The overloading of the term autism has had a real damaging effect on some people. My cousin is profoundly autistic: he's nonverbal, and will never live independently. In the 90s most autism research was focused on helping people like him. He was involved in some pioneering studies at John's Hopkins University.
Today most of the money and advocacy is for high-performing or moderately-performing people with autism. Not just in relative terms, the amount of funding for people like my cousin has gone down. It makes sense; they are the larger group by volume and are able to advocate better than people like my cousin.
I wish it weren't a zero-sum game, and we recognized that autism is just a word for a broad series of conditions. It would be like if we called everyone with poor eyesight 'blind': yes, your vision is impaired. But the solutions you need are very different than the solutions Stevie Wonder needs.
I have a former friend who listened to too many podcasts and self-diagnosed himself as autistic right around when his relationship was falling apart. The guy couldn't handle his girlfriend asking him to step up on some things so he decided his "out" socially was to call himself autistic to garner sympathy. The dude isn't autistic, he is simply terrible at accepting any responsibility for himself and doesn't care how that affects others. That was my first exposure to how out of control autism labeling was about to become and it's gotten a lot worse since then.
Unfortunately, many autistic people also get misunderstood to be irresponsible and lazy. They are also unable to understand other person's feelings and are thought to lack empathy, even though it is just that they are unable to recognize social cues.
So with just this information it is hard to say if your friend is indeed autistic or not. It would need a more professional diagnosis to say either way.
This is good advice - I always struggled but managed, then one day I just broke. Decided to do the thing everyone says and get some help. The therapist after a session was suggesting autism and some other stuff mixed in, because of the internet arm chair mental health crowd I was skeptical. I also know some people that are obviously autistic, and a good friend who's autistic and schizophrenic which made me feel like I have nothing to complain about, I'm obviously "fine." But, since the shrink kept mentioning it, I opted for the neuro-psych exam to get a more concrete diagnosis and indeed high functioning autism is there.
It's been interesting to see the therapy (and meds for the other problems) working. Now that we know, my wife has had some therapy to help support her and help her support me - and it's been wonderful. Understanding wtf is going on made it easier to talk about, address, and improve. It's an on-going thing but talking to qualified people was the first step.
Yes, it’s similar with ADHD as well. You really should seek a professional diagnosis before going around claiming it.
Even then you’re not free of the consequences. Sometimes just have to push yourself and say learn to bite your tongue to not blurt out an insensitive thing. What a diagnosis does give is knowing that yes it’ll be harder, to have patience with yourself, and to learn coping mechanisms.
Ironically, sometimes the worst criticism autistic or adhd people get though are from family or friends with undiagnosed autism or adhd themselves. Because they have to work so hard to mask they become very critical of people with legitimate diagnosis.
In many places getting an adult ADHD diagnosis is near impossible. I was diagnosed at age 8 personally, but I now live in a country where adult ADHD is borderline not acknowledged as even existing, and I know people have to fight very hard to get diagnosed and even harder to get access to medication if they can get it at all.
There can also be palpable downsides to having a diagnosis at all, eg in my birth country everyone with an ADHD or Asperger's diagnosis is legally required to pay for medical evaluation out of pocket to be allowed to get a driver's license and will face medical reevaluation on renewal as well.
It's not always great in the US despite it being acknowledged and somewhat accepted. It's gotta be really rough in a country that doesn't accept adhd. Ouch, a medical evaluation might make sense, but to have to pay for it out of pocket, ouch.
Though on the flipside in some countries the doctors don't care what meds they prescribe. It's very strange how things vary by coubtry. Some are absurd.
I guess my comment assumes the US where it has perhaps become a bit "trendy" as the OP suggested. I will say that when possible most ADHD'ers or aspergers do benefit from professional guidance.
Guidance definitely can be helpful. Of course it's important that the possibility exists; Ihhave high functioning AuDHD and without extra support I probably wouldn't have made it as far as I have, but there's shadow sides to "support" as well. From a very young age I had to constantly play manipulative games one way towards social workers to present myself as adequately dysfunctional to qualify for financial support that my (poor, single parent) family desperately needed, and on the other hand as more "normal" than I really was to counteract my elementary school that was convinced I should go to special education and went out of their way to contact my prospective middle/high school and try to talk them out of accepting me for instance (I ended up doing the honors track in secondary education and getting a BSc after).
I'm sure a lot of those shadow sides disappear in adulthood when one is more in control over one's own destiny but so do a lot of the benefits (eg workplace accommodations aren't nearly at the same level as school accommodations and unfortunately I'm convinced the vast majority of ADHDers/Aspies are better off not telling people at work).
It's hard to say what to make of the whole "trendy" thing, for every such person I know I know several others who are definitely on the spectrum but undiagnosed. I do think in our culture we have an unhealthy tendency to jump from "this is difficult for me" to "something is wrong with me" but on the other hand executive function or sensory difficulties are something many people experience from time to time and if "I'm a little bit autistic/ADHD" is people's best way of describing what they're going through then I don't want to silence them, because I know those difficulties are real and I have a lot of sympathy for that.
In an ideal world we'd be able to talk about the symptoms without having to reach for the syndromes, but that requires a level of experiential insight and standardized nomenclature and especially sympathy on a population level that's just not really there yet.
If you just tell people you struggle with procrastination or have analysis paralysis or get too sensorily overwhelmed by sounds or smells or the office environment to function people do still often treat each other like they're snowflake wusses that need to grit their teeth and pull their bootstraps or whatever.
The fact that this is all just part of "the human condition" often just hardens people more ("I had to grit my teeth and bear it's only fair you do the same"). Putting people in an exceptional "disease" bucket gives some respite from that, would that it be otherwise.
Better to acknowledge that there's nothing special about being diseased, there's nothing wrong with being diseased. We are all diseased and we all deserve and benefit from care. Those that don't think so should try talking to an older person ;-).
I think that part of the problem is fear of discrimination if your permanent medical record contains a diagnosis of autism. Its very conceivable that, now or in the future, a diagnosis could inhibit ones ability to immigrate, hold certain jobs, or get affordable health insurance.
Anyone who has experience with an autistic person can figure out pretty quickly that they have empathy if they try. When you tell an autistic person that you are feeling some way or another explicitly they will usually respond with empathy. But if you are just dropping subtle hints or using body language they will assume everything is okay.
I don't see the point in asking that question as his friend self-diagnosed himself as "autistic". Jsbi, I assume, is expressing doubt in the self-diagnosis rather than diagnosising his former friend.
I get it. Mental health issues have not been taken seriously in the past to say the least. And we're better off when people can openly talk about them without being ostracized. But you can definitely swing too far in the other direction. I keep meeting people who are almost bragging with their claimed collection of mental illnesses as if it's a lifestyle choice.
This still aligns to what I said no? He himself is expressing doubt with his own reasoning why. Either way it doesn't matter as the assumption shouldn't be his former friend is autistic by default.
The poster is claiming without any evidence other than the "friend" was "self-diagnosed", which doesn't tell us if the "friend" was right, or not, and adding that they knew the diagnosis was wrong because of other claimed attributes.
I'm honestly shocked at the response to me pointing that out.
If you want to go round making judgements on peoples' mental health without any qualification to do so, and post that judgement on social media (which Hacker News is) then I will call you out for that, every time I notice.
People come to these comments claiming to be all about science, all about serious thinking that's not found on other social media, but then this trash gets posted and people calling it out get attacked.
No, he pointed out how over-saturation of autism awareness has resulted in people self-diagnosing as a way to absolve themselves of shitty behavior.
My step-son is diagnosed. He is on the spectrum. He was non-verbal for longer than most children and low-verbal for years after that. He has fine-motor challenges and operates on an emotional level behind those of his peers.
If he's being an ass, we let him know. He knows his condition is not an excuse for his behavior. He needs to know how to cope with and navigate the world around him. Autism awareness and advocacy is about not shaming people for wearing ear protection in public. It's about recognizing that texture aversion is a thing. It's about knowing to extend grace when appropriate. It's not about letting people be shitty.
He may be autistic, but he does not get to interrupt us. He does not get to derail conversations into his interests. He does not get to ignore his hygiene. Instead, we try to teach him to be patient. To be polite. Strategies to make necessary things a part of his routine.
The biggest difference is that we do these things with compassion and with the realization that some things are more difficult for him. Rather than what we did in the past, which was browbeat autistic people into masking.
No, he made a diagnosis - neither party appear to be in a position to do so.
You can disagree with someone's self diagnosis all you like, but there's absolutely NO WAY for you to make a diagnosis yourself unless you are actually qualified to do so.
Not to justify it but 1) your responses have been misunderstanding their point, even after a good explanation of it and 2) they had some of their comments down voted (IMO, probably because of how they expressed their perspective rather than because of what it is).
So it is (or rather, seems like to me) a double whammy psychology of having their point be demonstrably misunderstood while it is also (seemingly) being rejected by down votes. (Again, just explaining, not justifying.)
(Also, I cannot help but notice the irony(?) of this misunderstanding and the necessity of this explanation in a thread on a post about autism. No shade to anyone, just making the observation.)
First of all, I firmly believe you're a sock puppet.
Where is the "good explanation"?
The first thing he did was demand qualifications of the poster. Exclaiming he's diagnosing something. He started aggressive.
I then pointed out that his friend also made his self-diagnosis with the same qualifications.
He then got all huffy and basically said "So you agree his story is rubbish", which is also rather aggressive. And all through this, he's been dismissive and condescending to people. And everyone else has been rather polite to him even with his attitude.
And I don't think anyone is misunderstanding him. Everyone acknowledges his point that the poster is likely not a qualified professional. However, they are pointing out that neither is his friend. And I also pointed out, diagnosis or not, there's no excuse for being an asshole. Being autistic does not give you carte blanche to treat people like shit.
So it's more like his refusal to understand everyone else's point. And likely why he's getting downvoted. But that shouldn't matter. So, you know, stay awesome, dude.
It was in the comment four up from my first one in this thread.
> No, he made a diagnosis - neither party appear to be in a position to do so.
(They also gave other explanations elsewhere in the thread but that is what I was referring to because it is enough for a reader to understand the point and you actually replied to it.)
Their point is that the other commenter should not have written "The dude isn't autistic" because that is a negative diagnosis rather than an agnostic statement.
> So it's more like his refusal to understand everyone else's point.
Others were failing to make substantive points against the commenter in question because their point was going misunderstood. It took a few back-and-forths to get to the actual point (in fairness, that's because of the vagueness in their initial comment) but that point is consistent with what they've written in this thread.
> I firmly believe you're a sock puppet.
Genuinely, I read this as feedback that I empathized well given that I'm not. But especially because I disagree with their point. (The presumption that the first commenter meant "The dude's not diagnosed" is very reasonable and obviates the other commenter's point, except as a general reminder to be more careful with phrasing, which their question wasn't.)
Saying “the guy isn’t autistic” isn’t a diagnosis. Mostly because he isn’t a doctor. So harping on people making diagnoses ignores the larger issue of the person using a self-diagnosis of autism to excuse his own shitty behavior.
> Saying “the guy isn’t autistic” isn’t a diagnosis.
Actually, this is how a diagnosis could be phrased by a particularly informal doctor. You mean to say it's not a valid diagnosis because he's not a doctor, which is rather the point.
> ignores the larger issue
Indeed, they wrote a comment in reply to what I can only assume is a pet peeve (I do hear and read a lot of careless negative assertions like that where they are not warranted; it's a worthy pet peeve) to bring up a smaller issue in the context of the bigger picture, while otherwise not addressing the other point. I think it's a reasonable assumption that they meant to do that.
I guess to this point, didn't you notice me also doing that? I'm just commenting on the things I want to comment on. I haven't mentioned what I think of the friend in the story because I haven't seen a reason to. Everyone knows being entirely self-centered is shitty.
But since I'm here, I guess I should comment on it. I wonder about that person and what their problems are. Why would they do something so anti-social? It's likely there's something else going on. Perhaps more to the point, it's unlikely there's nothing going on. Maybe it's actually autism. The idea that it's nothing and they're "simply terrible at accepting responsibility" is naive and, frankly, disrespectful. It's sad to me that nobody's wondering about OP's friend and everybody just takes OP's story at face value. I mean, if OP isn't qualified to diagnose but readers just roll with their diagnosis anyway, it's rather obviously unfair to the friend who has a similarly-qualified claim but is assumed by their former friend to be a scumbag.
Well, you came here to defend another poster. Your initial address wasn't to the story itself, the poster in question, etc.
And I even mentioned that even if he were autistic, it's never an excuse. A diagnosis is a tool for self-reflection, not a get-out-of-trouble-free card. So he's still shitty for using a diagnosis as a reason to be shitty.
People are taking OP's story at face value because it doesn't warrant investigation. It's minor enough that even if he were lying, it doesn't matter. The story is banal enough that it's likely happened to someone at some point. It doesn't require the display of credentials or anything like that. And no one is asking us to do anything about either side. Dude was just sharing an anecdote. That's why people are taking it at face value. Because to do otherwise is to dedicate too much energy to something that doesn't matter.
> People are taking OP's story at face value because it doesn't warrant investigation. It's minor enough that even if he were lying, it doesn't matter. The story is banal enough that it's likely happened to someone at some point. It doesn't require the display of credentials or anything like that. And no one is asking us to do anything about either side. Dude was just sharing an anecdote. That's why people are taking it at face value. Because to do otherwise is to dedicate too much energy to something that doesn't matter.
Whatever it's worth to someone else to tell a lie, it's worth to me to correct it.
> So he's still shitty for using a diagnosis as a reason to be shitty.
You're getting one side of the story and saying that doesn't warrant investigation. Empathy is literally the opposite of that. You do not have any reason to believe the friend was being shitty. OP didn't provide that.
> Genuinely, I read this as feedback that I empathized well given that I'm not. But especially because I disagree with their point. (The presumption that the first commenter meant "The dude's not diagnosed" is very reasonable and obviates the other commenter's point, except as a general reminder to be more careful with phrasing, which their question wasn't.)
FTR I read your initial comment as being critical (but fair) of my posts. How the person you are talking to missed that and jumped to you being me is quite the jump.
Honestly, re-reading everything, I think that paragraph is too harsh. In particular, that presumption of their intended meaning is not reasonable. They clearly meant "the dude's not autistic", which you correctly called out as a diagnosis. I appreciate your thoughtfulness.
Long before this was mainstream a misdiagnosis of ADHD and then autism led me on a decadeslong course of therapy and treatment that ultimately didn't address my issues. It was even worse since I was a child at the time labeled by people I was supposed to trust and could not comprehend the true meaning of these terms, so I grew up into an adult assuming what they told me was the truth, the whole time. Because of their actual role in my issues, I now know that nothing they could have labeled me with would have helped me and allowed them to take responsibility for my poor treatment.
All to say that the map is not the territory, and leaping to conclusions at the first label that sounds like it fits the bill can have devastating consequences.
And as in my case, labels can be used to shift the blame away from the caretaker responsible for trauma/etc. by medicalizing the consequences, or onto an existence that is perceived to be unchangeable/futile to address.
Same with my little brother. I've seen autism turn into an ignored subject to being hijacked by higher-functioning autistic people who are controlling the narrative. It's good to have more autism awareness, but they're the top 1% of people with discernable autism and can hurt large numbers of lower functioning people with autism who basically have to be taken care of by their families for the rest of their lives.
Social media is not disconnected from society as a whole. Influencers are called that because they have actual influence. You only need to look at and truly understand the MAHA movement to know this. It's not a movement by RFK; it's a movement of people (often moms) who are dissatisfied with their current situation and trying to do something to change it. They may be flat out wrong, but they have influence nonetheless.
Did the diagnostic criteria in DSM 5 change as a result of social media, was it the other way around, or was it hidden variables affecting both? Regardless, the money and attention tend to follow what the common people are saying. See: https://pubmed.ncbi.nlm.nih.gov
I don't disagree with this at all; but I do question if there's been a lot of research for what kind of resources even help "high-performing or moderately-performing people", let alone directing these resources to this demographic over autistic people who struggle to meet society's expectations for individual productivity.
