Autism's confusing cousins | Hacker News Reader

Autism's confusing cousins

psychiatrymargins.com

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I have done a rigorous job of self diagnosis. I am autistic. I’ve also had the privilege of being able to pursue meditation, therapy, and other self development practices: I’m not as severely autistic as I was as a young man. I also have childhood trauma that I know contributes to many of my autistic presentations — see the last section on comorbidity. I also have some distinct ADHD symptoms but have never pursued that path because my hyperfocus tends to win out often enough that it’s not a hindrance to productivity. But it still causes problems elsewhere in my life.

For some people these diagnoses will be a very good fit with clear predictive outcomes. But many of us have a grab-bag of traits from several categories and still mostly get along in life, maybe with some assistance particular to one of these diagnosis but no more help overall than anyone else needs otherwise.

The diagnostic models suck. They are too broad here, too narrow there, misunderstood by professionals. I had a psychiatrist (mis)diagnose me as bipolar based on a 45 minute appointment when I was in some sort of crisis in my early 30s and that ended up haunting me years later when applying for a job with a security clearance. I didn’t even know about it at the time. This was one of the top rated doctors in a major metro area. What a sham.

The field is a mess. It has a terrible history of horrific abuse. Some autistic children still receive involuntary-to-them ECT. I think we should be supportive of research into these topics while also being critical of the very obvious problems with them.

> Some autistic children still receive involuntary-to-them ECT.

Adults too; ask me how I know.

How do you know?

Maybe because it's a highly effective treatment for severe affective disorders, catatonia, and occasionally even schizophrenia.

https://www.reddit.com/r/IAmA/comments/1pfyjs5/removed_by_mo...

indeed electro shocking is so effective that posts discussing a potential lack of efficacy are so heinous that they must be censored

Let me ask you this: what is even the purpose of ECT? What does it cause in the brain, and how come people figured out that this may be a positive thing?

https://www.astralcodexten.com/p/peer-review-request-depress... has some discussion

I mean, I know it. But the antipsychiatry/anti-ECT folks often do not know the answer to this question.

it would be of more interest personally to discuss the topic at hand itself rather than involve our personal opinions , so if you can't make your point another way this is where our ways part

My “anti-ECT” stance is more that even modern ECT still has permanent side effects, “voluntary” does not have the standard meaning in in-patient psychiatry, and it is not impossible for a patient to have more or less every treatment thrown at their brain rather than contacting that patient's regular psychiatrist to get relevant context.

It’s never occurred to me that someone could become more or less autistic…could you say more about what that has been like for you?

Not the OP, but after a couple of decades of people pointedly talking about eye contact, small talk, and body language, you learn “coping mechanisms” to deal with neurotypicals and make them more comfortable.

Did your sporting team have success on the weekend? Wonderful, direct eye contact, smile, mirror. Ok, now, to business:

If you teach this to children while their brains are young and have high plasticity, they might "grow out" of many autistic symptoms entirely?

You don't grow out of it as much as learn to manage it, this requires that you develop some form of executive function though. In my case I was forcefully required to be responsible for my younger brother (when I was 7) and so learned out of necessity -- but this led to a lifetime of resentment and so I don't recommend it as a solution.

I was homeless by 16 and had no safety net, had to graduate high school on my own while living out of someone's garage, and generally take care of myself most of my life due to absentee, drug-addict parents, and I can tell you that this trauma only worsened my executive function by the time I had the privilege of being able to sit back and reflect from a place of security and comfort.

I'm sorry you have resentment issues... definitely get that.

I don't know the neurological mechanisms behind autism, but I know that ADHD is, briefly, defined by a reduction of dopamine receptors across your brain.

The brain is neuroplastic, especially when young, but I doubt you can just influence the growth of significantly more dopamine receptors out of pure willpower and habit-forming; especially given that ADHD disrupts those two facilities.

This is in part why dopaminergic drugs such as Adderall work so well, and why dopamine/reward-center disruption due to childhood trauma can have such a negative impact on one's ADHD symptoms.

Again, I don't know how much this applies back to autism, but it has definitely been a bane of my existence constantly explaining to people why I can't just meditate, habit-form or diet or exercise away my symptoms.

These things help, as does directed research and experimentation with what does and doesn't work for me, and because of my ADHD these things are integral to my ability to function as an adult in this insanely complex and stressful world. And it's definitely made a difference in how I manage my symptoms, especially when I look at how my siblings don't manage theirs and lack basic coping mechanisms.

But I frequently run into people who arrogantly assume I've never even heard of meditation, or that I have a bad diet, etc. and offer them up as panaceas. These people often get defensive and more arrogant whenever I try to explain to them that ADHD is not just some "mental block" or collection of bad habits that can be "fixed".

So yea... I also think we need to do way more clinical studies about the effects of teaching coping mechanisms at a young age, but I don't think autism is something that you can grow out of, there are likely specific underlying genetic and neurological factors that affect how much a specific individual can control or cope with their symptoms.

I get it.

Society is moving in the right direction at least. At one point, the bell curve had 3 sections: normal, genius, retarded. Now we have more gradients and some of them trigger help or maybe longer exam times.

This causes over-diagnosis and resentment. Coping mechanisms grow over time. It’s definitely better if you can appear neurotypical.

I think so. If I had had somebody in my youth who taught me how to interact with people I am pretty sure I would have done much better. The worst for me was to notice that I don’t fit in and had nobody to help. It was extremely lonely and depressing. But I am also a pretty mild case and performed well in school and work. I am not sure how it would have worked with severe autism cases, for example non verbal people. That’s a different ballgame.

A common issue is that autistic children tend to have autistic parents and many autistic parents are sadly bad att helping their kids understanding social interactions.

That’s what I’m curious to hear from you and OP…does that make the autistic person less autistic? Or is it a mask?

I—-as a non-autistic person—-have lots of default tendencies which were socially discouraged as a child and which are now no longer part of my self concept. I’m not “repressing” a desire to be awkward, I’ve simply learned to be less awkward.

But my understanding of autism, which is I think backed by the article itself, is that autism exists as a fundamental cognitive process and tends to be pretty stable.

Btw the reason I ask is to learn…as a software dev and manager, several of the people I interact with could probably be diagnosed autistic and I’m always curious to try to understand what that’s like better.

I think you can mask to appear less autistic, yes.

I think autistic people would have less eye corner wrinkles, because they don’t smile automatically when others smile. A study would be interesting.

As part of my job, I have to interview and hire people.

When I first started interviewing people, I would have crippling anxiety. On days I had a interview scheduled with a candidate, I would obsess and have anxiety to the point where I wasn't able to focus on anything until the interview was over. It was bad. I'd spend hours rehearsing every line I was going to say. I was an incredibly awkward interviewer.

Fast forward 10 years and hundreds of interviews later, the anxiety is completely gone and an interview doesn't even spike my heart rate anymore.

I absolutely met multiple DSM criteria for anxiety 10 years ago, but not anymore.

I suppose I was cured through "exposure therapy" (or whatever you call doing something repeatedly that gives you massive anxiety).

Interviewing still doesn't come naturally to me. But it's easy now because every interview is basically scripted. I repeat lines that I memorized over the years. I always start interviews with the same ice breaker. I use multiple tactics to put myself and the candidate at ease throughout the call.

Do I still have anxiety even though I've learned how to cope with it? I don't know.

Is someone still autistic if they were able to learn coping tactics that make the symptoms invisible to themselves and others? I don't know.

I think the difference is that if an autistic person learns to mask, that's probably useful as a coping mechanism but doesn't remove the autism in the sense of making the fundamental neurological difference go away. Anxiety (even in anxiety disorders) can be fundamentally reduced by exposure therapy, not only in the sense of finding more effective coping mechanisms but in the sense of the anxiety itself diminishing or ceasing to exist.

For what it's worth, exposure therapy is a real term and it's an actual part of cognitive behavioural therapy.

Very good questions. Some part of the answer might come down to your identify. Do you identify as an anxious person or a person with anxiety? The question would become even more interesting if you'd be taking a drug: is a person treating their depression successfully with an antidepressant still a depressed person? Or a person with depression? Do you have high blood pressure if you don't have high blood pressure due to meds?

> I suppose I was cured through "exposure therapy" (or whatever you call doing something repeatedly that gives you massive anxiety).

I think it’s called practice or experience.

I have a similar experience.

Interviews are pretty weird in that you meet a new person and then very soon need to have a really serious conversation about important things. It's also a social context which is inherently stressful for the candidate, and where being good at putting them at their ease gives you better results.

I even notice that during the times of my life when I hire a lot, I have a much easier time with being extrovert and social at parties and in everyday interactions.

During times I don't have to meet new people as often, I get worse at it.

The term I've heard is masking.

It sounds to me like the article author calls that social awkwardness not autism, no?

>The key distinctions are that socially awkward individuals understand what they should do socially but find it difficult or uninteresting (versus genuinely not understanding unwritten rules), show significant improvement with practice and maturity, are more comfortable in specific contexts, lack the sensory sensitivities and restricted/repetitive behaviors required for autism diagnosis, and generally achieve life goals despite awkwardness rather than experiencing clinically significant impairment.

It seems to me that this sort of definition would preclude any person having general intelligence such that they are able to learn to mask (or feel like they have to mask less in certain safe areas).

Yeah, really good point, and I question my own diagnoses sometimes. However: I did not understand for many years why I needed to mask. I was not being contrary or looking for attention - I really did not get it.

Once you understand that neurotypicals have special needs and you must play-act to smooth things over, then you play the game.

I think your comment is very insightful. It made me think and reflect. I am not socially awkward, however: but I am autistic. I really think so. My ability to appear less so over time is my own achievement.

I think I have some kind of autism because I have been doing this social skill game for decades and still has not "clicked" with me.

It does not mean I am bad at it, it means I don't understand the rules. I can copy others people tactics and sometimes it works, but still don't know why.

i suspect it’s only the minority of people who are normal

everyone needs to learn impulse control

we draw a semi? fully arbitrary line on what too many or too strong

being normal is just the balance of your talent to mask vs the strength of the oddness

One important detail which is missing from it. Masking is far from free. I have at least met several people who are capable of masking but just grow so resentful of it that they outright refuse to do it for the barking-mad neurotypical society any more. The reason for the harsh references to mental health? Because most common doesn't equate to not being deeply irrational and dysfunctional. Keeping up with the Joneses to the point of keeping oneself in debt? 'Normal' behavior but frankly belongs on a diagnostics list for something.

Masking is hugely mentally draining.

I masked for years but recently (possibly linked to some bereavements in the family, who knows what the actual trigger was if there even was one single trigger) the constant effort required just burned me out. Anxiety spiked, depression symptoms loomed, and I just felt exhausted all of the time.

I've spoken to many people in the past 10 years or so who were in a crisis/burnout/depression or however they personally labelled their situation with varying degrees of bad mood, depressed affect, and reduced energy. Every single one of them had a mask they had been wearing for a very long time, and which was hugely mentally draining on them. Most of them wore the mask especially when interacting with themselves, interestingly. Some of them self-identified as neuro-atypical (with or without professional diagnosis), others didn't. Some of them identified their situation as a co-morbidity of being atypical, others as a result of it, or as a pure coincidence. It's not clear to me whether the masks themselves and/or the current inability to wear them were a reason, a symptom, or just a coincidence of said situations and/or the subjective or objective atypicalliness. But whenever I hear that masking has such a huge drain on people with ADHD/autism I wonder about the questions of cause and effect, the question of correlation and causation, and the question of (self-)selection bias. It's really a mess and it's very difficult to make sense of any of that. But mostly, I feel that discussing ways how society could reduce the pressure to mask might be more beneficial to everyone than finding the perfect definitions for groups of people who have an accepted reason to be drained by their masking, while others must still endure because their masking is not socially or medically recognized as unnecessary suffering.

p.s.: hope you're doing better now.

> Masking is hugely mentally draining.

Sounds as though this is not a universal truth?

"Sounds as though" based on what?

The literal comment above the one I replied to.

> Not the OP, but after a couple of decades of people pointedly talking about eye contact, small talk, and body language, you learn “coping mechanisms” to deal with neurotypicals and make them more comfortable.

Why the snark? How are you concluding from that, that masking isn't draining? I don't see a connection

Masking is defined by being a maladaptive strategy, so I don't think that it being in general mentally draining is disputed. The issue is that sometimes there is a tendency to call any coping strategy as masking. There are coping strategies that can be successful, and there are reasons to adopt them other than to hide not being neurotypical or to make neurotypicals happy.

Commonly called masking - learning the 'rules of the road' for peopling - the hardest thing that young folks with autism or ADHD need to learn is that you must learn how to do this, the world will not (often or always) change to accommodate you - but once you do it, you can appear more or less normal most of the time.

that’s why acquiring wealth and power is so important

nice to throw off the shackles of the lifetimes of masks we wear and now the normies must adapt to us, instead of the other way around

fellow autists there is hope for us!

The problem is that at times the world is fucking insane and are the ones who belong involuntarily committed as a danger to self and others. Instead they are put into positions of power.

When I was starting in retail, I had several notebooks I made of conversational flowcharts. They helped a lot back when I was in my late teens, and, along with some improv training, I can put on a pretty convincing performance now (my customer service skills are top notch). The only problem I have is when people veer too far off of my training.

There's nothing in the diagnostic models for nearly any mental health concern that presumes a patient would forever earn that diagnosis nor (certainly) that its presentation would be identical through their life even if the diagnosis stood.

There are some clinicians and unfortunately now many patients and caregivers that nonetheless take an essentialist view of diagnosis and come to identify their patient/self/child/peer with what's really just meant to be a guideline for support with ongoing dysfunctions.

