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Comment by XCSme | Hacker News Reader

But different autistic people struggle with different things, in different ways.

What's even the point of having a general diagnosis umbrella, if the symptoms are different?

I'm reminded of an anecdote I heard once from a psych(ologist/iatrist?) that goes something like: if you think you hear voices in your head, but the voices tell you to go to bed on time and drink plenty of water, you don't need a diagnosis/treatment.

The point is that a lot of things, when it comes to humans and their brains, is judged first based as to whether or not it negatively affects your life. Think of how we define addiction.

Ha, that's a great analogy, I like it.

Even more, what is considered "positive impact" changes over time, so what was "crazy" 50 years ago, might be normal or even recommend now.

General doesn’t mean it applies to literally everyone. If autism turns out to be a specific condition that is e.g. the result of abnormal neuron pruning during early development, it could have a wide array of symptoms, but that understanding may someday lead to genetic treatments for sever cases, better early childhood interventions, etc.

I do think that the current ASD umbrella as written in the DSM is so broad as to seem nearly meaningless when take in isolation. It’s not meant to be in isolation however, it’s defined first and foremost as a disorder, so the symptoms need to cross some threshold of tolerable. It’s also associated with a growing body of research as to how nervous system development can cause related clusters of symptoms.

Is autism as we understand it scientifically accurate? Probably about as much as anything hovering in the intersection of social sciences and medicine. It does have some predictive power. If you meet the diagnostic criteria for autism you are likely to have certain comorbidities for example. Having certain autistic traits are good predictors of certain outcomes later in life. And we do have better therapies especially for young people than we have in the past.

The fact that people can have non-overlapping clusters of traits and still be autistic does seem problematic. It may not be the right model. Just my $.02, I’m not the autism researcher in this convo, but I am autistic :)

> But different autistic people struggle with different things, in different ways.

Different asthmatic people struggle with different things, in different ways too, but it's useful to have a general diagnosis umbrella to cover those who have asthma even though symptoms and effective treatments may vary.

Work is ongoing to get better defined categories for autistic people, but for now at least we've got a category for people that match a broad set of traits/symptoms/challenges to work from.

The problem is that the set of problems is very broadly defined, changes over time, varies from person to person, it's often impossible to obiectively test.

Can't it be that a neurotypical person is bothered by some autistic triggers? Would that make them neurodivergent? How many of those triggers do you need to have to be under that umbrella? 1? 5? 20?

It is indeed called a spectrum, and I think it gets so fuzzy at the edges that the only way to define where it starts or ends is purely arbitrarly chosen.

It's a bimodal distribution. There are people with few of these traits lightly, and people with many or with a few severe ones. Not so many in between. This already makes it an interesting line to draw.

That's interesting. Are there studies on this? I.e. 1000 participants, "count" the symptoms and make a graph of autistic symptomps/person.

No so different things, and not so different ways. The "if you met one, you met one" is overplayed. Yeah, they have different interests and might have different comorbidities, doesn't mean they don't just have different core issues that are merely expressed differently (e.g. hates jeans vs hates wool sweaters or hates noises, but underlying both is sensory sensitivity).

The fact that they don't is why diagnostic tests exist and work.

That's a good example: they hate certain things, and are ok with others.

Depending on what you "hate" your life and disability can vastly drastically. Be it eye contact, clothing, certain foods, or the inability to change your routine or environment at all, or to even leave the house alone.

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