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

http://www.salon.com/2013/09/21/thats_not_autism_its_simply_a_brainy_introverted_boy/

by jonnathanson • 13 years ago

78 65 13 years ago

iliiilliili4• 13 years ago

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

skylan_q• 13 years ago

I have aspergers. Give me money.

pstack3• 13 years ago

That's not how it works.

We are the medical industry and have codified the diagnosis of aspergers to be far encompassing and include people who have absolutely no real impact on their lives, but we've convinced them it is a problem and now we're going to provide them with a pharmaceutical and psychiatric therapy to help them "cope" with it -- GIVE US MONEY.

melange• 13 years ago

Why was this being downvoted?

psbp• 13 years ago

Because people assume it's an insubstantial conspiracy. I have plenty of friends and family who work in medicine and they'll readily admit that there are fad disorders closely preceded or followed by a pharmaceutical to treat them.

iliiilliili4• 13 years ago

I dunno, or care, but it's funny, there was an article posted here recently that was titled almost exactly `psychiatry is bullshit' and that got to the front page. It's not a conspiracy, it's incompetent doctors readily prescribing dangerous drugs to children for make believe illnesses. This has happened since the birth of medicine and will continue to do so.

pstack3• 13 years ago

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.)

darkarmani• 13 years ago

Because it is flamebait.

auctiontheory• 13 years ago

I am not aware of any pharmaceutical treatments for autism. (Nor is Google.)

If autism is indeed being over-diagnosed, this is not due to pressure from Big Pharma.

Careful of your generalizations.

liquidise• 13 years ago

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.

pstack3• 13 years ago

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

derleth• 13 years ago

pills and therapy

There's no recognized drug treatment for Autism/Asperger's[1], and I kind of question your skepticism towards therapy. What's wrong with getting help with things you could be doing better.

[1] The only drug treatments relevant are drugs used to treat comorbid conditions. http://www.webmd.com/brain/autism/autism-treatment-overview

Being intelligent does not a disorder make.

Nobody's saying it does.

jonnathanson7• 13 years ago

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• 13 years ago

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.

thenerdfiles• 13 years ago

We have to acknowledge the racial differences and interactions: racialism, no racism. Intelligence within one race does not necessarily trigger similar responses in perception by other races.

That's just a "C'mon," y'know?

And it is well established, for instance, that autism diagnosis in African American, Mexican American, and Native American peoples is delayed by ~2 years. So "intelligence" really does no service as a normative guideline here.

jonnathanson7• 13 years ago

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.

jasonlotito6• 13 years ago

While you make good points, all to often I see people use articles like this as an excuse to question those diagnosed with autism. As a father of 2 children with autism (and no, we're not talking about high-IQ introverted children), there is a lot of stigma associated with autism already.

So, this is just a friendly reminder not to try and make armchair diagnoses.

jonnathanson7• 13 years ago

"all to often I see people use articles like this as an excuse to question those diagnosed with autism"

That's certainly not my intent, and I hope that's not what this is being taken for. I apologize if I've given that impression!

For the record, I have a (legitimately) autistic family member myself.

I think we should work to ease both stigmata: the stigma associated with autism, and the stigma associated with this particular combination of high-IQ + introversion.

GarvielLoken3• 13 years ago

I am tired of that people equal introverts == intelligence and extroversion == ordinary. Have you actually bothered to learn any type classification system like MBTI or Jungs theories?

If you had (have?) then you know that extraversion and introversion are simply attitudes(positions) of any cognitive function and they can be rougly translated as objective or subjective position. Take me, i get ENTJ ( dominate function: Extroverted Thinking ) on a typical test and i identify with William.

Based on the text i guess William also is an TE dom or aux (auxillary function). This is because TE (Extroverted Thinking) is interested in knowing and structuring the world. Example is when William lead his mates for plays, what i know an TI (Introverted thinker) would Not have done so. Also William reads lots of facts, history books. He is interested in widening his Knowledge before his Understanding, an Ti is interested in understanding first. Ti are more the classical intelligence loners, that is because they focus on structuring their thoughts and internal models, a Te measures and structures the world.

Overall your post is very biased and uninformed. "extroversion" could be any of: extroverted thinking ( Archetype: General, CEO, Scientist (because Te is interested in measurements and result in the real world) ), extroverted intuition ( Archetype: Eccentric millionaire, eccentric professor, inventor), extroverted feeling ( Archetype: great writers, psychologies, political leaders ) or extroverted sensors (Archetype: Great athletes, competitors, chefs, sensor type critiques). All of the archetypes that i have listed usually are considered intelligent also, as alternatives to the Archetype of the Introverted thinker: philosopher and mathematician.

