I have been told by a colleague that I have ADHD because I am messy. A number of people have asked me if my now young adult kid has been tested for autism - none of these people are his health care providers or teachers. He has some stereotypical traits of autism - some of his friends tell him that he has autism - but he gets great grades in school and has plenty of friends, so what would be the point of testing?
One of his friends is also often told that he is autistic because he has a hyperfocus on certain topics, and he watches the same movies over and over. But this young man got a $300,000 book deal from a major publisher right out of college, and has roommates and friends, so, again, even if he is autistic (which he claims he is not. I do not know if he has been tested.) what is the goal of testing? There is only a finite amount of resources, so shouldn't they be reserved for more severe cases?
And even if there was a point to testing, what treatments or interventions would the "help" the friend or would the friend pursue? I have a child that exhibits some of the traits you highlight, but he has friends, does well in school and we would not start him on medication, so what is the point?
Sometimes people just want answers and that's fair enough. But I wonder how many more people want answers because there is more awareness of and less stigma around autism, ADHD and nuerdiversity. As Matt points out, this has almost certainly led to at least some of the increase in autism diagnoses that this Administration apparently wants desperately to stop.
I only learned long after the fact that parents + teachers had had Concerns about me as a kid, and there was some question of getting officially screened...but being mostly functional meant living out life ignorantly just on one side of the cutoff line of the 90s. Wouldn't say it's been blissful exactly, and an IEP wouldn't have done much - if anything, being aware I *had* some sort of limitation might have developed into an excuse to hold myself to lower standards - and yet...who's to say? Certainly things would be different without having to endure years of increasingly-abusive demands for eye contact; certainly things would be different with earlier insight into the particular cluster of traits I tend to love/hate in others*. It must be a rather different experience growing up under the modern DSM. Not all sunshine and roses either, as Freddie would expound upon at great length. I think there's a fine line between feeling shame for one's mental disability, and reducing stigma so hard that it rolls over into a positive trait instead. At some point one starts to feel like they're taking crazy pills when everyone's discussing their "neurodivergent superpower" and I'm sitting here like...I'd take the medication from Scott Alexander's Against Against Autism Cures in a heartbeat, wouldn't you? Normal is Good, Acktually?
(I do think it remains silly that it's way cheaper and easier to get an ASD diagnosis as a kid vs as an adult. It'd be nice to have formal social proof...but not so much that I wanna shell out several thousand dollars or whatever.)
*Autistic intense interest: other autistic people, who are either Instant Friend or Immediate Nemesis. No middle ground. I'm not sure why this doesn't occur with allistics, who have a normal distribution of affinity, as befits normal people...
I vaguely wonder if being diagnosed might have triggered steps that would have attenuated my intense hatred of academic busywork in school such that I would have found formal education more tolerable to pursue, but I kinda doubt it. I'm never gonna be effective at following someone else's curriculum.
Were your teachers shocked when you also aced the SATs? I qualified for a merit scholarship and my Physics teacher was open about their combined surprise.
ETA, remembering more closely, I guess that was actually the PSATs.
I shiver a bit when I realize the drastically different path my life could have taken had I had an excuse to not perform (which is very easy for a child to want to take) versus an expectation that I work really hard.
For those of us who still think of mental illness as a bad thing, the looser criteria have basically pathologized having deep hobbies other than watching Nascar or American football. I spent hundreds of hours writing a Connect Four solver in C++ a couple years ago. These days I spend my free time chatting with AI about European high-speed rail and running optimization problems. (The Italians really should have done a Y in the north with the nose about 15k west of Ferrara rather than building a separate Bologna-Milan and Milan-Venice high speed lines. This conclusion is robust to the reasonable range of assumptions about the value of passengers time and discount rates).
My hobbies would only be a disability if my inability to discuss the trash of TV kept me from having a girlfriend. Fortunately, there are enough smart women out there that I did just fine after I got my JD and stopped being obese.
I'm very suspicious of the timing of Trump's Tylenol announcement (right after Charlie Kirk's assassination.) Kirk's ideology about women prioritizing child-rearing is front and center now, and then the Trump White House decided to announce that pregnancy should be harder if you care about your child.
I think they chose now to announce this "link" to further put pressure on women to conform.
I once was talking to a psychiatrist trying to get a proper analysis of whether I had autism or just read the list of symptoms and matched self-perception to fit; I then accidentally got diagnosed by questionaire.
I already knew the answers to the test! What did that prove?
I kind of also wonder if the fact that there are greater financial incentives for working in STEM also mean people with mild autistic symptoms have also been more likely to have kids compared to their peers than in the past.
Autism maybe, ADHD definitely. In second grade (around 1987) I was identified as having trouble paying attention in class. What probably would happen today is I'd be medicated and left at that school. What actually happened was that my parents moved me to a better/more challenging school, and I'm very glad for that.
I certainly noticed, when I worked with what are now called Level 3 autistic kids, things I did behaviorally that were similar to things they did, but at the time that just made me empathize better with them.
I have OCD-ish tendencies too but nothing remotely impairing.
It does seem kind of ridiculous that someone who can't speak and needs 24/7 care is said to have the same "disease" as someone with a large Lego collection.
I’m sure it’s more accurate to call it a spectrum, but it’s unhelpful from a communications standpoint. Everyone understood the distinction between Asperger’s (manageable social challenges) and autism (profound impairment). But if you tell me someone has ASD, that could mean anything from mild weirdness to being nonverbal.
Yea, while there are probably advantages for placing people on a "spectrum", such as helping get access to care, it's clearly got some drawbacks as well like "increasing rates of autism" leading to nonsense and the ridiculousness you pointed out. When naming disorders, people should really look at the tradeoffs of those labels. Not just the tradeoffs that happen in a clinical setting, but also those that affect the larger society.
