Broader Autism Phenotype: What does it mean to have just a hint of autism? | Hacker News Reader

Broader Autism Phenotype: What does it mean to have just a hint of autism?

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68 pointsKaibeezy94 comments

> while others, including parents of children with severe autism, complained that he trivialized the real problems of a real disability.

As a former autism researcher I empathize with these parents. The cohort I worked with, considered mild Autism 20 years ago (now probably considered "severe") had unmistakable psychological impairments. They were not just quirky, or socially awkward, and certainly not giving highly articulate TED talks, or campaigning on twitter for NIH 'normies' to cancel genetic research on Autism.

I don't question there exists a spectrum of asocial phenotypes, with some neurocorrelate. But it's been a great disservice to individuals with Autism 'proper' to be grouped (even if just by name) in a spectrum with folks with such mild issues.

These things are not mutually exclusive. There are people who can speak articulately and campaign on Twitter some days, and have disabling meltdowns and total inability to manage life on other days.

Like many things, the truth is probably somewhere in the middle: I have no doubt that there are also a lot of people who have taken one dubious questionnaire and self-diagnosed as autistic, and I also empathize with the parents of autistic children who seem light-years apart from autistic folk who can at least live mostly independently. I don't know what the future of autism research and funding needs to look like, but it feels like there still needs to be further change.

> These things are not mutually exclusive. There are people who can speak articulately and campaign on Twitter some days, and have disabling meltdowns and total inability to manage life on other days.

That describes 90% of the population. The group of kids I worked with I'm sure have never used twitter. My main qualm is with the anti-research advocacy. Those that are advocating against basic research seem worried about losing their autism 'affiliation'. More research means scientists working towards defining physiological underpinnings, which would lead to more scientific diagnosis criteria (e.g. genomic markers, fMRI/DRI markers, etc.). And if they are found to not have those characteristics, well, what does that mean for them? Does it mean their issues aren't real? Of course not. But it certainly doesn't make sense to call them Autistic. Their disorder should be coined a different name.

> have disabling meltdowns and total inability to manage life on other days. > That describes 90% of the population.

It most definitely does not. I used to think it did too because it's my normal. But it turns out that most people manage to get on with life just fine on a consistent basis. Perhaps you have children in mind? But this applies to adults too.

> More research means scientists working towards defining physiological underpinnings, which would lead to more scientific diagnosis criteria (e.g. genomic markers, fMRI/DRI markers, etc.). And if they are found to not have those characteristics, well, what does that mean for them? Does it mean their issues aren't real? Of course not. But it certainly doesn't make sense to call them Autistic. Their disorder should be coined a different name.

I'm definitely in agreement with you that more research is called for and should be encouraged as much as possible.

My strong suspicion is that "mild" and "severe" autism (and quite possibly related conditions like ADHD) will turn out to have to have a common physiological basis. I guess this belief (as lacking in evidence as we are at this point) is partly why I think it does make sense to classify everyone under the label "Autism".

Yes - agree here.

Father to two Autistic children, both of whom are high functioning, attend mainstream school, excel etc.

The sheer burnout my son faces after dealing with social events is palpable - masking utterly drains him.

If someone labels cats and dogs and sheep and goats and a bunch of other animals as "dogs" just because they want to be called dogs, and feed those labeled samples into a classifier for training, when given novel samples of species, the pretrained classifier will recognize ("diagnose") anything on 4 legs as a dog. I imagine the same will happen if we compile a genotype database that includes dna from everyone on the "spectrum" (i.e. the "case" dataset will be highly polluted with control samples, which will no doubt turn up null results).

Don't get me wrong, I take your point. It's just that whatever is underpinning severe autism is subtle, and was already going to be difficult to tease out. Now I feel like it's perhaps impossible.

Case/control is not the only kind of analysis you can do here. You could define a numerical scale describing someone's degree of "autistic-ness" and train a classifier on that instead of a binary categorization, for example. Obviously there are challenges in doing so, just as there are with the binary case. But if a continuous scale turns out to be a better match for the underlying phenomenon, then obviously it's worth modeling in that way.

> the "case" dataset will be highly polluted with control samples, which will no doubt turn up null results

You seem to be assuming the answer to the research here. It's true that polluting the "case" dataset with control samples will make it hard to find patterns/results. But polluting the control dataset with "case" samples causes exactly the same problem.

I would suggest that we'll need lots of studies with different groupings

> a bunch of other animals as "dogs" just because they want to be called dogs

I am not suggesting that we consider people autistic because they want to be autistic. I am suggesting that a lot of the people with "mild" autism seem to have very similar symptoms and subjective experiences to those with "severe" autism (even though it presents very differently). And that it is not at all obvious that the underlying cause is different.

The analogy I would use is that of a noise in the environment. Suppose there is a high pitched whining noise, but it's fairly quiet. That would likely be annoying, but wouldn't majorly affect you. Now suppose the it's louder, akin to a loud concert. That would probably be ok for a while or some of the time, but after a while it would start to get to you and might make you irritable or more tired. Now suppose the noise was really loud, like standing next to a jet engine loud. This would be utterly intolerable and completely debilitating. The cause of the problem in each of these cases is similar, the difference is just the degree of loudness.

