Autism should not be treated as a single condition

(economist.com)

56 points | by bookofjoe an hour ago ago

69 comments

  • __MatrixMan__ 26 minutes ago

    It has always bothered me that by "spectrum" they mean not the sort of continuous thing that spectra actually are, but instead some disjoint set of "colors" any one of which might describe a person. That's called a partition, and its in an entirely separate thing.

    When I tell this to people they understand immediately that I am in fact on that "spectrum".

    • munificent 5 minutes ago

      Here are three separate metaphors:

      1. A linear continuum (like wavelength for light) from "no autism" to "really bad autism".

      2. A collection of disjoint sets (like individual named colors like "cyan" and "puce") for cases like "really into trains autism", "freaks out at parties autism", "non-verbal autism", etc.

      3. A continuous mixture of different properties (like rgb(.1, .2, .05)) for symptoms like "10% social dysfunction", "20% repetitive behavior", "5% sensory overstimulation".

      When people describe autism as a spectrum disorder, they generally mean the third metaphor. It's a mixture of different symptoms and different autistic people have different amounts of those symptoms but all people diagnosed with autism have a significant amount of them and their symptoms will have some amount of overlap with autistic people.

    • bonsai_spool 22 minutes ago

      > It has always bothered me that by "spectrum" they mean not the sort of continuous thing that spectra actually are, but instead some disjoint set of "colors" any one of which might describe a person. That's called a partition, and its in an entirely separate thing.

      Hmm, what are these 'colors' in your framing? I don't think anyone feels that ASD comprises totally distinct, 'disjoint' descriptions. It's true that there are multiple parameters along which one may vary, but that's true of any human syndromic disease, and probably true for any human disease, in general.

      Here's a popular press article that talks about a very recent framing of autism that uses clinical and genetic data:

      https://www.simonsfoundation.org/2025/07/09/new-study-reveal...

    • 4ndr3vv 23 minutes ago

      > It has always bothered me that by "spectrum" they mean not the sort of continuous thing

      Oh but they do. the "spectrum" is by how socially acceptable someone's autism is.

      • rusk 10 minutes ago

        > how socially acceptable someone

        I intuitively understand this but has it been clinically defined?

        • mikestorrent 2 minutes ago

          Has social acceptability in any context ever been defined, beyond say, rules of etiquette? It's a free market and everyone is arguably entitled to test to see what it will bear.

        • lazide 2 minutes ago

          The entire nature of the field of psychology and mental health treatment is relative to pain and dysfunction.

          If people fit in well and didn’t have issues (either internal pain/suffering or society interaction pain/suffering), they are not applicable to the field.

    • maxbond 15 minutes ago

      > It has always bothered me that by "spectrum" they mean not the sort of continuous thing that spectra actually are, but instead some disjoint set of "colors"...

      I get what you mean but I feel compelled to point out that colors are on a spectrum. A partition can be a quantized spectrum.

      • rusk 11 minutes ago

        GP’s concern is that the quantisation scale is not representative of linear severity. It’s more like classification of disjoint characteristics tagged with colour

    • spongebobstoes 8 minutes ago

      spectrum is a good word because of spectroscopy, where for example a single beam of light is broken down into constituent parts

      in this ASD model, a single person is like a light source, ASD traits are like frequencies, and ASD itself is like the EM spectrum

      this is useful because our best understanding of ASD today is multidimensional

      as you say, it is not supposed to be used as like "the spectrum" is a line from "normal" to "autistic"

      unfortunately most people aren't familiar with spectroscopy, but I think it's a good metaphor

      do you have a suggestion for a better word than spectrum, that could convey the same rich metaphor but be less easily misunderstood?

    • jckahn 15 minutes ago

      This is the most delightfully autistic response to the article.

    • dooglius 14 minutes ago

      I think the former is what they are trying to imply?

    • raverbashing 15 minutes ago

      The current shitshow was the result of several misshaps and naive thinking

      - Group together "rainman" type people (and people with even harder limitations) with "not overly social/minor social impairments"

      - The current overmedicalization and diagnostication of everyday life wanting to label every minor difference between people

      - Current "education was too hard, let's build accommodations" which is good but not when you can get any diagnosis by shopping for it

    • sfpotter 19 minutes ago

      Fun fact: some spectra are discrete, not continuous! And some have both parts. Depends on the operator...