In talking about my own child’s challenges—and mine—I find the words “spectrum disorder” useful. I feel like it flags a basket of behaviors without mentally summoning the more extreme autism imagery. Plus the word “spectrum” itself suggests the size of the possible outcome band.
As journalist Dan Gardner discussed in his book _Risk_, we humans are in possession of three-ish pounds of grey matter, much of which hasn’t evolved enough to deal with our current social/technological complexity. In short, we’re often terrible at assessing risk.
Some risk to taking Tylenol during pregnancy? Quite possibly-but as Matt pointed out the risk of fever is much greater.
Even so, I can see the appeal of RFK’s brand of crankery-to put some sort of chemically synthesized something in your body _seems_ unnatural. Our ancient ancestors, in their wanderings, must have been wisely hyper cautious about trying novel new plants as food sources.
"Our ancient ancestors, in their wanderings, must have been wisely hyper cautious about trying novel new plants as food sources."
Hard to say. They seem to have tried out just about everything and if 1 out of 50 people each generation died of being too curious about novel plants how would we ever know?
I just wish people paid closer attention to mortality rates back when people lived more "naturally." As your post points out with Tylenol, there are trade-offs for these decisions and the cranks (to a lesser extent scientists) often do a terrible job of discussing the trade-offs.
COVID is the same disease, even though I had what felt like a bad cold for a couple days and felt weak for a few weeks, and a friend ended up hospitalized on a ventilator.
There is a fundamental difference though in that you both had the same test, with the same result. You took a Covid test, they took a Covid test, you both had Covid. Because Covid is not described phenomenologically, it is described using objective criteria.
ASD on the other hand, is (quite literally) describing the phenomenon of having the disorder. If it doesn’t seem like you have it (definitionally) you don’t have it. So there is actually a reason to think that two people who both have the same disorder would be similar in a way that you would not necessarily expect in the case of Covid (or any condition diagnosed using laboratory tests).
I keep wondering if/when we're ever going to have a "...no sense of decency, sir, at long last?" moment that will cut through the haze. Maybe we won't have one. Or, maybe it'll be two or three things that crystalize together, and (finally) move public opinion decisively. Jimmy Kimmel is a pretty well-known brand. Tylenol is even more well-known. Fingers crossed the dam bursts sooner rather than later. Governance by kooks is scary.
There's something about the utter shamelessness that is specific to Trump that allows for the creation of impervious information bubbles in right wing systems. It's a bit of an emperor's new clothes situation. In my heart of hearts I believe most people have some sense of how absurd Trump is but a combination of being in so deep already and not truly knowing or being allowed to openly discuss with others on their side just how absurd they think MAGA is keeps it in tact. I think the dam will only truly break if Trump himself falters significantly (openly becomes shameful in a way that breaks the facade) or he dies with no successor in place strong enough to maintain the reality distortion field.
The GOP is very much in its Stalin/Mao era right now. The emperor is completely naked but still has total control. Everyone knows it's nuts but there's fear and a massive collective action problem. What's next will hopefully be more of a Deng Xiaoping, but at this point I'd also take a Kruschev.
My experience with the voters who have been voting Republican since before 2016, which is a lot of my family, is that they'll acknowledge "issues" but that they have a ready made laundry list (I assume from Fox News or wherever) of whataboutism and assertions of insanity and/or lawlessness that occurred during the Biden administration. Even where they have some points it strikes me as nevertheless a lot of false equivalence and very motivated reasoning but I'm not sure what you say to talk it down. Sadly I think the only way out is through and hope for a combination of a better Democrat alternative than the one that's been presented and a retrenchment to something less idiotic whenever Trump passes on to that tacky golden casino in the sky.
Murdoch probably (incredibly!) still doesn't come in for quite enough blame. Social media seems to get all the attention these days when it comes to diagnosing society's ills (no doubt for good reason). But the particulars of Fox News's model and reach have transformed our politics into a rage-filled cauldron. Imagine believing the other side is so dangerous you feel compelled to attack the US Capitol! The late Kevin Drum did quite a long, hard look at the data on this (worth a read if you've got 20 minutes):
>There's something about the utter shamelessness that is specific to Trump...<
Trump as sui generis is the optimist's take. You may well be right. I hope you are. Indeed, sometimes it seems the obvious interpretation: how could there be another like him?
Tucker Carlson comes to mind as a possibility. I think for Trump something about his prior cultural ubiquity made him legible for those outside the party to hold their noses and vote for him or at least become enamored of him. No one else comes to mind with that level of ubiquity.
(Disclaimer - this is a ten second hot take and not very well thought out)
It's been a decade of me thinking: Is THIS the thing that will finally turn people against Trump? I mean, come on.
Through blatant corruption, insane policies, and scandals that would have been a massive deal in previous presidentcies (he's done way worse stuff then happened in the Lewinsky, Iran Contra, Watergate and Teapot Dome scandals) he still remains fairly popular. At best, his disapproval rate inches up. It's frustrating.
It’s tough for real information to pierce the right wing media ecosystem that a lot of his voters live in. Only big events like a recession (or pandemic) have broken through.
I'm very skeptical about that happening. Give my anecdotal point of data from a single Australian sample all of the weight it deserves, but discussing Trump's performance at the United Nations with a Trumpy male relative resulted in this response: "At least he says what's on his mind in plain english, and he's willing to defend his own country." I'm astounded that people are prepared to rationalise unhinged, corrupt or criminal actions to the wild degree that is seen with Donald Trump. I know I wouldn't be given the same latitude if I acted in the same manner.
Joe McCarthy continued to have ardent fans long after the Red Scare was over, and long after his death. There will always be people who admire autocrats, bullies and thugs. The question is: will enough normies (and traditional conservatives) have the scales lifted from their eyes for a sea change to occur. In a *very* tightly divided, 50-50 nation, the movement in numbers required for big changes need not be all that huge for a decisive impact to transpire.
I waited for a really long time for this but it's not coming. The best case scenario is Trump leaves the scene and everyone pretends this never happened.
