5 ms·

The diagnostic reliability criteria even back then painted a picture of the details of the condition space being more nuanced than what were currently being cap

The diagnostic reliability criteria even back then painted a picture of the details of the condition space being more nuanced than what were currently being captured, not less nuanced, so the idea of reducing nuance and distinction still seems questionable by an empirical and epistemological standpoint. However, that decision remains defensible and supported by the social justice / equity / de-hierarchicalization / eponym erasure motivational drives. These, besides the eponym erasure specifically, also explain many of the other changes in the DSM-5, like the elimination of many other more-detailed diagnoses, like PDD-NOS. This isn't to assert that the clinical reasoning offered didn't have merit, just that institutional consensus-forming behavior isn't immune to the macro backdrop of the sociopolitical winds of the day. Committee member A thinks: "These diagnostic categories aren't reliable" (true, clinical concern) Committee member B thinks: "Honoring Asperger is ethically uncomfortable" (true, historical concern) Committee member C thinks: "Hierarchical categories are problematic" (true, equity concern) Committee member D thinks: "Spectrum model reflects current research better" (true, scientific concern) No single person needs a "primary political motivation." No conspiracy needed. No explicit coordination required. Yet the outcome eliminating Asperger's and collapsing categories - emerges from a system where: - Progressive ideology shapes what problems become salient - Shared epistemic frameworks determine what solutions seem natural - Professional incentives reward what can be publicly justified - Social proof operates through "everyone reasonable agrees" "The clinical rationale was legitimate" doesn't contradict "political ideology shaped the outcome."

cogman10 1y ago
> so the idea of reducing nuance and distinction still seems questionable by an empirical and epistemological standpoint. Again, it does not because the treatments as a result of diagnosis remain the same. The primary role of diagnosis is to inform treatment. If patients are seeing worse outcomes because of arbitrary "nuance", that indicates that the nuance carved out wasn't what needed to be carved out. > isn't immune to the macro backdrop of the sociopolitical winds of the day. This is conspiracy thinking. You don't have any evidence that it was "progressive ideology" that eliminated the diagnosis, you just surmise it based on some people not liking their diagnosis being named after a nazi. Slamming in reactionary politics in where it doesn't fit and a reasonable explanation does fit is just silly. Sure, nobody is immune from politics. But I'm going to need more than "feels, vibes, and makes sense to me" before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis. Diagnoses for mental disorders, by their nature, are almost always going to have a level of arbitrary lines that could be drawn. That's why we have 5 versions of the DSM and will likely have a 6th in the future.
- anonym29 1y ago
  >before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis. If empirical reliability of outcomes were based on social standing of the committee, you'd have a great point, but alas, there's a trending new paper on Nature explaining the precise mechanisms of how and why DSM-5's category elimination between Asperger's and ASD is a measurably less accurate approach than the DSM-4's categorical differentiation of the two conditions. TFA is saying that we should've been moving towards more categories with more nuance and detail, even back when we were at just 2 categories, not towards fewer categories with even less nuance, as the DSM-5 chose to do. Regardless of your opinion on influence of the politics involved, the hard fact of the matter is that DSM-5 made moves in the exact opposite direction for increasing understanding of autism-family disorders relative to DSM-4, and some of the newest, most comprehensive empirical science ever done on the subject is trending on Nature right now stating exactly that: we need more categories, more nuance, more differentiation, not to paint everyone under one broad brush of "it's all a spectrum of the exact same underlying pathology". It seems abundantly clear to me, and to I think anyone else who's had any amount of meaningful exposure to or working with both groups: nonverbal autism looks much more like profound, pervasive developmental disabilities - think down's syndrome - than Asperger's does. The latter has a bunch of people that can generously be called eclectic, but writ large, are generally capable of supporting themselves and leading independent lives: emotionally, financially, socially, mentally, physically, maybe with some therapy, some counseling, some CBT, and maybe reasonable workplace or school accommodations, like being allowed to wear noise-cancelling headphones during solitary work. The former, categorically, tend to not be capable of that level of independence. It seems facetious and absurd to allege on any level that these two groups are substantially or meaningfully similar, especially if such similarity is being used to justify a treatment approach that is as identical as you purport it to be. These are, very obviously, so obviously even a child could grasp it, at least two dramatically different groups, with at least two dramatically different sets of needs and courses of treatment. I say that as someone who grew up with more or less all of the hallmarks of (and was indeed diagnosed with) what we used to call Asperger's Syndrome, but also as someone who volunteered at events like the local Special Olympics chapter, and I'm firmly in agreement with in_cahoots's chief concern: 'Today most of the money and advocacy is for high-performing or moderately-performing people with autism.' There are a lot of people who need a lot more support than people like me, and those with that greater need are getting less of it than they need, because people with well-managed conditions like mine are being lumped in alongside people like in_cahoot's cousin who genuinely need much more support. These two groups are a difference of kind, not a difference in degree.

