quantpsychiatry.bsky.social
•Autistic (+ADHD, OCD, Tourettes) autism researcher and trainee psychiatrist (rising PGY-1)
•YaleCSC➡️VanderbiltMSTP➡️UCLA
•Catatonia enthusiast, patient advocate, stats guy
•MH research/methods/advocacy, autism/neurodiversity, academic medicine, dumb jokes
654 posts
3,029 followers
5,207 following
Getting Started
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There's a little bit on that in the discussion to talk about some sex asymmetries in certain outcomes (as sex asymmetries in BPD, fibro, and other conditions that would greatly increase suicide risk are totally a thing, and it's not like being autistic makes you immune to having those conditions)
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So I hope everyone enjoys the paper. For those of you without access to the paper, you can find a version of the PDF on my ResearchGate! Enjoy! www.researchgate.net/publication/...
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And even though the autistic sample is clearly not representative of the whole autistic population (they are much more depressed and suicidal than average, being selected from three studies that oversampled people for those topics), the descriptive clinical phenotype of that group *is* the paper.
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Similar age trends were observed for some but not all of the C-SSRS items representing suicidal ideation severity, as well as the ordinal "level of ideation," as seen below. No meaningful sex differences were observed across the sample in any of these outcomes.
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Below are the plots of (lifetime) suicidality and NSSI likelihood as a function of age in the sample. Both were quite common and had some complex/interesting age relationships that reflected both real clinical effects (like peaks in early adulthood) and recruitment biases (drop-offs later on)...
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P. S. I'm proud of how good I could make him look with a little Facebook stalking and a B+W filter. Shows what you get for accepting my friend requests 😉
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I think it's going to depend on just which services those are going to be. Home an community-based services through medicaid in the US, at least, definitely require a medical diagnosis, and I don't expect those to ever be granted on the basis of anything other than that.
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Though this paper made some pretty strong mechanistic claims, it was peak replication crisis for experimental psychology, and I'm not sure that the findings re: the association of pitch discrimination and clinical features actually hold up in later studies (or support that mechanism).
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I guess a question is whether ND activists will ever develop a clinically practicable alternative to medical autism diagnosis, because self-ID is clearly not sufficient for services/accommodations in many settings (hence the need to interface with the medical system).
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But once again, in a pluralistic field, it behooves us to respect the values of the other side and not force our approach on them, particularly if we acknowledge that both approaches are needed for some autistic people at least sometimes.
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I would argue that those using medical-model approaches should control the ways in which ASD is defined medically, and people who wish to have different (non-medical) definitions of autism "caseness" that reject the autism diagnosis (as many already do by including self-identification) can do so.
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of interest and make people eligible for medical services under that medical model. This is largely the function of a medical diagnosis in the first place.
ND activists also view diagnosis as a much more collaborative process than it has been historically, where a clinician just assigns labels.
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Though this is a reasonable perspective to have, I do wonder to what extent it actually makes sense to try and shift official DSM criteria to include non-pathological traits.
After all, the DSM and associated ASD diagnosis are clearly situated in a medical model *meant* to pathologize the traits
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intellectual disability and medical problems that are "co-occurring" with the characteristic physical features and hypotonia that signal the condition early in life. Again, @awaisaftab.bsky.social discusses how psychiatric labels go beyond simply being reflections if the same criteria on his blog.
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Imagine, for a second, if we diagnosed rare genetic NDD syndromes clinically and only used the features that didn't overlap with other conditions to make the diagnosis. Those diagnoses would have high specificity, but we would come to absurd conclusions like Down syndrome is highly associated with >
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Nevertheless, "autism" as a syndrome can go beyond DSM/ICD because the features exist in the world/phenotyping literature. This is why sensory features didn't magically appear in 2013--they were present all along and just elevated to be part of the diagnostic criteria at that point.
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is one example of a "non-DSM" feature of autism that's pretty uncontroversial, and gets used as a soft sign sometimes when making diagnoses. It's also not present in many autistic people, especially those with more significant forms of ID and rare genetic syndromes, so far from universal.
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See that seems paradoxical to me, especially when before you were calling (non-DSM) strengths part of autism. Autism itself is clearly more than just the behaviors used to diagnose it in DSM. Detail-oriented thinking (an autistic trait, undeniably-can be positive/negative/neutral based on context)
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I'll fully buy that.
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I do actually need to stop skeeting and get back to work, but I'll leave with this. It's really thought-provoking to have these discussions, and I enjoy doing so respectfully on this platform. What a totally different vibe than Twitter, lol.