The big problem with this analogy is that during the McCarthy era, the big shots in his own party and in Congress we’re looking for a chance to kick him down a dark stairwell. The have no decency moment, simply granted, a measure of permission to do that.
Oh, analogies are always problematic, owing to the fact that history rhymes much more so than repeats. So I grant your premise that our situation today is hardly the same as during the early 1950s. Agreed! On the other hand, I do rather think plenty of people in Trump's "own party and in Congress" find him odious, threatening and difficult. And I can't help but note that, with respect to the Kimmel imbroglio, a number of voices pushing back against the president—very openly and seemingly without fear—were Republicans. Also, a lot of Republican voters take Tylenol!
Maybe it's folly on my part, but I do believe it's pretty likely Trump will get out over his skis at some point. That won't mark the end of Trump's presidency or the MAGA movement. But it may begin to make their cultural revolution an increasingly uphill climb. I reckon until the midterms (or, more likely still, until January of 2029), that's about the best we can hope for.
What gets me is I wonder if he had been 50% better on a number of topics, if he would have gotten the GOP nomination in 2016 and his base would still be so attached to him. If he had been more of a legitimate entrepreneur instead of a conman? If he was less bigoted? If he was less of a creep or a conspiracy theorist? In those cases, he's someone like Mitt Romney they just feel stuck with.
As someone who had a child with “old school” autism — where it isn’t a fun quirk but in fact a range of huge developmental impairments that significantly alter the life of whole family — it’s been a rough week on the internet. I try to be chill and not precious about stuff but “heh if Tylenol caused autism then then USA would have mass transit” jokes hit different when your experience of autism is “can’t potty train your five year old”.
Thank you! I know several people with kids with profound autism, and all the discussion that "it isn't a disability," is really painful for them. It also makes me wonder if the widening of the definition leads to a decrease in care and research around "old school" autism.
Not quite the same, but I have a relative with OCD. Her case is fairly mild in that she is still mostly able to go to school, work, etc., but through treatment and conferences, she has met many people who are debilitated by it and can't even leave their house. To call someone who likes to have their books lined up by height as "having OCD" is trivializing. Also, the rant I always have - people who want things neat say they are OCD, but often a manifestation of OCD is not being able to clean or attack messes at all.
Tylenol is the only form of pain treatment available to pregnant women. It’s not all that good, but we aren’t allowed to take NSAIDS or anything stronger. Now the same men who want American women to have more babies are telling us to endure nine months of sciatica, back pain, leg cramps, and round ligament pain without any pain relief at all.
Perhaps being in a rough third trimester is making me touchy on this issue, but pregnant women are human beings with pain receptors, not just incubators.
> Doctors have been gradually chipping away at pregnant women’s ability to use pain medication. First it was “don’t use opioids, your baby could have birth defects”. Then it was “and don’t use ibuprofen, your baby could have kidney problems”. Then it was “and don’t use too much aspirin either, your baby could get cardiovascular problems”. That left Tylenol (aka Panadol, paracetamol, acetaminophen, etc) as the only pregnancy-safe pain reliever. Well, bad news…
....
> But remember: all the other painkillers, eg ibuprofen, are even worse. So what if you have pain during pregnancy?
My tolerance for food and drug woo has always been very low, but it has gotten me so more irked over the past four years due to gaining significant power. It's taking advantage of dull thinking that can't even account for basic statistical knowledge, and leading people down paths that range from merely exploitative to downright dangerous. Some of this is from pure grifters, some it is from arguing that suffering is good from an appeal to nature, with plenty of overlap in between. I'm so through with it.
I think another factor in the misperception of rising autism is visibility. Someone with actual knowledge on this should weigh in but my impression is that when I was in school (1991-2004) kids with various forms of autism were often sent to segregated special needs schools. Now many are integrated into regular schools so I, a parent of a kindergartener, see those kids at school more now than I did when I was a kid.
The epistemology of right wing cranks is shocking. Everything is a poison or an elixir. It is totally unpredictable which drugs or foodstuffs will belong in which category, because nothing makes sense. Who thought an anti parasite medication would be regarded as an elixir, and oils made from seeds would be regarded as poisons? The only thing that determines which is which is the charisma of YouTube influencers.
I have a family member with a severe intellectual disability, which gives me a bit of knowledge into that world (which of course includes a lot of autistic people). As late as the early nineties, having a “retarded” (in the language of that time) was a legit stigma and made a lot of people uncomfortable. The parents got a lot of unkind comments and generally people treated the situation the way they would if they found out a family member was a child molester—not your fault, but still a horrifying situation. Now the situation is extremely different in that an autism diagnosis has no stigma whatsoever.
I saw a LOT of posts after Trump’s announcement saying that autism isn’t actually a disability and treating it as something to be cured is ableist. If those people actually knew any severely autistic people (vs people who just don’t like wearing wool because it’s scratchy or whatever) they would certainly not think that. Autism is a terrible thing and it results in a much lower quality of life for those who have it and is a massive sacrifice for the caregivers. Expanding the definition of autism to mean practically anyone has done no favors to those who suffer from the real thing.
From a resource perspective, it is important to have lumping of diagnosis for ppl who are unable to function in society and gain employment or even leave their house. They may be talking and the behaviors might not lead to harm. They wouldn't be considered severe.
Yeah. Having a mercurial president and a bunch of cranks in charge isn't leading any of us in biotech or pharma to be optimistic about reforms.
I think I've made this point before in this space but I'll repeat it: the path from using LLMs to massive acceleration in drug discovery isn't clear at all. You need large reams of data for LLMs to be useful, which means mainly working on precedented targets with lots of literature (e.g., kinases, which are way easier to drug than things like transcription factors). Which means either "me too" type drugs (which get a little bit of a bad rap, but you're still mostly talking incremental progress) or longer timelines in order to generate the data needed to feed the models. Safety data, in particular, is problematic for LLMs since you don't usually generate it for more than a handful of molecules.
