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.
This interview is extremely frustrating. O’Sullivan and Thompson both suggest that people are being diagnosed with ASD who, in fact, have no disorder whatsoever.
This is a pretty extraordinary claim that requires a lot more proof than, "I don't really like the DSM."
It’s fair from a policy perspective to point out that a formal “diagnosis” is relatively meaningless if the criteria are too broad and vague for anyone to take action on the information of a diagnosis. Especially when the diagnosis is of an already well known condition that has a public meaning established by years of medical messaging that is entirely disconnected from the new meaning being applied.
OK, but this isn't true. A diagnoses has very specific criteria. I can only speak to ASD, but the definition is hardly vague or "wooly" as O’Sullivan repeats--it is very specifically outlined the DSM. Nobody is misdiagnosing awkwardness for Autism (as Thompson suggests).
And there are very specific actions to be taken based on said diagnoses: speech therapy, occupational therapy, physical therapy, ABA, CBT, etc.
All of this holds true even with the expanded definition of Autism (i.e, level 1/previously likely Aspergers) whether or not the public can keep up.
A complicating factor in this is that just because you are told someone is autistic or someone claims to be autistic it does not mean they have been formally diagnosed as autistic. I think a lot of people rely on anecdote and personal experience (like they do for a lot of things). And yes, I realize that I am basing that claim on personal experience.
This comes from Australia where I live but I imagine similar things happen around the world due to the principal-agent problem that insurances introduce. (Backgrounder: the government in Australia rolled out a new multi-billion dollar program called NDIS that, to be cynical, allows private companies access to unlimited government dollars by diagnosing a child with autism. That wasn't the original goal of the program, obviously, but that's what has de facto happened and has blown up the Federal budget. They are now planning to kick all kids with mild & moderate autism off the program to repair the budget hole.)
A report took advantage of the differential roll-out of NDIS to find how much it contributed to an increase in autism diagnosis, separate from all the other factors like changing diagnostic criteria, etc.
"The main finding was that the NDIS has accounted for nearly half of new autism diagnoses in Australia since 2013. When the scheme was announced, autism supports were expected to cost the NDIS about $1 billion. In June 2025, autism supports were costing the NDIS almost $9.5 billion. Half of this growth, or about $4.5 billion, is a direct result of the increased autism diagnoses that were generated by the existence of the NDIS.
"The effect of the NDIS on generating autism diagnoses has increased over time. According to Health and Disability Minister Mark Butler, one in every six 10-year-old boys in Australia is receiving NDIS supports. A total of 78 per cent of children in the NDIS have developmental delays (often, a precursor to an autism diagnosis) or autism.
"Diagnostic practices have clearly shifted in response to the NDIS."
I don't think it is a stretch to assume that when private companies are claming that 14% of boys are autistic that....they are making it up to get billions of government money that has very little oversight.
That's interesting, and if clinicians in Australia have been misdiagnosing children with Autism en masse that is certainly a huge scandal. Not to mention a massive, collective, malpractice.
I guess my problem with O’Sullivan and Thompson's discussion is they provide no such evidence in the US or UK (which seem to be the focus of her book). It's completely "vibes" based. And then they go well beyond Autism claiming pretty ALL disorders (ADHD, Bi-polar, anxiety, depression...) are being misdiagnosed. This would be a massive, global scandal.
We measure pain from 0 to 10. We measure hurricanes from category 1 to 5. We measure cancer in 4 stages. If 2 categories for ASD aren't accurate enough, we should just make a couple more.
The problem was that there was "high-functioning autism" and there was "Asperger's syndrome", and even though they were widely recognized as being basically the same thing, technically the DSM at the time treated them as separate disorders. So you could have a scenario where one could get services from a school for a diagnosis of high-functioning autism but be S.O.L. if one had a diagnosis of Asperger's. The different labels for the same thing were causing a mess.
Respectfully, in the legal context of accommodations, isn’t the point of diagnoses to separate those who really need accommodations from those who don’t? Schools, and society in general, don’t have unlimited resources.
Also, are they in fact the same thing, or not? Because if they are, you should just have one diagnosis for the same thing. Now we have one diagnosis for multiple things that are clearly different. I don’t see how that really helps.
"Respectfully, in the legal context of accommodations, isn’t the point of diagnoses to separate those who really need accommodations from those who don’t?"
Yes, and I would say that Asperger's/high-functioning autism still need accommodations -- just not the same ones as those more severely autistic.
"Also, are they in fact the same thing, or not?"
Yes, high-functioning autism and Asperger's are the same. This is not news.
(FYI, when I was a kid, local Autism Society support group meetings were held at my house for years. Heck, I was around when the Autism Society was NSAC. Point is, I've been around the block on this, and long before it became an Internet thing.)
"Now we have one diagnosis for multiple things that are clearly different."
No, we don't. Even in the latest DSM, there are clear distinctions between levels of autism. Level 1 autism is not the same diagnosis as level 3 autism.
Rottweilers and poodles are very different beasts even though they're both dogs. Doesn't mean we throw out the category of "dog."
I understand this impulse (complaints about the spectrum nature are common), but I honestly can't think of a scenario where it would create a significant communication issue.
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.
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).
Here's the thing. Autism runs in families, and it's not uncommon to see both severe autism and "little professors" (and not so little ones) in the family. It happened with me and my brother, for example. So there's an indication that there's a link between what at first seem like distinct conditions.
Yes, it’s not so much having a test as sharing a mechanism. That’s why it’s easy to understand a range of severity for COVID but it’s shakier for autism unless you can point to something like genetics.
But at this point, genetics does appear to be the primary cause for people all along the ADS. So there may be two questions, what causes someone to have ADS and what causes it to be more severe in some circumstances.
That’s right or we could be dealing with a variety of disorders. A genetic disorder with variable penetrance creating a spectrum but other disorders (or variants of normal behavior) mimicking different parts of the spectrum.
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.
(Full disclosure, I was only diagnosed with ASD myself a few months ago) I have found the opposite. When people think about the autism spectrum…the key work there isn’t spectrum. It’s autism. It makes
my struggles sound much worse than they are, in a way that using, say, Asperger’s would not
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.
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.
I recall reading a story of an Internet-pilled mom-to-be who got stuck in a “natural childbirth is good nobody needs doctors” algorithm discourse loop.
Everyone in that loop was telling her “women gave birth naturally for eons and it was good ‘nuff ‘cause we’re here right?”
They didn’t mention the spectacular mother and infant mortality rates. She didn’t get prenatal care, got care too late when she thought there was a problem, lost the baby and nearly her own life.
There are lots of stories like this. It makes me wonder what exactly leads people to so fully rely on Internet anecdotes and unverified memes, while completely discounting scientific studies. Like, where is the logic? I’d like to think “Huge percentages of our species are stupid AF” is not the explanation. But what other explanation is there?
It's like, should we be all that sad that those who follow RFK's advice have a bunch of miscarriages? Seems like Darwin in action.
I wouldn't permit Trump/RFK supporters to procreate in the first place, but if we're not going to properly require prospective parents pass multiple tests to be licensed for the privilege, the best option is for the pregnancies to fail. That being said, pregnancies carried to term with severe birth defects are the worst of all options, and that may be the more likely outcome.
Both a scientific study and an internet meme are somebody who claims to be smart telling you something interest. The difference is that scientific studies are written in harder-to-read prose.
(I'm being somewhat facetious; obviously the real difference is the credentials associated with the text.)
Even if it is not "huge percentages" there are going to be a very large number of people that are going to not be smart. Combine that with the fact that many smart people are not smart about everything and they can also be duped, etc. Even if 10% of people are really stupid about a given topic, that's 34 million people just in the US!
"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 think the best evidence for "humans subject to hunger pressure will do insane things for calories" is Surströmming.
Honorable mention to Hákarl (although that one I've actually tried. It's like a very ammoniacal smoked-cheese flavor. But the first person to bury and then dig up and eat a Greenland shark must have been nuts.)
I had to Google Fu Surstromming and after finding out it is fermented herring then reading “It is traditionally eaten outdoors or _underwater_ to contain the smell” I am dying 😂.
Cautious certainly doesn’t mean “never.” I’m sure if the available doors were 1)“starve” or 2)“nibble that unfamiliar fruit and see if it makes me sick” they’d opt for 🚪 number 2.
100%. My wife was a Special Education teacher in an Elementary setting and now she runs a day program for adults with disabilities. Even between the kids she'd see in Elementary School vs. the adults she provides services for now the differences were stark. All the adults she works with can't live alone, but they're far far more capable than most of the kids in any of her classes. So even among those who need 24/7 care the range is huge, the fact that we include people closer to the quirky end of the spectrum is baffling.
And parents of the quirky kid will flip out when you are talking about how horrible it is to deal with a child with the disease because there's just throw shit on the wall
I don't know if this is what you were asking "why" about, but I'm going to attempt to answer the question "Why do some members of the autistic community find the term 'high functioning' to be obnoxious?"
As Ben mentioned, "high functioning" generally refers to how well an autistic person can “fit in” to neurotypical society. A lot of interventions for autism are focused on making the autistic person “fit in” by acting more "normal". For example, many autistic people self-stimulate or "stim" by repetitive movement or behavior like rocking, flapping their arms, or repeating words to help them deal with overwhelming emotion, sensory overload, or sometimes just expressing excitement.
