Do you feel that autism is a catch-all diagnosis?

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Yellow-bellied Woodpecker
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25 Jul 2021, 4:42 pm

Do you feel that autism is a catch-all diagnosis? I feel like a lot of autistic people on the internet have sadly a lot of diagnoses. I know autism have comorbidities but I can't help thinking that autism must be "diluted" among all these diagnoses and that it is really about "unclassifiable" people that society doesn't want to deal with.
For other people, different than the ones I mentioned in my previous sentence, sometimes, I feel like autism is a fashion accessory or is fashionable to self-diagnose.
I don't feel very comfortable with autism-identity and I still can't come to terms with that diagnosis for years.

Sometimes I don't know why but I feel ashamed to be diagnosed with autism...
And I don’t want anyone to know.



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25 Jul 2021, 5:02 pm

It definitely feels that way, this is why I abandoned this label in the past. But I came back because I failed to find anything better, there simply doesn't seem to be? I need a way to quickly communicate to humans that I'm weird abomination in order to stop them from assuming things about be, as this can cause many annoying misunderstandings. Autism label seems to be the only practical way to do it?



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25 Jul 2021, 7:12 pm

My feeling is that "autism" describes a category of conditions which probably appear a lot more similar to outside observers than they do to the people who actually experience them.

For example, "poor social reciprocation" might have been observed at one's assessment, contributing to the overall diagnosis. But there is no requirement for the assessor to determine why there is this social behaviour. Such complex behaviour relies on countless sensory, perceptual, cognitive, attentive, memory, emotional, etc. processes all working in perfect harmony with each other. As with all behaviour, it will also be mediated by non-autism related personality traits, the social environments which one has lived in, what one has or hasn't had the opportunity to learn, how much effort one is making to "put on a performance" (e.g. masking), and so on.

So it seems to me, that even if you take just that single aspect of "autism", there could be dozens of different etiologies which explain why the person behaves that way. And I think you can see that here on WP - whenever there is a thread about "what do you find difficult about social situations", there is huge variety in the difficulties which people report. But are those differences really apparent to the untrained eye of the person one is socialising with? Probably not. And maybe not even to trained assessors either, because the diagnostic criteria don't require such distinctions (and finding out may not be possible at all for some patients).

That might also be where some of those "diluting" diagnoses come into play. If someone reports that this social behaviour is found difficult because of sensory integration problems, then it might not be a surprise to discover that they also have synaesthesia, for example. But, would their behaviour according to the diagnostic criteria necessarily be all that distinguishable from someone who's social reciprocation is affected by very poor working memory or attention deficits - especially if they are accustomed to trying to conceal their difficulties? So here are three "autistic" people with various secondary diagnoses, when in fact, maybe the "autism" is a phantom diagnosis - just a label for the observable behavioural consequences of the less visible "secondary" conditions.

I think this idea could be extended for a considerable number of the diagnostic criteria, as so many of them are defined exclusively in behavioural terms without reference to the patient's perceptions or motivations. A good example of the "motivations" part might be the diagnostic "need for routines". Is this even a "trait" of autism at all? - I experience it as a perfectly rational and beneficial coping strategy. My poor executive functioning makes it difficult to deal with the constant onslaught of necessary but trivial decisions that life often requires - so I just decide the same way every time to head off any dithering around.

I should make clear, I'm just throwing this out there as an idea based on my personal experience and the many conversations I've had with other autistic people - I'm perfectly happy to hear criticisms and counter-arguments. I don't know of any scientific grounding for it besides vague hints in a handful of studies showing correlations between things like alexithymia and sensory processing, or aphantasia and memory - the kind of things which autistic people often report as secondary or contributing traits/diagnoses. In any case, I certainly agree with the spirit of the thread that the current diagnostic criteria are a very blunt instrument and probably conflate conditions, and/or possibly personality types, which may not be as similar as they look.


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25 Jul 2021, 8:08 pm

Checkbox wrote:
Do you feel that autism is a catch-all diagnosis?

