Does anyone else ever have skepticism over too many dx?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My DC has those diagnoses, asd, adhd, pda, anxiety and sensory issues. He masks at school and craves novelty so loves visiting his cousins and behaves (somewhat) unproblematically there. So no one sees it but us at home. Or maybe we're just lousy parents.

I mean … I don’t think you are lousy parents but I also don’t think a child can “mask” to that extent.

Eyeroll. You think wrong.

would you like to support that with evidence? behavior does change with environment but the “masking” discourse suggests that kids are deliberately hiding their condition at school. that’s not really believable. of course kids behave differently at school v home, but the stressors are different. my kid is generally much better at home than school but he’s not “masking” at home - he has many fewer stressors at home that trigger him.

most of the DSM diagnoses require the symptoms to be apparent across multiple domains. if your kid is only having behavioral issues at home - yes that it due to something happening at home, likely including parenting style - not because your kid is somehow fooling everyone else.

(For clarification, I am the eyeroll PP but not the original PP who said "maybe we're just lousy parents" - although I feel similarly.)

Anecdotes don't equal data and I have only personal experience as I haven't had time to go looking for data, but in my experience, this is exactly what is happening - yes, my kid would deliberately hide his condition, or more specifically his distress, at school. I have watched him tell a counselor - one he knows and trusts - that he's fine now and would take their advice and go back to the classroom, even with me sitting right next to him pointing out that's not what he told me a minute ago, and then the instant the counselor left, he burst into tears and saying "no actually I can't do this! please don't make me go back!" He could hide a full-blown panic attack in the middle of the lunchroom with no one the wiser, until he was in a safe space. He would spend every ounce of energy he had to bottle up his distress and just get through the school day without crying, because he could not stand for people to see him cry. (Never mind that its not physically possible to learn under that level of stress.) And then as soon as he got home, the dam would break and alllllll that distress would come spilling out.

"Behavior issues" are not the only symptoms. Behavior is communication, and behavior issues are signals to the outside world that something is wrong. But the absence of obvious signals doesn't necessarily equal an absence of problems. It just means you may need to look harder to find them. Especially in a typical large classroom environment, one can absolutely have symptoms that fly under the radar because they aren't obvious as "issues" in that environment.

"Deficits in social-emotional reciprocity" can look like talking too much / dominating the conversation, or it can look like not talking at all. "Deficits in nonverbal communicative behaviors" can look like refusal to make eye contact and making strange hand gestures, or it can look like staring straight at you and not moving (and likely not actually absorbing anything you say). "Restricted, repetitive patterns of behavior, interests, or activities" can be less than obvious when the interest itself is not that abnormal, but the intensity or focus is - like the 13yo boy who will talk about Minecraft for 4 hours but who can't hold a typical conversation about anything else.

Which of these is likely to get overlooked in a middle school classroom with 40 kids? Does that mean those symptoms don't "count"? Middle schoolers can be CRUEL - do you blame the kid for learning their peers will make fun of them if they flap their arms or walk on their toes and learn to only do that at home? Do you blame the kid with crippling anxiety for not drawing *any* attention to themselves? Do you blame the kid for trusting their mom enough to say "I hate school so much I wish I could die", but not being able to say that to a school counselor?

so the kid isn’t actually masking then? they are having difficulties at school but internalizing instead of externalizing.

Not the PP, but I think masking and internalizing are pretty much the same thing. A way of pretending to outsiders that you are fine when you aren't. So the problems won't show up on the checklists that teachers complete, making it more difficult to get a diagnosis. And it comes at a very high cost.

No, they are not the same thing. internalizing means a symptom that is directed inwardly like depression. Externalizing usually means behavior that impacts others.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My DC has those diagnoses, asd, adhd, pda, anxiety and sensory issues. He masks at school and craves novelty so loves visiting his cousins and behaves (somewhat) unproblematically there. So no one sees it but us at home. Or maybe we're just lousy parents.

I mean … I don’t think you are lousy parents but I also don’t think a child can “mask” to that extent.

Eyeroll. You think wrong.

would you like to support that with evidence? behavior does change with environment but the “masking” discourse suggests that kids are deliberately hiding their condition at school. that’s not really believable. of course kids behave differently at school v home, but the stressors are different. my kid is generally much better at home than school but he’s not “masking” at home - he has many fewer stressors at home that trigger him.

most of the DSM diagnoses require the symptoms to be apparent across multiple domains. if your kid is only having behavioral issues at home - yes that it due to something happening at home, likely including parenting style - not because your kid is somehow fooling everyone else.

(For clarification, I am the eyeroll PP but not the original PP who said "maybe we're just lousy parents" - although I feel similarly.)