And different profiles of Autism could well be similar, having a similar underlying cause despite wildly different presentations. Given that there is evidence that one of the main aspects of Autism is differences in sensory processing this analogy might even be quite literal.

There is some meta humor here about the classifier not understanding absurdism.

> Their disorder should be coined a different name.

But I guess part of the concern may be that they’ll be told there’s no disorder at all. Which could be liberating and empowering for some people, but potentially deeply invalidating for others.

I'll give my devils advocate statement. As a background, I was not diagnosed until I was in my early 30s. That was after years of bouncing from doctor to doctor, every one before that giving a different diagnosis with a treatment that didn't work. None of the previous doctors even touched on ASD/ADHD.

> And if they are found to not have those characteristics, well, what does that mean for them? Does it mean their issues aren't real? Of course not.

No, but I think the fear for some, is the question of "Well WTF happens then?" Diagnosis and treatment of comorbidities (ADHD + social anxiety) let me go from being in a dead end hourly job to a person who has a moderately successful career, has been able to make impactful contributions to open source, and be able to mostly function as an adult.

I'm not against research, but if there is a different thing going on with some people I don't want to see them forgotten.

Do you have some examples of your kind of "anti-research advocacy"? Because the concerns I see are nothing like that. What I see is people being concerned about people wanting to "end autism" when a lot of people diagnosed as autism are not interested in being ended.

Which I think is a valid complaint. There's an endemic fetishization of "normal" that ends up causing a lot of harm [1], ranging from a lot of unnecessary abuse to medicalization [2] of deviance to outright eugenics. I could well believe that a lot of researchers and a lot of research are tainted with that. And I think it's ultimately the job of researchers to both make sure they're not part of it and be clear that they aren't.

[1] described about pilots and cockpits here: https://www.thestar.com/news/insight/2016/01/16/when-us-air-...

[2] https://wiki.ubc.ca/The_Process_of_Medicalization_of_Devianc...

This is exactly the redefinition and recentering process that infuriates me as the parent of a severely autistic child. The "autism" that people are self-advocating against ending and which dominates media discourse is a world of difference away from the totally disabling condition my daughter has. Yet the connotations of the term "autism" have been hijacked away from her by media attention focused on large numbers of high-functioning and self-diagnosed people agitating for their own agenda.

Yes, a lot of neuroatypicals are perfectly happy with their current situations -- as long as they receive accommodations at school and at work and online based on their diagnosis. Their _medical_ diagnosis. I am not for a minute trying to advocate that they be forced to take treatments they don't want. What I do object to, strenuously, is the diversion of resources away from severely impaired people who can barely communicate, let alone advocate for themselves online.

These people _do_ have a true medical condition, are suffering, and have the right to the support of the medical and research community just as much as the less impaired group has the right to forego that support.

You write this in a tone of extreme contradiction. But I don't think I actually said anything that you are contradicting. Did you mean to reply somewhere else?

> I have no doubt that there are also a lot of people who have taken one dubious questionnaire and self-diagnosed as autistic

Not to drop names, but sounds like El$n Mu$k.

As someone with close bonds with people diagnosed with "real" high-functioning autism, it is quite horrible to see random people (Mu$k claiming himself so[1], or mainstream newspapers attaching Asperger's to figures like Putin) being mislabeled as so for visibility, or because AS individuals have acquired this myth of being cool, quirky geniuses in popular culture.

Truth be told (correct me if I am wrong), the most common high-functioning autism symptoms are also present in other syndromes (especially the social ones), and even in neurotypical people, that (as should be obvious) without a proper assessment, such quick speculations or self-assessment are usually garbage.

[1] https://www.inc.com/minda-zetlin/elon-musk-aspergers-self-te..., ironic how the article starts suggesting readers to do an autism self-test

> But it's been a great disservice to individuals with Autism 'proper' to be grouped (even if just by name) in a spectrum with folks with such mild issues.

I feel like we need to both group and separate.

We need to group because everyone across the spectrum has things in common, and a lot of the accommodations that "mild" and "severe" autistics need be similar (for example, needing quiet spaces), and we shouldn't dismiss these needs in those with "mild" autism because they're coping with things better than others. I feel like we also shouldn't dismiss how helpful the insight gained from autistics who are more easily able to communicate might be in determining appropriate care for those who are less able to communicate.

We need to separate because some autistics have needs that others don't. And it is of course important that we recognise that and give the more disabling impairments the extra attention they deserve.

I agree with you in general. I think over time fields that are "fuzzy" with definitions, like psychology, will hopefully add additional layers of specificity to a number of neuro diseases/ailments/conditions. In the end if you took any condition out of the DSM each human probably falls some where along a spectrum for each one and the ultimate combination is what makes us "us" as individuals.

