[metamuas]

"Diagnoses of autism have risen dramatically over the past few decades, from an estimated one in 2500 children thirty years ago to one in 150 today." is one of the first lines of the article. If you are so smart, and only you are so smart, what environmental factor has increased that rapidly?

[sascha_sl]

Maybe because it's easier to get a diagnosis now and parents are more inclined to get their children checked? The medical system is not unchanging over the years.

This is the same kind of thoughtful question as "why are there so many more left-handed/gay/trans people than x years ago" - because social factors have changed visibility of these traits, not because they didn't exist.

[danparsonson]

We're much better at diagnosing it than we used to be.

[amatecha]

Agreed. I have a friend who has been autistic their entire life, but was only acknowledged/diagnosed in the past little while, in their 30's. Back when they were a little kid, it was interpreted as just being a challenging/picky/quirky child, nothing "diagnosis-worthy". If the medical system and society better understood autism back then, it would have been noticed and diagnosed back then. I have heard the same approximate story over and over.

[skissane]

That’s disputed; another point of view is that “autism” is a label and we’ve increased the scope of that label to cover a lot of things which in the past were either given different labels or no label at all. There are a number of voices in the academic/professional community questioning the great and growing breadth of the “autism” label and the flimsiness of the scientific justification for its expansion (people such as Laurent Mottron, Lynn Waterhouse, Allen Frances)

[Rury]

This. I think the problem is simply we're over-diagnosing autism. Basically borderline people would've been considered normal in the past, but are now considered autistic. Frankly, the entirety of symptoms involved in diagnosis sounds subject to a person's opinion of what people's behavior should be vs shouldn't be. Since this line is hard for everyone to agree on, we've come up with degrees of autism, like "high functioning" autism such as Asperger's syndrome. I'd argue, it's only when it's obvious (i.e. the person is largely dependent) while having said symptoms, that they're autistic... Just because someone behave's abnormally socially, has peculiar interests, and/or has delayed abilities (unless extreme), isn't sufficient IMO. Additionally, two different doctors may end up giving different diagnoses.

[sascha_sl]

Autism (and ASD) should really not be seen as this essentialist "yes or no".

There are degrees to which people, considered autistic or not by your favorite arbitrary standard, exhibit autistic traits. And those traits are not strictly inherently better or worse than neurotypical traits.

The standard for consideration as disorder should be the same as with most psychiatric disorders: Not mere presence, but causing issues that need support.

But at the same time, the people that are doing fine with autistic traits are no less autistic.

(Also, Asperger's has ceased existing a while ago)

[skissane]

> But at the same time, the people that are doing fine with autistic traits are no less autistic.

I’d question that statement. People with BAP (broad autism phenotype) have autistic traits and are doing fine with them, but by definition are “less autistic” than people with ASD. A lot of people with other psychiatric disorders such as schizophrenia, can have significant autistic traits as symptoms of that other disorder (the symptomatic overlap between ASD and schizophrenia is much larger than many people appreciate, although it is believed that the similar symptoms nonetheless are caused by rather different processes) and obviously are not “doing fine”, but nonetheless are in a very real sense “less autistic” than a person with an actual ASD diagnosis

> (Also, Asperger's has ceased existing a while ago)

That’s not really true; the DSM-IV still exists, and professionals are still free to use it if they wish. Our son’s psychiatrist told me that he still sometimes gives children DSM-IV Asperger’s diagnoses if the parents feel particularly uncomfortable with the label of “autism” inherent in DSM-5 ASD.

[aidenn0]

If you have ASD, but learn coping skills are you not "less autistic?"

[seba_dos1]

> Just because someone behave's abnormally socially, has peculiar interests, and/or has delayed abilities (unless extreme), isn't sufficient IMO.

Then it's a good thing that this is absolutely not sufficient to declare someone autistic (even "high functioning", although this kind of categorization is frowned upon these days) even now. Those are just some of possible externally visible symptoms.

[bayesianbot]

I and many other autistic people would strongly disagree. Neurotypical vs ASD isn't some gradient like you seem to think, it's much bigger, clearer wall between us.

