Anonymous wrote:I would encourage you to read Saving Normal by Dr Allen Frances. A really interesting look at the DSM from an insider and the regret he has over the ASD and ADHD diagnostic categories.

https://www.amazon.com/Saving-Normal-Out-Control-Medicalization/dp/0062229265?nodl=1&dplnkId=4ea1637b-a9fd-4888-9f2d-3e9fb3ed143a

I’ll check it out. Thanks!

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:I'm feeling very frustrated by this "what is autism?" question right now. I have a teen DD who was always sensitive and a bit quirky, with a tendency to daydream. We had her evaluated for some mild executive function issues a few years ago and the only diagnosis she got was anxiety. She always had friends and no one ever mentioned autism. During the pandemic, after several months of social isolation, she had what I'd describe as a mental breakdown, becoming severely depressed. She has tried several meds and therapy and is now somewhat better, but she's still somewhat depressed and is now having social problems.

I've now had a couple of people suggest very strongly to me that she is autistic and that the only reason I haven't had her evaluated yet is that I'm in denial. When I mention various ways in which she doesn't fit the typical profile, I hear "autism is different in girls" and "it doesn't matter that she has always had good eye contact, doesn't have restrictive interests, is spontaneous and imaginative, doesn't mind crowds, speaks with lots of dramatic flair, writes fiction that shows a lot of insight into other people - none of that means she's not autistic." Which, OK, I accept! I get that the definition is expanding and I'm not trying to resist a diagnosis if it's the best thing for her. I'm planning to have her evaluated again in case I am genuinely missing something. I just don't really understand how it can simultaneously be true that 1) the manifestations of autism are incredibly fluid and protean, and someone can be autistic despite few obvious differences from NT people; 2) there is a basic, binary NT/ND divide and it is very important to diagnose autism because otherwise you are missing something fundamental about who your DC is. And the DSM is not helpful because the criteria are so vague and don't really specify level of severity.

I want to clarify that I'm not trying to be disingenuous, I genuinely struggle with trying to figure out what it actually means to say that someone is autistic or what new information you get from the diagnosis. When my DD was a toddler, parents were constantly told we were supposed to watch our kids like a hawk for signs of autism and rush to get early intervention if we saw anything. And I ran through all those "early signs" checklists and there was never anything of the slightest concern. But I know other parents who could say the same and their kids are now diagnosed with ASD. So were those checklists meaningless? I keep hearing that we have a different understanding of autism than we did 10 years ago, but I still haven't heard a clear articulation of how or why it has changed.

I relate to your daughter. She sounds lovely.

I can't stand the different presentation in girls idea either.

Not sure why you can't stand this idea, considering it's a thing.

DP. Because it creates the notion that autism can be hidden and it over-medicalizes girls. Sure the presentation may be different for some girls, but the ADOS was tested on both genders.

I would encourage you to read Saving Normal by Dr Allen Frances. A really interesting look at the DSM from an insider and the regret he has over the ASD and ADHD diagnostic categories.

https://www.amazon.com/Saving-Normal-Out-Control-Medicalization/dp/0062229265?nodl=1&dplnkId=4ea1637b-a9fd-4888-9f2d-3e9fb3ed143a

Anonymous wrote:

Anonymous wrote:I'm feeling very frustrated by this "what is autism?" question right now. I have a teen DD who was always sensitive and a bit quirky, with a tendency to daydream. We had her evaluated for some mild executive function issues a few years ago and the only diagnosis she got was anxiety. She always had friends and no one ever mentioned autism. During the pandemic, after several months of social isolation, she had what I'd describe as a mental breakdown, becoming severely depressed. She has tried several meds and therapy and is now somewhat better, but she's still somewhat depressed and is now having social problems.

I've now had a couple of people suggest very strongly to me that she is autistic and that the only reason I haven't had her evaluated yet is that I'm in denial. When I mention various ways in which she doesn't fit the typical profile, I hear "autism is different in girls" and "it doesn't matter that she has always had good eye contact, doesn't have restrictive interests, is spontaneous and imaginative, doesn't mind crowds, speaks with lots of dramatic flair, writes fiction that shows a lot of insight into other people - none of that means she's not autistic." Which, OK, I accept! I get that the definition is expanding and I'm not trying to resist a diagnosis if it's the best thing for her. I'm planning to have her evaluated again in case I am genuinely missing something. I just don't really understand how it can simultaneously be true that 1) the manifestations of autism are incredibly fluid and protean, and someone can be autistic despite few obvious differences from NT people; 2) there is a basic, binary NT/ND divide and it is very important to diagnose autism because otherwise you are missing something fundamental about who your DC is. And the DSM is not helpful because the criteria are so vague and don't really specify level of severity.

