The line between neurotypical and autistic and severity

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autiecat
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07 Jul 2021, 8:17 pm

Jiheisho wrote:
autiecat wrote:
HeroOfHyrule wrote:
I think the part of it is that there are people who invalidate people with more "mild" autism and the support they may need. Whenever I've heard someone say you "can't be a little autistic" it's either in the situation Isa described, or where people are acting like higher functioning people are "less" autistic than others and less deserving of support.

Also, you can't really be a "little bit autistic" just because you match one or two criteria. Most NT people don't have the genetic or neurological changes that people with ASD have, and are not "a little" autistic even if they relate with a couple issues that we have. If an "NT" person qualifies as part of the "broader autism phenotype" and just got lucky with not developing full blown ASD then sure, but most aren't like that.


I'm thinking that there could be variations in brains that are in between the NT brain and ASD brain. Of course people with just a few traits won't meet the diagnostic criteria and are not technically classified as autistic. So they're not a "little bit autistic" in that they would be diagnosed as autistic - just in the sense that they have some autistic traits. When both neurotypicals and autistic people take autism assessments, there are always scores along the borderline.

I'm not talking about the implications of using the terms - just the fact that there is a distribution of scores that fall in the middle. In this sense, those toward to extreme end are "more autistic" as they have more autistic traits at greater severities. I completely understand why some people don't like the distinctions between different levels of autism. Some people feel that their struggles are invalidated if they're classified as "mildly" autistic or think that this means they are less deserving of supports.


None of these tests are diagnostic. Having the traits of autism does not mean you are autistic. Autism is a condition from birth and the test does not account for that. Other conditions have similar traits as well.

Also, there is no "mild" autism. Autism is classified by support levels from 1 to 3. You are categorized by the amount of support you need, not how you might appear to others.



I'm aware that the tests are not diagnostic. They are just meant to measure autistic traits and further professional evaluation is required. My point is that if everyone were to be assessed on their autistic traits, there would be a distribution with some people showing more autistic traits with greater intensities and others showing less traits and lower intensities even AMONG people who have been diagnosed as autistic. I'm aware that the DSM-5 doesn't use the term "mild" autism, but that doesn't mean some autistic people don't show milder or more severe traits.



autiecat
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07 Jul 2021, 8:25 pm

ToughDiamond wrote:
I remember Baron-Cohen saying that if you think you've got a bit of Aspergers, you probably haven't got it. I didn't agree with him and still don't. His view is that it's OK for him to draw a rather arbitrary line and say that anybody who doesn't quite score above that should have the diagnosis withheld from them. Me, I just see AS as a continuum, and I recognise that somebody who just scores enough for the DX is almost no different from somebody who doesn't quite score enough. I just can't do that reductionist thing that would conclude one is simply positive and the other simply negative. It's bad enough reducing AS to a single number, let alone trying to reduce it to yes or no. And the 3 levels of severity isn't much better. I suppose it's necessary for them to simplify it so they can calculate how much to spend on a given person or whatever they do, but I don't have that to worry about so I can just look at the individual and figure out what they're good at and what they're bad at, to assign a multi-faceted profile to them if you like. I don't know many people well enough to have that much information about them, but in principle that's what I always set out to do. It's probably not surprising that if you try to hammer real people into neat pigeon holes, it doesn't work very well.


This is my thinking too. Autistic people will have different presentations and combinations of traits, but some people will overall have more number of traits or at greater intensities and others will overall have fewer traits or at lower intensities. To be diagnosed as autistic you're going to need to pass some threshold (i.e. meeting the DSM 5 criteria), but that doesn't mean everyone at either side of this threshold have the same amount/intensities of autistic traits.



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08 Jul 2021, 8:33 am

The word "autism" may be used as a "synonym" for conditions from broader group of developmental disorders called "pervaisve developmental disorders" (PDD was a subcategory of disorders in ICD-10 and DSM-IV, but it is absent in DSM-V where are just autism spectrum disorder and social communication disorder).

