when this study is observations stage at best.
- asdfman123 2y ago
  For stuff like this, overfitting is a given.
- drewcon 2y ago
  My only and immediate reaction as well.
- throwup238 2y ago
  Those people often link to papers that directly contradict the claims they make, assuming no one is going to check them. This won't make a difference.
  - AnEro 2y ago
    yea example now there are guys in this comment section claiming keto has cured their adhd/autism. Helped reduce symptoms, sure, but cure? (I've got both of them been on keto, like crazy strict ensuring i was in ketosis every two days type, and it only reduced brain fog personally)
    - ryandrake 2y ago
      Whenever you get an HN story that even remotely brushes up against health, fitness, or nutrition, you inevitably get all the wacky exercise, supplements, and diet commenters coming out of the woodwork to tell you all about "what worked for me". It's a constant that you can 100% count on every time.
      - P_I_Staker 2y ago
        On reddit challenging intermittent fasting or keto can easily get you insulted, then banned. These fitness yahoos just won't stop. I also want to take a moment to call out all the deadlifters. Virtually 100% of people I know that have done substantial deadlifting eg. over 300lbs (give or take), for extended periods of time (several months to years) has wound up with either stress injuries or traumatic injuries; often it's both. Meanwhile the deadlift crowd will insist they are just idiots, doing the exercise wrong. The point was that many people have poor coordination and don't have teams to watch over them and correct mistakes. Even mentioning this will lead to mass ridicule from bros that will insist that heavy deadlifts can only make your body feel minty fresh. I'm not actually anti-deadlift, btw. I personally saw big improvements in the early stages. These problems seem to occur when the body starts fighting you, and you still want to keep going. Variation can help. Or you could just do vertical loading and/or more moderate exercise and don't worry about proving your worth.
whimsicalism 2y ago
Reveals developmental origins or merely an observational study of metabolites in children?
Der_Einzige 2y ago
I know of at least one book written by and for autistic people who advocates for a gluten free diet. They claim in the book that this significantly reduces their symptoms. I don’t know if I believe it or not, but the notion of gut-brain axis seems to imply that a good diet should help a bit, right?
- jl6 2y ago
  A gluten free diet may or may not help but it’s not synonymous with “a good diet”.
  - Der_Einzige 2y ago
    That’s what I thought too. It seems that the only general lesson we have in dieting which js reliable is “refined sugar bad” and that intermittent fasting works for getting blood sugar under control.
  - 0xcde4c3db 2y ago
    And it might also help for reasons that have nothing to do with gluten. Almost any major dietary restriction tends to cause broader changes in diet than just the thing that is restricted.
  - dkga 2y ago
    Indeed. ASD or not, everyone would surely benefit from following a nutritionist-set diet based on the person’s own requirements.
    - nradov 2y ago
      Nah. Most "nutritionists" are clowns. Anyone can call themselves a nutritionist with no formal training or certification. The whole field is mostly filled with frauds and grifters. There are some legitimate people with a Registered Dietician credential who can work as part of a care team to treat medical conditions. But most of us don't need them either. We know what we're supposed to eat, we just don't do it.
ModernMech 2y ago
"Prevention strategies" As an autistic person, no thanks. Let people be autistic.
- Slava_Propanei 2y ago
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- 2four2 2y ago
  Autistic as an identity and autism as a disease are different things that are difficult to uncouple. Similarly to obesity, it's difficult to talk about the health aspect without people being sensitive about the identity aspect. I find it's useful when reading about research to empathize with the authors and realize their work is an attempt to be constructive instead of providing social commentary.
  - mewpmewp2 2y ago
    Autism is not a disease. It's a diverging feature.
    - anon84873628 2y ago
      Saying this doesn't make you hip, woke, or cool. Autism is clearly a "spectrum" disorder that is not fully understood or categorized yet, which is exactly why we need this type of research to reach a conclusive, testable biological basis. To portray severely afflicted people as simply "neurodiverse" and dismiss treatment options for them, is far more bigoted than the reverse.
      - mewpmewp2 2y ago
        I don't care about being hip, woke or cool. It's just my perspective of the World. Also speaking of experience, I don't see how I have a disease for example. In my view, it's mostly the environment provided that's at fault. E.g. social expectations. I think it's a good thing for there to be variance of the way people perceive the World. I had a rough childhood, but I wouldn't have wanted someone to change who I am. I had a rough childhood because of the expected standards for how a person should behave or be socially. Now as I am older, and more confident, successful and have proven that given good environment I can do amazing, I understand how ridiculous people are being with their social requirements. None of it is needed. Also I find it quite funny how people treat labels in psychiatry as some sort of gospel or an actual thing.
Slava_Propanei 2y ago
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softfalcon 2y ago
Is anyone else reading this and seeing the worrying, “we can just medicate away the autism”? They’re talking about a possible pharmaceutical “fix” for autism in children under 5. Seems a bit premature for just recently finding a metabolic difference in a cohort of children.
- m00x 2y ago
  That's not what the article suggests at all. It's during the developmental stage, which is by nature temporary.
  - somenameforme 2y ago
    Yes it is. It's exactly what the article suggests: --- ... Naviaux and his team completed early clinical testing for suramin. ... Now, the researchers hope that by revealing the specific ATP-related pathways that are altered in autism, their work will help scientists develop more drugs that target these pathways to manage the symptoms of ASD. "Suramin is just one drug that targets the cell danger response," he said. "Now that we're closely interrogating how metabolism changes in ASD, we could be at the beginning of a drug renaissance that will create new options for treatment that never existed before." --- This study [literally] brought to you by Pannex Therapeutics, Yuva Biosciences, Kuzani, and Paxmedica, MaraBio Systems, Inc and undoubtedly numerous other big pharma interests that were able to keep the study at arm's length enough to avoid disclosure requirements. [1] [1] - https://www.nature.com/articles/s42003-024-06102-y#Sec36 https://www.nature.com/articles/s42003-024-06102-y#Sec36
    - softfalcon 2y ago
      Thanks, appreciate you backing up my thoughts on this. I’ve already received several down votes from folks who seem to disagree with my concern.
    - m00x 2y ago
      That doesn't mean it's permanent?
ldjkfkdsjnv 2y ago
Used to have a mix of what could be considered ADHD/light asperbergers. I dont eat carbs and mostly stick to a keto diet, it resolved many symptoms. Our food is poison
- 2four2 2y ago
  Lots of carbs make me fall asleep and kill my motivation. My lunches at work are light and carb-free for that reason.
- manmal 2y ago
  Do you have microbiome dysbiosis? A keto diet might improve things (eg lower LPS production), but long term can diminish microbial diversity. I’m not saying keto is bad at all - it’s just that microbial diversity is an important predictor in GI health and one should keep an eye on that too.
  - ldjkfkdsjnv 2y ago
    Yeah i mean i know that keto isnt great, but it has changed my life to some degree. When in ketosis, i feel like i have "agency", otherwise i am this foggy headed, sloth
    - hailruda 2y ago
      I can relate to this. Could you point me to any resources about keto diets?
      - eadz 2y ago
        https://www.metabolicmind.org https://www.metabolicmind.org is a non profit, with many MDs and PHDs dedicated to researching the link between metabolism and mental health, with a focus on keto diets.
- electrondood 2y ago
  I'm Broad Autism Phenotype (BAP) and prefer low carb because I feel better, but it doesn't change my personality traits or cognitive tendencies one iota.
b800h 2y ago
"with only 10–20% of children diagnosed before 5 years of age able to live independently as adults" > Well this is nonsense for starters - circular logic. Doctors won't diagnose autism in most cases before the age of eight. For the diagnosis to have happened before the age of five would imply that the case is profound in the first place.
- piker 2y ago
  The stat seems accurate on that basis. True, it may be read to imply more.
- willsmith72 2y ago
  That's the whole point. It's not like they took the age 5 at random, it's literally what was used in the study
- ffjffsfr 2y ago
  there are other factors here. Children diagnosed with autism at the age of 5 must be adults now to determine if they can live alone. So they were diagnosed at minimum 13 years ago, with many diagnosed much earlier. Autism diagnostics is much more common now than it used to be, especially in families with higher economic status. Diagnostics tools evolved, more kids are tested and tests capture more kids. So I think this number will be completely different in 10-20 years from now. In my experience as a parent of ASD kid, many kids now considered ASD would not be considered ASD 20 or 30 years ago.
grumpy-de-sre 2y ago
On the topic of metabolic disturbances in Autism, huge fan of the work Dr. Randy Blakely is doing on the links between Serotonin metabolism and Autism. One of the most surprising, and strongest (25-30% of patients), biomarkers for Autism is actually Platelet Hyperserotonemia (high levels of bound Serotonin in the blood). For decades it's been without explanation but recently Dr Blakely has described a bunch of cases where it was narrowed down to SERT transporter polymorphisms and inflammation. Worth a watch for those interested in the weeds of this stuff: https://www.youtube.com/watch?v=cpDtuKV5CJs https://www.youtube.com/watch?v=cpDtuKV5CJs I've got a pet hypothesis that differences in Serotonin metabolism (and receptor hypersensitivity) might play a role in why SSRIs aren't generally considered a first line treatment for ASD symptoms, https://www.pnas.org/doi/abs/10.1073/pnas.1112345109 https://www.pnas.org/doi/abs/10.1073/pnas.1112345109
- asdfman123 2y ago
  Genuine question: how do we know that's not just a side effect instead of a driver?
  - grumpy-de-sre 2y ago
    Dr. Blakelys lab has produced knock-in mice with the rare SERT variants described, and they have exhibited the behavioral and biochemical markers of ASD. It's actually a very remarkable finding. They also saw a reduction in ASD symptoms by pharmaceutically blocking the offending inflammatory pathways. So I think at-least for the tiny fraction of ASD patients with these rare SERT variants there's actually a chance that they are a major driver of the disorder. Regardless it provides a tantalizing look at some of the upstream pathways that could be involved more generally. I think we're going to find the disorder is very heterogenous and there will be many different subtypes and pathways involved.
john01dav 2y ago