The standard autism treatment is to extinguish this behavior using rewards and punishments. This approach, called Applied Behavior Analysis (ABA), is rooted in behaviorism—the theory that there is no mind, just behavior.
Autistic people usually find this “masking” of their true selves to be exhausting and demoralizing. Maybe some of the difficulty of “fitting in” should instead be addressed by making society more accepting. Why not teach neurotypical people that some people stim, and explain why they do it and that it’s okay? This is happening, slowly. In my teenage kids’ classes there is far more understanding, acceptance, and accessibility than when I was in school.
Another issue is that "high-functioning" implies that autism is a one-dimensional condition that you have more or less of—but really there are a variety of issues across social, physical, emotional, and sensory dimensions. Some autistic people have no trouble looking others in the eye and smiling, but melt down trying to cope with a buzzing fluorescent light. Some can barely control their muscles but given an alternative means of communication are bright and socially engaged. Some common autistic traits like extreme focus are actually gifts in an occupation requiring high attention to detail.
Many autistic people therefore resent the implication that they should want to be cured. They have a different experience of the world from neurotypical people but it can be positive. But this last point is also controversial. Some autistic people experience extreme debilitation and impairment and would be quite happy to have a cure, and they look at talk of autistic “super powers” as whitewashing their disability.
I kind of went through this thought when one of my children was diagnosed (in grade school, not as an infant or toddler) with what I would describe as "high functioning" ASD. At the time, I only knew about autism from Rain Man, so I did a lot of reading and watching.
And here's one of the things going on: there are a bunch of adults with ASD (of various "functioning" levels) who are capable enough of communicating to everyone else and they have a lot to say about ASD...in particular that it's neurodiversity and not a disease/disability and therefore all of the institutional money focusing on "curing" _realy pisses them off_.
Clearly there's a very different view of autism - something that drives "scares" and the hope of finding a "cause", something scary enough to drive anti-vax paranoia. My mental image for that is parents of child with ASD whose functionality is severely impaired such that parenting is much more difficult than they expected, e.g. developmental, language and communication impairment.
And to make it even more complicated, we sometimes get autistic adults who were at that level as children and can now tell us things about their experience...and they're not real happy about how they were treated as children.
My response to this as a parent has been to try to see my son as he is and not as I might wish him to be or as I might assume he is from some diagnosis or model. And I think that's not that different from how I should be a father under any other conditions.
(I've put "high functioning" in quotes here because some members of the autistic community find it to be obnoxious, but I'm using it because it's a short-hand to explain to everyone else a sense of a continuum, e.g. how does this person with ASD interact in a community of neurotypical people, how much friction is there, etc.)
The rise in people seeking a personality diagnosis from their doctor has resulted in a new permission structure where people just hand out personality diagnoses to other people unprompted.
A big thing that also contributes is the collapse of the Tumblr Containment Field that allowed the tendency to characterize oneself by one's pathologies and have entire worldview seen through a therapeutic lens to spill out into the realm of normal people.
The comic Craig Ferguson had a bit about the cult of personality disorders he observed around the entertainment industry, how it became almost fashionable to be 'on the spectrum' or ADHD or some addiction. His comment: "how do you know when you have a pathology and when you're just being....you?"
I wonder if what we describe as "autism" isn't really one end of a spectrum of normal brain function. Focused and less aware of others compared to very social and less able to focus. Occasionally something goes wrong and you have the people described in the original paper about autism. But "autism spectrum" is really just normal people of a type.Maybe "autism spectrum" says more about the way we insist on educating kids than it does about actual mental function.
It's not a fully fleshed-out hypothesis, but still...
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.
That seems unlikely, given how fashionable autism is these days. If the kid is gifted and doesn’t have behavioral problems, can’t imagine how it would be a problem.
I don’t think that’s true. Some private schools have amazing support for IEP kids. Even the ones that don’t are not going to reject a kid due to a diagnosis. It would be a case-by-case evaluation to determine if the school had access to the needed resources.
Ha, that is kind of what my son said. He said he could use it when people complained about his behavior. Also, maybe he could get accommodations on schoolwork. Which I doubt they would give because, I learned from today's column, he is in the top 1% of SAT scores. Maybe I need to start giving more deference to his seemingly wacky ideas.
I think testing should only be done if there are problems that actually interfere with someone’s life and I don’t think your son or his friend had them. And just having a few mild behaviors like watching the same movies might just mean he actually is getting something extra from the repeated viewing that would bore most people. This was a thoughtful post and I’m glad that your son and his friend are doing fine!
Are we sure about that. It seems relatively straightforward to get diagnosed ADHD as an adult, and I wouldn't think an autism diagnosis would be any more difficult.
Finding someone who'd do diagnostic testing for ASD in an adult took a lot of research and calling around, a couple thousand dollars, and hours of interviewing me and my family. Most of the psychologists I talked to would only do it for kids.
One problem I think some people have is to equate a personality trait that seems to be characteristic of an actual disease. An example that I got from Freddie DeBoer is about OCD. People who have obsessions can have compulsions about them that most people don’t have so they might tell people that they have OCD. But they live normal lives because they don’t have the clinical diagnosis. A person with real OCD has major problems with real life because the disorder is so severe! I feel like we need to focus on people with the most severe problems, especially with autism because the most severe cases prevent the patient from having a normal life. But we need to also be aware of how these high functioning people with mild ASD process social interactions differently and may also need other interventions that can be very useful in helping them reach their potential. Another author , Richard Hanania has a pretty interesting article on his Substack about his experiences with autism and how it really is a spectrum of conditions.
Yeah. I worked with a lady with OCD when I was a pharmacy student. She had the easiest job at a tiny hospital that might get 5 new admissions at most during her shift, but she literally couldn't get the orders out because of the compulsion to keep checking, double checking, 10x checking her work. As a work-study student I had to manage her rather than the other way around. A sweet lady though, she couldn't help it, it was a profound disability.
Paradoxically, she made lots of mistakes at work, too., I think all the checking made it worse
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 got detention in middle school for repeatedly hiding a book inside my textbook and reading during class. Always interested to hear the various coping strategies people employed to make it through school.
Having done the the autodidact thing as an adult, I think formal education, including lots of drilling, taught me a great deal even with the busywork. Without the drilling, knowledge doesn’t stick as well, but the discipline to drill is much easier to muster within an institution.
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.
The stupid stuff Trump said on accident is actually more worrying than the Tylenol announcements. Why is Trump talking about aluminum in vaccines? Not a good sign for things to come.
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.
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?
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.
"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."
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.
Freddie DeBoer, when not busy picking unedifying fights in other substacks' comments, has published a number of very good essays on this theme. I think this was the first one? (2022)
We ave one of those. He will be 65 in October. Lives in his own apartment, drives a car and has a job.
He was a difficult infant. No amount of cuddling would comfort him. He would arch his back trying to get away from touch. That really screws with a mother's head.
We were told to institutionalize him and go on with our lives. F'k That!!!
I hope that today's parents get better help than we did. We just soldiered on doing the best we could.
He started in public school where one teacher taught him to read. They kicked him out eventually. Special schools were not a big help. One staff said he needed Primal Scream Therapy. That lead to a lot of screaming at home. Thankfully did not do it in public. Another told him he needed a vegetarian diet. He could not process this so diner time was punctuated with: I Want To Make Denise Eat Meat!!!!
The special school was not very special. It was a bad idea to place him in with the kids who acted out weirdly. He tried to fit into his environment and copied their behavior. He got a protected job at a vet. He then copied the "Normies".
He was put on drugs but they made him dull so we stopped them.
From the above you can see I have a poor opinion of the psychiatric profession and the educational systems. The help they offer is very hit or miss with no quality control.
That sounds incredibly challenging and you have my sympathies. It’s still kind of a wasteland in terms of what actually works for treatment but it’s vastly better than it used to be as far as “refrigerator moms” and “scream therapy” and all that went. People in public are also much more understanding. Can’t imagine transposing my situation 60 years ago—it’s tough enough now!
I'm sorry you and your child have to deal with that. My son is not as impaired as your son. He can live independently, and work at a low paid job. But he has significant deficits, and we worry about what will happen when we die. Dreams that I had for my baby boy— a girlfriend, a wife, a family, a career rather than low-paid dead-end jobs—won't happen A couple of friends also have now-adult autistic kids, and they too can sort of function independently, but their lives are restricted. I don't think autism, or even Aspergers, is a funny joke.
Well hopefully we will get to that sort of independence someday! We are certainly trying and hope springs eternal. Right now “someone who needs a lot of support but has interests and is verbal” would be a big W, but that still has plenty of challenges and sadness and loss packaged with it too, I know.
And I am sure there are parents of kids with leukemia or with severe physical challenges who are in hospital constantly who would kill for my situation too—I try to remember that. Everyone has their own challenges.
My daughter was diagnosed with Asperger's as a two year old in 1994. She has grown into a self-confident, accomplished adult and I couldn't be prouder of her. Having worked hard to learn how to behave around other people, she comes across as someone whose condition would be very hard to detect, at least in briefer interactions.
That said, her first 20 years were hell and school, with the viciousness kids can inflict on strangely behaving classmates, was an endless torture.