No, not in general. However, I have heard of people trying to get kids diagnosed with autism just for access to certain therapies that health insurance would not otherwise cover. These kids didn't quite meet criteria for autism, but they had issues that the therapies addressed.

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I feel like a lot of autistic people on the internet have sadly a lot of diagnoses. I know autism have comorbidities but I can't help thinking that autism must be "diluted" among all these diagnoses and that it is really about "unclassifiable" people that society doesn't want to deal with.

I don't understand why you think these comorbid diagnoses are relevant. Autism as currently defined by diagnostic criteria seems to be rather distinct from most other diagnoses (both medical and psychiatric).

It actually seems normal that autistic people have certain comorbids. The brain controls the body, so someone who is autistic—i.e., has atypical neurology—is likely to have atypical connection between mind and body and atypical cognition. The atypicality, put into the social context, may then easily lead to social experiences that lead to things like anxiety.

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For other people, different than the ones I mentioned in my previous sentence, sometimes, I feel like autism is a fashion accessory or is fashionable to self-diagnose.

I agree with you on this, but I think many of the instances of "self-diagnosis" are a bit more serious—a manifestation of an unhealthy attachment to some aspect of autism, whether it be a desperate desire to be different/special, to have an excuse for perceived failures (in work, social life, etc.), to forge an idealized social connection with the autistic community regardless of the medical connection, or something else.

And some people seem attracted to an autistic identity because they have a fundamental misconception of what autism is (some people seem to think it's basically just a unique personality type).



CarlM
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25 Jul 2021, 8:11 pm

One thing that is fairly unique about autism is the requirement that symptoms are present in early childhood. This is not true of personality disorders. Autism is a developmental disorder. I would be suspicious of any self-diagnosis that doesn't include serious childhood symptoms. I found all my early school records and the dire reports to my parents from Kindergarten on. But this was way before the spectrum and I did not display classic autism. I realize however that girls have different childhood problems and the serious problems are later in childhood for them.


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25 Jul 2021, 8:17 pm

Trogluddite wrote:
So it seems to me, that even if you take just that single aspect of "autism", there could be dozens of different etiologies which explain why the person behaves that way.

The diagnostic criteria for autism helps clinicians avoid confusion of different etiologies by not taking "just that single aspect of autism."

The fact that the diagnostic criteria requires a person to exhibit behavior that satisfies several very distinct clusters of behavior is one of the main characteristics that makes autism a unique diagnosis.

In other words, if you take one autistic trait at a time, yes, it could be caused by many things, but the combination of traits that makes up autism is far less likely to be something other than autism.



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25 Jul 2021, 8:21 pm

I've seen other neurodiverse and other mental illness cases without any autism in them but may or may not also mimic it, while do not get misdiagnosed.

Also, I've seen plenty of autistics with and without the comorbidities.
That includes ones without the all too common anxiety disorders.
This also includes autistics who do not have certain personality traits that seem to be common in autism portrayals.



So no, not really.
And a real trained and serious professional (not the lazy ones) would know.

Unless there are accessibility issues involved, where one would just have the autism label for formality instead of their real but undiagnosed label.


From where I came from, it's not a fad like wokeism. :lol: :lol: :lol:
Unless they're teenagers or adults who all want to be or catch up from "millennials", and spent too much time in the internet.

Nor the parenting styles here involves this unmanageable kid or some kid with some weird trait = diagnosis + preferably medicated.



But beyond from a place of what I've said, I agree but only to some extent -- it requires further context to which where the statement that autism is a catch-all diagnosis applies.


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26 Jul 2021, 9:05 am

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I don't understand why you think these comorbid diagnoses are relevant. Autism as currently defined by diagnostic criteria seems to be rather distinct from most other diagnoses (both medical and psychiatric).