It's entirely possible that the state of machine learning will advance to the point where this will change, but that's the framework for the current state.
To be fair, there are completely different models than LLMs that are trained to do things like predict how amino acid sequences will ultimately fold into proteins (Google alpha fold). Those are incredibly effective and are already in use in biomedical research today. Predictive tools based on computational chemistry have already existed (Gaussian comes to mind) that have given pharma companies the capability to predict molecular structures that will bind to specific proteins without the need to synthesizs large batteries of target molecules for assay screening. They're not AGI or anything, but they are tools that have accelerated research meaningfully.
Absolutely correct! And we use these tools all the time. If we were to use LLMs similarly (with molecular generators or "active learning") then we get a similar meaningful acceleration in research. But what that *isn't* is something that's going to shave years off your timelines. In the current state and foreseeable future, it's simply the latest advancement in computational tools. It helps, but it's nowhere near revolutionary.
LLMs are pretty far from being able to win a college parliamentary debate tournament, and that is a purely oral task for which written training data are pretty useful. The more I think about it, the more I think LLMs will max out around the level of an in field PhD. Being able to think that well that cheaply is amazing and will revolutionize clinical practice, but it’s not really going to push the cutting edge that hard.
Also, I don’t think Tylenol has anything to do with it, but my understanding is that the rate of “actually really disabling” autism has also been sharply increasing. I don’t think it is all a detection/diagnosis story (though of course that is also happening).
If age at first birth has anything to do with this, then the ratio of heathy to less healthy children will change. Lower fertility (driven mainly by delayed childbirth) might be the driver of increased prevalence. The rate increases because the numerator decreases.
Would love to see statistics on this. I have three close friends who each have a chiled with pretty debilitating cases of autism, two of whom are now large, non-verbal young men, and the third a large, verbal young man who cannot really live independently (though desperately wants to). I don't recall anyone like that from my childhood, though perhaps they were just institutionalized and kept out of sight.
“I don’t think that necessarily means that the rise in diagnoses is entirely benign. There are reasonable questions to ask about whether more aggressive diagnosis of psychological maladies is making things better or worse.”
This resonates with me about depression / anxiety disorders as well. The single minded focus on eliminating “stigma” has, in my estimation, been a net negative for our society.
It's worth putting the question "what happens when lots more children get diagnoses of developmental issues" in conversation with the question "why are so many schools spending more money every year without getting better results".
Just for fun, someone should look into the strident “infant back sleeping” guidance the American Academy of Pediatrics issued in 1992. Has all the attributes of an explanation: timing, scale (every new parent in America!), plausible causal link. - if you deprive whole generations of quality sleep in the first 12 months, as neural circuitry proliferates like wildfire, some will get a little messed up. (I don’t disagree that diagnosis is a factor but the back sleeping thing hasn’t gotten nearly enough scrutiny IMO)
It's quite possible there one weird chemical or one weird position or some other one weird thing that's causing the autism spike, but finding it is nearly impossible.
Kids can roll over around 5 months at which point they almost universally sleep on their sides and stomachs… though it is possible I suppose there’s already an impact at this point.
As a person who plan to have another baby one day I would love this. There's so much nonsense out there which only serves to make life miserable for parents. If we make parenting easier, people might have more kids...
I was so scared my firstborn would suffocate on her tummy. The second I always came back to sleeping on his stomach, and I eventually stopped worrying.
I trust nothing the AAP says about sleep, but on the other hand so far all my babies have hated being on their stomachs anyway, so lucky for me I guess
If the past is to be a guide for the future, then any accelerated drug approval process will be centralized at the White House and done via executive fiat after the proper imperial tithes are paid.
Something that seems very peculiar to me is in addition to the broadening expansion of autism is something changed about attitude in the years between when I was an ese student to when I was a teacher.
Like we were all pulled out in a self contained classroom and the message I got there was like you can defeat your disability. And by the time I became a teacher, the message became we will accommodate you so you can succeed. Students are trained to ask for their accommodations.
I’m a level 1 autistic formerly Asperger’s and I still needed a lot of help to get through school and a bit of forbearance for my conditions and saying it’s all over diagnosis is weird. So is panicking about it.
Half this comment section at least, myself included, would have formal autism diagnoses had we been born 15 years later.
I am aghast at the fact that this administration is ignoring the main epigenetic trigger for autism, Star Wars.
Hell, this substack has been known to engage in Dune commentary. Clearly the mRNA of literary contaminants.
A good dose of Star Trek will set them straight.
Finally a medical reason to ban the prequels.
I can't tell you the number of times people have subtly suggested to me that I have a mild autism. I do not.
Or that I'm a lesbian. Nothing wrong with either of these things, but I'm also not a lesbian. I'm just smarter than you.
I have been told by a colleague that I have ADHD because I am messy. A number of people have asked me if my now young adult kid has been tested for autism - none of these people are his health care providers or teachers. He has some stereotypical traits of autism - some of his friends tell him that he has autism - but he gets great grades in school and has plenty of friends, so what would be the point of testing?
One of his friends is also often told that he is autistic because he has a hyperfocus on certain topics, and he watches the same movies over and over. But this young man got a $300,000 book deal from a major publisher right out of college, and has roommates and friends, so, again, even if he is autistic (which he claims he is not. I do not know if he has been tested.) what is the goal of testing? There is only a finite amount of resources, so shouldn't they be reserved for more severe cases?
And even if there was a point to testing, what treatments or interventions would the "help" the friend or would the friend pursue? I have a child that exhibits some of the traits you highlight, but he has friends, does well in school and we would not start him on medication, so what is the point?
Sometimes people just want answers and that's fair enough. But I wonder how many more people want answers because there is more awareness of and less stigma around autism, ADHD and nuerdiversity. As Matt points out, this has almost certainly led to at least some of the increase in autism diagnoses that this Administration apparently wants desperately to stop.