Even though her condition wasn't severe (she never had special treatment programs in school), I am eternally grateful that we got the diagnosis when we did. Even if one considers the criteria too all-encompassing and ha ha every somewhat awkward kid would be slapped with the autism label.
I have to say that I'm finding many of the jocular comments being posted today pretty loathsome.
We homeschooled our son, who wasn't diagnosed until he was 19. And sometimes I think, would he have had better outcomes if he'd been in school? And then I think, even if he had, would I have wanted to torture him for 13 years to get the outcomes? I have friends who sent their autistic kids to public school, and it was hell on earth for every one of them. I know of other parents who homeschooled their autistic kids, and it was not hell on earth.
I've listened to the stories of adults with ASD and two common themes I've heard are: "my parents willingness to accept my development as it was, not matching what neurotypical children learn and when, and just see me for me was a big positive contributor to my gaining capability" and (the sad flip side) "I was in this institutional situation and it was really awful and the pain didn't result in any gain".
It was a very tough choice. We changed schools to escape the most sadistic students (and sometimes, my god, parents) and almost pulled her out of high school completely. I still don't know if we made the right choice, given how much trauma she endured. But the upside was that once out of high school, she went to a wonderful small college (University of Puget Sound in Tacoma WA), found friends and activities and blossomed. Could she have gone from a specialized school or homeschooling to entering the wider world of college? Maybe, but I have my doubts. She would have been lacking the self-generated tools and the tough skin and callouses she developed in the preceding years.
My son does have a four year degree, though it took a lot more than four years. Would he have been better off having gone to school? Maybe, but I'm not sure that a school would have helped him with his extreme executive function deficits. Also having, myself, experienced the generation of tough skin and calluses from being someone on the spectrum in school, I do not recommend it. It's ghastly, and it still hurts when I think about it, many decades later.
My daughter didn't have *those* kinds of challenges (hers were a lot more social) but it was hard enough for her. She was smart enough to teach herself how to operate in society, in spite of (or apart from) any good or bad decisions her parents made during her youth.
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?
Skimming that made me laugh since the very first piece of advice is "avoid stress"... which cites a study where *pain* is inflicted to cause stress in pregnant animals. No winning for moms.
Endless lists of rules do a really bad job conveying levels of risk. But they do a great job creating a crushing burden for mothers by setting unachievable expectations!
It's like the least controversial thing in any pharmacy. It's like if they came out against milk or eating turkey during Thanksgiving. If anyone in your life freaked out because they saw you taking a normal dose of Tylenol while pregnant, you would think there was something wrong with them mentally.
I'm a woman and I've had two kids. I've used Tylenol during pregnancy to combat terrible headaches.
It seems the truth is that Tylenol's effects are inconclusive. Also, it is sometimes less risky than alternatives, like an untreated first trimester fever.
It should be up to every woman to choose what she can tolerate and what risks she wants to take.
I wish to god we wouldn't polarize things like this, as women will be afraid to make their own best decisions.
They will be afraid on both sides. As a left of center liberal with mostly leftist friends, since having a kid I've lost a lot of openness with my friend group, because nearly every experience needs to be coded through politics for them other wise I get 'educated' or shut down. Its been awful and extremely lonely. People don't understand that your lived personal experience doesn't fit neatly into prescribed political opinion. I don't know why people do this to themselves.
This is some important context that I didn’t know! I thought of Tylenol as a pain medication that is primarily for children, and that the French health authorities recommend over NSAIDs for many purposes. I hadn’t realized that it was the only easy analgesic without significant counter indications for pregnancy!
Yup, NSAIDs are bad news. I'd recommend PRN opiates over NSAIDs in pregnancy, though it's understandable for pregnant women and their docs to be wary of them. Still, an occasional dose of an opiate to treat moderate-severe pain during pregnancy is highly unlikely to cause damage, whereas a dose of advil at the wrong time just might.
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):
Matt's article "A boring history of the populist right" did a great deal to persuade me that Fox hasn't had as much influence as I thought. It highlighted that there were widespread views among the public that elites in government did not represent. I think that holds even more so for "mainstream media" which is dominated by left leaning views.
Murdoch has a significant presence in the anglosphere (US, UK, Australia), but I don't know that I would say the UK or Australia have had greater issues with the populist right than places in Europe where there is little such presence. The US is an outlier in large part because our governance system with the imperial presidency so powerful AND unconstrained.
"The rise in affective polarization starts in 1996, with a further kink in 2008."
By what metric and citation are you saying this?
The Gingrich led Republican takeover happens before that and he was pretty polarizing. Nor do I accept that Fox News come into existence in 1996 and you can immediately see its impact the same year. Social impact is not that rapid, especially pre internet.
If you want to say that Fox News is a continuation and expansion of what talk radio started in the 80s, then I would see it having more explanatory power. But again, I'd want you to rebut the points I made above where similar trends are happening in other countries without Fox News and such.
People have pointed out that comparatively few people actually watch Fox News. It may have been the start of real distortion 25 years ago, but it is unlikely particularly significant now.
The saddest part of all of this is that people have come away believing that the shamelessness is part of his "armor" and that he never pays any consequences for the stupid and shameless things he has done.
I cannot emphasize enough that the Biden administration was super unpopular, and thermostatic opinion meant that a hypothetical Nikki Haley would probably have won in a landslide. Go back further -- virtually any generic Republican would have done so in 2016 because Hilary was unpopular, and thermostatic opinion was on the Republican's side. Practically any other Republican could have used Covid the way that Bush used 9/11 to galvanize and unite the nation and ride to re-election. No other Republican would have lost Alabama by backing Roy Moore, two seats in Georgia by backing Hershel Walker, or a seat in Pennsylvania becuase of Dr. Oz. He has made countless mistakes and his scandals and stupidity have cost Republicans quite a lot, actually. It just hasn't mattered as much as Democrats would like, through a combo of a) sheer blind luck and b) Democrats fumbling.
Trump has literally been the absolute worst-case scenario for Republicans for nearly 10 years, but everyone is learning the opposite lessons from his behavior because of their binary results-oriented thinking.
At the same time, there's no law of nature that says Republicans have to stay all-in on Trump. We could have just finished up a relatively boring eight years of a Kasich administration.
Agreed. Hillary Clinton made some significant errors, AND she ran in a cycle that was pretty unfavorable to Democrats, and yet she STILL came pretty close to beating the Republican nominee that year. Trump is not nearly as talented a politician as a Ronald Reagan, say, or a Barack Obama. He's just brutally ruthless after he gains power.
I don't know if this is junk science or even if it agrees or disagrees with you. But I think there is some insight in this article which says that about 33% of Republicans basically like Trump because he meets their psychological needs to have someone they can trust 100%. Whether they "believe" his stances and what he says is sort of beside the point they just like the fact that he's strong.
What gets me is that if you got a bunch of Northeastern country club Republicans in a room together in 1999 and told them that Trump was someone you could trust 100%, they would take that as clear evidence that you were bad at business.
>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.
the one that's the most appalling to me about how out of touch middle class liberals are is that after the Kent State shooting, 58% of Americans blamed the protestors for their own deaths. Working class Americans have some truly appalling beliefs which are naturally glossed over by professional politicians and pundits who need their votes. But I think what you are seeing is with the growth of a large middle class liberal constituency that is not institutionally involved in partisan politics there is a real revulsion against the authoritarian instincts of the working class, which makes it difficult for the Democratic Party to appeal to both working class traditionally Democratic voters and middle class/upper middle class liberals.
i hope you're right; one scary thought for me is that the Democrats are going to take the lesson from Trump that their own voters will also excuse authoritarian tendencies as long as they're coming from the "right team" and they're getting wins in areas they otherwise care about. i'm not sure exactly what the thing is for upper middle class suburban libs that will get them to happily ignore Trumpian behavior from their own side -- culture war victories? more obamacare? everybody transgender? -- but I'm worried that some entrepreneurial governor or senator will find it, and then we'll have two parties I can't stand instead of just one.
How does the Kent State result show how out of touch middle class liberals were? Were they supposed to join that 58% in blaming the protesters for their own deaths?
Just because you're in the minority doesn't mean you're wrong.
(How you try to win elections, per Matt's catechism, is a completely different question.)
My best guess, and it's not a hopeful one, is that the country is deeply polarized around some important lines, like rural/not rural, religious/not religious, and a big dose still of white/not white, BUT that Trump was uniquely bad and no one will be able to get away with what he has and is getting away with.
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.
I don't recall any Republicans or MAGA/conservative types naming Trump specifically in their Kimmel pushback. That is the one line they have yet not dared to cross.
I keep thinking of Russia in 2022 when war with Ukraine was absolutely unthinkable to the public, right until it started. And then, just weeks later, large numbers of seemingly sane people started treating it as no-choice, defending the Motherland thing. Since the US administration seems intent on speed-running Russian political developments of the past quarter century, I’m prepared to see sincere popular support of ground wars with Canada and Denmark in a couple of years (to defend from evils of Tylenol, quite possibly).
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.
Given I’ve already seen my aunt sharing incoherent “Kirk vs Kimmel” memes on Facebook, I don’t think we can count Kimmel among one of the precipitating events.
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.