Pathologizing autistic behaviors is not the right approach here. Most autistic behaviors are harmless except insofar as allistic (non-autistic) people provide unnecessary consequences for it and through incompatibilities. We don't say that a Linux workstation in a network of Windows computers is broken or needs to be fixed (or visa-versa), but rather we recognize that the problems are due to the differences. As such, attempts to "cure" or "prevent" autism are actually an eugenic attempt to remove harmless variation that many people irrationally deem to be objectionable. For example, it is commonly stated that autistic people have communication deficits, but this is just a communication difference. We can see this because if a communication task is given to a group of only autistic people they perform comparably to when the same task is given to a group of allistic people. Problems only take place when the group is mixed with both autistic and allistic people being present. The keyword "double empathy problem" can be used to find more information about this. (https://doi.org/10.1177/1362361320919286 https://doi.org/10.1177/1362361320919286) As another example, allistic people tend to very harshly judge autistic people for extremely subtle cues that they are different. When allistic people are shown recordings of autistic people communicating and of allistic people doing similiar tasks they, within less than a second, judge the autistic people very harshly. This effect persists when controlling for the content of the communication. (https://doi.org/10.1038/srep40700 https://doi.org/10.1038/srep40700) Of course, doing anything that actually warrants such a judgement in a context like that is impossible so this is a bias against autistic people. I think that this can be compared to implicit racial bias: it is something that most people need to learn to consciously identify and then not perpetuate and is not due to any faults with the victim. Good resource on this: https://www.youtube.com/watch?v=A1AUdaH-EPM https://www.youtube.com/watch?v=A1AUdaH-EPM There are higher support needs autistic people who need help with activities of daily living. In my opinion, though, in many cases this is not autism but rather autism with an accompanying intellectual disability and the intellectual disability is the reason for higher supports needs. In some cases this could also be caregivers unnecessarily pathologizing behavior and then convincing someone that they need more support than they really do, which I have seen in real life.
- P_I_Staker 2y ago
  Do you have autism or ADHD? This is actually a really contentious issue. Tons of people with the condition are happy to let others be themselves, but want to be cured. With ADHD, it's actually a little crazy to me that people consider it "harmless". There's a ton of tangible ways that it hurts relationships and goals. I can't even make dinner and tidy house; doesn't matter how much time I have. I will say the medicine made me a little more robotic and took a bite out of my personality; but this was a small nibble compared to not being able to do almost anything comfortably, and the consequences of that. It's really damaging to your personality to not be able to conversate with people and understand each other. It's really damaging to your personality to not be able to practice your hobbies with friends. I really don't feel like my "true" self, and see others able to effortlessly be that person.
tsoukase 2y ago
Autism is rooted during fetal brain development. Behavioural and metabolic changes show up later. There is no an egg and chicken problem. The primary disease starts in the CNS and everything else follows
- computerphage 2y ago
  How do you know that?
  - tsoukase 2y ago
    Schizophrenia, Alzheimer's, Parkinson's have links with the gut too. But I "know" they start from the brain. No advanced or complicated hypothesis
    - kelseyfrog 2y ago
      How would you prove or disprove this theory?
      - tsoukase 2y ago
        The gut hypothesis hype is trendy right now. There is some correlation but when things settle down, some of the effect will be attributed to "picky eating". Proving that the source of mental disorders is the brain and not the gut (as it was believed in the distant past) is easy: 100% of patients show brain damage while a fraction of them have an abnormal gut
        kelseyfrog 2y ago
        How do you eliminate models where brain damage is a proximate cause?
        tsoukase 2y ago
        Exclusion of either cause directions is impossible by definition. This is science not mathematics. But saying that the primary mechanism of mental disease lies outside the brain must not contradict decades of research and simple observation (eg a small brain damage leads to a profound behavioural image while cutting 5 meters of small intestine to none) Extraordinary claims require extraordinary evidence.
lettergram 2y ago
[flagged]
- greenavocado 2y ago
  > Most vaccines are effectively laced with a chemical or biologic that the body will respond aggressively to Aluminum, btw https://www.educate-yourself.org/cn/Aluminum-Toxicity-Is-Well-Documented-in-Medical-Journals02aug15.shtml https://www.educate-yourself.org/cn/Aluminum-Toxicity-Is-Wel...
  - lettergram 2y ago
    Yeah that’s one of them. There’s also often mercury - https://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.html https://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.... I actually had a similar theory as to where egg allergies come from. Many vaccines have egg in them https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm
    - greenavocado 2y ago
      I thought mercury isn't used anymore in vaccines?
      - lettergram 2y ago
        Still used, just not recommended in vaccines for children under 6 https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/thimerosal-and-vaccines https://www.fda.gov/vaccines-blood-biologics/safety-availabi...
- thsksbd 2y ago
  "Most vaccines are effectively laced with a chemical or biologic that the body will respond aggressively to" Adjuvants to be exact. They're actually what Im annoyed at the most with (traditional) vaccines.
- 2y ago
mrangle 2y ago
>suramin They're investigating the use of a drug that they don't understand to treat a condition that they don't understand, through the lens of one model that variously competes with or incompletely conforms to a myriad of other models of the condition. In order to what? Nebulously "manage" a complex neurological difference that will always defy reversion to anything else? It sounds like they want something that they can prescribe, period. And it sounds like it has the potential to further complicate already difficult lives. Type 1 Autism may serve a general human gene pool function in terms of edge-dripping a specific intelligence trait into it (low probability of reproduction, protecting general social skill in the pool, but adding a divergent pattern solving skill at the edges). While autism is difficult, I'm not sure that solving for it in the context of industrial medicine is wise. We don't want to solve for Nicola Tesla, for example. Type 2 and 3 Autism could be genetically unsuccessful attempts at Type 1 autism development, to spitball. Assuming they are actually related, in most cases. Such management theoretically could be helpful here, but I think that these people deserve a lot better than injected parasite medicine with a lot of side effects. Besides, try getting an autistic child used to regular injections. Though a low-side effect oral or transdermal medication that would, say, specifically enhance energy support to the Autistic PFC with few side effects could be game changing. Likely for many more conditions than autism. Inventing such a medication that doesn't lead to a worse baseline would be critical and perhaps unlikely. Then again its possible that the unique pattern solving ability of the Autistic mind is related to the relative lack of energy supply to an increased volume of PFC neurons; and the subsequent failure of inhibition. Possibly accounting for increased environmental information perception, at least in-part. Which may in turn be mirrored in expanded cognition involved in pattern identification. The ideal, which again I think is unlikely, would be a PRN medication that could "quiet" the autistic mind via providing more energy to the PFC; while having no withdrawal semi-permanent side effects.
- Broken_Hippo 2y ago
  They're investigating the use of a drug that they don't understand to treat a condition that they don't understand... You'd probably be shocked to figure out how often this happens - and it used to happen a lot more in no small part because we didn't have the tools we have today: MRIs and better microscopes and other tech has really helped our understanding of the body. We are still figuring out how exactly the body works, after all, to the point that we occasionally discover a new body part. Of course we are going to do things we don't understand. Yet. This isn't limited to medicine, either. Maybe they want something to prescribe. For a lot of diseases, that's better than nothing. For example, I have MS. They know more than they used to about MS, but most of my life they've not known enough. I have medicine that isn't a cure, but I'll take it. Modern medicines mean that modern folks with MS have a much better quality of life than folks that didn't have medications. I'm more likely to have mobility and things like that. I'll take it. My ex was schizophrenic. Medicine gave them a life. They still couldn't work, but they weren't suffering as much either. Again, not a cure, but help. Imperfect cures or medicines that treat the symptoms are so much better than no help at all. This is where a lot of medicine starts - treating a symptom, and by doing so learning a bit more about the disease or affliction.
hcfman 2y ago
Yay! We can prevent another brilliant scientist from coming into existence. Nice work fellows!
zazazache 2y ago
As some one who is let’s say “autism adjacent” it really bothers me when people discuss a cure or prevention. I mean I get it, but this is also who I am and I wouldn’t want to be someone else.
- ModernMech 2y ago
  I have no problem with discussion about making some issues people face better with medication, although I think autistic people should be centered in those discussion. However “prevention” talk is a whole separate issue and that one does give me eugenics vibes.
- Perenti 2y ago
  I'm on the spectrum (diagnosed), and also like being me (most of the time). But what about the poor sods who have so much happening all the time that they don't get the chance to learn to speak, or read, and scream in terror continually at the unending sensory deluge they try to live through? If there was a way to prevent that kind of presentation of ASD I think everyone would be better off. I took "prevention" to be about prevention of the life restricting developments of the condition. On the other hand, if "prevention" is about culling the gene pool, I'm dead set against that.
  - gizmondo 2y ago
    > On the other hand, if "prevention" is about culling the gene pool, I'm dead set against that. Well, you can be against it by raising autistic children yourself, it seems you're in a perfect position for that. Why people feel they have the right to demand that from others is beyond me.
    - ModernMech 2y ago
      The problem is that when you teach society that a certain “kind” of person needs to be culled, that is a stigma about people in that group. IME such strong feelings don’t don’t stay relegated to your personal choices, they get reflected at a broader policy level. People say “well it was your choice to have such broken people, we gave you a pill that would make that not possible. Therefore we las a society will not support them (you’ll hear rhetoric along the lines of “why should we spend my hard-earned tax dollars on social programs for autistic people, that’s a you problem, why people demand I pay for their choices is beyond me”) Of course that’s when the government offers a “compassionate” final solution to the autist problem. Since autistic people can’t seem to stop reproducing despite the “cure”, we should sterilize them. Or we should make it mandatory because otherwise they are a drain. Then of course for the ones who are “too autistic” (I.e. who are nonverbal or who otherwise cannot be productive), we can euthanize them. No thanks we have been down that road before as a society. It doesn’t end well.

