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ASPartOfMe
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17 May 2022, 8:14 am

INSAR keynote reveals brain differences correlate with cognition, not diagnosis.

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University of Toronto child neurologist Evdokia Anagnostou dropped a bombshell in her keynote Saturday at the annual meeting of the International Society of Autism Research (INSAR) in Austin, Texas, which threatens the entire validity of the autism spectrum disorder (ASD) diagnosis.

Anagnostou and her colleagues had set out to use neuroimaging to identify brain differences unique to ASD, as compared to other neurodevelopmental differences like ADHD, OCD, and intellectual disability. And they did find that brain differences clustered into different groups—but not<diagnosis. In fact, brain scans could not distinguish children who had been diagnosed with ASD from those who had been diagnosed with ADHD or OCD.

Dr. Anagnostou reported data from multiple papers that looked at over 3,500 children,” Dr. Alycia Halladay, Chief Science Officer at the Autism Science Foundation, explained to me. “These studies looked at multiple structural and functional features of the brain—including cortical gyrification (the way the brain folds in the cortex), connectivity of different brain regions, and the thickness of the cortical area—and found no differences based on diagnosis.” Groupings did emerge, but they were along totally different axes. Added Halladay, “The brains themselves were more similar based on cognitive ability, hyperactivity, and adaptive behavior.” In other words, the brains of mildly affected autistic children looked much more like the brains of kids with ADHD than they did like those of severely autistic children.

These findings have tremendous implications for our current diagnostic framework. During the question and answer period following her talk, Anagnostou described two children who both carried the diagnosis of autism, one of whom was very mildly affected, while the other had such disordered behavior that “even their bus driver knows” he is autistic. “Should these kids have the same diagnosis?” she asked.

Right now, they do—but there has been a growing dissatisfaction among many stakeholders in the autism community with the American Psychiatric Association’s introduction of the all-encompassing ASD diagnosis in the 2013 revision of the Diagnostic and Statistical Manual (DSM-5) to replace more narrowly defined categories, including Asperger syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), and childhood disintegrative disorder. In 2021, the Lancet Commission—a group of 32 researchers, clinicians, autistic individuals, and family members—called for the creation of a new label, “profound autism,” that would carve out those autistic individuals who also suffer from cognitive and language impairments and require round-the-clock supervision. “Anagnostou’s data converge nicely with the Lancet Commission’s proposal,” Halladay observed. “They provide biological evidence for a category that was originally defined solely by external criteria.”

At the very least. The real question is whether this work demands an even more radical re-imagining of our classification of neurodevelopmental differences. If, as Anagnostou’s data demonstrates, cognition and hyperactivity are much more correlated with brain difference than variables like social deficit that have been considered core symptoms of autism, then perhaps it’s time to scrap our current model and introduce new diagnoses based on these more salient dimensions. Aligning our diagnostic system with underlying biology is the first step in the development of targeted interventions for some of the most intractable and dangerous behaviors exhibited by the developmentally disabled such as aggression, elopement, self-injury, and pica (the compulsion to eat inedible objects).


The articles author Amy Lutz is a long time critic of the neurodiversity movement and advocate for separating autistics by severity. Psychology Today was derelict in presenting this as a news story rather than an opinion column. That all said often correct things are discovered for the wrong reasons, and many of us understand autism is still poorly understood and that with further study the understanding of autism may radically change just as it has in the past. As with all new research it needs to be replicated before we put the autism diagnosis in the ash heap of history.

The rest of this opinion is based on the assumption that this is verified.

Will an overcorrection blind us to other explanations for what was formally diagnosed as Autism?

Despite Amy Lutz’s wish I do not see how this possible new understanding would negate the core concept of the neurodiversity movement that many brain differences that are judged harshly should be accepted. What would change is what those differences are.

I can envision “autistic” and the like sticking around as a colloquial descriptor for the set of traits formally known as autism. Or the definition of autism could be changed for the new understanding. Or maybe for except a few die hards the term “Autism” goes away. That is not going to be up to me or Amy Lutz :lol:


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carlos55
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17 May 2022, 10:59 am

Autism is so heterogeneous some 20% is caused by different genes so even by those facts it’s obvious there are more than one autism.

So the diagnosis of autism is just a temporary label that will one day be scrapped in favor of a more appropriate sub group


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Fnord
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17 May 2022, 11:17 am

carlos55 wrote:
Autism is so heterogeneous some 20% is caused by different genes so even by those facts . . .
Evidence, please?
carlos55 wrote:
So the diagnosis of autism is just a temporary label that will one day be scrapped in favor of a more appropriate sub group
Evidence, please?



carlos55
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17 May 2022, 12:56 pm

Fnord wrote:
carlos55 wrote:
Autism is so heterogeneous some 20% is caused by different genes so even by those facts . . .
Evidence, please?
carlos55 wrote:
So the diagnosis of autism is just a temporary label that will one day be scrapped in favor of a more appropriate sub group
Evidence, please?


