Autism's confusing cousins

It’s never occurred to me that someone could become more or less autistic…could you say more about what that has been like for you?

> Some autistic children still receive involuntary-to-them ECT.

Adults too; ask me how I know.

I don't think there's much underlying relationship. True they will both impact social relationships. But it's more like how being blind or being deaf will impact social relationships. The mechanics might be the same but the cause is very different.

IMHO schizophrenia is a breakdown in the barrier between imagination and processing of reality.

Autism and the like is an inability to process social cues like a blind person might have a damaged visual cortex.

If the mind is a kind of "prediction machine", wouldn't that make ALL psychiactric disorders a specific variation of faulty prediction mode though?

Yeah, the "mirror image" idea makes a lot of sense to me. Both groups feel out of sync socially, but for opposite reasons: autistic cognition leans too hard on raw sensory input, schizotypal cognition leans too hard on internal interpretations

Wouldn't the implication of them being "opposite" be that in some sense they are mutually exclusive? I don't really see evidence of that. Your example of sensory input vs world model weight is a bit flawed, because both of those are extremely multifaceted. One can have extreme weight in sensory input in one sense but not others, as well as extreme weight on world model for certain aspects of life.

> BTW, there's research that shows that schizotypy (schizotypal/schizophrenia) is sort of the opposite of autism.

And I disagree with that. There is a wide overlap of symptoms in all mood disorders. People with ASD show many traits of the negative symptoms of schizophrenia. This paper might change your mind:

https://pmc.ncbi.nlm.nih.gov/articles/PMC8931527/

I think I understand what you mean.

You're saying that relative to the 'typical individual', autistic brains weigh sensory inputs more heavily than their internal model. And that in schizotypal brains, relative to the 'typical individual', the internal model is weighed more heavily than the sensory input, right?

I don't know much about this area, so I can't comment on the correctness. However, I think we should be cautious in saying 'over-weigh' and 'under-weigh' because I really do think that there may be a real normative undertone when we say 'over-weigh'. I think it needlessly elevates what the typical individual experiences into what we should consider to be the norm and, by implicit extension, the 'correct way' of doing cognition.

I don't say this to try to undermine the challenges by people with autism or schizotypy. However, I think it's also fair to say that if we consider what the 'typical' person really is and how the 'typical' person really acts, they frequently do a lot of illogical and --- simply-put --- 'crazy' things.

> The day-to-day impact of being diagnosed is practically non-existant for me.

Yeah, as the old adage goes: with an ADH?D diagnosis you get to try drugs like lisdex or methylphenidate (or the non-stim options if those aren't suitable), but with an Autism/ASD diagnosis you get some pamphlets, coffee morning invites and a reading list.

I don't have a formal diagnosis but my child does and that made me read lots on the subject. Authors like Eliza Fricker, Ellie Middleton, Pete Wharmby amongst others.

It's opened my eyes to many other related aspects, specifically Rejection Sensitivity Dysphoria (RSD) and Pathalogical Demand Avoidance (PDA) and how those play into both ADH?D and ASD. In reading about them I've worked out just how much they apply to my-undiagnosed-self and how understanding the triggers and recognising the early behaviour has allowed me to adapt to minimise their impact.

Yeah, that's basically the best-case scenario: the diagnosis doesn't change who you are, but it gives you a map of the terrain

If you happen to have built a functioning support nets already, being diagnosed is at best a curiosity. If you didn't, or your existing ones have crumbled, it gives you tools to do that.

Being able to laugh about it, and know what is going on however is huge. Especially compared to being shit on all the time by others and self blaming (a common pattern!).

For my sister, getting diagnosed was important to her because she always felt like she was broken but now sees herself as simply different. I'm not aware of any workplace accommodations she has requested but it has been good for her self-esteem, which is a benefit in of itself.

Autism diagnosis has targeted screening questionnaires. So what kind of general purpose screening do you mean?

I never understood why people, especially americans, are so hyperfocused on "mental health" and wear their pseudoscientific bullshit diagnoses like medals. I agree that there is a small fraction of people that do have mental issues, but it is very likely that most of the people that encourage "therapy" and yap about "mental health" very likely don't have any meaningful issues worth diagnosing and are just unnecessary burden on the medical system. The term "autism" in itself is so overused nowadays that it doesn't mean absolutely anything anymore, the fact that it doesn't have precise, rigorous definition doesn't help either.

extremely high comorbidity rates

It feels like that whatever you seek to get diagnosed with you can get it.