    • Hard_Space 21 minutes ago

      It seems a poor analogy, since it's impossible not to be on the spectrum somewhere, even if it's #000000.

    • kube-system 11 minutes ago

      And yet, colors themselves are arbitrarily chosen partitions of a spectrum.

    • renewiltord 13 minutes ago

      Actually, the original word has nothing to do with continuity. That's a later adoption of it from Latin to English. So to be precise, you don't need continuity. It's just a re-adoption of the same word form the original Latin.

      But many without autism don't have that need for precision so they get confused by mixing up later word use in different contexts like you did there.

      • rusk 8 minutes ago

        The present day meaning describes a continuum. The term could indeed be defined in the anachronistic terms you describe so it is anachronistic, which is a reasonable complaint when something enters common usage. We see terms redefined all the time thusly

  • jawns 5 minutes ago

    The main argument in favor of treating it as a single condition tends to come from the advocacy side, rather than from the diagnostic side.

    In terms of advocacy, there is strength in numbers, and arguably having such a large autism community has been good for both research and support. Potentially breaking that up into several smaller communities might lead to an overall decrease in impact.

    On the other hand, pretty much everyone with autism, or families who have children with autism, will tell you that there is wide variation in both severity and presentation. And I think most would welcome better definition of subtypes.

  • bolangi 10 minutes ago

    Reacting to the headline, I understand the basic concept of medicine is you treat a patient who presents with a condition, not a condition in isolation like some kind of abstract math problem. I think it's a mistake when doctors say to each other, even as a shorthand, I have a gallbladder to deal with, when it's a real person, and the best results come from considering the whole person when pondering how to care for them and which treatments to administer, with the medicine being only a part.

    • rusk 7 minutes ago

      You are speaking commendably from the point of view of diagnostics but from the point of view of physical operation you absolutely need that specialisation.

  • bookofjoe an hour ago
  • bena 4 minutes ago

    It's difficult because the variance is so wide.

    To compare: Three profiles of people with diagnosed Autism.

    Blindboy Boatclub: An Irish satirist who wears a plastic bag on his head in public appearances. Formerly of a band called The Rubberbandits. Today he is known for his podcast and has authored three books of short stories. He comes across as eccentric, but he's quite capable of managing in society otherwise.

    Side note, one of the other members of The Rubberbandits went by the moniker of Mr Chrome, but is better known to people as Bobby Fingers today.

    My stepson: Just a teenager navigating one of the more emotionally turbulent times while being noticeably different. He has fine motor issues and some social deficiencies. The best I could describe it is that he's emotionally a few years behind where other kids his age would be. He has few accommodations, mostly extra time and the ability to leave a situation that is overstimulating him. He's odd, probably always be a bit odd. May never be able to tie his shoes, but with work, he should be able to navigate society as a functioning adult one day.

    Wife's student: My wife is a special education teacher and she has a student who is completely non-verbal. However, he is noticeably intelligent and can form complex thoughts and can attempt to express them. Managed to use his visual communication device to insult one of his teachers based on her appearance. He will likely have issues for his entire life and will likely need constant therapy.

    Now, what one thing can we do for these three very different autistic people?

    There's a reason people say "When you've met one person with autism, you've met one person with autism". While there are some commonalities and typical comorbidities, what we regard as autism presents in so many different ways, it's incredibly difficult to construct a single program to address it.

    And I can see why we'd want to break it up. But that gets difficult as well. My stepson started low-verbal. Didn't speak for a while. Spoke rarely for a while longer. And now he speaks a lot. And he's learning when it is appropriate to speak and to handle people speaking around him but not to him. So he was non-verbal. But then became verbal. But not all autistic children cross that border.

    All that to say: I dunno. Shit's complicated, yo.

  • ceejayoz 43 minutes ago

    > Robert F. Kennedy junior, America’s health secretary, thinks that autism has become an “epidemic” in his country. His concern stems from figures from the Centres for Disease Control and Prevention, which shows that the condition now affects 32 per 1,000 eight-year-old children in America (see chart). That is in contrast, he says, with the near-absence of the condition in his childhood. Mr Kennedy was born in the 1950s, and studies estimate a prevalence of autism to around two to four per 10,000 in the 1960s.