Google autism genes and many will come up. Some people have one others two or more. Most will have none because they are in the majority where their autism is unexplained. But they all have autism. So by that alone there are clearly multiple autisms, i.e CHD8 autism symptoms and SCN2A autism symptoms & so on. All similar but different slightly.

Its just easier at the moment to just call it autism but the label rather than genetic cause is clearly not a proper explanation

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So the diagnosis of autism is just a temporary label that will one day be scrapped in favor of a more appropriate sub group


I think logic of accepting greater scientific understanding of the brain & genetics means this will be true, although they will probably still refer to it as "autistic symptoms" a bit like sight loss or paralysis ( more a symptom than a specific single condition )

https://www.spectrumnews.org/news/analy ... ism-genes/


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Pteranomom
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18 May 2022, 1:07 pm

"Anagnostou and her colleagues had set out to use neuroimaging to identify brain differences unique to ASD, as compared to other neurodevelopmental differences like ADHD, OCD, and intellectual disability. And they did find that brain differences clustered into different groups—but not<diagnosis. In fact, brain scans could not distinguish children who had been diagnosed with ASD from those who had been diagnosed with ADHD or OCD."

I think this is awesome news. It's been obvious for decades that "Autism" has become a catch-all label for many different kinds of neuro-differences. (I worked with 'autistic' kids back in the 90s and that was immediately obvious back then.) The problem is that "Autism" is a list of behaviors, not causes, so any kid who displays some range of those behaviors for whatever reason gets the label, often more because their parents want the particular services that come with an autism diagnosis (but not other diagnoses). I know a lot of other moms and they are quite up front about doing this because they are trying to do the best they can for their kids, and regardless of what they 'actually' have, autism is the diagnosis that gets them services.

Personally, I find this kind of bad categorization absolutely... like nails on a chalkboard. It's like lumping colds and flus together under "fever syndrome." If someone can separate these out and make diagnosis less of a giant mess, hooray.



carlos55
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18 May 2022, 2:48 pm

Pteranomom wrote:
"Anagnostou and her colleagues had set out to use neuroimaging to identify brain differences unique to ASD, as compared to other neurodevelopmental differences like ADHD, OCD, and intellectual disability. And they did find that brain differences clustered into different groups—but not<diagnosis. In fact, brain scans could not distinguish children who had been diagnosed with ASD from those who had been diagnosed with ADHD or OCD."

I think this is awesome news. It's been obvious for decades that "Autism" has become a catch-all label for many different kinds of neuro-differences. (I worked with 'autistic' kids back in the 90s and that was immediately obvious back then.) The problem is that "Autism" is a list of behaviors, not causes, so any kid who displays some range of those behaviors for whatever reason gets the label, often more because their parents want the particular services that come with an autism diagnosis (but not other diagnoses). I know a lot of other moms and they are quite up front about doing this because they are trying to do the best they can for their kids, and regardless of what they 'actually' have, autism is the diagnosis that gets them services.

Personally, I find this kind of bad categorization absolutely... like nails on a chalkboard. It's like lumping colds and flus together under "fever syndrome." If someone can separate these out and make diagnosis less of a giant mess, hooray.


Its weird that brain scans in this study cant distinguish between ASD & OCD since there is a world of difference between them.

Although that is not strictly true since brain scans in other tests have shown brain structural differences in more severe autism cases as opposed to aspies

Personally in the long term i think its better to have issues in other areas that are more "fixable" like single gene mutations and auto immune issues, than major structural differences that are probably not.

Any brain scan that comes back as normal is of course excellent news.


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Pteranomom
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19 May 2022, 4:11 pm

carlos55 wrote:
[ Its weird that brain scans in this study cant distinguish between ASD & OCD since there is a world of difference between them.
is there?
My ASD son has OCD; I don't think of these as distinct at all. Rather, OCD seems to describe a specific cluster of his behaviors.



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19 May 2022, 4:41 pm

carlos55 wrote:
Fnord wrote:
carlos55 wrote:
Autism is so heterogeneous some 20% is caused by different genes so even by those facts . . .
Evidence, please?
carlos55 wrote:
So the diagnosis of autism is just a temporary label that will one day be scrapped in favor of a more appropriate sub group
Evidence, please?
Google autism genes . . .
Studies that only suggest genetic causes are not conclusive.



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19 May 2022, 7:16 pm

carlos55 wrote:
Autism is so heterogeneous some 20% is caused by different genes so even by those facts it’s obvious there are more than one autism.

