
People on the autism spectrum live an average of 18 fewer years, study finds - rgbrenner
https://www.washingtonpost.com/news/to-your-health/wp/2016/03/18/people-on-the-autism-spectrum-live-an-average-of-18-years-less-than-everyone-else-study-finds/?hpid=hp_hp-more-top-stories-2_autism-330pm%3Ahomepage%2Fstory
======
CM30
Do accidents play a role here? Everyone's always talking about suicide and the
possibility of that being more common among those on the autistic spectrum,
but...

As someone on said spectrum, I'd say I might be more accident prone than
someone who's normal, and potentially more likely to get into trouble in
general. For example, while I wasn't seriously injuried by any of it, I've
been nearly hit by traffic, fallen off various things, actually been hit by
traffic and done quite a few things which would probably be seen as rather
'stupid' (in an 'endangers your health' sense).

Perhaps it's possible that due to various behavioural factors, those on the
spectrum might be prone to getting into dangerous situations and paying the
price for them more than 'normal' people. Being generally clumsy seems to be a
common trait here.

There's also a potential darker side here, in that being on the spectrum might
make some more likely to end up in a violent confrontation than someone who
isn't. There were quite a few news stories in the past where people with these
traits have been assaulted or even killed because they did something that
somehow annoyed some random scumbag. Maybe people outside of the autistic
spectrum might be more likely to see a situation is trouble and stay out of
it.

Those things plus the risk of suicide could all explain this difference in
mortality.

~~~
notahacker
The original paper (paywall-free link: [http://sci-
hub.io/10.1192/bjp.bp.114.160192](http://sci-hub.io/10.1192/bjp.bp.114.160192)
) itemises the frequencies of causes of death by control population and autism
spectrum disorder population.

It suggests that autistic people are an order of magnitude more likely to
commit suicide. But the figures also suggest that autistic people were more at
risk from _all_ causes of death, including common causes of death amongst the
general populations (approx twice as likely to die of cancer; are autistic
people more at risk of not getting the best available treatments in time or
more prone to [uncontrolled] unhealthy behaviours?)

Some caution is needed in interpreting the figures, which appears to escape
the notice of a Washington Post subeditor who didn't even get the figure in
the headline right (the difference between a sample life expectancy of 70.20
years and 53.87 years is _not_ 18... )

It's worth noting that sometimes autism is likely to have been a _symptom_ of
the causes of death recorded (for example, people diagnosed as being on the
autism spectrum were more than eight times likely to have "congenital
malformation" as a course of death, which is a cause of death which by
definition doesn't have a behavioural component).

Another factor is the survey sample is unavoidably biased because the
individuals were separated into autistic and non-autistic groups based on
whether they had been in contact with clinical psychiatrists over their
autism, something plausibly _much_ more likely if they're suffering from
unrelated health problems; the short average period between diagnosis of
autism and death stands out here.

~~~
gwern
It sounds like the ascertainment bias there will be improved as time passes:

> Weaknesses of the present study include exclusive reliance on the National
> Patient Register for case ascertainment, leading to a selected and perhaps
> severely affected sample by only including individuals with ASD who had been
> in contact with clinical psychiatry services. This selection bias may be
> particularly relevant for individuals diagnosed before the year 2001 (i.e.
> before contact with out-patient psychiatric care services was included in
> the National Patient Register). However, after the year 2001 (88.2% in
> current data) all individuals having received an ASD diagnosis are
> registered in the National Patient Register because of the diagnostic
> assessment per se, i.e. also in cases with no further contact with
> psychiatric services.

Another way around this would be genotyping: use an autism polygenic score to
quantify genetic liability. If the increased mortality is observed even with
elevated polygenic scores which are insufficient to lead to diagnosable
symptoms, that would suggest the cause is greater general genetic risk to
disease rather than sequelae to symptoms.

~~~
tim333
I wonder how the mortality for people diagnosed with ASD compares with the
mortality for people diagnosed with anything by a psychiatrist. It seems
likely that by the time people see psychiatrists they're already on average
less healthy than the general population.

------
xyzzy4
That's interesting to me because I've often wondered if I fall on the autistic
spectrum (very high functioning though), and I've had suicidal ideation in the
past. Nothing I'd ever act on, of course.

I bet the primary cause of autistic people feeling suicidal is a lack of
social awareness and how to act around others. They probably incur large
social costs by not seeing social cues, saying the wrong things, and
opportunity costs like feeling too anxious or inadequate to even be social.

I think what helped me the most is focusing on being more empathetic, using
the golden rule, and thinking from other people's perspectives. It improved my
relationships with people drastically and now I'm generally happier. I usually
feel like my empathy isn't genuine and too intellectual, if that makes sense,
but the change in my focus has helped a ton.

Even if I'm not on the autistic spectrum, trying to be more socially aware and
provide value to others has been very worthwhile.