In reality, most people face some fluctuating bag of dysfunctions over the course of their life, with fluctuating intensity, with contributing causes too diffuse and numerous to identify. They might be diagnosed squarely by one clinician with one thing thing at one time, then see some other clinician the same day who thinks the diagnosis was overstated or preposterous. Or they might find that a qualifying symptom that seemed very salient at one time of their life hasn't been an issue for them for a long time because of some new learned behavior, some change of circumstance, etc. Likewise, they may even find themselves facing new or greater dysfunctions compared to what they'd experienced or noticed before, precipitated through known or unknown reasons.

For people most intensely disabled by mental health dysfunction, they often can't escape that dysfunction entirely without the discovery and resolution of some kind of radical physiological or environmental issue.

But for the majority of people who just found that they had a hard time with their daily life, but were otherwise independent, and received a diagnosis that helped them see some constellation of related factors and opportunities for accommodation or treatment, things are hardly so static.

For most of early psychology, this marked the distinction between "psychotic" and "neurotic" presentations. The former represented a disruption so severe that escaping disability and achieving independence were largely out of reach, whereas the latter were understood to be real but fluctuating or even ephemeral disturbances.

It's not really until very recently, when so many people started to obsess with "identifying" themselves with this thing or that thing in some kind of permanent way, that this distinction began to fall out of mind.

In the case of those diagnosed with autism as part of generally independent and functional lives, it's not hard to find people who have experienced changes to the symptoms that originally qualified them for the diagnosis -- sometimes positively, sometimes negatively; sometimes during certain times, sometimes permanently. It's also not hard to find people who received such a diagnosis at one time and either felt comfortable fully rejecting that diagnosis at some later time or had a clinician who strongly questioned it or refused to confirm it. None of this stuff is static and much of it is subjective.

Your experience illustrates something that often gets lost in the autism-vs-not-autism debate: many people don’t fall into clean diagnostic categories. You’re describing a profile that mixes autism traits, trauma adaptations, ADHD features, and developmental history, and instead of neatly labeling you, the system failed you outright with a bipolar misdiagnosis. That alone shows how fragile clinical certainty really is.

I think the most important part of what you wrote is that you changed over time. Whether that improvement came from meditation, therapy, maturity, trauma processing, or simply growing into yourself, it challenges the idea that autism is a static essence. Development, coping skills, neurology, and environment interact in ways the current diagnostic boundaries don’t fully capture.

Where I push back slightly is on the conclusion that self-diagnosis can automatically fill the gaps. For some people it’s deeply accurate and validating, for others it may explain one part of their experience but obscure another. As you said, many people carry a “grab-bag” of traits, and a single label can illuminate or compress that complexity depending on how it’s used.

You’re right that the field has a painful history and uneven present. Misdiagnosis is real. Forced treatment is real. Diagnostic tools are blunt instruments for a very diverse human reality. Supporting research while staying critical of the system makes sense, not because autism isn’t real, but because the categories we have are still evolving. Your story is a perfect example of why humility in diagnosis matters, whether it’s done by a psychiatrist or by oneself.

Edit:typo

I was also misdiagnosed as bipolar due to a crisis years ago, which destroyed my career path in the military and post service. Since then I’ve been diagnosed as autistic, but much like you I’m just capable enough to kind of run the rat race but not quite capable enough to thrive.

How though? Isn’t medical data private and you don’t need to share if you don’t want to.

Doesn’t work like that in the military, you have no privacy rights basically.

I strongly believe I was misdiagnosed with autism when in reality the traits were caused by traumatic backlash from those I was supposed to trust towards ADHD traits that would have calmed down after adolescence. The diagnosis was largely a red herring for me and led me down treatment paths that did not address the root of my issues, and I believe I suffered unnecessarily as a result. It is insane to me that people are sooner to blame vaccines and diet than childhood upbringing/environment for causing symptoms construed as autism or ADHD. It makes sense though - no parent wants to be blamed for their child's lifelong disorder, just as mine still don't to this day. Cancer might just be curable, but a parent who refuses to change their mind will never be.

I am doing better these days but I sometimes wonder how I would have turned out if I got help sooner, instead of spending years and years searching for the wrong kind of help. It doesn't help that society is talking more about this and inadvertently leading people to believe that these problems are just the way things are, without considering upbringing and environmental factors.

At the same time, blaming the wrong problem is different then spending all one's time blaming the right problem, which is different than letting go of the past and doing the best one can with one's life. It is nearly insurmountable for me but I try to put forth an effort each day.

> The diagnostic models suck

Mental healthcare in-general tends to suck. I went for years to a boutique psych that had suspect people working for them and that would just increase dose until prescribing the max allowed of various meds.

What I’ve noticed is that if a doctor’s or dentist office looks stylish, consider moving to a different one. It’s not worth ruining your life, health, teeth, etc.

BTW, there's research that shows that schizotypy (schizotypal/schizophrenia) is sort of the opposite of autism. You have to squint your eyes a bit, for example both of these neurotypes involve social difficulties, like the subjective feeling of being alien in the world (known as Anderssein in German psychiatry). However if you peel off the social layer then the remaining autistic features become anti-correlated with the remaining schizotypal features on the scale of the population. There are also some decent theories that suggest this should be the case - for example in the predictive coding theory it is believed that autistic brains over-weigh sensory inputs over their model of the world, whereas schizotypal brains over-weigh their model of the world over the sensory inputs. Or the Big Five traits, openness to experience is usually low in autism and high in schizophrenia.

I think I understand what you mean.

You're saying that relative to the 'typical individual', autistic brains weigh sensory inputs more heavily than their internal model. And that in schizotypal brains, relative to the 'typical individual', the internal model is weighed more heavily than the sensory input, right?

I don't know much about this area, so I can't comment on the correctness. However, I think we should be cautious in saying 'over-weigh' and 'under-weigh' because I really do think that there may be a real normative undertone when we say 'over-weigh'. I think it needlessly elevates what the typical individual experiences into what we should consider to be the norm and, by implicit extension, the 'correct way' of doing cognition.

I don't say this to try to undermine the challenges by people with autism or schizotypy. However, I think it's also fair to say that if we consider what the 'typical' person really is and how the 'typical' person really acts, they frequently do a lot of illogical and --- simply-put --- 'crazy' things.

Isn't "what the typical individual experiences" pretty much the definition of "normal"?

Whether "normal" is also "correct" is a completely separate question. There are plenty of fields where the behavior of the typical person is also widely perceived to be incorrect, like personal finance or exercise routines.

>However, I think we should be cautious in saying 'over-weigh' and 'under-weigh' because I really do think that there may be a real normative undertone when we say 'over-weigh'. I think it needlessly elevates what the typical individual experiences into what we should consider to be the norm and, by implicit extension, the 'correct way' of doing cognition.

No biggie, there's a real normative undertone to the world in general too.

Norm itself means "what the majority does" or the socially (i.e. majority) accepted yardstick ("norma" in latin was a literal yardstick-like tool).

It's not about the typical person _always_ doing things in a better way, or the autistic person always doing things differently. It's about the distribution of typical vs atypical behavior. So, it's not very useful to characterize such atypical behavior better or worse based on absolute moral or technical judgement. Morality changes over time, cultures, and even social groups, to a bigger or smaller degree.

If, however, we use "degree of comformity with majority behaviors/expectations" as the measurement, autistics do perform worse on that.

Norm is descriptive. Normative is prescriptive.

Knowing the difference is important to understanding and empathizing with the person you replied to.

Normative is just the adjective form of "related to norm" - can still be perfectly descriptive in use. The difference you allude do is more about the practical enforcement of a norm (or lack thereof), than the kind of the part of speech use to refer to it.

I 100% understand and empathize, doesn't mean I agree.

> Normative is just the adjective form of "related to norm"

You might want to recheck the definition of normative. Yours is a non-standard usage and you will be misunderstood if you continue to use it that way.

Norm is is, Normative is ought.

> Normative: pertaining to giving directives or rules

> Synonyms: prescriptive

No. Both definitions are correct. Don't tell people to recheck without first doing so yourself.

https://www.merriam-webster.com/dictionary/normative

Literally false.

It is fine if you disagree with Marriam Webster, but maybe chill a bit with your attitude.

You don't get to decide.

>You might want to recheck the definition of normative

Funny you should say that. Merriam-Webster:

1: of, relating to, or determining norms or standards 2: conforming to or based on norms 3: prescribing (see prescribe sense 1) norms

A "norm" can refer be either descriptive (average) or prescriptive (standard), but "normative" specifically is an adjective which refers to things establishing or relating prescriptive norms (this subtle distinction is often not made in short dictionary definitions but is readily observable in use.)

The center of the normal ditribution is “normal” or “normative.” That’s where the term comes from.

It’s like saying we shouldn’t call immigrants “aliens” because that conjures images of space. Where do you think the term comes from?

If the mind is a kind of "prediction machine", wouldn't that make ALL psychiactric disorders a specific variation of faulty prediction mode though?

Yes, but not always faulty. My (diagnosed) OCD and Anxiety have saved me from many bad situation. I see the many many many possibilities that something can go wrong and I have very low risk tolerance.

Given we're long evolved, and also tribal based animals, and that culture is an evolutionary pressure feedback mechanism, and prediction is fundamentally useful to our reality, different "thinking styles" (ways to predict/understand outcomes) are useful, aannnd, tribally we used people for their usefulness, I often wonder if "faulty" is the correct lens. That is to say, If prediction variation was useful to tribes, having both 'trust the model' and 'trust the senses' type people, I suppose framing these as disorders rather than trade offs is probably the wrong lens entirely. Society/culture/reality is so narrow and predictable these days, faulty in what context, you know? If you breed 20 generations of "best night watchers", in the jungle at night looking down, quiet, still, dark... you'd probably be selecting for specific traits, and creating new traits, retinal rod density and sensitivity, faster dark adaptation/contrast etc, attention/vigilance traits, pattern detection, anxiety adjacent traits in hypervigilance, prob something about circadian rhythm tolerance etc etc. (https://www.researchgate.net/publication/40886135_Not_By_Gen...)

it becomes a disorder when the person faces "too many" difficulties due to their difference (instead of enjoying the advantages)

and of course there are extreme cases, like the many non-verbal people (who likely wouldn't be able to live alone, their communication is limited to poking at pictures on a board), and the truly end of the spectrum where nothing sort of institutionalization can provide the environment and care necessary for survival

but of course having our society somehow become so narrow allows for the economic efficiency to even have the surplus that then we give to people with these disorders (in the form or care, attention, medical research, and so on)

Yes, having society "somehow" became ordered for a certain "norm" on a spectrum certain does create a disordered reality for the others...

There is a school of thought that all psychiatric crap can be expressed in terms of disordered synaptic plasticity ... Dementia it falls apart; psychosis it forms and prunes "wrongly", etc.

Unfortunately this view is a little ahead of technical capability to observe and intervene at that level so it's more of a clarifying viewpoint than a predictive tool

That is fascinating, I have seen the schizophrenia model of having "trapped priors" before.

I figured that this is probably something Scott Alexander has written about, and lo and behold: https://slatestarcodex.com/2018/12/11/diametrical-model-of-a...

> BTW, there's research that shows that schizotypy (schizotypal/schizophrenia) is sort of the opposite of autism.

And I disagree with that. There is a wide overlap of symptoms in all mood disorders. People with ASD show many traits of the negative symptoms of schizophrenia. This paper might change your mind:

https://pmc.ncbi.nlm.nih.gov/articles/PMC8931527/

Yeah, at face value the two diagnoses are positively correlated. This is simply true. And traits of these two only become negatively correlated if you remove the shared social difficulties, which includes a lot of the negative symptoms. Unfortunately everything is positively correlated in psychiatry. If you want to explore this deeper I recommend the "p factor" (general psychopathology factor), which is a serious, multi-year attempt at identifying something like the "first eigenvector of psychiatry", a loading common to all psychopathology, including substance use, affective disorders, psychotic disorders, conduct/personality disorders, ... The idea is that if you only know that someone has whatever goes into this vector then you know that person is quite likely to develop some disorder, but you don't know which one.

I would only add that ASDs do not have "real" negative symptoms of schizophrenia, but what they do have can look a bit similar. The research on anti-correlation was using questionnaires and binned the social questions taking that into account.

Yeah, the "mirror image" idea makes a lot of sense to me. Both groups feel out of sync socially, but for opposite reasons: autistic cognition leans too hard on raw sensory input, schizotypal cognition leans too hard on internal interpretations

Wouldn't the implication of them being "opposite" be that in some sense they are mutually exclusive? I don't really see evidence of that. Your example of sensory input vs world model weight is a bit flawed, because both of those are extremely multifaceted. One can have extreme weight in sensory input in one sense but not others, as well as extreme weight on world model for certain aspects of life.

I don't think there's much underlying relationship. True they will both impact social relationships. But it's more like how being blind or being deaf will impact social relationships. The mechanics might be the same but the cause is very different.

IMHO schizophrenia is a breakdown in the barrier between imagination and processing of reality.

Autism and the like is an inability to process social cues like a blind person might have a damaged visual cortex.

Autism is not the inability to process social cues. It seems more likely to be the difficulty to either filter or generalize sensory input.

The default mode network is so active that there is little bandwidth remaining for processing sensory input.

That's either schizophrenia, ADHD, or one of the many faces of anxiety.

Autism is more broad-spectrum than just related to social processing. It's most visible in social processing because that's the cognitive area that humans have highly specialized in as a species, where expectations of performance are very high, and thus where deficiencies processing complex information in real-time are most visible. If we were birds, we'd probably think autism had something to do with flying. Instead, we are talking tribal apes, so when someone has the cognitive differences that lead to autism, we notice most strongly that they are having trouble being a normal talking tribal ape.

But the effects of autism are visible outside of social interaction too, with repetitive behaviors, intense focused interests, trouble with adapting to change, rigidity in lifestyle, etc.