"I'm not a lesbian. I'm just smarter than you" would make a great bumper sticker, just saying
I only learned long after the fact that parents + teachers had had Concerns about me as a kid, and there was some question of getting officially screened...but being mostly functional meant living out life ignorantly just on one side of the cutoff line of the 90s. Wouldn't say it's been blissful exactly, and an IEP wouldn't have done much - if anything, being aware I *had* some sort of limitation might have developed into an excuse to hold myself to lower standards - and yet...who's to say? Certainly things would be different without having to endure years of increasingly-abusive demands for eye contact; certainly things would be different with earlier insight into the particular cluster of traits I tend to love/hate in others*. It must be a rather different experience growing up under the modern DSM. Not all sunshine and roses either, as Freddie would expound upon at great length. I think there's a fine line between feeling shame for one's mental disability, and reducing stigma so hard that it rolls over into a positive trait instead. At some point one starts to feel like they're taking crazy pills when everyone's discussing their "neurodivergent superpower" and I'm sitting here like...I'd take the medication from Scott Alexander's Against Against Autism Cures in a heartbeat, wouldn't you? Normal is Good, Acktually?
(I do think it remains silly that it's way cheaper and easier to get an ASD diagnosis as a kid vs as an adult. It'd be nice to have formal social proof...but not so much that I wanna shell out several thousand dollars or whatever.)
*Autistic intense interest: other autistic people, who are either Instant Friend or Immediate Nemesis. No middle ground. I'm not sure why this doesn't occur with allistics, who have a normal distribution of affinity, as befits normal people...
I vaguely wonder if being diagnosed might have triggered steps that would have attenuated my intense hatred of academic busywork in school such that I would have found formal education more tolerable to pursue, but I kinda doubt it. I'm never gonna be effective at following someone else's curriculum.
"intense hatred of academic busywork"
I feel seen.
I was the kid in high school who who got buy by aceing every test while only handing in half the homework.
Were your teachers shocked when you also aced the SATs? I qualified for a merit scholarship and my Physics teacher was open about their combined surprise.
ETA, remembering more closely, I guess that was actually the PSATs.
The school guidance counsellor was thoroughly confused when comparing my grades to 96th percentile PSATs.
Half?!? That's a lot!
My comment should not be construed to imply that the homework I did submit was thoroughly completed.
I shiver a bit when I realize the drastically different path my life could have taken had I had an excuse to not perform (which is very easy for a child to want to take) versus an expectation that I work really hard.
LOL
For those of us who still think of mental illness as a bad thing, the looser criteria have basically pathologized having deep hobbies other than watching Nascar or American football. I spent hundreds of hours writing a Connect Four solver in C++ a couple years ago. These days I spend my free time chatting with AI about European high-speed rail and running optimization problems. (The Italians really should have done a Y in the north with the nose about 15k west of Ferrara rather than building a separate Bologna-Milan and Milan-Venice high speed lines. This conclusion is robust to the reasonable range of assumptions about the value of passengers time and discount rates).
My hobbies would only be a disability if my inability to discuss the trash of TV kept me from having a girlfriend. Fortunately, there are enough smart women out there that I did just fine after I got my JD and stopped being obese.
Can confirm. I do love trains.
Hey now! I was tested, and to my parents disappointment I was "just like that."
I'm very suspicious of the timing of Trump's Tylenol announcement (right after Charlie Kirk's assassination.) Kirk's ideology about women prioritizing child-rearing is front and center now, and then the Trump White House decided to announce that pregnancy should be harder if you care about your child.
I think they chose now to announce this "link" to further put pressure on women to conform.
I think it's just because RFK promised to have the answer by September, so they had to come up with something.
edited to add an example: https://www.bbc.com/news/articles/cj0z9nmzvdlo
He did try to walk it back partially later though: https://www.axios.com/2025/05/23/rfk-jr-autism-report-september-march-timeline
I didn't know he said that. That's so dumb!
I once was talking to a psychiatrist trying to get a proper analysis of whether I had autism or just read the list of symptoms and matched self-perception to fit; I then accidentally got diagnosed by questionaire.
I already knew the answers to the test! What did that prove?
I kind of also wonder if the fact that there are greater financial incentives for working in STEM also mean people with mild autistic symptoms have also been more likely to have kids compared to their peers than in the past.
Autism maybe, ADHD definitely. In second grade (around 1987) I was identified as having trouble paying attention in class. What probably would happen today is I'd be medicated and left at that school. What actually happened was that my parents moved me to a better/more challenging school, and I'm very glad for that.
I certainly noticed, when I worked with what are now called Level 3 autistic kids, things I did behaviorally that were similar to things they did, but at the time that just made me empathize better with them.
I have OCD-ish tendencies too but nothing remotely impairing.
It does seem kind of ridiculous that someone who can't speak and needs 24/7 care is said to have the same "disease" as someone with a large Lego collection.
I’m sure it’s more accurate to call it a spectrum, but it’s unhelpful from a communications standpoint. Everyone understood the distinction between Asperger’s (manageable social challenges) and autism (profound impairment). But if you tell me someone has ASD, that could mean anything from mild weirdness to being nonverbal.
Derek Thompson had a good podcast episode on over diagnosing:
https://open.spotify.com/episode/1PXNiGG1V5bQmaaDABjIjC?si=qjgoanT8QbKGdfkkn7yNGQ
Bring back the term Asperger's! This has been my pet peeve for a while!
The funny thing is the way the average person talks about Asperger's vs. autism, I had assumed Asperger's was the more severe one.
This is lumping of the worst sort and it’s totally unecessary.
Yea, while there are probably advantages for placing people on a "spectrum", such as helping get access to care, it's clearly got some drawbacks as well like "increasing rates of autism" leading to nonsense and the ridiculousness you pointed out. When naming disorders, people should really look at the tradeoffs of those labels. Not just the tradeoffs that happen in a clinical setting, but also those that affect the larger society.
