8 ms·

> The researchers discovered that a small number of biochemical pathways are responsible for the majority of these changes, which could help inform new early de

> 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/

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/