That's a fair point.

Excellently put.

It is possible though, to unify those things, and to see those other effects also as second or third order effects of the same underlying deficiencies that cause problems in social interaction. I believe, for instance, that our super power as neurotypicals is our ability to see, process, model and make sense, especially in real-time, of what's inside the minds of other people. In a way, we are wired to be comfortable with multiple worlds or perspectives around us, because we can see them, process them, and make sense of them. It makes sense to me that a person who is less good at this, will end up seeking a model of the world that is more rigid. If the worlds of other people around you seem chaotic to you, and uncomprehensible, then you will seek an environment and an understanding of the world that is more static, rigid or fixed. So, I think, at least on a conceptual level, it's possible to link the root causes of social problems to the root causes of the need for rigidity and stability.

What's your interpretation of this study?

https://pmc.ncbi.nlm.nih.gov/articles/PMC6982569/

Something fascinating that has been noticed by many people is that LLMs with a low temperature setting produce output similar to autism and high temperature is schizo in style. You even see the AIs get stuck in repetitive loops at very low temperature settings.

> Or the Big Five traits, openness to experience is usually low in autism

Openness (to experience) in the Five Factor Model is quite strongly correlated to IQ, so I'd rather expect that highly intelligent autistic people would score much higher regarding openness.

both have an obsession with seeking the truth and understanding what's real

Oh schizophrenic brains ... I remember reading a journal article that the immune system was to blame... The immune system in the brain is used to remove axonal connections between different neurons ... Because this is overactive, control of ones mind is well harder...

I think part of the tension here comes from the way autism is understood both as a broad, fully-continuous, multivariate spectrum, and as a binary diagnosis.

To be sure, clinically, thresholds are useful because services, insurance, and research all rely on clear binary classifications, in our current society. But outside that context, it isn’t obvious that everyday language needs to mirror that line. Self-identification can be a way of making sense of one’s life, not an attempt to claim a clinical label.

But at the same time, the spectrum includes people with very high support needs, and there’s understandable concern that broad or casual uses of the term can hide those realities in ways that impact care.

To me, none of this means people are wrong for wondering about autism. And I do not have the experience to advocate for or against "anxiety disorders" being weighted more heavily in clinicians' priors than they currently are (as the OP article heavily implies with its length). I mean only to highlight the mismatch between a binary diagnostic system and a very heterogeneous spectrum, and the need for language that acknowledges self-understanding without flattening anyone’s experience.

The largest confusion with Autism is the ever changing definition from one DSM to the next where whole areas are suddenly included and others excluded.

It seems in the DSM 5 the definition was narrowed specifically to focus on two performance deficits: 1) immediate harms either to the inflicted or to those they interact with due to social interactions, 2) catastrophic academic failures due strictly to input/output perception irregularities not otherwise explained by neuro-transmission disorders (things that can be treated with drugs) or low intelligence measures.

That excludes a massive host of social and perception abnormalities that do result in less immediate social rejection and abstract reasoning failures.

As far as I can tell, the definition of autism coincides with the desire of healthcare to address it without having to carve out 100+ variations of behavioral outcomes to get insurance to pay for it.

We know autism affects all sorts of long term outcomes, but if you tried to split it into actual diagnoses, you end up with insurance companies dividing and conquering approvals.

So instead of having several definitions, we put them all behind autism because that has already received appreopiate laws that establish requirements to treat both at school and in healthcare settings.

So basically, once it breached the "we need to address this", rather than every new diagnosis having to struggle to say "look, this problem effects society", it just grows offshoots and spectrum status.

Because it's definitely not a physically identifiable disability. It's all behavioral and that will always have more coincidences.

You nailed it. I've spoken with doctors who were involved in changing DSM V to have a more inclusive definition of ASD with the express purpose of getting more kids access early intervention that they wouldn't with the PDD-NOS and other diagnoses from DSM IV.

That might be the intent but in practice the opposite has come true. The more narrow definition is more exclusive, which means fewer child with autism can be diagnosed as autistic. For example criteria under the description of Asperger’s and PDA are excluded so those children cannot be diagnosed as autistic and therefore those children cannot receive additional support. That is a massive handicap that requires main streaming children that cannot function or learn in a normal classroom.

I think you might be in the wrong state.

Many states require health insurance cover autism and have their own definitions.

It's definitely a broad sprectrum if the right healthcare system from the State's POV.

So how do other countries other than US define autism?

The UK follows the DSM

> It seems in the DSM 5 the definition was narrowed

I think it may have been narrowed in theory, but often not in practice.

Here in Australia, making DSM-5 ASD a shortcut to getting funded by our national disability insurance scheme (NDIS) caused a lot of pressure to broaden the diagnosis in practice - if clinicians have to stretch the diagnosis to get someone the support they need, they feel ethically obliged to engage in that stretching, since it is in the best interests of their client (who are experiencing real challenges, even if those challenges map poorly to the official diagnostic criteria).

And Australia is not unique in providing funding pressures for ASD diagnosis, although NDIS is arguably a global outlier in the scale of that pressure. Apart from funding, growing popular and clinical mindshare of the diagnosis creates independent pressure to broaden its definition.

So a theoretical narrowing coexists with a practical broadening - and the latter is arguably what really counts

The day-to-day impact of being diagnosed is practically non-existant for me. It might explain "why" I might react to a specific stimuli but it doesn't stop the reaction. At best it's something to laugh about with my wife. It does also offer an early-warning system when I'm over stimulated and that I need to 'get home' soon.

> The day-to-day impact of being diagnosed is practically non-existant for me.

Yeah, as the old adage goes: with an ADH?D diagnosis you get to try drugs like lisdex or methylphenidate (or the non-stim options if those aren't suitable), but with an Autism/ASD diagnosis you get some pamphlets, coffee morning invites and a reading list.

I don't have a formal diagnosis but my child does and that made me read lots on the subject. Authors like Eliza Fricker, Ellie Middleton, Pete Wharmby amongst others.

It's opened my eyes to many other related aspects, specifically Rejection Sensitivity Dysphoria (RSD) and Pathalogical Demand Avoidance (PDA) and how those play into both ADH?D and ASD. In reading about them I've worked out just how much they apply to my-undiagnosed-self and how understanding the triggers and recognising the early behaviour has allowed me to adapt to minimise their impact.

I don't know if PDA is real, one of the popular books on the subject is just a copypaste of the discussions on the facebook group.

Anyway I have it and it's crippling.

Intuniv/guanfacine helped me a lot with that and time blindness, but in exchange it makes you tired and affects your sex drive.

Also have to ramp off it, which is a problem if you run out or are traveling and can't get a refill.

Thanks for the advice. There's never a free lunch with psych meds, eh?

There's rarely a free lunch for any meds.

I know someone who needs Meds A because of $SERIOUS_CONDITION (medical, not psych.)

They're on Meds B to deal with some side effects of Meds A.

They're on Meds C to deal with a side effect of Meds B.

They would like to be on Meds D to deal with a side effect of Meds C but Meds D are absolutely contraindicative with one of the other meds.

Out of the various combinations (no meds, Meds A, Meds A+B, Meds A+B+C, Meds A+B+C+D) they've chosen the one that is most bearable (Meds A+B+C) and they can live with the remaining side effects. The other options are worse. 'no meds' and 'Meds A+B+C+D' would mean death in the very near term, whilst 'Meds A' and 'Meds A+B' have some quite annoying and restricting side effects. 'Meds A+B+C' is the least worst option.

"Rejection Sensitivity Dysphoria" is not medically recognized and is literally just something a guy with a blog made up.

(Note, the guy with the blog is a doctor, but he specifically recommends certain medications for this that I don't think anyone else who discusses RSD online would agree with if they knew this.)

Personally, I think it just sounds like a description of anxiety.

Homosexuality used to be a medically recognized medical disorder so probably worth taking everything with a grain of salt either way.

For my sister, getting diagnosed was important to her because she always felt like she was broken but now sees herself as simply different. I'm not aware of any workplace accommodations she has requested but it has been good for her self-esteem, which is a benefit in of itself.

Being able to laugh about it, and know what is going on however is huge. Especially compared to being shit on all the time by others and self blaming (a common pattern!).

If you happen to have built a functioning support nets already, being diagnosed is at best a curiosity. If you didn't, or your existing ones have crumbled, it gives you tools to do that.

Yeah, that's basically the best-case scenario: the diagnosis doesn't change who you are, but it gives you a map of the terrain

> But autism may also be the only relevant diagnosis they’ve heard of or are familiar with. They haven’t seen any cool TikToks about being schizoid. No one’s offering them quizzes about being schizotypal.

Don't underestimate TikTok. You can find all sorts of weird fad mental illness there. For a while tourette syndrome was all the rage and the platform was filled with kids faking tics. There are fake epileptics faking seizures too. OCD is another common "cool" self-diagnosis and there are online quizzes to tell you how OCD, or ADHD or bipolar you are. It wouldn't surprise me at all if schizoid or schizotypal caught on.

I think some people are looking for the self-validation that can come with a diagnoses, an explanation for why they are the way the are, feel the way they do, or why they struggle with certain things. Others are just looking for views, attention, or a community to belong to.

While it can be fairly harmless the ability for mass sociogenic illness to spread via social media is interesting and a bit frightening.

> For a while tourette syndrome was all the rage and the platform was filled with kids faking tics.

Kind of like all those kids in Le Roy, NY who began experiencing involuntary tics. IIRC, it was interesting that it was mostly girls who were affected by the "craze".

https://www.npr.org/2012/03/10/148372536/the-curious-case-of...

There was (perhaps still is) a lot of stuff on there by people claiming to have dissociative identity disorder (what used to be called multiple personalities)

While this topic is here

Also see specialisms WITHIN Autism that are different to the mainstream Autism

The one I know most about is

PDA: Pathological Demand Avoidance [1]

PDA presents differently and needs very different strategies to mainstream Autism.

Main signs… kids under 12 attend school. However they explode at home or in private. At school the PDAers are masking (pretending to fit in) which is draining. When they get home the pent up frustration is released (explosively). So the family at home see a very different kid to the one that school/extended family witness. If this is an A-Ha! lightbulb moment for you or your child, see the questionnaire at the PDA Society[1]

[1] https://www.pdasociety.org.uk/what-is-pda/

But ... pda behaviour is very similar to OCD.

Is it due to stimulous overload or anxiety? I think that's the difference.

The point being misdiagnosis ocd as pda is a risk if autism is the only thing people consider. Maybe not a a huge deal since realistically a misdiagnosis often means you get a pamphlet with broadly similar advice and maybe and cbt anyway ... but maybe I'm being overly cycnical.

Do you really mean OCD? Or do you mean OCPD? I wouldn't think that OCD would be similar to PDA.

Yes. And yes, OCD can look similar I think (IANAP). Both are often anxiety driven. Try telling someone with OCD to put on their shoes quickly if they are paranoid there's a spider in them ...

Sure there might be some "pure" pda where it's 100% down to reacting against demands. But AFAIK it can be also driven by autism related anxieties ("I can't do that because for some reason it's freaking me out and I can't explain it, so I'll get mad and then think I'm mad because I don't want you ordering me around"). Or it's just "I didn't understand the first 16 times and now I'm mad that you're mad ..." which is more like pda as it's often described ... but is it always that?

OCD is often anxiety over specific fears ("if I do that I might make a mistake, and if I make a mistake it's the end of the world, so I'll get mad and think I'm mad because I don't want you ordering me around").

Anyone a bit "weird" can be reactive if you tell them something that seems reasonable to you but isn't reasonable to them.

Spot on. My daughter's PDA led me to the self-reflection of my own PDA, and ultimately to the self-discovery of my ASD.

If you think you (or a loved one) may have a psychological condition, go to a psychologist and get a screening. The diagnosis isn't the important part. The value is in the 20-something pages of detailed analysis by a professional.

At a bare minimum, it will give you a fresh perspective on things you already knew. In my experiences, there will be things you didn't realize about yourself.

They aren't going to tell you what the solution is to all your problems; that's for you and your doctor to figure out. They will give you everything you need to make well-informed decisions, and that's priceless.

Autism diagnosis has targeted screening questionnaires. So what kind of general purpose screening do you mean?

Get screened for whatever you think you've got. Think you've got ADHD? Go get an ADHD screening. Autism? It's not easy to find a psych who does adult Autism screenings, but they're out there. OCD? You get the idea.

Regardless of whether the conclusion is "yes you have x" or "no you don't have x" the diagnosis will be accompanied by a detailed analysis of your psychological condition. Whether or not you are diagnosed, that analysis will cover the issues that led you to believe you may have that condition.

This approach might help some, but it might hinder too.

There is a post here about someone who was misdiagnosed and bipolar and that later came up when security clearance was needed for a job.

I think you mean the full diagnostic process? Screening is just the first step in (what should be) a long process to decide whether the full workup makes sense. Screening takes on the order of minutes to an hour and it doesn't come with a diagnosis, the actual diagnostic process should take many hours and several appointments.

> It's not easy to find a psych who does adult Autism screenings, but they're out there

And it’s very expensive to get the diagnosis, it can be up to $20k in California

I paid $150 on crap startup insurance.

And then what?

Nobody will accommodates you.

Suing for ADA violations will cost $20k just for a retainer. And then it's a gamble if you win or not.

And the US government wants to aggregate us into a list for who knows what reason.

In lieu of repeating myself: https://news.ycombinator.com/item?id=46178777

Mental health, like physical health, requires action on your part. If the only thing you're seeking from a diagnosis is accommodations from others, then yeah, you're probably going to be disappointed.

I'm getting a full neuro-psych screening next month because my therapist suspects I may have OCD. It's a 4-6 hour series of tests/interviews (and probably other stuff, I'll find out). I'm guessing that's what they're referring to?