You had to catch them all ;)

It's worth noting the UK already commissioned a review that was published this year, that showed ADHD is in fact under-recognised here[0]. I can only assume they're commissioning a new one because that one gave the "wrong" answer.

For a long time ADHD was ignored or dismissed in the UK as an "americanitis", so it's no surprise that there's a backlog of people who weren't diagnosed in childhood.

[0] https://www.england.nhs.uk/long-read/report-of-the-independe...

As a diagnosed autistic, I think I would ask -- does ticking these boxes make you feel like, "oh shit, this could explain some difficulties..." or just go, "huh, interesting?"

I tend to invite people to think about how their lives have been impacted. For example, I experience anxiety at late invites to events I'd enjoy. I panic and decline them because I'm experiencing a highly irrational anger fear response to changing schedules. This causes me to miss events I would otherwise enjoy, and then I feel guilty. Having to process all those feelings takes a lot of energy, and it's really draining. That has significant impact on my life.

Compare to a friend of mine who just prefers quiet evenings. She declines things all the time but never gives it a second thought.

Disability vs preference. It's ok if it's either! Neither of us are wrong, we just experience different impacts in our lives.

You could add "I'm a HN regular" as a diagnostic criterium.

The HN crowd is surely over-represented in ASD, which makes sense for people enjoying debating nerdy topics and pedantry.

And "I like Lisp" should be an automatic qualifier.

I used to be an educator, and many of my students had an autism diagnosis. I would get to know them and often eventually decide that they were "just like" me, except that whatever their problems were, I had it worse.

So then I would look at these autism checklists and say, "yep, that's me," but when I actually looked at the strict diagnostic criteria, it wasn't that clear.

Looking at this article, I get it. There are other, more focused criteria that can be more appropriate. But those diagnoses don't trigger the special services, so they don't get used often enough.

What is my takeaway? People often don't conform to a model of average human behavior. Being unusual isn't necessarily a grave character flaw (which is what my mother had me believe) but merely an expression of the great variety of human intellect and behavior. It gives me license, without official diagnosis, to enjoy being who I am without shame or embarrassment.

They are useful if they are understood properly. For example different "similar" groups respond to different treatments differently. Social phobia responds very well to exposure therapy, anti-social personality disorder does not. If you are able to follow the distinctions you are able to leverage more effective treatments. I don't think they have any use outside of psychological treatment though. This is a great video on a good way of breaking down how personality disorders in general are broken down and function and are separated. https://youtu.be/4mgifm3ftl8

This is the wrong framing: We all have degrees of “diagnosable” traits, it’s only when those traits become problematic do we need to seek help. For example, obsessive tendencies can help you stick with a tough problem or they can become an unhealthy fixation.

Also, if someone is mean they are mean: Diagnosis is not a “get out of jail free” card for bad behavior.

This is kinda how I've come to view psychology because in the context I was raised mental health support was a luxury left for the wealthy. Albeit more about personality, upbringing and status rather than just individual idiosyncracies.

I understand that this may be a categorical error, since psychology can be the categorization of symptoms, but a lot of the things I learned "from the outside" really still stick.

Like the wealthier populations getting neat little explanations/excuses whenever convenient. Theres the scholastic benefit of ADHD diagnosis and anxiety diagnosis, which can help a lot in school/academia and to everyone else who cant afford it they get the cheaper label: "being bad at school" or "dumb". And still requires even more effort.

Theres the trauma and therapy cycles for otherwise normal behaviors like separation anxiety from parents, not being popular or highly esteemed, stress from not attaining goals, etc. The cheaper treatment being to suck it up.

What is normal for the poor to carry is a diagnoses and special treatment for those who can afford it.

And this is also reflected within the office as well! The outcome can be better if the professionals empathize with the one seeking treatment (theres a whole class/racial component here).

I agree with your sentiment and I think it's really all down to wealth and/or availability.

Regarding your last sentence, typically when the individual seeks it. It's generally considered both rude and ineffective to diagnose others who are not seeking diagnosis.