    I'd note that RFK Jr.'s very own aunt was lobotomized then hidden away for something that sounds a lot like autism if diagnosed today. https://en.wikipedia.org/wiki/Rosemary_Kennedy

    • bluGill 34 minutes ago

      Read any old book (like from the 1800s), or look into anyone's family history. There is always some version of "Larry never leaves the farm". Nobody every diagnosed "Larry" so we don't know what he had and often we only have a small fraction of the symptoms recorded, but what we have sounds suspiciously like Autism (and one of a dozen other things we now have names for)

      • ceejayoz 33 minutes ago

        Yup. Or if they were rich, "eccentric".

        https://en.wikipedia.org/wiki/John_Bentinck,_5th_Duke_of_Por...

        > The tunnels under the estate were reputed to have totalled 15 mi (24 km), connecting various underground chambers and above-ground buildings. They included a 1,000 yd (910 m) long tunnel between the house and the riding house, wide enough for several people to walk side by side. A more roughly constructed tunnel ran parallel to this for the use of his workmen.

        > The duke was highly introverted and well known for his eccentricity; he did not want to meet people and never invited anyone to his home. He employed hundreds through his various construction projects, and though well paid, the employees were not allowed to speak to him or acknowledge him.

        > He ventured outside mainly by night, when he was preceded by a lady servant carrying a lantern 40 yards (37 m) ahead of him. If he did walk out by day, the duke wore two overcoats, an extremely tall hat, an extremely high collar, and carried a very large umbrella behind which he tried to hide if someone addressed him.

        > He insisted on a chicken roasting at all hours of the day and the servants brought him his food on heated trucks that ran on rails through the tunnels.

        • DaveZale 27 minutes ago

          Pugsley's tunnels! The Adams Family old black and white tv show...

    • alaithea 29 minutes ago

      It could be, but the Wikipedia article notes that she may have also suffered a birth injury from hypoxia.

      Rosemary's story is so tragic and heartbreaking. Her life was filled with what would today be considered multiple instances of medical malpractice, and heartless, unethical behavior on the part of the Kennedy family. Her father didn't even tell her mother about the lobotomy until after it was done.

      Incredible that she lived to the age of 86. The nuns taking care of her might have actually cared, which could hardly be said of the Kennedy family.

      • o11c 10 minutes ago

        Those are not unrelated. Both from my family and from looking at the research, there's a strong correlation between long/difficult births (sometimes explicitly hypoxia) and autism.

    • neilv 27 minutes ago

      The Rosemary Kennedy story is tragic.

      JFK was great in some ways, but that political dynasty had serious problems even before RFK Jr.

      The Wikipedia article paints this as partly driven by the political aspirations of the patriarch. I suspect this is yet another example of we'd be in much better shape if the US didn't have quasi-royalty, nor families aspiring to that.

    • joezydeco 12 minutes ago

      That's like saying there were maybe a few hundred stars in the sky before the telescope was invented. Completely stupid.

  • mrguyorama 16 minutes ago

    It is called "Autism spectrum disorder"

    Disorder by definition means that we do not consider it to have a single cause or issue, and we acknowledge that we don't understand it well enough to give it a single name, cause, or objective diagnostic criteria.

    When we know what causes something, or how to strictly and objectively identify it, then we usually call it a disease.

    This is well understood by medical professionals, and a normal part of their job, and not confusing for the vast majority of people diagnosed with some disorder or other.

    This article is utter trash. As per the usual for the economist

  • dboreham 32 minutes ago

    What's going on with the brain of any particular person is a point in a very high dimension space. What doctors call conditions are regions in that space. The definition of those regions has something to do with understanding and helping the humans and their families, but also something to do with the doctors making money. In the US Healthcare system nothing can be paid for unless it is in service of treating a "condition". Slightly odd that an article in The Economist doesn't mention this.

    • o11c 8 minutes ago

      Related: doctors will refuse to test you to see if what you're suffering from is a particular condition unless that condition actually has a known treatment.