I never understood why people, especially americans, are so hyperfocused on "mental health" and wear their pseudoscientific bullshit diagnoses like medals. I agree that there is a small fraction of people that do have mental issues, but it is very likely that most of the people that encourage "therapy" and yap about "mental health" very likely don't have any meaningful issues worth diagnosing and are just unnecessary burden on the medical system. The term "autism" in itself is so overused nowadays that it doesn't mean absolutely anything anymore, the fact that it doesn't have precise, rigorous definition doesn't help either.

Because it's what has been advertised to teenagers to maximize profit.

Western culture is a mental issue beyond repair. It will soon be gone and it will not be missed.

Maybe if you were less angry at people trying their best to live a life that's happier and easier, things might be easier for you.

By downvoting we missed out a joke: Lets apply the article to the comment

>> I never understood why ... americans ... wear their pseudoscientific bullshit diagnoses like medals.

> Borderline Personality Borderline personality disorder involves intense emotional instability, ... and devaluation of others.

>Social Communication Disorder ... knowing how much detail to give, adjusting their speaking style for different situations, understanding implied meanings or hints,

> B5: Antisocial personality disorder (ASPD): People diagnosed with ASPD show a lack of respect toward others. They generally don’t follow socially accepted rules.

> B5: Narcissistic personality disorder (NPD): People diagnosed with NPD have a sense of being better than others... They lack empathy for others

---

> I agree that there is a small fraction of people

What exactly makes you believe the fraction is small?

I'll ignore the baiting and just answer this: >> What exactly makes you believe the fraction is small?

Because it's not as prevalent in other societies. The fixation of Americans, and especially younger Americans with mental health is not something I've (or clearly, GP) witnessed elsewhere.

I don't think the discussion here is due to a lack of empathy, rather it's curiosity of people looking into this society from the outside (which we're doing all the time because we live in an Americanized world, after all). It seems like the participants in this game of self diagnosis and mental health crusade are very self centered and not very fit to deal with life (which is a complicated matter, I admit to that).

This is not to dismiss the hardships of those people professionally diagnosed with mental conditions, obviously.

you completely nailed it, i just want to add more thoughts:

> Because it's not as prevalent in other societies.

Is it because (a) we have not looked close enough, (b) because it is a culture dependent thing, or (c) because there is no norm and therefore no deviation.

The problem is such screenings are incredibly expensive (at least in the US), and for things like ADHD or Autism, you need a specific screening that is often even more expensive.

And even then if you get an autism diagnosis as an adult, this report is effectively all you get, there are no medicines or treatment options that this opens up afaict.

You may be able to get accommodations from your employer. Maybe.

Nope, I've been architecting, creating, and maintaining web apps since 1996 (most recently 12 years at an S&P 500 company), but I can't do live coding interviews to save my life.

Nobody will accommodate me in two years of job searching. They don't deny me outright, they just ghost me if I ask to do a "take home" or any other alternative.

Here are a few ideas to get you started: My spouse's paperwork has helped us change habits around the home to better fit their needs. They're getting better at self-advocacy, in part because it's easier to articulate what exactly feels wrong. Their quality of life was directly improved because we read the paperwork together, and took action based on it.

This is something you can do with a self-diagnosis. If reading the literature on autism gives you processes that improve your life, you don't need the diagnosis to confirm that. The life improvements were the end-goal in the first place.

This kind of presupposes that you have suspicions about autism rather than just something in general. If you think you have autism, you're can target that literature anyway regardless of the diagnosis, while if you have no concrete suspicions, you'll be firing blind, and probably miss a lot more than if you could nail it down to one diagnosis.

By the time I got mine, I didn't need the processes, since I'd figured those out by myself, so the diagnosis is just a nice piece of paper pointing to a road I've already walked.

For ADHD though, that story is very different, since step zero there really should be medication,[1][2] and that is locked behind a diagnosis.

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC2515906/

[2] https://borretti.me/article/notes-on-managing-adhd

If you have a referral, it's much, much more reasonable. My spouse's autism screening was less than $200 on my terrible startup insurance.

> If you think you (or a loved one) may have a psychological condition, go to a psychologist and get a screening. The diagnosis isn't the important part. The value is in the 20-something pages of detailed analysis by a professional.

Throughout my entire interaction with psychiatry (years, on and off) I never figured this is a thing. Go figure.

I have all the symptoms listed by the author. I went to get professionally diagnosed and I have… autism AND anxiety AND ADHD surprisedpikachu.jpg

It feels like that whatever you seek to get diagnosed with you can get it.

This has been my experience, it’s not very convincing and doesn’t give me confidence in the field.

I would say people who are not as disabled as I am should not get a diagnosis. My condition is obvious. I was hospitalized several times and now I cannot work, I have one friend, and I am homeless living in a minivan.

I had one good PDoc who helped me, with my genetics, not to diagnose me, but to help me find what helped me and my specific symptoms. Diagnosis is not as helpful as looking at your own symptoms and own history and using that to find what helps you.

If you don't get the diagnosis before it causes a crisis, it can be _much_ harder to get appropriate support _after_ a crisis.

That is absolutely false. And I stare that from experience. I was looking for help long before my life collapsed and no one thought I was sick enough.

Don't read what I didn't say.

Sorry, I misread that.

Or it’s entirely predictable that those who have a set of symptoms get diagnosed with the stuff that tends to cause all those symptoms

Do you think neurotypical people often go, "I would like to spend significant time and money to get an autism diagnosis"?

I don't think it's particularly common. When I went through my dx, I was really hoping for adhd because then I could get meds, but my doc and all my screenings were like, "definitely not adhd, definitely autism".

So, maybe you are seeing rising diagnosis rates and considering that too easy? If encourage you to think about why you feel this way.

How do I know if I'm neurotypical? I have some challenges, I've done a few tests, but I could just be a lazy neurotypical bastard. I think if you go to therapy you can get to take yourself more seriously, look at the signs, self reflections and process that. Now that can easily lead to "I need to get diagnosed with XYZ". Just to be sure.

It's not about the rising rates, that could be explained in other ways.

You go to a testing center, not a therapist, to get a diagnosis. The online tests don't count. A thorough test will take a half-day or more, with tests ranging from conversations to Q&A to visual to a battery of multiple choice questions.

Yep. For some extra anecdata, mine included a 2 hour introductory session (briefly covering the many forms and [official] online tests she had me do ahead of time), and then two 4-hour test sessions, each of which left me utterly exhausted.

> Do you think neurotypical people often go, "I would like to spend significant time and money to get an autism diagnosis"?

The diagnosis is a road to help. I doubt many people travel down that road without there being some merit to their ideas, but even if it is the case that lots of people travel down that road, that doesn't say great things either. That just means we have a giant group of people screaming out for help and they are using one of few outlets to try and get it. I'd rather they get that help through travelling down that road than blocking off the road to anyone isn't 'actually ill', whatever we define that as.

The real question should be how many false positives does ADOS-2 produce? (The gold standard of autism diagnosis)

How do you measure a true positive? Afaik, we don't have an objective, repeatable method of diagnosis.

If you can't measure a true positive, you can't determine the false positive rate.

I've read that fMRI may be used as an objective diagnostic tool for autism. This was a few years back and I'm not sure how further research panned out.

You've probably read about some differences that show up on a population level (just like there are with ADHD) but it's not a diagnostic tool.

It feels like some people just say things these days. Research shows that autism and ADHD are highly comorbid, I forget the exact numbers off the top of my head but they're something like ~50% of autistic people having ADHD, and ~20% of people with ADHD having autism.

So then you grow up as autistic and/or ADHD person which creates a lot of social friction and conflict in your life, you're called lazy, careless, difficult, overly sensitive, and this is particularly bad if you're undiagnosed. You don't fit in socially so you develop social anxiety (this is par for the course), and after a while that can spiral into depression or even a personality disorder, you might start to self-medicate which can turn into a substance use disorder, and ultimately people afflicted by these disorders are taking their own lives at alarming rates. You should look up statistics for suicidal ideation among children and adults with autism for a reality check.

Most of this can be prevented if those affected were diagnosed and offered support as early in life as possible.

So no, having ADHD and autism, two very closely related neurodiversities, and then developing anxiety as a result of that is not at all unusual.

How are you so familiar with the topic? I feel like you described my life perfectly.

If there’s a phrase to describe this wonderful experience of life, it’s “social friction.”

This life trajectory seems quite common in tech tbh. I suspect the proportion of autistics with ADHD in tech is quite high, given the appeal of: not working with people, novel difficult problems to solve, immediate sensory feedback from working on your computer. It also describes my life accurately as well.

Ironically, we chose a work style that requires maintaining prolonged focus, which sucks without meds (especially when dealing with boring tasks).

I was diagnosed with ADHD as an adult in a healthcare system that doesn't consistently recognize and treat ADHD in adults. Many clinicians are unfamiliar with it and still believe in myths like ADHD being a disorder that only affects children, or who fail to recognize ADHD as the primary condition and waste years of people's lives on diagnosis and medications that don't work, so I was forced to largely figure it out myself to try to advocate for myself - DSM-5, ICD-11, research papers, personal experiences from other people.

This is a long shot but have any of you had issues with noise and light sensitivity?

It’s something new that started happening to me in my early 30s. I can’t seem to get a diagnosis. Wondering if it’s autism related.

I’ve been to a bunch of specialists and they say it’s all in my head. But car headlights look 10x brighter than they should. And cutlery sounds 10x louder.

My son has ASD. I think I have it too on some degree. And yes, headlights especially nights are very hard to eyes. I have no issue on sounds though.

extremely high comorbidity rates

You had to catch them all ;)

> I remember seeing a woman who was a classic example of someone with high neuroticism, poor self-esteem, and severe social anxiety, and she had believed for much of her life that she was autistic ... it fit in with her experience of being awkward-shy-weird.

I so strongly agree with this and it's not just based on my own experience, but many people I know.

Growing up broke and in sketchy places with sketchy people will induce plenty of anxiety. Then I managed to get out of all that as an adult and starting a career.

The anxiety never fully went away, but it now presents itself the way one would expect instead of "weirdness". Maturing and having a more stable life happened to my friends also and nobody says "I think I'm autistic" anymore like we did in high school and college. Now it's hard to distinguish if we were saying that to ourselves as a slur in self-deprecation, or if we really believed it. Young people are just awkward and too many people get older without letting go of the things they told themselves a long time ago.

Make of that what you will. I know my story is super common, but the only reason I bothered to write this is that it doesn't get said enough.

People nowadays are just desperate to have a diagnosis. Everybody wants to be special and unique, everybody wants a stamp on their forehead that says "I have [x]" "I am [x]". People cant accept that the issues they have might just be not special at all and are mere human issues all of us have. Its the result of aggressive sensationalism and the desire to stand out from the crowd.

I think it's less a result of a desire to be special and more a result of the way that late stage capitalism will throw away anyone who doesn't fit into its narrow mold of what makes an "ideal employee". When only a small number of career paths provide a good quality of life and employeers can fire people at will, then any divergence from the ideal becomes a disability.

People are desperate for an identity. It has always been that people would latch on to things that seem fitting for them - maybe they put a lot of stock in their identity as a soldier, or as a fan of a band, or maybe as a member of a group like skateboarders. And, interestingly, most of these historic manifestations also have an aspect of "stamp on their forehead advertising their identity" - patches, shirts, other identifying aesthetics from their community.

Upon realizing "I just have anxiety" and there's "nothing wrong with me" it initially reduced my anxiety... then I wondered why I'm so fixated on some mirage of "normal" and my anxiety flared up again thinking about it way too much.

Anxiety with intrusive and obsessive thoughts is definitely a real phenomena, but nowadays it's just a sign I'm getting fussy and need a break or a nap.

> People nowadays are just desperate to have a diagnosis. Everybody wants to be special and unique

I've never managed to understand this when it comes to autism. Autism used to be considered something as extreme as a severe disability (e.g. Rain Man), and latterly with the inclusion of Asperger's into the spectrum, at the very least a collection of undesirable behavioural characteristics. Do people really want to be diagnosed with something wrong with them, or has the perception of autism shifted to at least neutral (if not positive)?

I think it's useful to look at the alternative. It is still socially acceptable, even among progressives, to viciously mock people who are socially awkward and simply write them off as undeserving of help. At least with autism many people extend some degree of sympathy and willingness to help.

Yes. Social awkwardness then is not seen as a character flaw but more like a birth defect.

At the risk of offending some people, I think it's similar to why people lie about their dog being a "service dog".

It may genuinely be that their dog is their emotional support, but it's ultimately a bit of selfishness and wanting to be treated preferentially in a world that feels crowded and rigid.

"unique" and "diagnosis" are opposites. If you have a diagnosis then, by definition, you are part of a group of people with defined attributes.

Unique meaning unique within their social bubble, I agree with the general statement

Almost all of the people I know who are neurodivergent in some way are friends with a bunch of other neurodivergent people.

Either deliberately or because that's how all of the other train spotters/board gamers/coders they've ended up hanging out with are.

> Everybody wants to be special and unique, everybody wants a stamp on their forehead that says "I have [x]" "I am [x]".

Spend a moderate amount of time with some humans-- e.g., war veterans-- and you'll find that denial of a diagnosis is common enough to trivially disprove this statement.

Pretty sure war veterans dont hang out on TikTok or Instagram 24/7

There are lots of them on both.

Yeah, of course. When a "normal" person asks for a reasonable accommodation--like being able to wear a smooth cotton polo alternative they bought with their own money rather than the piqué fabric one assigned by the company--they get "wow you want to be so special and unique, no you need to wear the shirt assigned by the company and get over it." Is it any surprise that someone would want to go get an autism diagnosis or whatever else so they can... just wear the damn shirt that doesn't make them half-grimace at all the customers?