This happens to be right-coded now, but weak epistemic reasoning has historically been pretty bipartisan. I think it still is, what varies is just the subject that each side brings salience to.
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.
Similarly, something I noticed when I lived in DC during the lowest point of crime rates was the fact that since DC has a lot of veterans living here and this was around the time of two wars, there were a fair number of visibly physically disabled people in the White House/K Street/Georgetown parts DC. You could tell people who weren't used to DC were visibly uncomfortable and felt the crime rate had to be higher than it was because of that.
There's even more to your comment. Without an ASD diagnosis, a school may label a child as having emotional dysregulation and force them into a special needs school. Even though this is more expensive for the district, it's a brute force means of making the gen ed classroom more manageable. With an ASD diagnosis, schools are legally required to offer more robust support and cannot use the emotional dysregulation term. Given this, parents who want to avoid outplacement for their kid have a very strong incentive to get an ASD diagnosis. This includes kids who probably would do better in outplacement but the parents are in denial and kids who would do worse in outplacement and the parents need tools to help prevent it.
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 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)child 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.
"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."
I think this is true *if* you change the word autism to go back to what was meant several decades ago, but at this point I think the definition is too in-flux/wide/contended to say this.
There is clearly some part of the spectrum that _is_ like this - in another thread parents of children in this situation have spoken about how difficult it is. And my son (diagnosed with ASD, _not_ like this) clearly isn't like that.
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.
I don't have stats on how many in field PhDs exist now for most fields, but I have a very hard time believing that changing that number to "effectively infinite, and you don't have to pay much for any of them, and they don't get tired, and you don't have to secure any grant money to keep them working on your desired project" would not push the cutting edge VERY far.
The question comes down to how much the cutting edge is pushed by replacement level PhDs versus the top 1 or 10% of researchers in a field. I suspect there’s a fairly harsh power curve and most of the improvements flow from the top.
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.
Yes and the mix and ratios of intellectual disabilities among the handicapped population has also changed. Used to be a majority of kids in special schools had Downs, for example, but most of those pregnancies are terminated these days.
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.
They were institutionalized, or at best they were just left to be cared for at home by the family with little to no support. The families were shunned, and everybody was encouraged to not really speak about it at all. And of course everybody wondered at least a little what the mother did wrong during pregnancy to cause this.
My cousin, is/was like this, born in the late 50s. I remember my aunt and uncle struggling with the decision to cede parentage of him so he could become a ward of the state. It was the only way to secure any kind of meaningful support, but it also meant giving up any decision making about his care.
My uncle later became the President of the National Association for Retarded Children, which was instrumental in getting some of the law changes that made it just a little less of a nightmare for families and more importantly the patients.
I too have read convincing articles that the rate of autism is actually increasing, beyond the increase in diagnosis. There are some suspected causes. Air pollution is thought to be a major culprit.
So much we don’t know. Air pollution, various other toxins (from plastics to PFCs to who knows what else), older parents, to diet, etc. Same factors causing declining sperm counts? Who knows!? Doesn’t help that a lot of those areas to explore are also areas of interest for RFK type cooks. Poisoning the well.
I live in Silicon Valley, and am convinced that assortative mating is also involved. Silicon Valley nerds marrying other Silicon Valley nerds are going to have a higher chance of having an autistic kid.
I believe it remains an open question whether the true incidence ASD is increasing. It is an active area of research. Here is a study examining the possibility that excessive prenatal folic acid supplementation increases the incidence of ASD.
The folate stuff is really interesting—I read a book on this recently. Maybe someday pregnant women will take folinic acid instead of folic acid to get the best of both worlds.
Another interesting angle to this is the increase in gender diversity and the high prevalence of gender diversity in ASD, could there be common metabolic pathways?
I do — it is called the Folate Fix and mostly about how Leucovorin is a promising therapy for some people (and the biochemistry of why that is so). It mentions the problems with Folic Acid in passing. Good, but narrow, book.
I'd like to see that study with N=50,000 (or just N=all babies born in the next 5 years, it's fucking dumb that we don't just collect lots of medical data on everyone that researchers are free to use)
Actually, I don't think this is true. There was an episode of Plain English recently that talked about how the rate of severe Autism symptoms has been basically stable for decades. We just don't shut them away anymore.
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".
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.
Yes, that was my thought after seeing Matt's praise for the Trump administration's efforts to speed pharmaceutical approvals. Surely he knows that whatever the Sauron eye of Trump turns toward will result in corruption and damage to the public.
Has there been one objectively good thing Trump has done in office?
You mean things Trump personally pushes for, there are some things the administration has done on NEPA, CEQ, and natural gas permitting that can be construed as going in the correct direction (but that is probably in spite of him rather than because of.)
“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.
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.
The problem is already overdetermined. We have a rise in demand for diagnoses, a reduction in criteria, greater willingness among experts to diagnose, and a feedback loop where autism is seen as common or even desirable.
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 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
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.
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’m astounded by the number of otherwise smart people that convinced themselves that Trump was going to be so good in some niche, but important area, like clinical trial regulations, that it would make up for all of his other obvious flaws. Trump seems to be the beneficiary of so much wishful thinking and denial about what he actually believes.
Smart people are just as guilty of motivated reasoning and bias as anyone else, and they're also better at constructing ridiculously over-engineered mental models to rationalize blatant absurdities to themselves.
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
This interview is extremely frustrating. O’Sullivan and Thompson both suggest that people are being diagnosed with ASD who, in fact, have no disorder whatsoever.
This is a pretty extraordinary claim that requires a lot more proof than, "I don't really like the DSM."
It’s fair from a policy perspective to point out that a formal “diagnosis” is relatively meaningless if the criteria are too broad and vague for anyone to take action on the information of a diagnosis. Especially when the diagnosis is of an already well known condition that has a public meaning established by years of medical messaging that is entirely disconnected from the new meaning being applied.
OK, but this isn't true. A diagnoses has very specific criteria. I can only speak to ASD, but the definition is hardly vague or "wooly" as O’Sullivan repeats--it is very specifically outlined the DSM. Nobody is misdiagnosing awkwardness for Autism (as Thompson suggests).
And there are very specific actions to be taken based on said diagnoses: speech therapy, occupational therapy, physical therapy, ABA, CBT, etc.
All of this holds true even with the expanded definition of Autism (i.e, level 1/previously likely Aspergers) whether or not the public can keep up.
A complicating factor in this is that just because you are told someone is autistic or someone claims to be autistic it does not mean they have been formally diagnosed as autistic. I think a lot of people rely on anecdote and personal experience (like they do for a lot of things). And yes, I realize that I am basing that claim on personal experience.
This comes from Australia where I live but I imagine similar things happen around the world due to the principal-agent problem that insurances introduce. (Backgrounder: the government in Australia rolled out a new multi-billion dollar program called NDIS that, to be cynical, allows private companies access to unlimited government dollars by diagnosing a child with autism. That wasn't the original goal of the program, obviously, but that's what has de facto happened and has blown up the Federal budget. They are now planning to kick all kids with mild & moderate autism off the program to repair the budget hole.)
A report took advantage of the differential roll-out of NDIS to find how much it contributed to an increase in autism diagnosis, separate from all the other factors like changing diagnostic criteria, etc.
"The main finding was that the NDIS has accounted for nearly half of new autism diagnoses in Australia since 2013. When the scheme was announced, autism supports were expected to cost the NDIS about $1 billion. In June 2025, autism supports were costing the NDIS almost $9.5 billion. Half of this growth, or about $4.5 billion, is a direct result of the increased autism diagnoses that were generated by the existence of the NDIS.
"The effect of the NDIS on generating autism diagnoses has increased over time. According to Health and Disability Minister Mark Butler, one in every six 10-year-old boys in Australia is receiving NDIS supports. A total of 78 per cent of children in the NDIS have developmental delays (often, a precursor to an autism diagnosis) or autism.
"Diagnostic practices have clearly shifted in response to the NDIS."
I don't think it is a stretch to assume that when private companies are claming that 14% of boys are autistic that....they are making it up to get billions of government money that has very little oversight.
That's interesting, and if clinicians in Australia have been misdiagnosing children with Autism en masse that is certainly a huge scandal. Not to mention a massive, collective, malpractice.
I guess my problem with O’Sullivan and Thompson's discussion is they provide no such evidence in the US or UK (which seem to be the focus of her book). It's completely "vibes" based. And then they go well beyond Autism claiming pretty ALL disorders (ADHD, Bi-polar, anxiety, depression...) are being misdiagnosed. This would be a massive, global scandal.
Bring back the term Asperger's! This has been my pet peeve for a while!
We measure pain from 0 to 10. We measure hurricanes from category 1 to 5. We measure cancer in 4 stages. If 2 categories for ASD aren't accurate enough, we should just make a couple more.
There are currently three, and it works pretty well.
1) Aspergers
2) Maybe non-verbal or needs significant support
3) profound or severe
Edit: I should say, this is my own very rough shorthand. For more specifics check the DSM.
But just from the common sense perspective, Aspies are anything but non-verbal. What’s the common basis for a “spectrum” here?
Social deficits, I reckon
Yes, indeed, it's a very wide-ranging spectrum. Why they got rid of the Asperger's designation is beyond me. It created a helpful distinction.