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What pluralism means, however, is that some people will use one approach (medical, non-medical, etc.), and some people will use another, and some both/a mix. Both are valid, and both can be useful (for some people in some contexts). And being intolerant of any of those viewpoints seems unhelpful.
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I do hold in high esteem, for doing something as neutral (to me) as promoting better epidemiology/prevalence estimation. I just think the answer here to get most people's needs met is pluralism (as @awaisaftab.bsky.social has beautifully articulated in a more general psychiatric context).
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"clearly need support" and providing a lot of that in the form of sometimes not-benign treatments (like ECT and clozapine as adjuncts when benzodiazepines alone are insufficient to treat catatonia in an autistic person). So it just hit a little hard when I felt criticized by you, a colleague who...
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And I probably did go off in too many directions there, but I think that my main point was that there does seem to be a push in some academic circles that a fully de-medicalized approach to autism is somehow morally superior. As if working within the medical system with the autistic people who...
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If there is no "medicalized autism," then there are no "medical services specifically for autism" or "counting of autism in a health care context." These are things I want to see remain, and that's why de-medicalization can only go so far as to be a alternative model not the only model.
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real evidence for, but it could potentially have had some effects on my level of sensory responsiveness (I can't know for sure, but that service, which was medically indicated under my diagnosis may be the reason I'm so much less reactive to sensory stimuli than so many of my autistic peers).
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entry into early intervention (e.g., the only reason I can even write as awfully as I can is because of years of OT as a child - probably gave me the passable fine motor skills I needed to pass a surgery rotation and become a doctor). I also had years of sensory integration, which there's no...
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multiple core developmental milestone domains (i.e., gross motor, fine motor, language, cognitive, and social-emotional/behavioral). Once a young child is identified as having (or even being at high likelihood of) autism, "developmental surveillance" is medically indicated to support prompt...
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As Fred Volkmar always taught, autism is a pervasive (affecting a wide range of skill domains) developmental disorder (even though not officially called that anymore), and many autistic people (including me, a seemingly very "high functioning" individual) have very sizable delays in...
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This extension of the medical model beyond diseases is OK, because professionals view the "service provision" aspects of what doctors do for people with those conditions (like prenatal checkups, HRT) as an essential service. I would argue this should be true for autism too.
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As @sameihuda.bsky.social notes in work "The Medical Model in Mental Health," the medical model itself (and by extension, epidemiology's definition of what a "medical condition" actually is) extends to non-pathological states like pregnancy/menopause too (not to mention normal aging--hair loss, ED).
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For governments to allocate funding for individual services, people still need a diagnosed medical condition (the thing that the field of epidemiology studies, last I checked). Therefore, any "disability" as classified within any officially-recognized framework would also fall within its purview.
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Moreover, I think you and I simply differ in the amount to which we want to de-medicalize autism. I'm more than fine with a plurality of approaches to autism (some of which are non-medical and identity-based, others of which are based in the medical system and require specialized care/services).
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I'm not actually implying that you're one of the loudest or most critical voices at all, just to be clear (though you are influential community voice nevertheless). Just making a broader point that those axes of "engagement tactics" shouldn't give people more weight to represent a community.
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and though it's fine to be beholden to "the community" in theory, that doesn't necessarily mean that the loudest or most critical people on social media actually get to represent that community.
All of that to say, I just want to defend "prevalence" as a neutral, descriptive (epidemiologic) term.
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having broader use cases and being perfectly applicable to autism in a non-pathological framework if people in the field were willing to assimilate it into their lexicons under such a framework).
I think we as researchers have become too concerned with optics (especially to random people online),>
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in Autism Research that painted language guidelines as stifling meaningful scientific communication, but this could be an example of such guidance going a touch too far (i.e., taking offense at a word that has scientific merit for perceived similarity to its use in medical contexts despite it >
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I would hope (at least) that the word "prevalence" not be discouraged in psy-science discourse re: traits that aren't necessarily (always) medically-framed, because it does have a precise scientific definition that is hard to replicate elsewhere. I'm not terribly sympathetic to Singer's commentary >
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I'm just saying that (even in epidemiological parlance) "prevalence" doesn't imply that the trait in question is in any way, shape, or form a disease (just that it's of interest to health and therefore worth studying in the context of epidemiology - see the below epi dictionary).
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You know that "prevalence" can be used for any trait, right? Like I would say the prevalence of red hair is 1-2% of the global population, and that doesn't pathologize red hair any more or less...
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Or "closer" or "gangnam style" or any other of the songs with a billion+ streams. It's actually amazing that something can become *that* popular for a short time, but this is what (globalized) popular culture has become I suppose.