171 points by wglb 2y ago

> The researchers discovered that a small number of biochemical pathways are responsible for the majority of these changes, which could help inform new early detection and prevention strategies for autism. It won’t. Autism is a socioculturally bound diagnosis, not a single disease that exists in biology. It’s a label for those perceived by others in a certain light, defined in such a way that two with the same label can have remarkably little overlap in terms of observed behaviour. You diagnose autism based on how people act, not who they are. Any biological markers for autism are politically suspect as it would imply those without those markers are invalid, while also raising the spectre of eugenics for those with the markers. More likely and productivity it might eventually REPLACE autism as a diagnosis with something scientifically valid and treatable, as if somebody displays no autistic behaviours as a result of treatment of a metabolic disorder, why diagnose them with autism?

furyofantares 2y ago
> defined in such a way that two with the same label can have remarkably little overlap in terms of observed behaviour I believed this until my daughter was diagnosed and then I was later diagnosed. My experience with (some) professionals was a surprise to me; a much wider variety of "observed behaviors" than I expected seem to stem from sensory issues for example. And I think it makes sense that humans might adopt a wide variety of ways to deal with for a much smaller variety of processing issues. (Unrelated to the professional experience) Have you looked into monotropism? It's a fairly compact theory that ties a lot of behaviors together that might look like they have no overlap from the outside. Also: > It’s a label for those perceived by others in a certain light Lots of people self-diagnose.
- faeriechangling 2y ago
  If you ask the majority of people if somebody who they do not perceive as engaging in autisitic behaviours, and was not diagnosed as autistic, but considers themselves autistic, is autistic, they will say no. Scientifically (which how it’s defined in the OP), it’s not defined by psychiatrist appraisal and self-assessment plays no necessary role in the process and alone holds no diagnostic validity. We can also invert this: self-denial doesn’t make one non-autistic if they’re seen as engaging in autistic behaviours and are diagnosed as autistic by a professional. I’ll concede that a minority believe that autism is self-definable though. I’d prefer things that way myself, but the among other things it would make it impossible to gatekeep services for the autistic if self-diagnosis were held in the same esteem as physician diagnosis, so it won’t catch on anytime soon.
  - flatline 2y ago
    I’m not sure what point you are making with this reply. I’m late/adult self-identifying autistic. I’ve done this with some of the standard tests that psychiatrists use, attended workgroups related to the topic, and studied extensively. Self-diagnosis is highly accurate for autism, both for positive and negative evaluations. I am also pursuing a formal diagnosis because so many people downplay it when I tell them I’m autistic. I don’t have the affect at first glance, but it does come out in my behaviors if you get to know me a bit. I’ve also had the luxury of therapy, eduction, etc. I also agree that the categorization is overly broad and your original post resonates. There are various non-overlapping clusters of traits that fall under autism. I do think, however, that at the core of it is a common difference in information and sensory processing.
    - zeroonetwothree 2y ago
      Adults that get diagnosed later typically have developed very good ability to mask so casual acquaintances probably don’t suspect they are autistic. So it’s not surprising they would downplay it.
    - faeriechangling 2y ago
      >Self-diagnosis is highly accurate for autism, both for positive and negative evaluations. I've also gone into autism communities before and declared that I had self-undiagnosed myself with autism, which is something I've desired recently, to re-diagnose myself as not being autistic and either having nothing or ADHD. This was totally rejected, and repeatedly brought up was my admittance to a lengthy period of diagnosis, overseen my multiple doctors, from a very young age, which all were seen as evidence of the validity of my diagnosis (conversely, I'd presume, they treat the opposite as more less valid or invalid). Interestingly the same people generally accepted diagnosis, but to reject a diagnosis, well that was beyond the pale and denialism. I brought up the same to a psychiatrist, saying I wanted to be treated by a psychiatrist for ADHD and NOT autism because I believe it will lead to superior outcomes. They blew me off, exasperated, saying that any psychiatrist would simply observe my symptoms and deem me autistic and treat me that way no matter what I did, denying that I even had the capability or possibility to receive treatment which was not based on the premise that I was autistic. Metabolic testing and self-diagnosis be damned. Just this moment I'm in the process of seeking accommodations. I self reported autistic symptoms to my employer. In the past, during interviews they have accepted my diagnosis and pledged to "accommodate" me accordingly, and I was ticked off as a diversity hire. They asked me to verify such symptoms with a doctor. They subsequently said they reserve the right to an independent psychological assessment of myself or my records. This is very pleasing to me, as either I shall receive accommodations and an affirmation that I am autistic, or my undiagnosis, which is truly a win-win. If I was in family court, and it was argued that I was unable to say take care of children because I'm autistic, I could not successfully object on the grounds that "I'm not autistic". Yet my observation is what is considered the true measure of somebodies autisticness, the validity of their diagnosis and their symptoms, is independent psychological assessments by an examiner not beholden to your own self-assessment. I theorise this is both because of a lack of faith in the competence of either of us to assess an autism diagnosis, as well as a lack of faith in our objectivity. I've met a number of self-diagnosed people who are shy about disclosure or asking for accommodation BECAUSE they are self-diagnosed, and while obviously believing in the reality of their autism, are either self-sceptical or believe in others scepticism to a degree not commonly seen in those medically diagnosed. I don't mean to be exclusionary or gatekeeping, just descriptive of what I believe to be social/political/legal/scientific reality. I don't like that things are this way, I'm aware that hilariously I've never seen ANY evidence that suggests physician diagnosis is more accurate than self-diagnosis, I'm aware of the many historical problems with physician diagnosis, I merely believe that they ARE this way.
- somenameforme 2y ago
  Here [1] is the DSM diagnostic criteria for autism. It's broad to the point of absurdity. The reason many people think autism is a faux disorder is because it includes everything from an individual who simply sits in the corner endlessly flapping his hands, completely unable to function as a human being, to Bill Gates or Elon Musk. The weaker diagnoses, which is an increasingly large chunk of all of them, often seem like an effect to pathologize normal behavioral differences within people. This is, IMO, one of those things people are definitely going to look back at think 'wtf were they even thinking?' [1] - https://a4.org.au/dsm5-asd https://a4.org.au/dsm5-asd
  - zeroonetwothree 2y ago
    Drug users can include people from a homeless addict who can barely stay conscious to Elon Musk. Does that mean the concept is absurd?
  - whimsicalism 2y ago
    frankly, this will continue as long as performance-enhancing drugs and accommodations are gated behind diagnoses
    - pseudalopex 2y ago
      What performance enhancing drugs are prescribed for autism?
      - whimsicalism 2y ago
        i thought we prescribed adderall for autism, but i guess cross-diagnoses are just so common nowadays that i didn’t realize what it was being prescribed for among people i know
        ModernMech 2y ago
