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Comment by andy_ppp | Hacker News Reader

Are you really saying most people can’t discern autistic spectrum behaviour in their peers?

To the level of a clinical diagnosis, yeah it seems quite likely to me that most people can’t discern autistic spectrum behaviour in their peers. I bet most people couldn't even accurately say what those behaviours would be.

Definitely nobody in this thread struggling to see the grey areas and wanting to make sure everything is very cleanly defined, as if it’s difficult for them to deal with situations that are outside of rigorously defined clinical diagnostic criteria, for example… BTW just to be crystal clear - I’m obviously making a silly joke here it’s not intended to be serious :-D

A clinical diagnosis isn't the only way to look at what's going on here. We can have differences that aren't medical problems. Differences that are measurable and nameable, even. Those categories can overlap with or be congruent to medical terms while still being valid and useful.

"On the spectrum" has more or less become code for "introverted, obsessive, socially inept, and a little scary."

That can certainly be a syndrome, but the official DSM definition of autism is not based on those criteria.

Clinical autism tends to be much harsher in its presentation.

Clinical autism and clinical ADHD are notoriously difficult to diagnose in adults. In some countries it's even illegal to prescribe stims unless there's a childhood ADHD diagnostic.

Adults have been socialised to mask the more problematic behaviours, and they can also be unaware that what they're doing is masking: they can believe that everyone struggles like that.

Only difficult because the criteria are misaligned. We diagnose school children more consistently, because we subject school children to strict measured criteria (school), and can point to the data (grades/homework) as objective evidence.

Why do we care so much about objective evidence? Because of prohibition. Prescribing stimulants isn't illegal because it is difficult to diagnose ADHD. It's difficult to diagnose ADHD for the very same reason it's illegal to prescribe stimulants: our society values prohibition of drugs over actual healthcare. An ADHD diagnosis implies a compromise of prohibition, so our society has structured the means to that diagnosis accordingly.

Experts in the field estimate a very high incidence of undiagnosed ADHD in adults. During the height of the COVID-19 epidemic, telehealth services were made significantly more available, which lead to a huge spike in adult ADHD diagnoses. Instead of reacting to that by making healthcare more ADHD accessible, our society backslid; lamenting telehealth providers as "pill mills", and generating a medication shortage out of thin air.

Very well said. I think it's hard for people to understand that ADHD is simultaneously over diagnosed and under diagnosed.

> Why do we care so much about objective evidence? Because of prohibition.

That may be true for ADHD, but autism diagnoses don't "unlock" any particularly sought-after prescription medication, so I don't think that can be the whole story. In kids, diagnoses do unlock accommodations in schools, but not so much for adults.

That's mostly true, but there is a huge overlap in ASD and ADHD diagnosis. It's very common to be diagnosed with both, and that expectation (from a healthcare provider's perspective) has implications.

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