For some people these diagnoses will be a very good fit with clear predictive outcomes. But many of us have a grab-bag of traits from several categories and still mostly get along in life, maybe with some assistance particular to one of these diagnosis but no more help overall than anyone else needs otherwise.
The diagnostic models suck. They are too broad here, too narrow there, misunderstood by professionals. I had a psychiatrist (mis)diagnose me as bipolar based on a 45 minute appointment when I was in some sort of crisis in my early 30s and that ended up haunting me years later when applying for a job with a security clearance. I didn’t even know about it at the time. This was one of the top rated doctors in a major metro area. What a sham.
The field is a mess. It has a terrible history of horrific abuse. Some autistic children still receive involuntary-to-them ECT. I think we should be supportive of research into these topics while also being critical of the very obvious problems with them.
Adults too; ask me how I know.
Did your sporting team have success on the weekend? Wonderful, direct eye contact, smile, mirror. Ok, now, to business:
I—-as a non-autistic person—-have lots of default tendencies which were socially discouraged as a child and which are now no longer part of my self concept. I’m not “repressing” a desire to be awkward, I’ve simply learned to be less awkward.
But my understanding of autism, which is I think backed by the article itself, is that autism exists as a fundamental cognitive process and tends to be pretty stable.
Btw the reason I ask is to learn…as a software dev and manager, several of the people I interact with could probably be diagnosed autistic and I’m always curious to try to understand what that’s like better.
I think autistic people would have less eye corner wrinkles, because they don’t smile automatically when others smile. A study would be interesting.
The brain is neuroplastic, especially when young, but I doubt you can just influence the growth of significantly more dopamine receptors out of pure willpower and habit-forming; especially given that ADHD disrupts those two facilities.
This is in part why dopaminergic drugs such as Adderall work so well, and why dopamine/reward-center disruption due to childhood trauma can have such a negative impact on one's ADHD symptoms.
Again, I don't know how much this applies back to autism, but it has definitely been a bane of my existence constantly explaining to people why I can't just meditate, habit-form or diet or exercise away my symptoms.
These things help, as does directed research and experimentation with what does and doesn't work for me, and because of my ADHD these things are integral to my ability to function as an adult in this insanely complex and stressful world. And it's definitely made a difference in how I manage my symptoms, especially when I look at how my siblings don't manage theirs and lack basic coping mechanisms.
But I frequently run into people who arrogantly assume I've never even heard of meditation, or that I have a bad diet, etc. and offer them up as panaceas. These people often get defensive and more arrogant whenever I try to explain to them that ADHD is not just some "mental block" or collection of bad habits that can be "fixed".
So yea... I also think we need to do way more clinical studies about the effects of teaching coping mechanisms at a young age, but I don't think autism is something that you can grow out of, there are likely specific underlying genetic and neurological factors that affect how much a specific individual can control or cope with their symptoms.
I'm sorry you have resentment issues... definitely get that.
>The key distinctions are that socially awkward individuals understand what they should do socially but find it difficult or uninteresting (versus genuinely not understanding unwritten rules), show significant improvement with practice and maturity, are more comfortable in specific contexts, lack the sensory sensitivities and restricted/repetitive behaviors required for autism diagnosis, and generally achieve life goals despite awkwardness rather than experiencing clinically significant impairment.
It seems to me that this sort of definition would preclude any person having general intelligence such that they are able to learn to mask (or feel like they have to mask less in certain safe areas).
Society is moving in the right direction at least. At one point, the bell curve had 3 sections: normal, genius, retarded. Now we have more gradients and some of them trigger help or maybe longer exam times.
This causes over-diagnosis and resentment. Coping mechanisms grow over time. It’s definitely better if you can appear neurotypical.
Once you understand that neurotypicals have special needs and you must play-act to smooth things over, then you play the game.
I think your comment is very insightful. It made me think and reflect. I am not socially awkward, however: but I am autistic. I really think so. My ability to appear less so over time is my own achievement.
When I first started interviewing people, I would have crippling anxiety. On days I had a interview scheduled with a candidate, I would obsess and have anxiety to the point where I wasn't able to focus on anything until the interview was over. It was bad. I'd spend hours rehearsing every line I was going to say. I was an incredibly awkward interviewer.