In my country (Poland) there is a special category of disability called "pervasive developmental disorders" ("całościowe zaburzenia rozwoju") which has the symbol 12-C (from first letter of Polish word "całościowe"), not the category of "autism" or "autism spectrum disorder" and this category of disability is different from "metall illnesses" ("choroby psychiczne") category (which covers, for example, psychotic disorders, more significant affective disorders, severe anxiety disorders), this category has the symbol 02-P (from first letter of Polish word "psychiczne").

I think that not every PDD meet DSM-V criteria for ASD or even ICD-10 or DSM-IV criteria for any of PDDs. I think that PDDs can be not present in birth or infancy, but may develop later, but still weel before adolescence. Also PDDs have not to be genetic and (or) hereditary. And, of course, not all PDDs have to be related to bookish cases of childhood autism from DSM-IV/ICD-10 or autism spectrum disorder from DSM-V.

I think that people with social communication disorder from DSM-V or most of individuals with nonverbal learning disability (NLD, NVLD) or individuals with persistent personality disorders (at least ones of cluster A (odd-eccentric), like schizoid or schizotypal, or similar to it) which are present and noticeable since pre-adolescence in fact have certain forms of PDD also when they do not make DSM-V criteria of ASD. I think that they should have symbol 12-C on they ruling of disability when they have certain impairment in normal life (for example in occupational area) and do not meet criteria for autism spectrum disorder. Not every pervasive developmental disorder have to be autism spectrum disorder!

PDD tends to be similarily disabling as intellectual development disorder (IDD has diffrent level of severity from mild to profound, PDD also can have different levels of severity), both PDD and IDD last since childhood and are persistent, they can't be "generally cured" by meditations like, for example, depressive disorder, there are no remissions in PDD and IDD.

I would say that I definitely have a PDD but it differs clearly from stereotypical image of ASD (even better-functioning ASD). I did not have any speech delay, I think in words, I does not need sameness and predictability in the way in which people with typical autism need them, I do not have splinter skills, I learned how to lie early, I am not so bad in understanding figurative language, I am poor in tolerating unpleasant sensory feelings but I do not have idiosyncratic processing of sensory stimuli (I think that I do not have hyposensitivity or hypersensitivity of senses and I think that I have never experienced sensory overload(!))). I even have symbol 12-C (along with an other symbol, 02-P) on my ruling of moderate (not mild, but also not (the most) severe) level of disability.



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08 Jul 2021, 11:45 am

People have varying amounts and intensity of autistic traits. How many and intensely one has to have these traits to be considered autistic is subjective and has changed radically over the years. If you are close to a subjective line be it enough traits to be autistic, enough sexual attraction to ones own sex to be considered bi sexual, or even being born in a year near a subjective generational divide it is going to cause difficulties for you. Yet we need to draw line a line somewhere, accepting that everybody is autistic renders the concept useless.

Logically having more autistic traits and having them more intensely makes you “more autistic”. Also by definition “less autistic” is not the same as “not autistic” but we pretend it is for a number of social and political reasons. The long history of “less autistic” being othered or being dismissed, as a very small minority any type of dividing us hurts our cause. People take offense to “less autistic” because of often justified fears of being judged as “not autistic enough” or even “not autistic”.


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naturalplastic
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08 Jul 2021, 12:24 pm

Well...being NT is like being "Goy". And autism is a spectrum. Like Judaism. You can be Orthodox, Conservative, or Reform. Level 1 autistics are "reform", level 2 are "Conservative", and level 3 are "Orthodox". :D



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08 Jul 2021, 4:49 pm

OK, I'll be serious for once.

This is where functioning labels ARE useful and DO exist. Usually high-functioning Aspies do a better job at masking and can come across as NT, how that drains them on the inside is a different thing but the way they can carry out day-to-day tasks and communication is to do with being high-functioning.
Moderate-functioning is a bit of both; the Aspie may be able to do certain things on certain days but can only mask for limited times, also their symptoms show a bit more like they might flap their hands in front of people or lack tone in their voice, and their functioning may fluctuate depending on their current state of mind.
Low-functioning Aspies are less likely to cope in most situations and may need support or care their entire lives. Intelligence doesn't always come into it, as some low-functioning Aspies might have a better IQ than me, but usually they have very minimal social and communication skills that they may not be capable of learning.