        You may be under this impression because ADHD and Autism are so frequently comorbid: According to the scientific literature, 50 to 70% of individuals with autism spectrum disorder (ASD) also present with comorbid attention deficit hyperactivity disorder (ADHD). From a clinical perspective, this high rate of comorbidity is intriguing. What is the real significance of this dual diagnosis? Is ADHD in fact always present in such cases? Might the attentional impairment reported among our ASD patients actually be a distinct trait of their ASD—namely, impaired joint attention—rather than an ADHD attention deficit? Could their agitation be the consequence of this joint attention impairment or related to a physical restlessness etiologically very different from the agitation typical of ADHD? The neurobiological reality of ASD-ADHD comorbidity is a subject of debate, and amphetamine-based treatment can have paradoxical or undesirable effects in the ASD population. Consequently, does a dual diagnosis, notwithstanding its currency in the literature, prevent us from shedding sufficient light on major physiopathologic questions raised by the clinical picture of ASD? https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2022.837424/full https://www.frontiersin.org/journals/psychiatry/articles/10....
- neom 2y ago
  I mean I was diagnosed with a salad of things. And then different doctors tell me different things about how they're all related or unrelated. It was honestly a very amusing situation. The only sense I got out of the whole long ass process was: neurological sensory difference "combo" in the roll of the dice, some of it given hereditarily, some this that and the other. I really see why this stuff is so frustrating for people. I'm super lucky circumstances are such for me that I can give less shits about the social issues my autism causes, allowing me to explore it.I actually just started a blog last week to share as I explore this stuff, I'm a bit shy to share it as I've never blogged in earnest before, so I have no sense of if this is good, bad, silly, lame, boring, etc: https://b.h4x.zip/autism-thinking-and-whiteboards/ https://b.h4x.zip/autism-thinking-and-whiteboards/
  - ntxy 2y ago
    Please keep writing. I'm hooked!
ninininino 2y ago
FTA: "only 10–20% of children diagnosed before 5 years of age able to live independently as adults" ^ the article and the medical treatment is aimed at those so severely impacted/compromised that they cannot live independently.
- Der_Einzige 2y ago
  People with high functioning autism make up a majority of the “people who died at 25 and didn’t know it until they were 80” crowd.
  - giantg2 2y ago
    I'm not sure I understand the quote.
    - normaler 2y ago
      There is an increased comorbidity with neuro divergence and harmful behaviour.
    - IggleSniggle 2y ago
      I think they meant "people who didnt die before 25." I don't know much about autism, but I had three friends who died before 30 in accidents that were almost certainly related to ADHD. Two of them were doing behavioral therapy but didn't believe in pharmaceutical treatment. One of them was generally medicated but wasn't taking their medication on the day they died (due to medication shortages for ADHD drugs). That last one rear-ended a semi-truck at high speed. Probably after getting lost in thought after reading a "You shouldn't text and drive. If you text and drive, it may be the last text you ever read. Remember, don't read superfluous text; pay attention to the road, for your own safety and the safety of those around you." Obviously I don't know that last part; I am just bitter.
      - giantg2 2y ago
        I knew someone in high school that had ADHD. He totaled many cars when he wasn't on meds for things like game day for sports (not sure if that's a performance or health thing). What baffles me, is how someone diagnosed with a condition that affects driving is allowed to drive without the condition being treated - especially if they are under a prescription and just not taking it, and also if they have multiple accidents attributed to the condition. We already require this for people with seizures, for people needing glasses to wear them, etc.
RobotToaster 2y ago
IMO, it will probably end up like Ehlers Danlos, where you have 20 or so subtypes defined by certain genes.
- Perenti 2y ago
  EDS is also highly associated with ADHD and ASD.
deleted 2y ago
[deleted]
2four2 2y ago
I think most people understand that disease nomenclature changes rapidly. Even if the word "autism" is deprecated in the future and replaced by a litany of other terms for conditions, the research is still useful and interesting.
jncfhnb 2y ago
Because it’s fully possible and commonly understood that a medical condition can arise from multiple different circumstances
m00x 2y ago
That's completely incorrect. Autism has clear physiological differences in the brain. It's not just a personality difference. People like to call themselves autistic when it's just social awkwardness, and some doctors might even improperly diagnose them, but these are separate from the condition. https://www.healthcentral.com/condition/autism/autism-brain-differences https://www.healthcentral.com/condition/autism/autism-brain-... This could help us prevent autism completely.
- faeriechangling 2y ago
  >People like to call themselves autistic when it's just social awkwardness, and some doctors might even improperly diagnose them, but these are separate from the condition. What makes such a diagnosis incorrect when various forms of social awkwardness satisfy criteria A and D of the diagnostic criteria [1], and all of the criteria for social pragmatic disorder[2]? In the DSM-V-TR era psychiatrists are instructed to not just judge somebody to not be autistic if they do not appear socially awkward, and to additionally ask if they find social interactions distressing, and observe them for longer in more naturalistic settings to find the deficit in social functioning[3] as part of a thus far continuously lowering diagnostic bar as to what is considered sufficient social awkwardness to be diagnosable. >Autism has clear physiological differences in the brain. Which physiological changes in the brain make you autistic, or put another way, which physiological changes in the brain must you lack to NOT be autistic? I've heard of any autism diagnosis's and self-diagnosis's and I've never heard of any of them being based on a brain scan and yet people go around calling others and themselves autistic. I've never heard of a diagnosis being lost or gained due to a brain scan. I've heard this insistence that we can infer the territory, the neurological conditions of peoples brains, from the map, the behaviourist diagnosis, and there may be a correlation but it can't be said that any given person with an autism diagnosis has any given specific neurological change. The only thing we test for IS behaviour, and infer biology from it. [1] https://www.cdc.gov/ncbddd/autism/hcp-dsm.html https://www.cdc.gov/ncbddd/autism/hcp-dsm.html [2] https://en.wikipedia.org/wiki/Social_(pragmatic)_communication_disorder#Diagnosis https://en.wikipedia.org/wiki/Social_(pragmatic)_communicati... [3] https://www.reddit.com/r/aspergirls/comments/th9hku/dsm5tr_new_diagnostic_criteria_for_autism/ https://www.reddit.com/r/aspergirls/comments/th9hku/dsm5tr_n...
mewpmewp2 2y ago
It's gross to hear that they want to prevent it.
ants_everywhere 2y ago
> Autism is a socioculturally bound diagnosis This is untrue and unsupported by evidence > It's a label for those perceived by others in a certain light This is untrue and unsupported by evidence > defined in such a way that two with the same label can have remarkably little overlap in terms of observed behaviour This is untrue and unsupported by evidence > You diagnose autism based on how people act, not who they are You diagnose all disorders based on observable phenomena, not some sort of metaphysical essence. > Any biological markers for autism are politically suspect What is this, Lysenkoism? > as it would imply those without those markers are invalid Are you saying that in your view biology has some ability to mark people as valid or invalid? That's an extremist view and I wonder how you arrived at it. If your ideology requires you divide the world into "valid" and "invalid" people, then it's probably a good time to rethink your approach.
- zer00eyz 2y ago