Anecdotes don't equal data and I have only personal experience as I haven't had time to go looking for data, but in my experience, this is exactly what is happening - yes, my kid would deliberately hide his condition, or more specifically his distress, at school. I have watched him tell a counselor - one he knows and trusts - that he's fine now and would take their advice and go back to the classroom, even with me sitting right next to him pointing out that's not what he told me a minute ago, and then the instant the counselor left, he burst into tears and saying "no actually I can't do this! please don't make me go back!" He could hide a full-blown panic attack in the middle of the lunchroom with no one the wiser, until he was in a safe space. He would spend every ounce of energy he had to bottle up his distress and just get through the school day without crying, because he could not stand for people to see him cry. (Never mind that its not physically possible to learn under that level of stress.) And then as soon as he got home, the dam would break and alllllll that distress would come spilling out.

"Behavior issues" are not the only symptoms. Behavior is communication, and behavior issues are signals to the outside world that something is wrong. But the absence of obvious signals doesn't necessarily equal an absence of problems. It just means you may need to look harder to find them. Especially in a typical large classroom environment, one can absolutely have symptoms that fly under the radar because they aren't obvious as "issues" in that environment.

"Deficits in social-emotional reciprocity" can look like talking too much / dominating the conversation, or it can look like not talking at all. "Deficits in nonverbal communicative behaviors" can look like refusal to make eye contact and making strange hand gestures, or it can look like staring straight at you and not moving (and likely not actually absorbing anything you say). "Restricted, repetitive patterns of behavior, interests, or activities" can be less than obvious when the interest itself is not that abnormal, but the intensity or focus is - like the 13yo boy who will talk about Minecraft for 4 hours but who can't hold a typical conversation about anything else.

Which of these is likely to get overlooked in a middle school classroom with 40 kids? Does that mean those symptoms don't "count"? Middle schoolers can be CRUEL - do you blame the kid for learning their peers will make fun of them if they flap their arms or walk on their toes and learn to only do that at home? Do you blame the kid with crippling anxiety for not drawing *any* attention to themselves? Do you blame the kid for trusting their mom enough to say "I hate school so much I wish I could die", but not being able to say that to a school counselor?

so the kid isn’t actually masking then? they are having difficulties at school but internalizing instead of externalizing.

Not the PP, but I think masking and internalizing are pretty much the same thing. A way of pretending to outsiders that you are fine when you aren't. So the problems won't show up on the checklists that teachers complete, making it more difficult to get a diagnosis. And it comes at a very high cost.

No, they are not the same thing. internalizing means a symptom that is directed inwardly like depression. Externalizing usually means behavior that impacts others.

I never said internalizing and externalizing are the same -- they are opposites. Masking is usually understood to mean that a person is acting as if everything is fine, hiding the ways in which they are not fine. Hurting in the inside, but not letting others see the pain or difficulty. That is exactly what internalizing is.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Many of these things are not actual diagnosis and the actual diagnosis are basically checklists so it's easy to qualify. Sensory issues is not a diagnosis. Its an OT term for billing.

It's a symptom. It's not a diagnosis but that doesn't mean it's not real.

A symptom is different than a diagnosis.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My DC has those diagnoses, asd, adhd, pda, anxiety and sensory issues. He masks at school and craves novelty so loves visiting his cousins and behaves (somewhat) unproblematically there. So no one sees it but us at home. Or maybe we're just lousy parents.

I mean … I don’t think you are lousy parents but I also don’t think a child can “mask” to that extent.

You are mistaken!

-Adult who was a kid who did mask to that extent

I’m sorry, it’s just not possible that a kid with that laundry list of issues has not problem at school or in social settings outside the house.

There is no sense apologizing in sarcasm. You are mistaken.

[Anonymous]

I totally agree.

[Anonymous]

Np and new to this, so I appreciate the discourse.

I never heard the term “masking” before - years ago I think it was “fake it til you make it.” And it would’ve been a positive thing to be able to go to school and “fake it” - ie be a model student. Even if you went home and had a panic attack.

Wouldn’t it be a positive thing to be able to “mask” for 8-9 hours? I feel like that’s what I’ve been doing my whole life!!

I understand what pp is saying that if your kid can mask for 8 hours at school, maybe it’s your parenting / home environment. Maybe you aren’t providing enough discipline like they do at school, or you’re letting your kid get away with too much. I think that could be true for some kids.

For other kids, I think it would be that the kid feels safe at home and therefore can let out his feelings - ie your home environment is wonderful and your parenting is great.

[Anonymous]

Can someone please explain how an autistic person can ‘fake’ all the nuanced things that go into not being perceived as at all different (irony, sarcasm, inference, nuance, complex humor, perspective taking)?
If you know enough to fake those abilities then I just don’t get how you can be secretly autistic?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:My DC has those diagnoses, asd, adhd, pda, anxiety and sensory issues. He masks at school and craves novelty so loves visiting his cousins and behaves (somewhat) unproblematically there. So no one sees it but us at home. Or maybe we're just lousy parents.