But it's not as black and white as that, it's just a rough idea of different types of autism.

(Ps. In this post Aspies = all autistics)


That's how I see it.

Maybe someone should start a thread asking what your diagnosis was (where you are medically considered to be on the spectrum), then ask questions about your daily functioning and social skills. Just to see how different people answer and to see if there are any patterns.


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Last edited by Joe90 on 08 Jul 2021, 4:52 pm, edited 1 time in total.

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08 Jul 2021, 4:50 pm

naturalplastic wrote:
Well...being NT is like being "Goy". And autism is a spectrum. Like Judaism. You can be Orthodox, Conservative, or Reform. Level 1 autistics are "reform", level 2 are "Conservative", and level 3 are "Orthodox". :D


At least we don't need to get surgically altered to join this club. :lol:


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autiecat
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08 Jul 2021, 5:41 pm

nca14 wrote:
I think that people with social communication disorder from DSM-V or most of individuals with nonverbal learning disability (NLD, NVLD) or individuals with persistent personality disorders (at least ones of cluster A (odd-eccentric), like schizoid or schizotypal, or similar to it) which are present and noticeable since pre-adolescence in fact have certain forms of PDD also when they do not make DSM-V criteria of ASD. I think that they should have symbol 12-C on they ruling of disability when they have certain impairment in normal life (for example in occupational area) and do not meet criteria for autism spectrum disorder. Not every pervasive developmental disorder have to be autism spectrum disorder!


It's always possible that the diagnostic criteria for ASD and other disorders can (again) change in the future. Who knows!



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08 Jul 2021, 5:43 pm

Yep....There will be a DSM-VI---some day.



autiecat
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08 Jul 2021, 5:46 pm

ASPartOfMe wrote:
People have varying amounts and intensity of autistic traits. How many and intensely one has to have these traits to be considered autistic is subjective and has changed radically over the years. If you are close to a subjective line be it enough traits to be autistic, enough sexual attraction to ones own sex to be considered bi sexual, or even being born in a year near a subjective generational divide it is going to cause difficulties for you. Yet we need to draw line a line somewhere, accepting that everybody is autistic renders the concept useless.

Logically having more autistic traits and having them more intensely makes you “more autistic”. Also by definition “less autistic” is not the same as “not autistic” but we pretend it is for a number of social and political reasons. The long history of “less autistic” being othered or being dismissed, as a very small minority any type of dividing us hurts our cause. People take offense to “less autistic” because of often justified fears of being judged as “not autistic enough” or even “not autistic”.


I do agree that we need to draw a line somewhere. Being autistic, I got caught up in the details of the technicality of being more or less autistic (i.e. more autistic traits at greater intensities being more autistic). I'm being very literal about it. :lol: But yes, I do understand that for social reasons we don't use less/more autistic and that autistic people with milder symptoms feel invalidated if they're told their autism isn't severe as it could it.



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08 Jul 2021, 5:53 pm

LOL....it really was much easier pre DSM-IV. There was only one "autism," and it had very definite symptoms. The Spectrum idea didn't take hold until the 90s.



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08 Jul 2021, 6:25 pm

I'm fairly comfortable with no line at all. To me, everybody has ASD, but some have so little ASD that you'd need a microscope to find it. But it's still there. What a person considers negligible depends on how they feel about the matter and what they're trying to do. It does make some things easier to think about if you use reductionism, but it's wise not to forget that in doing that, to some extent you're ignoring the truth.



autiecat
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08 Jul 2021, 6:35 pm

ToughDiamond wrote:
I'm fairly comfortable with no line at all. To me, everybody has ASD, but some have so little ASD that you'd need a microscope to find it. But it's still there. What a person considers negligible depends on how they feel about the matter and what they're trying to do. It does make some things easier to think about if you use reductionism, but it's wise not to forget that in doing that, to some extent you're ignoring the truth.


I think some people think having ASD or being neurotypical is like being a cat or a dog. There's no such thing as a cat-dog mix. The way I think about having ASD or being neurotypical is like being a poodle or a golden retriever. Goldendoodle mixes exist. And if you breed a goldendoodle back to a poodle, you'll get a mix that is more poodle-y than like a golden retriever. There is a range from being a purebred poodle to being a purebred golden retriever. (And even amongst the purebred poodles, some poodles fit the purebred poodle standard better than other poodles.)