  >> defined in such a way that two with the same label can have remarkably little overlap in terms of observed behaviour > This is untrue and unsupported by evidence Here is the diagnostic criteria for ASD: https://www.cdc.gov/ncbddd/autism/hcp-dsm.html https://www.cdc.gov/ncbddd/autism/hcp-dsm.html ... It literally lays out a path that can generate a non overlapping diagnosis. It sort of has to because we lummped what were previously two disorders together because people are sensitive to nazi's having existed. Now go to the UK where there is strong advocacy for a whole other set of diagnostic criteria for women. The DSM begins to look barbaric and/or sexist if not misinformed. The moment there is a biological underpinning to something like ASD it gets interesting because what do you do with all the folks with a diagnosis who DONT fit that label. They have something that looks the same but isnt... and the whole psychiatry/psychology community looks like quacks. DO note that im not opposed to these fields but they need to get their shit together on reproducibility.
  - ants_everywhere 2y ago
    Thanks I'm thoroughly familiar with the DSM criteria, the ICD criteria, and the research literature. > It literally lays out a path that can generate a non overlapping diagnosis. It does not. If you believe there are exist two autistic people who have no overlapping symptoms please present an example. > The moment there is a biological underpinning to something like ASD it gets interesting because what do you do with all the folks with a diagnosis who DONT fit that label. Compare this to, "The moment there is a biological underpinning to something like cancer it gets interesting because what do you do with all the folks with a diagnosis who DONT fit that label." To which the answer is "that's a red herring, the current understanding of cancer doesn't require all cancers share the same biological origins, so why should finding one marker call that into question?" Or "The moment you locate the code line with a buffer overflow it gets interesting because some programs that seem like they have a buffer overflow don't have that line of code."
ModernMech 2y ago
> the same label can have remarkably little overlap in terms of observed behaviour.... You diagnose autism based on how people act, not who they are. I'm able to mask until I'm alone. My meltdowns look exactly like the observed behavior you see in other people, I just hide it better. I'm also verbal mostly, until I'm not and I'm dissociating. Then I look a lot what you're used to seeing, except i don't let you see that. I don't let you see me rocking and stimming. I can talk for an hour in front of 100 people about my special interests at any depth, but I can't complete simple tasks that others can do every day like going to the grocery store and restaurants without extreme difficulty. Some people are "high functioning" autists, meaning that they are able to suppress their negative autistic expressions for the benefit and comfort of people around them. This doesn't make them "not autistic" -- they still are even if you personally can't tell. It just means they're putting on an act for you, to make you happy, so that you don't respond in the negative way they are used to being received. You are witnessing a performance. That suppression is not a constant, and it can't go on forever. Someone doing this long enough will go into autistic burnout, which is like an extended depression and comes with skill loss and an inability to function in society. If you were to see this person at that point, you'd "see" the autism then. Is this all there is to being autistic though? No! Being autistic comes with a great capacity for curiosity, creativity, artistic expression, innovation, and excellence associated with committing fully (as in actually 100%, eschewing loved ones and society) to an endeavor. These are things we don't want to "cure". Most of the problems I face related to my autism have to do with interfacing with society, and not understanding people or not being able to do things everyone else seems to be able to, without any compassion for my inability to do so. As far as I can tell they come from being dysregulated, and being dysregulated comes from extreme sensory overload. If we can fix the sensory overload a lot of other things are fixed. But that doesn't mean we should be "curing" or "preventing" autism, and it doesn't mean people who aren't melting down and who can live by themselves aren't autistic -- they're just well regulated.,
- faeriechangling 2y ago
  From the DSM-V-TR: "Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life)." "Core diagnostic features are evident in the developmental period, but intervention, compensation, and current supports may mask difficulties in at least some contexts." "Individuals who have developed compensation strategies for some social challenges still struggle in novel or unsupported situations and suffer from the effort and anxiety of consciously calculating what is socially intuitive for most individuals. This behavior may contribute to lower ascertainment of autism spectrum disorder in these individuals, perhaps especially in adult women. Thus, longer assessments, observation in naturalistic settings, and inquiring about any tolls of social interaction may be needed(Cage and Troxell-Whitman 2019; Hull et al. 2017). If asked about the costs of social interaction, for example, these individuals might respond that social interactions are exhausting for them, that they are unable to concentrate because of the mental effort in monitoring social conventions, that their self-esteem is adversely affected by being unable to be themselves, and so forth." Observation is STILL actually essential to a diagnosis, you can't merely just claim to be masking, but it's not technically considered disqualifying for symptoms to only appear in certain contexts. >Some people are "high functioning" autists, meaning that they are able to suppress their negative autistic expressions for the benefit and comfort of people around them. This doesn't make them "not autistic" -- they still are even if you personally can't tell. It just means they're putting on an act for you, to make you happy, so that you don't respond in the negative way they are used to being received. You are witnessing a performance. The research I've seen on the cat-q shows that [1]: - Neurotypicals men mask a statistically insignificant amount more than autistic men - Autistic women mask a statistically insignificant more than neurotypical women - Autistic women mask a statistically significant amount more than autistic men - Autistics "Compensate" more, copy others behaviour, copy behaviour they learned from movies - Autistics "Assimilate" more, they will force themselves unwillingly more than others to be social or not be social. We should also get over what gets somebody defined as having "high functioning" or "level 1" autism. It's a lack of severity of social impairments AND restricted & repetitive behaviours. With autistic men specifically, the evidence points to the "high functioning" as simply naturally exhibiting less autistic social interactions and behaviours than the "low functioning" without any exceptional effort beyond what the everyday non-disabled person does. Some of them may be tortured actors, but said people are no more prevalent than they are in the general population. It's things like imitation, and being in unwanted social situations, which is more characteristic of autism. >Being autistic comes with a great capacity for curiosity, creativity, artistic expression, innovation, and excellence associated with committing fully (as in actually 100%, eschewing loved ones and society) to an endeavor. Those may correlate with autism, but aren't definitional of it. The DSM-V-TR's 1891 word diagnostic criteria briefly mentions "Special interests may be a source of pleasure and motivation and provide avenues for education and employment later in life" as the sole positive trait of autistics. I don't mean to be a dick here - more activist. If these are qualities of autistics, they should either be part of the criteria for "Autism spectrum disorder" or autism should be conceptualised as being distinct from disorder similar to how we distinguish between being transgender and having gender dysphoria. Otherwise, one can say that all they wish, but they'll face negative stigmatisation from those who see autism as a definitionally negative mental disorder with no upside other than employability. "Autism" is quite the stigmatised word today and I blame psychiatry and The DSM for that more than anything else as they treat negatives associated with autism as definitional but not positives. [1] ctrl-f "What it tests" "Average Scores" https://embrace-autism.com/cat-q/ https://embrace-autism.com/cat-q/