I am one of those that you wouldn't diagnose autistic, but in reality me and my thoughts are much much much closer to the ones you would than neurotypicals. I wasn't diagnosed as a kid, partly because autism wasn't diagnosed at least in my country when I was born, partly because even though it was obvious to everyone how different I was my parents tried to pretend I'm just a normal kid. And partly because with time I honed my high quality human emulator to the perfection so at some point I could play that almost-"normal" kid part that they and society wanted from me.

Doesn't mean I didn't constantly feel there's been a mistake, I've been born on wrong planet, in middle of different species that doesn't understand me and which I don't understand. Absolutely nothing about the world made sense, life was hard and strange even if I was extremely good at pretending it isn't. It all changed when I found out and found others like me. Nowadays I'd be diagnosed at two years old, and my life would have been so much easier. I wouldn't have the need to pretend (or mask as we call it) as much, which is a HUGE constant stress. I could understand the world and myself much better, and adjust my life knowing better why and how I'm different. I feel like I could have grown up to be much less of a broken person. There are millions and millions like me, many of whom still don't know and are thinking what is going on in this world. They should be diagnosed as early as possible so they could start enjoying life like I have in much healthier way after finding out.

It's not really surprising that it was - and is - underdiagnosed and we're now finding more cases, as not that long time ago we didn't really diagnose it at all, and after that we only diagnosed the minority of cases who couldn't come up with an acceptable human emulator.

And because the mental image we have of autism is so wrong. I spent decades trying to find people like me, disorders that would explain the things. I gave up, thinking I'm unique. But my mental image was wrong also, so I didn't really give it enough thought - autism was a list of symptoms on wikipedia page and Rainman - that's not me, it's just that my brain and thinking is completely different and nobody understands, I can't even tell anyone because it's impossible to explain. It wasn't until I randomly read an article written by autistic person, and like 1/4 way through it I knew I found my kind - before that nobody understood, and that article could have been word to word written by me, except he knew the reasons behind it.

[skissane]

> I've been born on wrong planet, in middle of different species that doesn't understand me and which I don't understand. Absolutely nothing about the world made sense, life was hard and strange even if I was extremely good at pretending it isn't.

Is it only "autistic" people who feel that way? Could it be, that there are people out there who don't meet the diagnostic criteria for "autism"/"ASD"/etc – either some other psychiatric diagnosis fits them better, or none at all – yet they feel much the same way? (What about people on the schizophrenia spectrum, especially those at the "milder" end of it, such as those with schizoid or schizotypal personality disorders–have you ever thought that maybe some of them feel this way too? But most of them would not be "autistic", in that ASD would be the wrong diagnosis for them.) Conversely, isn't it possible that there are people actually diagnosed with autism/Aspergers/ASD/etc who don't feel that way? If "feeling that way" and "autism" can exist independently of each other, maybe there is no necessary connection between the two?

If one feels like one was "born on wrong planet", is that because there is something fundamentally different about you? Or maybe you were raised in an unsupportive environment – there are lots of ways environments could be more supportive without having to structure that support around a diagnostic label – and if you grew up in a more supportive environment you would have felt less like that? Maybe, if the events of your life had taken a somewhat different turn, you might have grown up in a more supportive environment purely perchance, even if nobody had been consciously trying to be more supportive.

Also, isn't it possible that those kinds of thoughts of estrangement and alienation ("born on the wrong planet") can be an idea which enters into one's mind – generally a mind which has some genuine things to feel upset about, and whose upset is not being properly recognised or acknowledged by others; yet still maybe those things are nonetheless insufficient to logically entail that particular statement – but then the idea takes hold, and it grows, and puts down roots, and becomes a lens through which future experiences are interpreted, constantly finding more confirmation for itself – maybe, even at times, turning into a self-fulfilling prophecy? In which case – maybe the real problem is that very thought, and a possible solution is to challenge and question and doubt it, rather than seeking out a community who will affirm and encourage it?

> It all changed when I found out and found others like me.