The problem was that there was "high-functioning autism" and there was "Asperger's syndrome", and even though they were widely recognized as being basically the same thing, technically the DSM at the time treated them as separate disorders. So you could have a scenario where one could get services from a school for a diagnosis of high-functioning autism but be S.O.L. if one had a diagnosis of Asperger's. The different labels for the same thing were causing a mess.
So get rid of the first one?
But if you do that, then it obscures the commonalities (including the *genetic* ones) between the lower- and higher-functioning autistics.
I can live with that.
Respectfully, in the legal context of accommodations, isn’t the point of diagnoses to separate those who really need accommodations from those who don’t? Schools, and society in general, don’t have unlimited resources.
Also, are they in fact the same thing, or not? Because if they are, you should just have one diagnosis for the same thing. Now we have one diagnosis for multiple things that are clearly different. I don’t see how that really helps.
I mean, it shouldn't be too hard to give schools practically unlimited resources (in America). The problem is, would they actually do a better job?
"Respectfully, in the legal context of accommodations, isn’t the point of diagnoses to separate those who really need accommodations from those who don’t?"
Yes, and I would say that Asperger's/high-functioning autism still need accommodations -- just not the same ones as those more severely autistic.
"Also, are they in fact the same thing, or not?"
Yes, high-functioning autism and Asperger's are the same. This is not news.
(FYI, when I was a kid, local Autism Society support group meetings were held at my house for years. Heck, I was around when the Autism Society was NSAC. Point is, I've been around the block on this, and long before it became an Internet thing.)
"Now we have one diagnosis for multiple things that are clearly different."
No, we don't. Even in the latest DSM, there are clear distinctions between levels of autism. Level 1 autism is not the same diagnosis as level 3 autism.
Rottweilers and poodles are very different beasts even though they're both dogs. Doesn't mean we throw out the category of "dog."
Didn't they get rid of it because Asperger was a Nazi or something?
Partly. What a stupid reason.
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.
I understand this impulse (complaints about the spectrum nature are common), but I honestly can't think of a scenario where it would create a significant communication issue.
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.
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).
Here's the thing. Autism runs in families, and it's not uncommon to see both severe autism and "little professors" (and not so little ones) in the family. It happened with me and my brother, for example. So there's an indication that there's a link between what at first seem like distinct conditions.
Yes, it’s not so much having a test as sharing a mechanism. That’s why it’s easy to understand a range of severity for COVID but it’s shakier for autism unless you can point to something like genetics.
But at this point, genetics does appear to be the primary cause for people all along the ADS. So there may be two questions, what causes someone to have ADS and what causes it to be more severe in some circumstances.
That’s right or we could be dealing with a variety of disorders. A genetic disorder with variable penetrance creating a spectrum but other disorders (or variants of normal behavior) mimicking different parts of the spectrum.
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.
(Full disclosure, I was only diagnosed with ASD myself a few months ago) I have found the opposite. When people think about the autism spectrum…the key work there isn’t spectrum. It’s autism. It makes
my struggles sound much worse than they are, in a way that using, say, Asperger’s would not
When I think about autism these days it’s a practically meaningless label
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.
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.
I recall reading a story of an Internet-pilled mom-to-be who got stuck in a “natural childbirth is good nobody needs doctors” algorithm discourse loop.
Everyone in that loop was telling her “women gave birth naturally for eons and it was good ‘nuff ‘cause we’re here right?”
They didn’t mention the spectacular mother and infant mortality rates. She didn’t get prenatal care, got care too late when she thought there was a problem, lost the baby and nearly her own life.
There are lots of stories like this. It makes me wonder what exactly leads people to so fully rely on Internet anecdotes and unverified memes, while completely discounting scientific studies. Like, where is the logic? I’d like to think “Huge percentages of our species are stupid AF” is not the explanation. But what other explanation is there?
It's like, should we be all that sad that those who follow RFK's advice have a bunch of miscarriages? Seems like Darwin in action.
I wouldn't permit Trump/RFK supporters to procreate in the first place, but if we're not going to properly require prospective parents pass multiple tests to be licensed for the privilege, the best option is for the pregnancies to fail. That being said, pregnancies carried to term with severe birth defects are the worst of all options, and that may be the more likely outcome.
Both a scientific study and an internet meme are somebody who claims to be smart telling you something interest. The difference is that scientific studies are written in harder-to-read prose.
(I'm being somewhat facetious; obviously the real difference is the credentials associated with the text.)
It's definitely the explanation... It's really amazing what we're able to accomplish given that reality.
Even if it is not "huge percentages" there are going to be a very large number of people that are going to not be smart. Combine that with the fact that many smart people are not smart about everything and they can also be duped, etc. Even if 10% of people are really stupid about a given topic, that's 34 million people just in the US!
"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 think the best evidence for "humans subject to hunger pressure will do insane things for calories" is Surströmming.
Honorable mention to Hákarl (although that one I've actually tried. It's like a very ammoniacal smoked-cheese flavor. But the first person to bury and then dig up and eat a Greenland shark must have been nuts.)
I had to Google Fu Surstromming and after finding out it is fermented herring then reading “It is traditionally eaten outdoors or _underwater_ to contain the smell” I am dying 😂.
SURELY milking started post-domestication. No?
Domestication is a spectrum though, yes?
Sorry, couldn't resist.
Probably, but my version is funnier.
Cautious certainly doesn’t mean “never.” I’m sure if the available doors were 1)“starve” or 2)“nibble that unfamiliar fruit and see if it makes me sick” they’d opt for 🚪 number 2.
100%. My wife was a Special Education teacher in an Elementary setting and now she runs a day program for adults with disabilities. Even between the kids she'd see in Elementary School vs. the adults she provides services for now the differences were stark. All the adults she works with can't live alone, but they're far far more capable than most of the kids in any of her classes. So even among those who need 24/7 care the range is huge, the fact that we include people closer to the quirky end of the spectrum is baffling.
And parents of the quirky kid will flip out when you are talking about how horrible it is to deal with a child with the disease because there's just throw shit on the wall
Why?
I don't know if this is what you were asking "why" about, but I'm going to attempt to answer the question "Why do some members of the autistic community find the term 'high functioning' to be obnoxious?"
As Ben mentioned, "high functioning" generally refers to how well an autistic person can “fit in” to neurotypical society. A lot of interventions for autism are focused on making the autistic person “fit in” by acting more "normal". For example, many autistic people self-stimulate or "stim" by repetitive movement or behavior like rocking, flapping their arms, or repeating words to help them deal with overwhelming emotion, sensory overload, or sometimes just expressing excitement.
The standard autism treatment is to extinguish this behavior using rewards and punishments. This approach, called Applied Behavior Analysis (ABA), is rooted in behaviorism—the theory that there is no mind, just behavior.
Autistic people usually find this “masking” of their true selves to be exhausting and demoralizing. Maybe some of the difficulty of “fitting in” should instead be addressed by making society more accepting. Why not teach neurotypical people that some people stim, and explain why they do it and that it’s okay? This is happening, slowly. In my teenage kids’ classes there is far more understanding, acceptance, and accessibility than when I was in school.
Another issue is that "high-functioning" implies that autism is a one-dimensional condition that you have more or less of—but really there are a variety of issues across social, physical, emotional, and sensory dimensions. Some autistic people have no trouble looking others in the eye and smiling, but melt down trying to cope with a buzzing fluorescent light. Some can barely control their muscles but given an alternative means of communication are bright and socially engaged. Some common autistic traits like extreme focus are actually gifts in an occupation requiring high attention to detail.
Many autistic people therefore resent the implication that they should want to be cured. They have a different experience of the world from neurotypical people but it can be positive. But this last point is also controversial. Some autistic people experience extreme debilitation and impairment and would be quite happy to have a cure, and they look at talk of autistic “super powers” as whitewashing their disability.
They're are levels.
I kind of went through this thought when one of my children was diagnosed (in grade school, not as an infant or toddler) with what I would describe as "high functioning" ASD. At the time, I only knew about autism from Rain Man, so I did a lot of reading and watching.
And here's one of the things going on: there are a bunch of adults with ASD (of various "functioning" levels) who are capable enough of communicating to everyone else and they have a lot to say about ASD...in particular that it's neurodiversity and not a disease/disability and therefore all of the institutional money focusing on "curing" _realy pisses them off_.
Clearly there's a very different view of autism - something that drives "scares" and the hope of finding a "cause", something scary enough to drive anti-vax paranoia. My mental image for that is parents of child with ASD whose functionality is severely impaired such that parenting is much more difficult than they expected, e.g. developmental, language and communication impairment.
And to make it even more complicated, we sometimes get autistic adults who were at that level as children and can now tell us things about their experience...and they're not real happy about how they were treated as children.
My response to this as a parent has been to try to see my son as he is and not as I might wish him to be or as I might assume he is from some diagnosis or model. And I think that's not that different from how I should be a father under any other conditions.
(I've put "high functioning" in quotes here because some members of the autistic community find it to be obnoxious, but I'm using it because it's a short-hand to explain to everyone else a sense of a continuum, e.g. how does this person with ASD interact in a community of neurotypical people, how much friction is there, etc.)
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.
"Liked" because I laughed, but I'm very sure "Star Trek" is substantially more autistically coded.
Depend on if we're talking Kirk being James Bond in space or Picard alone in his quarters playing his flute.