squigz 2y ago

Actual paper: https://www.nature.com/articles/s42003-024-06102-y https://www.nature.com/articles/s42003-024-06102-y

m00x 2y ago
^^^^ Better to read the paper instead of the pop journals. Most writers don't understand the issues fully and make mistakes, or sensationalize the discovery.
- cwillu 2y ago
  “This ^” style comments work very poorly on a site that doesn't maintain temporal ordering of comments.
  - rexer 2y ago
    I’ve only ever seen “this ^” refer to the parent comment, not the one directly above it as you mention. So as long as the comment hierarchy is maintained (which it is on HN) then the reference is clear
quodestabsurdum 2y ago
The paper is a super fascinating read, and lines up with several key features I've noticed in both of my professionally diagnosed autistic children (good luck getting access to a competent diagnostician who understands how the ASD criteria manifest in passing adults). It's really enlightening to see the association between Xanthine, one of the end-stage products of eATP metabolization, and the anxiety that is so prevalent within my own family. From the Discussion[1] section of the paper: > These self-calming connections in metabolism failed to develop in ASD. The natural consequence of the loss of these metabolic safeguards to overexcitation is for children with ASD to seek sameness to avoid the anxiety produced by change91, and to be more sensitive to environmental changes across many sensory domains. And a bit further on: > In the current study, xanthine was the purine that gained the most stimulatory (+r) correlations in 5-year-olds with ASD. Xanthine is one of the end-products of eATP metabolism97. Xanthine is known to trigger a cascade of events that leads to mitochondrial network fragmentation, reactive oxygen species and reactive nitrogen species (ROS and RNS), eicosanoid (e.g., leukotriene, HETE, and prostaglandin) signaling, immune activation, anxiety-associated behaviors, and consolidates long-term aversive memories that make the animal hypersensitive to future environmental changes that warn of environmental danger, cause fear, and trigger anxiety in mice, and is elevated in the blood of adults with anxiety disorders98. Anxiety is a common but under-recognized problem in autism99. Another really important observation: > A major result of this research was that the developmental differences observed in ASD were not the result of an increase or decrease of one causal metabolite, or an isolated change in the gut-brain axis, or neuroendocrine, autonomic, cytokine, or immunologic circuits. Instead, it was the interconnectedness and developmental state of the metabolic network that underlies all these systems that was fundamentally changed. In the last year, the All Brains Belong VT organization has been working on a collection of information they call "All The Things" [2], which lines up with the paper's observation that there is an underlying metabolic network at play. As a side note, All Brains Belong VT is a fantastic organization that focuses heavily on validation and support in a healthcare industry which often feels incredibly invalidating for individuals who have been reporting symptoms across a wide variety of siloed physician specialties. [1]: https://www.nature.com/articles/s42003-024-06102-y#Sec25 https://www.nature.com/articles/s42003-024-06102-y#Sec25 [2]: https://allbrainsbelong.org/all-the-things/ https://allbrainsbelong.org/all-the-things/

AnEro 2y ago

I feel like this is going to be used by pseudo-science influencers to push trendy diets to prevent autism when this study is observations stage at best.

asdfman123 2y ago
For stuff like this, overfitting is a given.
drewcon 2y ago
My only and immediate reaction as well.
throwup238 2y ago
Those people often link to papers that directly contradict the claims they make, assuming no one is going to check them. This won't make a difference.
- AnEro 2y ago
  yea example now there are guys in this comment section claiming keto has cured their adhd/autism. Helped reduce symptoms, sure, but cure? (I've got both of them been on keto, like crazy strict ensuring i was in ketosis every two days type, and it only reduced brain fog personally)
  - ryandrake 2y ago
    Whenever you get an HN story that even remotely brushes up against health, fitness, or nutrition, you inevitably get all the wacky exercise, supplements, and diet commenters coming out of the woodwork to tell you all about "what worked for me". It's a constant that you can 100% count on every time.
    - P_I_Staker 2y ago
      On reddit challenging intermittent fasting or keto can easily get you insulted, then banned. These fitness yahoos just won't stop. I also want to take a moment to call out all the deadlifters. Virtually 100% of people I know that have done substantial deadlifting eg. over 300lbs (give or take), for extended periods of time (several months to years) has wound up with either stress injuries or traumatic injuries; often it's both. Meanwhile the deadlift crowd will insist they are just idiots, doing the exercise wrong. The point was that many people have poor coordination and don't have teams to watch over them and correct mistakes. Even mentioning this will lead to mass ridicule from bros that will insist that heavy deadlifts can only make your body feel minty fresh. I'm not actually anti-deadlift, btw. I personally saw big improvements in the early stages. These problems seem to occur when the body starts fighting you, and you still want to keep going. Variation can help. Or you could just do vertical loading and/or more moderate exercise and don't worry about proving your worth.

whimsicalism 2y ago

Reveals developmental origins or merely an observational study of metabolites in children?

Der_Einzige 2y ago

I know of at least one book written by and for autistic people who advocates for a gluten free diet. They claim in the book that this significantly reduces their symptoms. I don’t know if I believe it or not, but the notion of gut-brain axis seems to imply that a good diet should help a bit, right?

jl6 2y ago
A gluten free diet may or may not help but it’s not synonymous with “a good diet”.
- Der_Einzige 2y ago
  That’s what I thought too. It seems that the only general lesson we have in dieting which js reliable is “refined sugar bad” and that intermittent fasting works for getting blood sugar under control.
- 0xcde4c3db 2y ago
  And it might also help for reasons that have nothing to do with gluten. Almost any major dietary restriction tends to cause broader changes in diet than just the thing that is restricted.
- dkga 2y ago
  Indeed. ASD or not, everyone would surely benefit from following a nutritionist-set diet based on the person’s own requirements.
  - nradov 2y ago
    Nah. Most "nutritionists" are clowns. Anyone can call themselves a nutritionist with no formal training or certification. The whole field is mostly filled with frauds and grifters. There are some legitimate people with a Registered Dietician credential who can work as part of a care team to treat medical conditions. But most of us don't need them either. We know what we're supposed to eat, we just don't do it.

ModernMech 2y ago

"Prevention strategies" As an autistic person, no thanks. Let people be autistic.

Slava_Propanei 2y ago
[dead]
2four2 2y ago
Autistic as an identity and autism as a disease are different things that are difficult to uncouple. Similarly to obesity, it's difficult to talk about the health aspect without people being sensitive about the identity aspect. I find it's useful when reading about research to empathize with the authors and realize their work is an attempt to be constructive instead of providing social commentary.
- mewpmewp2 2y ago
  Autism is not a disease. It's a diverging feature.
  - anon84873628 2y ago
    Saying this doesn't make you hip, woke, or cool. Autism is clearly a "spectrum" disorder that is not fully understood or categorized yet, which is exactly why we need this type of research to reach a conclusive, testable biological basis. To portray severely afflicted people as simply "neurodiverse" and dismiss treatment options for them, is far more bigoted than the reverse.
    - mewpmewp2 2y ago
      I don't care about being hip, woke or cool. It's just my perspective of the World. Also speaking of experience, I don't see how I have a disease for example. In my view, it's mostly the environment provided that's at fault. E.g. social expectations. I think it's a good thing for there to be variance of the way people perceive the World. I had a rough childhood, but I wouldn't have wanted someone to change who I am. I had a rough childhood because of the expected standards for how a person should behave or be socially. Now as I am older, and more confident, successful and have proven that given good environment I can do amazing, I understand how ridiculous people are being with their social requirements. None of it is needed. Also I find it quite funny how people treat labels in psychiatry as some sort of gospel or an actual thing.