I have a lot of autistic traits – I strongly suspect that if I wanted the diagnosis, there are professionals out there who would give it to me. I've never thought I was "born on the wrong planet" though – to me that just seems such a bizarre thought. My response to our son's ASD diagnosis was basically "What do you mean X and Y and Z are 'symptoms of autism'? I did stuff like that all the time as a child, I even still do as an adult". I definitely don't want our son growing up believing he was "born on the wrong planet". He's really no more "autistic" than his father is – and his little sister has lots of "autistic traits" too, and I can even see many in his mother (although she really doesn't like it when I say that.) Rather than saying our children have "autism", I think it is more appropriate to say that they are the children of their parents, whose problems are largely continuous with (and inherited from) those of both their parents, and their behaviour is fundamentally normal and even typical for children who have the kind of parents which they have. And they were born on the only planet on which they could ever have been born–this is their planet, they belong here, they may sometimes struggle with fitting in with the crowd but so do heaps of other people (their parents included)–and I hate to think some people might try to plant in their minds the idea that they don't belong on this planet, and if anyone tries I hope they might listen to me and reject it.

Despite my own autistic traits, I don't really like the "autistic community" – it seems to me to be filled with people who put immense faith (at times even verging on religious) in a diagnostic construct which is rather dubious from a scientific viewpoint–but they seem to (by and large) not know that, and even to not want to know that. Many of them express a great deal of resistance presented with the idea that this diagnostic construct on which they've chosen to build their personal identity might be bad science or even a harmful cultural construct – I am left with the impression that many of them don't even want to hear the arguments against it, they already know the arguments must false before they've even heard them–much as many religious people don't even need to hear the arguments against their religion's doctrines in order to know their fallaciousness.

[sascha_sl]

>Many of them express a great deal of resistance presented with the idea that this diagnostic construct on which they've chosen to build their personal identity might be bad science or even a harmful cultural construct – I am left with the impression that many of them don't even want to hear the arguments against it, they already know the arguments must false before they've even heard them–much as many religious people don't even need to hear the arguments against their religion's doctrines in order to know their fallaciousness.

I think you're misreading the situation. I don't know anyone who is particularly happy about how inconsistent the experience of trying to get diagnosed with autism (particularly in adulthood) is.

The strict defensiveness is simply a result of the existence of exterminationist parties. Many autistic people are happy with the way they are, and just want some support to exist in a society that expects differently from them. But the likes of Autism Speaks keep framing autism as a severe disorder, mostly defined through the suffering of parents, that we need to "cure". Even if many people do not want to be cured.

I'm not diagnosed with ASD, despite having a bunch of autistic traits and being in two groups that are seeing much higher rates of ASD (ADHD, trans), but I know the exact same problem with trans people. For how small of a population trans people are, the evidence for affirmation being the best way forward is overwhelming, and yet there are constant attacks on trans healthcare that stem more from an extension of anti-gay republican partisanship, the more fascist (in the "every enemy needs to be the worst threat to civilization possible" way) part of has started to call us "groomers" now.

Of course we'll have a hard time differentiating between good faith criticism and and the constant barrage of exterminationist thought veiled in "just asking questions".

This is also the big reason a lot of autism and trans advocates heavily oppose researching autism and transness within genetics. Because it looks like a precursor to elimination.

[bayesianbot]

You seem to put a lot on weight on me feeling born on a wrong planet, but it's only a thing I thought because of all the massive differences I noticed compared to all of the other people I ever met, all the way from the way I think to small traits I have. As I didn't think it's very likely that I should be that way and nobody else on this planet is, so it felt like something had gone really wrong. Had I been diagnosed as a kid like your son I obviously would not have felt that way, I'd know the real reason for it and that I'm not the only one. The place where I was born did probably affect it, if not in other ways maybe at least I would have met other open autistic people earlier, but in my town mentally different people were a shame to the family to be hidden and not talked about, and good masking wasn't really optional if you wanted to try to be a part of the community.

