
Autism diagnoses are up 78% in 10 years. We're dramatically overdiagnosing it - jonnathanson
http://www.salon.com/2013/09/21/thats_not_autism_its_simply_a_brainy_introverted_boy/
======
jonnathanson
OP here (FYI - I am not the author).

My big concern with misdiagnosing autism in high-IQ children is that it
conflates autism with introversion -- a conflation that has been progressing
for some time now, and which has been accelerating in recent decades. This is
bad for the legitimately autistic, and it's bad for introverts.

It's bad for the autistic because it lumps a fairly heterogeneous set of
children into the same spectrum, confounding our best efforts to get to the
true roots of autism. If we're treating too many nonautistic children as
"autistic," then by nature, we're diluting the actual pool of people we should
be studying and helping. We're throwing too many red herrings and exceptions
into the data set.

It's bad for the introverted and highly intelligent because it further
stigmatizes both of those things, especially in combination. By establishing
extroversion and median IQ as "ideal," we're insinuating that the introverted
and gifted are somehow defective. We're behaving as though our gifted children
should be bent and twisted into acting more like everyone else, when in fact,
we should be nurturing their gifts.

While autism-spectrum disorders, introversion, and high IQ can certainly
overlap, they are not by nature the same things.

~~~
thaumasiotes
> It's bad for the introverted and highly intelligent because it further
> stigmatizes both of those things, especially in combination. By establishing
> extroversion and median IQ as "ideal,"

Let's be honest. Intelligence is widely regarded as a good thing to have,
better than the alternative. People are regularly lionized for it. Nobody
says, or thinks, "I wish my child was a little dumber" (whereas "I wish they
weren't so shy" is common).

There's a class of intelligent people that other people find off-putting. But
those other people aren't being put off by the intelligence, nor are they
attributing it to the intelligence.

The concept of an acceptance campaign for introverts at least makes sense. The
highly intelligent are already accepted.

~~~
jonnathanson
I would disagree slightly. The _idea_ of high intelligence is lionized, but
society does a pretty spotty job recognizing it when they come across it in
real time.

In _practice,_ the highly intelligent themselves are often stigmatized.
They're often misunderstood. They can have a hard time communicating with
others, because at their level, their minds work very differently.

For the record, this article is specifically about kids with IQs at a level
several standard deviations above the norm. It's not talking about those
simply above average.

------
darkxanthos
This is a complex issue and is essentially being boiled down to "smart people
are misunderstood." A topic that garners a lot of empathy here.

Autism Spectrum Disorder isn't just that the child is introverted. They must
show several signs in order to be diagnosed. According to my partner (with a
Master's in Social Work), it's also not something one can diagnose or counter
in minutes like the author states he did with one child. That seems like a
large credibility strike. Here information on how a diagnosis is made:
[http://www.autism-society.org/about-autism/diagnosis/](http://www.autism-
society.org/about-autism/diagnosis/)

Further there's nothing but anecdotal evidence given in the article for making
the leap from "diagnoses went up" to "we're misdiagnosing it." This is really
just an opinionated fluff peace that resonates with our community.

~~~
jonnathanson
Did you read the whole article? I'm curious, because I don't think you're
actually disagreeing with the author on many of your points. For instance,
"Autism Spectrum Disorder isn't just that the child is introverted." That's
basically one of the core arguments of the piece.

 _"...there's nothing but anecdotal evidence..."_

No, the author actually points out that a lot of the current methodology used
to _diagnose and test_ children is limited and at risk of observational or
situational bias.

For example:

 _" Of the two hundred autism assessment programs his team surveyed across the
country, many of which were located in prestigious medical centers, only 10
percent emphasized the need to observe a child along with a parent or guardian
for more than ten minutes as they spontaneously interacted together. He tended
to observe children playing with a parent for forty-five minutes or more,
waiting for choice points to engage a child to determine if he or she was
capable of more sustained eye contact, elaborate verbalizations, or shared
emotional reactions. Dr. Greenspan believed that these conditions of safety
and sensitive interaction were essential in order to obtain an accurate
reading of a child’s true verbal and social skills."_

Here is he saying that we're not spending _enough_ time with children to make
conclusive diagnoses, one way or the other. Autism or otherwise.

------
205guy
And so the backlash against autism spectrum begins...

There are many things wrong with the article, but my main gripe is how the
author totally ignores the Asperger's end of the spectrum. Calling it a
spectrum provides great insight (there are a large number of behaviors, and
individuals have various combinations of each to a varying degree), but the
author uses it to blur the line between what I would call functioning and non-
functioning individuals (and seemingly on purpose). "Full" autism causes
people to be unable to cope with the regualar world and all its stresses (see
article about how autistics can take an airplane[1]). The author is exploiting
the fear of parents whose children are found to be on the "autistic spectrum"
(but more likely on the more functioning Asperger's end) and justifying a
refusal of the diagnosis.

My perception is that Asperger's individuals (and the William in the article
seems to fit--though I am not a doctor) have quirks and are difficult to
raise. They have emotional issues and are socially maladapted. But they can
lead fully independent lives and often contribute greatly to society. My issue
with the author is that I believe Asperger's children can benefit greatly from
psychological help, to teach them emotional and social skills in a way that
parents can't. I believe that in certain cases, this help is critical to
making the difference between the Asperger's person leading an almost normal
life (including getting married and having kids), and leading a miserable life
as a social outcast (bullied, unable to be in a relationship, unable to deal
with child-raising).

So I think more nuance is in order, more distinction between autism and
Asperger's (even though they are on the same spectrum), and more help for
Asperger's children and adults, not less.

[1]
[http://www.bbc.co.uk/news/health-23989422](http://www.bbc.co.uk/news/health-23989422)