I know autism is distinct from other diagnoses but it has comorbid diagnoses like anxiety disorder, OCD, depression. When I wrote this I was thinking more about disorders such as IDD, bipolar disorder, borderline disorder, schizo-affective disorder, anorexia nervosa, and so on: disorders that are not recognized as frequent commorbidities of autism. I can’t figure out how a person can have multiple diagnosis AND autism.

I should mention that I see this phenomenon a lot on Twitter even though I am not registered, I can't help but click on tweets.
I am in a virtual group with autistic people and some want to be diagnosed. I try to help people in their diagnostic process but some of them get stuck in a Barnum bias when they read the DSM and I sometimes have a hard time understanding how they can self-diagnose or how they can understand what this or that item in the DSM criteria refers to, how they can categorize their behaviors.

I don't know if you know Dr. Mottron from Quebec who is a reference in the research on autism spectrum disorders but he says that the clinical observation of the etiology that comes from the DSM would not be restrictive and specific enough and that it penalizes research because autistic individuals look more and more like neurotypical individuals.

Moreover, I must specify that I am French.
France is known for under-diagnosing autism because of its long psychoanalytical heritage. Autism is rather unknown here but the groups are extremely militant in my country because we are forty to fifty years behind.
In France, when someone tells a doctor that he or she is autistic and have a diagnosis (it hasn't happened to me yet but I don't think I'll escape it either), the doctors make fun of him or her and think that he or she has self-diagnosed or that the psychiatrist who diagnosed him or her was incompetent.



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26 Jul 2021, 9:51 am

I feel that Autism Spectrum Disorders -- especially "Asperger's Syndrome" -- are catch-all scapegoats.


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26 Jul 2021, 11:47 am

Checkbox wrote:
Do you feel that autism is a catch-all diagnosis? I feel like a lot of autistic people on the internet have sadly a lot of diagnoses. I know autism have comorbidities but I can't help thinking that autism must be "diluted" among all these diagnoses and that it is really about "unclassifiable" people that society doesn't want to deal with.
For other people, different than the ones I mentioned in my previous sentence, sometimes, I feel like autism is a fashion accessory or is fashionable to self-diagnose.
I don't feel very comfortable with autism-identity and I still can't come to terms with that diagnosis for years.

Sometimes I don't know why but I feel ashamed to be diagnosed with autism...
And I don’t want anyone to know.


Autism is just a name for a group of symptoms that occur together. It’s never been defined biologically.

So there are probably many autism’s like there are many causes of paralysis (another symptom of something) someone can be paralyzed by a motorcycle accident, born with a deformed spine or have Motor Neuron Disease. But the end result is the same unable to feel or use their limbs.

Autism is like that too, the autism Elon Musk claims to have is likely very different causes from that of the adult with the living skills of a 3 year old.

The brain probably has the potential to have multiple faults but limited ways of expressing those other than autism symptoms.

Also autism is where the brain is not functioning in the way it was evolved to so makes it susceptible to a whole range of other disorders and deficits such as epilepsy, anxiety, ID etc etc…

So at the end of the day it’s just a label psychiatrists in the mid 20th century gave kids who had these symptoms.

Back then computers were crude and the size of a house and planes had propellers.

Brain science was crude and to an extent still is but one day hopefully they’ll be able to give specific diagnosis of what’s going on and help people as a result.


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26 Jul 2021, 1:32 pm

carlos55 wrote:
Autism is just a name for a group of symptoms that occur together. It’s never been defined biologically.

Exactly.

Also this OP nicely demonstrates the limits of attempting classification based solely upon clinical phenomena.
It's the tool being applied, --but it is a very rough tool.

Diagnostic "boxes" are attempts to make sense of the whole and to help clinicians organize their thoughts and communicate - but they aren't real, any more than lines of latitude and longitude are real. And they're not labels. We need not consider ourselves "branded" or "limited."

Proof of the correctness of any diagnosis is this:
Do the therapies indicated by the diagnosis prove actually beneficial when applied.

