I remember a time when autistic meant that a person was unable to interact with others outside of a tightly controlled and consistent environment. Now autistic is being used to label people that just need to 'veg out' at the end of the day.
This is what science does -- we continuously challenge what we know and change our definitions when we learn. The people who are experiencing diagnosis with autism and ADHD today will seem totally different than the diagnoses 50 years from now.
You cannot hold on to one, old definition for something like autism (or any other non-neurotypical behavior) and expect it to remain the definition, unchanging.
If I'm autistic I absolutely will.
(This is not meant with sarcasm, only a slight nod at programming language version numbers)
How SPECIFICALLY are these additional people getting diagnosed? Is there special training diagnosticians get to unveil the secret masked signs of autism? What are these scientific advances I've heard vaguely cited for the rise in autism diagnosis over the years? Why is it even possible for a diagnostic criteria that hasn't changed to result in dramatically different diagnostic rates over time, doesn't that prove the diagnostic process is fundamentally unreliable and thus fundamentally scientifically invalid?
The fundamental cause of the rise of Autism is that both schools and parents both financially benefit from a child being labelled as "Autistic" and because the diagnostic criteria is so vague to begin with you can interpret it as it suits you. The driver isn't "science", there aren't scientists and doctors marching into schools outraged at improper diagnostic practices and making changes happen. It's driven by parents and schools looking for money, money is the dynamo driving this, autistics are rainmakers. Then schools will often restrict some of their resources to those with special needs or whatever, which only drives up the need for other parents to play the same game. I've seen how the sausage is made too, with parents and teachers and doctors outright committing fraud to ensure a child looked appropriately disabled on paper, downplaying their ability as much as possible, which further jades me regarding how "scientific" this all is. I've also seen no analysis on if this practice actually helps kids, which you really think there should be because all these kids we labelled as disordered all reported being suicidal later in life.
> If somebody has coping strategies that effectively mask their autism (in the early childhood/developmental stage specifically), they DO NOT HAVE autism
The DSM V diagnoses autism much more broadly -- https://www.cdc.gov/ncbddd/autism/hcp-dsm.html -- and it's very plausible that a child might not be identified. (For example, my parents were drunkards, I was not assessed as a child.) A child might also learn that they are punished for some behaviors such as stimming, and learn not to do it publicly, but still engage in that behavior privately.
Autism diagnoses only require that person needs 'support', and explicitly calls out that symptoms may be masked by coping strategies.
> How SPECIFICALLY are these additional people getting diagnosed?
Psychologists and psychiatrists usually start with a series of screening questions, followed by several in person discussions sessions where they probe into both your own self perceptions and the perceptions of others.
There is a 2018 paper that specifically identifies camoflauging traits and a screener that can be used to help identify adults (and others) who have built systems to survive in the world. It's called the CAT-Q. See the paper: https://link.springer.com/article/10.1007/s10803-018-3792-6
> Is there special training diagnosticians get to unveil the secret masked signs of autism?
Yes. Typically a psych degree (doctorate) with an emphasis on ASD, but sometimes masters level mental health professionals working in concert with an MD.
> What are these scientific advances I've heard vaguely cited for the rise in autism diagnosis over the years?
Well, see the 2018 paper I linked above. If it would be helpful, there are many other papers from 2000 onward that specifically address everything from repetitive behaviors to social isolation to meltdowns, etc. Mostly, we've improved our screening processes, which means we've got better, more accurate criteria.
> Why is it even possible for a diagnostic criteria that hasn't changed to result in dramatically different diagnostic rates over time, doesn't that prove the diagnostic process is fundamentally unreliable and thus fundamentally scientifically invalid?
The DSM criteria have changed between DSM 4 and DSM 5, in 2013. The DSM used to separate Autism and Aspergers as categorically different, but they've removed the Asperger's category and adjusted the criteria for a diagnosis.
It's also important to remember that science is never stable. The point of science is to revise over time our criteria. The point is to evaluate what new information we have.
And observed rates have risen, from about 1% to about 2% over the past decade, which you've correctly identified, but you would expect that because screenings have improved, diagnosticians have evolved, and we've put more emphasis on testing people.
That's not a huge number of people, and it's fairly reasonable to assume that as we've developed the science, we're catching people who previously would have been missed by less accurate tests.
It could also be that whatever causes autism is also happening more. There's a whole lot of factors, but no, that doesn't mean the science is bad it just means we haven't answered all the questions we have yet.
> The fundamental cause of the rise of Autism is that both schools and parents both financially benefit from a child being labelled as "Autistic"
That's a pretty conspiratorial claim for an increase in diagnoses that can adequately be explained by "we're better at testing for it now."
> It's driven by parents and schools looking for money, money is the dynamo driving this, autistics are rainmakers.
This is likewise a conspiratorial claim. Can you provide evidence of this? Because "I've seen it" is at best anecdotal, and runs counter to the prevailing idea that being labelled as autistic by the medical community can deny you agency in academic, medical, and social contexts.
Although it is still real. The people who present completely normal are still autistic, because behind the scenes they have some unusual way of thinking or strong obsession or strong reaction to the mild stimuli, they just don't show it.
Hard agree with this. As someone who was diagnosed with Asperger's back when that was still a thing, it was a lot easier for me to say "I have mild Asperger's" on the rare occasion that I felt a need to explain than it is to quantify where I am on the huge swath of area now occupied by the term "autistic".
[Caveat: I'm super uninterested in hearing about big pharma conspiracies or whatever, please don't send me this.]