Neither. We're talking about Sisko on the bridge of the Defiant.
Going around all cloaked and invisible has to be something-coded.
Both ST:TOS and ST:TNG. Like, are you not familiar with depictions of "Trekkies" from the 1970s to mid-'80s (i.e., pre-TNG)?
A good dose of Star Trek will set them straight.
Finally a medical reason to ban the prequels.
Surely you mean post-quels?
Being a Star Wars fan is less
indicative of autism and more indicative of a pulse (at least pre Disney+)
Everyone on this thread: please drop this juvenile humor. Autism disorder is not a laughing matter.
I think most people are missing my point that the RFK and Trump’s unsubstantiated claims are nonsensical.
Went right by me. My apologies. (All the subsequent commenters obviously missed the point as well.)
"/s" is often usefully employed for clarity.
It’s fine. I toed close to the line. People just wanted to indulge themselves in mocking nerd stereotypes (or meta mocking nerd stuff.)
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.
The rise in people seeking a personality diagnosis from their doctor has resulted in a new permission structure where people just hand out personality diagnoses to other people unprompted.
A big thing that also contributes is the collapse of the Tumblr Containment Field that allowed the tendency to characterize oneself by one's pathologies and have entire worldview seen through a therapeutic lens to spill out into the realm of normal people.
It’s very hard to listen to Trump every day and not label him with a personality disorder.
Sociopathy or narcissism? Or maybe both?
¿Por qué no los dos?
that's obvious, though
The comic Craig Ferguson had a bit about the cult of personality disorders he observed around the entertainment industry, how it became almost fashionable to be 'on the spectrum' or ADHD or some addiction. His comment: "how do you know when you have a pathology and when you're just being....you?"
I wonder if what we describe as "autism" isn't really one end of a spectrum of normal brain function. Focused and less aware of others compared to very social and less able to focus. Occasionally something goes wrong and you have the people described in the original paper about autism. But "autism spectrum" is really just normal people of a type.Maybe "autism spectrum" says more about the way we insist on educating kids than it does about actual mental function.
It's not a fully fleshed-out hypothesis, but still...
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.
Also if you ever want your kid to go to private school, I imiagine an autism diagnosis is the end unless you're extremely wealthy.
What are you trying to say? An autism diagnosis gives you a leg up in getting into private school?
Man, if ever there was a [citation needed].
No, I imagine you cannot get your child into a private school that is not "special".
That seems unlikely, given how fashionable autism is these days. If the kid is gifted and doesn’t have behavioral problems, can’t imagine how it would be a problem.
They also won’t have much of an IEP.
I don’t think that’s true. Some private schools have amazing support for IEP kids. Even the ones that don’t are not going to reject a kid due to a diagnosis. It would be a case-by-case evaluation to determine if the school had access to the needed resources.
Why would they bother? They can't fill seats with students who don't complicate the classroom?
If messiness is an indicator of ADHD, then I must have some sort of car-specific version of ADHD.
The point of testing would seem to be bragging rights
Ha, that is kind of what my son said. He said he could use it when people complained about his behavior. Also, maybe he could get accommodations on schoolwork. Which I doubt they would give because, I learned from today's column, he is in the top 1% of SAT scores. Maybe I need to start giving more deference to his seemingly wacky ideas.
He’s heroically overcoming his disability. He should be profiled on local TV news.
I mean maybe he could use it to get out of classes he hates
I think testing should only be done if there are problems that actually interfere with someone’s life and I don’t think your son or his friend had them. And just having a few mild behaviors like watching the same movies might just mean he actually is getting something extra from the repeated viewing that would bore most people. This was a thoughtful post and I’m glad that your son and his friend are doing fine!
One problem with this is that it's harder to get diagnosed as an adult, if problems do come up later in life
Are we sure about that. It seems relatively straightforward to get diagnosed ADHD as an adult, and I wouldn't think an autism diagnosis would be any more difficult.
I've been through the process for both.
Finding someone who'd do diagnostic testing for ASD in an adult took a lot of research and calling around, a couple thousand dollars, and hours of interviewing me and my family. Most of the psychologists I talked to would only do it for kids.
Finding someone for ADHD took one Google search.
"I'm not a lesbian. I'm just smarter than you" would make a great bumper sticker, just saying
What is this stereotype? I've never heard it in my life. Lesbians are smarter than het women?
There is a lot of nerd/lesbian sartorial overlap.
i don't think it's actually a stereotype, it's just a joke
One problem I think some people have is to equate a personality trait that seems to be characteristic of an actual disease. An example that I got from Freddie DeBoer is about OCD. People who have obsessions can have compulsions about them that most people don’t have so they might tell people that they have OCD. But they live normal lives because they don’t have the clinical diagnosis. A person with real OCD has major problems with real life because the disorder is so severe! I feel like we need to focus on people with the most severe problems, especially with autism because the most severe cases prevent the patient from having a normal life. But we need to also be aware of how these high functioning people with mild ASD process social interactions differently and may also need other interventions that can be very useful in helping them reach their potential. Another author , Richard Hanania has a pretty interesting article on his Substack about his experiences with autism and how it really is a spectrum of conditions.
Yeah. I worked with a lady with OCD when I was a pharmacy student. She had the easiest job at a tiny hospital that might get 5 new admissions at most during her shift, but she literally couldn't get the orders out because of the compulsion to keep checking, double checking, 10x checking her work. As a work-study student I had to manage her rather than the other way around. A sweet lady though, she couldn't help it, it was a profound disability.
Paradoxically, she made lots of mistakes at work, too., I think all the checking made it worse
"I'm not a lesbian. You're just an asshole."
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.
“…half the homework”
That half done on the bus on the way to school?
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.
My high school guidance counselor accused me of cheating on the SAT.
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 did my homework a lot of the time, but that's because I was in in-school suspension and could read my own book after turning in the hw lol
I got detention in middle school for repeatedly hiding a book inside my textbook and reading during class. Always interested to hear the various coping strategies people employed to make it through school.
Having done the the autodidact thing as an adult, I think formal education, including lots of drilling, taught me a great deal even with the busywork. Without the drilling, knowledge doesn’t stick as well, but the discipline to drill is much easier to muster within an institution.
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'm surprised he felt committed to his word
Turns out the brain worm punishes him for disobedience, Wrath of Khan-style.
He already had the answer in mind back in March.
I didn't know he said that. That's so dumb!
The stupid stuff Trump said on accident is actually more worrying than the Tylenol announcements. Why is Trump talking about aluminum in vaccines? Not a good sign for things to come.
But yeah, they also don't like women.
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.
Nearly all millennials had self diagnosed ADHD 15 years ago. Doesn't seem that different now...
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?
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.
"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."
Isn't Level 3 autism extremely severe?
Yes, but that's my point. Like I would notice myself spacing out and doing some repeated action (tapping a pen, maybe) and think, oh I'm stimming.
I think everyone has characteristics like that.
I blame the trains.
No, that's a stupid observation and demeans all the people who have that diagnosis.
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.
Freddie DeBoer, when not busy picking unedifying fights in other substacks' comments, has published a number of very good essays on this theme. I think this was the first one? (2022)
https://freddiedeboer.substack.com/p/the-gentrification-of-disability
This really is his best topic.
He is talented but spends too much time dunking
We ave one of those. He will be 65 in October. Lives in his own apartment, drives a car and has a job.
He was a difficult infant. No amount of cuddling would comfort him. He would arch his back trying to get away from touch. That really screws with a mother's head.
We were told to institutionalize him and go on with our lives. F'k That!!!
I hope that today's parents get better help than we did. We just soldiered on doing the best we could.
He started in public school where one teacher taught him to read. They kicked him out eventually. Special schools were not a big help. One staff said he needed Primal Scream Therapy. That lead to a lot of screaming at home. Thankfully did not do it in public. Another told him he needed a vegetarian diet. He could not process this so diner time was punctuated with: I Want To Make Denise Eat Meat!!!!
The special school was not very special. It was a bad idea to place him in with the kids who acted out weirdly. He tried to fit into his environment and copied their behavior. He got a protected job at a vet. He then copied the "Normies".
He was put on drugs but they made him dull so we stopped them.
From the above you can see I have a poor opinion of the psychiatric profession and the educational systems. The help they offer is very hit or miss with no quality control.
That sounds incredibly challenging and you have my sympathies. It’s still kind of a wasteland in terms of what actually works for treatment but it’s vastly better than it used to be as far as “refrigerator moms” and “scream therapy” and all that went. People in public are also much more understanding. Can’t imagine transposing my situation 60 years ago—it’s tough enough now!
I'm sorry you and your child have to deal with that. My son is not as impaired as your son. He can live independently, and work at a low paid job. But he has significant deficits, and we worry about what will happen when we die. Dreams that I had for my baby boy— a girlfriend, a wife, a family, a career rather than low-paid dead-end jobs—won't happen A couple of friends also have now-adult autistic kids, and they too can sort of function independently, but their lives are restricted. I don't think autism, or even Aspergers, is a funny joke.
Well hopefully we will get to that sort of independence someday! We are certainly trying and hope springs eternal. Right now “someone who needs a lot of support but has interests and is verbal” would be a big W, but that still has plenty of challenges and sadness and loss packaged with it too, I know.