~~~
eliasmacpherson
Asperger's has been pushed off of the Euphemism Treadmill by the APA from
their DSM book, the same organisation that had homosexuality down as a mental
illness. It's replacement: "Autism spectrum disorder".

Now when you put something in a 'spectrum' it allows you to talk about
somebody with a very mild tick, and someone with an extreme condition in the
same breath. Some examples: "homosexuality"(sic), "perversion", "alcoholism",
"racism" and "substance abuse". You can put any of those on a spectrum and it
will allow you to make some very unfair comparisons between two very different
people.

I disagree that putting anything on a spectrum provides a great deal of
insight. I think it's intellectually lazy and actually quite dangerous an
idea. I find as you found, that people can use it to blur lines that should
not be blurred.

A relative once said that the autism spectrum helped her understand that her
son's and husband's predisposition to use logic to justify their behaviour was
a genetic fault. She found that concept comforting, because otherwise she
couldn't understand why they don't agree with her on certain matters. Neither
of them have been diagnosed, and they seem perfectly fine to me. I pointed out
to her that that didn't represent a huge leap in understanding them.

[0]
[https://en.wikipedia.org/wiki/American_Psychiatric_Associati...](https://en.wikipedia.org/wiki/American_Psychiatric_Association#Controversies)

[1]
[http://www.aane.org/about_asperger_syndrome/as_dsmv.html](http://www.aane.org/about_asperger_syndrome/as_dsmv.html)

[2] [http://englishcowpath.blogspot.com/2011/06/euphemism-
treadmi...](http://englishcowpath.blogspot.com/2011/06/euphemism-treadmill-
replacing-r-word.html)

------
ericabiz
Hello, author. Meet me. I was much like the boy in your article--except in one
way.

I was thrown into tests at a young age which showed a high IQ. I had
difficulty in school with outbursts. I did not easily read social cues from
others. I had strange interests, like an obsession with the Civil War or (in
sixth grade) a personal God that I carried around with me because I liked the
word "polytheism."

I was an obsessive and voracious reader, but always an outcast. I was
ridiculously pedantic--in first grade I refused to write "Mr." with a period
at the end of it (I'm American) because in Roald Dahl books, he didn't use the
period after "Mr".

I still write my periods outside of quotes, and I argued with a teacher in
college regarding two sentences after a period. These and other arguments
eventually led me to dropping out of college. Fortunately, I found computers
and entrepreneurship--plus a lot of books on how to read body language--and
I've done pretty well for myself since.

Oh, and did I mention I'm a woman? Yep, born female, with every issue you
describe.

FTA: "Jordan secretly confessed to me that his English teacher must be dumb
because she referred to certain assignments as “homework” when she allowed
them to be completed in class. She should have renamed them “schoolwork,” he
said, because they were being completed at school. In twenty-five years of
therapy practice, I’ve never known a girl to make such a comment."

Well, good news for you, then, sir: There's an entire subreddit of us.
[http://www.reddit.com/r/2x_intj](http://www.reddit.com/r/2x_intj) Perhaps you
should come visit sometime. Or are you too busy making gendered statements and
deciding that it must be "masculinity" that causes these issues, instead of
diving deeper into the issue?

I certainly could have benefited from a class on how to understand facial
cues. I could still benefit from a class on tact. I still make people
uncomfortable sometimes when I talk to them.