It's similar to the euphemism treadmill issue in general.
In talking about my own child’s challenges—and mine—I find the words “spectrum disorder” useful. I feel like it flags a basket of behaviors without mentally summoning the more extreme autism imagery. Plus the word “spectrum” itself suggests the size of the possible outcome band.
As journalist Dan Gardner discussed in his book _Risk_, we humans are in possession of three-ish pounds of grey matter, much of which hasn’t evolved enough to deal with our current social/technological complexity. In short, we’re often terrible at assessing risk.
Some risk to taking Tylenol during pregnancy? Quite possibly-but as Matt pointed out the risk of fever is much greater.
Even so, I can see the appeal of RFK’s brand of crankery-to put some sort of chemically synthesized something in your body _seems_ unnatural. Our ancient ancestors, in their wanderings, must have been wisely hyper cautious about trying novel new plants as food sources.
"Our ancient ancestors, in their wanderings, must have been wisely hyper cautious about trying novel new plants as food sources."
Hard to say. They seem to have tried out just about everything and if 1 out of 50 people each generation died of being too curious about novel plants how would we ever know?
Somebody had to be the first person to push aside a wild baby calf and steal its milk.
I just wish people paid closer attention to mortality rates back when people lived more "naturally." As your post points out with Tylenol, there are trade-offs for these decisions and the cranks (to a lesser extent scientists) often do a terrible job of discussing the trade-offs.
That's how diseases work though.
COVID is the same disease, even though I had what felt like a bad cold for a couple days and felt weak for a few weeks, and a friend ended up hospitalized on a ventilator.
There is a fundamental difference though in that you both had the same test, with the same result. You took a Covid test, they took a Covid test, you both had Covid. Because Covid is not described phenomenologically, it is described using objective criteria.
ASD on the other hand, is (quite literally) describing the phenomenon of having the disorder. If it doesn’t seem like you have it (definitionally) you don’t have it. So there is actually a reason to think that two people who both have the same disorder would be similar in a way that you would not necessarily expect in the case of Covid (or any condition diagnosed using laboratory tests).
They're are levels.
I keep wondering if/when we're ever going to have a "...no sense of decency, sir, at long last?" moment that will cut through the haze. Maybe we won't have one. Or, maybe it'll be two or three things that crystalize together, and (finally) move public opinion decisively. Jimmy Kimmel is a pretty well-known brand. Tylenol is even more well-known. Fingers crossed the dam bursts sooner rather than later. Governance by kooks is scary.
There's something about the utter shamelessness that is specific to Trump that allows for the creation of impervious information bubbles in right wing systems. It's a bit of an emperor's new clothes situation. In my heart of hearts I believe most people have some sense of how absurd Trump is but a combination of being in so deep already and not truly knowing or being allowed to openly discuss with others on their side just how absurd they think MAGA is keeps it in tact. I think the dam will only truly break if Trump himself falters significantly (openly becomes shameful in a way that breaks the facade) or he dies with no successor in place strong enough to maintain the reality distortion field.
The GOP is very much in its Stalin/Mao era right now. The emperor is completely naked but still has total control. Everyone knows it's nuts but there's fear and a massive collective action problem. What's next will hopefully be more of a Deng Xiaoping, but at this point I'd also take a Kruschev.
I think that's true at the senior party level.
My experience with the voters who have been voting Republican since before 2016, which is a lot of my family, is that they'll acknowledge "issues" but that they have a ready made laundry list (I assume from Fox News or wherever) of whataboutism and assertions of insanity and/or lawlessness that occurred during the Biden administration. Even where they have some points it strikes me as nevertheless a lot of false equivalence and very motivated reasoning but I'm not sure what you say to talk it down. Sadly I think the only way out is through and hope for a combination of a better Democrat alternative than the one that's been presented and a retrenchment to something less idiotic whenever Trump passes on to that tacky golden casino in the sky.
The transgressions of another does not excuse one’s own transgressions.
That is my retort to whataboutism. If they are a man, then you can talk about virtue and personal integrity. Trump is not a man, he is a child.
Murdoch probably (incredibly!) still doesn't come in for quite enough blame. Social media seems to get all the attention these days when it comes to diagnosing society's ills (no doubt for good reason). But the particulars of Fox News's model and reach have transformed our politics into a rage-filled cauldron. Imagine believing the other side is so dangerous you feel compelled to attack the US Capitol! The late Kevin Drum did quite a long, hard look at the data on this (worth a read if you've got 20 minutes):
https://www.motherjones.com/politics/2021/07/american-anger-polarization-fox-news/
https://jabberwocking.com/yes-fox-news-deserves-the-blame-for-american-rage/
That tacky golden casino deep, deep underground (FTFY)
For me, it's not just voting against the Democrats that is the question, but why no Republican alternative was seen as a better choice.
>There's something about the utter shamelessness that is specific to Trump...<
Trump as sui generis is the optimist's take. You may well be right. I hope you are. Indeed, sometimes it seems the obvious interpretation: how could there be another like him?
Tucker Carlson comes to mind as a possibility. I think for Trump something about his prior cultural ubiquity made him legible for those outside the party to hold their noses and vote for him or at least become enamored of him. No one else comes to mind with that level of ubiquity.
(Disclaimer - this is a ten second hot take and not very well thought out)
Trump gives them permission to act on their most debased and immoral impulses.
It's been a decade of me thinking: Is THIS the thing that will finally turn people against Trump? I mean, come on.
Through blatant corruption, insane policies, and scandals that would have been a massive deal in previous presidentcies (he's done way worse stuff then happened in the Lewinsky, Iran Contra, Watergate and Teapot Dome scandals) he still remains fairly popular. At best, his disapproval rate inches up. It's frustrating.
