When I tell this to people they understand immediately that I am in fact on that "spectrum".

My dad was highly successful; a leader in his industry and did a great job supporting us. His life was relatively easy (as easy as life can be in general) and he was a contributing member of society.

We love my friends kids to death and they do have many positive things going for them, but they will likely never be able to live on their own. Even if they do, they are in for a very hard life. They will likely always need to be supported by family and will likely never be contributing members of society.

To lump both those together is insane. It drives me crazy when people who are functional members of society run around laughing about how they are "autistic". I can't think of anything more disrespectful to those who can never have a "normal" life.

With that being said, I do recognize that medically there is a spectrum. I, as someone with ADHD am likely on that spectrum somewhere as well, from how the science is sounding these days. We need to make this spectrum obvious and respectful though. Why can't we classify a level or something? For example "Autistic level 1" for Asperger's, "Autistic level 2" for barely verbal, "Autistic level 3" for non-verbel... Something like that, so we can unite the cause, but still differentiate the effects and potential outcomes.

In terms of advocacy, there is strength in numbers, and arguably having such a large autism community has been good for both research and support. Potentially breaking that up into several smaller communities might lead to an overall decrease in impact.

On the other hand, pretty much everyone with autism, or families who have children with autism, will tell you that there is wide variation in both severity and presentation. And I think most would welcome better definition of subtypes.

They even eliminated "Asperger" and then just folded that into the spectrum as well.

I sometimes think about two women sitting on down on a bench. Once says a bit uneasily "my son, well he is on the spectrum" The other responds with "Oh I know what you are going through my daughter is also on the spectrum"

At this point neither has any idea whatsoever about what the others experience is like.

One may be highly functional, socially awkward and doesn't think like normal people and processes sight and sounds the same. I find myself moderately down this path.

The other may be non verbal and violent.

The presence of too many/particular ones of them is notably disabling for certain tasks, or makes perceiving some things difficult (and other things easier). But I think the presence of some is preferable to having none, and implies “can think abstractly for/about oneself.”

(And yes, a lot of the “problems” that arise with folks on the spectrum happen because, well, being aware of yourself as a cog/workmeat creates friction… It’s important to keep in mind how much of our history of psychological medicine that created the label “autism” is ultimately oriented towards “fixing the cog/workmeat.”)

The people without intellectual disability are more convenient to recruit for studies. As a result, across a wide variety of studies on autism, only 6% of autistic participants had intellectual disability.

https://link.springer.com/article/10.1186/s13229-019-0260-x

"Stomach ache" is not a spectrum disorder, even though is comes in many severities. It's a symptom of dozens of different medical conditions.

I suspect "autism" is similar.

I'd note that RFK Jr.'s very own aunt was lobotomized then hidden away for something that sounds a lot like autism if diagnosed today. https://en.wikipedia.org/wiki/Rosemary_Kennedy

The overlap also makes it difficult to diagnose ADHD when both are present.

Particularly when it comes to the brain. It's a reflection of how little we know about it.

To compare: Three profiles of people with diagnosed Autism.

Blindboy Boatclub: An Irish satirist who wears a plastic bag on his head in public appearances. Formerly of a band called The Rubberbandits. Today he is known for his podcast and has authored three books of short stories. He comes across as eccentric, but he's quite capable of managing in society otherwise.

Side note, one of the other members of The Rubberbandits went by the moniker of Mr Chrome, but is better known to people as Bobby Fingers today.

My stepson: Just a teenager navigating one of the more emotionally turbulent times while being noticeably different. He has fine motor issues and some social deficiencies. The best I could describe it is that he's emotionally a few years behind where other kids his age would be. He has few accommodations, mostly extra time and the ability to leave a situation that is overstimulating him. He's odd, probably always be a bit odd. May never be able to tie his shoes, but with work, he should be able to navigate society as a functioning adult one day.

Wife's student: My wife is a special education teacher and she has a student who is completely non-verbal. However, he is noticeably intelligent and can form complex thoughts and can attempt to express them. Managed to use his visual communication device to insult one of his teachers based on her appearance. He will likely have issues for his entire life and will likely need constant therapy.

Now, what one thing can we do for these three very different autistic people?

There's a reason people say "When you've met one person with autism, you've met one person with autism". While there are some commonalities and typical comorbidities, what we regard as autism presents in so many different ways, it's incredibly difficult to construct a single program to address it.

And I can see why we'd want to break it up. But that gets difficult as well. My stepson started low-verbal. Didn't speak for a while. Spoke rarely for a while longer. And now he speaks a lot. And he's learning when it is appropriate to speak and to handle people speaking around him but not to him. So he was non-verbal. But then became verbal. But not all autistic children cross that border.

All that to say: I dunno. Shit's complicated, yo.

If anyone must be branded atypical (not saying anyone should but am willing to pushback on those who do) and in need of special attention it should be the historical story-mode dependent who cannot move on from childhood allegory.

I think very few people actually consider it a single condition. To the point that most people that I know, including myself, say that we are "somewhere on the spectrum" or some variant of that.

This isn't a post diagnoses understanding either, it is well understood by anyone I have talked to about this in the last 10ish years? (maybe less, I cant really pinpoint that).

