Autists against neurodiversity unite!
An autistic individual's rebuttal of the spectrum
Autistic spectrum disorder rates have increased substantially in the West, largely due to diagnostic expansion. This has generated a discussion as to whether we are overdiagnising autism, which if true would yield a sizeable distortion of labour markets in Britain and America given anti-discrimination laws, as well as suboptimally high disability welfare claims. Therefore, it is imperative that diagnoses are as accurate as possible. Yet the diagnostic criteria, and the notion of autism as a spectrum that aggregates classic autism with Asperger's, generates notable controversy. As an autistic individual, I have a stake in this, so my preliminary thoughts on this matter form an invaluable contribution to this subject.
Crémieux writes the following:
“After the DSM-III became available, clinicians started diagnosing more and more children with the condition: an autism diagnosis was a shiny new tool in the psychiatric arsenal. To qualify for a diagnosis, a child had to be judged as having all of six different criteria, including “Onset before 30 months of age”, “pervasive lack of responsiveness to other people”, “gross deficits in language development”, “if speech is present, peculiar speech patterns such as immediate and delayed echolalia, metaphorical language, pronominal reversal”, “bizarre responses to various aspects of the environment”, and “absence of delusions, hallucinations, loosening of associations, and incoherence as in schizophrenia.”
Prior to this, autism was only diagnosed for the highly nonverbal that required intensive support. DSM III marks the departure of autism from a severe learning disability, as these set of symptoms can be consistent with high intelligence and a fully-functioning and independent livelihood. DSM IV then expanded the possible set of symptoms to seventeen, and one only needed a score of six to be diagnosed. Crucially, one no longer needed to have suffered delays in language acquisition; paving the way for Asperger's (distinct from classic autism by the very absence of delayed language learning) to be merged under the creation of the spectrum in 2013 with the DSM V.
My mental model of ASD conceives of three categories consistent with the DSM III criteria, with some overlap:
The nonverbal, or those requiring intensive round-the-clock care. Intellectually handicapped, and cannot live independently.
Those that can function independently, and are often of high intelligence. They also encountered a delay in language development.
Asperger's - characterised as (2) with no delays to language development.
All three share the symptoms of communication frictions, enhanced sensory processing (often to the point of notable discomfort), and a proclivity towards repetition with obsessive interests. Henceforth, I am not opposed to the DSM III criteria, although I do view Asperger's and autism as worthy of distinct diagnoses. I can usually sense if an individual is on the spectrum. Our relatively flat tonal and rhythmic patterns of spoken communication, and idiosyncrasies in frequency and volume of speech relative to the neurotypical party of an interaction, and more “robotic” body coordination, tends to give it away. All of us also yield a preference for literal speech, as opposed to idioms or sarcasm, or even metaphors for me. It has been noted that I tend to speak in rather elongated manner1. These mannerisms are subtle yet distinct, and therefore our neurological profile is indeed distinct from neurotypicals, and not solely a social construct of diagnosis.
Nonetheless, there is marked heterogeneity between the level of assistance required for the three categories. Those with Asperger's may appear superficially “socially awkward”, yet they clearly suffer no abnormal development hence any need for accomodations (as mandated in equality laws) is not obvious. Those in categories (2) may require additional support within their early childhoods, yet once they can communicate intelligibly with neurotypicals, they tend to share the same features as aspies. Only category (1) can credibly be conceptualised as a mental disability requiring substantial medical attention. For the rest of us, autism or Asperger's is no more dehabilitating than a cluster B personality disorder.
As such, it seems sensible to revive the distinction between Asperger's and autism, as they differ in language acquisition and hence need for additional accommodation in early childhood. Of course, whether a child ends up in category (2) or (1) may not be easily identifiable ex-ante. How do we predict the likely outcome? My intuition is that intelligence is the separating factor here - those in category (1) generally have left-tail IQ scores consistent with intellectual disability. Those in category (2) tend to be within one standard-deviation point from the mean, and when they do depart, it is overwhelmingly on the right-tail.
So the solution to overdiagnosis is obvious. Just IQ test everyone who receives an autism diagnosis in early childhood. However, this would require overcoming the entrenched ideological opposition to the very concept of IQ - one of the hallmarks of wokeness, as can be seen in their institutionalised discouragement under anti-discrimination laws, and the insistence of blank-slateists to attribute 100% of the gap in mean black and white IQ scores to environment.
Indeed, my opposition to the nascent neurodiversity ideology is derivative. Not only is the neurodiversity movement an extension of wokeness, and an attempt to place us within their hierarchy of the oppressed, it is also epistemologically bunk. No, we are not just one bundled set of cognitive traits uniformally distributed across everyone. There are clear trait correlations that reflect an underlying distinct neurobiology. There are discrete heterogeneities in severity of disability, which have obvious implications for their optimal institutional treatment. Yes, I used the word disability specifically, as neurodiversity theory advocates will deny that ASD is a disability, yet claim that disability is not to be stigmatised and viewed as a negative. Their obsessive pursuit of political correctness requires this gaping contradiction.
My concern regarding the neurodiversity concept is not solely an opposition to the wider DEI agenda, nor solely rooted in my desire to restrict anti-discrimination and disability laws to the greatest extent that politics will allow. As autistic individuals, we disproportionately care about the truth for its own sake. We do not consume ideas to signal, nor to self-aggrandise. Indeed many of us hate signalling, and find the elaborate norms and rituals relating to signalling bizarre or frustrating. We simply want theory to match with empirics. Neurodiversity clearly does not align with the empirical data, and is instead an elaborate ritual of self-aggrandisement by autistics whom desperately seek to be regarded as “normal” whilst denying that deviance from “normal” is bad! What they fail to notice is, by aggregating Elon Musk into the same condition as an intellectually disabled person who requires a carer for basic household maintenance, they diminish the former. If you wish to help the autists who need it, we must clearly start from an accurate representation of the condition.
For those of you wondering, I was diagnosed under DSM IV, and consider myself to fall in category (2). Technically, my diagnosis refers to “autistic tendencies”, yet functionally this has been treated as equivalent to autism. I considered writing about my childhood development and symptoms here, yet it bears no relevance beyond egotism, so it was cut out. Another post awaits…