  • photochemsyn 23 minutes ago

    The Economist should not be treated as reliable source of information on medical issues.

    [edit] To be more specific, this is a lazy take and is about as insightful as saying 'cancer should not be treated as a single condition' which for HN is about as meaningful as saying 'the CPU and the GPU may both contain chips, but they should not be programmed the same.'

    • zzzeek 15 minutes ago

      and times a hundred, Robert F Kennedy Jr., an absolute con artist with no qualifications of any kind

  • Cypher 34 minutes ago

    Who was?

  • nerdjon 36 minutes ago

    I will admit that I stopped reading the article because I think the article is completely mixing things up and honestly just did not feel like reading anymore of it.

    I think very few people actually consider it a single condition. To the point that most people that I know, including myself, say that we are "somewhere on the spectrum" or some variant of that.

    This isn't a post diagnoses understanding either, it is well understood by anyone I have talked to about this in the last 10ish years? (maybe less, I cant really pinpoint that).

    While I feel like there is value for professionals to be more specific about it, from an everyday person prospective I feel like "Autism" is well enough understood to be not just a single thing. Enough so that some phrasing along the lines of "my tism is..." is somewhat commonplace.

    The real problem is anti-science people joining the conversation, but splitting up Autism is not going to change that.

    Edit: To be very clear here I am not trying to say that most people in general are saying "I am somewhere on the spectrum". I am saying that most people I know which a larger portion of the people I regularly talk to are also diagnosed.

    • tokai 26 minutes ago

      Understanding autism as a spectrum does not at all imply that its multiple conditions. Just one with varying severity.

      • phito 20 minutes ago

        It's not a one dimensional spectrum with just severity as variable. It's a multi dimensional spectrum, you could potentially assign a "condition" to each dimension (hypersensitivity, OCD, rigid thinking, non-verbality, ...)

    • bluGill 31 minutes ago

      The reason we say "somewhere on the spectrum" is there are a lot of high functioning people who have a few autism like symptoms that benefit from some autism treatments. You can change the name/diagnosis what you want, but in the end we need to get people the treatment they need.

      • cogman10 27 minutes ago

        That's the benefit of a broad diagnosis. Narrow diagnoses make it hard to get specific treatments for problems.

        That's my main concern about trying to split up autism. It's all well and good for study purposes, but for "can I get my insurance to pay for my kid's occupational therapy" purposes I'm really skittish about such a breakup. All the sudden my kid might have "omegaism" or whatever and boom, it's uncommon for them to need OT so insurance won't cover it.

        • phito 14 minutes ago

          That's exactly my issue with "autism" because it feels like lumping a bunch of things together just for the sake of simplifying health care. Meanwhile you have a bunch of people that have completely different symptoms, experiences and causes with the same diagnostic.

      • nerdjon 27 minutes ago

        So... you agree with what I am saying?

        My point is, if it is commonplace to refer to Autism as a spectrum we are already acknowledging that it is not a single thing.

        Which seems to be the entire basis of this article while also mixing in the rambling of someone anti-science that frankly won't change even if it was split up.

        • bluGill 13 minutes ago

          I don't know enough above the subject (and what I could make of the article isn't helpful) to know if I agree or not. We should split Autism if we can conclusively separate people into the different diagnoses and then give them the correct treatment (which would be wrong for the other). However if we still give the same treatments in the end there isn't any point even if we can find different symptoms to result in a different diagnosis.

          As science learns more (or I learn more) I reserve the right to change my position.

    • squigz 19 minutes ago

      > To the point that most people that I know, including myself, say that we are "somewhere on the spectrum" or some variant of that.

      I'm not entirely sure why this comment is apparently so controversial, but I think people are confused by this. My reading of it was that you meant "most autistic people you know", and you yourself are. Maybe I'm wrong?

      • nerdjon 14 minutes ago

        That is exactly what I meant to say which is why I added an edit. I for sure could have phrased that a lot better.

        Now yes there are people who are undiagnosed for whatever reason (including some people I know that don't see the point after being diagnosed with ADHD, I know personally I had to have this conversation with my psychologist to determine if there was a point to actually do it at that point) that use that phrase and it gets a bit tricky.