cogman10 1y ago

> so the idea of reducing nuance and distinction still seems questionable by an empirical and epistemological standpoint. Again, it does not because the treatments as a result of diagnosis remain the same. The primary role of diagnosis is to inform treatment. If patients are seeing worse outcomes because of arbitrary "nuance", that indicates that the nuance carved out wasn't what needed to be carved out. > isn't immune to the macro backdrop of the sociopolitical winds of the day. This is conspiracy thinking. You don't have any evidence that it was "progressive ideology" that eliminated the diagnosis, you just surmise it based on some people not liking their diagnosis being named after a nazi. Slamming in reactionary politics in where it doesn't fit and a reasonable explanation does fit is just silly. Sure, nobody is immune from politics. But I'm going to need more than "feels, vibes, and makes sense to me" before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis. Diagnoses for mental disorders, by their nature, are almost always going to have a level of arbitrary lines that could be drawn. That's why we have 5 versions of the DSM and will likely have a 6th in the future.

anonym29 1y ago
>before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis. If empirical reliability of outcomes were based on social standing of the committee, you'd have a great point, but alas, there's a trending new paper on Nature explaining the precise mechanisms of how and why DSM-5's category elimination between Asperger's and ASD is a measurably less accurate approach than the DSM-4's categorical differentiation of the two conditions. TFA is saying that we should've been moving towards more categories with more nuance and detail, even back when we were at just 2 categories, not towards fewer categories with even less nuance, as the DSM-5 chose to do. Regardless of your opinion on influence of the politics involved, the hard fact of the matter is that DSM-5 made moves in the exact opposite direction for increasing understanding of autism-family disorders relative to DSM-4, and some of the newest, most comprehensive empirical science ever done on the subject is trending on Nature right now stating exactly that: we need more categories, more nuance, more differentiation, not to paint everyone under one broad brush of "it's all a spectrum of the exact same underlying pathology". It seems abundantly clear to me, and to I think anyone else who's had any amount of meaningful exposure to or working with both groups: nonverbal autism looks much more like profound, pervasive developmental disabilities - think down's syndrome - than Asperger's does. The latter has a bunch of people that can generously be called eclectic, but writ large, are generally capable of supporting themselves and leading independent lives: emotionally, financially, socially, mentally, physically, maybe with some therapy, some counseling, some CBT, and maybe reasonable workplace or school accommodations, like being allowed to wear noise-cancelling headphones during solitary work. The former, categorically, tend to not be capable of that level of independence. It seems facetious and absurd to allege on any level that these two groups are substantially or meaningfully similar, especially if such similarity is being used to justify a treatment approach that is as identical as you purport it to be. These are, very obviously, so obviously even a child could grasp it, at least two dramatically different groups, with at least two dramatically different sets of needs and courses of treatment. I say that as someone who grew up with more or less all of the hallmarks of (and was indeed diagnosed with) what we used to call Asperger's Syndrome, but also as someone who volunteered at events like the local Special Olympics chapter, and I'm firmly in agreement with in_cahoots's chief concern: 'Today most of the money and advocacy is for high-performing or moderately-performing people with autism.' There are a lot of people who need a lot more support than people like me, and those with that greater need are getting less of it than they need, because people with well-managed conditions like mine are being lumped in alongside people like in_cahoot's cousin who genuinely need much more support. These two groups are a difference of kind, not a difference in degree.