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One complicating factor that I put into every thread about random things being associated with autism: the diagnostic criteria for autism doesn't just measure how autistic someone is, but also how well they've learned to cope with being autistic. It measures things like frequency of meltdowns, ability to handle their everyday life without assistance, ability to "mask" by doing things like holding eye contact or memorizing social scripts, etc.

Better brain function in general means that someone on the autism spectrum is less likely to have general life issues that lead to an official diagnosis. Anything that could reasonably be linked to a decrease in IQ can also reasonably be linked to autism. IQ is positively correlated with general life outcomes, and negative life outcomes are part of the diagnostic criteria for autism.

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> the diagnostic criteria for autism doesn't just measure how autistic someone is, but also how well they've learned to cope with being autistic.

I'm not medically qualified at all, but that sounds a bit like saying Typhoid Mary didn't have typhoid because she was asymptomatic. That someone is able to effectively cope with a condition doesn't mean they don't have the condition. Am I missing something?

Medical practitioners aren't on a platonic quest for truth when they make diagnoses. They're generally trying to separate out those who would benefit from treatment. Physical tests aren't often that useful for mental conditions, so official diagnostic criteria often has a section about how the observed traits and behaviors cause problems for the patient at home, in school, or at work.

Furthermore, people simply don't seek diagnosis and care unless they're having problems that are severe enough. One example is Bill Gross, the "bond king", who figured out that he had Aspergers in his 70s. If someone is adjusted enough to their social niche, why would they seek a mental health diagnosis?

Thank you for that clarification, that is my rough understanding of mental health having been sent to a whole mess of shrinks.

I guess what my ultimate misunderstanding is:

> One complicating factor that I put into every thread about random things being associated with autism

How is that a complicating factor in discovering causes themselves? If someone has the Foo and Bar factors that cause autism, but has otherwise been able to work around it they are still "autistic" but just at a subclinical (is that the right phrase?) level. I guess I'm having some (pedantic?) misunderstanding around autism as a diagnosis vs. a disease you have.

Subclinical is the right word for that, yeah.

>How is that a complicating factor in discovering causes themselves?

The study links the factor under study to autism diagnosis, rather than some hypothetical "true" rate of autism that includes undiagnosed and subclinical cases. Ten IQ points can be the difference between otherwise-identical autistics barely passing a class versus failing it and getting referred to a psychologist. Or after getting referred, the difference between qualifying for a diagnosis or not.

The latter actually happened to me personally in elementary school: I had held my pen funny in a way that made my hand hurt after a while, and my teacher referred me for refusing to complete a handwritten class assignment. They did a test on various types of school subjects, and I ranked a bit above grade level in some and far above grade level on others. If I was a grade lower in each subject and thus had below grade level scores, I'd've gotten an official diagnosis of some kind of subject-specific learning disability. But instead, there wasn't enough of a problem to need to do stuff, and doing stuff costs money, so they basically shrugged their shoulders and sent me on my way.

In the case of something like autism, the presentation of symptoms is massively complicated by the amount of support and therapy/'training' a person has had. In a population where everyone had equal levels of Foo and Bar, but a widely varying level of therapy, they would show widely varying levels of 'autism' in their diagnosis - and this would complicate any attempt to study the relationship of Foo+Bar<->autism.

Should have said: that is in an imaginary scenario where foo+bar really does cause autism

We don't know what autism really is, beyond it's symptomatic effects and correlations like that of TFA. It's not clear that there is a meaningful notion of being autistic but asymptomatic. Typhoid, on the other hand, is a bacteria that exists independent of its symptoms.

"Asymptomatic" just means poor or absent testing, not an inherent property. Better diagnostic tests can detect low visibility symptoms.

It's like saying that someone with nearsightedness is asymptomatic and therefore not nearsighted because someone is good at squinting. There are still symptoms if you know what to check for.

Typhoid Mary, the example the parent used, was asymptomatic in an inherent way, not just due to poor or absent testing.

> There are still symptoms if you know what to check for.

What are these in autism? Are you sure they exist? It may be that "inability to mask" is just what autism _is_.

I'm a medical practitioner and that sounds a little silly to me too. I don't diagnose autism, though. I leave that to the paediatricians. The main reason that diagnosis is a big deal here is it's related to funding packages. I suspect that's also why ability comes into it.

The other thing is that autism is somewhat nebulous and it's in part a condition of not being able to cope socially in this world. So because of this, it makes sense what GP was saying.

I'm glad I don't need to diagnose autism. Severe is easy to see from 100m away. Borderline would be a coin toss.

Adults can be autistic and can have great quality of life improvements from diagnosis and treatment.

What could a high-functioning autistic adult gain from diagnosis and treatment, one who has managed to blend in well enough to go undiagnosed.

A diagnosis allows life to finally make sense. Even for those that are able to blend in, it's really great to have a framework to understand things, and that there's a community that actually understands you because they have first-hand experience of eg, the rage and meltdowns that plague individuals with autism.

Post diagnosis, there's even treatment for some of the things that high-end functioning adults with autism simply can't do without medication, and are negatively judged for by society.

In that case I leave it to the psychiatrists. In practice, very few adults are diagnosed with autism where I'm from.

I would be interested in references here, as I'm not aware of treatments specific to autism in adults.

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