I could certainly see autism be rated on a 1-10 scale of severity to provide additional clarity or each one of those ten points on the gradient receiving a new diagnostic name. Going further we could probably have a broader scale that includes severe autism on one side and severe empathy on the other. The empathetic traits aren't as well studied even though being severely empathetic can also have a host of social challenges.

Please don't consider autism as opposite to empathy. Autistic individuals are often highly empathetic. It's just that they don't express it in the same way as neurotypical people and it can get lost in translation.

I feel this too. People have different needs. I had an ex who despaired at the idea of marrying me because she didn’t want kids with autism. To me, I’m fine, my kids would be fine, and I don’t want any stigma or to be seen as defective. I just want the same respect anyone else gets, and an ounce of understanding. Other people, however, really struggle, either themselves or to help someone close to them. They don’t want their situation trivialized, and need effective help. Striking this balance will take a mindful culture, and the field can help much in guiding that, along with the other benefits they bring with research and interventions and such.

> We need to group because everyone across the spectrum has things in common

Do they really? One of the articles on here recently was about how Autism is this gigantic smorgasbord of often very different symptoms and that every Autism disgnosis pulls from a different palette of symptoms.

That sounds a lot like psychologists decided to call "Not Neurotypical" (however you define that) as "Autism" and then dumped everything into the category.

> That sounds a lot like psychologists decided to call "Not Neurotypical" (however you define that) as "Autism" and then dumped everything into the category.

"Neurodiverse" includes a lot more conditions, such as ADHD, developmental speech disorders, dyslexia, dysgraphia, dyspraxia, dyscalculia, dysnomia, intellectual disability, Tourette syndrome, schizophrenia, bipolar disorder, schizoaffective disorder, and antisocial personality disorder.

See https://en.wikipedia.org/w/index.php?title=Neurodiversity&ol...

My understanding is that autism is much more complex than "mild"/"severe". I know an autistic with a high-powered career who requires a full time minder because otherwise random shit will happen like frequent skin infections from not keeping hygiene. I know another autistic who can't hold a job but keeps her home in order and is fairly well organized and articulate.

In your expertise, What separates the asociality that comes with mild/high functioning autism from that which comes from a coping mechanism for an unhappy childhood of someone who would otherwise be "normal"?

The distinction is subtle but I would say physiology vs. psychology. The former (probably) manifests from genomic, epigenetic, or early developmental biochem conditions; the latter arises from experience (e.g. manifests from stored explicit or implicit memories).

Whether that matters is a different discussion. One area it might is treatment (for those who want it). If two similar disorders have wholly different etiologies, there is a good chance that a treatment that works well for one won't work at all for the other.

> One area it might is treatment (for those who want it). If two similar disorders have wholly different etiologies, there is a good chance that a treatment that works well for one won't work at all for the other.

Which is a prelude to my second set of questions:

How do you determine which is which in a diagnostic setting, where one normally has an n of 1 as an information provider?

How do you determine the need or kind of treatment and whether such treatment is truly effective or little more than a band-aid for what would be complicated sociological issues?

In what way does real or perceived agency (or lack thereof) have a part to play in asociality in relation to in-born or apparent autism itself and by what measure?

I don't know what you mean by n=1. If someone goes to the hospital to get treatment for a rash, the doctor has methods to determine if the rash is from poison ivy, or an allergic reaction, or a burn, or eczema, even if those rashes all look visually similar, even with an N=1 patient. Because we have established diagnostic lab tests to assay for certain biomarkers.

If your question is, how can we currently do this with Autism, the answer is, we cant. Yet. That is the whole point of performing basic research to understand the underlying etiology. If we stop doing this research, we'll never find out.

Wrt. your second question, a lot of medications are simply "bandaids", and that is indeed a problem. Adderall doesn't cure ADHD, Zoloft doesn't cure depression, Levodopa doesn't cure Parkinson's. They are acceptable for now because they offer some relief from the symptoms, but do nothing to fix underlying problem.

So for a concrete example Levodopa is given to both Parkinson's and Huntington's disease patients. However if we get to the point where we can reverse Huntington's disease using CRISPR to edit the trinucleotide repeat issue, should we expect this same method to work with Parkinsons patients just because the two disorders have similar symptoms? Absolutely not. Parkinsons has nothing to do with trinucleotide repeats. Which is good to know, so we don't attempt a highly invasive treatment on people who we know for a fact won't benefit from it (and may likely do more harm than good on them).

What campaign to end genetic research into Autism? I must have missed it. Personally, as someone with hEDS, I wish there was more genetic research into it.

Edit: found it, End Spectrum 10K. There seems to be a concern with negative eugenic screening which I kind of get. My ‘touch of autism’ seems to be a bit of a career advantage but I do worry about the possibility of having a more severely afflicted child. I think more good than harm will come from these studies.

A lot of autistic people (including me) see this as eugenics - the idea of genetic research is to prevent autistic people from being born, not to improve the lives of autistic people.