I want to clarify that I'm not trying to be disingenuous, I genuinely struggle with trying to figure out what it actually means to say that someone is autistic or what new information you get from the diagnosis. When my DD was a toddler, parents were constantly told we were supposed to watch our kids like a hawk for signs of autism and rush to get early intervention if we saw anything. And I ran through all those "early signs" checklists and there was never anything of the slightest concern. But I know other parents who could say the same and their kids are now diagnosed with ASD. So were those checklists meaningless? I keep hearing that we have a different understanding of autism than we did 10 years ago, but I still haven't heard a clear articulation of how or why it has changed.

I relate to your daughter. She sounds lovely.

I can't stand the different presentation in girls idea either.

Not sure why you can't stand this idea, considering it's a thing.

Anonymous wrote:I'm feeling very frustrated by this "what is autism?" question right now. I have a teen DD who was always sensitive and a bit quirky, with a tendency to daydream. We had her evaluated for some mild executive function issues a few years ago and the only diagnosis she got was anxiety. She always had friends and no one ever mentioned autism. During the pandemic, after several months of social isolation, she had what I'd describe as a mental breakdown, becoming severely depressed. She has tried several meds and therapy and is now somewhat better, but she's still somewhat depressed and is now having social problems.

I've now had a couple of people suggest very strongly to me that she is autistic and that the only reason I haven't had her evaluated yet is that I'm in denial. When I mention various ways in which she doesn't fit the typical profile, I hear "autism is different in girls" and "it doesn't matter that she has always had good eye contact, doesn't have restrictive interests, is spontaneous and imaginative, doesn't mind crowds, speaks with lots of dramatic flair, writes fiction that shows a lot of insight into other people - none of that means she's not autistic." Which, OK, I accept! I get that the definition is expanding and I'm not trying to resist a diagnosis if it's the best thing for her. I'm planning to have her evaluated again in case I am genuinely missing something. I just don't really understand how it can simultaneously be true that 1) the manifestations of autism are incredibly fluid and protean, and someone can be autistic despite few obvious differences from NT people; 2) there is a basic, binary NT/ND divide and it is very important to diagnose autism because otherwise you are missing something fundamental about who your DC is. And the DSM is not helpful because the criteria are so vague and don't really specify level of severity.

I want to clarify that I'm not trying to be disingenuous, I genuinely struggle with trying to figure out what it actually means to say that someone is autistic or what new information you get from the diagnosis. When my DD was a toddler, parents were constantly told we were supposed to watch our kids like a hawk for signs of autism and rush to get early intervention if we saw anything. And I ran through all those "early signs" checklists and there was never anything of the slightest concern. But I know other parents who could say the same and their kids are now diagnosed with ASD. So were those checklists meaningless? I keep hearing that we have a different understanding of autism than we did 10 years ago, but I still haven't heard a clear articulation of how or why it has changed.

that’s a pretty insightful post especially about the inherent conflict between the need to put someone in the category, and the incredibly broad and nebulous category.

personally I would just drop it and not do further assessment. mainly that’s because and autism diagnosis for such mild cases does not actually provide any information regarding treatments. your daughter can decide for herself later. teen girl social issues are very common.

Anonymous wrote:I'm feeling very frustrated by this "what is autism?" question right now. I have a teen DD who was always sensitive and a bit quirky, with a tendency to daydream. We had her evaluated for some mild executive function issues a few years ago and the only diagnosis she got was anxiety. She always had friends and no one ever mentioned autism. During the pandemic, after several months of social isolation, she had what I'd describe as a mental breakdown, becoming severely depressed. She has tried several meds and therapy and is now somewhat better, but she's still somewhat depressed and is now having social problems.