"Advocacy" I could see more clearly, and I question how much of this "advocacy" is actually doing for "high-performing or moderately-performing" people.
IMO, the only way to really "resolve" the anxiety over prioritizing one group over another in either discourse or in resources in the long term is finding a way to integrate non-productive people into the daily lives of productive people. This seems difficult to imagine in today's America, where community is largely based around interests and careers that will self-select these people away.
Topically relevant: the DSM 5 eliminated the distinction between what was formerly called an Asperger's Syndrome diagnosis from an Autism diagnosis, in part because the name "Asperger" came from a Nazi scientist, and therefore, per then-current political winds, the only morally correct action to take was to erase the name. Of course, this motive needed some kind of non-political justification to not come across as what it was (an example of non-medical political partisanship aimed at erasing history that was disfavored by the political partisans pushing the agenda), which is where the idea of re-categorizing what were and still are clearly at least two distinct clusters of diagnostic patterns as one grand, unified "autism spectrum" that functionally resulted in little more than muddying of waters in the field, which now need to be cleared up again - as pointed out by TFA.
You're right that there are external variables, including non-medical variables, influencing the DSM-5's diagnostic shuffle, I just don't see them as particularly well "hidden".
How much does the DSM actually matter outside of clinical contexts? Labels have a life of their own, and people were linking aspergers and autism many years before the DSM did.
Asperger's was eliminated as a diagnosis because differentiating it from autism was hard to do. Two different evaluations could land a kid as either autistic or asperger's depending on the day and the evaluator.
And, importantly, Asperger's qualified for less therapies and treatment than autism did. That meant that even though your kid likely needed more treatment, they'd be denied it because they had a good day when being evaluated.
The crossover for treatment was largely the same with autism qualifying for more.
Even if it was the "Nazi link" they'd simply have changed the name to something more acceptable.
TFA is suggesting that there are probably multiple conditions which cluster around similar symptoms which makes it hard to identify the exact cause of autism.
The diagnostic reliability criteria even back then painted a picture of the details of the condition space being more nuanced than what were currently being captured, not less nuanced, so the idea of reducing nuance and distinction still seems questionable by an empirical and epistemological standpoint. However, that decision remains defensible and supported by the social justice / equity / de-hierarchicalization / eponym erasure motivational drives. These, besides the eponym erasure specifically, also explain many of the other changes in the DSM-5, like the elimination of many other more-detailed diagnoses, like PDD-NOS.
This isn't to assert that the clinical reasoning offered didn't have merit, just that institutional consensus-forming behavior isn't immune to the macro backdrop of the sociopolitical winds of the day.
Committee member A thinks: "These diagnostic categories aren't reliable" (true, clinical concern)
Committee member B thinks: "Honoring Asperger is ethically uncomfortable" (true, historical concern)
Committee member C thinks: "Hierarchical categories are problematic" (true, equity concern)
Committee member D thinks: "Spectrum model reflects current research better" (true, scientific concern)
No single person needs a "primary political motivation." No conspiracy needed. No explicit coordination required. Yet the outcome eliminating Asperger's and collapsing categories - emerges from a system where:
- Progressive ideology shapes what problems become salient
- Shared epistemic frameworks determine what solutions seem natural
- Professional incentives reward what can be publicly justified
- Social proof operates through "everyone reasonable agrees"
"The clinical rationale was legitimate" doesn't contradict "political ideology shaped the outcome."
> so the idea of reducing nuance and distinction still seems questionable by an empirical and epistemological standpoint.
Again, it does not because the treatments as a result of diagnosis remain the same. The primary role of diagnosis is to inform treatment.
If patients are seeing worse outcomes because of arbitrary "nuance", that indicates that the nuance carved out wasn't what needed to be carved out.
> isn't immune to the macro backdrop of the sociopolitical winds of the day.
This is conspiracy thinking.
You don't have any evidence that it was "progressive ideology" that eliminated the diagnosis, you just surmise it based on some people not liking their diagnosis being named after a nazi.
Slamming in reactionary politics in where it doesn't fit and a reasonable explanation does fit is just silly.
Sure, nobody is immune from politics. But I'm going to need more than "feels, vibes, and makes sense to me" before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis.
Diagnoses for mental disorders, by their nature, are almost always going to have a level of arbitrary lines that could be drawn. That's why we have 5 versions of the DSM and will likely have a 6th in the future.
>before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis.
If empirical reliability of outcomes were based on social standing of the committee, you'd have a great point, but alas, there's a trending new paper on Nature explaining the precise mechanisms of how and why DSM-5's category elimination between Asperger's and ASD is a measurably less accurate approach than the DSM-4's categorical differentiation of the two conditions. TFA is saying that we should've been moving towards more categories with more nuance and detail, even back when we were at just 2 categories, not towards fewer categories with even less nuance, as the DSM-5 chose to do.
Regardless of your opinion on influence of the politics involved, the hard fact of the matter is that DSM-5 made moves in the exact opposite direction for increasing understanding of autism-family disorders relative to DSM-4, and some of the newest, most comprehensive empirical science ever done on the subject is trending on Nature right now stating exactly that: we need more categories, more nuance, more differentiation, not to paint everyone under one broad brush of "it's all a spectrum of the exact same underlying pathology".
It seems abundantly clear to me, and to I think anyone else who's had any amount of meaningful exposure to or working with both groups: nonverbal autism looks much more like profound, pervasive developmental disabilities - think down's syndrome - than Asperger's does. The latter has a bunch of people that can generously be called eclectic, but writ large, are generally capable of supporting themselves and leading independent lives: emotionally, financially, socially, mentally, physically, maybe with some therapy, some counseling, some CBT, and maybe reasonable workplace or school accommodations, like being allowed to wear noise-cancelling headphones during solitary work. The former, categorically, tend to not be capable of that level of independence. It seems facetious and absurd to allege on any level that these two groups are substantially or meaningfully similar, especially if such similarity is being used to justify a treatment approach that is as identical as you purport it to be. These are, very obviously, so obviously even a child could grasp it, at least two dramatically different groups, with at least two dramatically different sets of needs and courses of treatment.
I say that as someone who grew up with more or less all of the hallmarks of (and was indeed diagnosed with) what we used to call Asperger's Syndrome, but also as someone who volunteered at events like the local Special Olympics chapter, and I'm firmly in agreement with in_cahoots's chief concern: 'Today most of the money and advocacy is for high-performing or moderately-performing people with autism.'
There are a lot of people who need a lot more support than people like me, and those with that greater need are getting less of it than they need, because people with well-managed conditions like mine are being lumped in alongside people like in_cahoot's cousin who genuinely need much more support. These two groups are a difference of kind, not a difference in degree.
> TFA is saying that we should've been moving towards more categories with more nuance and detail, even back when we were at just 2 categories, not towards fewer categories with even less nuance, as the DSM-5 chose to do.
TFA explicitly says the opposite
> “The term ‘autism’ likely describes multiple conditions,” said Dr Varun Warrier, from Cambridge’s department of psychiatry, senior author of the research. “For the first time, we have found that earlier and later diagnosed autism have different underlying biological and developmental profiles.”
> The scientists are *not* advocating for a move towards two diagnostic categories, saying that this could be unhelpful for the many who fall somewhere in the middle.
> “It is a gradient,” said Warrier. “There are also many other factors that contribute to age of diagnosis, so the moment you go from averages to anything that is applicable to an individual, it’s false equivalency.”
The Nature article and the guardian article are both just saying that these are likely multiple genetic disorders with similar symptoms and treatments. Classifying and understanding them is useful valid research to do, nobody doing this research is suggesting that actually DSM 4 had it right.
These will split into different diagnoses if it's found that significant differences in treatments can yield better results. Otherwise, they are just going to call it autism. Much like, for example, we call uncontrolled tumor growth cancer even though it's really 1000 different diseases that all manifest the same way.
Do blind people and nearsighted people have the same treatment? Saying people with profound autism need the same treatment as people with autism commenting on Hacker News is patently absurd. Go ahead and try offering therapy and workplace accommodations to nonverbal people living in a residential home. You're proving my point for me, we've lost sight of these people.
Even with cancer- the diagnosis and treatment vary tremendously depending on what type of cancer you have, how far along it is, and more recently how your particular genome responds to that version of cancer and each version of treatment. We don't just say, "whoops you have cancer" and start chemotherapy on the targeted area. Your argument doesn't make any sense.
> Do blind people and nearsighted people have the same treatment?
Yes, they both need to see optometrists on a regular basis. They get the same therapy even though a blind person won't get glasses.
It's the same for autism. Someone with profound autism will still see occupational, behavior, and speech therapists. The therapy will be different from what someone with mild autism gets, but the specialists involved will largely be the same. The OT for someone with profound autism can be identical to mild autism because there are many different aspects. Profound autism simply means several aspects have severe problems.
That's my point.
Very similar to how with an oncologist you might have a specialist for your cancer but ultimately you deal with a team that often treat different cancers. For example, people to draw your blood and run labs.
That's why hospitals have an oncology department and not a lung cancer department.
They see the same people but definitely don't get the same treatment. The insurance codes are different and the body of research is different. Putting $1 of research into genetic blindness does nothing for preventing astigmatism, even though patients may go to the same doctor.
Saying that everyone who goes to a therapist, or an oncologist gets the same treatment and therefore should be lumped together is absurd. Most other specialties are moving toward taxonomic differentiation, not away from it.
The study "speaks to the need to be a bit more fine-grained in our approaches to diagnosis" with subtypes rather than a single condition, as one of the authors put it, there. Additional context: https://www.scientificamerican.com/article/four-new-autism-s...
Nobody's making the argument that the DSM-4 had it right: the argument being made is that the DSM-5's direction of fewer categories and more generalization was the wrong direction, and going instead towards more categories and less generalization was and is the right direction for increasing understanding, treatment attempt outcomes, and greater efficiency in diagnosing and serving those with greater needs.
The main difference is that we don't immediately institutionalize kids with severe autism, which does save a lot of money.
For my kid with severe autism, about the only real impact of more people getting therapy is that sometimes it's harder to get an appointment (triage is more first come first serve and less needs based).
Realistically, that simply translates into a month to a half year waiting for an opening.
I think one of the major mistakes in this was folding in what used to be Aspergers into the Autism Spectrum diagnosis.
I received an Aspergers diagnosis back when it was still separate. To me it still doesn't feel right for my condition to also be lumped in with people like your cousin. I understand that it can still be a "spectrum" but the spectrum is far too wide now.
Your cousin has very different struggles and needs compared to someone with a more high functioning autism, or even someone with (formerly known as Aspergers) like myself.
I disagree. The problem is that the Aspergers-vs-Autism distinction was largely "looks normal at first glance" vs "doesn't", which is almost entirely unrelated to the many axes of actual symptoms.
An glaringly incorrect division is more harmful than a lack of division. If it had been a "good enough" division it could've been kept.
The best-attested actual axis is "has epileptic seizures?"; partitioning by it gets rid of most of the bimodalities in the data.
My estimate is that there are around 5 individual axes but many of them are continuous and it's not perfectly clear if some are actually correlated to others. And since the others are usually not bimodal it becomes difficult to choose different diagnoses based solely on symptoms, in the absence of knowing and testing actual mechanisms.
Some candidates include: sensory processing (including keen senses, overload, and undersensitivity - sometimes different for each sense!), trauma when unplanned/unexpected actions or lies occur (part of "patterns/routines" in general, but I exclude mere "pop-sci OCD"), difficulty reading facial/social cues (and the sheer terror of how people can read your mind if you meet their eyes).
I'm unsure about "difficulty expressing yourself clearly even when you know exactly what you mean". Nonverbality is a possibility but I'm actually skeptical of it, though it does give a very useful hook for experiments - there are some toddlers who are initially verbal like normal, then gradually become nonverbal and can recognize "something is happening to me!". I specifically exclude intelligence-vs-retardation; though both are common, neither seems intrinsic to autism itself (though perhaps they are potential causes?). Despite their correlations, I also exclude general introversion, ADHD, special interests as being either external or secondary. And "making repetitious movements" or even "throwing tantrums" is clearly on the side of "coping strategy" rather than a part of the disease.
Many autism quizzes split the questions into categories which somewhat align with the axes, but as I said before it's not clear what's actually independent and forms a meaningful difference.
Two axes outside of autism are also clear: schizophrenia is the formation of the patterns too detached from the world (as opposed to autism which where internal patterns result from the real world being too strong in some way - it's quite striking that for all the comorbidities autism has, diagnosis of schizophrenia in the same individual is exceedingly rare and probably wrong in at least one of the cases, though they intermingle at the family level); dementia is when the brain fails to build enough patterns (where autism builds too many).
One opinion I hold vehemently: if you're still in the "the problem is other people" phase, you aren't claim autism, you're just an asshole. Doing anything useful about autism requires recognizing: "my brain (my body?) is the reason I am suffering"; the best others can give is palliative care.
The thing is even in it's earliest days, there were examples of autistic people able to live independently. The first person diagnosed with autism was employed as a banker.
I’d like to piggyback on your comment to get your (and broader audiences) opinion on a situation I’m facing:
I’ve recently learned my 5 year old is exhibiting behavior problems in kindergarten. His teacher has put the notion in his mother’s head that he may have autism and has provided his mother a fast track referral to have him tested/diagnosed. I feel strongly that he does not have autism; aside from being disruptive in class he doesn’t have any other characteristics—-he is very verbal, social, doesn’t avoid eye contact or physical contact. I’ve spoken to his Sunday school teachers, daycare workers, etc and they were incredulous that he potentially has autism.
‘Well if he doesn’t have it what’s the harm in having him tested at a facility that specializes in pediatric autism? If you’re right they’ll easily determine he’s not autistic, right?’ Is the question I can imagine being asked at my reluctance to consent to the testing and diagnostics. Frankly, I’m suspicious of the (potential) conflict of incentives that a clinic specializing in pediatric autism may have; I positive diagnosis is only good for business in the way that a men’s clinic is incentivized to find every patient that walks through their door has low testosterone. Especially considering the subjectivity and ‘spectrum’ that falls under the blanket term ‘autism’.
On a scale from likely to incredibly unlikely, how rooted in reality would you characterize my concerns? Also what harm, if any would come from a false positive diagnosis? Would it outweigh the harm of a person being an undiagnosed, high functioning person with autism?
I am way way out of my wheelhouse here. But you asked, so I'll share my experience and opinion in a roundabout way.
When I was a kid, my parents' nicknames for me were Spock and Ms. Literal. I was gifted, at the top of my class, and my parents advocated for me every single year so that I received a high-quality education. The school was receptive, and I thrived academically. I struggled socially, but being a girl it demonstrated in a lack of friends rather than behavioral disruption. So in every way I was the ideal student. Today I would easily be diagnosed as autistic, but in the 90s that wasn't in the conversation. Especially given our experience with my cousin. I don't think of myself as autistic, I'm just a person with strengths and weaknesses.
Today for better or worse we live in a society that thrives on labels and categorization. Your kid gets a label and all of a sudden the school is able to give him an IEP and the support he deserves and should have been getting all along. In the cynical perspective, your kid gets a label and that affects the way he sees himself and relates to the world. The label becomes a justification instead of just a descriptor.
From the educational perspective, I want the school to do everything possible to help my child succeed. If that means jumping through hoops to get him support then so be it. But from the identity perspective I want my kid to be unburdened. To learn from the world around him without getting pigeonholed. And if a diagnosis was going to lead down this path I would be very intentional about when and to whom I disclosed this information.
This isn't getting into the world of false positives. In my experience (2 boys similar in age to your own) teachers tend to be good referrers just because of the volume of kids they deal with. So if your teacher recommends this there's a good chance they will fall under some diagnostic criteria at some testing facility. The question is what to do with the information.
The school system needs an Official™ medical justification to grant your kid extra accommodations for whatever his behavioral issues are. They are less interested in whether he "actually" has autism than in a rubber stamp that gives them more options for managing him. Which might indeed be a good thing for your son! It's hard to say without being closer to the situation.