The gene mutations are going to be found eventually while searching for other things, so at best it’s delaying the inevitable.

By identifying the gene mutations it can make treatments much easier to find as you can often see which exomes are effected and thus which proteins may be missing. Could give rise to an effective peptide treatment similar to an insulin injection.

The knowledge may be inevitable, but the eugenics isn't. It's perfectly plausible that as a society we are not ready for knowledge yet. Look, for example at the plague of sex-selective abortion: https://en.wikipedia.org/wiki/Sex-selective_abortion

It's perfectly possible that knowledge of and tests for, say, genes related to homosexuality would currently result in a huge eugenics campaign in many places. The same could well be true of all sorts of cognitive "deviance", which could be not only a moral horror, but cause long-term damage to the fate of the species.

Imho eugenics is already inevitable. It can confer too great of an advantage and the technology is already eminently accessible. People already do it on the small scale with discretionary abortions for various genetic defects. Going from that to pre selecting IVF embryo candidates is a minor detail of a relatively small amount of money. It can also be done in secret so it’s perfect for a black market. And there is a first mover advantage so maintaining an anti-eugenic cartel would be impossible in the long term.

I do agree that it could result in the nightmare scenario.

Will some number of people do it on a black market? Possibly! But I think that's worlds away from broadly accepted eugenics for non-dangerous characteristics. So I think eugenics is only inevitable in the same sense that slavery is inevitable: we may not be able to eliminate it totally, but we can certainly keep it very much to the margins.

I don't think the taboo of eugenics has any particular durability to it. I think it'll flip rather quickly. You'll get places like Eastern Europe, Russia, and China doing it and all of a sudden we'll have to do it to in order to 'remain competitive'.

Weaponizing drones was taboo for about a nanosecond, now we can look forward to a future WWIII with flying robots raining down death from above, all because it was more convenient at the time.

That one taboo falls quickly is not proof all of them will. The eugenics taboo has endured for more than a century, which sounds like particular durability to me.

I don't know how to not be too blunt but we already do it with down syndrome and others we can detect. It's not called eugenics because they the word has a bad meaning but essentially this is what it is.

Oh, I am quite aware that eugenics is already a thing we do. That doesn't make it right, and it certainly doesn't mean it's something we should be looking to expand.

One might note that down syndrome individuals are often quite happy, and can make others around them quite happy as well. They just don't succeed under capitalism - they can't really work, and because caretaking is not financially compensated, they greatly reduce someone else's ability to work. In a more collectivist society, caring for them would be quite straightforward.

Eugenics based on who can be "productive" takes you directly to Nazi territory, do not pass Go, do not collect $200. Once you've accepted it, the only question left (assuming we can get "accurate" predictions) is where you draw the line: autistic? deformed limb? mentally ill? criminal? gay? short? black?

And I realize this is a slippery slope argument, but slippery slope arguments are particularly compelling in cases where there is direct historical precedent. Mass sterilization to reduce "undesirable" populations has been done by law in the United States. From there, coerced or even forced abortion is just an improvement in technology.

I feel like this is an unintended consequence that the neurodivergent crowd overlooks.

Those most able to advocate for social justice towards (and de-medicalization of) autism are going to be the highest functioning and most socially astute autistic people. The most ‘privileged’ and able to lead comfortable lives.

Making the medical model of autism taboo is going to really negatively impact parents of the severely autistic kids who need constant supervision and access to medical professionals who take the condition seriously.

This is exactly correct. I suspect the next move is going to be to give the original Kanner syndrome autism a new name, as the terms "autism" and "autistic" are increasingly appropriated into a social identity group rather than a medical diagnosis.

Will you please go into more detail about the people you worked with, and how they presented? What sorts of deficits and behaviors did you see in the "mild" cases?

I realize it made sense scientifically to merge autism and Asperger’s, but socially it was a terrible thing.

My severely autistic cousin killed their family dog with a knife when he was a teenager because it jumped on him and got him dirty. He’ll never be able to live on his own and his mother’s two divorces were in large part due to his existence.

Mild autistic quirks may make life a little harder, but the impact is absolutely nothing like that.

A non-trivial part of the reason is that Asperger's is named for the Nazi doctor whose research was focused on drawing a line between "functional" autistics, and autistics who should be put to death.

> My severely autistic cousin killed their family dog with a knife when he was a teenager because it jumped on him and got him dirty.

This would seem to indicate a comorbidity; lethal violence is not a typical trait for autistic people, regardless of situation.

They maybe should have renamed it then.

He's severely mentally deficient and as far as I know has never been violent other than that incident. He picked up weight lifting a few years after that, which was pretty scary combined with what he'd done.

Many people within the Autism community have pointed out that the diagnostic criteria for Autism tends to include mainly traits of distressed autistics: things like meltdowns, shutdowns, and poor social skills. Whereas there seem to be a much larger group of people who have similar traits and experiences but who are coping with it much better (although not necessarily entirely well) who get completely missed.

