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I think the word autism has become such a loaded term that it has become undesirable. The removal of the distinction between 'autistic person with significant access needs' and 'autistic person with low access needs' (formerly aspies) has been problematic, in that it took a term historically (and incorrectly) associated with Rain Man and conflated with someone who's socially awkward, might struggle with emotional regulation, be hypersensitive, may have difficulty with motor skills, have nervous ticks and habits, shutdown in overwhelming situations, burnout from normal tasks, etc. but otherwise can function in a day job, pay the bills, do the laundry, cook, eat, and bathe themselves, if only with more struggle.

I've heard this plaint a lot lately, that there needs to be different language to talk about this common neurological phenomenon. I heard that there was a push to write the DSM VI in terms of its biological mechanisms. It sounds like an almost insuperable challenge, and might explain why an updated revision of DSM V was released after a decade, instead of a new manual.

[skissane]

> I heard that there was a push to write the DSM VI in terms of its biological mechanisms

There are two basic problems with that proposal (1) we still largely don't know what those biological mechanisms actually are, especially not with the degree of confidence necessary for them to be used for individual diagnosis (2) there is massive social/cultural/political/institutional/professional/financial investment in some of the current labels (especially autism/ASD), even though they correspond poorly to what is really going on in the brain, and any attempt to replace them with a more accurate system of labelling or diagnosis produces major pushback from people who are threatened by loss of those investments

I think to gain a better understanding of "what's really going on", good places to start are https://www.nature.com/articles/s41398-019-0631-2 and https://link.springer.com/article/10.1007/s40489-016-0085-x and also https://stresstherapysolutions.com/uploads/wp-uploads/RA.pdf

One proposal (in the second paper I linked) is to merge ASD, ADHD, intellectual disability, borderline personality disorder, oppositional defiance disorder, language impairments, learning disabilities, tic disorders, atypical epilepsy, and reactive attachment disorder into a single disorder (an undifferentiated "neurodevelopmental disorder" or what Christopher Gillberg calls "ESSENCE"). ASD is already a kitchen sink, but still small enough that people can pretend it isn't; let's make a kitchen sink so big that nobody can deny it is one. Including BPD and reactive attachment disorder also helps clarify the complexity of causation, that many children's problems are produced by complex interactions between biological factors (genetics, in utero exposures, etc) and social environmental factors (trauma, abuse, neglect, maltreatment, parental mental illness, etc)–whereas labels like "ASD" wrongly put all the emphasis on the former to the exclusion of the latter

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Regarding the two basic problems: I imagine the people involved are aware of the enormity of the challenge, and don't seem to be concerned about Big Psychiatry (nor does new hard-science based diagnosis and treatment threaten profits of that industry). But really I don't know. It was just an off-hand comment from Robert Sapolsky's Human Behavioral Biology lecture series on YouTube, they might not be attempting this at all.

> whereas labels like "ASD" wrongly put all the emphasis on the former to the exclusion of the latter

Early intervention autism treatment has limited success. If you've got dyspraxia, inattention/hyperattention, fidget, avoid eye contact, have meltdowns, speech/processing delay, etc. you're fighting something at the neurological level that can at best be attenuated over time by plasticity, or simply just managed, like epilepsy.

[skissane]

> you're fighting something at the neurological level that can at best be attenuated over time by plasticity, or simply just managed, like epilepsy.

Nowadays, the label "ASD" is applied both to children whose issues become apparent in early childhood, and also to children who don't develop serious issues until later in childhood, even adolescence. A two year old with severe issues, it is much more likely to be predominantly biological in origin. But a ten year old with milder issues, it becomes much harder to say to what extent it is biological compared to what extent it is due to how they've been raised.

Consider families where one of the parents (sometimes even both) has a personality disorder such as BPD or NPD – that can produce difficulties with the parent displaying consistent emotional responsiveness to the child, which can harm the child's emotional development, resulting in attachment disorders, emotional and behavioural disturbances, etc. Ideally, the parent is aware of this and can get professional help in preventing this from happening; however, many such people are in complete denial about their condition, and will refuse to seek help. There is a lot of symptomatic overlap between children with attachment disorders and ASD. Commonly, there is lots of funding and resources available for the ASD label, little or none for any others. If the parents aren't open about what is really going on, few professionals want to go digging. So they'll diagnose the child with ASD. If anyones suggests parental issues may be a contributor, many will trot out the tired talking point of "Bruno Bettelheim's discredited refrigerator mother theory".

Added to this, it isn't like "autistic traits due to bad parenting" and "autistic traits due to biological factors" are mutually exclusive categories. It is entirely possible the child already has a baseline genetic disposition to autistic traits, which are then being amplified by the poor family environment. There is a lot of overlap between personality disorders (especially BPD) and ASD, and some even question the validity of the ASD-BPD boundary – even if they are indeed distinct conditions, they likely have some shared genetic loading.

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> Commonly, there is lots of funding and resources available for the ASD label, little or none for any others. If the parents aren't open about what is really going on, few professionals want to go digging. So they'll diagnose the child with ASD.

I agree that there's probably a lot of mis-diagnosis, but that's hard to quantify as an outsider to the profession of psychology. I think this is separate to autism being a nurture over nature thing.

> Added to this, it isn't like "autistic traits due to bad parenting" and "autistic traits due to biological factors" are mutually exclusive categories. It is entirely possible the child already has a baseline genetic disposition to autistic traits, which are then being amplified by the poor family environment.

I agree that genetic, pre-natal, and very early childhood environments have a huge impact on behaviour. My opinion relies heavily on an assumption that there's genetic and pre-natal neurological/gene expression differences for autistic people, and that is probably the source of our disagreement (i.e., nurture vs nature).

[skissane]

> I agree that genetic, pre-natal, and very early childhood environments have a huge impact on behaviour.

I agree, but I don't know why we should have "very early" there. Late childhood and adolescent environments can also have an enormous impact on behaviour.

> My opinion relies heavily on an assumption that there's genetic and pre-natal neurological/gene expression differences for autistic people, and that is probably the source of our disagreement (i.e., nurture vs nature).

There's genetic and pre-natal neurological/gene expression differences for lots of people–yes, including "autistic" people, but also including people with "non-autistic" disorders (such as ADHD, OCD, personality disorders, schizophrenia spectrum, bipolar). I'm unconvinced there is any fundamental difference between "autism" and "non-autistic neurodiversity"–"autism" is a heterogenous collection of many distinct differences, and some individuals with "autism" likely have more in common with certain cases of "non-autistic neurodiversity" than they do with most other cases of "autism". The same difference in gene expression or neuroanatomy can produce radically different behavioural results in different social environments