> I am still struggling to understand the way in which many people naturally form casual connections with others. [...] I perceive a lot of confusion here - and in my own life - about personal wants and needs being met, meeting someone else’s needs, where one’s personal boundaries lie, and how we effectively communicate them - or not.
I think this is a really interesting question. Speaking just from my perspective and experience, casual connections can form naturally from the basis of having no specific intention to connect. You simply give your attention to the other person without any preconceived needs or wants. Maybe the interaction is brief and superficial, maybe it goes somewhere deeper, who knows. But either way you get to experience the real, rubber-hits-the-road connection of being present with the other.
An important understanding is that it's possible to genuinely connect without being entangled in any way.
You're right that sensory issues make up a small (optional) part of the diagnostic criteria for ASD under the DSM-5. And I agree that "autism" in popular discourse seems to be very flexible and inclusive, but the medical diagnostic criteria are much more specific. When someone does meet these criteria, there's something going on that isn't just a collection of unrelated peculiarities. This seems to be supported by the very high heritability of diagnosed ASD.
I would agree with you that there are issues caused by the wide range of presentations. It seems as though there's a tension between differentiation and unification at the various levels of scientific research, social understanding, social accommodation, etc. I expect things will get teased out over time.
> To meet diagnostic criteria for ASD according to DSM-5, a child must have persistent deficits in each of three areas of social communication and interaction (see A.1. through A.3. below) plus at least two of four types of restricted, repetitive behaviors (see B.1. through B.4. below).
Example (A.1):
> Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions
The medical diagnostic criteria, despite using technical language, are still vague: "deficits in..." has a wide interpretation. Furthermore, "at least two of the four" permits two people diagnosed with autism to have different symptoms: one child may only have limited interests and insistence on sameness, while another may only have "stereotyped" motor movements and hypersensitivity (and the specific interests, "stereotyped" behaviors, and hypersensitive stimuli can vary).
I've copied the required features from your linked document. With that said, I'd say most people tend to have every trait there to some extent. So I'm not sure that the medical criteria is as specific as you implied. It seems like the main criteria they use is that the symptoms cause significant impairment in your life.
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Essential (Required) Features:
Persistent deficits in initiating and sustaining social communication and reciprocal social interactions that are outside the expected range of typical functioning given the individual’s age and level of intellectual development.
Specific manifestations of these deficits vary according to chronological age, verbal and intellectual ability, and disorder severity.
Manifestations may include limitations in the following:
Understanding of, interest in, or inappropriate responses to the verbal or non-verbal social communications of others.
Integration of spoken language with typical complimentary non-verbal cues, such as eye contact, gestures, facial expressions and body language.
These non-verbal behaviours may also be reduced in frequency or intensity.
Understanding and use of language in social contexts and ability to initiate and sustain reciprocal social conversations.
Social awareness, leading to behaviour that is not appropriately modulated according to the social context.
Ability to imagine and respond to the feelings, emotional states, and attitudes of others.
Mutual sharing of interests.
Ability to make and sustain typical peer relationships.
Persistent restricted, repetitive, and inflexible patterns of behaviour, interests, or activities that are clearly atypical or excessive for the individual’s age and sociocultural context.
These may include:
Lack of adaptability to new experiences and circumstances, with associated distress, that can be evoked by trivial changes to a familiar environment or in response to unanticipated events.
Inflexible adherence to particular routines; for example, these may be geographic such as following familiar routes, or may require precise timing such as mealtimes or transport.
Excessive adherence to rules (e.g., when playing games).
Excessive and persistent ritualized patterns of behaviour (e.g., preoccupation with lining up or sorting objects in a particular way) that serve no apparent external purpose.
Repetitive and stereotyped motor movements, such as whole body movements (e.g., rocking), atypical gait (e.g., walking on tiptoes), unusual hand or finger movements and posturing.
These behaviours are particularly common during early childhood.
Persistent preoccupation with one or more special interests, parts of objects, or specific types of stimuli (including media) or an unusually strong attachment to particular objects (excluding typical comforters).
Lifelong excessive and persistent hypersensitivity or hyposensitivity to sensory stimuli or unusual interest in a sensory stimulus, which may include actual or anticipated sounds, light, textures (especially clothing and food), odors and tastes, heat, cold, or pain.
The onset of the disorder occurs during the developmental period, typically in early childhood, but characteristic symptoms may not become fully manifest until later, when social demands exceed limited capacities.