I've now had a couple of people suggest very strongly to me that she is autistic and that the only reason I haven't had her evaluated yet is that I'm in denial. When I mention various ways in which she doesn't fit the typical profile, I hear "autism is different in girls" and "it doesn't matter that she has always had good eye contact, doesn't have restrictive interests, is spontaneous and imaginative, doesn't mind crowds, speaks with lots of dramatic flair, writes fiction that shows a lot of insight into other people - none of that means she's not autistic." Which, OK, I accept! I get that the definition is expanding and I'm not trying to resist a diagnosis if it's the best thing for her. I'm planning to have her evaluated again in case I am genuinely missing something. I just don't really understand how it can simultaneously be true that 1) the manifestations of autism are incredibly fluid and protean, and someone can be autistic despite few obvious differences from NT people; 2) there is a basic, binary NT/ND divide and it is very important to diagnose autism because otherwise you are missing something fundamental about who your DC is. And the DSM is not helpful because the criteria are so vague and don't really specify level of severity.

I want to clarify that I'm not trying to be disingenuous, I genuinely struggle with trying to figure out what it actually means to say that someone is autistic or what new information you get from the diagnosis. When my DD was a toddler, parents were constantly told we were supposed to watch our kids like a hawk for signs of autism and rush to get early intervention if we saw anything. And I ran through all those "early signs" checklists and there was never anything of the slightest concern. But I know other parents who could say the same and their kids are now diagnosed with ASD. So were those checklists meaningless? I keep hearing that we have a different understanding of autism than we did 10 years ago, but I still haven't heard a clear articulation of how or why it has changed.

I relate to your daughter. She sounds lovely.

I can't stand the different presentation in girls idea either.

I'm feeling very frustrated by this "what is autism?" question right now. I have a teen DD who was always sensitive and a bit quirky, with a tendency to daydream. We had her evaluated for some mild executive function issues a few years ago and the only diagnosis she got was anxiety. She always had friends and no one ever mentioned autism. During the pandemic, after several months of social isolation, she had what I'd describe as a mental breakdown, becoming severely depressed. She has tried several meds and therapy and is now somewhat better, but she's still somewhat depressed and is now having social problems.

I've now had a couple of people suggest very strongly to me that she is autistic and that the only reason I haven't had her evaluated yet is that I'm in denial. When I mention various ways in which she doesn't fit the typical profile, I hear "autism is different in girls" and "it doesn't matter that she has always had good eye contact, doesn't have restrictive interests, is spontaneous and imaginative, doesn't mind crowds, speaks with lots of dramatic flair, writes fiction that shows a lot of insight into other people - none of that means she's not autistic." Which, OK, I accept! I get that the definition is expanding and I'm not trying to resist a diagnosis if it's the best thing for her. I'm planning to have her evaluated again in case I am genuinely missing something. I just don't really understand how it can simultaneously be true that 1) the manifestations of autism are incredibly fluid and protean, and someone can be autistic despite few obvious differences from NT people; 2) there is a basic, binary NT/ND divide and it is very important to diagnose autism because otherwise you are missing something fundamental about who your DC is. And the DSM is not helpful because the criteria are so vague and don't really specify level of severity.

I want to clarify that I'm not trying to be disingenuous, I genuinely struggle with trying to figure out what it actually means to say that someone is autistic or what new information you get from the diagnosis. When my DD was a toddler, parents were constantly told we were supposed to watch our kids like a hawk for signs of autism and rush to get early intervention if we saw anything. And I ran through all those "early signs" checklists and there was never anything of the slightest concern. But I know other parents who could say the same and their kids are now diagnosed with ASD. So were those checklists meaningless? I keep hearing that we have a different understanding of autism than we did 10 years ago, but I still haven't heard a clear articulation of how or why it has changed.

I think there is going to be a watershed moment in psychiatry within the next 10-20 years that changes everything. Certainly the DSM. Most likely will arise out of research related to cellular biology (if you have read Chris Palmer's Brain Energy you know what I mean).

At least I really hope so. Psych is in the dark ages. FWIW, my interest is in mood disorders, not ASD, which is a little different and skews my perspective.

But yeah, the DSM will either change significantly or disappear altogether soon enough -- if the research that should get done gets done (which is, unfortunately, a big if--big pharma drives psych research, which is good for no one but big pharma).