But is it the profound autism or is there something else? I think we actually need to define the term a little differently for mental retardation and bring it back. Is he profoundly autistic with an average IQ? Or is he profoundly autistic and essentially incapable of communication? It's not the autism that's the problem. He might also be autistic but a lot of people started labeling retardation as autism. Which really tainted the term autistic for normal people. So I do actually agree with the shift. Not that they should take anything away from the profoundly autistic. They should offer them more. But there should be a program for that type of person. Assisting them greater than the autistic programs. Autistic help should be more about understanding the internal issues we face on a daily basis and how to deal with them. How does that help someone who can't communicate? The help he needs is probably different and more extreme than what an autistic person needs.
It's like saying I can't run. My arm hurts. Then you say. What do you mean? You're a quadriplegic!! He's like oh yea that too but I can feel a tingle in my arm. Treating the arm isn't fixing the problem lol. If that person was an advocate for treating tingles in their arm. You would think it's kind of silly because if they were to treat that. It doesn't really help the quadriplegic part. But he keeps saying it will. It's not that I don't believe he has a problem with his arm. I'm sure he does. But the problem on why he can't run isn't that.
> It is time to realise that ‘autism’ has become a ragbag of different conditions.
Look, I get it and somewhat agree. However, the reason for the diagnosis (and any diagnosis) is treatment.
Maybe there are two different conditions that require speech, occupational, and behavior therapy to different degrees, however, in terms of convincing insurance companies in the US to cover those having a single diagnosis makes everything easier.
It's not as if a separate diagnosis would change how a speech therapist interacts with a child.
I applaud efforts to figure out what is going on and to categorize. But I also think that practically the ragbag diagnosis makes treatment a lot easier to access for patients.
> It's not as if a separate diagnosis would change how a speech therapist interacts with a child.
This is the really big part that a lot of people seem to miss when complaining about the changes in DSMV.
Previously there were dozens of conditions that had nearly the exact same symptoms and super similar treatments that may work.
The change basically said, for these given symptoms here's a bunch of treatments that may work.
I've known a few people that were diagnosed as something that would now be under autism, but because they had that diagnosis that didn't happen to include some of the treatments that actually ended up working for them they ended up not finding them until they happened to get a doctor that said "you know these diagnoses are really close, lets try this instead".
From talking with doctors I don't think I've heard anyone disagree that autism is almost assuredly a cover term for many different things similar to cancer not being a singular disease. The difference right now is that we don't have any concrete test to differentiate between any of the autisms yet, just various sets of treatments that work to varying degrees for different people.
They figured out that autism is actually four completely distinct disease clusters with four completely different symptomologies, with some overlap of symptoms in the middle. One of the disease clusters correlates with Fragile X retardation. The idea that we clump together an actual genetic condition that causes retardation with 3 other disorders is ludicrous.
Therapists need to understand that many disorders can produce "autism-like" downstream effects, just like many things could cause anxiety or depression. Not understanding the disorders doesn't "help patients".
Yeah, "thinks or reacts to things differently than most people" is way too broad.
It also shouldn't be a binary classifier. Some people are definitely "autistic", and some are definitely not, but many of the personality traits that define autism are continuous: e.g. some people are barely distracted by loud noises (normal), others are distracted by loud but not quiet noises (normal), others are distracted by specific quiet noises like chewing (autism?), others are very distracted by any noise even with noise-cancelling headphones (autism?).
I think people should just say "I have sensory issues" (or clarify "noise really distracts me"), "I'm bad at reading emotions", "my mood is really affected by others". And accommodations maybe do need to be binary (or graded), but should ideally be informal, and definitely be for specific traits instead of "autism": e.g. don't give someone who thinks methodically but isn't bothered by loud environments their own room (unless you give everyone that), but don't assign them vague tasks or they'll perform poorly.
You're right that sensory issues make up a small (optional) part of the diagnostic criteria for ASD under the DSM-5. And I agree that "autism" in popular discourse seems to be very flexible and inclusive, but the medical diagnostic criteria are much more specific. When someone does meet these criteria, there's something going on that isn't just a collection of unrelated peculiarities. This seems to be supported by the very high heritability of diagnosed ASD.
I would agree with you that there are issues caused by the wide range of presentations. It seems as though there's a tension between differentiation and unification at the various levels of scientific research, social understanding, social accommodation, etc. I expect things will get teased out over time.
> To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction (see A.1. through A.3. below) plus at least two of four types of restricted, repetitive behaviors (see B.1. through B.4. below).
Example (A.1):
> Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions
The medical diagnostic criteria, despite using technical language, are still vague: "deficits in..." has a wide interpretation. Furthermore, "at least two of the four" permits two people diagnosed with autism to have different symptoms: one child may only have limited interests and insistence on sameness, while another may only have "stereotyped" motor movements and hypersensitivity (and the specific interests, "stereotyped" behaviors, and hypersensitive stimuli can vary).
I've copied the required features from your linked document. With that said, I'd say most people tend to have every trait there to some extent. So I'm not sure that the medical criteria is as specific as you implied. It seems like the main criteria they use is that the symptoms cause significant impairment in your life.
---
Essential (Required) Features:
Persistent deficits in initiating and sustaining social communication and reciprocal social interactions that are outside the expected range of typical functioning given the individual’s age and level of intellectual development.
Specific manifestations of these deficits vary according to chronological age, verbal and intellectual ability, and disorder severity.
Manifestations may include limitations in the following:
Understanding of, interest in, or inappropriate responses to the verbal or non-verbal social communications of others.
Integration of spoken language with typical complimentary non-verbal cues, such as eye contact, gestures, facial expressions and body language.
These non-verbal behaviours may also be reduced in frequency or intensity.
Understanding and use of language in social contexts and ability to initiate and sustain reciprocal social conversations.
Social awareness, leading to behaviour that is not appropriately modulated according to the social context.
Ability to imagine and respond to the feelings, emotional states, and attitudes of others.
Mutual sharing of interests.
Ability to make and sustain typical peer relationships.
Persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or activities that are clearly atypical or excessive for the individual’s age and sociocultural context.
These may include:
Lack of adaptability to new experiences and circumstances, with associated distress, that can be evoked by trivial changes to a familiar environment or in response to unanticipated events.
Inflexible adherence to particular routines; for example, these may be geographic such as following familiar routes, or may require precise timing such as mealtimes or transport.
Excessive adherence to rules (e.g., when playing games).
Excessive and persistent ritualized patterns of behaviour (e.g., preoccupation with lining up or sorting objects in a particular way) that serve no apparent external purpose.
Repetitive and stereotyped motor movements, such as whole body movements (e.g., rocking), atypical gait (e.g., walking on tiptoes), unusual hand or finger movements and posturing.
These behaviours are particularly common during early childhood.
Persistent preoccupation with one or more special interests, parts of objects, or specific types of stimuli (including media) or an unusually strong attachment to particular objects (excluding typical comforters).
Lifelong excessive and persistent hypersensitivity or hyposensitivity to sensory stimuli or unusual interest in a sensory stimulus, which may include actual or anticipated sounds, light, textures (especially clothing and food), odors and tastes, heat, cold, or pain.
The onset of the disorder occurs during the developmental period, typically in early childhood, but characteristic symptoms may not become fully manifest until later, when social demands exceed limited capacities.
The symptoms result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Some individuals with Autism Spectrum Disorder are able to function adequately in many contexts through exceptional effort, such that their deficits may not be apparent to others.
A diagnosis of Autism Spectrum Disorder is still appropriate in such cases.
"I'm autistic" could mean "I'm non-verbal and can't function without constant care", "I'm very good at hacking, but need help with basic things", "I can function independently, but tend to over-think and over-explain and can't read people's emotions", "I can read people's emotions but am overwhelmed by them, I'm also unusually soothed by ASMR", "I'm unusually irritated by ASMR"...and there's no boundary that separates "real" autism from almost normal with certain traits slightly elevated.
Idk. If someone can pinpoint a single cause, it is binary. Not that I think that's possible: the human mind is so poorly understood, a real cause-effect relationship is scifi.
> some people are barely distracted by loud noises ...
It's not an argument for a non-binary classification. The whole point is that that a symptom, even a group of symptoms, doesn't define autism. Sensitivity to noise is just one of those things that some group has managed to be associated with autism.
Its definition has been expanded significantly. If it continues, there'll be two types of people: autists and psychopaths.
Yes, the problem isn't that the definition isn't 100% formal. If "autism" meant "unusually sensitive to loud noise" (and presumably other symptoms get new labels) that would be reasonable. But it seems to mean "unusually sensitive to something OR unusually methodical OR unusually bad at reading emotions OR unusually affected by other's emotions OR ... ", and almost nobody has every symptom, but two people may have completely different symptoms while a third person has some from each.
If you just have one of the symptoms you shouldn't be diagnosed with autism.
I think a lot of people miss that the changes that combined a ton of stuff into autism was because we had a ton of different disorders that had super similar treatment plans, but it could cause issues when your doctor didn't know all of the related disorders to be able to know to try different treatment plans.
The combining was an acknowledgement that we don't know what causes these combinations of symptoms to occur but they seem to be related when certain combinations of them occur and these treatments can work to lessen the impact on the person experiencing it.
Well of course, we basically expanded the ASD definition to cover a wide range in order to ensure that everyone gets access to support if needed, but in the process turned "autism" into a grab bag of different conditions which makes discussions about it difficult because everyone is talking about something else.
It's kinda like mental health issues go through their own hype-cycles. Autism now is where ADHD was in the late 90s / early 2000s. I say this as someone who went through the Ritalin treatment a long time ago, but that was after my parents were at their wits end tried drugging me with gravol. If that were today, it'd probably be some neurospicy autism diagnosis and treatment.
I mean a lot of people Autistic and non-autistic exhibit that behavior. There should be some genetic or biological component to autism, otherwise we're just labelling boutique awkward behavior as Autism
Agreed. I believe both autism and ADHD are labelled as syndromes, which is basically a circle drawn around a collection of symptoms, as the biological basis is not currently known. This research could be a step towards changing it.
My views may not carry much influence, but I’ve argued this point for years—and not only about ADHD, but about many psychiatric conditions, including Autism.
For what it is worth, I have ADHD -- 'cousin' disorder to Autism. Like Autism, ADHD has an array of presentations. I hold the belief that diagnostic labels are simply abstractions for grouping clusters of vague and often arbitrary symptoms. In that sense, many labels are tautological. For example, ADHD/Autism is defined by a set of behaviors, yet people are said to have ADHD/Autism because they exhibit that exact same set of behaviors.
From my perspective, conditions like ADHD and Autism are unusual conditions in terms of their pathology. I suspect some autistic people might agree when I say this: ADHD (and certain forms of Autism) seem to be treated less for the benefit of the individual and more for the benefit of those around them. Compare this to depression -- a condition where the primary suffering is internal -- experienced by the person themselves. With ADHD and Autism, the person is not necessarily suffering directly, but their behaviors often cause difficulty for others, and in turn those others impose suffering on the individual. Treatment, then, improves behavior (somewhat), which first benefits those around the person, and only indirectly improves the individual's own quality of life.
I may be struggling to articulate it perfectly, but I can’t shake the sense that there’s something unsettling about the pathology of these conditions. It has become almost imperative that I take amphetamines every single day. A practice that is far from pleasant, to say the least. Technically, no one forces me to medicate myself, yet the pressures of society make it feel obligatory. I alter myself not primarily for my own sake, but because society has deemed my natural state defective, disruptive, or unworthy. Treatment to me seems less about addressing my own suffering and more about making me tolerable to others.
Treated for others' benefit? Your opinion has to be in the extreme minority here, at least for ADHD. ADHD is hell. Can't sleep and eat properly, can't focus on your work and hobbies, can't maintain your relationships, constantly losing shit... everyone I know is incredibly grateful to be on medication.
Would be less of a problem if I was not forced to conform to society's expectations. I also have been diagnosed with Delayed Sleep-Phase Disorder, so I am also well aware. Also what are two of the most common side-effects of stimulants? Sleep disturbances and reduced appetite.
Also, what type of eating issues are directly due to ADHD and not a comorbid disorder? I skip meals a lot due to laziness, but I wouldn't say it causes any dysfunction in my life.
> can't focus on your work
Who is more negatively affected by this behavior: your employer or you?
> and hobbies
So what if I struggle to commit to one hobby or finish a hobby? I do my hobbies for my enjoyment, not some ulterior motive. I do not think there is anything pathological about being a jack-of-all trades type or not committing to some hobby.
> can't maintain your relationships
Which I believe is direct evidence of how our symptoms affect others and not inherently oneself.
> everyone I know is incredibly grateful to be on medication
I remember feeling the same way once. I have been taking medication for over a decade now. Grateful is not the word I would personally use. I would say that I made a deal with the Devil just to feel some sense of respite.
Symptoms and side effects can vary a lot between people, you could've gotten unlucky.
> Who is more negatively affected by this behavior: your employer or you?
I like my job. I think I am making the world a better place, and I would choose to do this even if I was wealthy enough to never work. When I am unable to do my job because my ego does not align with my id, it makes me angry and disappointed.
> I do not think there is anything pathological about being a jack-of-all trades type or not committing to some hobby.
Nor do I. I do, however, think there is something pathological about sitting on the floor for three hours doing nothing because you're procrastinating on deciding what book to read next, or debugging a 3D printer, or replying to an invitation (or because you need to shower, or cook, ...). This behavior is not enjoyable at all.
It sounds like you primarily experience ADHD as getting in the way of things you have to do, rather than things you want to do. I'm sure that sucks in its own way, but the grass looks greener from over here.
> Which I believe is direct evidence of how our symptoms affect others and not inherently oneself.
I inherently care about other people, and when I let them down, it makes me sad. Perhaps you prefer to define all instances of your friends having desires and expectations around your relationship as oppression, that when I am upset I missed an important event it is because I am being brainwashed by society. But I think this is a small, selfish way of viewing the world. Many traits can get in the way of being a good friend (surely you know someone who is prone to anger, or envy, or insecurity), and if you are a good friend, you try to mitigate them.
> I would say that I made a deal with the Devil just to feel some sense of respite.
Next time you see the Devil, do me a favor and ask him if he has any other opportunities.
It's a mixed bag. I personally wish I had access to medication (but don't have the emotional energy fighting that fight with the medical system and getting rediagnosed in my current country) but amphetamines are unobtainium here through the medical system and methylphenidate turns me into a zombified wreck most of the time.
>ADHD (and certain forms of Autism) seem to be treated less for the benefit of the individual and more for the benefit of those around them. Compare this to depression -- a condition where the primary suffering is internal -- experienced by the person themselves. With ADHD and Autism, the person is not necessarily suffering directly, but their behaviors often cause difficulty for others, and in turn those others impose suffering on the individual.
I think it would be helpful to specifically characterize what forms you are talking about. Paint a picture of such a case. Because the forms my mind jump to are definitely suffering themselves and I dont want to strawman you.
Sensory overload, unmanageability, etc. Someone who may be perfectly content to obsess over some niche interest but cant take care of themselves because they are inconsistent at work. Cant pay bills, neglected health issues, etc. I can begin to imagine how someone might characterize this as you have but I think that would be quite flawed and I'm not sure this is what you're talking about.
Sorry, I tried to preface that I would butcher my explanation, and it appears I was correct in that assumption. I also apologize if this answer is no better. I likely lack the mental acuity to formulate these thoughts well.
To be clear, I’m not denying that some people experience direct suffering like sensory overload, daily dysfunction, etc.. Though I would argue much of this is somewhat expected when one lives in a society that wasn't designed around edge cases (nor am I saying such a society is truly possible at our scale).
My point is about a different subset of cases, like mine and say individuals with high-functioning Autism, where the suffering is mainly socially imposed. The pressure to medicate or "fix" ourselves comes less from unbearable symptoms and more from others' expectations that we be more tolerable or productive. That was the unsettling part I was trying to get at. I was trying to make a point about a little compassion from others would go a long way. I was not trying to absolve myself and others like me of our responsibilities/symptoms. Often times, the symptoms of these disorders are not treated as symptoms of a disorder, but rather, direct flaws of one's character. All in all, I find the difficulties hard to describe unless one has lived the same or a similar experience.