I mean … I don’t think you are lousy parents but I also don’t think a child can “mask” to that extent.

Eyeroll. You think wrong.

would you like to support that with evidence? behavior does change with environment but the “masking” discourse suggests that kids are deliberately hiding their condition at school. that’s not really believable. of course kids behave differently at school v home, but the stressors are different. my kid is generally much better at home than school but he’s not “masking” at home - he has many fewer stressors at home that trigger him.

most of the DSM diagnoses require the symptoms to be apparent across multiple domains. if your kid is only having behavioral issues at home - yes that it due to something happening at home, likely including parenting style - not because your kid is somehow fooling everyone else.

(For clarification, I am the eyeroll PP but not the original PP who said "maybe we're just lousy parents" - although I feel similarly.)

Anecdotes don't equal data and I have only personal experience as I haven't had time to go looking for data, but in my experience, this is exactly what is happening - yes, my kid would deliberately hide his condition, or more specifically his distress, at school. I have watched him tell a counselor - one he knows and trusts - that he's fine now and would take their advice and go back to the classroom, even with me sitting right next to him pointing out that's not what he told me a minute ago, and then the instant the counselor left, he burst into tears and saying "no actually I can't do this! please don't make me go back!" He could hide a full-blown panic attack in the middle of the lunchroom with no one the wiser, until he was in a safe space. He would spend every ounce of energy he had to bottle up his distress and just get through the school day without crying, because he could not stand for people to see him cry. (Never mind that its not physically possible to learn under that level of stress.) And then as soon as he got home, the dam would break and alllllll that distress would come spilling out.

"Behavior issues" are not the only symptoms. Behavior is communication, and behavior issues are signals to the outside world that something is wrong. But the absence of obvious signals doesn't necessarily equal an absence of problems. It just means you may need to look harder to find them. Especially in a typical large classroom environment, one can absolutely have symptoms that fly under the radar because they aren't obvious as "issues" in that environment.

"Deficits in social-emotional reciprocity" can look like talking too much / dominating the conversation, or it can look like not talking at all. "Deficits in nonverbal communicative behaviors" can look like refusal to make eye contact and making strange hand gestures, or it can look like staring straight at you and not moving (and likely not actually absorbing anything you say). "Restricted, repetitive patterns of behavior, interests, or activities" can be less than obvious when the interest itself is not that abnormal, but the intensity or focus is - like the 13yo boy who will talk about Minecraft for 4 hours but who can't hold a typical conversation about anything else.

Which of these is likely to get overlooked in a middle school classroom with 40 kids? Does that mean those symptoms don't "count"? Middle schoolers can be CRUEL - do you blame the kid for learning their peers will make fun of them if they flap their arms or walk on their toes and learn to only do that at home? Do you blame the kid with crippling anxiety for not drawing *any* attention to themselves? Do you blame the kid for trusting their mom enough to say "I hate school so much I wish I could die", but not being able to say that to a school counselor?

so the kid isn’t actually masking then? they are having difficulties at school but internalizing instead of externalizing.

Not the PP, but I think masking and internalizing are pretty much the same thing. A way of pretending to outsiders that you are fine when you aren't. So the problems won't show up on the checklists that teachers complete, making it more difficult to get a diagnosis. And it comes at a very high cost.

No, they are not the same thing. internalizing means a symptom that is directed inwardly like depression. Externalizing usually means behavior that impacts others.

I never said internalizing and externalizing are the same -- they are opposites. Masking is usually understood to mean that a person is acting as if everything is fine, hiding the ways in which they are not fine. Hurting in the inside, but not letting others see the pain or difficulty. That is exactly what internalizing is.

That’s not how it’s used when people discuss masking wrt autism. The claim about masking/camouflage in social media/pop-psychology is that there can be undectable autism because the person can compensate so thoroughly. That makes little sense to me.

[Anonymous]

Anonymous wrote:Can someone please explain how an autistic person can ‘fake’ all the nuanced things that go into not being perceived as at all different (irony, sarcasm, inference, nuance, complex humor, perspective taking)?
If you know enough to fake those abilities then I just don’t get how you can be secretly autistic?

It’s because (like so many other things) a concept with some kernel of truth has been completely distorted. Masking/camouflage in autism is supposed to describe the efforts that people with autism make to conform to social norms, including by ABA therapy that tried to supress autistic symptoms like stimming. Some researchers think this can result in mental health impacts.

But the concept has expanded to the point that parents claim their kid has autism only visible at home, or NT adults seeking attention make tik toks about how “I am so tired of maskiiiing!!”