Regarding the article posted above I’ve never heard that before, nobody I knew had difficulty telling them apart if you looked at full case profiles. Sure if you just looked at them in a classroom in elementary school and beyond you might not know right off but they had very distinct diagnostic criteria.

https://www.autismsocietyofindiana.org/dsm-iv-diagnostic-classifications/

ASD diagnostic criteria was much more clear in DSM IV (6 total, 1 from this category, had to be present before age 3, etc). I still don’t understand their full reasoning for the change as they don’t link their study in the article. I’d like to know when it was done, if it was after the insurance mandate started in the late 00’s then I’d speculate it makes sense why people would be trying to push for ASD and not Asperger’s- I don’t recall Asperger’s being commonly covered by insurance, though I could be wrong (I also can’t recall how PDD NOS was viewed by those early insurance carriers, be interesting to see if there’s a connection).

I do think diagnostic changes along with insurance created a push/need for using the ADOS and other standardized testing, which used to be more secondary/less necessary than a combination of behavioral and developmental assessments (interestingly enough the person in your article from above that had a hand in changing the diagnostic criteria also helped create the ADOS).

I think getting rid of PDD-NOS was not useful either (though it could have been better expanded into it’s own criteria, separate from SCD-see below). It was very good for early diagnostics when you didn’t actually know what was going in. Often times children at say 18 months are not testable due to so many problem behaviors, lack of attending, etc so they’d get PDD-NOS until further intervention and development could take place. PDD NOS often times would be changed to ASD or something else or dropped all together. It was also a placeholder for older kids just like it was for younger kids. So if a child received that diagnosis at age 4/5 it indicated to me this child might have ASD/ADHD or something else but again the problem behaviors, attending, etc were interfering so much it was difficult to tease out the problem.

It’s interesting that the article compares social classes, I can see how that could play out. If you have more money you’d be more likely to have gotten an early PDD NOS diagnosis, intervention is applied, more assessments and information applied, you get a more clear diagnosis at a younger age. If you didn’t have the money you’d probably not be able to seek help until the child was flagged by the school, you’d get a PDD NOS diagnosis to satisfy the school and may or may not have the resources to get intervention, more testing, and eventually a clearer diagnosis.

While I can appreciate the class distinction, comparing PDD NOS as a whole diagnosis to Asperger’s diagnosis as a reason for elimination was detrimental imo. Of course if you have a thorough evaluation vs just a doctor writing a script you’ll get a more succinct diagnosis like Asperger’s vs PDD NOS. PDD NOS was never really meant to be a stand-alone diagnosis in the DSM IV, so that could have been expanded to meet the actual reasons doctors were using it.

I think their study made it clear (in theory, I haven’t read the study) that having increased access to early diagnostics/intervention is important for obtaining a clear diagnosis, but instead of just saying that they completely eliminated the very diagnosis that was commonly used to get access to those interventions. It just doesn’t make any sense. There has to be more to this that I’m not understanding…

Apparently they have since changed PDD NOS to SCD, which doesn’t actually make sense to me either (none of the changes do) because it aligns more to part 1 of DSM-IV Asperger’s.

Regardless I do like the SCD diagnostic criteria. It seems some combination of ADHD/ASD/Anxiety has taken the place of Asperger’s, when SCD actually fits quite well. I’m not sure why it’s not more utilized.

https://www.autismalert.org/uploads/PDF/INFO--DSM%205%20Diagnostic%20Criteria.pdf

Whatever the reasons for all these changes I certainly don’t think it did any children or caregivers any favors. We will get to a point where these diagnoses mean very little and you’ll need extensive testing to figure out what’s actually going on because the diagnosis alone will be almost useless.

Anonymous wrote:The biggest differences between Asperger’s and ASD used to be age of onset and deficit areas.

When you combine 2 things (as they did by making Asperger’s into ASD Level 1) that don’t really look the same you end up with something that means nothing.

These are from the old DSM-IV for Asperger’s, and certainly don’t fit the “traditional criteria” for ASD. I still can’t figure out why they combined these once very distinct diagnoses (besides insurance money):

There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, or adaptive
behavior (other than social interaction and curiosity about the environment in childhood).

I thought they combined them because the distinction wasn't really valid - the same kid would be diagnosed with Aspergers by one person and autism by another.

