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Many people exhibit ASD-type symptoms without actually having ASD, as already mentioned on another thread some people fidget a lot, or some people have structured eating habits such as always having to eat food separately, or in a certain order etc so not all ASD type symptoms are indicative of an ASD. It's up to the person doing the diagnosis to decide if the symptom is significant. Obviously where it has a negative impact on your life then it is almost definitely significant, and after that it does become subjective...but not for you or I. I'm not a qualified psychologist, I don't have the experience or training so I couldn't tell you what is significant or not, and that goes for everyone here too.

I have a little theory. I'm okay if it goes under or up in flames.

The DSM criteria was made by people observing a condition or state of being mostly from an outsiders perspective.

Like, for me, an interesting question would be... What is behind these traits that manifest and can be observed?

So from a bit of casual research here and there I noticed that some people think that some of their repetitive behaviours are caused by sensory hypersensitivity (like to block out a bad sensory experience with another experience like a particular sound or movement that looks stereotypical). It can also be sensory seeking for hyposensitivity. This is like a movement or action you crave and might not always be able to control if you are experiencing severe sensory disturbance and need relief.

Other repetitive stuff could be because of rigid or black and white thinking patterns. Like strict routines that cannot be interrupted or reacting badly to unexpected changes or spoiled expectations.

Still more repetitive behaviours might be a coping mechanism for executive disfunction. I relate to that. If I don't do a complex task a certain way I get derailed or even feel panicked. Especially if there is a time limit. Usually there is.

The DSM doesn't look at the scene behind the scene. If you learn to cope better with executive disfunction or learn more discreet sensory relieving stims, you might not present obviously anymore but the underlying cause is still there and will manifest more strongly under stress.

Also I think Aspies can sometimes be unaware of how much they stim and do repetitive behaviours. To us it feels so normal unless someone comments on it.

I've been looking out for it in myself lately and I think I'm seeing there is stuff. It's sometimes not obvious. I talk to myself as a stim and stim visually a tonne. This might or might not be obvious from the outside. Maybe it is. Not sure.

I agree with you soloha

I know people can have traits without the actual diagnosis, but I was thinking more of a hypothetical situation where someone really struggles socially and needs support, but doesn't need that same support for RRB's (but they still have some repetitive behaviors). They should still get a diagnosis, in my opinion.

Thank you for sharing your theory; I completely agree with it. That's why some cases of ASD are harder to diagnose, especially in adults. I exhibited a lot of autistic behaviors in childhood, but I never thought there could be a reason behind those behaviors until about a year ago (when I was under a ton of stress). Again, thanks for sharing .

One thing people should keep in mind:

The DSM-V diagnostic model can only be seen as a generalized framework for diagnosis. It's up to the diagnostician to interpret the generalized framework to his/her own notions as to any disorder.

That's why the latest research should be read---because it might not be reflected in the notion of a disorder as it was constituted at the time the DSM-V, or any diagnostic manual, was compiled.

Even the compilers of the DSM-V would tell you that their specifications are not perfect, and are subject to change, and must not be used as the only group of specifications within a diagnostic process.

True; I feel like the DSM changes a lot. It makes people think Asperger's never existed or something like that. You can't really place your faith in a criteria that changes all the time .

The criteria HAVE to change all the time. New research is always superseding old research.

Before the DSM-IV, autism wasn't a "Spectrum." All autism was, then, was a composite of what would be called "classic autism" today and regressive autism. People who would have had Aspergers, or Type I Autism would have been diagnosed with many disorders, including some that don't exist any more.

That's really the whole point: a clinician should not rely solely on something like the DSM-V, or the ICD-10.

Yeah; I don't think clinicians should focus on the criteria so much, especially when the person needs support.

Yep that's it.

Congratulations on 9,000 posts by the way. That's quite a lot .

I believe clinicians should take the patient's situation into account:
• Is there no stress?
• Have they developed coping strategies?
• Do they have lots of support?
• Have these changed over time?
• Have those changes affected the severity of the patient's symptoms?

But I believe that each symptom should be individually measured (without support, coping strategies, etc.) as clinically significant to be counted toward an autism diagnosis. Scale:
• Normal Range;
• Clinically Significant but Mild;
• Clinically Significant and Moderate;
• Clinically Significant and Severe.

Isn't this kind of what they do? For the first part of your post I think this is part of determining "clinically significant" The second part is: No autism, level 1, 2 or 3? No?