Very much this. I’ve spoken to a lot of parents of autistic kids and a whole bunch of symptoms commonly associated with autism are actually stress reactions and nothing to do with autism at all.

If you found that people behaved in weird and confusing ways every day you might get withdrawn too.

Plus, instead of accepting autistic behaviors as quirks, we often try to psychologically beat it out of them (ABA therapy). This of course tends to make things worse rather than better, and you end up with a lot of autistic people who have two modes: pretending their best to be "normal", and complete meltdown when that fails.

Having a hint of autism, from personal experience, puts you in this uncanny valley, where you act in ways that confound other people, and you have a hell of a time fitting in, but not enough to make it click for them. If you mask almost well enough and fall a little short, people categorize you as eccentric, creepy, foolish, or all of the above. This is one context where I think identifying as autistic can be helpful, even though that can arouse some deeply held prejudices in some.

"people categorize you as eccentric, creepy, foolish, or all of the above."

This was the first time I've heard the foolish part. This is definitely making me question some of my past and pushing me even closer to consider getting evaluated.

The main thing stopping me is, how will a diagnosis help me? I feel what it wouldn't change anything in my personal life. I would like to make my job better, but I'm not sure what they would actually do since my biggest issues are when they lie or otherwise don't honor their word. Then I have managers telling me things don't work the way the policies say they should and that I'm foolish for taking the approach that relies on those policies/systems.

Honestly, a diagnosis probably won’t help very much. There just aren’t very many support systems available for autistic adults. What I have had good success with is asking for accommodations with a business justification. Why do I need X? Because I’m more productive that way and otherwise I’m prone to burn out. That might be because I’m autistic, but in some ways that's not actually relevant.

This reminds me of how diagnostic criteria for autism all tends to focus on _presented behaviours_ rather than _internal experiences_. People who have different sensory perceptions of the world get overlooked when they're not getting overloaded by it, because there's less reason for them to try to describe their experiences if they're not distressed. You ask those people how they think/feel/perceive out of _curiosity_, though, and a whole bunch can be revealed!

I relate to that a lot, having a recent ADHD diagnosis as an adult - there's definitely some overlap between autism/ADHD traits; in conversation with my autistic friends and ADHD friends there's definitely some stuff we share when it comes to sensory stuff, and it's even _more_ overlooked when it comes to ADHD d/x. Like, _why_ is that kid throwing a massive meltdown? Has anyone helped them to work out their triggers? Is it something as simple as: overhead fluorescent lighting, or the area is too busy with sounds?

It really bugged me when I got my ADHD d/x that my psychiatrist, as lovely as he was, described me as "a mild case". Because psychiatry is all about quantifying "health risk" of "disorder". In his mind, because I had "no trouble holding a job down" and "had never been to prison", I was doing great. (Way to feed into my impostor syndrome, doc!)

But after diagnosis, after access to the stimulant meds, and making much more sense of how my brain ticks - all the day to day stuff I was _silently_ struggling with _without even noticing that I was struggling_, I can handle better!

Concrete example: Large, busy supermarkets and shopping malls. Those places don't make me melt down: I don't get angry or upset. But visually, audibly and olfactor-ily, those places can be really overwhelming for me. I tend to get quite quiet (shutdown?) and dissociate a bit, but I don't present as being _distressed_. And all I notice, is that after being in those environments, I am tired out, and need some recovery time in my own environment. Now I'm taking ADHD meds, those places are a _lot_ easier to handle and I require less recovery time after.

It's especially difficult for kids to describe their internal experiences which I think is partly the reason why diagnostic criteria is so focused on behaviours - and those behaviours are the most evident when they come from distress, which results in our neurodivergence being pathologised so much. But I really really hope that the focus - especially in schools - can shift, and that people can help kids think and describe how they perceive the world more. What we have now is "kid is not developing at same rate as their peers" and "kid has 'odd' behaviours".

I strongly relate to your example - I find crowded places extremely stressful, but not in a way that leads to impaired functioning, but that seems to take an inordinate amount of time to recover from. I'm not sure how I feel about forming a diagnosis from that as a diagnosis seems to imply some sort of disordered functioning while to me it is simply normal neuro-diversity and not at all pathological.

On the other hand, if identifying these aspects of how our brains function can lead to concrete improvements in quality of life, it seems crass to deprive someone of that. I do wish, though, that we had ways to describe our neurological functioning without it necessarily becoming a clinical diagnosis. I can be tired on a hike and use a walking stick without first needing to see a doctor to diagnose the condition of my legs.

Thanks in part to recent trauma, situations that I used to just find exhausting now cause me to have meltdowns/shutdowns.

In a wild twist, this has improved my life, because people are much more understanding and caring about it, and I also feel much more empowered to leave situations before I get to that point.

My kid is being evaluated now. He’s been a bit behind his peers and seems to struggle socially, but only in bigger groups. The psychologist first thought it could be some kind of autism, but after observing him at school, talking to him and putting him through “the tests” she was very conflicted. So far the “working diagnosis” is adhd, but who knows. There definitely is some overlap and probably a lot of people has the wrong diagnosis.