~~~
SeanDav
Fear of death is arguably either an emotion, or has a high emotional component
and since autistic people do not process emotion well, they may well be far
more inclined to see suicide as an option. (disclaimer: pure layman
speculation)

------
verisimilidude
Public perception and available resources have changed dramatically over the
last 25 years. As recently as the mid-80s, nobody even knew about autism. Not
even doctors. Depending upon where you lived, you might have to visit a dozen
different specialists before you could find someone familiar with autism and
get that diagnosis. Once you had the diagnosis, all the normal people you'd
encounter in life would regard it as some made-up condition ("Hey, I'm
_artistic_ too, lol."). It was difficult to explain, which made it difficult
to get special services at school, etc. Early childhood intervention was not
widely available the way it is today.

The people who are now dying early and contributing to these statistics got
little of the help and awareness that benefits newer generations of those on
the spectrum. I have hope that these numbers will improve over time as autism
becomes more widely understood.

~~~
Hydraulix989
Nobody knew about autism, so instead you were mislabeled as mentally
challenged or mentally ill.

Treatment was a lot less humane too for those affected by mental illnesses.
Things like lobotomy and electroconvulsive therapy were accepted as routine,
safe, and effective treatments for those patients afflicted with what you
would now call autism in modern medicine.

------
intrasight
I thought that everybody was on the "spectrum". So what does it mean to say
the average lives 18 fewer years? Isn't that like saying that people on the
skin color spectrum live 18 fewer years?

~~~
atdt
The autism spectrum is a continuum of mild to severe impairment in the domains
of social communication and restrictive repetitive behaviors and interests. It
is not coextensive with the range of possible cognitive dispositions. The
introduction of autism spectrum disorder in the DSM-V was meant to collapse
hard-and-fast distinctions between what were previously classified as four
distinct disorders (autistic disorder, Asperger's disorder, childhood
disintegrative disorder, and pervasive developmental disorder). It does not
recast autism as just another shade of normal.

~~~
intrasight
There is no 'normal'

------
im3w1l
Could it be that autists are being told to kill themselves in "certain" online
communities?

For instance, from the urban dictionary entry on autism: "Shut up weeaboo
faggot kill yourself you autistic bitch!!!!!11!!!"

That is not an isolated example.

------
cloverich
Curious the depth to which they compared reduced cognitive function in general
and how much that correlated with other low functioning conditions. Autism
often brings the image of a quirky or simply socially awkward individual to
mind, but the reality is some are sufficiently developmentally delayed that
they lack the ability to care for themselves at all. (Its a very wide
spectrum). Which is only to say I wonder if the statistic is autism specific
or generalizable to any low functioning individual.

~~~
tremon
_Its a very wide spectrum_

I don't think the autism diagnosis has been broadened for long enough to
actually have meaningful lifetime statistics.

Is the data for this study public? I wouldn't be surprised if the their claim
is simply based on the fact that only severe impairment would have been
classified as "autism".

------
julie1
Afro american have also fewer years, as well native americans, as well as
males, as well as ... depressive, bipolars...

Is the difference in life expectancy due to autism, or is it a potential
effect of discrimination?

If it was due to discrimination, maybe life expectancy discrepancies could be
a practical measure of discrimination?

And what about the distribution? If the 90th percentile was higher than for
other "categories" what would you conclude?

------
pjdorrell
People should refuse to take part in studies that will not be published as
open science.

------
anonbanker
For those of us using Privacy Badger to block stuff, can someone repaste the
article?

~~~
atdt
[https://dpaste.de/zXsM](https://dpaste.de/zXsM)

------
timwaagh
thats really sad news

------
jorgecurio
I get frequent suicidal ideations. It's always like when I'm overhwlemed and
upset, it just goes from angry --> sad --> suicide --> planning but I never go
through with it. It's impossible for me to do it. So I just take it as my way
of coping...with self destructive fantasies.

I think studying Eastern philosophy, buddhism and taoism will help people on
spectrum gain a much more rational and scientific view on reality.

Anyways, sure is a struggle, especially with people, relationships, intimacy,
everything is that much more difficult but you know I just think like people
have different skills, people on autistic spectrum are off the scale in one
area but equally unable in many other areas that normal people will have no
issues with.

~~~
DiabloD3
So, I'm autistic. Anyone who follows me on HN or Reddit has seen me speak
about what it's like to grow up autistic in a part of America that didn't
officially recognize Autism (let alone variants like Aspergers) until it was
too late to help me.

I sometimes do suicidal ideations, but then the part of me that is usually
being like "hey, you can't have fun and enjoy yourself, because ten years ago
someone you didn't know very well said bad shit about you" (ahh, depression,
my old friend), is like "you committing suicide isn't the answer... them
committing is a more acceptable answer."

And, well, that part of me is right. If you're that big of a pile of shit to
attack people based on their disabilities, well, society doesn't really need
you, and you're representative of the cancer that is killing society.

And, for a while, I'm okay again. The depression goes away, and I start
functioning half way decent again.

I will say, though, 200mg of Theanine twice daily with a strong cup of coffee
(and only one, let's not get into caffeine obsession), one an ~hour after I
wake up, one about 6-8 hours later, powers me through the day and shuts that
part of me up.

~~~
jorgecurio
that was edgy