Slava_Propanei 2y ago

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softfalcon 2y ago

Is anyone else reading this and seeing the worrying, “we can just medicate away the autism”? They’re talking about a possible pharmaceutical “fix” for autism in children under 5. Seems a bit premature for just recently finding a metabolic difference in a cohort of children.

m00x 2y ago
That's not what the article suggests at all. It's during the developmental stage, which is by nature temporary.
- somenameforme 2y ago
  Yes it is. It's exactly what the article suggests: --- ... Naviaux and his team completed early clinical testing for suramin. ... Now, the researchers hope that by revealing the specific ATP-related pathways that are altered in autism, their work will help scientists develop more drugs that target these pathways to manage the symptoms of ASD. "Suramin is just one drug that targets the cell danger response," he said. "Now that we're closely interrogating how metabolism changes in ASD, we could be at the beginning of a drug renaissance that will create new options for treatment that never existed before." --- This study [literally] brought to you by Pannex Therapeutics, Yuva Biosciences, Kuzani, and Paxmedica, MaraBio Systems, Inc and undoubtedly numerous other big pharma interests that were able to keep the study at arm's length enough to avoid disclosure requirements. [1] [1] - https://www.nature.com/articles/s42003-024-06102-y#Sec36 https://www.nature.com/articles/s42003-024-06102-y#Sec36
  - softfalcon 2y ago
    Thanks, appreciate you backing up my thoughts on this. I’ve already received several down votes from folks who seem to disagree with my concern.
  - m00x 2y ago
    That doesn't mean it's permanent?

ldjkfkdsjnv 2y ago

Used to have a mix of what could be considered ADHD/light asperbergers. I dont eat carbs and mostly stick to a keto diet, it resolved many symptoms. Our food is poison

2four2 2y ago
Lots of carbs make me fall asleep and kill my motivation. My lunches at work are light and carb-free for that reason.
manmal 2y ago
Do you have microbiome dysbiosis? A keto diet might improve things (eg lower LPS production), but long term can diminish microbial diversity. I’m not saying keto is bad at all - it’s just that microbial diversity is an important predictor in GI health and one should keep an eye on that too.
- ldjkfkdsjnv 2y ago
  Yeah i mean i know that keto isnt great, but it has changed my life to some degree. When in ketosis, i feel like i have "agency", otherwise i am this foggy headed, sloth
  - hailruda 2y ago
    I can relate to this. Could you point me to any resources about keto diets?
    - eadz 2y ago
      https://www.metabolicmind.org https://www.metabolicmind.org is a non profit, with many MDs and PHDs dedicated to researching the link between metabolism and mental health, with a focus on keto diets.
electrondood 2y ago
I'm Broad Autism Phenotype (BAP) and prefer low carb because I feel better, but it doesn't change my personality traits or cognitive tendencies one iota.

b800h 2y ago

"with only 10–20% of children diagnosed before 5 years of age able to live independently as adults" > Well this is nonsense for starters - circular logic. Doctors won't diagnose autism in most cases before the age of eight. For the diagnosis to have happened before the age of five would imply that the case is profound in the first place.

piker 2y ago
The stat seems accurate on that basis. True, it may be read to imply more.
willsmith72 2y ago
That's the whole point. It's not like they took the age 5 at random, it's literally what was used in the study
ffjffsfr 2y ago
there are other factors here. Children diagnosed with autism at the age of 5 must be adults now to determine if they can live alone. So they were diagnosed at minimum 13 years ago, with many diagnosed much earlier. Autism diagnostics is much more common now than it used to be, especially in families with higher economic status. Diagnostics tools evolved, more kids are tested and tests capture more kids. So I think this number will be completely different in 10-20 years from now. In my experience as a parent of ASD kid, many kids now considered ASD would not be considered ASD 20 or 30 years ago.

grumpy-de-sre 2y ago

On the topic of metabolic disturbances in Autism, huge fan of the work Dr. Randy Blakely is doing on the links between Serotonin metabolism and Autism. One of the most surprising, and strongest (25-30% of patients), biomarkers for Autism is actually Platelet Hyperserotonemia (high levels of bound Serotonin in the blood). For decades it's been without explanation but recently Dr Blakely has described a bunch of cases where it was narrowed down to SERT transporter polymorphisms and inflammation. Worth a watch for those interested in the weeds of this stuff: https://www.youtube.com/watch?v=cpDtuKV5CJs https://www.youtube.com/watch?v=cpDtuKV5CJs I've got a pet hypothesis that differences in Serotonin metabolism (and receptor hypersensitivity) might play a role in why SSRIs aren't generally considered a first line treatment for ASD symptoms, https://www.pnas.org/doi/abs/10.1073/pnas.1112345109 https://www.pnas.org/doi/abs/10.1073/pnas.1112345109

asdfman123 2y ago
Genuine question: how do we know that's not just a side effect instead of a driver?
- grumpy-de-sre 2y ago
  Dr. Blakelys lab has produced knock-in mice with the rare SERT variants described, and they have exhibited the behavioral and biochemical markers of ASD. It's actually a very remarkable finding. They also saw a reduction in ASD symptoms by pharmaceutically blocking the offending inflammatory pathways. So I think at-least for the tiny fraction of ASD patients with these rare SERT variants there's actually a chance that they are a major driver of the disorder. Regardless it provides a tantalizing look at some of the upstream pathways that could be involved more generally. I think we're going to find the disorder is very heterogenous and there will be many different subtypes and pathways involved.

john01dav 2y ago

Pathologizing autistic behaviors is not the right approach here. Most autistic behaviors are harmless except insofar as allistic (non-autistic) people provide unnecessary consequences for it and through incompatibilities. We don't say that a Linux workstation in a network of Windows computers is broken or needs to be fixed (or visa-versa), but rather we recognize that the problems are due to the differences. As such, attempts to "cure" or "prevent" autism are actually an eugenic attempt to remove harmless variation that many people irrationally deem to be objectionable. For example, it is commonly stated that autistic people have communication deficits, but this is just a communication difference. We can see this because if a communication task is given to a group of only autistic people they perform comparably to when the same task is given to a group of allistic people. Problems only take place when the group is mixed with both autistic and allistic people being present. The keyword "double empathy problem" can be used to find more information about this. (https://doi.org/10.1177/1362361320919286 https://doi.org/10.1177/1362361320919286) As another example, allistic people tend to very harshly judge autistic people for extremely subtle cues that they are different. When allistic people are shown recordings of autistic people communicating and of allistic people doing similiar tasks they, within less than a second, judge the autistic people very harshly. This effect persists when controlling for the content of the communication. (https://doi.org/10.1038/srep40700 https://doi.org/10.1038/srep40700) Of course, doing anything that actually warrants such a judgement in a context like that is impossible so this is a bias against autistic people. I think that this can be compared to implicit racial bias: it is something that most people need to learn to consciously identify and then not perpetuate and is not due to any faults with the victim. Good resource on this: https://www.youtube.com/watch?v=A1AUdaH-EPM https://www.youtube.com/watch?v=A1AUdaH-EPM There are higher support needs autistic people who need help with activities of daily living. In my opinion, though, in many cases this is not autism but rather autism with an accompanying intellectual disability and the intellectual disability is the reason for higher supports needs. In some cases this could also be caregivers unnecessarily pathologizing behavior and then convincing someone that they need more support than they really do, which I have seen in real life.