My better half is working in a related field and told me after our last meeting with the psychologist that she has been suspecting that I have adhd. It never occurred to me, but reading up a bit there’s a lot of my life that makes more sense…

There's a reason that ADHD and autistic people come together under the umbrella of neurodivergent/neurodiverse. There's a ton of overlap between the two.

I've found that most neurodivergent people communicate in very similar ways and describe very similar experiences when not experiencing burnout/meltdowns.

How much of the overlap do you think is due to the high rates of ADHD in people with Autism? From what I last researched (Dr. Russell Barkley's works on the matter), it's a one-way street i.e. having Autism greatly increases the chances of having ADHD, but the opposite is not true because a large majority of people with ADHD do not have Autism.

The fact that ADHD and autism are categorized as two separate things says more about medicine than it does about people with ADHD/autism.

What does it say about medicine? I am not medical professional, but I have never considered the two illnesses to be that related.

Do you think anxiety and depression should be classified as one disorder? How about bipolar and depression? Bipolar I with Psychotic Features and Schizophrenia?

Do the treatments for ADHD help Autism, because if not, I'd argue they are not that similar?

> There's a reason that ADHD and autistic people come together under the umbrella of neurodivergent/neurodiverse. There's a ton of overlap between the two.

"Neurodiverse" also includes schizophrenia, bipolar disorder, schizoaffective disorder, and antisocial personality disorder (see [1]). I don't think that including such a wide net of conditions under the "neurodiversity" umbrella term makes a lot of sense.

[1] https://en.wikipedia.org/w/index.php?title=Neurodiversity&ol...

You might want to point your kid (or yourself) at the #ActuallyAutistic tag on instagram. There’s a whole community of autistic content creators out there, and I’ve personally found it really helpful to see my own experiences reflected in that of others.

> Like, _why_ is that kid throwing a massive meltdown? Has anyone helped them to work out their triggers? Is it something as simple as: overhead fluorescent lighting, or the area is too busy with sounds?

I don't have a diagnosis now, but was diagnosed with ADHD as a child (and I actually think I might have mild autism), but this question here made me consider something in a new light. I have extremely acute hearing, even now as a middle-aged adult. Something I find highly annoying is the buzzing sound that some transformers make, and primarily flyback transformers which were common in CRT televisions. I always used to have worse experiences as a child when I was forced to be in the room with a TV and strongly preferred rooms with no TVs in them. I managed to use computers, but was very picky about monitors because of this (I would only own Sony Trinitron because they didn't buzz where I could hear them). It was so impactful that I avoided television as a rule and basically didn't watch TV growing up, and while I now own a TV as an adult, I still don't watch TV shows and I avoid the room that it's in unless I have a specific reason to be there.

I think it would have helped immensely if I could have gotten away from that as a child, but at the time I didn't know that was one of the things bothering me. I ended up naturally avoiding it, anyway, which is why I spent so much time in the library. As a side note, similarly, I am very sensitive to out of spec ballasts on fluorescent lighting because it buzzes as well. And I can hear the buzzing of transformers sometimes on power lines (maybe this is why I always liked Serial Experiments Lain).

> But visually, audibly and olfactor-ily, those places can be really overwhelming for me.

I have crippling ADHD and never experienced anything like this. So I'd say that ADHD and autism are definitely very different things, you can have problems with one and not the other.

There's also a newer category called Highly Sensitive Person (HSP), that incorporates visual, olfactory, and auditory sensitivity without many of the other traits from a standard autism diagnosis. It's still considered neuro diverse, but helps those with it to draw their own awareness to their own unique challenges. As an adult, it's much easier to cope when you can clearly list what sensory inputs will be challenging, and work to avoid or change them. If you haven't heard of it there's a book called Highly Sensitive Person that can give good advice for self care.

> to include mainly traits of distressed autistics

When you understand that mental illness is meeting the criteria such that they cause serious issue in in your life, this makes perfect sense.

We're all sad sometimes, maybe even fall into "a funk" but that might not well meet the level of clinical depression. Someone might be able to casually smoke some meth, while another goes off the rails into substance abuse disorder. We diagnose based on the impact, if you're the former and not the latter you do not have the diagnosis even if you have the same basal elements as the latter.

I think the point is that specifically in the case of autism, it would be really useful to provide preventative support before it gets to the point of complete dysfunction.

Except that's not really it. The focus isn't on what causes serious issues for us, it's all about the things that cause distress for the people around us.

Autism is largely understood, diagnosed, and "treated" as You're Making Us Uncomfortable Disease

I've only skimmed the article, there was a lot of... ehhh in there. That said, ASD is a spectrum (as the S indicates), and it's not a "yes or no" spectrum, but more like a row of sliders that will be different for everybody, and THEN you have to make the distinction between sliders that people have, sliders that people show, and sliders that adjust over a lifetime of things like coping mechanisms, experiences, masking-turned-into-a-personality, etc.