"Why Combine Autism and Asperger’s?
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Why Combine Autism and Asperger’s?
Experts didn't find them different enough, but advocates aren't pleased

Writer: Bryan King, MD

Clinical Expert: Bryan King, MD

When the DSM-5 was released in 2013, Asperger’s and PDD-NOS were eliminated as separate conditions that children could be diagnosed with. The criteria for an autism diagnosis also changed.

The new criteria collapsed what were three separate categories of behaviors into two: persistent deficits in social communication and social interaction, and restricted, repetitive patterns of behavior. They also reduce the number of symptoms within each category while increasing the number required fordiagnosis, effectively limiting the “menu” and, to critics, making the diagnosis more restrictive.

Others argue that any fall off in diagnosis should be very modest, or perhaps diagnoses might even increase under the DSM-5 criteria. Many experts have said the revisions are not at all intended to kick people off the spectrum, but rather fine-tune the diagnosis so it is more useful and representative of data gathered over the past 20 years.

Reaction from the Asperger’s community

This uncertainty—the real sense that investigators are figuring out the new diagnosis as they go—does not sit well with some members of the very passionate community of parents of children with Asperger’s and adult Aspies themselves. The diagnosis is the basis for important treatment like applied behavioral analysis and school services. “As a parent of a child who is diagnosed with high functioning autism the possibility of losing his designation overwhelms me,” one parent wrote in the Times comments section. “Monsters. Pure and simple,” quipped another commenter. From another parent: “These ‘experts’ need to take a step back and look at whose life they are about to change!” Many also worry that removing the Asperger’s diagnosis will seriously impact the sense of identity of some in the autism community even if does not result in reduced services.

Catherine Lord, PhD, a member of the task force that revised the diagnosis and director of Weill Cornell Medical College/ NY Presbyterian Hospital Institute for Brain Development, says the intent was not to undo the old manual. “We didn’t start out criticizing DSM-IV,” she says. “It just feels like we can move beyond it. The intention of the new criteria is to include everybody who has a carefully diagnosed ASD,” not exclude the majority of them. “That was not part of the intention and there is no evidence that that is true. There’s just none.”

The reasoning

In 2012 Robert Hendren, DO, the director of child and adolescent psychiatry at the University of California, San Francisco, said he was sad to see Asperger’s go. “At first I wondered if the APA would back down and the committee would back down on making the change,” he says. “But the first meeting they had of that committee they presented the evidence, and it’s just so strong, that you can’t make these distinctions” between Asperger’s and PDD-NOS and autism.

What is that evidence? For one, Dr. Lord conducted a study across multiple sites, with thousands of subjects, looking at the diagnostic accuracy of the DSM-IV. “Asperger’s diagnosis in the 12 sites was predicted by who saw you,” she says, a troubling result. “There was also a social class factor in a couple of sites. So upper-middle class parents got kids with Asperger’s. The same kid with the same characteristics with less educated parents ends up as PDD-NOS. This is not good.”

https://childmind.org/article/why-combine-autism-and-aspergers/

The biggest differences between Asperger’s and ASD used to be age of onset and deficit areas.

When you combine 2 things (as they did by making Asperger’s into ASD Level 1) that don’t really look the same you end up with something that means nothing.

These are from the old DSM-IV for Asperger’s, and certainly don’t fit the “traditional criteria” for ASD. I still can’t figure out why they combined these once very distinct diagnoses (besides insurance money):

There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, or adaptive
behavior (other than social interaction and curiosity about the environment in childhood).

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:Yup, OP, I am totally with you. Wish we could get the Aspergers diagnosis back - give it a new name if you must!

We have a kid without an ASD diagnosis. But outwardly seems super Aspergers. The whole thing is just so useless now.

Even if we got an ASD diagnosis, I don't understand how that is useful at all - to provide that information to teachers or friends. Because ASD is so meaninglessly broad.

I also recognize the absurd focus on diagnosing basically 1 out of every 10 boys as ASD - essentially, every quicky, socially challenged, math loving boy, of which there's one in every class - is incredibly distracting to real issue of what we think of as traditional autism. Those are the kids who need tremendous help and resources, and research.

I also hate that we've pathologized boys being socially quirky and into math. Why does that require a diagnosis?? Why isn't that just a personality type? (which incidentally, is the "diagnosis" DS got after a neuropsych. She said sometimes it's okay to just label his social oddities as personality, when they don't otherwise meet the full ASD diagnosis).