I don't see those differences compared to other autistic people. I always thought what kind of people they'd be if I were to find others like me, and in the end the similarities surprised me, I always thought we'd still have bigger differences but now I see so much more common between us than I ever expected. And like seba_dos1 said, overwhelm me too much (which there are multiple ways to do, all similar to other autists I've met) and I get to similar state as non-verbals - extreme trouble processing speech as well as speaking, robotic movement, feels like my brain just doesn't work.

[sascha_sl]

I don't see how both can't be true.

The diagnosis itself has changed a lot (retiring Aspergers, changing it to "ASD") to account for this though, and I'd generally say that having more awareness of how people deviate from neurotpicallity is a good thing.

If you see it purely as a disorder (and thus a bad thing) maybe you have an interest in continued underdiagnosis, but many people now see autism as different, but not strictly worse or better.

[skissane]

> I don't see how both can't be true.

Laurent Mottron believes that the original narrow view of autism had some genuine scientific value, but DSM-5 ASD has broadened the concept to the point that it has become scientifically meaningless. He presents the idea of a “spectrum” as essentially taking a wrong turn, and he argues the only way to get autism research back on track is to move away from the idea of a “spectrum” and return to a focus on “prototypical” autism

Lynn Waterhouse goes further - she believes that even the original narrower concept of “autism” is a failed scientific hypothesis, and the best way forward is to drop the concept of “autism” entirely (and related concepts such as ASD, Asperger’s and PDD-NOS), and look for alternative constructs to replace it with (her tentative proposal is “phenotypes of neurodevelopmental social impairment”)

Allen Frances has said that (in hindsight) he made a big mistake by agreeing to put Asperger’s in the DSM-IV. He says it was sold to him as a very rare disorder and he was shocked to see how frequently it came to be diagnosed. And he’s said that DSM-5 ASD is “even worse” than DSM-IV Asperger’s. (Like Mottron, unlike Waterhouse, he has no objection to DSM-III/IV autistic disorder; Mottron is less negative on DSM-IV Asperger’s than Frances, but I suspect there is actually less distance between them in practice on that issue than a cursory reading of their public statements might suggest.)

While they don’t agree with each other in all the details, what they all have in common, is a critical attitude towards contemporary mainstream diagnostic practices - maybe I’m misunderstanding you, but your response sounded to me like an attempt to harmonise those criticisms away

> I'd generally say that having more awareness of how people deviate from neurotpicallity is a good thing.

I think “neurotypicality” is a myth. Nobody is “neurotypical”. As the English child psychiatrist Sami Timimi says, “we are all, all humanity, neurodiverse”.

[verilux68]

Interview with Sami Timimi where he touches on similar ideas concerning the validity of autism as a clinical diagnosis:

https://www.psychologytoday.com/us/blog/rethinking-mental-he...

An interesting quote he ends with:

It pains me as a psychiatrist to say this, but as things stand I would recommend that you avoid seeing a psychiatrist. I know may great psychiatrists, but without personal recommendation, given the nature of current dominant models, you are putting your loved one in danger of being prescribed medications that may lead to some short term gain at the expense of long term enslavement to a 'chronic' disease model, addiction to difficult to come off meds and lack of empowerment to take control of finding a path for their own recovery.

[aidenn0]

Besides the obvious differences in diagnosis that others point out (my parents specifically had me screened, and both neuropsychologists said no, while every therapist I've seen as an adult says yes), there's some reasonably compelling evidence that assortive mating has a role, and don't less compelling evidence that parents being older at time of conception may play a role.

[jat850]

Why not diagnosis over environment?

[danamit]

While it can be argued for other things like ADHD, I doubt it can be argued for cases of severe autism.

[cyphar]

1. The quote says "diagnoses of autism" not "diagnoses of severe autism" so if the definition of autism has expanded over time due to improvements in our understanding of autism (which it has) the diagnosis argument is far more effective.

2. It is easier for children of poorer people to get an autism diagnosis now than it was 50 years ago, so even severe cases might not have shown up in the stats if the child was born to a poor family.

[danamit]

I meant it could explain some of it, but not the full 16x times.

I am talking under the presumption that researchers today are aware are correcting for that fact that there is some selection bias (if that's what I can called) in stats.