        But nowhere am I trying to imply that *everyone* is saying this.

    • some_random 21 minutes ago

      I disagree completely, the discourse around RFK and "anti-science people" makes it extraordinarily clear that when most people hear "Autism Spectrum Disorder" they think exclusively of common, mild cases where the person has no serious issues existing in society and frequently benefits from their "disorder". They consider discussion of "curing" autism insulting, and challenge the idea that it's a read detriment at all. They do not for a moment think about the more severe cases that require people to have full time caretakers because they are unable to feed themselves.

      I can't read the article because of the paywall, but I assume that it is referring the fact that these two extremes need to be treated completely differently and even discussing ASD is made remarkably difficult because these extremes are the same diagnosis.

      • squigz 10 minutes ago

        I don't think it's safe to draw conclusions about what "most people" think based on the discourse around RFK and his nonsense.

    • jklinger410 34 minutes ago

      > I think very few people actually consider it a single condition. To the point that most people that I know, including myself, say that we are "somewhere on the spectrum" or some variant of that.

      Couldn't disagree more. The "autism is my super power" movement is borderline offensive to people dealing with severe or low functioning autism.

      Dismissive, uninformed comment.

      • squigz 31 minutes ago

        ???

        In what way is GP being dismissive, or taking the "autism is my super power" position with that comment?

      • mystraline 28 minutes ago

        > Couldn't disagree more. The "autism is my super power" movement is borderline offensive to people dealing with severe or low functioning autism.

        I doubt those types are saying much of anything. Its more likely their caregivers.

        Again the old name for those of us who think its more a super power used to be called Aspergers syndrome. https://en.wikipedia.org/wiki/Asperger_syndrome . And we got folded in to Autism Spectrum Disorder, as did a whole host of other diagnostics.

        And we have been found to be more truthful, better at focusing, can hyperfocus, notice more details than NT's, and plenty more. We're only a disease cause we're the minority.

        • jklinger410 a few seconds ago

          > I doubt those types are saying much of anything. Its more likely their caregivers.

          It doesn't really matter whose saying it. The point is that autism is not cool or fun for many people. We need a way to distinguish the difference, besides saying high or low functioning.

          > We're only a disease cause we're the minority.

          WHICH WE ARE WE TALKING ABOUT THEN? IS IT NOT A DISEASE WHEN SOMEONE IS NON-VERBAL? Holy shit. Point, meet case.

        • alphager 3 minutes ago

          It's not a disease, it's a disability.

          As someone with a diagnosis, I would add several sensory issues (for me it's noises, multiple conversations at the same time, stickiness, physical contact, whole categories of food and several others) and several social issues to your list of superpowers.

          Seeing it purely as a positive is insultingly reductive.

          To be clear: I would not take a cure if it somehow got invented, but it /is/ limiting in a multitude of ways even in the best cases.

        • some_random 11 minutes ago

          >And we have been found to be more truthful, better at focusing, can hyperfocus, notice more details than NT's, and plenty more. We're only a disease cause we're the minority.

          Yeah and this is why Autism shouldn't be treated as a single condition, even if the cause is the same the outcome is meaningfully different than someone who cannot function.

        • kube-system 17 minutes ago

          Many with Aspergers take advantage of their strengths (as anyone does) but it is not without its difficulties

      • nerdjon 32 minutes ago

        I have never in my life used "autism is my super power" so please don't put words in my mouth. I will agree that it is offensive but that is very different from saying "somewhere on the spectrum" when I don't feel like having a more in dept conversation.

        And again my point is that contrary to what the article seems to be trying to make, no one really considers Autism a single thing.

        • jklinger410 20 minutes ago

          I'm not putting words in your mouth. What I'm saying is, if we had different names for different types of autism, saying "autism is my super power" wouldn't be such an issue.

          And if "no one considers autism a single thing" THEN WHAT IS EACH THING? lol

          • ceejayoz 15 minutes ago

            > And if "no one considers autism a single thing" THEN WHAT IS EACH THING? lol

            We don't have a name for every color on the light spectrum, nor can the average person tell you what's different about #FF0000 vs #FE0000. They still exist!