P_I_Staker 2y ago
Do you have autism or ADHD? This is actually a really contentious issue. Tons of people with the condition are happy to let others be themselves, but want to be cured. With ADHD, it's actually a little crazy to me that people consider it "harmless". There's a ton of tangible ways that it hurts relationships and goals. I can't even make dinner and tidy house; doesn't matter how much time I have. I will say the medicine made me a little more robotic and took a bite out of my personality; but this was a small nibble compared to not being able to do almost anything comfortably, and the consequences of that. It's really damaging to your personality to not be able to conversate with people and understand each other. It's really damaging to your personality to not be able to practice your hobbies with friends. I really don't feel like my "true" self, and see others able to effortlessly be that person.

tsoukase 2y ago

Autism is rooted during fetal brain development. Behavioural and metabolic changes show up later. There is no an egg and chicken problem. The primary disease starts in the CNS and everything else follows

computerphage 2y ago
How do you know that?
- tsoukase 2y ago
  Schizophrenia, Alzheimer's, Parkinson's have links with the gut too. But I "know" they start from the brain. No advanced or complicated hypothesis
  - kelseyfrog 2y ago
    How would you prove or disprove this theory?
    - tsoukase 2y ago
      The gut hypothesis hype is trendy right now. There is some correlation but when things settle down, some of the effect will be attributed to "picky eating". Proving that the source of mental disorders is the brain and not the gut (as it was believed in the distant past) is easy: 100% of patients show brain damage while a fraction of them have an abnormal gut
      - kelseyfrog 2y ago
        How do you eliminate models where brain damage is a proximate cause?
        tsoukase 2y ago
        Exclusion of either cause directions is impossible by definition. This is science not mathematics. But saying that the primary mechanism of mental disease lies outside the brain must not contradict decades of research and simple observation (eg a small brain damage leads to a profound behavioural image while cutting 5 meters of small intestine to none) Extraordinary claims require extraordinary evidence.

lettergram 2y ago

[flagged]

greenavocado 2y ago
> Most vaccines are effectively laced with a chemical or biologic that the body will respond aggressively to Aluminum, btw https://www.educate-yourself.org/cn/Aluminum-Toxicity-Is-Well-Documented-in-Medical-Journals02aug15.shtml https://www.educate-yourself.org/cn/Aluminum-Toxicity-Is-Wel...
- lettergram 2y ago
  Yeah that’s one of them. There’s also often mercury - https://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.html https://www.cdc.gov/vaccinesafety/concerns/thimerosal/index.... I actually had a similar theory as to where egg allergies come from. Many vaccines have egg in them https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm https://www.cdc.gov/flu/prevent/how-fluvaccine-made.htm
  - greenavocado 2y ago
    I thought mercury isn't used anymore in vaccines?
    - lettergram 2y ago
      Still used, just not recommended in vaccines for children under 6 https://www.fda.gov/vaccines-blood-biologics/safety-availability-biologics/thimerosal-and-vaccines https://www.fda.gov/vaccines-blood-biologics/safety-availabi...
thsksbd 2y ago
"Most vaccines are effectively laced with a chemical or biologic that the body will respond aggressively to" Adjuvants to be exact. They're actually what Im annoyed at the most with (traditional) vaccines.
2y ago

mrangle 2y ago

>suramin They're investigating the use of a drug that they don't understand to treat a condition that they don't understand, through the lens of one model that variously competes with or incompletely conforms to a myriad of other models of the condition. In order to what? Nebulously "manage" a complex neurological difference that will always defy reversion to anything else? It sounds like they want something that they can prescribe, period. And it sounds like it has the potential to further complicate already difficult lives. Type 1 Autism may serve a general human gene pool function in terms of edge-dripping a specific intelligence trait into it (low probability of reproduction, protecting general social skill in the pool, but adding a divergent pattern solving skill at the edges). While autism is difficult, I'm not sure that solving for it in the context of industrial medicine is wise. We don't want to solve for Nicola Tesla, for example. Type 2 and 3 Autism could be genetically unsuccessful attempts at Type 1 autism development, to spitball. Assuming they are actually related, in most cases. Such management theoretically could be helpful here, but I think that these people deserve a lot better than injected parasite medicine with a lot of side effects. Besides, try getting an autistic child used to regular injections. Though a low-side effect oral or transdermal medication that would, say, specifically enhance energy support to the Autistic PFC with few side effects could be game changing. Likely for many more conditions than autism. Inventing such a medication that doesn't lead to a worse baseline would be critical and perhaps unlikely. Then again its possible that the unique pattern solving ability of the Autistic mind is related to the relative lack of energy supply to an increased volume of PFC neurons; and the subsequent failure of inhibition. Possibly accounting for increased environmental information perception, at least in-part. Which may in turn be mirrored in expanded cognition involved in pattern identification. The ideal, which again I think is unlikely, would be a PRN medication that could "quiet" the autistic mind via providing more energy to the PFC; while having no withdrawal semi-permanent side effects.

Broken_Hippo 2y ago
They're investigating the use of a drug that they don't understand to treat a condition that they don't understand... You'd probably be shocked to figure out how often this happens - and it used to happen a lot more in no small part because we didn't have the tools we have today: MRIs and better microscopes and other tech has really helped our understanding of the body. We are still figuring out how exactly the body works, after all, to the point that we occasionally discover a new body part. Of course we are going to do things we don't understand. Yet. This isn't limited to medicine, either. Maybe they want something to prescribe. For a lot of diseases, that's better than nothing. For example, I have MS. They know more than they used to about MS, but most of my life they've not known enough. I have medicine that isn't a cure, but I'll take it. Modern medicines mean that modern folks with MS have a much better quality of life than folks that didn't have medications. I'm more likely to have mobility and things like that. I'll take it. My ex was schizophrenic. Medicine gave them a life. They still couldn't work, but they weren't suffering as much either. Again, not a cure, but help. Imperfect cures or medicines that treat the symptoms are so much better than no help at all. This is where a lot of medicine starts - treating a symptom, and by doing so learning a bit more about the disease or affliction.

hcfman 2y ago

Yay! We can prevent another brilliant scientist from coming into existence. Nice work fellows!

zazazache 2y ago

As some one who is let’s say “autism adjacent” it really bothers me when people discuss a cure or prevention. I mean I get it, but this is also who I am and I wouldn’t want to be someone else.

ModernMech 2y ago
I have no problem with discussion about making some issues people face better with medication, although I think autistic people should be centered in those discussion. However “prevention” talk is a whole separate issue and that one does give me eugenics vibes.
Perenti 2y ago
I'm on the spectrum (diagnosed), and also like being me (most of the time). But what about the poor sods who have so much happening all the time that they don't get the chance to learn to speak, or read, and scream in terror continually at the unending sensory deluge they try to live through? If there was a way to prevent that kind of presentation of ASD I think everyone would be better off. I took "prevention" to be about prevention of the life restricting developments of the condition. On the other hand, if "prevention" is about culling the gene pool, I'm dead set against that.
- gizmondo 2y ago
  > On the other hand, if "prevention" is about culling the gene pool, I'm dead set against that. Well, you can be against it by raising autistic children yourself, it seems you're in a perfect position for that. Why people feel they have the right to demand that from others is beyond me.
  - ModernMech 2y ago
    The problem is that when you teach society that a certain “kind” of person needs to be culled, that is a stigma about people in that group. IME such strong feelings don’t don’t stay relegated to your personal choices, they get reflected at a broader policy level. People say “well it was your choice to have such broken people, we gave you a pill that would make that not possible. Therefore we las a society will not support them (you’ll hear rhetoric along the lines of “why should we spend my hard-earned tax dollars on social programs for autistic people, that’s a you problem, why people demand I pay for their choices is beyond me”) Of course that’s when the government offers a “compassionate” final solution to the autist problem. Since autistic people can’t seem to stop reproducing despite the “cure”, we should sterilize them. Or we should make it mandatory because otherwise they are a drain. Then of course for the ones who are “too autistic” (I.e. who are nonverbal or who otherwise cannot be productive), we can euthanize them. No thanks we have been down that road before as a society. It doesn’t end well.