And I am sure there are parents of kids with leukemia or with severe physical challenges who are in hospital constantly who would kill for my situation too—I try to remember that. Everyone has their own challenges.
Thank you for reminding me that I'm very lucky. My son is great. He has severe deficits but also some extraordinary strengths. And he's fun.
I hope your son can live independently one day. My best wishes and highest hopes to your family.
My daughter was diagnosed with Asperger's as a two year old in 1994. She has grown into a self-confident, accomplished adult and I couldn't be prouder of her. Having worked hard to learn how to behave around other people, she comes across as someone whose condition would be very hard to detect, at least in briefer interactions.
That said, her first 20 years were hell and school, with the viciousness kids can inflict on strangely behaving classmates, was an endless torture.
Even though her condition wasn't severe (she never had special treatment programs in school), I am eternally grateful that we got the diagnosis when we did. Even if one considers the criteria too all-encompassing and ha ha every somewhat awkward kid would be slapped with the autism label.
I have to say that I'm finding many of the jocular comments being posted today pretty loathsome.
We homeschooled our son, who wasn't diagnosed until he was 19. And sometimes I think, would he have had better outcomes if he'd been in school? And then I think, even if he had, would I have wanted to torture him for 13 years to get the outcomes? I have friends who sent their autistic kids to public school, and it was hell on earth for every one of them. I know of other parents who homeschooled their autistic kids, and it was not hell on earth.
I've listened to the stories of adults with ASD and two common themes I've heard are: "my parents willingness to accept my development as it was, not matching what neurotypical children learn and when, and just see me for me was a big positive contributor to my gaining capability" and (the sad flip side) "I was in this institutional situation and it was really awful and the pain didn't result in any gain".
It was a very tough choice. We changed schools to escape the most sadistic students (and sometimes, my god, parents) and almost pulled her out of high school completely. I still don't know if we made the right choice, given how much trauma she endured. But the upside was that once out of high school, she went to a wonderful small college (University of Puget Sound in Tacoma WA), found friends and activities and blossomed. Could she have gone from a specialized school or homeschooling to entering the wider world of college? Maybe, but I have my doubts. She would have been lacking the self-generated tools and the tough skin and callouses she developed in the preceding years.
My son does have a four year degree, though it took a lot more than four years. Would he have been better off having gone to school? Maybe, but I'm not sure that a school would have helped him with his extreme executive function deficits. Also having, myself, experienced the generation of tough skin and calluses from being someone on the spectrum in school, I do not recommend it. It's ghastly, and it still hurts when I think about it, many decades later.
Good luck to your son!
My daughter didn't have *those* kinds of challenges (hers were a lot more social) but it was hard enough for her. She was smart enough to teach herself how to operate in society, in spite of (or apart from) any good or bad decisions her parents made during her youth.
I have nothing to say other than that absolutely sucks and I am very sorry.
Thank you; that is very kind.
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.
Every day I ask myself, "My god, why do people support these loons?"
They give a permission structure to act poorly.
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
Skimming that made me laugh since the very first piece of advice is "avoid stress"... which cites a study where *pain* is inflicted to cause stress in pregnant animals. No winning for moms.
Endless lists of rules do a really bad job conveying levels of risk. But they do a great job creating a crushing burden for mothers by setting unachievable expectations!
“So what if you have pain during pregnancy?”
An abortion?
PRO LIFE
It's like the least controversial thing in any pharmacy. It's like if they came out against milk or eating turkey during Thanksgiving. If anyone in your life freaked out because they saw you taking a normal dose of Tylenol while pregnant, you would think there was something wrong with them mentally.
I'm a woman and I've had two kids. I've used Tylenol during pregnancy to combat terrible headaches.
It seems the truth is that Tylenol's effects are inconclusive. Also, it is sometimes less risky than alternatives, like an untreated first trimester fever.
It should be up to every woman to choose what she can tolerate and what risks she wants to take.
I wish to god we wouldn't polarize things like this, as women will be afraid to make their own best decisions.
> women will be afraid
This is fundamentally, more than nearly anything else, what the far right wants.
They will be afraid on both sides. As a left of center liberal with mostly leftist friends, since having a kid I've lost a lot of openness with my friend group, because nearly every experience needs to be coded through politics for them other wise I get 'educated' or shut down. Its been awful and extremely lonely. People don't understand that your lived personal experience doesn't fit neatly into prescribed political opinion. I don't know why people do this to themselves.
Yeah. Thank you. It’s really not just fevers. I wouldn’t be able to work while pregnant without Tylenol. Thought maybe that’s what MAGA wants.
Just remembering clinging to the hope that the Tylenol would help while suffering through regular severe migraines in pregnancy.
I hope your third trimester passes quickly and safely!
Thank you!! Omg, I’ve been fortunate not to have migraines, but cannot imagine managing them without NSAIDs. You poor thing…
This is some important context that I didn’t know! I thought of Tylenol as a pain medication that is primarily for children, and that the French health authorities recommend over NSAIDs for many purposes. I hadn’t realized that it was the only easy analgesic without significant counter indications for pregnancy!
Yup, NSAIDs are bad news. I'd recommend PRN opiates over NSAIDs in pregnancy, though it's understandable for pregnant women and their docs to be wary of them. Still, an occasional dose of an opiate to treat moderate-severe pain during pregnancy is highly unlikely to cause damage, whereas a dose of advil at the wrong time just might.
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/
Matt's article "A boring history of the populist right" did a great deal to persuade me that Fox hasn't had as much influence as I thought. It highlighted that there were widespread views among the public that elites in government did not represent. I think that holds even more so for "mainstream media" which is dominated by left leaning views.
Murdoch has a significant presence in the anglosphere (US, UK, Australia), but I don't know that I would say the UK or Australia have had greater issues with the populist right than places in Europe where there is little such presence. The US is an outlier in large part because our governance system with the imperial presidency so powerful AND unconstrained.
The rise in affective polarization starts in 1996, with a further kink in 2008.
There's maybe some effect from the internet... but Fox News has a big role. It was founded in 1996.
"The rise in affective polarization starts in 1996, with a further kink in 2008."
By what metric and citation are you saying this?
The Gingrich led Republican takeover happens before that and he was pretty polarizing. Nor do I accept that Fox News come into existence in 1996 and you can immediately see its impact the same year. Social impact is not that rapid, especially pre internet.
If you want to say that Fox News is a continuation and expansion of what talk radio started in the 80s, then I would see it having more explanatory power. But again, I'd want you to rebut the points I made above where similar trends are happening in other countries without Fox News and such.
People have pointed out that comparatively few people actually watch Fox News. It may have been the start of real distortion 25 years ago, but it is unlikely particularly significant now.
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.
That tacky golden casino deep, deep underground (FTFY)
The saddest part of all of this is that people have come away believing that the shamelessness is part of his "armor" and that he never pays any consequences for the stupid and shameless things he has done.
I cannot emphasize enough that the Biden administration was super unpopular, and thermostatic opinion meant that a hypothetical Nikki Haley would probably have won in a landslide. Go back further -- virtually any generic Republican would have done so in 2016 because Hilary was unpopular, and thermostatic opinion was on the Republican's side. Practically any other Republican could have used Covid the way that Bush used 9/11 to galvanize and unite the nation and ride to re-election. No other Republican would have lost Alabama by backing Roy Moore, two seats in Georgia by backing Hershel Walker, or a seat in Pennsylvania becuase of Dr. Oz. He has made countless mistakes and his scandals and stupidity have cost Republicans quite a lot, actually. It just hasn't mattered as much as Democrats would like, through a combo of a) sheer blind luck and b) Democrats fumbling.
Trump has literally been the absolute worst-case scenario for Republicans for nearly 10 years, but everyone is learning the opposite lessons from his behavior because of their binary results-oriented thinking.
At the same time, there's no law of nature that says Republicans have to stay all-in on Trump. We could have just finished up a relatively boring eight years of a Kasich administration.
Agreed. Hillary Clinton made some significant errors, AND she ran in a cycle that was pretty unfavorable to Democrats, and yet she STILL came pretty close to beating the Republican nominee that year. Trump is not nearly as talented a politician as a Ronald Reagan, say, or a Barack Obama. He's just brutally ruthless after he gains power.
I don't know if this is junk science or even if it agrees or disagrees with you. But I think there is some insight in this article which says that about 33% of Republicans basically like Trump because he meets their psychological needs to have someone they can trust 100%. Whether they "believe" his stances and what he says is sort of beside the point they just like the fact that he's strong.
https://www.psychologytoday.com/us/blog/finding-a-new-home/202407/what-donald-trumps-most-loyal-followers-may-have-in-common
What gets me is that if you got a bunch of Northeastern country club Republicans in a room together in 1999 and told them that Trump was someone you could trust 100%, they would take that as clear evidence that you were bad at business.
I suspect those same country club republicans would agree that a large fraction of voters are just bad at business.
>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.
The Triumph of the Id.
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.
So I'm not the only one that reached for that comparison... Wonderful.