            • jklinger410 6 minutes ago

              Autism should not be treated as a single condition

              • ceejayoz 4 minutes ago

                No one is disagreeing with that.

                People are trying to point out that the "spectrum" thing is the medical field doing precisely what you're asking for.

        • nxor 27 minutes ago

          The article is about ASD.

        • dpark 25 minutes ago

          You obviously did not claim autism as a superpower.

          Still this “everyone is a bit autistic” stuff is kind of absurd. It diminishes the condition.

          > most people that I know, including myself, say that we are "somewhere on the spectrum"

          No one says “everyone I know is a bit paraplegic”, because that would be insane. Yet people glibly call themselves autistic as if having geeky hobbies or a job in software is the same as being diagnosable as having an autism spectrum disorder.

          • mystraline 18 minutes ago

            Well, I won't get a diagnosis. Especially so after trump put in RFK.

            RFK ordered all MDs to report all autistic people to the federal government. I know how history works, and know exactly where that leads.

            So yeah, self-treat in ways that make me effective. And so far, washed out of college but working as a senior systems engineer. I say I'm doing rather well.

            My dad also had the similar affect as well. He was too old to be diagnosed by medical establishment.

          • nerdjon 21 minutes ago

            > Still this “everyone is a bit autistic” stuff is kind of absurd. It diminishes the condition.

            Again nowhere am I saying that.

            Maybe I could have worded it much better but I never meant to imply, it happens that like myself a larger portion of the people I hang out with are diagnosed which for me works with just saying "most people" but I can see why that was not clear.

            • dpark 15 minutes ago

              Fine. You said most people you know.

    • stuffn 27 minutes ago

      > Enough so that some phrasing along the lines of "my tism is..." is somewhat commonplace.

      In the 1990s we drugged kids (especially young boys) who weren't able to sit still with ADHD medication. Every parent's kid suddenly had ADHD, people would talk about their quirky behavior as "oh its my ADHD".

      This generation it's autism, and it's likely over-diagnosed just as much as ADHD. You do it in your own post, attributing a defined, binary, thing as "I am somewhere on the spectrum". If anything, your own post demonstrates the anti-scientific (pop-sci) instagramification of mental illness. You either have some quantity of illness or you don't. You can't just ascribe some quirky, possibly somewhat anti-social, behavior as being on the spectrum. Sadly, this is often used like ADHD self-diagnoses to gain sympathy or social leeway. Much to the disservice of people suffering from the condition.

      It comes as no surprise that psychiatry, and medicine in general, is suffering from a massive reproducibility crisis. It's not anti-science to call into question the amount of bunk, p-hacked, corporate funded garbage coming out of even the highest tier of medical grade journals.

      • flatline 11 minutes ago

        I both agree and disagree with the over-diagnosis claim. Yes, everyone is suddenly autistic, which lessens the meaning or impact of the term. Also, the DSM 5 reclassifies a good portion of human behavior under the umbrella of ASD, so this is in part driven by the diagnostic model itself. We continue to see rising rates of severe autism in children, which are likely attributable to this reclassification as well as better common understanding of the diagnostic criteria. Presumably, just as many adults either qualify now or would have qualified as children.

        At the same time, there’s the neurodiversity movement that seeks to destigmatize and depathologize these diagnoses for both high functioning and more profoundly disabled individuals. Just because you don’t conform to the norm - and ASD is heavily defined in relation to deviation from an underspecified norm - does not make you “mentally ill.” So we have autism as an identity additional to a diagnosis, which I think can be really empowering for people, and also cause confusion and frustration for others. It’s a reclaiming of “disability” from the paternalistic and abusive medical and pseudoscientific practitioners that have been harming autistic people for decades.

        I also wish you were not being downvoted. You express some common sentiments and I think your comment adds to the conversation.

  • ilaksh 13 minutes ago

    We don't have any geniuses or stupid people anymore -- just autistic and ADHD.

    Are you shy, slightly socially awkward and very intelligent? You must be "on the spectrum".

    The most intelligent, knowledgeable, socially tuned and socially integrated people I see online claim to be autistic. I swear it is absolute nonsense.