They're going to be accused of wanting the special and unique stamp in either case, but at least in the second one they can feel somewhat comfortable.

People will, of course, conjure up an unreasonable accommodation (in an attempt to paint all accommodations as unreasonable) in their head to try to justify why this sort of request can't be accommodated, which just increases the fuel for the desire to get the autism diagnosis.

Put another way, if people were a little more accepting, less only-slightly-weird people would be seeking these diagnoses.

Based on personal experience with others, for some I think the diagnosis is a substitute for an identity that then brings belonging into a group, filling a need for them that has been otherwise unfilled.

If anything this just kinda suggests to me that the diagnostic categories are almost completely random/useless. It's just a set of pigeonholes made by people whose goal is to have a pigeonhole for every kind of thing so that the world doesn't seem messy and complicated anymore.

But the one thing we know for sure it's that the world is more complex than even this set of 10 pigeonholes. These are more like good insults for people. Haha, a loner, that guy's a schizo! The clinical coldness is almost a perfect mirror for the way we express personal cruelty to others. To reduce them to a factoid, an epithet. It's no wonder people want to reclaim these words as terms of identity, of pride, of nuanced meaning.

They are useful if they are understood properly. For example different "similar" groups respond to different treatments differently. Social phobia responds very well to exposure therapy, anti-social personality disorder does not. If you are able to follow the distinctions you are able to leverage more effective treatments. I don't think they have any use outside of psychological treatment though. This is a great video on a good way of breaking down how personality disorders in general are broken down and function and are separated. https://youtu.be/4mgifm3ftl8

> It's just a set of pigeonholes made by people whose goal is to have a pigeonhole for every kind of thing so that the world doesn't seem messy and complicated anymore.

I mean, that is kind of how science/medicine work in general. Group the things that look similar, try and find things that work, and use the patterns to generalize the solution.

If you don't generalize you can't apply knowledge from other cases.

I mean, they literally called AD(H)D after what annoyed parents and teachers would complain of (pay attention!) rather than any of the actual symptoms of the patents.

Life is difficult for people with severe autism (e.g. early childhood). Due to the increasing number of misdiagnoses, self-diagnoses, romanticization and constant trivialization, life is becoming even more difficult for these people. The opinion that autism is not a disease but a buzzword for strange people leads to real autistic people being denied the disease. It is often said: “They should just try harder or pull themselves together”. Please don't use the word autism in an inflated way - it harms those affected.

In a maximally earnest way — to what degree should we be sure these language harms are real on net? Are there data as opposed to anecdata? (Of course many phenomena are real without data; we can just be more confident in cases with data)

I enjoyed reading that. My daughter had recently been diagnosed with "social anxiety" but had suspected it was autism.

Somewhat related, "Health Secretary Wes Streeting is launching an independent review into rising demand for mental health, ADHD and autism services in England." https://www.bbc.co.uk/news/articles/ce8q26q2r75o

Working in IT I've came across lots of extremely smart people with their quirks and eccentricity (not exclusive to smart people of course), I guess there's just a higher proportion of _quirky_ smart people in IT. A lot of the time it just seems to be introversion- it seems lack of interaction with society has to be justified.

It's worth noting the UK already commissioned a review that was published this year, that showed ADHD is in fact under-recognised here[0]. I can only assume they're commissioning a new one because that one gave the "wrong" answer.

For a long time ADHD was ignored or dismissed in the UK as an "americanitis", so it's no surprise that there's a backlog of people who weren't diagnosed in childhood.

[0] https://www.england.nhs.uk/long-read/report-of-the-independe...

I think a crucial bit of context is that in the UK, many people who are seeking diagnosis as adults grew up in areas where there were no or very few child psychiatry services in the 80s/90s. In such areas only very profound cases would be referred to out of area services. Most people with neurodevelopment disorders in such areas were diagnosed with SpLDs like dyspraxia or dyslexia which could be diagnosed by community paediatricians, usually with evidence from educational psychologists and occupational therapists.

In fact the pattern is almost the opposite of what you'd see in the US where it would be hard to get diagnosed with a SpLD and e.g. ADHD was more widely recognised. But the rub lies in the fact that ADHD, ASD and many SpLDs have fairly high rates of comorbidities with one another, to the point where if you've got dyspraxia and no other diagnosable comorbidity, you're actually in the minority of people with it.

Also the NHS ADHD/ASD services are completely overrun. Waiting lists for children can be more than 5 years long.

In order to cope with this the NHS has spun out much of the ADHD/ASD assessments through the Right To Choose program (well, in England at least, Scotland/Wales/NI are on their own), which means that private companies are being paid by the NHS to make up the shortfall. Ref: https://adhduk.co.uk/right-to-choose/

Some people say some of the private companies are too lenient with their diagnoses. Some people say that the NHS is too strict with their diagnoses. I'm sure the real answer is somewhere in the middle.

As you say, the sharp rise in diagnoses is probably more due to people become more aware, with less stigma attached, and having better access to assessment.

Shit like _Rain Man_ almost 30 years ago or, more recently stuff like _The Good Doctor_ really don't help though, as those just reinforce the negative stereotypes of Autism.

ADHD also has a strong genetic component with heritability around 75% according to various studies. My parents (undiagnosed but one definitely ADD+ASD) have 1/4 children diagnosed (and another 2/4 almost certainly undiagnosed, one neurotypical), and 6/10 grandchildren diagnosed (the other 4 are neurotypical).

Who knows, in 20 years time mainstream schools could have switched from 20% SEND and 80% neurotypical to 80% SEND and 20% neurotypical.

In my family it's been difficult for some to accept my sister's autism diagnosis because Rain Man is the prototype of autism they have in their heads. Younger family members who have been exposed to classmates who are on the Autism spectrum have been accepting of the diagnosis as their image of autism is very different than the one older family members have. Good thing is despite some not believing in the accuracy of the label, they're still supportive of her.

Eye contact makes me very uncomfortable.”

“I suck at small talk.”

“I have rigid routines.”

“I hyper-focus on my hobbies.”

“I am always fidgeting.”

“Social interaction exhausts me.”

“I really bad at making friends.”

“I don’t fit in; people find me weird.”

I never considered it althought I'm ticking all the buttons (bad gear ? [0])

[0] https://youtube.com/@audiopilz?si=g6iGJK3ygnCWESWW

You could add "I'm a HN regular" as a diagnostic criterium.

The HN crowd is surely over-represented in ASD, which makes sense for people enjoying debating nerdy topics and pedantry.

And "I like Lisp" should be an automatic qualifier.

I honestly prefer C/assembly over lisp, which should be even more so.

C maybe, Assembly for sure. Haskell too.

The peak ASD diagnostic criterium should be Forth though.

I am schizotypy and I very much love Common Lisp but not so much Racket haha

How do you feel about Scheme ?

lisp-1 (s) give me the chills: very much prefer doubled namespaces. Though these days I focus on systems security or threat analysis. I still fondly remember the days where I could launch Emacs with sbcl and write some Montecarlo simulations on Common Lisp with electric-parens haha Those were the days of stimulating learning

That's funny, I never found doubled namespaces that interesting; what are your opinions, why do you prefer them ?

> electric parens

I get you, I was amazed by the litterature around lisps (I always found the beginning of SICP (the wizard-programmer analogy) quite inspiring and fun)

It was kind of a joke intent but it gives out to better naming position although unambiguous symbols to specify a symbol; such as #' for function names. Plus now that I remember the common Lisp ANSI specification is just awesome, free and locally installable and browsable from Emacs at symbols from ages. Common Lisp images were myriads ahead in an intospectable sense, like Smalltalk. Objects and primitives can use the built-in debugger to display their inwards. The environment is just plain astonishing, moreover ten years ago - when I started - and Emacs is free as in speech and compilable from scratch, plus org-mode is awesome as well. Nowadays I feel sorry of Python introspection capabilities although hinted typing improved it so much. Not to mention Common Lisp tight generated assembly and it's garbage collector which was ahead of its own: first with Boehm and then with parallel ones. SICP was nice although nicest was the one about gravitational physics, or brownian motions, also in Scheme. Good times.

Yes, browsing the hyperspec (what a glorious name) inside of emacs was such a joy also.

That's truly a shame scripting/glue languages took a different path than lisp, but well, you can always lisp shape anything.

Lisp-2 virgins want to name a variable 'list' and not shadow the function named 'list', so they add on a separate function binding to each symbol. "So you have to type sharpquote if you want the function value of a symbol," they say. "What's the big deal?" Except they don't stop there: symbols also have to have package awareness and "property lists", or in other words an arbitrary number of other bindings.

Scheme chads understand that perfection is achieved not when there is nothing left to add but when there is nothing left to take away. They realize functions are nothing special, just another object that can be manipulated and operated on, so why create a separate namespace and binding for them? Why put bindings in the symbol at all, since if you are designing your language correctly bindings will vary with lexical environment? So symbols have been stripped down to just a name that the language recognizes as an identifier for a value, function, special form, or whatever else. And functions are just values that get applied whenever in head position of an eval'd list.

I jest, I jest. Seriously, I love Common Lisp, but I'm with you: Lisp-1s appeal better to my aesthetic sensibilities.

I'm reminded of a post on r/Factorio. (Factory builder game.)

(Paraphrase, I don't recall the words)

If you like Factorio you should be tested for autism because you might be autistic. If you like Pymods (a mod that adds an extreme number of hoops to the game) you should be tested for autism because there's a chance you don't have it.

What percentage of Factorio & Pymod users are not autistic but simply overcompensating for their insecurities with a productive fantasy life?

> And "I like Lisp" should be an automatic qualifier.

Very funny and on the nose :)

We definitely do run in packs. All of my really good friends have ended up being diagnosed with (or strongly suspected of having) ADHD or autism.

As a diagnosed autistic, I think I would ask -- does ticking these boxes make you feel like, "oh shit, this could explain some difficulties..." or just go, "huh, interesting?"

I tend to invite people to think about how their lives have been impacted. For example, I experience anxiety at late invites to events I'd enjoy. I panic and decline them because I'm experiencing a highly irrational anger fear response to changing schedules. This causes me to miss events I would otherwise enjoy, and then I feel guilty. Having to process all those feelings takes a lot of energy, and it's really draining. That has significant impact on my life.

Compare to a friend of mine who just prefers quiet evenings. She declines things all the time but never gives it a second thought.

Disability vs preference. It's ok if it's either! Neither of us are wrong, we just experience different impacts in our lives.

Well, I exiled myself to the countryside because I want to be able to choose how much exposure to society I want.

I guess I gamed the problems you are talking about, but as a side effect I am sometimes probably weirder than before (which is a non problem when you live where I live).

I would probably live a sad and boring life if I were to live in any small/medium/big city.

Yeah, exactly. Having an ADHD diagnosis has been incredibly helpful, because now I can make much more accurate predictions on what is likely to be difficult and figure out strategies.

It can really be the difference between struggling with or enjoying a situation

I used to be an educator, and many of my students had an autism diagnosis. I would get to know them and often eventually decide that they were "just like" me, except that whatever their problems were, I had it worse.

So then I would look at these autism checklists and say, "yep, that's me," but when I actually looked at the strict diagnostic criteria, it wasn't that clear.

Looking at this article, I get it. There are other, more focused criteria that can be more appropriate. But those diagnoses don't trigger the special services, so they don't get used often enough.

What is my takeaway? People often don't conform to a model of average human behavior. Being unusual isn't necessarily a grave character flaw (which is what my mother had me believe) but merely an expression of the great variety of human intellect and behavior. It gives me license, without official diagnosis, to enjoy being who I am without shame or embarrassment.

agreed.

I studied philosophy during a large extent of my life, and I am a convinced Witgensteinian.

The diagnosis criteria are written by and for neurotypical people. Autistic people are likely to dismiss them as not fitting because they are reading them too literally.

Also we tend to underestimate our own symptoms. As a ADHD person it took me a long time to understand that many of my struggles were not things everyone experienced. I still find it hard to really grasp that most people don't suffer from executive dysfunction and can just do things, even things they are not interested in.

Honestly if you relate to autistic people chances are high that you have some form of neurodivergence. It might be worth trying to get a diagnosis, even just to be sure.

Thank you for sharing this article. I find people claiming I have autism for random reasons, mainly because I like to code. It's frustrating and they can concern-troll all they want.

"They haven’t seen any cool TikToks about being schizoid. No one’s offering them quizzes about being schizotypal." I'm eagerly awaiting the Great Meme Reset of 2026 when people will stop using memes as their shared knowledge. I even know a pediatrician who does this to support her anti-vax practice so meme culture has reached frightening levels.

Therapy-speak has become weaponized by people who are not well meaning. Please don't go around diagnosing people. If you say someone is bipolar, a lawyer can use this against them in court. I urge people to identify the sources of their (mis)information and humble themselves before offering diagnostics.

The internet is turning society into a kind of "social emulsion" where everyone is their own little droplet in the fluid, but they don't merge together.

It's not "the internet". It is "this internet".

Back in the 90s early 00s the internet made us mesh together because each one of us there was a specific person. We had forum signatures and every single post was clearly made by a person, for a person.

Then social media took over and relegated every single person into a tiny unidentifiable avatar next to a non-prominent name, not unlike NPCs in CRPGs.

In turn this has been exploited by the powers that be to ensure the social glue gets even weaker: a society barely held together won't revolt. There's only one thing left to do: productivity, productivity, productivity.

The political opponent is no longer a person. Just a nameless, faceless NPC (personifying everything that's wrong) spawned there to be defeated and collect their social loot tokens.

But I might just be an old fart rambling about the good, old days.

Maybe the issue is this perception that "the Internet" consists mainly of the big 4 social media sites.

Go on Discord. People have usernames, avatars. Discord Profile Bios are just as unique as forum signatures.