Whether or not one has a disorder does not make them less of a human being. Thus, I do not think it is a coincidence that depression, anxiety, substance abuse, and suicide are highly correlated with disorders like ADHD and high functioning Autism, and I do not think a lot of those comorbid issues stem purely from some kind of internal (hypothetical) brain difference.
There are so many people out there sacrificing their own mental and physical health for their children or their loved ones or their students or patients to simply have a few hours of calm happiness every day.
And you flippantly dismiss them. You paint them with a broad negative brush.
This is an ice cold, selfish, naive and incorrect statement.
You've misread me. I'm not dismissing caregivers, but rather, I am pointing out that treatment often serves their needs before the needs of the individual. Psychiatry too often prioritizes making people tolerable over making them well.
Is there anything we can infer about the nature of Autism Spectrum Disorder from the fact that it's a spectrum, as opposed to some binary thing?
If ASD is comprised of a variety of qualities that may not all be expressed at once, and they are expressed in varying degrees, what does that mean?
For example, it seems unlikely its just the existence of single gene that determines if you have it or not.
Or maybe its cause is continuous as well. More microplastics more autism (massively simplifying here, but just illustrating).
I dont really know... seems like maybe there are more interesting instincts people might have here. The fact that it's kind of an amorphous mess seems to suggest something about the nature of the thing we are talking about here.
Harvard sees a potential link, hell it’s the name of the paper: “Using acetaminophen during pregnancy may increase children’s autism and ADHD risk ”.
I think that it might be a real thing is because nobody really knows how acetaminophen even works. All the theories involve influencing the brain‘s chemistry. Who knows, maybe influencing a fetus’s brain chemistry can be bad.
As far as I can tell, none of the author's (Public Health Dean Andrea A. Baccarelli) work has demonstrated anything causal, but rather just some correlation. His testimony in a case against Tylenol in 2023 attempting to link the drug to autism was thrown out by the judge for cherry-picking and misinterpretation of study results.
"Don't take Tylenol, don't take it. If you just can't… I mean, it's just fight like hell not to take it. There may be a point where you have to and that you have to work out with yourself. So don't take Tylenol."
That's what they said, which is fucking stupid.
The existing guidance is to discuss use with your doctor and to take the minimum necessary. It is not "fight like hell", ostensibly through fever and significant pain, to avoid it.
There is no good evidence to substantiate this belief, and if there were, then it'd be part of the guidance and we wouldn't need somebody who learned acetaminophen == Tylenol at 79 years old saying things like "Don't take Tylenol" on national TV.
That is what Trump said about the FDA decision to update labels. I agree it was stupid and misleading. The actual action taken was as the original commenter said.
The FDA decisions to update labels said:
>The U.S. Food and Drug Administration today initiated the process for a label change for acetaminophen (Tylenol and similar products) to reflect evidence suggesting that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and ADHD in children. The agency also issued a related letter alerting physicians nationwide.
Yes, you're right that the FDA had to downplay pretty much the entirety of the ignorant fearmongering done on national TV by the sitting President and the head of Health and Human Services.
This is stupid and bad, actually, and absolutely should be viciously criticized.
No that supports what I'm saying. They already made the decision. Yes, Trump announced it then they filed the paperwork. They didnt decide to relabel the next day just based on some comments Trump made the night before lol
The claims are that Trump gave people the impression that Tylenol causes autism, which is a claim we've failed to substantiate 100% of the dozens of times we've tried, and that FDA put out guidance that is much, much softer in direct controversion of Trump’s claims.
In other words: Trump’s statements weren’t in response to the FDA decision nor was the FDA decision in response to Trump’s statements. Both were distinct responses to the head of HHS (a scientific illiterate and world famous grifting conspiracy theorist) deciding that vague gesticulating about Tylenol could help him meet his self-imposed September deadline to solve autism.
Nobody is saying that it is caused by one thing, only that one of the causes are directly attributed by acetaminophen.
This is coming from studies by Johns Hopkins University, Harvard University, and Mount Sinai to name a few.
"Autism spectrum disorder", by virtue of being a "disorder" ISN'T a single condition with one cause.
That's what disorder means
Every single medical professional is aware of that.
None of the neurodivergent conditions have a single "cause" yet. None of them are "diseases" yet because we don't know what causes them.
Yes, lots of people have small amounts of the "symptoms" that get labeled as a condition. That is not meaningful.
Everyone gets diarrhea sometimes. But if you get diarrhea regularly, or really bad diarrhea, or diarrhea that includes severe pain, then it might be IBD. IBD doesn't have one cause. It's very unlikely that it's even a single problem.
If you eat too much greasy food and have bad shits, you do not have IBD even though you have that "symptom". If you claim to have IBD, you are just wrong.
Yes, some people on tiktok who think they have ADHD or Autism are just wrong. If Americans could afford to go to the doctor for non-life threatening problems, they could get a psychologist to tell them that. Americans self diagnose because they can't go to the doctor.
This is all true of "Cancer" as well, but there isn't a giant PR campaign to convince Americans that we are diagnosing too many people as having cancer. Nobody gives a shit that both they guy who dies in a month from metastasizing brain tumors and the guy who had to remove a benign skin mole both had "Cancer". Every kind of cancer has a name, but people will still say "I have Cancer" just fine.
It's only with Autism and ADHD that people insist we have somehow done something wrong by using the exact same language structures as other medical problems.
Meanwhile, with attacks against Social Security, this admin who claims to care so much about helping Autistic people is ensuring that people who cannot function in society will die miserably and uncared for.
Maybe Tylenol while pregnant is a risk factor for people who are already genetically predisposed to it or something. The data sucks so far, but maybe further study will show something. My sister worked on a study in the 2000s that was looking at this, as well as looking at getting the flu while pregnant. Nothing came of it.
Except autism, or as it was called then "autistic psychopathy" is anything but a condition or discovery https://archive.ph/nOH4z (note: it's a nature.com link)
Autism is exactly one thing, according to its discoverer, Hans Asperger: a diagnosis to remove the mentally undesirable from society to safeguard the genetic purity of the noble aryan race (translated from the paper by Hans Asperger)
Note: by removing he meant killing anyone with the "diagnosis", child or adult. Hans Asperger signed the orders to kill at least 5 children, probably many more.
In other words: the "discovery of autism" was nothing other than an excuse to massacre children deemed to be a burden on families for whatever reason. If you were diagnosed with autism and weren't hyperintelligent, you were sent away to be killed. It was the absolute opposite of neurodiversity, of tolerance, of neurodivergent people and it was never meant as a real diagnosis of a real condition. It was an excuse for murder.
Of course, psychology sees no problem with this little part of history and still revere Hans Asperger as a hero, as opposed to someone who should have been hanged at Nuremberg along with his colleagues. Psychology has a history of doing this. If you check what happened to Freud's patients, especially the women, you'll see that he was a seriously disturbed person as well. He made (in today's dollars) billions testifying in court that women who accused rich Austrians, often their own family, of rape they wanted to be raped and should be locked up for this deviant behavior ("not" to protect and satisfy the desire for revenge in their rapists). Oh and in a few cases, that male victims of murder by their own family were guilty of their own murder.
I agree. Of course genes are involved... but that doesn't make it Mendelian. Autism would be caused by a combination of genetic and environmental factors.
The fact exists that there is no singular autism gene. And there could never be a genetic test for autism. It could predict the likelihood, but it wouldn't be pass/fail. Because there are many autism-related genes but no single gene trigger like a light switch. And you could still have all of those genes turned on and not have autism due to environmental factors.
Unless we find Utopia some day, the economic system does not matter. People will have to work whether they be nomads, fishermen or fisherwomen, live in Neoliberal economies, live in Socialist economies, Communist economies or a loaner in the jungle. People have to produce: "From each according to his ability, to each according to his needs" as they say. It's expected people who have the ability to produce to produce. It's not Wall-E land where you get plugged in and can veg out to your heart's content. We have the same phenomenon in the non-political animal kingdom. You hold your weight or you're out. We have little more ruth as a species... but not that much more because it's hard to afford more --you see even if we evenly spread the wealth from billionaires evenly, it would not amount to much for each individual -just over a thousand dollars per person and it would be a one-time thing.
Technocracies have a pretty bad record unironically. Places which let lawyers run society do better than places which let engineers run it.
Edit, since I can't make a post right now since HN thinks I've posted too much, here's some examples of technoracies:
"The former government of the Soviet Union has been referred to as a technocracy.[20] Soviet leaders like Leonid Brezhnev often had a technical background. In 1986, 89% of Politburo members were engineers.[20] "
"Many previous leaders of the Chinese Communist Party had backgrounds in engineering and practical sciences. According to surveys of municipal governments of cities with a population of 1 million or more in China, it has been found that over 80% of government personnel had a technical education"
"Since the 1990s, Italy has had several such governments (in Italian, governo tecnico) in times of economic or political crisis,[27][28] including the formation in which economist Mario Monti presided over a cabinet of unelected professionals."
"The term 'technocratic' has been applied to governments where a cabinet of elected professional politicians is led by an unelected prime minister, such as in the cases of the 2011-2012 Greek government led by economist Lucas Papademos and the Czech Republic's 2009–2010 caretaker government presided over by the state's chief statistician, Jan Fischer.[3][31] In December 2013, in the framework of the national dialogue facilitated by the Tunisian National Dialogue Quartet, political parties in Tunisia agreed to install a technocratic government led by Mehdi Jomaa."
"The Syrian Salvation Government, the predecessor to the Syrian transitional government,[33] was characterized by observers as an authoritarian technocracy"
The problem with technocracies is that government faces choices that aren't a question that can be answered by some neutral evaluation but are instead questions of whose interests are prioritized or what values are enforced.
However there ARE questions that can be neutrally evaluated, or at least where neutral evaluation can narrow the field of reasonable decisions. Medical policy is replete with decisions like this, and so we really should be consulting experts and strongly listening to their decisions in this field.
Can you provide examples of such a place? From my perspective, I find it difficult to believe that this has ever been attempted at a scale that is sufficient to come to that conclusion. I'd love to hear otherwise.
A "true" technocracy has never been, but China has exhibited the only "almost" example during the late 20th century. That was the period when they transformed from a sustenance-farming backwater to a powerhouse on the world stage.
Of course, it is always easy for a backwater to play catchup after someone else has already figured out how to advance. It is difficult to attribute that success to technocracy, and it is likely that any system could have allowed the same forward momentum, but the correlated track record is quite good regardless.
The USA flirted with the idea of technocracy around the time of the Great Depression. That is, perhaps, where the "bad record" idea has come from, but that's a pretty big leap.
The king of england ran england while his (the institution) power eroded until he started working for the british parliament/government
the point being, official institutions are not always the strongest in the state, a state can be practically ruled by lawyers while having a functioning government
Let me clarify again because it seems you haven't really understood what I meant.
The british king example is how a country can evolve from one point of power to another over time, while keeping the existing institutions.
When imagining a system of government ruled by lawyers, I see it similar to an organization ruled by lawyers. In such organization/government the leaders are afraid of doing and thus are using lawyers as their excuse not to do anything.
Because of the vacuum of power, essentially the only policies actually being enacted are decided by the lawyers, which is whatever makes their job easier (minimum legal risk, minimum interpretations)
> When imagining a system of government ruled by lawyers, I see it similar to an organization ruled by lawyers. In such organization/government the leaders are afraid of doing and thus are using lawyers as their excuse not to do anything.
My point is you're not describing an organisation ruled by lawyers. You're describing one ruled by nobody.
It would be like me saying organisations led by engineers don't work because if I imagine an organisation where the engineers aren't actually in charge, but someone asks an engineer whenever they don't want to make a decision, it doesn't work.
So, here I don't agree, when no one steps up to take decisions someone will, and in some organization these are lawyers. If the decisions are taken by lawyers, it doesn't matter there's someone that has the title CEO like it doesn't matter that someone has the title King
Others might imagine a parliament system as a system where the lawyers are in control, I don't think that's the case with parliaments
Of course, likewise, the best engineering is to do nothing. All actions have consequences, and while engineers may not look at the exact same consequences as lawyers, they are both equally concerned about consequences.
But sitting back and doing nothing on the basis of their worry wouldn't fly in the real world. If such a hypothetical government existed, the leaders would have to act, else be quickly overthrown. Power is only able to be held if the people want to give it to you.
The overloading of the term autism has had a real damaging effect on some people. My cousin is profoundly autistic: he's nonverbal, and will never live independently. In the 90s most autism research was focused on helping people like him. He was involved in some pioneering studies at John's Hopkins University.
Today most of the money and advocacy is for high-performing or moderately-performing people with autism. Not just in relative terms, the amount of funding for people like my cousin has gone down. It makes sense; they are the larger group by volume and are able to advocate better than people like my cousin.
I wish it weren't a zero-sum game, and we recognized that autism is just a word for a broad series of conditions. It would be like if we called everyone with poor eyesight 'blind': yes, your vision is impaired. But the solutions you need are very different than the solutions Stevie Wonder needs.
See also: https://www.nytimes.com/2025/10/01/health/autism-spectrum-ne...
> The overloading of the term autism
I have a former friend who listened to too many podcasts and self-diagnosed himself as autistic right around when his relationship was falling apart. The guy couldn't handle his girlfriend asking him to step up on some things so he decided his "out" socially was to call himself autistic to garner sympathy. The dude isn't autistic, he is simply terrible at accepting any responsibility for himself and doesn't care how that affects others. That was my first exposure to how out of control autism labeling was about to become and it's gotten a lot worse since then.
Unfortunately, many autistic people also get misunderstood to be irresponsible and lazy. They are also unable to understand other person's feelings and are thought to lack empathy, even though it is just that they are unable to recognize social cues.
So with just this information it is hard to say if your friend is indeed autistic or not. It would need a more professional diagnosis to say either way.
This is good advice - I always struggled but managed, then one day I just broke. Decided to do the thing everyone says and get some help. The therapist after a session was suggesting autism and some other stuff mixed in, because of the internet arm chair mental health crowd I was skeptical. I also know some people that are obviously autistic, and a good friend who's autistic and schizophrenic which made me feel like I have nothing to complain about, I'm obviously "fine." But, since the shrink kept mentioning it, I opted for the neuro-psych exam to get a more concrete diagnosis and indeed high functioning autism is there.
It's been interesting to see the therapy (and meds for the other problems) working. Now that we know, my wife has had some therapy to help support her and help her support me - and it's been wonderful. Understanding wtf is going on made it easier to talk about, address, and improve. It's an on-going thing but talking to qualified people was the first step.
Yes, it’s similar with ADHD as well. You really should seek a professional diagnosis before going around claiming it.
Even then you’re not free of the consequences. Sometimes just have to push yourself and say learn to bite your tongue to not blurt out an insensitive thing. What a diagnosis does give is knowing that yes it’ll be harder, to have patience with yourself, and to learn coping mechanisms.
Ironically, sometimes the worst criticism autistic or adhd people get though are from family or friends with undiagnosed autism or adhd themselves. Because they have to work so hard to mask they become very critical of people with legitimate diagnosis.
In many places getting an adult ADHD diagnosis is near impossible. I was diagnosed at age 8 personally, but I now live in a country where adult ADHD is borderline not acknowledged as even existing, and I know people have to fight very hard to get diagnosed and even harder to get access to medication if they can get it at all.
There can also be palpable downsides to having a diagnosis at all, eg in my birth country everyone with an ADHD or Asperger's diagnosis is legally required to pay for medical evaluation out of pocket to be allowed to get a driver's license and will face medical reevaluation on renewal as well.
Good points, thanks. That's rough.
It's not always great in the US despite it being acknowledged and somewhat accepted. It's gotta be really rough in a country that doesn't accept adhd. Ouch, a medical evaluation might make sense, but to have to pay for it out of pocket, ouch.