According to your stereotype text i guess you associate extroversion with extroverted sensing and extroverted feeling in a dom or aux place in individuals.

I would recommend that you expand your knowledge before posting more biased texts about extroverts.

Daniel_Newby• 13 years ago

The grandparent comment does not equate intelligence and introversion.

epsylon• 13 years ago

MBTI

MBTI is a commercial product based on old theories. It sells well because the results are usually presented as only positive and desirable traits (the archetypes). For a more accurate representation of personality types, the Big Five has more or less the consensus nowadays. (it's more "scientific", as far as psychology can be "science")

Both are somehow correlated, but a well known failure of the MTBI model is the lack of distinction between introversion and neuroticism.

http://skepdic.com/myersb.html

http://www.theguardian.com/science/brain-flapping/2013/mar/1...

http://skeptoid.com/episodes/4221

https://en.wikipedia.org/wiki/Myers-Briggs_Type_Indicator#Cr...

https://en.wikipedia.org/wiki/Big_five_personality_traits

k1kingy• 13 years ago

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• 13 years ago

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.

pyre2• 13 years ago

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.

darkxanthos• 13 years ago

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/

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.

jonnathanson7• 13 years ago

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.

ericabiz2• 13 years ago

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 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.

roarroar• 13 years ago

Yeesh. Why take his personal experience as some kind of denial of your existence? This article wasn't about you. And citing the membership of a subreddit against him is irrecoverably flawed, since niche Internet collectives aggressively select from the extrema.

jonnathanson7• 13 years ago

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).

jacalata• 13 years ago

You didn't see either of those things? His main argument seemed to be "we can mistake traditional masculine behavior for high-functioning autism." The overwhelming presence of quotes like "Is he high-functioning autistic or really a more masculine-identified boy?" "Brainy, introverted boys beware", "... these behaviors might be characteristic of both willful male toddlers and autistic children", "....it is tough to distinguish between early signs of autism spectrum disorder and indications that we have on our hands a young boy who is a budding intellectual" combine to make it pretty unlikely that we just happen to be reading the single part of the book where he overwhelmingly focuses on the association of autism and 'normal masculine behaviour'.

ericabiz2• 13 years ago

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.

Nktakumi• 13 years ago

Which books on body langauge did you specifically read if I may ask?

Tichy• 13 years ago

I think it is generally understood that such articles are about averages. Your existence has no bearing on the proportions of boys vs girls who display certain behaviors. If there are on average gender differences in behavior, it makes sense to look into that. And if the typical behavior of one gender is taken as a desirable baseline, then it can be a problem for the other gender.

I agree that it would be a problem if the same kind of behavior would be categorized as "she has ADHD or autism" in girls and "it's just boys being boys" in boys.

Just curious, how did the ADHD diagnosis make your life better?

tekalon• 13 years ago

I don't know about the parent comment you are asking- for me, ADD diagnosis all my life helped me understand my quirks. Why I'm impulsive, why I have trouble concentrating (especially in XYZ environment). Knowing what to google or ask councilor for help with. It helped my parents raise me since they were able to work with my quirks. My sister has autism and was diagnosed in her early twenties. Same with my husband. They are under that high functional Aspergers spectrum that the article author is describing - intelligent, introverted, few behavior/social quirks. From what both of them have told me, having that 'name' they can attribute their quirkiness helps them deal and manage rather than a vague 'being weird/different/wrong' feeling otherwise.

loceng• 13 years ago

Just out of curiosity have you ever heard of or looked into Auditory Integration Re-Training as an option - see if it can help with the "ADHD" you have? The website is geared towards children though I did it in my early twenties, and just this past summer and I'm 30. It has been highly beneficial each time, allowing my ADHD-like behaviours dissipate. http://aitinstitute.org/ is the website. If you scroll down to the bottom of the content body you'll see "Berard AIT Can Help These Diagnoses" - which then lists a number of symptoms/diagnoses that the therapy has helped.

205guy• 13 years ago

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

eliasmacpherson2• 13 years ago

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...

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

[2] http://englishcowpath.blogspot.com/2011/06/euphemism-treadmi...

codezero• 13 years ago

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• 13 years ago

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.

malandrew• 13 years ago

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.

bsullivan01• 13 years ago

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.

sparkie2• 13 years ago

Don't forget the cost of all those drugs.

jlgreco• 13 years ago

What medications do they prescribe for autism?

adamconroy• 13 years ago

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

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

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