I'm a female, an introvert, and I have been diagnosed with ADHD. (A diagnosis
which unequivocally changed my life for the better.) Making light of issues
like this, or narrowing them to "boys will be boys", is a sad
misinterpretation of a real issue. Do I have Asperger's? It's certainly been
suggested to me several times by others, but ADHD more fits who I am.

To those of you reading this, I hope you don't take it too literally. There
are kids out there who need real help. I wish I would have had more of it.
Asperger's/autism or not, school was pretty much miserable for me, and I would
have been grateful for the opportunity to learn how to really connect with
others.

~~~
jonnathanson
Indeed, it's unfortunate that he's insisting on "boys" and using the masculine
pronouns in this piece. This is, however, an excerpt from a book, focusing
specifically on one case study. I would hope and expect -- though I cannot
confirm -- that the book looks at children of both genders.

 _" Making light of issues like this, or narrowing them to "boys will be
boys", is a sad misinterpretation of a real issue."_

I didn't read either of those things in the article. Agree completely that his
focus on "boys" in this excerpt is limiting and probably misguided, but I
don't see him "making light" of any of these subjects. Nor did I see him
categorically tying these behaviors to masculine behaviors ("boys will be
boys"). Again, keep in mind that he uses one case study to illustrate the
points made in a much longer book. And the headline, while certainly gender-
limited, may not have been written by the author (Salon's editors, like the
editors of many other publications, probably wrote it).

~~~
ericabiz
> I would hope and expect -- though I cannot confirm -- that the book looks at
> children of both genders.

I haven't read the book either, but the article doesn't give me much hope.

All of the following are direct quotes from the article:

"That’s not autism: It’s simply a brainy, introverted boy" <\--This is the
title.

"How boys communicate and socialize" <\--This is one of the subheadings.

> Nor did I see him categorically tying these behaviors to masculine behaviors
> ("boys will be boys").

FTA: "As educated people, we don’t want to believe in overarching differences
in communication styles between the sexes. When I was in college in the 1980s
and ’90s, “essentialism” was a dirty word. To believe that males and females
might be different in essential ways was akin to admitting that you were
unenlightened. There’s still a pervasive sense in our culture that to be
educated is to be gender-blind, and there is something of a taboo against
voicing aloud explanations for a child’s behavior in terms of his or her
gender. If you don’t believe me, try uttering some version of the following
statements at your son’s next parent-teacher conference: Jamal is so logical
and brusque when he talks. I know he needs all our help to ease up. But these
are traditional masculine behaviors, after all, and we might need to accept
him more for who he is. Or, Billy overtalks and really needs an audience,
especially when he has a new favorite hobby or interest. He needs to be a
better listener. But he’s not unlike a lot of boys I know.

It’s this public discomfort with discussing children’s gendered behavior that
gets many traditionally masculine boys inappropriately labeled as high-
functioning autistic. Poor eye contact, long-winded monologues about one’s new
favorite topic, being overly serious and businesslike, appearing uninterested
in other’s facial expressions, and restricting friendships to those who share
one’s interests, may all be signs of Asperger’s syndrome or high-functioning
autism. However, these same traits typify boys who are traditionally masculine
in their behavior. Parents somehow have to ask the uncomfortable question in
the doctor’s office: Is he high-functioning autistic or really a more
masculine-identified boy?"

Or...you know...a girl. Who just so happens to have strange interests, be
introverted, and struggle socially.

~~~
jonnathanson
_" "That’s not autism: It’s simply a brainy, introverted boy" <\--This is the
title. "How boys communicate and socialize" <\--This is one of the
subheadings."_

As I mentioned, it's entirely possible, if not highly likely, that both the
title and the subtitles were chosen by editors at Salon and not by the author
himself.

For example: I've rarely been able to write my own headline whenever I've been
published. I've also been heavily edited, and occasionally even pigeonholed in
a certain direction, by my editors. It depends on the publication, the
editor's chosen focus, etc. (Curiously enough, in fact, I didn't even write
_this_ link's headline for HN; I submitted this article under a different
headline).

 _" Or...you know...a girl. Who just so happens to have strange interests, be
introverted, and struggle socially."_

But discussing a particular aspect of masculine behavior that's misunderstood
does not necessarily imply that _only_ masculine behavior is at issue, nor
does it imply that only boys exhibit such behaviors.

It may well be the case that boys are more often disciplined or misdiagnosed
for these issues in classrooms. I don't know. There are any number of reasons
why he could have chosen this focus -- and while that focus is a limitation, I
am choosing to give him some benefit of the doubt until reading further.

If indeed his focus in the book is purely on boys, then that's a very serious
limitation. And it would be a very unfortunate one. I have not read the book,
so I cannot say for certain whether his book itself is only about boys. I hope
it's not.

------
codezero
Sometimes a jump in diagnoses just means we had previously been misdiagnosing
or under diagnosing. Don't just call an increase an over diagnosis. If we
suddenly had an increase in obesity or cancer we wouldn't say "i call
bullshit, doctors are cashing in on this". Maybe there is something else going
on but automatically calling over diagnosis is just as bullshit as anything
else.