I'm pretty confident that a lot of sliders are shared with ADHD; it seems like more and more research shows (citation needed) that the two have a lot in common / overlap / etc.

I'm not convinced it's environmental at all though. Genetic, I can see that; the one thing to note there though is that our parents and grandparents' environments dealt with ASD and ADHD differently from today, think of different education systems, different work, access to information, punishment for maladjusted behaviours, and diagnosis. In hindsight, people with ADHD and ASD, especially if only diagnosed as an adult, will see similar traits in their parents.

I've always considered myself "slightly autistic". Like many in this community I'm highly technical, geeky etc. I always considered it an advantage. It got me great academic results and a great job.

But I'm really bad at relationships. I've been unable to maintain one for more than a few years. Looking back I can see what the problems were. Not listening properly to my partner because I'm too busy with something else. Not understanding her feelings and not thinking about how my actions might make her feel. Being completely content with routine for months on end and being inflexible when it comes to new ideas.

At the end of the relationship I basically went into a mild shutdown. Unable to process what was happening until many months later.

This is now causing me great distress as I long to have a family. I'm confident these problems can be overcome with some up front understanding of what I need to do to combat my weaknesses. I just wish someone had told me earlier to expect these kinds of problems and that relationships won't be as easy as programming is for me.

Being warned early would definitely help, and I'm glad that people are now getting these warnings sometimes, because it's picked up sooner.

I hope you can find the right things to help you learn.

(I recommend making platonic friends with people, and talking to them about it.)

I think relationships are just hard for everyone, and those outcomes may not be because of geekiness but maybe just incompatibility. Being super outgoing or social is no guarantee of relationship success either, although yeah it does make getting the dates in the first place easier.

I reckon the fact you are self reflecting like this puts you in the top 5% in terms of “good at relationships” and future ones will be better.

In otherwords; be kind to yourself!

Concur. Persist and reap ongoing improvement. I identify with globular-toast's self-description and experiences, but often erred in relationships (both personal and professional) in the opposite way as well, that is, by over-accommodating and failing to see the end had long passed. Finding the balance of im/patience, but not too much, with both others and myself, has been a permanent project, with many and increasing successes.

Is it possible you can proactively work on these skills with a therapist while you date? Dating is a lot about learning about yourself as well as learning about someone else. It sounds like you've learned about a weakness in yourself that you think you can work on, so why not find a certified professional to work on it? I'm sure the ability to consider others and be flexible when necessary will be useful outside of dating too.

Most things in medicine are like this. There's a normal range of some trait, and then there are the extremes which have known pathologies.

Take blood pressure for example, you can be "on the higher end of normal" without having "high blood pressure". Personality traits are of course harder to define and measure, but it seems to be the same principle.

It's partly statistics ("this person is an outlier") and partly effects ("this condition is causing problems for the patient, such that the benefits of medical intervention xyz would outweigh the costs/risks").

Society medicalizes outliers, the common 'nerd' in 1980's would be labeled as 'aspie' or autistic today. The cultural status has changed drastically, since technological skill became a valued commodity but judgement of nerds as 'abnormal' remains. "Autistic traits" ascribed to people without serious mental deviations are Western culture rationalizations of intellectual withdrawal and critical vision of social circles coming from intellectuals: the social values that drive this distinction are relics of primitive societies that focused on biological performance and let intellect be merely a tool to achieve some concrete task. This obviously changed with time, but socially the ranks of 'apes in modern clothing' prevail in numbers over the intellectual minority, deciding their 'mental traits' as some troublesome deviation that has to be normalized and streamlined to 'fit in mainstream society'. It does not occur to them that society itself is pathological amalgamation of incompatible and competing cliques/interest groups that does't have any 'inherent human values' like a corporation doesn't value much from profit and market share. The idea of social skills and (enforced) social integration assumes this is the 'default' state and not culturally-bound complex of psychologically divergent behaviors that cannot be "normal" as 'asocial' behavior is right below the surface of most societies and requires arcane control mechanisms to suppress and redirect(law, armies,police, education,etc) - the 'normality' of this social structure is never questioned and people treat this "enculturation" process as some mandatory part of civilization, that their identity is based on - they cannot see their individual worth without social approval and social circles of support, the manufactured narratives and media feeds dictating what to think today. All of which are disgusting and exploitative controls that keep these 'apes in modern clothing' in line, as bread and circuses continue. Medicalizing me would not change society or improve it overall, it would just enforce another layer of cultural control - training people to treat intelligence itself as symptoms of some manufactured "spectrum" or "complex"( formally approved by Science™ as 'Broader Autism Spectrum')..as if Idiocracy was slowly seeping into real world.

Making something genetic without even being able to define what it is. It's self-report surveys and grouping by association all the way down. Says something about the state of psychology.

10 question test mentioned in article: https://docs.autismresearchcentre.com/tests/AQ10.pdf

I scored a 6 and I'm unable to answer number 2...