I am on Discord and the balkanization+homogeneization is still as prominent there as everywhere else.

Server admins are just NPCs providing @everyone announcements from time to time, to keep the player engaged (spoiler: the average Joe is just irritated by those). Sometimes you get a quest from them.

Also: 99% won't read profile bios (and you have to pay for actual customization, don't you?) while forum signatures were front-and-center.

I have to say I'm surprised to see Discord mentioned as an opposite to social media instead of... just yet another iteration of the same ploy.

> Server admins are just NPCs providing @everyone announcements from time to time, to keep the player engaged. Sometimes you get a quest from them.

Maybe you should join better servers. I'll also add that this was common back in the forum days too. Most admins would just... admin the site.

> Also: 99% won't read profile bios (and you have to pay for actual customization, don't you?) while forum signatures were front-and-center.

Wrong on both counts.

> I have to say I'm surprised to see Discord mentioned as an opposite to social media instead of... just yet another iteration of the same.

I did not present it as an "opposite to social media" - I presented it as a counter to the idea that we've lost the personality GP is talking about

You're one of the 1% who reads profile bios.

Of course, because the alternative - that they're wrong, and more people actually do read bios - couldn't possibly be true.

In any case, I see no reason to believe any higher % of people paid any particular attention to forum signatures back in the day.

“Paid attention”, you're probably right. Seen them enough to remember? Forum signatures were far harder to miss than Discord bios.

Fuck discord. Another big for-profit platform that is swallowing big chunks of the internet. before discord there were lots of self-organized forums with their own communities and rules. Now I need to register with some big overlord and download their shitty app just to read what has before been just an URL away?

But you can enjoy it before enshittification arrives!

All praise our VC overlords.

Nah. Right in the browser works great: discord.com/app

You’re going to keep running into a wall thinking of discord like a forum replacement; It’s designed to be an IRC replacement.

The invitation system intentionally creates some privacy so you can build a sense of enclosed community around them, and so you have some control over who sees what. Not having your conversations on full automatic blast to the public is a feature.

IRC works in the browser now thanks to IRCv3. Matrix is another option

The invitation system gives a false sense of privacy. There are bots that crawl publicly posted invites, public IRC channels, etc. Eventually people will understand that IRC and discord are public in the same way we understand usenet to have been public

> before discord there were lots of self-organized forums with their own communities and rules.

And running them was awful and drove the people who did it insane, mostly because you had to fight spambots.

Yeah, sadly it is the spambots which have killed off independent platforms more than anything else. It sounds like something which could easily give rise to conspiracy theories from people putting the spammers into the same mental baskets as the controlling companies. It isn't the expense of having to leave on a raspberry pi running a server.

Discord also is a centralized piece of proprietary totalitarianism. No thanks.

back in the 90's a minority of people were on the internet in the first place. it predates eternal september.

The internet is now dominated by the opinion of the lowest common denominator, so we find ourselves holed up on forums like this.

It's not specific to the internet. It's just that basically everyone came into the internet when it became cheap and easy enough to use. However, previously it was only a subset of people who were willing to put in the effort because it offered some benefits to them.

It is simply the typical effect of regression to the mean of large groups. Previously there was the illusion of meshing because the group was more homogenous. Diversity is touted as a panacea, but it actually has many deleterious effects, the most obvious being the reduction of what is deemed acceptable/normal behavior and speech.

It is not surprising that everyone looks like an NPC because bringing everyone into the fold requires a redefinition of what is considered the acceptable norm. It systematically goes through narrowing the definition to artificially create the illusion of homogeneity (necessary to reduce conflicts).

This is the same process happening to society at large. Psychology is just a replacement for religion, and the various diagnostics just serve as a tool to police what is acceptable behavior. This is very much the same thing as the various religious scriptures, using moral arguments, appeals to emotions, and enforced tribalism to promote the “correct” way to live one's life.

The endless discussion of psychologists around diagnostics is hopeless; they are just gurus replacing preachers, but instead of using gospels and mythological stories, they use pseudoscientific bullshit to categorize/label behaviors and argue for what they believe should be the norm.

I wouldn't say Internet is a problem, but centralisation towards big tech algos and clearly gamed social media comment sections do control the narrative of what the majority of people see most of the time.

> Social communication disorder is rarely diagnosed in favor of autism primarily because autism provides access to critical services, insurance coverage, educational support, and legal protections that social communication disorder does not reliably offer

That feels important

Yes. When I first read about autism it really felt like me, but overstated. Then, years later, I ran into Asperger's--score way out there on the screening test and it very much feels like me. Still later, found the actual diagnostic criteria--comes down to at least 2 of 4--and I clearly have 1 yes, 2 no, and one hint of a yes that's impossible to confirm without a time machine. DSM V comes along, I do not feel the autism diagnosis fits me, but social communication disorder again comes down to 2 of 4, 1 yes, 2 no, 1 maybe that again can never be resolved. And it describes me to a T. But what benefit would there be to a diagnosis? As someone well into adulthood before I ever heard of any of this it's not going to change anything.

It's also become quite fashionable to pathologize oneself and make it a kind of marker of identity. "I'm neurodivergent!" they declare, even though the concept is dubious as a bona fide category. It's a weird phenomenon; a disease or disorder is not an identity, but a defect. But people in general seem to be starving for identity - hence the popularity of odd subcultures and ideologies - but too weak to forge their own.

Part of the motivation also seems to be that we've fetishized disorders; having or claiming to have disorder X is a weird way to feel "special" or exceptional. Another part of it is that it functions as a kind of instrument for uptight people to gain a sense of exemption from social norms - real or merely perceived - that they feel burdened by or live in terror of "violating", but who are incapable of or unwilling to ignore them, because what would people say! "Oh, I'm weird, because I have disorder X. Can't help it, sorry! Can't judge me, because then you, not me, are the asshole!"

Needless to say, it's not very rational.

Which is not to say various disordered conditions don't exist.

That's a misunderstanding. I argue elsewhere in this thread that these categories aren't real, yet I identify as neurodivergent.

One problem is that the language we've been given is one of defects (ADHD, ASD) and often people are stuck using that label even if they don't see their trait as a defect. So we're stuck saying "ADHD" because psychiatry decided that it's a defect. In reality, nearly every "disorder" has some other context-dependent benefit.

And while there's no "neurodivergence" in nature, there is a divergence from what is considered "normal" by society. "Normal" is an artificial construct, but we all have to live with it, and there are many aspects of my nervous system that clearly function in a way that's outside of two standard deviations from the mean, and this causes me a lot of problems in a society that can't tolerate that. These are very very real, and 95% of the time, I never say a word, and no one else has any idea that I'm suffering. I'm not telling anyone else that they're the asshole. Most neurodivergent people are living like this, despite what you're implying, that we're all just walking around being assholes to everyone we meet. That, is bullshit.

There's one type of autism that doesn't really exist as a disease but as a social phenomena.

It appears when someone sees a smarter person and cannot accept that fact, proceeding then to look for any sign of awkwardness so that gap can be explained by "autism".

Not medically relevant, but probably one of the most common uses of the word.

The following are my half-processional half-radical POV.

Autism and schizo- spectrums have a common base/mechanism: impairment of psychic functions (lack of empathy and non verbal commun, shallow feelings, social distance and similar). Their difference is autism starts at early childhood (maybe birth?), before any intelligence, language, soul and personality has evolved, while schizo/psychosis starts later (after teen age) when all these are fully developed.

The impact of each disorder on behaviour is different due to the different state it finds the rest of the brain. The maturity in schizo, for example, is the cause of its "positive" symptoms like hallucinations/delirium because the brain is full of images and words. On the other side autism heavily blocks social and verbal skills because it kills any "motive" of the brain to develop further from a very early stage.

Some casual unscientific research - a question to my fellow autistic HN contributors:

Do you have a "mind's eye" - that is, can you close your eyes, and voluntarily visualise mental images?

If you can't, you have a condition called "Aphantasia"

https://en.wikipedia.org/wiki/Aphantasia

When I found out about aphantasia, I was fascinated. I'd always imagined that "mind's eye" was a metaphor. I never knew it was literal, and that most of the population are able to visualise imagery in their head.

Could there be a link beteen aphantasia and autism?

Since I'm unable to visualise the faces (and thus expressions) of people, maybe this contributes to my lack of empathy and ability to predict other people's emotional state.

If you have autism, do you also have aphantasia?

Interesting! I'm autistic and I'm the complete opposite! I've always been super artistic, and usually visualize what I design/draw in my head before it ever hits paper/screen. It blew my mind when I learned about aphantasia.

> Autism exists, to the extent that any psychiatric disorder exists.

Which is to say, not really. I say this as someone who has been diagnosed as autistic, and identifies as autistic. All of these diagnoses are presented as clear, well defined constructs that exist in the world, but in reality they’re fictions that that committees have drawn around a vast gradient of human traits.

No individual human truly fits any single diagnosis. For example, I have two family members that depending on how you frame their behaviors could be described as either autistic or narcissistic, yet these are supposedly completely different disorders. Prior to being diagnosed as autistic, I’d been diagnosed with some of the ones suggested in the article as well. Was I misdiagnosed? I don’t think so. None of those constructs are real either. So, they’d not even wrong. For a time, some were useful. Some were harmful. But seeing myself as autistic has been a lot more useful.

What matters to me about identifying as autistic is that it allowed me to find other people who experience the world similarly to me. Until I found other autistic people, I felt like I was a single alien stranded on Earth, alone. Finding other autistic people was like finding out that there were millions of other aliens like me hiding in plain sight.

I hope that someday we can move beyond the 1950s-style nosology of the DSM and have a more rigorous science of mental health, but right now, it’s what we’re stuck with.

I am sorry, but if you’re saying there’s no biological, physiological or neurophysiological evidence of these conditions then you’re just plain wrong. I cannot emphasize that enough.

That’s not what GP is saying. He’s saying that a term like “autism” is a lasso trying to capture a gigantic number of individual traits and symptoms. This is true of any other “psychiatric disorder” as well. There is no “autism”, there is no “ADHD”, there is no “OCD”, any more than there are tables or chairs.

Something being a table is a label we slap on it to abstract certain attributes, that allows us to reason about it without having to think about all of the non-table-attributes it has. What do tables do? What can we do with them? We can put things on, eat off them. We can’t feed them to our pets. We can’t use them as a trampoline. The object being “a table” is just a categorization we make to allow us to think about the object; it isn’t something that the object is.

Similarly, people aren’t “autistic”. They’re just people, who have certain traits, which psychiatrists have decided should be lumped into a category called “autism”, because they’ve noticed a cluster of other people who have similar traits. So, from this standpoint, someone “being autistic” does not tell us anything. We can already see that person’s traits or characteristics. That categorization might be helpful to some people, and it might be harmful to other people; and they should use or avoid using it accordingly. But they can choose to do that, because “autism” isn’t a “thing” - it’s a mental construct.

It’s the same thing as any condition which deviates from the set of characteristics considered “normal” for a given population.

Eczema is a skin condition which happens to some people, it’s not something that happens in most people. But we can see evidence of varying degrees of severity of skin damage due to eczema. This condition can happen for any number of reasons, immunological, endocrinological, or some combination of factors. There are different types of eczema, but for ease for conversation with anyone other than a doctor, you just say you have eczema.

Same for mental conditions, they have their underlying causes, and some representative characteristics we found on average and grouped them as classes for ease of diagnosis and treatment.

I understand the folly of mischaracterizing, so it doesn’t make sense for researchers or medical professionals to not care about the categorical distinctions.

However, as far as the normal public is concerned, someone’s problem is their problem, and they don’t owe you a detailed explanation of their condition, or a doctors note because you’ve been socially offended (I understand maybe that’s not the point in either of your posts, but I thought I should say it now that it occurred to me in the flow of this post).

Psychiatric disorders are leaky abstractions.

Be that as it may, they’re still predicated on a set of underlying biochemical and physiological processes.

That tend to hold "on average" for a population but often don't hold for the individual within a population. This is the ecological fallacy [0], just one of the fallacies underlying psychiatry.

My argument isn't that psychiatric symptoms don't exist or aren't real and there is no real underlying phenomenon. My argument is simply that we've drawn the lines between the units of study too high up and we should be more granular. This level of nosology was chosen in 1952. Do you really think they got it 100% right almost 75 years ago? And what is the mechanism for defining and maintaining these categories? A bunch of committees get together every few years and decide on them, then they tell us all what's "true". Bullshit. What are the odds that a committee will define itself out of existence? Pretty slim. [1]

I have traits that could be considered as autism, ADHD, obsessive compulsive personality disorder, PTSD, bipolar II, social anxiety disorder, and probably a dozen more disorders. But by quantizing the disorder at the current level, by necessity, the other traits are cropped out of view. Relevant information is lost and irrelevant information is blurred together. And the level of overlap between disorders is absurd. They cannot possibly be "real" because the lines between them aren't even distinct.

The useful unit to study is the individual trait, not the cluster of traits that is different in each individual. The traits are more granular and map more closely map to underlying biology anyway. The current model is akin to what the geocentric model was in astronomy. It's outdated, wrong, and holding us back from a more accurate, detailed view.

[0] https://en.wikipedia.org/wiki/Ecological_fallacy

[1] https://en.wikipedia.org/wiki/Conway%27s_law

> My argument is simply that we've drawn the lines between the units of study too high up and we should be more granular.

I agree with this, and your overall post. I’ll just add that if the purpose is treatment, it helps to find root causes, and maybe there’s a common thread in the underlying root causes, likely related to gene expression.

Schizoid personality is not a "disorder".

Having your own ideal and philosophy and not sheepishly following corporate and government propaganda (so called "trend") is what every other person should do.