Though on the flipside in some countries the doctors don't care what meds they prescribe. It's very strange how things vary by coubtry. Some are absurd.
I guess my comment assumes the US where it has perhaps become a bit "trendy" as the OP suggested. I will say that when possible most ADHD'ers or aspergers do benefit from professional guidance.
Guidance definitely can be helpful. Of course it's important that the possibility exists; Ihhave high functioning AuDHD and without extra support I probably wouldn't have made it as far as I have, but there's shadow sides to "support" as well. From a very young age I had to constantly play manipulative games one way towards social workers to present myself as adequately dysfunctional to qualify for financial support that my (poor, single parent) family desperately needed, and on the other hand as more "normal" than I really was to counteract my elementary school that was convinced I should go to special education and went out of their way to contact my prospective middle/high school and try to talk them out of accepting me for instance (I ended up doing the honors track in secondary education and getting a BSc after).
I'm sure a lot of those shadow sides disappear in adulthood when one is more in control over one's own destiny but so do a lot of the benefits (eg workplace accommodations aren't nearly at the same level as school accommodations and unfortunately I'm convinced the vast majority of ADHDers/Aspies are better off not telling people at work).
It's hard to say what to make of the whole "trendy" thing, for every such person I know I know several others who are definitely on the spectrum but undiagnosed. I do think in our culture we have an unhealthy tendency to jump from "this is difficult for me" to "something is wrong with me" but on the other hand executive function or sensory difficulties are something many people experience from time to time and if "I'm a little bit autistic/ADHD" is people's best way of describing what they're going through then I don't want to silence them, because I know those difficulties are real and I have a lot of sympathy for that.
In an ideal world we'd be able to talk about the symptoms without having to reach for the syndromes, but that requires a level of experiential insight and standardized nomenclature and especially sympathy on a population level that's just not really there yet.
If you just tell people you struggle with procrastination or have analysis paralysis or get too sensorily overwhelmed by sounds or smells or the office environment to function people do still often treat each other like they're snowflake wusses that need to grit their teeth and pull their bootstraps or whatever.
The fact that this is all just part of "the human condition" often just hardens people more ("I had to grit my teeth and bear it's only fair you do the same"). Putting people in an exceptional "disease" bucket gives some respite from that, would that it be otherwise.
Better to acknowledge that there's nothing special about being diseased, there's nothing wrong with being diseased. We are all diseased and we all deserve and benefit from care. Those that don't think so should try talking to an older person ;-).
I think that part of the problem is fear of discrimination if your permanent medical record contains a diagnosis of autism. Its very conceivable that, now or in the future, a diagnosis could inhibit ones ability to immigrate, hold certain jobs, or get affordable health insurance.
Anyone who has experience with an autistic person can figure out pretty quickly that they have empathy if they try. When you tell an autistic person that you are feeling some way or another explicitly they will usually respond with empathy. But if you are just dropping subtle hints or using body language they will assume everything is okay.
Your friend's issue isn't whether he is or isn't autistic. It's that he gave up his agency.
Tylenol catching strays over people like this
Can you share your qualifications that demonstrate how you are able to make any form of diagnosis on your "friend"
I don't see the point in asking that question as his friend self-diagnosed himself as "autistic". Jsbi, I assume, is expressing doubt in the self-diagnosis rather than diagnosising his former friend.
> The dude isn't autistic, he is simply terrible at accepting any responsibility for himself and doesn't care how that affects others.
Did you miss that?
Unless either party has an actual set of qualifications to diagnose, then neither should be pronouncing one way or the other.
I get it. Mental health issues have not been taken seriously in the past to say the least. And we're better off when people can openly talk about them without being ostracized. But you can definitely swing too far in the other direction. I keep meeting people who are almost bragging with their claimed collection of mental illnesses as if it's a lifestyle choice.
> I keep meeting people who are almost bragging with their claimed collection of mental illnesses as if it's a lifestyle choice.
It could be, it could also be that people are finding a "reason" for their behavioural issues/predicaments.
It's far too complex (even for qualified professionals) to be making broad statements.
This still aligns to what I said no? He himself is expressing doubt with his own reasoning why. Either way it doesn't matter as the assumption shouldn't be his former friend is autistic by default.
The poster shouldn't be assuming anything.
The poster is claiming without any evidence other than the "friend" was "self-diagnosed", which doesn't tell us if the "friend" was right, or not, and adding that they knew the diagnosis was wrong because of other claimed attributes.
I'm honestly shocked at the response to me pointing that out.
If you want to go round making judgements on peoples' mental health without any qualification to do so, and post that judgement on social media (which Hacker News is) then I will call you out for that, every time I notice.
People come to these comments claiming to be all about science, all about serious thinking that's not found on other social media, but then this trash gets posted and people calling it out get attacked.
This might as well be on Reddit, or Facebook.
The same qualifications his friend had when he made his self-diagnosis
So you agree then that the story was rubbish
No, he pointed out how over-saturation of autism awareness has resulted in people self-diagnosing as a way to absolve themselves of shitty behavior.
My step-son is diagnosed. He is on the spectrum. He was non-verbal for longer than most children and low-verbal for years after that. He has fine-motor challenges and operates on an emotional level behind those of his peers.
If he's being an ass, we let him know. He knows his condition is not an excuse for his behavior. He needs to know how to cope with and navigate the world around him. Autism awareness and advocacy is about not shaming people for wearing ear protection in public. It's about recognizing that texture aversion is a thing. It's about knowing to extend grace when appropriate. It's not about letting people be shitty.
He may be autistic, but he does not get to interrupt us. He does not get to derail conversations into his interests. He does not get to ignore his hygiene. Instead, we try to teach him to be patient. To be polite. Strategies to make necessary things a part of his routine.
The biggest difference is that we do these things with compassion and with the realization that some things are more difficult for him. Rather than what we did in the past, which was browbeat autistic people into masking.
No, he made a diagnosis - neither party appear to be in a position to do so.
You can disagree with someone's self diagnosis all you like, but there's absolutely NO WAY for you to make a diagnosis yourself unless you are actually qualified to do so.
Please try to understand the difference.
You only questioned the poster's qualifications, never the subject's.
Only now are you even acknowledging that it could be in error as well.
And without an actual medical diagnosis, we shouldn't treat him as autistic.
Oh, how terrible, I called out the posted directly on their behaviour instead of addressing the "friend" who it is *claimed" had done X, Y Z.
There, you have your out for your poor responses.
Why are you being so aggressive?
Not to justify it but 1) your responses have been misunderstanding their point, even after a good explanation of it and 2) they had some of their comments down voted (IMO, probably because of how they expressed their perspective rather than because of what it is).
So it is (or rather, seems like to me) a double whammy psychology of having their point be demonstrably misunderstood while it is also (seemingly) being rejected by down votes. (Again, just explaining, not justifying.)
(Also, I cannot help but notice the irony(?) of this misunderstanding and the necessity of this explanation in a thread on a post about autism. No shade to anyone, just making the observation.)
First of all, I firmly believe you're a sock puppet.
Where is the "good explanation"?
The first thing he did was demand qualifications of the poster. Exclaiming he's diagnosing something. He started aggressive.
I then pointed out that his friend also made his self-diagnosis with the same qualifications.
He then got all huffy and basically said "So you agree his story is rubbish", which is also rather aggressive. And all through this, he's been dismissive and condescending to people. And everyone else has been rather polite to him even with his attitude.
And I don't think anyone is misunderstanding him. Everyone acknowledges his point that the poster is likely not a qualified professional. However, they are pointing out that neither is his friend. And I also pointed out, diagnosis or not, there's no excuse for being an asshole. Being autistic does not give you carte blanche to treat people like shit.
So it's more like his refusal to understand everyone else's point. And likely why he's getting downvoted. But that shouldn't matter. So, you know, stay awesome, dude.
> Where is the "good explanation"?
It was in the comment four up from my first one in this thread.
> No, he made a diagnosis - neither party appear to be in a position to do so.
(They also gave other explanations elsewhere in the thread but that is what I was referring to because it is enough for a reader to understand the point and you actually replied to it.)
Their point is that the other commenter should not have written "The dude isn't autistic" because that is a negative diagnosis rather than an agnostic statement.
> So it's more like his refusal to understand everyone else's point.
Others were failing to make substantive points against the commenter in question because their point was going misunderstood. It took a few back-and-forths to get to the actual point (in fairness, that's because of the vagueness in their initial comment) but that point is consistent with what they've written in this thread.
> I firmly believe you're a sock puppet.
Genuinely, I read this as feedback that I empathized well given that I'm not. But especially because I disagree with their point. (The presumption that the first commenter meant "The dude's not diagnosed" is very reasonable and obviates the other commenter's point, except as a general reminder to be more careful with phrasing, which their question wasn't.)
Saying “the guy isn’t autistic” isn’t a diagnosis. Mostly because he isn’t a doctor. So harping on people making diagnoses ignores the larger issue of the person using a self-diagnosis of autism to excuse his own shitty behavior.
> Saying “the guy isn’t autistic” isn’t a diagnosis.
Actually, this is how a diagnosis could be phrased by a particularly informal doctor. You mean to say it's not a valid diagnosis because he's not a doctor, which is rather the point.
> ignores the larger issue
Indeed, they wrote a comment in reply to what I can only assume is a pet peeve (I do hear and read a lot of careless negative assertions like that where they are not warranted; it's a worthy pet peeve) to bring up a smaller issue in the context of the bigger picture, while otherwise not addressing the other point. I think it's a reasonable assumption that they meant to do that.
I guess to this point, didn't you notice me also doing that? I'm just commenting on the things I want to comment on. I haven't mentioned what I think of the friend in the story because I haven't seen a reason to. Everyone knows being entirely self-centered is shitty.
But since I'm here, I guess I should comment on it. I wonder about that person and what their problems are. Why would they do something so anti-social? It's likely there's something else going on. Perhaps more to the point, it's unlikely there's nothing going on. Maybe it's actually autism. The idea that it's nothing and they're "simply terrible at accepting responsibility" is naive and, frankly, disrespectful. It's sad to me that nobody's wondering about OP's friend and everybody just takes OP's story at face value. I mean, if OP isn't qualified to diagnose but readers just roll with their diagnosis anyway, it's rather obviously unfair to the friend who has a similarly-qualified claim but is assumed by their former friend to be a scumbag.
Well, you came here to defend another poster. Your initial address wasn't to the story itself, the poster in question, etc.
And I even mentioned that even if he were autistic, it's never an excuse. A diagnosis is a tool for self-reflection, not a get-out-of-trouble-free card. So he's still shitty for using a diagnosis as a reason to be shitty.
People are taking OP's story at face value because it doesn't warrant investigation. It's minor enough that even if he were lying, it doesn't matter. The story is banal enough that it's likely happened to someone at some point. It doesn't require the display of credentials or anything like that. And no one is asking us to do anything about either side. Dude was just sharing an anecdote. That's why people are taking it at face value. Because to do otherwise is to dedicate too much energy to something that doesn't matter.
> People are taking OP's story at face value because it doesn't warrant investigation. It's minor enough that even if he were lying, it doesn't matter. The story is banal enough that it's likely happened to someone at some point. It doesn't require the display of credentials or anything like that. And no one is asking us to do anything about either side. Dude was just sharing an anecdote. That's why people are taking it at face value. Because to do otherwise is to dedicate too much energy to something that doesn't matter.
Whatever it's worth to someone else to tell a lie, it's worth to me to correct it.
> So he's still shitty for using a diagnosis as a reason to be shitty.
You're getting one side of the story and saying that doesn't warrant investigation. Empathy is literally the opposite of that. You do not have any reason to believe the friend was being shitty. OP didn't provide that.
Thanks for showing everyone that you bring ignorance to the table.
The poster claimed that a "friend" did so.
Let me know if you ever discover if that friend really exists.
>> I firmly believe you're a sock puppet.
> Genuinely, I read this as feedback that I empathized well given that I'm not. But especially because I disagree with their point. (The presumption that the first commenter meant "The dude's not diagnosed" is very reasonable and obviates the other commenter's point, except as a general reminder to be more careful with phrasing, which their question wasn't.)
FTR I read your initial comment as being critical (but fair) of my posts. How the person you are talking to missed that and jumped to you being me is quite the jump.
> critical (but fair)
Honestly, re-reading everything, I think that paragraph is too harsh. In particular, that presumption of their intended meaning is not reasonable. They clearly meant "the dude's not autistic", which you correctly called out as a diagnosis. I appreciate your thoughtfulness.
Long before this was mainstream a misdiagnosis of ADHD and then autism led me on a decadeslong course of therapy and treatment that ultimately didn't address my issues. It was even worse since I was a child at the time labeled by people I was supposed to trust and could not comprehend the true meaning of these terms, so I grew up into an adult assuming what they told me was the truth, the whole time. Because of their actual role in my issues, I now know that nothing they could have labeled me with would have helped me and allowed them to take responsibility for my poor treatment.
All to say that the map is not the territory, and leaping to conclusions at the first label that sounds like it fits the bill can have devastating consequences.
And as in my case, labels can be used to shift the blame away from the caretaker responsible for trauma/etc. by medicalizing the consequences, or onto an existence that is perceived to be unchangeable/futile to address.
Sorry, I'm a little confused here. Are you saying you were misdiagnosed with ADHD/Autism?
That you actually had a different condition that superficially presented as ADHD/Autism.
Their abusive caregiver(s) used an ADHD-then-autism misdiagnosis to blame/misdirect the effects of their abuse away from themself (or selves).
Same with my little brother. I've seen autism turn into an ignored subject to being hijacked by higher-functioning autistic people who are controlling the narrative. It's good to have more autism awareness, but they're the top 1% of people with discernable autism and can hurt large numbers of lower functioning people with autism who basically have to be taken care of by their families for the rest of their lives.
> Today most of the money and advocacy is for high-performing or moderately-performing people with autism.
Is this true? I think it's important to distinguish between social media (and other sorts of) discourse and where money is actually flowing.
Social media is not disconnected from society as a whole. Influencers are called that because they have actual influence. You only need to look at and truly understand the MAHA movement to know this. It's not a movement by RFK; it's a movement of people (often moms) who are dissatisfied with their current situation and trying to do something to change it. They may be flat out wrong, but they have influence nonetheless.
Did the diagnostic criteria in DSM 5 change as a result of social media, was it the other way around, or was it hidden variables affecting both? Regardless, the money and attention tend to follow what the common people are saying. See: https://pubmed.ncbi.nlm.nih.gov
I don't disagree with this at all; but I do question if there's been a lot of research for what kind of resources even help "high-performing or moderately-performing people", let alone directing these resources to this demographic over autistic people who struggle to meet society's expectations for individual productivity.
"Advocacy" I could see more clearly, and I question how much of this "advocacy" is actually doing for "high-performing or moderately-performing" people.
IMO, the only way to really "resolve" the anxiety over prioritizing one group over another in either discourse or in resources in the long term is finding a way to integrate non-productive people into the daily lives of productive people. This seems difficult to imagine in today's America, where community is largely based around interests and careers that will self-select these people away.
Topically relevant: the DSM 5 eliminated the distinction between what was formerly called an Asperger's Syndrome diagnosis from an Autism diagnosis, in part because the name "Asperger" came from a Nazi scientist, and therefore, per then-current political winds, the only morally correct action to take was to erase the name. Of course, this motive needed some kind of non-political justification to not come across as what it was (an example of non-medical political partisanship aimed at erasing history that was disfavored by the political partisans pushing the agenda), which is where the idea of re-categorizing what were and still are clearly at least two distinct clusters of diagnostic patterns as one grand, unified "autism spectrum" that functionally resulted in little more than muddying of waters in the field, which now need to be cleared up again - as pointed out by TFA.
You're right that there are external variables, including non-medical variables, influencing the DSM-5's diagnostic shuffle, I just don't see them as particularly well "hidden".
I'm not well-versed in the Asperger's debacle so I didn't feel like it was my place to speak up here. Thanks for adding your perspective.
How much does the DSM actually matter outside of clinical contexts? Labels have a life of their own, and people were linking aspergers and autism many years before the DSM did.
