alt Hacker NewsAutism's confusing cousins
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BTW, there's research that shows that schizotypy (schizotypal/schizophrenia) is sort of the opposite of autism. You have to squint your eyes a bit, for example both of these neurotypes involve social difficulties, like the subjective feeling of being alien in the world (known as Anderssein in German psychiatry). However if you peel off the social layer then the remaining autistic features become anti-correlated with the remaining schizotypal features on the scale of the population. There are also some decent theories that suggest this should be the case - for example in the predictive coding theory it is believed that autistic brains over-weigh sensory inputs over their model of the world, whereas schizotypal brains over-weigh their model of the world over the sensory inputs. Or the Big Five traits, openness to experience is usually low in autism and high in schizophrenia.
I have done a rigorous job of self diagnosis. I am autistic. I’ve also had the privilege of being able to pursue meditation, therapy, and other self development practices: I’m not as severely autistic as I was as a young man. I also have childhood trauma that I know contributes to many of my autistic presentations — see the last section on comorbidity. I also have some distinct ADHD symptoms but have never pursued that path because my hyperfocus tends to win out often enough that it’s not a hindrance to productivity. But it still causes problems elsewhere in my life.
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.
The day-to-day impact of being diagnosed is practically non-existant for me. It might explain "why" I might react to a specific stimuli but it doesn't stop the reaction. At best it's something to laugh about with my wife. It does also offer an early-warning system when I'm over stimulated and that I need to 'get home' soon.
Life is difficult for people with severe autism (e.g. early childhood). Due to the increasing number of misdiagnoses, self-diagnoses, romanticization and constant trivialization, life is becoming even more difficult for these people. The opinion that autism is not a disease but a buzzword for strange people leads to real autistic people being denied the disease. It is often said: “They should just try harder or pull themselves together”. Please don't use the word autism in an inflated way - it harms those affected.
> But autism may also be the only relevant diagnosis they’ve heard of or are familiar with. They haven’t seen any cool TikToks about being schizoid. No one’s offering them quizzes about being schizotypal.
Don't underestimate TikTok. You can find all sorts of weird fad mental illness there. For a while tourette syndrome was all the rage and the platform was filled with kids faking tics. There are fake epileptics faking seizures too. OCD is another common "cool" self-diagnosis and there are online quizzes to tell you how OCD, or ADHD or bipolar you are. It wouldn't surprise me at all if schizoid or schizotypal caught on.
I think some people are looking for the self-validation that can come with a diagnoses, an explanation for why they are the way the are, feel the way they do, or why they struggle with certain things. Others are just looking for views, attention, or a community to belong to.
While it can be fairly harmless the ability for mass sociogenic illness to spread via social media is interesting and a bit frightening.
While this topic is here
Also see specialisms WITHIN Autism that are different to the mainstream Autism
The one I know most about is
PDA: Pathological Demand Avoidance [1]
PDA presents differently and needs very different strategies to mainstream Autism.
Main signs… kids under 12 attend school. However they explode at home or in private. At school the PDAers are masking (pretending to fit in) which is draining. When they get home the pent up frustration is released (explosively). So the family at home see a very different kid to the one that school/extended family witness. If this is an A-Ha! lightbulb moment for you or your child, see the questionnaire at the PDA Society[1]
If you think you (or a loved one) may have a psychological condition, go to a psychologist and get a screening. The diagnosis isn't the important part. The value is in the 20-something pages of detailed analysis by a professional.
At a bare minimum, it will give you a fresh perspective on things you already knew. In my experiences, there will be things you didn't realize about yourself.
They aren't going to tell you what the solution is to all your problems; that's for you and your doctor to figure out. They will give you everything you need to make well-informed decisions, and that's priceless.
I have all the symptoms listed by the author. I went to get professionally diagnosed and I have… autism AND anxiety AND ADHD surprisedpikachu.jpg
If anything this just kinda suggests to me that the diagnostic categories are almost completely random/useless. It's just a set of pigeonholes made by people whose goal is to have a pigeonhole for every kind of thing so that the world doesn't seem messy and complicated anymore.
But the one thing we know for sure it's that the world is more complex than even this set of 10 pigeonholes. These are more like good insults for people. Haha, a loner, that guy's a schizo! The clinical coldness is almost a perfect mirror for the way we express personal cruelty to others. To reduce them to a factoid, an epithet. It's no wonder people want to reclaim these words as terms of identity, of pride, of nuanced meaning.