I found this article very interesting, because I feel that I fall in the category of people that think they have it, although I probably don't. My psychiatrist who is not an expert on autism told me I display autistic traits but that doesn't necessarily put me on the spectrum. Also my RAADS-R scores fall into the autistic spectrum but on the low end. Another psychiatrist diagnosed me with OCD. I am in my late 20s and I don't see how I could ever know for sure or if I am autistic or not, but nowadays most people in my country would say "we are all somewhat autistic in some way or another"

I am in the same boat as you (Schizoaffective, OCD, Panic Disorder). My therapist said I had many traits but the overlap in these disorders is quite substantial.

I was involuntarily committed to a psychiatric hospital once and my behavior had them thinking I was Autistic.

> nowadays most people in my country would say "we are all somewhat autistic in some way or another

Careful with this. In small amounts it can be good -- recognizing that autistic traits are human traits and we should recognize each others humanity -- but in large amounts it is regularly used to deny autistic people experiences. Like, "it's not so bad. It's not a disability. We're all a little autistic." Etc.

I know that this is a slippery slope. I just meant with this that even if I get diagnosed it wouldn't really change anything in my daily life, because people in my country are not very well educated on these issues anyway.

It gets even more complicated when you add things like Williams Syndrome into the mix -- WS causes you to feel safer with 'friendly' people and so you're typically more social not less, but is often comorbid with autism and so can make diagnosing autism more challenging (in my case it was mostly because I had an abnormally high IQ and sensory challenges). But I am highly empathetic, have some talent for music and writing and was basically a TA for most of my school years, while still having most of the autism-related issues such as RSD, demand avoidance, meltdowns and so forth.

Autism is over diagnosed, because you get government money as a doctor and a patient.

My niece has a disibility that they haven't really been able to diagnose.

If it is Autism, there is all kinds of free care available.

Usually when you follow the money, you get answers.

There was this notion of psychiatry promoting conformity back in the 1960s, and while that has diminished, I detect conformist tendencies in this writer. Stuff like social isolation and magical thinking can be the result of cultural forces. (In some parts of the world, magical thinking is still the norm.) Urban environments can also be antisocial for a number of reasons despite high population density.

What is missing is the occurence of these disorders.

Adhd 5-10%, autism 0.5%, cluster b 5%. The rest is quite rare. Adhd has the highest comormobility.

The DSM-5 states schizoid has a prevalence of 4.9%, schizotypal 3.3% and OCPD 2.4 - 7.9%

Even if you don't think it has validity as a single disorder, autism is at least diagnosed in a way that's fairly consistent between clinicians using ADOS.

I'm more dubious of clinicians who like to pick random dubious rare disorders that people can't even agree about the basic description of like schizoid out of the DSM like the author of this article.

And then they enroll their patients in the Drug of the Month Club.

I find all these conversation around neuro-divergence extremely weird, for the simple reason that I have a never seen a proper definition of what a "normal" person actually is, and for good and obvious reasons:

I personally believe that "normal", when it comes to people's behavior, social interactions, and the way their mind works, is a completely broken idea. All of these attributes are completely fluid, depending on the when, where and who with you happen to be.

On that premise, the whole idea of neuro-divergence and the idea that you can classify people in arbitrary categories such as ADHD, Autism, etc ... and that this classification will lead to a way to "fix them" is complete and utter BS.

> I find all these conversation around neuro-divergence extremely weird, for the simple reason that I have a never seen a proper definition of what a "normal" person actually is, and for good and obvious reasons:

The problem is that no-one can easily understand how their brain works compared to other people. People on both sides don't talk about it enough or openly enough. If you look at the science it quickly descends in to endless confusing/impenetrable psychiatric terminology.

You can study things like anaemia as you can objectively measure the red blood cell count of a patient's blood. You can't objectively measure a patient's "focus" or "motivation". It's really hard to even get a good subjective measure of those things.

For example, it's just one aspect, but prior to diagnosis and taking methylphenidate (Ritalin/Concerta) I thought everyone had hundreds of competing thoughts running through their head all the time. I thought everyone just had better ways of dealing with it than I did. I had no idea that's not the case. I'd got to 50+ years old, got several degrees, married and had a family, had a successful career, not quite FAANG but earning more than 6 figures, all in spite of how my brain works. Surely there can't be anything "wrong" with me.

But when the medication first kicked in I was simply astounded how quiet my brain became and how clearly I could think about just one thing (it may not be the thing I actually wanted to focus on at that time but that's another facet of the fun). How the hell did I manage to get by all this time without this? It's only then in speaking to other people do I find out that, no, most other people don't have hundreds of competing thoughts running through their head all the time snapping at their focus.

> On that premise, the whole idea of neuro-divergence and the idea that you can classify people in arbitrary categories such as ADHD, Autism, etc ... and that this classification will lead to a way to "fix them" is complete and utter BS.

I agree with point about broad classifications, but medicine is far from the exact science that people believe it is. Got these symptoms? Does medication A improve them? Can you live with the side effects of medication A? Does medication B help with the side effects of medication A and not interfere with the improvements given my medication A? etc...

> but medicine is far from the exact science

Truer words ...

As a matter of fact, calling it science ... quite the stretch when it comes to most medical professionals I've met in my long life.

> The problem is that no-one can easily understand how their brain works compared to other people. People on both sides don't talk about it enough or openly enough. If you look at the science it quickly descends in to endless confusing/impenetrable psychiatric terminology.

It's not just how the "science" is conducted, or limited to a fixed number of sides. Everyone doesn't quite know what anyone else experiences. We all just throw around symbols, hoping someone gets what we mean by what we say, and assuming that we know what others mean by what they say. The meat of what we know and experience never gets transmitted faithfully to anyone.

To be certain, many people do have conditions that, say, I will never have. But that doesn't make me "normal" or those people "abnormal". The definition of a disorder by showing harm to living one's life is a good start, but fraught with the complexity of analyzing things in an implicit social context. If it seems that someone has a problem, I'll consider it a problem, not only if it seems sufficiently and officially abnormal.

Lot to unpack from what you said, but whatever you want to make of the classifications (created by people much more knowledgeable than you or I in this field, but with plenty of conformist baggage), my time with ADHD or whatever you'd like to call it has absolutely shaped the experience of my life, and taking medication has objectively helped. My brain objectively processes things differently from whatever you'd like to call the median of people, and functions different with different chemicals. Personally, because of this medication that allows me to focus, I have been able to remain on par with my peers, if not with more elbow grease -- so I quite benefit from the label, weird and fluid as it may be.

An interesting fact is that caffeine will often affect the "ADHD mind" differently. It's been reported to have no effect, or have very limited effect, or make people even sleepy, but almost always something non-standard. Once, in high school, without the supervision of my parents, I drank maybe 2 red bulls and 2 cups of coffee, 1 black. I remember feeling disappointed it didn't work, and I didn't feel any rush of energy.

I was certainly not trying to say that differences between people do not exist and most certainly never claimed that your brain should work the way other people's brain do (At my age, I absolutely know mine does not, by a wide margin, and never has, and I'm in fact quite fond of that fact).

I'm simply saying that the way we're classifying people is utter BS, and assigning labels is very hurtful

Everyone is different. The "median man" does not exist. Or if he does there are maybe 3 on the whole planet, not something significant.

Much like your fingerprints, your brain is completely unique, and what chemicals / lifestyle / circumstances affect it in what way is a hugely personal affair. And to make matters even more complicated, it changes very much over time.

If you agree to let any kind of random bozo, with a so-called specialist title and a diploma tell you that you are a "typical neuro-divergent belong to class XYZ", run like hell.

The only way is to experiment with the way your mind works: chemicals, social groups, type of work, meditation, yoga, sports, more or less social interaction, whatever ultimately gets you to where you want to be.

But if you let every other snake oil salesman out there, or the rest of humanity in general, tell you who you are and who you ought to be ... good luck to you.

This "x chemical affects some people differently" thought is incoherent because what matters is the /dose/, not if it exists at all.

> whatever ultimately gets you to where you want to be

Money.

> classifying people is utter BS, and assigning labels is very hurtful

Is saying "you have cardiovascular issues" labeling or diagnosis? Where would you draw the line? We have a definition of a healthy heart, likewise we have a definition of a healthy brain. If I suffered a stroke, it's not because my body is unique, it's because of a disease.

A diagnosis is literally just a heuristic category so they can do research on rough groupings of symptoms to evaluate how treatments impact them. That's it. To get a diagnosis is literally just a statement "my psychologist thinks my symptoms align with this group and that the treatments they found effective for those symptoms will be effective for mine." The idea these things are identities or real categories is completely absurd and disconnected from why they actually exist. There is 0 basis to assume because two people have the same diagnosis they have the same underlying causes for what leads them to end up with that rough grouping of symptoms. There may be some general similarities or correlations but again the whole point of these is literally just to establish heuristic groups so we can do research on how people respond to treatments. People allowing them or speaking in a way that makes them seem like more than that is extremely destructive.

a crumbling society is basically ideal for maximizing human stress and its various expressions ... or so dictated the deprecated term neurasthenia ... while many individuals are forced to deal with debilitating mental conditions , this situation is often incorrectly conflated with having experienced temporary behavioural breakdowns that later resolved (aka normal evolutionary response) ... this conflation wouldnt be such an issue if big pharma wasn't in the picture , overpathologization is definitely in somebodys best interests !

I think this is broadly well considered although I have a bit of trouble understanding this point:

> Social awkwardness refers to social ineptness without meaningful impairment

Isn't social awkwardness sort of inherently impairing in social relationships?

Probably but at the risk of giving a bad analogy maybe the distinction here is like that between an itchy wool sweater (uncomfortable, broadly decreases mobility by making you not want to move) and a garment that actually restricts movement (a too small blazer that won’t let you reach straight up or, in the extreme, a straight jacket).

Yep. Psychiatry (or most of medicine really) is not trying to bring everyone up to the top 10% of the population, or even the top 50% along some dimension of interest. Psychiatry is mainly trying to move people from the bottom ~5% (what we call a "disorder") to the top ~95% of the population - which is then considered normal variability. So, if you take for example extraversion/social skills, then many "psychiatry-healthy" people will not be good at this at all, will make fewer connections, will not ask for raises, will be skipped for promotion, will have weak social support structures if shit hits the fan, etc. That's just normal trait variation.

I think a really good example of this is self-diagnosing with bipolar disorder (and thus mania). Let's forget for a second that mania must last at least a few days non stop; most people do not notice this part somehow :). If you read the DSM criteria you may think that you actually fit them sometimes: elevated/irritable mood, highly talkative, distractible, flight of ideas, ... . However, you probably don't, and it is mainly a matter of understanding the scale of the problem. Most people do not know just how wide the range of "mood" is in humans, and what does it mean to be on either of the far ends of it.

(percentages are much more illustrative than accurate)

I read it as "without other psychological or psychiatric issues which cause social difficulties."

It seems very tightly focussed, and more behavioural - and open to behavioural training - than other categories.

> Isn't social awkwardness sort of inherently impairing in social relationships?

Yes, but I think the distinction is explained in the article: "show significant improvement with practice and maturity" and "generally achieve life goals despite awkwardness".

To put it another way, those who are socially awkward can get better, whereas some of the other diagnoses are lifetime impairments with little or no possibility for improvement or cure.

As some on with Schizoaffective Disorder, OCD, and Panic Disoder, I know why people want to have an Autism diagnosis. It is because people with Autism are more studied, get more assistance, and are get more sympathy from the general public.

Someone with Autism can act out and people will be like "That's OK, he has Autism". But when I act out, there is no understanding.

What is missing in the article is there does exist overlap in these condiations, not only symptomatically, but also genetically. As far as genetics, just take a look at the calcium channel gene CACNA1C:

https://pubmed.ncbi.nlm.nih.gov/31805042/

I would probably had an Asperger's diagnosis when I was a kid, but most of my Autism was beaten out of my by my older brother's and kids in school. I mean, I was so deep into astronomy when I was 10 and I would not let go if it even though everyone teased me about it and I talked about it all the time anyway.

I am in my early 60's now, homeless, living in a Minivan, driving around, researching my genetics obsessively to the point where I communicate with some leading specialists in the United States, but still no one cares.

So yeah, do I wish I could say I had clinical Asperger's? Yes. Yes. Only so I can be accepted for my neurodivergence.

No worries. I am schizotypy but I have suffered plenty. It's not so much better than Asperger's but I can lead an autonomous life. I could prefer to be normal but there's that. Some people use it for greatness, some suffer it for live; thing is you're not alone. Please give some time to the outward world and focus on some socials from time to time. Things will be fine.

I think it also comes down to whether the person's behavior is seen as a threat. Autism weirdness translates into disengagement always works. Schizo doesn't have that same safety, thus people are a lot more worried.

I’m beginning to wonder whether one can qualify simply as an “eccentric” is a function of social + economic standing. Or whether whatever people think you are, or what you think of yourself are determined by these factors.

Often times it seems like the “soft diagnosis” of a condition can be used to hedge against less-than-desirable personality traits if the person is held in high enough esteem. If they aren’t held in popular regard to some extent or if there’s other factors that can be used to explain their behavior (e.g. the stereotypical “German coldness” or whatever) then they don’t get those benefits. Characteristics like their political views may also negatively affect the likelihood of this “psychiatric hedging”.

At what point do idiosyncrasies become subject to pathology.

This is the wrong framing: We all have degrees of “diagnosable” traits, it’s only when those traits become problematic do we need to seek help. For example, obsessive tendencies can help you stick with a tough problem or they can become an unhealthy fixation.

Also, if someone is mean they are mean: Diagnosis is not a “get out of jail free” card for bad behavior.

I'm autistic and the difficulty was high for me to learn, "being autistic is no excuse for also being an asshole". I had to work a little harder, sure, but it's doable for many of us.