Fast forward 10 years and hundreds of interviews later, the anxiety is completely gone and an interview doesn't even spike my heart rate anymore.
I absolutely met multiple DSM criteria for anxiety 10 years ago, but not anymore.
I suppose I was cured through "exposure therapy" (or whatever you call doing something repeatedly that gives you massive anxiety).
Interviewing still doesn't come naturally to me. But it's easy now because every interview is basically scripted. I repeat lines that I memorized over the years. I always start interviews with the same ice breaker. I use multiple tactics to put myself and the candidate at ease throughout the call.
Do I still have anxiety even though I've learned how to cope with it? I don't know.
Is someone still autistic if they were able to learn coping tactics that make the symptoms invisible to themselves and others? I don't know.
I think the most important part of what you wrote is that you changed over time. Whether that improvement came from meditation, therapy, maturity, trauma processing, or simply growing into yourself, it challenges the idea that autism is a static essence. Development, coping skills, neurology, and environment interact in ways the current diagnostic boundaries don’t fully capture.
Where I push back slightly is on the conclusion that self-diagnosis can automatically fill the gaps. For some people it’s deeply accurate and validating, for others it may explain one part of their experience but obscure another. As you said, many people carry a “grab-bag” of traits, and a single label can illuminate or compress that complexity depending on how it’s used.
You’re right that the field has a painful history and uneven present. Misdiagnosis is real. Forced treatment is real. Diagnostic tools are blunt instruments for a very diverse human reality. Supporting research while staying critical of the system makes sense, not because autism isn’t real, but because the categories we have are still evolving. Your story is a perfect example of why humility in diagnosis matters, whether it’s done by a psychiatrist or by oneself.
Edit:typo
There are some clinicians and unfortunately now many patients and caregivers that nonetheless take an essentialist view of diagnosis and come to identify their patient/self/child/peer with what's really just meant to be a guideline for support with ongoing dysfunctions.
In reality, most people face some fluctuating bag of dysfunctions over the course of their life, with fluctuating intensity, with contributing causes too diffuse and numerous to identify. They might be diagnosed squarely by one clinician with one thing thing at one time, then see some other clinician the same day who thinks the diagnosis was overstated or preposterous. Or they might find that a qualifying symptom that seemed very salient at one time of their life hasn't been an issue for them for a long time because of some new learned behavior, some change of circumstance, etc. Likewise, they may even find themselves facing new or greater dysfunctions compared to what they'd experienced or noticed before, precipitated through known or unknown reasons.
For people most intensely disabled by mental health dysfunction, they often can't escape that dysfunction entirely without the discovery and resolution of some kind of radical physiological or environmental issue.
But for the majority of people who just found that they had a hard time with their daily life, but were otherwise independent, and received a diagnosis that helped them see some constellation of related factors and opportunities for accommodation or treatment, things are hardly so static.
For most of early psychology, this marked the distinction between "psychotic" and "neurotic" presentations. The former represented a disruption so severe that escaping disability and achieving independence were largely out of reach, whereas the latter were understood to be real but fluctuating or even ephemeral disturbances.
It's not really until very recently, when so many people started to obsess with "identifying" themselves with this thing or that thing in some kind of permanent way, that this distinction began to fall out of mind.
In the case of those diagnosed with autism as part of generally independent and functional lives, it's not hard to find people who have experienced changes to the symptoms that originally qualified them for the diagnosis -- sometimes positively, sometimes negatively; sometimes during certain times, sometimes permanently. It's also not hard to find people who received such a diagnosis at one time and either felt comfortable fully rejecting that diagnosis at some later time or had a clinician who strongly questioned it or refused to confirm it. None of this stuff is static and much of it is subjective.
I masked for years but recently (possibly linked to some bereavements in the family, who knows what the actual trigger was if there even was one single trigger) the constant effort required just burned me out. Anxiety spiked, depression symptoms loomed, and I just felt exhausted all of the time.
For what it's worth, exposure therapy is a real term and it's an actual part of cognitive behavioural therapy.
p.s.: hope you're doing better now.
It does not mean I am bad at it, it means I don't understand the rules. I can copy others people tactics and sometimes it works, but still don't know why.