No.
Asperger's was eliminated as a diagnosis because differentiating it from autism was hard to do. Two different evaluations could land a kid as either autistic or asperger's depending on the day and the evaluator.
And, importantly, Asperger's qualified for less therapies and treatment than autism did. That meant that even though your kid likely needed more treatment, they'd be denied it because they had a good day when being evaluated.
The crossover for treatment was largely the same with autism qualifying for more.
Even if it was the "Nazi link" they'd simply have changed the name to something more acceptable.
TFA is suggesting that there are probably multiple conditions which cluster around similar symptoms which makes it hard to identify the exact cause of autism.
The diagnostic reliability criteria even back then painted a picture of the details of the condition space being more nuanced than what were currently being captured, not less nuanced, so the idea of reducing nuance and distinction still seems questionable by an empirical and epistemological standpoint. However, that decision remains defensible and supported by the social justice / equity / de-hierarchicalization / eponym erasure motivational drives. These, besides the eponym erasure specifically, also explain many of the other changes in the DSM-5, like the elimination of many other more-detailed diagnoses, like PDD-NOS.
This isn't to assert that the clinical reasoning offered didn't have merit, just that institutional consensus-forming behavior isn't immune to the macro backdrop of the sociopolitical winds of the day.
Committee member A thinks: "These diagnostic categories aren't reliable" (true, clinical concern)
Committee member B thinks: "Honoring Asperger is ethically uncomfortable" (true, historical concern)
Committee member C thinks: "Hierarchical categories are problematic" (true, equity concern)
Committee member D thinks: "Spectrum model reflects current research better" (true, scientific concern)
No single person needs a "primary political motivation." No conspiracy needed. No explicit coordination required. Yet the outcome eliminating Asperger's and collapsing categories - emerges from a system where:
- Progressive ideology shapes what problems become salient
- Shared epistemic frameworks determine what solutions seem natural
- Professional incentives reward what can be publicly justified
- Social proof operates through "everyone reasonable agrees"
"The clinical rationale was legitimate" doesn't contradict "political ideology shaped the outcome."
> so the idea of reducing nuance and distinction still seems questionable by an empirical and epistemological standpoint.
Again, it does not because the treatments as a result of diagnosis remain the same. The primary role of diagnosis is to inform treatment.
If patients are seeing worse outcomes because of arbitrary "nuance", that indicates that the nuance carved out wasn't what needed to be carved out.
> isn't immune to the macro backdrop of the sociopolitical winds of the day.
This is conspiracy thinking.
You don't have any evidence that it was "progressive ideology" that eliminated the diagnosis, you just surmise it based on some people not liking their diagnosis being named after a nazi.
Slamming in reactionary politics in where it doesn't fit and a reasonable explanation does fit is just silly.
Sure, nobody is immune from politics. But I'm going to need more than "feels, vibes, and makes sense to me" before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis.
Diagnoses for mental disorders, by their nature, are almost always going to have a level of arbitrary lines that could be drawn. That's why we have 5 versions of the DSM and will likely have a 6th in the future.
>before I start second guessing why a well respected diagnostic committee (and others besides the DSM like the ICD) decided to merge the two diagnosis.
If empirical reliability of outcomes were based on social standing of the committee, you'd have a great point, but alas, there's a trending new paper on Nature explaining the precise mechanisms of how and why DSM-5's category elimination between Asperger's and ASD is a measurably less accurate approach than the DSM-4's categorical differentiation of the two conditions. TFA is saying that we should've been moving towards more categories with more nuance and detail, even back when we were at just 2 categories, not towards fewer categories with even less nuance, as the DSM-5 chose to do.
Regardless of your opinion on influence of the politics involved, the hard fact of the matter is that DSM-5 made moves in the exact opposite direction for increasing understanding of autism-family disorders relative to DSM-4, and some of the newest, most comprehensive empirical science ever done on the subject is trending on Nature right now stating exactly that: we need more categories, more nuance, more differentiation, not to paint everyone under one broad brush of "it's all a spectrum of the exact same underlying pathology".
It seems abundantly clear to me, and to I think anyone else who's had any amount of meaningful exposure to or working with both groups: nonverbal autism looks much more like profound, pervasive developmental disabilities - think down's syndrome - than Asperger's does. The latter has a bunch of people that can generously be called eclectic, but writ large, are generally capable of supporting themselves and leading independent lives: emotionally, financially, socially, mentally, physically, maybe with some therapy, some counseling, some CBT, and maybe reasonable workplace or school accommodations, like being allowed to wear noise-cancelling headphones during solitary work. The former, categorically, tend to not be capable of that level of independence. It seems facetious and absurd to allege on any level that these two groups are substantially or meaningfully similar, especially if such similarity is being used to justify a treatment approach that is as identical as you purport it to be. These are, very obviously, so obviously even a child could grasp it, at least two dramatically different groups, with at least two dramatically different sets of needs and courses of treatment.
I say that as someone who grew up with more or less all of the hallmarks of (and was indeed diagnosed with) what we used to call Asperger's Syndrome, but also as someone who volunteered at events like the local Special Olympics chapter, and I'm firmly in agreement with in_cahoots's chief concern: 'Today most of the money and advocacy is for high-performing or moderately-performing people with autism.'
There are a lot of people who need a lot more support than people like me, and those with that greater need are getting less of it than they need, because people with well-managed conditions like mine are being lumped in alongside people like in_cahoot's cousin who genuinely need much more support. These two groups are a difference of kind, not a difference in degree.
> TFA is saying that we should've been moving towards more categories with more nuance and detail, even back when we were at just 2 categories, not towards fewer categories with even less nuance, as the DSM-5 chose to do.
TFA explicitly says the opposite
> “The term ‘autism’ likely describes multiple conditions,” said Dr Varun Warrier, from Cambridge’s department of psychiatry, senior author of the research. “For the first time, we have found that earlier and later diagnosed autism have different underlying biological and developmental profiles.”
> The scientists are *not* advocating for a move towards two diagnostic categories, saying that this could be unhelpful for the many who fall somewhere in the middle.
> “It is a gradient,” said Warrier. “There are also many other factors that contribute to age of diagnosis, so the moment you go from averages to anything that is applicable to an individual, it’s false equivalency.”
The Nature article and the guardian article are both just saying that these are likely multiple genetic disorders with similar symptoms and treatments. Classifying and understanding them is useful valid research to do, nobody doing this research is suggesting that actually DSM 4 had it right.
These will split into different diagnoses if it's found that significant differences in treatments can yield better results. Otherwise, they are just going to call it autism. Much like, for example, we call uncontrolled tumor growth cancer even though it's really 1000 different diseases that all manifest the same way.
Do blind people and nearsighted people have the same treatment? Saying people with profound autism need the same treatment as people with autism commenting on Hacker News is patently absurd. Go ahead and try offering therapy and workplace accommodations to nonverbal people living in a residential home. You're proving my point for me, we've lost sight of these people.
Even with cancer- the diagnosis and treatment vary tremendously depending on what type of cancer you have, how far along it is, and more recently how your particular genome responds to that version of cancer and each version of treatment. We don't just say, "whoops you have cancer" and start chemotherapy on the targeted area. Your argument doesn't make any sense.
> Do blind people and nearsighted people have the same treatment?
Yes, they both need to see optometrists on a regular basis. They get the same therapy even though a blind person won't get glasses.
It's the same for autism. Someone with profound autism will still see occupational, behavior, and speech therapists. The therapy will be different from what someone with mild autism gets, but the specialists involved will largely be the same. The OT for someone with profound autism can be identical to mild autism because there are many different aspects. Profound autism simply means several aspects have severe problems.
That's my point.
Very similar to how with an oncologist you might have a specialist for your cancer but ultimately you deal with a team that often treat different cancers. For example, people to draw your blood and run labs.
That's why hospitals have an oncology department and not a lung cancer department.
They see the same people but definitely don't get the same treatment. The insurance codes are different and the body of research is different. Putting $1 of research into genetic blindness does nothing for preventing astigmatism, even though patients may go to the same doctor.
Saying that everyone who goes to a therapist, or an oncologist gets the same treatment and therefore should be lumped together is absurd. Most other specialties are moving toward taxonomic differentiation, not away from it.
Sorry, I forget not everyone is as up-to-date on related studies on the subject from earlier this year that are not TFA: https://www.nature.com/articles/s41588-025-02224-z
The study "speaks to the need to be a bit more fine-grained in our approaches to diagnosis" with subtypes rather than a single condition, as one of the authors put it, there. Additional context: https://www.scientificamerican.com/article/four-new-autism-s...
Nobody's making the argument that the DSM-4 had it right: the argument being made is that the DSM-5's direction of fewer categories and more generalization was the wrong direction, and going instead towards more categories and less generalization was and is the right direction for increasing understanding, treatment attempt outcomes, and greater efficiency in diagnosing and serving those with greater needs.
Not really.
The main difference is that we don't immediately institutionalize kids with severe autism, which does save a lot of money.
For my kid with severe autism, about the only real impact of more people getting therapy is that sometimes it's harder to get an appointment (triage is more first come first serve and less needs based).
Realistically, that simply translates into a month to a half year waiting for an opening.
I think one of the major mistakes in this was folding in what used to be Aspergers into the Autism Spectrum diagnosis.
I received an Aspergers diagnosis back when it was still separate. To me it still doesn't feel right for my condition to also be lumped in with people like your cousin. I understand that it can still be a "spectrum" but the spectrum is far too wide now.
Your cousin has very different struggles and needs compared to someone with a more high functioning autism, or even someone with (formerly known as Aspergers) like myself.
I disagree. The problem is that the Aspergers-vs-Autism distinction was largely "looks normal at first glance" vs "doesn't", which is almost entirely unrelated to the many axes of actual symptoms.
An glaringly incorrect division is more harmful than a lack of division. If it had been a "good enough" division it could've been kept.
The best-attested actual axis is "has epileptic seizures?"; partitioning by it gets rid of most of the bimodalities in the data.
My estimate is that there are around 5 individual axes but many of them are continuous and it's not perfectly clear if some are actually correlated to others. And since the others are usually not bimodal it becomes difficult to choose different diagnoses based solely on symptoms, in the absence of knowing and testing actual mechanisms.
What are the other axes in your theory?
Some candidates include: sensory processing (including keen senses, overload, and undersensitivity - sometimes different for each sense!), trauma when unplanned/unexpected actions or lies occur (part of "patterns/routines" in general, but I exclude mere "pop-sci OCD"), difficulty reading facial/social cues (and the sheer terror of how people can read your mind if you meet their eyes).
I'm unsure about "difficulty expressing yourself clearly even when you know exactly what you mean". Nonverbality is a possibility but I'm actually skeptical of it, though it does give a very useful hook for experiments - there are some toddlers who are initially verbal like normal, then gradually become nonverbal and can recognize "something is happening to me!". I specifically exclude intelligence-vs-retardation; though both are common, neither seems intrinsic to autism itself (though perhaps they are potential causes?). Despite their correlations, I also exclude general introversion, ADHD, special interests as being either external or secondary. And "making repetitious movements" or even "throwing tantrums" is clearly on the side of "coping strategy" rather than a part of the disease.
Many autism quizzes split the questions into categories which somewhat align with the axes, but as I said before it's not clear what's actually independent and forms a meaningful difference.
Two axes outside of autism are also clear: schizophrenia is the formation of the patterns too detached from the world (as opposed to autism which where internal patterns result from the real world being too strong in some way - it's quite striking that for all the comorbidities autism has, diagnosis of schizophrenia in the same individual is exceedingly rare and probably wrong in at least one of the cases, though they intermingle at the family level); dementia is when the brain fails to build enough patterns (where autism builds too many).
One opinion I hold vehemently: if you're still in the "the problem is other people" phase, you aren't claim autism, you're just an asshole. Doing anything useful about autism requires recognizing: "my brain (my body?) is the reason I am suffering"; the best others can give is palliative care.
The thing is even in it's earliest days, there were examples of autistic people able to live independently. The first person diagnosed with autism was employed as a banker.
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I’d like to piggyback on your comment to get your (and broader audiences) opinion on a situation I’m facing:
I’ve recently learned my 5 year old is exhibiting behavior problems in kindergarten. His teacher has put the notion in his mother’s head that he may have autism and has provided his mother a fast track referral to have him tested/diagnosed. I feel strongly that he does not have autism; aside from being disruptive in class he doesn’t have any other characteristics—-he is very verbal, social, doesn’t avoid eye contact or physical contact. I’ve spoken to his Sunday school teachers, daycare workers, etc and they were incredulous that he potentially has autism.
‘Well if he doesn’t have it what’s the harm in having him tested at a facility that specializes in pediatric autism? If you’re right they’ll easily determine he’s not autistic, right?’ Is the question I can imagine being asked at my reluctance to consent to the testing and diagnostics. Frankly, I’m suspicious of the (potential) conflict of incentives that a clinic specializing in pediatric autism may have; I positive diagnosis is only good for business in the way that a men’s clinic is incentivized to find every patient that walks through their door has low testosterone. Especially considering the subjectivity and ‘spectrum’ that falls under the blanket term ‘autism’.
On a scale from likely to incredibly unlikely, how rooted in reality would you characterize my concerns? Also what harm, if any would come from a false positive diagnosis? Would it outweigh the harm of a person being an undiagnosed, high functioning person with autism?
I am way way out of my wheelhouse here. But you asked, so I'll share my experience and opinion in a roundabout way.
When I was a kid, my parents' nicknames for me were Spock and Ms. Literal. I was gifted, at the top of my class, and my parents advocated for me every single year so that I received a high-quality education. The school was receptive, and I thrived academically. I struggled socially, but being a girl it demonstrated in a lack of friends rather than behavioral disruption. So in every way I was the ideal student. Today I would easily be diagnosed as autistic, but in the 90s that wasn't in the conversation. Especially given our experience with my cousin. I don't think of myself as autistic, I'm just a person with strengths and weaknesses.
Today for better or worse we live in a society that thrives on labels and categorization. Your kid gets a label and all of a sudden the school is able to give him an IEP and the support he deserves and should have been getting all along. In the cynical perspective, your kid gets a label and that affects the way he sees himself and relates to the world. The label becomes a justification instead of just a descriptor.
From the educational perspective, I want the school to do everything possible to help my child succeed. If that means jumping through hoops to get him support then so be it. But from the identity perspective I want my kid to be unburdened. To learn from the world around him without getting pigeonholed. And if a diagnosis was going to lead down this path I would be very intentional about when and to whom I disclosed this information.
This isn't getting into the world of false positives. In my experience (2 boys similar in age to your own) teachers tend to be good referrers just because of the volume of kids they deal with. So if your teacher recommends this there's a good chance they will fall under some diagnostic criteria at some testing facility. The question is what to do with the information.
thanks so much for sharing this.
The school system needs an Official™ medical justification to grant your kid extra accommodations for whatever his behavioral issues are. They are less interested in whether he "actually" has autism than in a rubber stamp that gives them more options for managing him. Which might indeed be a good thing for your son! It's hard to say without being closer to the situation.
Thanks. That indeed was one of the questions I had in my mind--"what changes once a diagnosis or label has been affixed?"
But is it the profound autism or is there something else? I think we actually need to define the term a little differently for mental retardation and bring it back. Is he profoundly autistic with an average IQ? Or is he profoundly autistic and essentially incapable of communication? It's not the autism that's the problem. He might also be autistic but a lot of people started labeling retardation as autism. Which really tainted the term autistic for normal people. So I do actually agree with the shift. Not that they should take anything away from the profoundly autistic. They should offer them more. But there should be a program for that type of person. Assisting them greater than the autistic programs. Autistic help should be more about understanding the internal issues we face on a daily basis and how to deal with them. How does that help someone who can't communicate? The help he needs is probably different and more extreme than what an autistic person needs.