I enjoyed reading that. My daughter had recently been diagnosed with "social anxiety" but had suspected it was autism.
Somewhat related, "Health Secretary Wes Streeting is launching an independent review into rising demand for mental health, ADHD and autism services in England." https://www.bbc.co.uk/news/articles/ce8q26q2r75o
Working in IT I've came across lots of extremely smart people with their quirks and eccentricity (not exclusive to smart people of course), I guess there's just a higher proportion of _quirky_ smart people in IT. A lot of the time it just seems to be introversion- it seems lack of interaction with society has to be justified.
What is missing is the occurence of these disorders.
Adhd 5-10%, autism 0.5%, cluster b 5%. The rest is quite rare. Adhd has the highest comormobility.
Eye contact makes me very uncomfortable.”
“I suck at small talk.”
“I have rigid routines.”
“I hyper-focus on my hobbies.”
“I am always fidgeting.”
“Social interaction exhausts me.”
“I really bad at making friends.”
“I don’t fit in; people find me weird.”
I never considered it althought I'm ticking all the buttons (bad gear ? [0])
I’m beginning to wonder whether one can qualify simply as an “eccentric” is a function of social + economic standing. Or whether whatever people think you are, or what you think of yourself are determined by these factors.
Often times it seems like the “soft diagnosis” of a condition can be used to hedge against less-than-desirable personality traits if the person is held in high enough esteem. If they aren’t held in popular regard to some extent or if there’s other factors that can be used to explain their behavior (e.g. the stereotypical “German coldness” or whatever) then they don’t get those benefits. Characteristics like their political views may also negatively affect the likelihood of this “psychiatric hedging”.
At what point do idiosyncrasies become subject to pathology.
> Autism exists, to the extent that any psychiatric disorder exists.
Which is to say, not really. I say this as someone who has been diagnosed as autistic, and identifies as autistic. All of these diagnoses are presented as clear, well defined constructs that exist in the world, but in reality they’re fictions that that committees have drawn around a vast gradient of human traits.
No individual human truly fits any single diagnosis. For example, I have two family members that depending on how you frame their behaviors could be described as either autistic or narcissistic, yet these are supposedly completely different disorders. Prior to being diagnosed as autistic, I’d been diagnosed with some of the ones suggested in the article as well. Was I misdiagnosed? I don’t think so. None of those constructs are real either. So, they’d not even wrong. For a time, some were useful. Some were harmful. But seeing myself as autistic has been a lot more useful.
What matters to me about identifying as autistic is that it allowed me to find other people who experience the world similarly to me. Until I found other autistic people, I felt like I was a single alien stranded on Earth, alone. Finding other autistic people was like finding out that there were millions of other aliens like me hiding in plain sight.
I hope that someday we can move beyond the 1950s-style nosology of the DSM and have a more rigorous science of mental health, but right now, it’s what we’re stuck with.
The internet is turning society into a kind of "social emulsion" where everyone is their own little droplet in the fluid, but they don't merge together.
> Autism exists, to the extent that any psychiatric disorder exists.
Autism is a neurodevelopmental disorder which causes and contributes to various psychiatric disorders.
The author is not seeing the forest for the trees, which is incredibly ironic.
I found this article very interesting, because I feel that I fall in the category of people that think they have it, although I probably don't. My psychiatrist who is not an expert on autism told me I display autistic traits but that doesn't necessarily put me on the spectrum. Also my RAADS-R scores fall into the autistic spectrum but on the low end. Another psychiatrist diagnosed me with OCD. I am in my late 20s and I don't see how I could ever know for sure or if I am autistic or not, but nowadays most people in my country would say "we are all somewhat autistic in some way or another"
Even if you don't think it has validity as a single disorder, autism is at least diagnosed in a way that's fairly consistent between clinicians using ADOS.
I'm more dubious of clinicians who like to pick random dubious rare disorders that people can't even agree about the basic description of like schizoid out of the DSM like the author of this article.