I also agree about the need for a specific category for those who need the most support.

I have an older teen who does not have a diagnosis. He also has a quirky personality, but before the pandemic, an ASD diagnosis had not entered my mind. However, since the pandemic, he has been exhibiting characteristics strongly consistent with A.1-A.3 of the DSM (less so with the B categories). I have been wondering whether, for some younger people, pandemic isolation has caused profound personality changes so that, while not exactly meeting the criteria for ASD, they need similar supports to address social and communication deficits.

DS is 11 and goes to a big magnet public gifted school (not in the DC area). We'd always heard it would likely be a better fit for DS and his social issues - that there would be more kids like him there and those who weren't like him would be less likely to bully him. At the first parent welcome coffee, the guidance counselor straight up said we have a lot of kids that verge into the ASD spectrum (when discussing social skills supports for the general school population). So it's been that way for a while. But I was chatting with the teacher supervisor of the new robotics club, and he said something along the lines of "all 30 kids in this robotics club are, while maybe not as severe as DS, definitely in that space of socially challenged" and he went on to question what the heck was happening in the last year or so. But interesting, our school system is in the south and was fully open by fall 2020 (with mandatory masks, and about 25% who homeschooled for at least part of that first year). But point is, they weren't isolated to the same extent as up north. Could masks alone be triggering something major on the social front for these kids?

omg, masks didn't harm your kid but maybe you should look into the after effects of having Covid. especially several times.

Anonymous wrote:

Anonymous wrote:Its like making Blind cover people who need glasses. It makes no sense, and it's really annoying to people whose kids can't see.

This is it. Blind. Near-sighted. Far-sighted. Needs reading glasses once over 50. Glasses only when driving.

We don't describe everyone under one sight abled spectrum umbrella.

Thank you.

Anonymous wrote:Yup, OP, I am totally with you. Wish we could get the Aspergers diagnosis back - give it a new name if you must!

We have a kid without an ASD diagnosis. But outwardly seems super Aspergers. The whole thing is just so useless now.

Even if we got an ASD diagnosis, I don't understand how that is useful at all - to provide that information to teachers or friends. Because ASD is so meaninglessly broad.

I also recognize the absurd focus on diagnosing basically 1 out of every 10 boys as ASD - essentially, every quicky, socially challenged, math loving boy, of which there's one in every class - is incredibly distracting to real issue of what we think of as traditional autism. Those are the kids who need tremendous help and resources, and research.

I also hate that we've pathologized boys being socially quirky and into math. Why does that require a diagnosis?? Why isn't that just a personality type? (which incidentally, is the "diagnosis" DS got after a neuropsych. She said sometimes it's okay to just label his social oddities as personality, when they don't otherwise meet the full ASD diagnosis).

Can I ask who did your neuropsych? I like them already

Anonymous wrote:

Anonymous wrote:It bothers me because I feel like lately the self-diagnosed or late-diagnosed people, especially teens and people in their early 20s, are monopolizing the conversation. People who were able to access the mainstream curriculum in schools, who are verbal/speaking, who maybe have some deficits in communication and/or “restricted interests,” but who are able to live a pretty “normal” life. And then people who have more severe symptoms, higher support needs, who were diagnosed at an early age, are non -speaking, have outbursts/tantrums etc. are overlooked. I mean I see these people who are like, I can’t deal with loud noises/outbursts in public because of my autism … but my DS who is now 4 and who was diagnosed with autism at 2 is prone to randomly yelping and screaming in public just because that’s something he does … so these people are autistic out here saying they can’t stand other autistic people? It doesn’t sit right with me or with a lot of other parents of higher support needs kids.

80% of adults who are identified with Autism have either attempted suicide, engaged in self-harm or experienced other severe mental illness. I agree that there should be different terms, but as a mother of a nine year old girl who was a rock star masker until she landed in the hospital four times in one year from the overload required by constant masking. I think you are misunderstanding the gravity of what people incorrectly refer to as "high functioning autism."

This post is a bit nebulous. Do you have a reference for that statistic? (seems really high unless... is this 80% of "high functioning" (how is that defined)? Severe mental illness because of *masking* or because of natural occurring comorbidities (because that would not really be a counter to the PP...)? does "self-harm" include the kind of self harm that severe autistic persons often engage in (again... not really a counter to the PP if that's the case)?