It's like saying I can't run. My arm hurts. Then you say. What do you mean? You're a quadriplegic!! He's like oh yea that too but I can feel a tingle in my arm. Treating the arm isn't fixing the problem lol. If that person was an advocate for treating tingles in their arm. You would think it's kind of silly because if they were to treat that. It doesn't really help the quadriplegic part. But he keeps saying it will. It's not that I don't believe he has a problem with his arm. I'm sure he does. But the problem on why he can't run isn't that.
> It is time to realise that ‘autism’ has become a ragbag of different conditions.
Look, I get it and somewhat agree. However, the reason for the diagnosis (and any diagnosis) is treatment.
Maybe there are two different conditions that require speech, occupational, and behavior therapy to different degrees, however, in terms of convincing insurance companies in the US to cover those having a single diagnosis makes everything easier.
It's not as if a separate diagnosis would change how a speech therapist interacts with a child.
I applaud efforts to figure out what is going on and to categorize. But I also think that practically the ragbag diagnosis makes treatment a lot easier to access for patients.
> It's not as if a separate diagnosis would change how a speech therapist interacts with a child.
This is the really big part that a lot of people seem to miss when complaining about the changes in DSMV.
Previously there were dozens of conditions that had nearly the exact same symptoms and super similar treatments that may work.
The change basically said, for these given symptoms here's a bunch of treatments that may work.
I've known a few people that were diagnosed as something that would now be under autism, but because they had that diagnosis that didn't happen to include some of the treatments that actually ended up working for them they ended up not finding them until they happened to get a doctor that said "you know these diagnoses are really close, lets try this instead".
From talking with doctors I don't think I've heard anyone disagree that autism is almost assuredly a cover term for many different things similar to cancer not being a singular disease. The difference right now is that we don't have any concrete test to differentiate between any of the autisms yet, just various sets of treatments that work to varying degrees for different people.
This reminds me of the "America is run by Lawyers, China is run by engineers quote"
We can't let Lawyering/word smithing/insurance manipulation restrain our access to the truth.
They figured out that autism is actually four completely distinct disease clusters with four completely different symptomologies, with some overlap of symptoms in the middle. One of the disease clusters correlates with Fragile X retardation. The idea that we clump together an actual genetic condition that causes retardation with 3 other disorders is ludicrous.
Therapists need to understand that many disorders can produce "autism-like" downstream effects, just like many things could cause anxiety or depression. Not understanding the disorders doesn't "help patients".
https://www.princeton.edu/news/2025/07/09/major-autism-study...
Yeah, "thinks or reacts to things differently than most people" is way too broad.
It also shouldn't be a binary classifier. Some people are definitely "autistic", and some are definitely not, but many of the personality traits that define autism are continuous: e.g. some people are barely distracted by loud noises (normal), others are distracted by loud but not quiet noises (normal), others are distracted by specific quiet noises like chewing (autism?), others are very distracted by any noise even with noise-cancelling headphones (autism?).
I think people should just say "I have sensory issues" (or clarify "noise really distracts me"), "I'm bad at reading emotions", "my mood is really affected by others". And accommodations maybe do need to be binary (or graded), but should ideally be informal, and definitely be for specific traits instead of "autism": e.g. don't give someone who thinks methodically but isn't bothered by loud environments their own room (unless you give everyone that), but don't assign them vague tasks or they'll perform poorly.
You're right that sensory issues make up a small (optional) part of the diagnostic criteria for ASD under the DSM-5. And I agree that "autism" in popular discourse seems to be very flexible and inclusive, but the medical diagnostic criteria are much more specific. When someone does meet these criteria, there's something going on that isn't just a collection of unrelated peculiarities. This seems to be supported by the very high heritability of diagnosed ASD.
I would agree with you that there are issues caused by the wide range of presentations. It seems as though there's a tension between differentiation and unification at the various levels of scientific research, social understanding, social accommodation, etc. I expect things will get teased out over time.
DSM summary: https://www.cdc.gov/autism/hcp/diagnosis/index.html
DSM and ICD summary: https://www.autism.org.uk/advice-and-guidance/topics/diagnos...
ICD-11 direct: https://icd.who.int/browse/2024-01/mms/en#437815624
From the DSM summary:
> To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction (see A.1. through A.3. below) plus at least two of four types of restricted, repetitive behaviors (see B.1. through B.4. below).
Example (A.1):
> Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions
The medical diagnostic criteria, despite using technical language, are still vague: "deficits in..." has a wide interpretation. Furthermore, "at least two of the four" permits two people diagnosed with autism to have different symptoms: one child may only have limited interests and insistence on sameness, while another may only have "stereotyped" motor movements and hypersensitivity (and the specific interests, "stereotyped" behaviors, and hypersensitive stimuli can vary).
I've copied the required features from your linked document. With that said, I'd say most people tend to have every trait there to some extent. So I'm not sure that the medical criteria is as specific as you implied. It seems like the main criteria they use is that the symptoms cause significant impairment in your life.
---
Essential (Required) Features:
Persistent deficits in initiating and sustaining social communication and reciprocal social interactions that are outside the expected range of typical functioning given the individual’s age and level of intellectual development.
Specific manifestations of these deficits vary according to chronological age, verbal and intellectual ability, and disorder severity.
Manifestations may include limitations in the following:
Understanding of, interest in, or inappropriate responses to the verbal or non-verbal social communications of others.
Integration of spoken language with typical complimentary non-verbal cues, such as eye contact, gestures, facial expressions and body language.
These non-verbal behaviours may also be reduced in frequency or intensity.
Understanding and use of language in social contexts and ability to initiate and sustain reciprocal social conversations.
Social awareness, leading to behaviour that is not appropriately modulated according to the social context.
Ability to imagine and respond to the feelings, emotional states, and attitudes of others.
Mutual sharing of interests.
Ability to make and sustain typical peer relationships.
Persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or activities that are clearly atypical or excessive for the individual’s age and sociocultural context.
These may include:
Lack of adaptability to new experiences and circumstances, with associated distress, that can be evoked by trivial changes to a familiar environment or in response to unanticipated events.
Inflexible adherence to particular routines; for example, these may be geographic such as following familiar routes, or may require precise timing such as mealtimes or transport.
Excessive adherence to rules (e.g., when playing games).
Excessive and persistent ritualized patterns of behaviour (e.g., preoccupation with lining up or sorting objects in a particular way) that serve no apparent external purpose.
Repetitive and stereotyped motor movements, such as whole body movements (e.g., rocking), atypical gait (e.g., walking on tiptoes), unusual hand or finger movements and posturing.
These behaviours are particularly common during early childhood.
Persistent preoccupation with one or more special interests, parts of objects, or specific types of stimuli (including media) or an unusually strong attachment to particular objects (excluding typical comforters).
Lifelong excessive and persistent hypersensitivity or hyposensitivity to sensory stimuli or unusual interest in a sensory stimulus, which may include actual or anticipated sounds, light, textures (especially clothing and food), odors and tastes, heat, cold, or pain.
The onset of the disorder occurs during the developmental period, typically in early childhood, but characteristic symptoms may not become fully manifest until later, when social demands exceed limited capacities.
The symptoms result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Some individuals with Autism Spectrum Disorder are able to function adequately in many contexts through exceptional effort, such that their deficits may not be apparent to others.
A diagnosis of Autism Spectrum Disorder is still appropriate in such cases.
What you're describing is the whole reason it's called autism *spectrum* disorder
True, but it's still very vague.
"I'm autistic" could mean "I'm non-verbal and can't function without constant care", "I'm very good at hacking, but need help with basic things", "I can function independently, but tend to over-think and over-explain and can't read people's emotions", "I can read people's emotions but am overwhelmed by them, I'm also unusually soothed by ASMR", "I'm unusually irritated by ASMR"...and there's no boundary that separates "real" autism from almost normal with certain traits slightly elevated.
Idk. If someone can pinpoint a single cause, it is binary. Not that I think that's possible: the human mind is so poorly understood, a real cause-effect relationship is scifi.
> some people are barely distracted by loud noises ...
It's not an argument for a non-binary classification. The whole point is that that a symptom, even a group of symptoms, doesn't define autism. Sensitivity to noise is just one of those things that some group has managed to be associated with autism.
Its definition has been expanded significantly. If it continues, there'll be two types of people: autists and psychopaths.
Yes, the problem isn't that the definition isn't 100% formal. If "autism" meant "unusually sensitive to loud noise" (and presumably other symptoms get new labels) that would be reasonable. But it seems to mean "unusually sensitive to something OR unusually methodical OR unusually bad at reading emotions OR unusually affected by other's emotions OR ... ", and almost nobody has every symptom, but two people may have completely different symptoms while a third person has some from each.
If you just have one of the symptoms you shouldn't be diagnosed with autism.
I think a lot of people miss that the changes that combined a ton of stuff into autism was because we had a ton of different disorders that had super similar treatment plans, but it could cause issues when your doctor didn't know all of the related disorders to be able to know to try different treatment plans.
The combining was an acknowledgement that we don't know what causes these combinations of symptoms to occur but they seem to be related when certain combinations of them occur and these treatments can work to lessen the impact on the person experiencing it.
Well of course, we basically expanded the ASD definition to cover a wide range in order to ensure that everyone gets access to support if needed, but in the process turned "autism" into a grab bag of different conditions which makes discussions about it difficult because everyone is talking about something else.
It's kinda like mental health issues go through their own hype-cycles. Autism now is where ADHD was in the late 90s / early 2000s. I say this as someone who went through the Ritalin treatment a long time ago, but that was after my parents were at their wits end tried drugging me with gravol. If that were today, it'd probably be some neurospicy autism diagnosis and treatment.
I wouldn’t even be surprised to find that it’s a matrix: multiple causes correlate with multiple (but not necessarily all) expressions.
Like myocarditis or auto immune diseases.
Seems almost inevitable. The definition is so messy. And even things that seem clearly NOT autism still seem closely related. Such as ADHD.
This tracks my experience. People in my family probably have PDA autism (https://www.autism.org.uk/advice-and-guidance/topics/behavio...) and it bears very little resemblance to what I know of the "standard" experience of autism.
I've heard the same thing for women although Im not sure I've had any experience with it first hand.
Which seems kinda strange. If we dont know the cause and the symptoms are entirely different then what makes it the same thing?
I mean a lot of people Autistic and non-autistic exhibit that behavior. There should be some genetic or biological component to autism, otherwise we're just labelling boutique awkward behavior as Autism
Agreed. I believe both autism and ADHD are labelled as syndromes, which is basically a circle drawn around a collection of symptoms, as the biological basis is not currently known. This research could be a step towards changing it.
A biological basis for autism is starting to be understood, which can be extremely summarized as neuron pruning dysfunction/regulation issues.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9671112/
My views may not carry much influence, but I’ve argued this point for years—and not only about ADHD, but about many psychiatric conditions, including Autism.
For what it is worth, I have ADHD -- 'cousin' disorder to Autism. Like Autism, ADHD has an array of presentations. I hold the belief that diagnostic labels are simply abstractions for grouping clusters of vague and often arbitrary symptoms. In that sense, many labels are tautological. For example, ADHD/Autism is defined by a set of behaviors, yet people are said to have ADHD/Autism because they exhibit that exact same set of behaviors.
From my perspective, conditions like ADHD and Autism are unusual conditions in terms of their pathology. I suspect some autistic people might agree when I say this: ADHD (and certain forms of Autism) seem to be treated less for the benefit of the individual and more for the benefit of those around them. Compare this to depression -- a condition where the primary suffering is internal -- experienced by the person themselves. With ADHD and Autism, the person is not necessarily suffering directly, but their behaviors often cause difficulty for others, and in turn those others impose suffering on the individual. Treatment, then, improves behavior (somewhat), which first benefits those around the person, and only indirectly improves the individual's own quality of life.
I may be struggling to articulate it perfectly, but I can’t shake the sense that there’s something unsettling about the pathology of these conditions. It has become almost imperative that I take amphetamines every single day. A practice that is far from pleasant, to say the least. Technically, no one forces me to medicate myself, yet the pressures of society make it feel obligatory. I alter myself not primarily for my own sake, but because society has deemed my natural state defective, disruptive, or unworthy. Treatment to me seems less about addressing my own suffering and more about making me tolerable to others.
Treated for others' benefit? Your opinion has to be in the extreme minority here, at least for ADHD. ADHD is hell. Can't sleep and eat properly, can't focus on your work and hobbies, can't maintain your relationships, constantly losing shit... everyone I know is incredibly grateful to be on medication.
> ADHD is Hell
I am well aware.
> Can't sleep and eat properly
Would be less of a problem if I was not forced to conform to society's expectations. I also have been diagnosed with Delayed Sleep-Phase Disorder, so I am also well aware. Also what are two of the most common side-effects of stimulants? Sleep disturbances and reduced appetite.
Also, what type of eating issues are directly due to ADHD and not a comorbid disorder? I skip meals a lot due to laziness, but I wouldn't say it causes any dysfunction in my life.
> can't focus on your work
Who is more negatively affected by this behavior: your employer or you?
> and hobbies
So what if I struggle to commit to one hobby or finish a hobby? I do my hobbies for my enjoyment, not some ulterior motive. I do not think there is anything pathological about being a jack-of-all trades type or not committing to some hobby.
> can't maintain your relationships
Which I believe is direct evidence of how our symptoms affect others and not inherently oneself.
> everyone I know is incredibly grateful to be on medication
I remember feeling the same way once. I have been taking medication for over a decade now. Grateful is not the word I would personally use. I would say that I made a deal with the Devil just to feel some sense of respite.
Symptoms and side effects can vary a lot between people, you could've gotten unlucky.
> Who is more negatively affected by this behavior: your employer or you?
I like my job. I think I am making the world a better place, and I would choose to do this even if I was wealthy enough to never work. When I am unable to do my job because my ego does not align with my id, it makes me angry and disappointed.
> I do not think there is anything pathological about being a jack-of-all trades type or not committing to some hobby.
Nor do I. I do, however, think there is something pathological about sitting on the floor for three hours doing nothing because you're procrastinating on deciding what book to read next, or debugging a 3D printer, or replying to an invitation (or because you need to shower, or cook, ...). This behavior is not enjoyable at all.
It sounds like you primarily experience ADHD as getting in the way of things you have to do, rather than things you want to do. I'm sure that sucks in its own way, but the grass looks greener from over here.
> Which I believe is direct evidence of how our symptoms affect others and not inherently oneself.
I inherently care about other people, and when I let them down, it makes me sad. Perhaps you prefer to define all instances of your friends having desires and expectations around your relationship as oppression, that when I am upset I missed an important event it is because I am being brainwashed by society. But I think this is a small, selfish way of viewing the world. Many traits can get in the way of being a good friend (surely you know someone who is prone to anger, or envy, or insecurity), and if you are a good friend, you try to mitigate them.
> I would say that I made a deal with the Devil just to feel some sense of respite.
Next time you see the Devil, do me a favor and ask him if he has any other opportunities.
It's a mixed bag. I personally wish I had access to medication (but don't have the emotional energy fighting that fight with the medical system and getting rediagnosed in my current country) but amphetamines are unobtainium here through the medical system and methylphenidate turns me into a zombified wreck most of the time.
>ADHD (and certain forms of Autism) seem to be treated less for the benefit of the individual and more for the benefit of those around them. Compare this to depression -- a condition where the primary suffering is internal -- experienced by the person themselves. With ADHD and Autism, the person is not necessarily suffering directly, but their behaviors often cause difficulty for others, and in turn those others impose suffering on the individual.
I think it would be helpful to specifically characterize what forms you are talking about. Paint a picture of such a case. Because the forms my mind jump to are definitely suffering themselves and I dont want to strawman you.
Sensory overload, unmanageability, etc. Someone who may be perfectly content to obsess over some niche interest but cant take care of themselves because they are inconsistent at work. Cant pay bills, neglected health issues, etc. I can begin to imagine how someone might characterize this as you have but I think that would be quite flawed and I'm not sure this is what you're talking about.
Sorry, I tried to preface that I would butcher my explanation, and it appears I was correct in that assumption. I also apologize if this answer is no better. I likely lack the mental acuity to formulate these thoughts well.