There have been some really good posts in this thread....

I think using a diagnostic tool is also affected (like everything) by whether the clinician is taking their job seriously enough to keep up to date with current research and insights (like Kraftiekortie mentioned) and is actually interested in uncovering the truth. Diagnosing something that presents subtly, according to fairly subjective criteria, may take a bit of uncommon skill.

There are a lot of clinicians who are just doing the job but don't have much interest in it. They're only human beings. Some go into the field because they think they'll like it and later on realise that they hate it. Some are just perhaps a bit lazy. Some are only interested in a particular topic, such as personality disorders, and will look at everything through those glasses.

For a good opinion you do have to find the right person. Someone with some passion. I've been manhandled by a lot of medical people. Realising they are only human beings with limited resources has helped me forgive many things. I realise it's somewhat my job to find my direction and find the help I need to go on the best way I can.

If I could find someone I'm confident in, I'd have to accept their opinion. Hope I do some day.

I like what you said, especially the part about taking the patient's situation into account.

This sounds similar to the "intense world" theory I've heard about, which claims sensory, emotional, and logical processing tend to be intense to the point of overwhelming in those of us on the spectrum. (I would argue this also goes in the other direction, for the hypo sensitive folks.) That theory better describes the reasons behind what I do, at least. I have this stim I sometimes don't even notice myself doing, where I rapidly bounce my right leg. My dad was getting on my case just yesterday about it, for shaking the whole car. I definitely do it a lot more when I'm stressed, especially when there is too much or too little sensory input. I have also only recently become aware that some of my awkward habits such as this do fall under the umbrella of "stimming." When I was diagnosed, I may have underplayed this aspect of how it affects me for that reason, because I assumed the only form of stimming was hand flapping, which I don't do. I do, however, shake a lot when I'm focusing intensely on something, constantly mess with my clothes and jewelry, and make a lot of weird little squeaking noises. I also need to doodle in class in order to focus and block out external stimuli, which has gotten me into trouble in the past, because teachers would assume I was ignoring them. These are things I just did. I didn't recognize them as "significant" until later. I think, especially in girls, who are less frequently diagnosed, a lot of things are missed simply because we don't realize they are significant, or because we learn to cope subtly by necessity. My symptoms were certainly more severe as a child. Back then, all I understood was "being myself." As I grew up, I spent a ton of time studying "how to be normal" because I wanted friends, so I was able to imitate some of the things that don't come naturally to me. I also learned to suppress and internalize my sensory meltdowns. Of course, this results in exhaustion and massive amounts of anxiety from essentially being acting all the time when I am around other people. I seriously struggle to handle more than a little bit of social interaction per day, because I need to analyze and script out everything if I want to avoid ridicule, whereas other people might just "hang out with friends" and find that fun and relaxing. Even around my closest friends, knowing whether I'm being "normal enough" for them or not is a nightmare.

However, most of my friends are completely unaware of my autism, until I flat out tell them. They'll even deny it and say they think I was misdiagnosed. They just think I'm "a little bit weird, obsessive, and awkward." As you say, not everything is as obvious as "oh, that person flaps/doesn't flap, therefore they are/aren't autistic!"

Also, it tends to present differently on a person by person basis, so you can't exactly say "that person is/isn't like me, therefore they are/aren't autistic." They could just be experiencing it or coping with it in a different way, or maybe it's more or less severe for them.



I think this is exactly right. The environment we grow up in can have a massive impact on how we end up presenting. I know my parents have spent many hours going through analysis of social situations with me, trying to figure out what I'm doing wrong and what I can change, so it's allowed me to create my own sort of "social handbook" for myself. Not everyone has this support, though. I probably would never have figured a lot of these "rules" of interaction out on my own. I would probably still be trying to play pretend with my adult peers and consistently infodump my newest obsessions on them. Now I tend to save my obsessions for people who share them, or the internet, where other obsessed people hang out. You can see how that may look a lot less obvious.

I'm also very good with coping strategies, and when I can't think of one, I do my research and adopt the coping strategies of others. These things allow me to "pass" as neurotypical, though I can't really say if that's a good thing or a bad thing, because then people tend to think of me as just a terribly awkward person rather than one dealing with a disability, and people refuse to be compassionate in the instances where I actually do need accommodations. They also refuse to believe me when I do decide to disclose my professional diagnosis, because I don't look like the more severely autistic people they've met or like the ones they see on TV.