It’s tough for real information to pierce the right wing media ecosystem that a lot of his voters live in. Only big events like a recession (or pandemic) have broken through.
I just keep telling myself, he's The Mule, and hoping we outlast him.
I'm very skeptical about that happening. Give my anecdotal point of data from a single Australian sample all of the weight it deserves, but discussing Trump's performance at the United Nations with a Trumpy male relative resulted in this response: "At least he says what's on his mind in plain english, and he's willing to defend his own country." I'm astounded that people are prepared to rationalise unhinged, corrupt or criminal actions to the wild degree that is seen with Donald Trump. I know I wouldn't be given the same latitude if I acted in the same manner.
Joe McCarthy continued to have ardent fans long after the Red Scare was over, and long after his death. There will always be people who admire autocrats, bullies and thugs. The question is: will enough normies (and traditional conservatives) have the scales lifted from their eyes for a sea change to occur. In a *very* tightly divided, 50-50 nation, the movement in numbers required for big changes need not be all that huge for a decisive impact to transpire.
I waited for a really long time for this but it's not coming. The best case scenario is Trump leaves the scene and everyone pretends this never happened.
The big problem with this analogy is that during the McCarthy era, the big shots in his own party and in Congress we’re looking for a chance to kick him down a dark stairwell. The have no decency moment, simply granted, a measure of permission to do that.
Oh, analogies are always problematic, owing to the fact that history rhymes much more so than repeats. So I grant your premise that our situation today is hardly the same as during the early 1950s. Agreed! On the other hand, I do rather think plenty of people in Trump's "own party and in Congress" find him odious, threatening and difficult. And I can't help but note that, with respect to the Kimmel imbroglio, a number of voices pushing back against the president—very openly and seemingly without fear—were Republicans. Also, a lot of Republican voters take Tylenol!
Maybe it's folly on my part, but I do believe it's pretty likely Trump will get out over his skis at some point. That won't mark the end of Trump's presidency or the MAGA movement. But it may begin to make their cultural revolution an increasingly uphill climb. I reckon until the midterms (or, more likely still, until January of 2029), that's about the best we can hope for.
Right on!
What gets me is I wonder if he had been 50% better on a number of topics, if he would have gotten the GOP nomination in 2016 and his base would still be so attached to him. If he had been more of a legitimate entrepreneur instead of a conman? If he was less bigoted? If he was less of a creep or a conspiracy theorist? In those cases, he's someone like Mitt Romney they just feel stuck with.
As someone who had a child with “old school” autism — where it isn’t a fun quirk but in fact a range of huge developmental impairments that significantly alter the life of whole family — it’s been a rough week on the internet. I try to be chill and not precious about stuff but “heh if Tylenol caused autism then then USA would have mass transit” jokes hit different when your experience of autism is “can’t potty train your five year old”.
I have two cousins with autism. One can function independently but can’t really work. The other is a 6’2” non verbal giant that needs constant care.
There has been so much “trivializing” of this condition by people (and those self diagnosed fully functional clout chasers online really are vile.)
Thank you! I know several people with kids with profound autism, and all the discussion that "it isn't a disability," is really painful for them. It also makes me wonder if the widening of the definition leads to a decrease in care and research around "old school" autism.
Not quite the same, but I have a relative with OCD. Her case is fairly mild in that she is still mostly able to go to school, work, etc., but through treatment and conferences, she has met many people who are debilitated by it and can't even leave their house. To call someone who likes to have their books lined up by height as "having OCD" is trivializing. Also, the rant I always have - people who want things neat say they are OCD, but often a manifestation of OCD is not being able to clean or attack messes at all.
Tylenol is the only form of pain treatment available to pregnant women. It’s not all that good, but we aren’t allowed to take NSAIDS or anything stronger. Now the same men who want American women to have more babies are telling us to endure nine months of sciatica, back pain, leg cramps, and round ligament pain without any pain relief at all.
Perhaps being in a rough third trimester is making me touchy on this issue, but pregnant women are human beings with pain receptors, not just incubators.
Several years ago Scott Alexander reviewed the lesser-evidence things that might help during pregnancy:
https://www.astralcodexten.com/p/obscure-pregnancy-interventions-much
> Avoid Painkillers, Including Tylenol (Tier 2)
> Doctors have been gradually chipping away at pregnant women’s ability to use pain medication. First it was “don’t use opioids, your baby could have birth defects”. Then it was “and don’t use ibuprofen, your baby could have kidney problems”. Then it was “and don’t use too much aspirin either, your baby could get cardiovascular problems”. That left Tylenol (aka Panadol, paracetamol, acetaminophen, etc) as the only pregnancy-safe pain reliever. Well, bad news…
....
> But remember: all the other painkillers, eg ibuprofen, are even worse. So what if you have pain during pregnancy?
> Then Perish
My tolerance for food and drug woo has always been very low, but it has gotten me so more irked over the past four years due to gaining significant power. It's taking advantage of dull thinking that can't even account for basic statistical knowledge, and leading people down paths that range from merely exploitative to downright dangerous. Some of this is from pure grifters, some it is from arguing that suffering is good from an appeal to nature, with plenty of overlap in between. I'm so through with it.
I think another factor in the misperception of rising autism is visibility. Someone with actual knowledge on this should weigh in but my impression is that when I was in school (1991-2004) kids with various forms of autism were often sent to segregated special needs schools. Now many are integrated into regular schools so I, a parent of a kindergartener, see those kids at school more now than I did when I was a kid.
The epistemology of right wing cranks is shocking. Everything is a poison or an elixir. It is totally unpredictable which drugs or foodstuffs will belong in which category, because nothing makes sense. Who thought an anti parasite medication would be regarded as an elixir, and oils made from seeds would be regarded as poisons? The only thing that determines which is which is the charisma of YouTube influencers.