A diagnosis is literally just a heuristic category so they can do research on rough groupings of symptoms to evaluate how treatments impact them. That's it. To get a diagnosis is literally just a statement "my psychologist thinks my symptoms align with this group and that the treatments they found effective for those symptoms will be effective for mine." The idea these things are identities or real categories is completely absurd and disconnected from why they actually exist. There is 0 basis to assume because two people have the same diagnosis they have the same underlying causes for what leads them to end up with that rough grouping of symptoms. There may be some general similarities or correlations but again the whole point of these is literally just to establish heuristic groups so we can do research on how people respond to treatments. People allowing them or speaking in a way that makes them seem like more than that is extremely destructive.
I think this is broadly well considered although I have a bit of trouble understanding this point:
> Social awkwardness refers to social ineptness without meaningful impairment
Isn't social awkwardness sort of inherently impairing in social relationships?
This is the third article in a row that I am seeing on hacker news that is spreading misinformation about autism.
This seems to be targeted campaign. I urge people to not be fooled by ill-researched blog posts. Listen to autistic people. Listen to researchers that represent the scientific consensus.
Any diagnosis for autism will first consider whether the symptoms can be explained better by another diagnosis. This is why you fill out a lot of questionnaires and the like when you get your diagnosis. This is the state of art.
Also women are systematically underdiagnosed when it comes to autism, they often get labeled with boderline and the like. The idea that someone is labeling everything as autism is silly.
This honestly tracks with what I've seen: autism has become the catch-all public label for "socially struggling person," even when the underlying cause is anxiety, trauma, personality patterns, or just plain awkwardness.
> I remember seeing a woman who was a classic example of someone with high neuroticism, poor self-esteem, and severe social anxiety, and she had believed for much of her life that she was autistic ... it fit in with her experience of being awkward-shy-weird.
I so strongly agree with this and it's not just based on my own experience, but many people I know.
Growing up broke and in sketchy places with sketchy people will induce plenty of anxiety. Then I managed to get out of all that as an adult and starting a career.
The anxiety never fully went away, but it now presents itself the way one would expect instead of "weirdness". Maturing and having a more stable life happened to my friends also and nobody says "I think I'm autistic" anymore like we did in high school and college. Now it's hard to distinguish if we were saying that to ourselves as a slur in self-deprecation, or if we really believed it. Young people are just awkward and too many people get older without letting go of the things they told themselves a long time ago.
Make of that what you will. I know my story is super common, but the only reason I bothered to write this is that it doesn't get said enough.
It gets even more complicated when you add things like Williams Syndrome into the mix -- WS causes you to feel safer with 'friendly' people and so you're typically more social not less, but is often comorbid with autism and so can make diagnosing autism more challenging (in my case it was mostly because I had an abnormally high IQ and sensory challenges). But I am highly empathetic, have some talent for music and writing and was basically a TA for most of my school years, while still having most of the autism-related issues such as RSD, demand avoidance, meltdowns and so forth.
> Social communication disorder is rarely diagnosed in favor of autism primarily because autism provides access to critical services, insurance coverage, educational support, and legal protections that social communication disorder does not reliably offer
That feels important
This fits in with another thread on an article about over-diagnosis.
I think it’s safe to say that if someone appears “weird” to the hive mind of a community, that person is more likely to be correctly diagnosed.
There are people who desire a diagnosis for special treatment, but if the first time you find out about a person’s diagnosis is after knowing them as “weird” the whole time, then they’re not acting weird on purpose, or saying they are X for attention or special treatment.
Disabled people, mentally or otherwise, usually like to keep their business to themselves, unless they absolutely don’t need to. Some mentally disabled people might even forgo getting special treatment via disability services at their colleges, or getting parking permits for disability because they’re not interested in bringing attention to their difficulties or differences, or using these issues as a cause for special treatment. Though, I’d advised that people who need accommodations should get them.
I also saw a comment about disability becoming normalized due to late stage capitalism, which sounds like a thesis out of postmodernist thinking. The fact is that group behavior has always isolated “weird” behaviors and put undue negative attention on them, but it just happened to be the case that that weird behavior was evolutionary helpful, which is why it has persisted for millions of generations of humans across their evolutionary history.
This only applies to high-functioning categories of behaviors. But I’ve found that more often than not, it’s the social reaction of groups that is the problem for high-functioning autists, and less the autism itself. Maybe neurotypical behavior or neurotypical mindedness is the disease because I don’t understand why or how some people find it so hard to think differently. Are they not individuals, are they zombies?