Regarding your last sentence, typically when the individual seeks it. It's generally considered both rude and ineffective to diagnose others who are not seeking diagnosis.

This is kinda how I've come to view psychology because in the context I was raised mental health support was a luxury left for the wealthy. Albeit more about personality, upbringing and status rather than just individual idiosyncracies.

I understand that this may be a categorical error, since psychology can be the categorization of symptoms, but a lot of the things I learned "from the outside" really still stick.

Like the wealthier populations getting neat little explanations/excuses whenever convenient. Theres the scholastic benefit of ADHD diagnosis and anxiety diagnosis, which can help a lot in school/academia and to everyone else who cant afford it they get the cheaper label: "being bad at school" or "dumb". And still requires even more effort.

Theres the trauma and therapy cycles for otherwise normal behaviors like separation anxiety from parents, not being popular or highly esteemed, stress from not attaining goals, etc. The cheaper treatment being to suck it up.

What is normal for the poor to carry is a diagnoses and special treatment for those who can afford it.

And this is also reflected within the office as well! The outcome can be better if the professionals empathize with the one seeking treatment (theres a whole class/racial component here).

I agree with your sentiment and I think it's really all down to wealth and/or availability.

> Like the wealthier populations getting neat little explanations/excuses whenever convenient. Theres the scholastic benefit of ADHD diagnosis and anxiety diagnosis, which can help a lot in school/academia and to everyone else who cant afford it they get the cheaper label: "being bad at school" or "dumb". And still requires even more effort.

What I find interesting is that now we’re beginning to see more of the “un-wealthy” (i.e., not quite middle class, not quite rich; just covered by health insurance) achieve these diagnoses. Whether or not a child in a single-parent household is diagnosed with “oppositional defiant disorder” likely becomes a question of where that single parent works. While their peers with similar traits are pushed into a classroom in the basement.

> What is normal for the poor to carry is a diagnoses and special treatment for those who can afford it.

With this I’ll defer to our colleague in this thread, jt2190, with two modifications of my own:

> We all have degrees of “diagnosable” traits, it’s only when those traits become problematic [to our position in society] do we [become compelled] to seek help.

It feels like you’ve mixed up cause and effect: Getting access to mental health resources that can result in a diagnosis does not bestow a higher social rank upon people, those people’s existing higher social rank allows them easier access to mental health resources and thus they are more frequently diagnosed/treated.

You also seem to be implying that these diagnoses are frequently not merited and just used to increase social rank somehow, which is extremely cynical.

Yeah, he lost me here:

"Autism spectrum is wide enough to have very different prototypes within it. On one end we have profound autism, representing someone with severe autistic traits who is completely dependent on others for care and has substantial intellectual disability or very limited language ability. At the other end, we have successful nerdy individuals with autistic traits and superior intelligence, often seen in science or academia, à la Sheldon Cooper."

He's just another ableist crank who thinks people with intellectual disabilities who are also autistic are “profoundly” or “severely” autistic. Neither of those are actual diagnostic categories; they were invented by “autism parents” (not autistic parents; parents of autistic children) as a way to exclude everyone except level-3 autistic kids with intellectual disabilities.

Then he throws in the “superior intelligence” nonsense. No. Just no. More ableist BS.

I’m a late-diagnosed “level 1” autistic adult (also ADHD) who works full-time as a network admin. Functioning labels don’t make someone “less autistic”; they just reflect different support needs.

He also brings up BPD. Lots of autistic women get misdiagnosed with BPD. My wife was one of them. Once I dug into how autism presents differently in men vs. women, it became obvious she checked all the boxes. She later got an autism diagnosis too.

This honestly tracks with what I've seen: autism has become the catch-all public label for "socially struggling person," even when the underlying cause is anxiety, trauma, personality patterns, or just plain awkwardness.

> Autism exists, to the extent that any psychiatric disorder exists.

Autism is a neurodevelopmental disorder which causes and contributes to various psychiatric disorders.

The author is not seeing the forest for the trees, which is incredibly ironic.

it does not mention that since ICD-11 you are "allowed" to have both autism and schizotypal personality.

the agenda being pushed with the recent spate of articles to the effect of "people are saying they're autistic when they're really not, and should be classified differently" I think has mostly to do with RFKs overarching claim that people who are autistic are all suffering a horrible, debilitating disease, where in his words verbatim: “These are kids who will never pay taxes, they’ll never hold a job, they’ll never play baseball, they’ll never write a poem, they’ll never go on a date” [1] , which from there goes into his bigger goal which is to create a "database" of autistic people [2], for which no valid reason has ever been given. By redefining "autism" to be only those who we've decided are those severely disabled who "will never pay taxes or hold a job", then creating a catalog of exactly who these people are, the final step is quite obvious if you've studied the treatment of autistic people in Nazi Germany [3].

So I'm going to flag these posts for now because the goal in the current US climate is pure eugenics. RFK is at his core a eugenicist, as are all high-level anti-vaxxers. Anti-vaxxers seek to blame the diseased for their disease, on such factors as "poor diet", "lack of exercise", or in the case of autism, "having your child vaccinated", against all scientific consensus, and would prefer people suffer and die of horrible and completely preventable diseases like measles and polio since they somehow "deserve it". Governments like the current one have plenty of plans for people they deem unworthy.

[1] https://thehill.com/policy/healthcare/5256614-autism-communi...

[2] https://www.npr.org/2025/05/08/nx-s1-5391310/kennedy-autism-...

[3] https://mjhnyc.org/blog/autism-and-disability-in-nazi-vienna...

This is the third article in a row that I am seeing on hacker news that is spreading misinformation about autism.

This seems to be targeted campaign. I urge people to not be fooled by ill-researched blog posts. Listen to autistic people. Listen to researchers that represent the scientific consensus.

Any diagnosis for autism will first consider whether the symptoms can be explained better by another diagnosis. This is why you fill out a lot of questionnaires and the like when you get your diagnosis. This is the state of art.

Also women are systematically underdiagnosed when it comes to autism, they often get labeled with boderline and the like. The idea that someone is labeling everything as autism is silly.

This fits in with another thread on an article about over-diagnosis.

I think it’s safe to say that if someone appears “weird” to the hive mind of a community, that person is more likely to be correctly diagnosed.

There are people who desire a diagnosis for special treatment, but if the first time you find out about a person’s diagnosis is after knowing them as “weird” the whole time, then they’re not acting weird on purpose, or saying they are X for attention or special treatment.

Disabled people, mentally or otherwise, usually like to keep their business to themselves, unless they absolutely don’t need to. Some mentally disabled people might even forgo getting special treatment via disability services at their colleges, or getting parking permits for disability because they’re not interested in bringing attention to their difficulties or differences, or using these issues as a cause for special treatment. Though, I’d advised that people who need accommodations should get them.

I also saw a comment about disability becoming normalized due to late stage capitalism, which sounds like a thesis out of postmodernist thinking. The fact is that group behavior has always isolated “weird” behaviors and put undue negative attention on them, but it just happened to be the case that that weird behavior was evolutionary helpful, which is why it has persisted for millions of generations of humans across their evolutionary history.

This only applies to high-functioning categories of behaviors. But I’ve found that more often than not, it’s the social reaction of groups that is the problem for high-functioning autists, and less the autism itself. Maybe neurotypical behavior or neurotypical mindedness is the disease because I don’t understand why or how some people find it so hard to think differently. Are they not individuals, are they zombies?

Let’s also shed light on what behaviors neurotypicals usually have a problem with that they cast as negatives in high-functioning autists:

1) Not being mindful of hierarchy

2) Not being mindful of socially determined rules, that is rules which are not codified in any official language of conduct

3) Not wanting to socialize, or wanting to socialize differently

4) Trouble with emotional regulation, possibly due to social issues

Tell me, which of these points, and there are many more, point to this being an individual’s problem?

For high-functioning autists, the problem is other people.

People need to realize that they’re not great to deal with on average, and if someone chooses to not engage with you, don’t take that as an insult. Maybe you’re all better off not interacting with each other, but that doesn’t imply causing someone financial, emotional or physical harm just because they’re autistic.

Society both explicitly and implicitly punishes high-functioning autism.

But note that the not interacting bit messes with you in both the job and romantic markets. That's not intentional but it sure hurts them.

It shouldn’t interfere with the job market, but the sad truth is that NTs need to make everything into a social game because otherwise they can’t compete or survive.

It does because you aren't as good at presenting yourself, you don't fare well at corporate politics etc.

Neither of those things is job related, necessarily

> I think it’s safe to say that if someone appears “weird” to the hive mind of a community, that person is more likely to be correctly diagnosed.

It's officially frowned upon, but doctors still use the term "FLK" (for "funny looking kid") to describe babies or children with nonspecific facial deformities, which are pretty reliable indicators of cognitive or learning disability even if the doctor can't put his finger on what the deformity actually is.

> This only applies to high-functioning categories of behaviors. But I’ve found that more often than not, it’s the social reaction of groups that is the problem for high-functioning autists, and less the autism itself. Maybe neurotypical behavior or neurotypical mindedness is the disease because I don’t understand why or how some people find it so hard to think differently. Are they not individuals, are they zombies?

It's the uncanny valley effect. I'm convinced that one of our primal atavistic fears, besides snakes, spiders, and so forth, is "something evil or hostile disguised as one of our own". In the EEA this fear would have protected a community against spies, as well as profoundly sick (e.g. rabies) individuals who risked spreading their disease throughout the whole village. Different cultures give different names to creatures of this sort: vampire, zombie, changeling, skinwalker, bakemono, etc.

Profoundly autistic people are clearly disabled, and so attract nurturing and care; "high functioning" autistic people resemble humans who can function independently, but their behavior is different enough to trigger what I call the Kendrick Lamar response ("they not like us, they not like us") and hence are viewed with fear and suspicion. It's a flaw in the neurotypical mindset born of a trait that helped preserve neurotypical communities against invasion or outbreak, but it's not very specific so others get caught in its dragnet.

That's my idea anyway. Maybe I'm just steelmanning the NT perspective. There has to be a reason why the poor blighters are the way they are...

> There has to be a reason why the poor blighters are the way they are...

Maybe I am biased, but to me NT appear as cognitively lazy. They don’t question norms or standards, unless those norms or standards interfere with their feed-fuck cycles.

They come built in with a set of heuristics that help them interact with other NT minds very well with very little cognitive effort, so why spend it if you don't need to? There's a certain perverse genius to it which you'd see if you spend any time around profoundly NT people: for example those who fit the "theatre kid" archetype, or even skilled marketers. They can shape the trajectory of an interpersonal relationship in real time as easily as we breathe.

Expending large amounts of cognitive effort to better understand and deal with others can be exhausting. We do it because we have to just to survive. The benefit is we have a lot of uncommitted neural capacity potentially freed up for other things, like experimenting with computers. But it's a stiff price to pay, and in the EEA it's advantageous to be able to participate in a cohesive group without thinking much about it. Our brains are our most energy-hungry organs, and sustenance could get scarce...

It depends on the task at hand, that unspoken understanding can work against your best interests. In general, the NT way leads to stagnation and complacency for building and maintaining systems as conditions change. I am not saying one way of thinking is better than the other, you bring up a great point about conserving resources. I think survival pressures have always necessitated a balance of human cognitive abilities. I guess only time can tell how things may transpire, and what’s actually useful. Maybe there’s a way to simulate this in silico…

For thousands of years, the way humans lived changed so slowly as to be imperceptible. That's no longer the case. Starry-eyed types who think of their autistic children as "indigo" or "crystal" children may wax poetic about autism being the next phase of human evolution, but recent scientific work lends a kernel of credence to that: autism is now thought to be one of the side effects of rapid changes to our brains that were evolutionarily necessary to cope with our rapidly changing world and circumstances.

Based on what I've read lately, my consensus perspective is that 80% of what people consider autism is actually just the western diet's effect on normal brain chemistry.

[flagged]

You should also think before you call people stupid. If you google autism test, you'll find this:

https://www.clinical-partners.co.uk/for-adults/autism-and-as...

"I prefer to do things on my own, rather than with others."

"I prefer doing things the same way - for instance my morning routine or trip to the supermarket"

"I find myself becoming strongly absorbed in something – even obsessional"

These are all questions everybody living in a modern society can relate to.

Of course autism is a real condition, but modern society somewhat requires people to be machine like and that can easily look like someone is on the spectrum.

Those have the same diagnosis power as "what Hogwarts school are you in" quizzes.

Real assessments are different. Also, ADHD/ASD folks tend to overestimate how universal their experiences and preferences are.

Didn’t call anyone stupid. I said the comment was stupid. I maintain it was.

No, I'm afraid the original poster was right. The original comment was just plain stupid. For one there isn't a single 'western diet' any more than there is one 'eastern diet'. If you had attributed a single social issues cause to 'eastern society' like conformity to what you think 'the eastern diet' is and does you'd rightfully be called out for racist stereotyping.

Their comment was against the guidelines and I've replied to it to explain how, but it's still not OK to comment like this on HN, no matter what it's in reply to. Please take a moment to remind yourself of the guidelines and make an effort to observe them when participating here. https://news.ycombinator.com/newsguidelines.html

I will Tom. That comment was touching the third rail for me and I reacted where I shouldn’t have.

If you think you've explained autism, I invite you to publish a paper.

What you read lately is likely derived from Brain Worm's attempts to blame diet for the ills of society. Remember, he doesn't believe in infectious disease, think he gets the rest of it any better?

Please don't post flamebait like this on HN. It's covered by this guideline:

Comments should get more thoughtful and substantive, not less, as a topic gets more divisive.

It's fine to make the point, but it's inevitable that it will stir up strong feelings in others, so it's important to express the point thoughtfully and substantively. In this case, citing credible evidence and being compassionate rather than dismissive, would make a big difference.

https://news.ycombinator.com/newsguidelines.html

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