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.
the one that's the most appalling to me about how out of touch middle class liberals are is that after the Kent State shooting, 58% of Americans blamed the protestors for their own deaths. Working class Americans have some truly appalling beliefs which are naturally glossed over by professional politicians and pundits who need their votes. But I think what you are seeing is with the growth of a large middle class liberal constituency that is not institutionally involved in partisan politics there is a real revulsion against the authoritarian instincts of the working class, which makes it difficult for the Democratic Party to appeal to both working class traditionally Democratic voters and middle class/upper middle class liberals.
i hope you're right; one scary thought for me is that the Democrats are going to take the lesson from Trump that their own voters will also excuse authoritarian tendencies as long as they're coming from the "right team" and they're getting wins in areas they otherwise care about. i'm not sure exactly what the thing is for upper middle class suburban libs that will get them to happily ignore Trumpian behavior from their own side -- culture war victories? more obamacare? everybody transgender? -- but I'm worried that some entrepreneurial governor or senator will find it, and then we'll have two parties I can't stand instead of just one.
How does the Kent State result show how out of touch middle class liberals were? Were they supposed to join that 58% in blaming the protesters for their own deaths?
Just because you're in the minority doesn't mean you're wrong.
(How you try to win elections, per Matt's catechism, is a completely different question.)
Out of touch with public opinion (which I sort of thought was the common use of the phrase)
"Out of touch" conveys being oblivious to that opinion. Maybe they just profoundly disagreed with the majority.
https://www.merriam-webster.com/dictionary/out%20of%20touch#:~:text=:%20in%20a%20state%20of%20not,touch%20with%20the%20younger%20generation.
That's a very interesting insight.
No, they will just conveninently forget they were ever for Trump if things go as badly for Trump as they did for W.
Best we pretend Trump has been president since 2016 and act like all of Biden's failures were Trump's. It worked pretty well for 2020 with the chuds.
Republicans are amazing in their ability to turn their previous Presidents into unpersons.
2031: "Who is this Trump of whom you speak? Does not ring a bell."
By 2013 a majority of Louisiana republicans blamed Obama for the Katrina response
Would that Democrats had that kind of loyalty, we could get a lot more done!
My best guess, and it's not a hopeful one, is that the country is deeply polarized around some important lines, like rural/not rural, religious/not religious, and a big dose still of white/not white, BUT that Trump was uniquely bad and no one will be able to get away with what he has and is getting away with.
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.
I don't recall any Republicans or MAGA/conservative types naming Trump specifically in their Kimmel pushback. That is the one line they have yet not dared to cross.
Right on!
I keep thinking of Russia in 2022 when war with Ukraine was absolutely unthinkable to the public, right until it started. And then, just weeks later, large numbers of seemingly sane people started treating it as no-choice, defending the Motherland thing. Since the US administration seems intent on speed-running Russian political developments of the past quarter century, I’m prepared to see sincere popular support of ground wars with Canada and Denmark in a couple of years (to defend from evils of Tylenol, quite possibly).
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.
Given I’ve already seen my aunt sharing incoherent “Kirk vs Kimmel” memes on Facebook, I don’t think we can count Kimmel among one of the precipitating events.
I wonder how long Trump will do the anti-vax thing. You can tell his heart isn’t in it.
I predict no
Once Trumpen isn't useful and needs to be jettisoned because of unpopularity / poor economic performance.
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.
This happens to be right-coded now, but weak epistemic reasoning has historically been pretty bipartisan. I think it still is, what varies is just the subject that each side brings salience to.
Yes, RFK was left-coded until he switched right, and left-wing people are still kind of idiots about GMOs.
I had kinda hoped that right-wingers would've been a bulwark against anti-vaxxers/anti-gmo/etc but nope, crank realignment destroyed that.
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.
Similarly, something I noticed when I lived in DC during the lowest point of crime rates was the fact that since DC has a lot of veterans living here and this was around the time of two wars, there were a fair number of visibly physically disabled people in the White House/K Street/Georgetown parts DC. You could tell people who weren't used to DC were visibly uncomfortable and felt the crime rate had to be higher than it was because of that.
There's even more to your comment. Without an ASD diagnosis, a school may label a child as having emotional dysregulation and force them into a special needs school. Even though this is more expensive for the district, it's a brute force means of making the gen ed classroom more manageable. With an ASD diagnosis, schools are legally required to offer more robust support and cannot use the emotional dysregulation term. Given this, parents who want to avoid outplacement for their kid have a very strong incentive to get an ASD diagnosis. This includes kids who probably would do better in outplacement but the parents are in denial and kids who would do worse in outplacement and the parents need tools to help prevent it.
I didn't know this
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 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)child 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.
I agree, and that's why it was bonkers to get rid of the "Asperger's" designation. Save the word autism for the truly impaired.
"Now the situation is extremely different in that an autism diagnosis has no stigma whatsoever."
Probably because the possibly needing to be institutionalized severely affected patient is not what people conisder when they think about autism.
"...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.
"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."
I think this is true *if* you change the word autism to go back to what was meant several decades ago, but at this point I think the definition is too in-flux/wide/contended to say this.
There is clearly some part of the spectrum that _is_ like this - in another thread parents of children in this situation have spoken about how difficult it is. And my son (diagnosed with ASD, _not_ like this) clearly isn't like that.
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.
I don't have stats on how many in field PhDs exist now for most fields, but I have a very hard time believing that changing that number to "effectively infinite, and you don't have to pay much for any of them, and they don't get tired, and you don't have to secure any grant money to keep them working on your desired project" would not push the cutting edge VERY far.
The question comes down to how much the cutting edge is pushed by replacement level PhDs versus the top 1 or 10% of researchers in a field. I suspect there’s a fairly harsh power curve and most of the improvements flow from the top.
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.
Yes and the mix and ratios of intellectual disabilities among the handicapped population has also changed. Used to be a majority of kids in special schools had Downs, for example, but most of those pregnancies are terminated these days.
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.
They were institutionalized, or at best they were just left to be cared for at home by the family with little to no support. The families were shunned, and everybody was encouraged to not really speak about it at all. And of course everybody wondered at least a little what the mother did wrong during pregnancy to cause this.
My cousin, is/was like this, born in the late 50s. I remember my aunt and uncle struggling with the decision to cede parentage of him so he could become a ward of the state. It was the only way to secure any kind of meaningful support, but it also meant giving up any decision making about his care.
My uncle later became the President of the National Association for Retarded Children, which was instrumental in getting some of the law changes that made it just a little less of a nightmare for families and more importantly the patients.
I too have read convincing articles that the rate of autism is actually increasing, beyond the increase in diagnosis. There are some suspected causes. Air pollution is thought to be a major culprit.
So much we don’t know. Air pollution, various other toxins (from plastics to PFCs to who knows what else), older parents, to diet, etc. Same factors causing declining sperm counts? Who knows!? Doesn’t help that a lot of those areas to explore are also areas of interest for RFK type cooks. Poisoning the well.
But it is not just measurement, I don’t think.
I live in Silicon Valley, and am convinced that assortative mating is also involved. Silicon Valley nerds marrying other Silicon Valley nerds are going to have a higher chance of having an autistic kid.
I thought a nerd refers to a good student.
I believe it remains an open question whether the true incidence ASD is increasing. It is an active area of research. Here is a study examining the possibility that excessive prenatal folic acid supplementation increases the incidence of ASD.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5796848/#:~:text=There%20was%20a%20%E2%80%9CU%E2%80%9D%20shaped,were%20associated%20with%20ASD%20risk.
The folate stuff is really interesting—I read a book on this recently. Maybe someday pregnant women will take folinic acid instead of folic acid to get the best of both worlds.
Do you recommend the book you read on this?
Another interesting angle to this is the increase in gender diversity and the high prevalence of gender diversity in ASD, could there be common metabolic pathways?
I do — it is called the Folate Fix and mostly about how Leucovorin is a promising therapy for some people (and the biochemistry of why that is so). It mentions the problems with Folic Acid in passing. Good, but narrow, book.
I'd like to see that study with N=50,000 (or just N=all babies born in the next 5 years, it's fucking dumb that we don't just collect lots of medical data on everyone that researchers are free to use)
What? That's shocking
Actually, I don't think this is true. There was an episode of Plain English recently that talked about how the rate of severe Autism symptoms has been basically stable for decades. We just don't shut them away anymore.
I’d be interested to hear more. Do you have a link? Not a podcast I follow.
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".
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.
Yes, that was my thought after seeing Matt's praise for the Trump administration's efforts to speed pharmaceutical approvals. Surely he knows that whatever the Sauron eye of Trump turns toward will result in corruption and damage to the public.
Has there been one objectively good thing Trump has done in office?
You mean things Trump personally pushes for, there are some things the administration has done on NEPA, CEQ, and natural gas permitting that can be construed as going in the correct direction (but that is probably in spite of him rather than because of.)
“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.
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.
The problem is already overdetermined. We have a rise in demand for diagnoses, a reduction in criteria, greater willingness among experts to diagnose, and a feedback loop where autism is seen as common or even desirable.
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 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
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.
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’m astounded by the number of otherwise smart people that convinced themselves that Trump was going to be so good in some niche, but important area, like clinical trial regulations, that it would make up for all of his other obvious flaws. Trump seems to be the beneficiary of so much wishful thinking and denial about what he actually believes.
Smart people are just as guilty of motivated reasoning and bias as anyone else, and they're also better at constructing ridiculously over-engineered mental models to rationalize blatant absurdities to themselves.