To be clear, I’m not denying that some people experience direct suffering like sensory overload, daily dysfunction, etc.. Though I would argue much of this is somewhat expected when one lives in a society that wasn't designed around edge cases (nor am I saying such a society is truly possible at our scale).
My point is about a different subset of cases, like mine and say individuals with high-functioning Autism, where the suffering is mainly socially imposed. The pressure to medicate or "fix" ourselves comes less from unbearable symptoms and more from others' expectations that we be more tolerable or productive. That was the unsettling part I was trying to get at. I was trying to make a point about a little compassion from others would go a long way. I was not trying to absolve myself and others like me of our responsibilities/symptoms. Often times, the symptoms of these disorders are not treated as symptoms of a disorder, but rather, direct flaws of one's character. All in all, I find the difficulties hard to describe unless one has lived the same or a similar experience.
Whether or not one has a disorder does not make them less of a human being. Thus, I do not think it is a coincidence that depression, anxiety, substance abuse, and suicide are highly correlated with disorders like ADHD and high functioning Autism, and I do not think a lot of those comorbid issues stem purely from some kind of internal (hypothetical) brain difference.
Does that make any more sense?
> those others impose suffering on the individual
There are so many people out there sacrificing their own mental and physical health for their children or their loved ones or their students or patients to simply have a few hours of calm happiness every day.
And you flippantly dismiss them. You paint them with a broad negative brush.
This is an ice cold, selfish, naive and incorrect statement.
You've misread me. I'm not dismissing caregivers, but rather, I am pointing out that treatment often serves their needs before the needs of the individual. Psychiatry too often prioritizes making people tolerable over making them well.
Is there anything we can infer about the nature of Autism Spectrum Disorder from the fact that it's a spectrum, as opposed to some binary thing?
If ASD is comprised of a variety of qualities that may not all be expressed at once, and they are expressed in varying degrees, what does that mean?
For example, it seems unlikely its just the existence of single gene that determines if you have it or not.
Or maybe its cause is continuous as well. More microplastics more autism (massively simplifying here, but just illustrating).
I dont really know... seems like maybe there are more interesting instincts people might have here. The fact that it's kind of an amorphous mess seems to suggest something about the nature of the thing we are talking about here.
Did anyone, including the people proclaiming it, believe that "Tylenol causes autism"?
They likely do.
Belief is one of the methods by which we demonstrate loyalty - and to the person affected, it's indistinguishable from any other belief.
Harvard sees a potential link, hell it’s the name of the paper: “Using acetaminophen during pregnancy may increase children’s autism and ADHD risk ”.
I think that it might be a real thing is because nobody really knows how acetaminophen even works. All the theories involve influencing the brain‘s chemistry. Who knows, maybe influencing a fetus’s brain chemistry can be bad.
https://hsph.harvard.edu/news/using-acetaminophen-during-pre...
As far as I can tell, none of the author's (Public Health Dean Andrea A. Baccarelli) work has demonstrated anything causal, but rather just some correlation. His testimony in a case against Tylenol in 2023 attempting to link the drug to autism was thrown out by the judge for cherry-picking and misinterpretation of study results.
https://www.thecrimson.com/article/2025/9/24/autism-dean-pub...
"Harvard" doesn't see anything. The researchers who conducted a specific study work at Harvard.
And yes, these links exist all over the place. The problem is that we have failed to establish causality 100% of the times we've tried.
No one proclaimed that.
They announced that Tylenol could be linked to neurological development issues, including autism.
"Don't take Tylenol, don't take it. If you just can't… I mean, it's just fight like hell not to take it. There may be a point where you have to and that you have to work out with yourself. So don't take Tylenol."
That's what they said, which is fucking stupid.
The existing guidance is to discuss use with your doctor and to take the minimum necessary. It is not "fight like hell", ostensibly through fever and significant pain, to avoid it.
There is no good evidence to substantiate this belief, and if there were, then it'd be part of the guidance and we wouldn't need somebody who learned acetaminophen == Tylenol at 79 years old saying things like "Don't take Tylenol" on national TV.
That is what Trump said about the FDA decision to update labels. I agree it was stupid and misleading. The actual action taken was as the original commenter said.
The FDA decisions to update labels said:
>The U.S. Food and Drug Administration today initiated the process for a label change for acetaminophen (Tylenol and similar products) to reflect evidence suggesting that the use of acetaminophen by pregnant women may be associated with an increased risk of neurological conditions such as autism and ADHD in children. The agency also issued a related letter alerting physicians nationwide.
https://www.fda.gov/news-events/press-announcements/fda-resp...
Yes, you're right that the FDA had to downplay pretty much the entirety of the ignorant fearmongering done on national TV by the sitting President and the head of Health and Human Services.
This is stupid and bad, actually, and absolutely should be viciously criticized.
I think you have it backwards. Trump was talking about the FDA decision. He way overstated the action.
You are incorrect.
FDA's communication came after the press conference.
> The announcement __followed__ President Trump’s announcement from the White House in which he repeatedly told pregnant women, “Don’t take Tylenol.”
https://thehill.com/policy/healthcare/5518478-tylenol-acetam...
No that supports what I'm saying. They already made the decision. Yes, Trump announced it then they filed the paperwork. They didnt decide to relabel the next day just based on some comments Trump made the night before lol
Nobody claimed that?
The claims are that Trump gave people the impression that Tylenol causes autism, which is a claim we've failed to substantiate 100% of the dozens of times we've tried, and that FDA put out guidance that is much, much softer in direct controversion of Trump’s claims.
In other words: Trump’s statements weren’t in response to the FDA decision nor was the FDA decision in response to Trump’s statements. Both were distinct responses to the head of HHS (a scientific illiterate and world famous grifting conspiracy theorist) deciding that vague gesticulating about Tylenol could help him meet his self-imposed September deadline to solve autism.
Why would they do that? Why would they suggest that maybe these two things are related?
Why didn't they say it earlier? Didn't they say they were going to release the cause of autism earlier?
Nobody is saying that it is caused by one thing, only that one of the causes are directly attributed by acetaminophen. This is coming from studies by Johns Hopkins University, Harvard University, and Mount Sinai to name a few.
A correlation has been established. No causation has been established. You are mistaken.
"Autism spectrum disorder", by virtue of being a "disorder" ISN'T a single condition with one cause.
That's what disorder means
Every single medical professional is aware of that.
None of the neurodivergent conditions have a single "cause" yet. None of them are "diseases" yet because we don't know what causes them.
Yes, lots of people have small amounts of the "symptoms" that get labeled as a condition. That is not meaningful.
Everyone gets diarrhea sometimes. But if you get diarrhea regularly, or really bad diarrhea, or diarrhea that includes severe pain, then it might be IBD. IBD doesn't have one cause. It's very unlikely that it's even a single problem.
If you eat too much greasy food and have bad shits, you do not have IBD even though you have that "symptom". If you claim to have IBD, you are just wrong.
Yes, some people on tiktok who think they have ADHD or Autism are just wrong. If Americans could afford to go to the doctor for non-life threatening problems, they could get a psychologist to tell them that. Americans self diagnose because they can't go to the doctor.
This is all true of "Cancer" as well, but there isn't a giant PR campaign to convince Americans that we are diagnosing too many people as having cancer. Nobody gives a shit that both they guy who dies in a month from metastasizing brain tumors and the guy who had to remove a benign skin mole both had "Cancer". Every kind of cancer has a name, but people will still say "I have Cancer" just fine.
It's only with Autism and ADHD that people insist we have somehow done something wrong by using the exact same language structures as other medical problems.
Meanwhile, with attacks against Social Security, this admin who claims to care so much about helping Autistic people is ensuring that people who cannot function in society will die miserably and uncared for.
Maybe Tylenol while pregnant is a risk factor for people who are already genetically predisposed to it or something. The data sucks so far, but maybe further study will show something. My sister worked on a study in the 2000s that was looking at this, as well as looking at getting the flu while pregnant. Nothing came of it.
Posting this on Hacker News is like contacting a bunch of marine biologists to tell them "water = wet"
Except autism, or as it was called then "autistic psychopathy" is anything but a condition or discovery https://archive.ph/nOH4z (note: it's a nature.com link)
https://www.bbc.com/news/world-europe-43820794
Autism is exactly one thing, according to its discoverer, Hans Asperger: a diagnosis to remove the mentally undesirable from society to safeguard the genetic purity of the noble aryan race (translated from the paper by Hans Asperger)
Note: by removing he meant killing anyone with the "diagnosis", child or adult. Hans Asperger signed the orders to kill at least 5 children, probably many more.
In other words: the "discovery of autism" was nothing other than an excuse to massacre children deemed to be a burden on families for whatever reason. If you were diagnosed with autism and weren't hyperintelligent, you were sent away to be killed. It was the absolute opposite of neurodiversity, of tolerance, of neurodivergent people and it was never meant as a real diagnosis of a real condition. It was an excuse for murder.
Of course, psychology sees no problem with this little part of history and still revere Hans Asperger as a hero, as opposed to someone who should have been hanged at Nuremberg along with his colleagues. Psychology has a history of doing this. If you check what happened to Freud's patients, especially the women, you'll see that he was a seriously disturbed person as well. He made (in today's dollars) billions testifying in court that women who accused rich Austrians, often their own family, of rape they wanted to be raped and should be locked up for this deviant behavior ("not" to protect and satisfy the desire for revenge in their rapists). Oh and in a few cases, that male victims of murder by their own family were guilty of their own murder.
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> Autism is not Mendelian. There is no autism gene.
Autism is heritable which suggests there are autism genes involved. [1]
It's not a 100% thing, which could point to things other than genetics causing autism. It is, however, very strongly correlated to your parents.
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC5818813/
I agree. Of course genes are involved... but that doesn't make it Mendelian. Autism would be caused by a combination of genetic and environmental factors.
The fact exists that there is no singular autism gene. And there could never be a genetic test for autism. It could predict the likelihood, but it wouldn't be pass/fail. Because there are many autism-related genes but no single gene trigger like a light switch. And you could still have all of those genes turned on and not have autism due to environmental factors.
Unless we find Utopia some day, the economic system does not matter. People will have to work whether they be nomads, fishermen or fisherwomen, live in Neoliberal economies, live in Socialist economies, Communist economies or a loaner in the jungle. People have to produce: "From each according to his ability, to each according to his needs" as they say. It's expected people who have the ability to produce to produce. It's not Wall-E land where you get plugged in and can veg out to your heart's content. We have the same phenomenon in the non-political animal kingdom. You hold your weight or you're out. We have little more ruth as a species... but not that much more because it's hard to afford more --you see even if we evenly spread the wealth from billionaires evenly, it would not amount to much for each individual -just over a thousand dollars per person and it would be a one-time thing.
Oh, a scientist. What do they know? I thought we don’t listen to these people anymore.
In what reality would we be living if we listened to knowledgeable people?
Technocracies have a pretty bad record unironically. Places which let lawyers run society do better than places which let engineers run it.
Edit, since I can't make a post right now since HN thinks I've posted too much, here's some examples of technoracies:
"The former government of the Soviet Union has been referred to as a technocracy.[20] Soviet leaders like Leonid Brezhnev often had a technical background. In 1986, 89% of Politburo members were engineers.[20] "
"Many previous leaders of the Chinese Communist Party had backgrounds in engineering and practical sciences. According to surveys of municipal governments of cities with a population of 1 million or more in China, it has been found that over 80% of government personnel had a technical education"
"Since the 1990s, Italy has had several such governments (in Italian, governo tecnico) in times of economic or political crisis,[27][28] including the formation in which economist Mario Monti presided over a cabinet of unelected professionals."
"The term 'technocratic' has been applied to governments where a cabinet of elected professional politicians is led by an unelected prime minister, such as in the cases of the 2011-2012 Greek government led by economist Lucas Papademos and the Czech Republic's 2009–2010 caretaker government presided over by the state's chief statistician, Jan Fischer.[3][31] In December 2013, in the framework of the national dialogue facilitated by the Tunisian National Dialogue Quartet, political parties in Tunisia agreed to install a technocratic government led by Mehdi Jomaa."
"The Syrian Salvation Government, the predecessor to the Syrian transitional government,[33] was characterized by observers as an authoritarian technocracy"
https://en.wikipedia.org/wiki/Technocracy
The problem with technocracies is that government faces choices that aren't a question that can be answered by some neutral evaluation but are instead questions of whose interests are prioritized or what values are enforced.
However there ARE questions that can be neutrally evaluated, or at least where neutral evaluation can narrow the field of reasonable decisions. Medical policy is replete with decisions like this, and so we really should be consulting experts and strongly listening to their decisions in this field.
Can you provide examples of such a place? From my perspective, I find it difficult to believe that this has ever been attempted at a scale that is sufficient to come to that conclusion. I'd love to hear otherwise.
A "true" technocracy has never been, but China has exhibited the only "almost" example during the late 20th century. That was the period when they transformed from a sustenance-farming backwater to a powerhouse on the world stage.
Of course, it is always easy for a backwater to play catchup after someone else has already figured out how to advance. It is difficult to attribute that success to technocracy, and it is likely that any system could have allowed the same forward momentum, but the correlated track record is quite good regardless.
The USA flirted with the idea of technocracy around the time of the Great Depression. That is, perhaps, where the "bad record" idea has come from, but that's a pretty big leap.
I feel like they are coming with the same energy as "socialism never works and always fails....because we make it fail."
In my experience organizations ruled by lawyers are ruled by inertia. You can delegate any question to a lawyer who will advise you to not do anything
If they’re being delegated decision making they are, by definition, not running things.
As in, "running things" by being the last decider, the class with the most power in the system, etc
Just as the king of england is the head of state yet not the source of power
> Just as the king of england is the head of state yet not the source of power
The king of England doesn’t run Britain in any sense.
American oligarchs exercise more political power than he does.
The king of england ran england while his (the institution) power eroded until he started working for the british parliament/government
the point being, official institutions are not always the strongest in the state, a state can be practically ruled by lawyers while having a functioning government
> king of england ran england while his (the institution) power eroded until he started working for the british parliament/government
So by “running things” you mean person whose ancestors ran things. Q. E. D.
Your top comment does not describe “organizations ruled by lawyers.”
Let me clarify again because it seems you haven't really understood what I meant.
The british king example is how a country can evolve from one point of power to another over time, while keeping the existing institutions.
When imagining a system of government ruled by lawyers, I see it similar to an organization ruled by lawyers. In such organization/government the leaders are afraid of doing and thus are using lawyers as their excuse not to do anything.
Because of the vacuum of power, essentially the only policies actually being enacted are decided by the lawyers, which is whatever makes their job easier (minimum legal risk, minimum interpretations)
> When imagining a system of government ruled by lawyers, I see it similar to an organization ruled by lawyers. In such organization/government the leaders are afraid of doing and thus are using lawyers as their excuse not to do anything.
My point is you're not describing an organisation ruled by lawyers. You're describing one ruled by nobody.
It would be like me saying organisations led by engineers don't work because if I imagine an organisation where the engineers aren't actually in charge, but someone asks an engineer whenever they don't want to make a decision, it doesn't work.
So, here I don't agree, when no one steps up to take decisions someone will, and in some organization these are lawyers. If the decisions are taken by lawyers, it doesn't matter there's someone that has the title CEO like it doesn't matter that someone has the title King
Others might imagine a parliament system as a system where the lawyers are in control, I don't think that's the case with parliaments
Of course, likewise, the best engineering is to do nothing. All actions have consequences, and while engineers may not look at the exact same consequences as lawyers, they are both equally concerned about consequences.
But sitting back and doing nothing on the basis of their worry wouldn't fly in the real world. If such a hypothetical government existed, the leaders would have to act, else be quickly overthrown. Power is only able to be held if the people want to give it to you.
> Places which let lawyers run society do better than places which let engineers run it.
Can you provide any examples?
Weird to throw China in there as an example of a failed technocracy. They’re currently performing so well that it’s considered a massive problem.
They’re not perfect, but frankly they humiliate the US in a lot of areas because the US system is too sclerotic to adapt and improve.
Lol, we have to live in this reality for at least another 3 years.