Well, except for the severely disabled who can't advocate for themselves because they can't speak or communicate online, and now find themselves crowded out for the very benefits that were created to support them in the first place. But they're not the ones that vote or sound off on social media, so they're easier to ignore.
edited to add: wait, so if there are accomodations for autism, were there not accomodations for aspergers or other developmental disorder? why not expand the accomodation and not the diagnosis?? The same professionals that determine autism from other disorders should be able to prescribe similar accomodations??
Accommodation is not good for everybody. I've had to get into serious conversations with people with serious disabilities about divvying up responsibilities because we worked the same shift, if they accommodated me they were fucked, if I accommodated them I was fucked, if we complained and tried to get accommodation elsewhere we would both be fucked and we both knew it. Accommodation is often hard as shit and sucks ass, it's grinding work, it's not something that falls from the sky, it's something actual people spend their days working on. Further people aren't unaware that they're accommodating you, that you rely on them, and thus they have power over you, people aren't stupid and they will take advantage when they need to and think they can get away with it, and feel morally justified in doing so.
It's only a SUBSET of accommodation which is good for everybody, and those are the truly special accommodations, those are the cases where we remove systemic barriers. Work from home is the best contemporary example of this which has simply made the employment opportunities for the disabled fucking explode while increasing their quality of life and importantly the disabled aren't usually being perceived as getting any sort of special treatment or favouritism because everybody gets the same benefit (unless you have a work in office mandate). The idealistic and impossible goal of disability rights is not accommodation, it's the total breaking down of systemic barriers to create a utopia where everybody lives equally and independently with no need for accommodation, but we have accommodation because that shit is an impossible ideal.
To summarise though, accommodation is a lesser evil to the alternative which tends to be better for all parties involved, breaking down systemic barriers is the ideal which can actually create true equality. I tend to see curb cuts as falling into the latter category more than the former.
https://disneyparks.disney.go.com/blog/2013/10/guest-assista...
http://babesindisneylandblog.com/my-thoughts-on-the-disabled...
My take on why accommodations were not expanded to different diagnoses is that there is, rightly or wrongly, a perception of lesser severity with a diagnosis of PDD-NOS or Asperger's that would stratify the level of services available. And since people always want more, you'd have ended up with more push into the "autism" category anyway.
It’s not as simple as ‘no intellectual disability’ because there are non-verbal autistic people who have no intellectual disability.
The theory is that it is all the same underlying thing, just with different severity and presentation.
No, there is no underlying thing in the DSM-classification. There are the "same" symptoms.
The most obvious evidence for this is that "pervasive developmental disorder-not otherwise specified (PDD-NOS)" and "childhood disintegrative disorder" both merged into "autism". Autism now means "anything with this symptom basket that is not covered by s more specific diagnosis".
> with different severity and presentation.
This part is true.
DSM classification is not fact, it is a diagnostic tool to assist with treatment. The theory of monotropism is an interesting area of research which potentially explains the underlying mechanism.
If the article is correct, and the behaviors are quite unique to people labeled autistic, it actually supports autism as a diagnosis rather than just a label. Labels with predictive power regarding psychological behavior have some semblance of a diagnosis.
I'm now realizing this could've been a mistake, but it also might just be a crisis of realizing autism has basically nixed my ability to live a life that I enjoy.
What changed everything for me, was finding the right stimulant medication. Turns out it wasn't the socialising, it was the big groups. I can't understand what people are saying, get distracted by background noises, lose my train of thought and then get anxious about how I'm acting (and how the person I'm talking to thinks of it). With medication it's just... normal. I still lose my train of thought or get distracted by background noises, but I'm able to return to the conversation much easier. More importantly, I'm not getting anxious in social environments anymore. Even the understanding that its ADHD related has helped my mental health a lot.
I understand this doesn't quite relate to autism, but if you aren't diagnosed and only suspect it, I'd recommend investigating ADHD (as well as AUT+ADHD, which is its own thing entirely).
For me, my social problems are usually just not caring enough about being interesting to the other person or misreading facial expressions and thinking they're annoyed I'm talking to them.
I started on slow-release Rubifen which is generic methylphenidate, at 20mg/day. This was increased to 20mg/morn+20mg/afternoon, then 40mg/morn+20mg/afternoon. My issue was it would always wear off early and leave me unable to do anything basically from 4pm onwards.
I recently switched over to Concerta, which is still methylphenidate but lasts 12hrs instead of the 6hrs from Rubifen (which was really closer to 4hrs for me). I started on 74mg/day and am now on 92mg/day with the option to go up, but I think this works for me.
My psych did mention I'd be better on dextroamphetamine as methylphenidate doesn't seem strong enough for me, but we only have instant release here and I need the full day/consistent effect.
In regards to social problems, mine are basically identical! That was then causing me to stress over what the other person thought of me, which lead to pretty bad anxiety. With medication this is much easier to handle. I still have trouble if I'm not overly interested, but have a much better time dealing with the situation, especially the anxiety part. Just knowing the cause is (mostly) ADHD helps a lot too.
It's kind of like infection with a coronavirus: could be a mild cold, could be long COVID, depending on the type of coronavirus and the susceptibility of the patient. The spectrum for autism is similarly wide.
It just resulted in the teachers calling them disordered and sending extra staff to smother and socially stunt the students they deemed to have Aspergers, and then stopping this before puberty occurred, resulting in even more wedgies and swirlies. However, we started calling these students disordered, and let everybody know certain students who got bullied weren't victims of school neglect or other students or cultural norms, but of their disordered brains. So woke!
We live in such enlightened times.
So can self diagnosis and over diagnosis.
I see many traits in me that are consistent with various forms of autism but I've always struggled to express them to others in a way that doesn't cause them to say "well can't you just not do that then?".