The symptoms result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
Some individuals with Autism Spectrum Disorder are able to function adequately in many contexts through exceptional effort, such that their deficits may not be apparent to others.
A diagnosis of Autism Spectrum Disorder is still appropriate in such cases.
I think the word "spectrum" is reasonable, as it implies a broad range. Or it's analogous to the rainbow with a variety of colours.
But what people consistently misunderstand is that there is a fundamental dichotomy at the diagnostic level. Speaking from the perspective of the DSM, which I prefer because it's at least concrete and has medical relevance in North America, you meet the criteria for Autism Spectrum Disorder ("on the spectrum") or you do not ("not on the spectrum").
In other words, the diagnostic criteria themselves do not constitute a spectrum, especially not a linear one. Maybe people are confusing this with the DSM's three levels of support needs.
In clinical contexts, cognitive tests are used for diagnostic purposes. They are important to determine exactly what sort of ongoing care and support the person needs in order to thrive. In these sorts of contexts, it's not hard to imagine the utility in knowing someone's cognitive ability. It's also not arbitrary—a good cognitive test will give insight into the ability to perform everyday cognitive tasks.
> In clinical contexts, cognitive tests are used for diagnostic purposes.
I'm not certain I agree. If anything, cognitive tests can be used as a single point of datum, but to my knowledge, no condition can be diagnosed via a cognitive test alone. Of course, I could be mistaken. I wish administered the WAIS-IV on top of many other tests for an ADHD diagnosis.
> They are important to determine exactly what sort of ongoing care and support the person needs in order to thrive.
Interesting, upon my receiving my diagnosis, I was not provided any support nor would I declare I have thrived. Obviously, n = 1. I was merely given the social approval to take pharma-grade speed and thrown back to the wolves.
> It's also not arbitrary—a good cognitive test will give insight into the ability to perform everyday cognitive tasks.
That's the part I believe I am clearly missing. These tests provide insight into the ability to perform everyday cognitive tasks better than one's history of already performing various tasks? It's not as if someone with a perfect SAT score takes an IQ tests and then is met with the sudden reality that they are mentally disabled nor vice versa.
What do these tests tell us that we already do not know? If I want to find someone with high mathematical abilities, then I would administer a math exam. Reading? Reading exam. Chess? Chess tournament. And so on...
> I'm not certain I agree. If anything, cognitive tests can be used as a single point of datum, but to my knowledge, no condition can be diagnosed via a cognitive test alone.
I did not read the comment you're replying to as saying otherwise.
Honestly, imo clinically in aggregate the actually score itself provides very little information beyond what a 5 minute conversation would achieve, and the result could be better thought as bordering on 5-6 level categorical variable rather than a gradient due to their biases and inherent individual patient variance on performance and test taking context.
The sub-sections of things like the WAIS can be of some value for identifying specific abnormalities or deficiencies, but as you said, is probably of more value clinically to split them out into separate tests/activities rather than to group them all together into an aggregate score. It's a bit like judging athletic ability and skill by BMI and fat percentage rather than just playing an opponent in tennis to find out if they're a good tennis player.
> Interesting, upon my receiving my diagnosis, I was not provided any support nor would I declare I have thrived. Obviously, n = 1. I was merely given the social approval to take pharma-grade speed and thrown back to the wolves.
United States? It's not quite like that everywhere.
Yes, United States. I should add that I wasn't diagnosed until I was 22.5 years old.
Growing up in the South East, USA, there were no such things as Autism, ADHD, etc.. Things have gotten better, I suppose, but I'm in my early 30s, so this wasn't exactly a long time ago either. You know how schools have 'gifted and talented' programs? I was in the 'cursed and talentless' program.
Strictly speaking, any intervention other than exercise is going to give you a subset of the total stimulation. A drug acting on the tissues directly would bypass the neurological component, for example.
If the idea is to avoid the effort of exercise, perhaps it would be worth considering the possibility that the effort itself is essential.
If we were good enough to have drugs that could work with that precision we’d eliminate an enormous category of things. The side effects are usually the scary things. We have drugs that can cure the symptoms of depression and anxiety - they just so happen to be insanely addictive, cause respiratory depression, loss of coordination, and you quickly build a tolerance to them.
Of course, they certainly do. But this article is really something else! I don't care if it's written by AI or not, but it has a rhetorical style that relies much more on rhythm than on connecting the conceptual dots. Like a TED talk or a revivalist preacher.