Here’s an article about it: https://www.spectrumnews.org/opinion/q-and-a/spotting-the-problems-with-camouflaging-in-autism-research/

[Anonymous]

Anonymous wrote:Can someone please explain how an autistic person can ‘fake’ all the nuanced things that go into not being perceived as at all different (irony, sarcasm, inference, nuance, complex humor, perspective taking)?
If you know enough to fake those abilities then I just don’t get how you can be secretly autistic?

In elementary school, kids don't do all of that consistently anyway. Skating under the radar is a lot easier than you're thinking, if someone is motivated and a reasonable mimic/chameleon.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Can someone please explain how an autistic person can ‘fake’ all the nuanced things that go into not being perceived as at all different (irony, sarcasm, inference, nuance, complex humor, perspective taking)?
If you know enough to fake those abilities then I just don’t get how you can be secretly autistic?

In elementary school, kids don't do all of that consistently anyway. Skating under the radar is a lot easier than you're thinking, if someone is motivated and a reasonable mimic/chameleon.

Right but I’m not talking about skating under the radar in elementary (totally get that with milder cases). I’m talking about the masking discourse that goes beyond elementary and posits that an individual may so effectively ape neurotypical behavior as to be indistinguishable from a person without asd.

I don’t completely not buy it but to me this absolutely underlines the need to better define autism. All humans stim in some ways. All humans can find social interaction exhausting. But to me to be able to understand it to the extent you can fake it is fundamentally different from a disorder of inability to perceive others intent, perspective and motivation and thus unable to even pretend. Fundamentally so so different

[Anonymous]

I think it's pretty common knowledge that there is a lot more OVER dx'ing now because of insurance purposes and the EI studies to front load as much as possible in the early years. Several Dev Peds and our regular Ped have admitted to this and have seen grow out of a DX or have it manifest to something else over the years. Sure there are some cases which are clearly a for life DX, but many on the border change over the years...

[Anonymous]

Anonymous wrote:I think it's pretty common knowledge that there is a lot more OVER dx'ing now because of insurance purposes and the EI studies to front load as much as possible in the early years. Several Dev Peds and our regular Ped have admitted to this and have seen grow out of a DX or have it manifest to something else over the years. Sure there are some cases which are clearly a for life DX, but many on the border change over the years...

FWIW, I don't kids are getting a diagnosis for PDA in their early years. ASD, yes; all those diagnoses, probably not.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Can someone please explain how an autistic person can ‘fake’ all the nuanced things that go into not being perceived as at all different (irony, sarcasm, inference, nuance, complex humor, perspective taking)?
If you know enough to fake those abilities then I just don’t get how you can be secretly autistic?

In elementary school, kids don't do all of that consistently anyway. Skating under the radar is a lot easier than you're thinking, if someone is motivated and a reasonable mimic/chameleon.

Right but I’m not talking about skating under the radar in elementary (totally get that with milder cases). I’m talking about the masking discourse that goes beyond elementary and posits that an individual may so effectively ape neurotypical behavior as to be indistinguishable from a person without asd.

I don’t completely not buy it but to me this absolutely underlines the need to better define autism. All humans stim in some ways. All humans can find social interaction exhausting. But to me to be able to understand it to the extent you can fake it is fundamentally different from a disorder of inability to perceive others intent, perspective and motivation and thus unable to even pretend. Fundamentally so so different

Are you talking about specific individuals you've observed to be able to perceive intent, perspective and motivation in others and have been diagnosed with ASD? My understanding of masking is it means the individual has to work really hard to do it, and it doesn't always work. Like not having intuition about certain social rules and so they memorize them instead. They are succeeding sometimes and not in others.

I was listening to some podcasts featuring Donna Henderson, and it helped me understand the concept of masking.

[Anonymous]

I think there are two huge things the masking skeptics are missing or glossing over.

1. Masking comes at HUGE personal cost/drain. It is HARD and EXHAUSTING. So while a kid might be able to mask through an 8hr school day, it means they will be an absolute wreck when they get home. This is where accommodations can be a huge help - find a tool or an environment that addresses their sensory issues (smaller class sizes, ear defenders, wiggle stools, classrooms that allow more movement, etc.) and make classrooms more accepting of different communication and learning styles.

2. People AREN’T masking perfectly. They mask enough to fly just under the radar, but they won’t have many friends, people think they’re a little bit weird, they have to memorize social scripts so they may not always use them correctly, etc. Cultural stereotypes of autism are not always accurate / don’t represent a lot of autistic people, so NT folks with no personal experience may not recognize it.

It’s really disheartening that folks are dismissive of masking and the very real mental health effects it can cause. I just do not understand why it’s so hard to believe. A lot of accomplished actors are autistic!