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08 Jul 2021, 7:06 pm

You know, whenever someone says "I think I have teeny-weeny, mild case of Asperger's," it makes me pause. Since Asperger's is already on the "milder" end of Autism, extremely mild Asperger's may as well be NT. But I suspect some of these people are on the spectrum, but can't fully accept it. They're testing the waters by saying, "I'm practically normal, except..." then go on to list why they are rather autistic.

In contrast, actual NTs typically tend to say things like, "Everyone feels that way sometimes..." not realizing we feel that way more often than not.



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08 Jul 2021, 7:32 pm

I do not believe a neurotypical can be a little bit autistic, allow me to explain?

I read somewhere that the traits of autism develop when there is a neurological problem in the brain, maybe related to nerve function or synaptic conditions. What happens is that the brain "rewires" itself into an autistic configuration, so to speak, as it tries to adapt to the underlying neurological issue.

So there are several reasons why autism is so heterogeneous:
- One is that there are many different neurological problems which can cause autism, and some may affect the nerve signalling more than others and hence lead to a greater degree of autism. In severe and non-verbal autism, for example, it may be that the rewiring is quite extreme but still not enough to fully compensate enough for the underlying neurological issue.
- Another reason for the heterogeneity is that, although the "rewiring" tends to occur in enough of a pattern to form a recognisable disorder (i.e. autism), there are individual differences in the details of that rewiring. Some autistics have connections between senses for example (synaesthesia) while others do not.
- A third reason is that individuals vary in their personalities, intelligence and aptitudes, which means that some may be better able to compensate for their autism by learning work-arounds and/or masking difficulties than others. So even with the same underlying neurological issue, autism presentation and behaviours will vary.

So my opinion is that there is huge variation amongst autistic people in the degree and presentation of their autism, and it is truly a wide spectrum. I also believe there is some overlap with the neurotypical spectrum, in the degree of autistic behaviours that individuals might exhibit. That is, when people score around, say, 30 to 35 on the AQ, we cannot be sure based on that score alone whether they have autism or not.

However, if as I believe there is always an underlying neurological issue involved, I do not believe that neurotypicals can be "a little bit autistic". Either their brain was affected by an underlying neurological issue or it was not. So even if neurotypicals have personality traits which overlap with autistic traits to some extent, that does not make them autistic. I believe the diagnostic criteria have been developed over time with intent to capture the particular pattern of traits associated with autistic brain rewiring.

It is always debatable, though, whether diagnostic criteria based on behavioural issues can be reflective of underlying neurology. It seems to me that in the old days pre-1990s, only those with more severe traits were diagnosed as autistic - but since the 1990s there has been greater recognition of the spectrum nature of autism and adjustment of the criteria to include those with less obvious traits. However, it seems to me that the same diagnostic criteria might inevitably include some neurotypicals within the diagnosis due to that overlap.

But perhaps overdiagnosis is no bad thing? For myself, with Asperger-type autism, I wonder sometimes if the autism diagnosis truly fits me or whether I might just be at an extreme in terms of my personality traits, so that I lie within that overlap zone. But I know that my autistic traits, whether true autism or not, cause me many difficulties in life and am very grateful to have the opportunity to be included in fora such as this, and for the usefulness of the autism label in explaining to others the oddities of my behaviour.



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08 Jul 2021, 7:50 pm

MrsPeel wrote:
I believe the diagnostic criteria have been developed over time with intent to capture the particular pattern of traits associated with autistic brain rewiring.


I do agree that there is a biological basis for the autistic traits that we see, but it's likely that there are variations of the brain wiring which is why the spectrum is so varied. This also means that there may be brain wiring that look somewhere in between neurotypical and the autism standard. I don't think neurotypicals can be "a little bit autistic" in the sense that they would meet the diagnostic criteria for autism. I only mean that in a sense that neurotypicals may have brain wiring that is also varied with some variations that look closer to the autistic standard.



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