Based on what I've read lately, my consensus perspective is that 80% of what people consider autism is actually just the western diet's effect on normal brain chemistry.
I find all these conversation around neuro-divergence extremely weird, for the simple reason that I have a never seen a proper definition of what a "normal" person actually is, and for good and obvious reasons:
I personally believe that "normal", when it comes to people's behavior, social interactions, and the way their mind works, is a completely broken idea. All of these attributes are completely fluid, depending on the when, where and who with you happen to be.
On that premise, the whole idea of neuro-divergence and the idea that you can classify people in arbitrary categories such as ADHD, Autism, etc ... and that this classification will lead to a way to "fix them" is complete and utter BS.
As some on with Schizoaffective Disorder, OCD, and Panic Disoder, I know why people want to have an Autism diagnosis. It is because people with Autism are more studied, get more assistance, and are get more sympathy from the general public.
Someone with Autism can act out and people will be like "That's OK, he has Autism". But when I act out, there is no understanding.
What is missing in the article is there does exist overlap in these condiations, not only symptomatically, but also genetically. As far as genetics, just take a look at the calcium channel gene CACNA1C:
https://pubmed.ncbi.nlm.nih.gov/31805042/
I would probably had an Asperger's diagnosis when I was a kid, but most of my Autism was beaten out of my by my older brother's and kids in school. I mean, I was so deep into astronomy when I was 10 and I would not let go if it even though everyone teased me about it and I talked about it all the time anyway.
I am in my early 60's now, homeless, living in a Minivan, driving around, researching my genetics obsessively to the point where I communicate with some leading specialists in the United States, but still no one cares.
So yeah, do I wish I could say I had clinical Asperger's? Yes. Yes. Only so I can be accepted for my neurodivergence.
the agenda being pushed with the recent spate of articles to the effect of "people are saying they're autistic when they're really not, and should be classified differently" I think has mostly to do with RFKs overarching claim that people who are autistic are all suffering a horrible, debilitating disease, where in his words verbatim: “These are kids who will never pay taxes, they’ll never hold a job, they’ll never play baseball, they’ll never write a poem, they’ll never go on a date” [1] , which from there goes into his bigger goal which is to create a "database" of autistic people [2], for which no valid reason has ever been given. By redefining "autism" to be only those who we've decided are those severely disabled who "will never pay taxes or hold a job", then creating a catalog of exactly who these people are, the final step is quite obvious if you've studied the treatment of autistic people in Nazi Germany [3].
So I'm going to flag these posts for now because the goal in the current US climate is pure eugenics. RFK is at his core a eugenicist, as are all high-level anti-vaxxers. Anti-vaxxers seek to blame the diseased for their disease, on such factors as "poor diet", "lack of exercise", or in the case of autism, "having your child vaccinated", against all scientific consensus, and would prefer people suffer and die of horrible and completely preventable diseases like measles and polio since they somehow "deserve it". Governments like the current one have plenty of plans for people they deem unworthy.
[1] https://thehill.com/policy/healthcare/5256614-autism-communi...
[2] https://www.npr.org/2025/05/08/nx-s1-5391310/kennedy-autism-...
[3] https://mjhnyc.org/blog/autism-and-disability-in-nazi-vienna...
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Autism is over diagnosed, because you get government money as a doctor and a patient.
My niece has a disibility that they haven't really been able to diagnose.
If it is Autism, there is all kinds of free care available.
Usually when you follow the money, you get answers.
I think part of the tension here comes from the way autism is understood both as a broad, fully-continuous, multivariate spectrum, and as a binary diagnosis.
To be sure, clinically, thresholds are useful because services, insurance, and research all rely on clear binary classifications, in our current society. But outside that context, it isn’t obvious that everyday language needs to mirror that line. Self-identification can be a way of making sense of one’s life, not an attempt to claim a clinical label.
But at the same time, the spectrum includes people with very high support needs, and there’s understandable concern that broad or casual uses of the term can hide those realities in ways that impact care.
To me, none of this means people are wrong for wondering about autism. And I do not have the experience to advocate for or against "anxiety disorders" being weighted more heavily in clinicians' priors than they currently are (as the OP article heavily implies with its length). I mean only to highlight the mismatch between a binary diagnostic system and a very heterogeneous spectrum, and the need for language that acknowledges self-understanding without flattening anyone’s experience.