I have a family member with a severe intellectual disability, which gives me a bit of knowledge into that world (which of course includes a lot of autistic people). As late as the early nineties, having a “retarded” (in the language of that time) was a legit stigma and made a lot of people uncomfortable. The parents got a lot of unkind comments and generally people treated the situation the way they would if they found out a family member was a child molester—not your fault, but still a horrifying situation. Now the situation is extremely different in that an autism diagnosis has no stigma whatsoever.
I saw a LOT of posts after Trump’s announcement saying that autism isn’t actually a disability and treating it as something to be cured is ableist. If those people actually knew any severely autistic people (vs people who just don’t like wearing wool because it’s scratchy or whatever) they would certainly not think that. Autism is a terrible thing and it results in a much lower quality of life for those who have it and is a massive sacrifice for the caregivers. Expanding the definition of autism to mean practically anyone has done no favors to those who suffer from the real thing.
"...to practically anyone.. "
From a resource perspective, it is important to have lumping of diagnosis for ppl who are unable to function in society and gain employment or even leave their house. They may be talking and the behaviors might not lead to harm. They wouldn't be considered severe.
Yeah. Having a mercurial president and a bunch of cranks in charge isn't leading any of us in biotech or pharma to be optimistic about reforms.
I think I've made this point before in this space but I'll repeat it: the path from using LLMs to massive acceleration in drug discovery isn't clear at all. You need large reams of data for LLMs to be useful, which means mainly working on precedented targets with lots of literature (e.g., kinases, which are way easier to drug than things like transcription factors). Which means either "me too" type drugs (which get a little bit of a bad rap, but you're still mostly talking incremental progress) or longer timelines in order to generate the data needed to feed the models. Safety data, in particular, is problematic for LLMs since you don't usually generate it for more than a handful of molecules.
It's entirely possible that the state of machine learning will advance to the point where this will change, but that's the framework for the current state.
To be fair, there are completely different models than LLMs that are trained to do things like predict how amino acid sequences will ultimately fold into proteins (Google alpha fold). Those are incredibly effective and are already in use in biomedical research today. Predictive tools based on computational chemistry have already existed (Gaussian comes to mind) that have given pharma companies the capability to predict molecular structures that will bind to specific proteins without the need to synthesizs large batteries of target molecules for assay screening. They're not AGI or anything, but they are tools that have accelerated research meaningfully.
Absolutely correct! And we use these tools all the time. If we were to use LLMs similarly (with molecular generators or "active learning") then we get a similar meaningful acceleration in research. But what that *isn't* is something that's going to shave years off your timelines. In the current state and foreseeable future, it's simply the latest advancement in computational tools. It helps, but it's nowhere near revolutionary.
LLMs are pretty far from being able to win a college parliamentary debate tournament, and that is a purely oral task for which written training data are pretty useful. The more I think about it, the more I think LLMs will max out around the level of an in field PhD. Being able to think that well that cheaply is amazing and will revolutionize clinical practice, but it’s not really going to push the cutting edge that hard.
Also, I don’t think Tylenol has anything to do with it, but my understanding is that the rate of “actually really disabling” autism has also been sharply increasing. I don’t think it is all a detection/diagnosis story (though of course that is also happening).
If age at first birth has anything to do with this, then the ratio of heathy to less healthy children will change. Lower fertility (driven mainly by delayed childbirth) might be the driver of increased prevalence. The rate increases because the numerator decreases.
Would love to see statistics on this. I have three close friends who each have a chiled with pretty debilitating cases of autism, two of whom are now large, non-verbal young men, and the third a large, verbal young man who cannot really live independently (though desperately wants to). I don't recall anyone like that from my childhood, though perhaps they were just institutionalized and kept out of sight.
“I don’t think that necessarily means that the rise in diagnoses is entirely benign. There are reasonable questions to ask about whether more aggressive diagnosis of psychological maladies is making things better or worse.”
This resonates with me about depression / anxiety disorders as well. The single minded focus on eliminating “stigma” has, in my estimation, been a net negative for our society.
It's worth putting the question "what happens when lots more children get diagnoses of developmental issues" in conversation with the question "why are so many schools spending more money every year without getting better results".
Just for fun, someone should look into the strident “infant back sleeping” guidance the American Academy of Pediatrics issued in 1992. Has all the attributes of an explanation: timing, scale (every new parent in America!), plausible causal link. - if you deprive whole generations of quality sleep in the first 12 months, as neural circuitry proliferates like wildfire, some will get a little messed up. (I don’t disagree that diagnosis is a factor but the back sleeping thing hasn’t gotten nearly enough scrutiny IMO)
It's quite possible there one weird chemical or one weird position or some other one weird thing that's causing the autism spike, but finding it is nearly impossible.
Kids can roll over around 5 months at which point they almost universally sleep on their sides and stomachs… though it is possible I suppose there’s already an impact at this point.
5 months of everyone not sleeping is an eternity.
As a person who plan to have another baby one day I would love this. There's so much nonsense out there which only serves to make life miserable for parents. If we make parenting easier, people might have more kids...
I was so scared my firstborn would suffocate on her tummy. The second I always came back to sleeping on his stomach, and I eventually stopped worrying.
if they roll over themselves it's fine.
I trust nothing the AAP says about sleep, but on the other hand so far all my babies have hated being on their stomachs anyway, so lucky for me I guess
If the past is to be a guide for the future, then any accelerated drug approval process will be centralized at the White House and done via executive fiat after the proper imperial tithes are paid.
Something that seems very peculiar to me is in addition to the broadening expansion of autism is something changed about attitude in the years between when I was an ese student to when I was a teacher.
Like we were all pulled out in a self contained classroom and the message I got there was like you can defeat your disability. And by the time I became a teacher, the message became we will accommodate you so you can succeed. Students are trained to ask for their accommodations.
I’m a level 1 autistic formerly Asperger’s and I still needed a lot of help to get through school and a bit of forbearance for my conditions and saying it’s all over diagnosis is weird. So is panicking about it.