While I feel like there is value for professionals to be more specific about it, from an everyday person prospective I feel like "Autism" is well enough understood to be not just a single thing. Enough so that some phrasing along the lines of "my tism is..." is somewhat commonplace.

The real problem is anti-science people joining the conversation, but splitting up Autism is not going to change that.

Edit: To be very clear here I am not trying to say that most people in general are saying "I am somewhere on the spectrum". I am saying that most people I know which a larger portion of the people I regularly talk to are also diagnosed.

There's a reason Asperger Syndrome was abandoned as a separate condition and folded into ASD (in DSM-5) -- until then, anyone who wanted the diagnosis could get it, by displaying symptoms popularly associated with the condition. So we had clinical indicators, but no objective biological tests -- still true for most DSM-listed conditions. This led to widespread abuse and uncertainty.

The single label "autism" has many drawbacks, but one important advantage -- it reveals what we know in a scientific sense, which is next to nothing. Eventually neuroscience will change this and identify biological causes for many "mental" conditions. This will end diagnoses based on clinical interviews and replace them with objective biological tests.

I imagine this scene in a future neuroscience clinic:

Patient: "Let me tell you what I think is wrong with me."

Clinician: "Don't bother, we have objective biological tests now -- your narrative would only confuse the process. Remember psychology?"

Disorder by definition means that we do not consider it to have a single cause or issue, and we acknowledge that we don't understand it well enough to give it a single name, cause, or objective diagnostic criteria.

When we know what causes something, or how to strictly and objectively identify it, then we usually call it a disease.

This is well understood by medical professionals, and a normal part of their job, and not confusing for the vast majority of people diagnosed with some disorder or other.

This article is utter trash. As per the usual for the economist

This actively harms diagnostics and encourages cure-all peddlers.

Definitely has been good for financial benefits and such but... Once someone gets the "autistic" diagnosis all further research stops.

For example somebody with PDA autism cannot interpret the nonverbal communications of other people because they have already made the immediate decision that they want to be liked by others, so therefore they are. They cannot try new foods because they may not like it if they do try, so therefore they don't like it already. They would rather suffer hours of punishment grounded in their room than accomplish a 2 minute chore, because they already know in advance they would prefer to not do the chore given a choice to not do it.

People with PDA autism often appear to be sociopaths and pathological liars. They are not either of those things, due only to a minor difference in motivation. Sociopaths don't care if somebody else gets hurt so long as they get what they want, while harm to others does impact somebody with PDA in a very normal way. Since they have no capacity for empathy and color every past observance to fit their world definition of saving face it takes a lot of time with a PDA person to see the distinctions between them and a sociopath.

90% of the "conversation" around autism today is a bunch of handwavey bullshit. There's no incentive for people to be intellectually honest. It's now a moral hazard because so many people are "attached" to the label and get accommodations out of it. You can pay phony therapists online to just go straight to a diagnosis so you can get accommodations. There are financial and political incentives in diagnosing more people.

People can't have an honest conversation around it either because it's such a charged issue. We either get one side that wants to expand the scope of autism to infinity or the RFK vaccine bullshit

It looks like this article is talking about that exact preprint, but a quick skim didn't reveal any sort of link.

Ever since I first read it, I've been training myself to identify the subtypes. I don't have good names for them, nor do I know how they correspond to the names in the preprint, but I can usually tell them apart. I have indeed seen exactly four.

I would love for there to be more research into the intricacies of each subtype, because I feel that care and accommodation could get a lot more personalized and helpful if there were less of "anything goes / anything could happen" and more specialization to what's most likely to be effective for each particular subtype. As it is, a lot of care programs or individuals supporting them may be specialized to an unknown degree to particular subtypes and not really understand how to become less specialized or even specialize further.

On top of that, I greatly want to understand better the subtypes other than my own, not least because a couple of them I can find very difficult to communicate with because my knowledge and arguments are formatted differently than how they learn. I want to learn how to format my knowledge in a way that's easier for them to understand and more convincing for them.

I'm just very curious and interested and I really hope the idea of autistic subtypes takes off because it absolutely agrees with what I've seen in practice.

[edit] To be more specific, this is a lazy take and is about as insightful as saying 'cancer should not be treated as a single condition' which for HN is about as meaningful as saying 'the CPU and the GPU may both contain chips, but they should not be programmed the same.'

So people who have problems get lumped together because these systems are all stripped for parts because of capitalism and religiousity.

It'd be great to have a functional science based medical care but that won't help the children stuck in a hellhole of anti science, antisocial and pathological liars.

But calling people with social challenges “Assburgers,” I mean, wow. Just wow.

https://getpartner.ai

Are you shy, slightly socially awkward and very intelligent? You must be "on the spectrum".

The most intelligent, knowledgeable, socially tuned and socially integrated people I see online claim to be autistic. I swear it is absolute nonsense.

Not that people low on the spectrum aren’t important, they are, but that just using standard interaction tactics that I would with non-spectrum people works well enough.

So trying to save time that someone doesn’t need to interrupt the conversation to say they are on the spectrum and can only eat smooth foods or whatever.