Cool... well I've never been considered autistic and I scored a 5, so there's some confirmation.

I have been wondering about this because my current work has attracted many mentally divergent people, probably due to its intense detail. Though this is generally a good thing right now.

Disproportionately annoyed that 'slightly' and 'definitely' have their own columns but equal weight.

Autism or at least high functioning autism is characterised by poor theory of mind.

ie. you have defective/poor/inaccurate models for understanding how emotions effect thoughts/behaviour and the other way around. More or less the same thing as poor emotional intelligence.

If someone would tell me that they have a little bit of autism I would interpret that as them having poor emotional intelligence.

> Autism or at least high functioning autism is characterised by poor theory of mind.

Neurotypical people have (with few exceptions) a similarly poor theory of mind of what goes on inside autistic/Asperger people. But because the latter are a minority, it is those who get stigmatized.

It is true that many people who are not diagnosed with autism have quite terible theory of mind to.

But it seams like you are missing a part of what poor theory of mind means here. It means that you don’t understand yourself and your own minds tendencies just as much as you don’t understand other peoples perspectives.

Imagine thinking that you know gp commenter's internal mental faculties better than gp. Remind me again which one of you is supposed to have the faulty theory of mind?!

I read a ridiculous text, and I then I tried to figure out what made the author write that ridiculous text. After which I responded with the hypotesis that was the result of my pondering.

The pondering is not intended as a truth about the authors mental state, it is simply my intuition of an idea that a mind that would write such a statement might be blind to.

But who knows... here I am on the internet trying out my ideas.

The only reason you think its ridiculous is because your perspective is limited and you can't understand the perspective that generated the comment

I understand why a person would think like that…

It makes sense that someone would come to that conclusion given certain beliefs about the world.

I call it ridiculous cause I think it is narrow minded and not optimal to think of things like that.

Indeed, it seems to me that the inability of NTs to understand ASD minds is far more impactful in social interactions than vice versa. NTs have several advantages (some contingent on NTs being the majority) which should allow them to better leverage a functioning theory of mind to improve social interactions, but in general they fail to do so when interacting with ASD people. One such advantage is that NTs should just be more practiced at benefiting from their theory of mind, since they have more opportunities to do so. Emotional regulation is another; it's an often reported ASD trait that emotions originating from empathy can be quickly overwhelming, whereas the NT doesn't have this problem.

This is grossly inaccurate. Sure, it's possible that someone can just be socially stunted in a way that looks "autistic" to non-autistic people. But that's not at all what autism is.

I'm autistic. I have a great understanding of my own emotional state and how it affects my mental function, and I often use this understanding to get myself out of situations before they deteriorate into me having a breakdown. Meanwhile you have allistic people everywhere who will neglect to eat and gradually start getting angry at everything with no awareness of what's going on. Who's the one lacking emotional intelligence?

I'm also perfectly fine at understanding most social norms; I just find a lot of them ridiculous, irritating, and counterproductive, so I'm inclined to fight against them, which goes variously well or poorly depending on the audience. (It tends to go very well around other autistic people!)

Most social norms make perfect sense. They have evolved from reasons that make sense in the context where they are performed.

Social norms are emergent, but not all emergent behavior is good. If they were correct, you wouldn't expect them to vary so heavily between cultures. (The variance is particularly noticeable when you start looking at cultures that were not heavily conquered and/or colonized.)

"Correct" and "good" depends on the context where you evaluate.

example: Shaking peoples hands is a strange social norm and a risk for spreading infections. But it is a useful interaction that you can play out when you are interacting with someone.

FWIW this article is from 2014

> I cant be successful I have autism!!

then goes back to playing video games and working as a grocery bagger at age 35. "Mild" autism is just an excuse.

I think a better way to approach it is, "I may need to find a different path to success than the neurotypical examples I've seen because I'm autistic."

It's a level of work NTs don't have to put in. They can follow the examples of other NTs and reasonably expect it to work.

Autistic people have to step back, evaluate why the method isn't working for them, iterate, and try again.

But you're right--it doesn't have to be insurmountable.

I figure if my challenge weren't this, it would just have been something else. No sense wishing to trade struggles. I have the one I have. So it's up to me to make a strategy to handle it.

Follow-on comment: I think the helpful thing about labels is that they help people find other people who are also trying to make strategies around similar struggles and learn from them.

Mild autism can mean different things. It shouldn't be an absolute prevention of success, but I'm sure it could make it harder (life is already hard).

I haven't been diagnosed, but a lot of the articles on this resonate (I scored a 6/10 on the screening and I don't even know how I can answer one of the remaining questions). I absolutely hate my job. I used to like it when I didn't have to worry about politics, policies, etc. Now it's absolute torture to go into work because I know I have to play politics, other people don't see things the way I do, I'm being told I have to change my opinions/insights/personality to match others, and the company violates their policies or says they don't mean what they literally say. If I have mild autism, then it's absolutely exhausting with no reward or end in sight. But maybe that's how it is for everyone?

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