So the diagnosis of autism is just a temporary label that will one day be scrapped in favor of a more appropriate sub group


As an ASD/Asperger's person with schizophrenia/schizo-affective I'm going to be somewhat different to a person with ASD + ADHD. I'm not even sure where ,or if, I fit in with the autistic community. I don't see myself as part of the highly vocal, often self appointed, 'autistic elite' . I'm also not a a 'needs constant supervision' level autistic person.

Most late dxed people with ASD seem to have had some, at least patchy, history employment, but not me. They don't usually have difficulty getting to places and are reasonably self sufficient.


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carlos55
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20 May 2022, 6:52 am

Pteranomom wrote:
carlos55 wrote:
[ Its weird that brain scans in this study cant distinguish between ASD & OCD since there is a world of difference between them.
is there?
My ASD son has OCD; I don't think of these as distinct at all. Rather, OCD seems to describe a specific cluster of his behaviors.


While there are overlapping symptoms they are rather different.

Many NTs have OCD which is invisible and doesn’t usually cause too many problems like language development

The same can’t really be said about ASD in most cases


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Pteranomom
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20 May 2022, 11:22 am

By definition, you can't be NT and OCD at the same time.

OCD causes repetitive thoughts and behaviors which, in practice, look like the obsessions and ritualized behaviors found in autism. Parents who have a kid who keeps talking about the same subject over and over and who goes into a screaming meltdown if you interrupt him while he's lining up his trains go get an autism diagnosis because an autism diagnosis entitles them to free therapy and support. An OCD diagnosis doesn't.

Yes, autism has other traits, like sensory issues or delays in social reasoning, but there's no rule that says someone with OCD can't also have sensory issues or social delays. My kid has a classic case of OCD contamination-phobia, complete with washing his hands raw, but *why*? I think it's at least partially a sensory issue: he can't stand the feeling of anything on his hands and so gets upset at the mere thought of it.

There's a lot of overlap.

Edited to add: OCD really isn't "invisible." How it manifests varies by person, of course, but repetitive behaviors get noticed.



carlos55
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20 May 2022, 12:24 pm

Pteranomom wrote:
By definition, you can't be NT and OCD at the same time.

OCD causes repetitive thoughts and behaviors which, in practice, look like the obsessions and ritualized behaviors found in autism. Parents who have a kid who keeps talking about the same subject over and over and who goes into a screaming meltdown if you interrupt him while he's lining up his trains go get an autism diagnosis because an autism diagnosis entitles them to free therapy and support. An OCD diagnosis doesn't.

Yes, autism has other traits, like sensory issues or delays in social reasoning, but there's no rule that says someone with OCD can't also have sensory issues or social delays. My kid has a classic case of OCD contamination-phobia, complete with washing his hands raw, but *why*? I think it's at least partially a sensory issue: he can't stand the feeling of anything on his hands and so gets upset at the mere thought of it.

There's a lot of overlap.

Edited to add: OCD really isn't "invisible." How it manifests varies by person, of course, but repetitive behaviors get noticed.


Ive never heard OCD as anything other than NT. Many people have OCD & its treatable. The same cant be said about ASD.

While there are overlapping symptoms are some ASD traits OCD? or just a different condition with the same symptoms.

Treatments that work on NTs with OCD like handwashing dont really work on autistic people.


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Pteranomom
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21 May 2022, 1:08 am

How can OCD be NT? It's a mental/neurological condition. If the sufferer were neurotypical, they would"t have it.

OCD has treatments, like therapy and medication. These treatments can help with specific behaviors or thoughts caused by OCD, just as therapy and medication can treat specific autistic behaviors, but in neither case do they just make the condition go away.

Hand washing isn't a treatment for OCD, btw. It's a compulsion; the treatment aims at getting the person to stop washing their hands so often.

"While there are overlapping symptoms are some ASD traits OCD?"
Some ASD traits certainly look like OCD. Who knows what they "really" are.

"or just a different condition with the same symptoms."

Well, the difficulty here is that both conditions are defined by their symptoms. We don't know what causes them. Right now it's kind of like saying that both the flu and a cold produce fevers without knowing what causes flus and colds, so some people with flu get told they have a cold and some people with colds think they have the flu, just because they have a fever.



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29 May 2022, 5:42 am

Studies that only suggest genetic causes are not conclusive.[/color][/quote]

This!

Any studies that only suggest causes ditto. Most published papers are exploratory and results are not facts! Many are based on hypothesis, not even theory... asking a question but until more testing is done, answers are more like innuendo or speculation. Thank you for pointing this out!

Media tends to run with first time suggested theories as though the study published is proof in itself.

It seems to happen a lot. Somebody finds something in a mouse model and the media claims a cure is at hand.

Many readers here seem to be better at discrimination of facts from such hype. ( glad of that)


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