~~~
emilv
Indeed. Where I live, Asperger was diagnosed by only a couple of university
hospitals ten years ago, with waiting times counted in years. Today it's
diagnosed by hundreds of local psychiatry clinics around the country, and a
study is usually initiated within months. We also have a bigger awareness
about the issues, which may drive more people to be diagnosed; people that we
wouldn't "find" otherwise.

------
liquidise
I am very happy to see this topic opened for discourse by a longstanding
professional.

Some of my closest friends in elementary school fell into the above-average +
introverted group. To teachers they stood out like sore thumbs. To those of us
with similar interests and abilities, but more extroverted, they were just
kids who double checked their answers before blurting them out.

In an age where there is a tendency toward pills and therapy as solutions for
almost anything (not trying to spawn a pharmaceuticals debate), articles like
this feel like a breath of fresh air. Being intelligent does not a disorder
make.

~~~
pstack
If the DSM doesn't have something to qualify you to be classified, medicated,
or even monitored today -- they will, tomorrow.

------
malandrew
Personally, I would like to see a move away from the approach of putting
labels on everyone, which is made worse by treating the DSM-V as dogma. The
DSM has kept back legitimate science in the area by forcing everyone into
discrete boxes instead of recognizing the continuity of many symptoms. The
NIMH is already moving away from it and most organizations except maybe the
APA should move away from it. This would promote an environment where we spend
more time measuring and researching body chemistry to better understand the
relationship of what is happening in the body that produce undesirable
psychological symptoms. Every person that is diagnosed and sent off with drugs
is a lost opportunity to collect information about the state of their body and
their symptoms and using computing to discover other leads on how to better
treat or cure those specific symptoms instead of a broad classification which
imperfectly characterizes many people.

------
adamconroy
I dont remember the exact numbers but this reminds of a story in Norway
recently where overnight they went from 30% of the population being vitamin D
deficient to 90%. The cause of this was a change in the official definition of
vitamin D deficiency

------
k1kingy
Put it this way. Everyone is somewhere on the autism spectrum. I don't think
we're over diagnosing it as such, but more diagnosing it at a lower level.

~~~
r00fus
> Everyone is somewhere on the autism spectrum.

Just because it's a spectrum doesn't mean it's all-encompassing. At some
point, it's clear that someone is _not_ on the spectrum. I am willing to bet
you're wrong, most of the autism cases are not fringe.

~~~
pyre
I'm willing to bet that the post your replied to was considering "No Autism"
as a point on the spectrum, even if that's misguided.

------
bsullivan01
Autism diagnoses are up 78% in 10 years. We're dramatically overdiagnosing it*

Look at the funds being thrown at autism. If your child ain't autistic, no
funds and job for all those special ed teachers, schools and psychologists.

~~~
sparkie
Don't forget the cost of all those drugs.

~~~
jlgreco
What medications do they prescribe for autism?

~~~
sparkie
Adderall, Ritalin for ADHD, Asperger's and such.

------
iliiilliili
Ten years ago it was ADD, now it's autism. Psychiatry is bullshit, and the
pharmaceutical industry it drives is dangerous.

~~~
melange
Why was this being downvoted?

~~~
pstack
Because 90% of geeks have /self-diagnosed/ themselves as having aspergers and
they take any criticism of it as a personal attack on them and their
"illness".

Don't worry, something else will come along that is way more trendy in a few
years and these same people will move on to claiming they have _that_ ,
instead.

(Obviously not claiming autism itself is not real and not a legitimate and
difficult problem to deal with. I shouldn't have to disclaim this, but I'm
obviously talking about the Slashdot type crowd that has convinced themselves
that because they are detail oriented and are sometimes awkward in crowds,
they have aspergers and constantly talk about it.)

~~~
pyre
Or you could just chalk it up to the fact that the post was a "shoot from the
hip" post that was channelling a bunch of rage against Big Pharma and
psychiatry while containing very little in the way of facts. Not only that,
but Big Pharma has no horse in the race as there is no drug to sell here.