Any diagnosis is a very rough approximation to be taken with skepticism.
In the end we each do the best we can with the cards dealt, despite any diagnosis or lack thereof.



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26 Jul 2021, 2:46 pm

Sometimes I wonder... Why autism?

Why not... (Insert IQ level here) (Insert Social passing ability there)-NOS? :lol: :lol: :lol:

"Borderline Intellectual Socially Pragmatic Not Otherwise Specified"?
"Intellectually Disabled Nonverbal Volatile NOS"?

:lol: :lol: :lol: :lol: :lol: Wait. There's already PDD-NOS! "Pervasive Developmental Disorder-Not Otherwise Specified"

How could I forgotten that?? :P
Oh wait. Cause it was removed from the DSM along with other autism spectrum labels. :roll:

So focused on the Aspergers and the classic ID-types, PDD-NOS that covers either/both -- the very label that blurs between the so-called HFA and LFA, where a lot of heterogeneity happens -- if BAP is even in there with the same room as severe levels of GDD+(ID++), I won't be so surprised...
And is neglected. :lol: :lol: :lol:

Maybe I'd rather question why autism even stayed at all and dropped PDD-NOS?
Levels are practical and all but... Eh. :twisted:


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26 Jul 2021, 4:51 pm

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CarlM wrote:
. I found all my early school records and the dire reports to my parents from Kindergarten on. .

How did you find those records?. I would have assumed the school would have thrown them out by 1970 or so.


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26 Jul 2021, 4:55 pm

I don't know exactly what "catch-all" means, but I think that what we know as the "autism spectrum" is going to eventually get broken up into individual disorders with their own associated symptoms and causes. I often wonder what specific disorder I have and what genes cause it.


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07 Aug 2022, 10:56 am

Sorry to resurrect an old although not ancient thread, as I felt the need to comment.

Yes, I absolutely believe it's a "catch-all" diagnosis. It's applied where a significant subset of a certain category of symptoms are observed but unlike schizophrenia, for example, the root cause could be one of several possible things and the personal experience of the person being diagnosed might be very different from that of another person with the same diagnosis. One example is someone who experiences sensory overload. This can cause that person to exhibit symptoms similar to another person who does not have any particular trouble processing sensory input. A good example would be my son, who was diagnosed at age 3 and is "severe" enough to be unable to live independently, however I have never gotten any sense that he has significant issues with sensory input e.g. he can watch a movie with a lot of flashy SFX and loud noises and not be especially bothered; however much of his behavior is almost "classically" autistic.

Another example is asexually vs. hypersexuality. Some people seem to identify their sexuality with being autistic yet being diagnosed autistic by no means determines one's sexuality.

Also I find that we tend to informally label people as autistic if they're "weird" in some way. Like I had a girlfriend who most people described as weird especially when exposed to some of her speech habits, and my parents pressured me not to marry her because in their opinion she wasn't "normal", yet she did manage to live independently, served several years in the military, got married (at least for a while) and raised two kids (at least one of which is arguably also weird), has hobbies and seems to be OK with her current life although less than satisfied with the society in which she lives. At one point I thought she was on the autism spectrum but now I'm less convinced of that. Nevertheless I can see how, had she been born 40 years later, she might have been diagnosed as such and her life could have been drastically different as a result. Just as I can see how, given my observed behavior as a young child, I might also have been diagnosed and then spent the rest of my school career in Special Ed and might have also ended up in a different place than where I am given that I have always been held to the standards of a "normal" person.

In addition, this may be, to some extent, why WP is not always a harmonious "community" because its members don't really have as much in common as assumed.


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07 Aug 2022, 3:18 pm

I can see that many other individuals who have been identified (whether formally diagnosed or self diagnosed) with autism are not at the same wavelength as me.

But I can also see that an individual, after listening to the feelings and thoughts that I once thought were so strange that I'm the only one, replied decisively "same" so much so that drive me cry.

However, the similar essence is not always occlusive after being distorted by different environments.


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