‘Interesting’ article on overdiagnosing in Times.

[Soontobe60]

Just putting this here for discussion.
https://www.thetimes.com/article/9f82545c-57f5-4db2-8a47-9a8cc2304243?shareToken=c0f809004b0c59cf1b96f6b6eb6129c3

Lots of people have severe MH that requires this, GPs are not equipped to manage MH for the majority in any case, it doesnt mean there is a difference in that MH for someone who is ND to someone who isnt. Their management of it and coping strategies may be different however

My sibling has suffered mild anxiety at times in their life, however luckily their ability to see things in quite a compartmentalised manner and black and white, meant they sort of saw it as a job or task to be managed and did very well

Me on the other hand with a breakdown I had in my 30s, managed much worse and was ill on and off for many many years later. I was under psychiatry opposed to the GP.

Someone under a psychiatrist simply has more severe mental health problems. I know various people this has applied to at various times. None are neurodiverse.

I agree. I was answering a question from another poster asking specifically about the types of anxiety which can be experienced as co-morbidities to ND.

TBH, I don't know why Eng Lit is taught in schools. It's a set of opinions about what a character is thinking presented as facts. What's the benefit to kids of learning this? History is as much about patterns as facts and at least in history the things presented as facts are real events that happened and have continued impact on our lives.

I love reading, I read acres of science fiction and fantasy, and I love going to see Shakespeare's plays performed on stage as the Bard himself intended for them to be consumed. The actors fill the gaps in the texts with voice tone, gesture, and interaction, and what the characters are thinking become easier to infer. If I wanted to get kids to hate reading, I'd teach them Shakespeare plays as books with canned interpretations to memorise.

Part of my autism presentation is alexithymia, meaning that most of the time if you ask me how I feel, I literally don't know. Even big emotions, I cannot name, so a lot of things live under one label "bad". So you ask me how Lady Macbeth feels, based on words in Elizabethan English on a page, and I don't even have a snowball's chance in hell of knowing.

My point being that, my inability to memorise patternless data in the form of "this is what Lady Macbeth felt here and she was trying to get her husband to feel this" and my alexithymia stopping me from inferring that information for myself meant that Eng Lit was a completely unpassable exam for a kid who got nine A-Cs.

@JoyousGreyOrca
You know for a fact none are ND? Maybe they don't realise themselves yet?

Anyone can see a psychiatrist privately. It's Just the shitty NHS that decides who is unwell enough for one and that's not right.

My dd has been hugely helped with her Autism struggles with a private psychiatrist and we are very fortunate.

Schools are not fit for purpose in many respects

I have that trait, I often dont know how I feel!

I do know how others feel though which is strange.

Im not a fan of Shakespeare if Im honest, overrated in my view, but totally agree that if he is going to be consumed, it needs to be live, not reading it as a book.

I couldn’t edit my post further, but wanted to add information about anxiety caused by sensory issues, not from a place of victimhood, poor me, but because people are clearly not understanding that those of us diagnosed autistic aren’t just people who have normal difficulties (depression, anxiety, friend issues) but take it the extra mile, but have a diagnosis based on a set of specific criteria which may manifest in different ways, hence looking very different (eg demand avoidance and complete compliance (not a good thing for autistics!) are opposite behaviours, both come from the same source and can be improved with the same methods) - but the root of the behaviour is the same.

(I used to be a complete victim because I was always a step or ten behind my peers and couldn’t for the life of me understand why or catch up, and then had to fight through the issues my dc had, and life was utterly shit, and I had so many wankers telling me they knew best, but then I was diagnosed and was able to work it out. I’m not a victim now, but I’m not standing for anyone suggesting any autistic is, because unless you’ve walked a mile in their shoes…)

So, sensory issues - yes everyone can find loud noises difficult, or bright lights, flickering lights, low buzzy noises, smells, etc difficult to take.

From an autistic perspective it disregulates the nervous system.

So for example - loud noise effects - distorts my hearing and takes a little while to stop, my inner ears tense up (don’t know how else to describe it) and I get headaches. If I can’t escape it to recover, or other stuff is going on and adding to the stress, I end up feeling anxious, really jittery, like my skin is a force field that’s breaking up and I’m disintegrating, if left too long it affects other senses, so I can’t see properly, I can be disoriented, I can panic. This is not something you can CBT away. It’s something that those on the spectrum need to be aware of and need to learn how to manage. Loud noises are just one of many things that can set off this sort of reaction.

I had health anxiety and social anxiety for years, but the sensory type is like anxiety on steroids, and needs some specific strategies to recover. These sorts of strategies are things we learn to use for our children (if you have NT children this is likely to be new information because you don’t need to do any of these). We learn to build up a sensory diet, which is almost a toolkit of strategies to deal with the sensory anxiety.

I think some people posting are really clueless about ND conditions and the very real effects they have. I agree there’s more about, but I don’t think it’s a big mystery. Life is far more complicated and frazzling than it was. Humans aren’t coping with it.

Low grade cancer doesn't always stay low grade though and because of diagnosis and monitoring, it would mean faster treatment should it become high grade.

Well autism is a physical response to an outside stimulus isn't it? If you come from an angle of autism being an over active nervous system, and ADHD being a subset of autism, then the 'overdiagnosis' makes sense. What we need is to re categorise autism and our understanding of it and understand it is very much a spectrum.

Understanding how the nervous system affects our brain is a fairly new thing for a lot of psychologists. We need to move on from old ideas about autism.

Edited to add.. yes I agree that holistic approaches should be explored re anxiety and ADHD.

Sounds like me. I think I could walk into either an ADHD or autism diagnosis. I once considered getting a formal diagnosis because I was upset that I was struggling with university-level coursework after cruising until then. I raised this with a tutor expecting sympathy and he told me to get off my arse and stop crying. Best advice I ever got. I got similar advice at a different point regarding social skills (something quite similar to the scene in Pride & Prejudice where Elizabeth and Darcy are discussing her piano skills).

I have never read an account of a "woman diagnosed in adulthood with ADHD/autism" that I didn't resonate with strongly, but I continue to believe that that diagnosis is in most (almost all?) cases is inappropriate.

It's so clearly something different from the "nonverbal boy diagnoses as a young child" that it honestly bewilders me that people insist on grouping them just because they're both something vaguely about social skills. They are different not just in degree but in essence.

@JoyousGreyOrca

Nowdays children are diagnosed even though their symptoms are only seen at home and so self reported by the parent. This is at odds with the DSM diagnostic criteria.

That's just not true. Symptoms are seen in clinic during an ADOS and we will sometimes send a clinician to do a school observation, but teachers are just not trained to spot symptoms.

Alexithymia isn't a trait associated solely with autism. Some people have alexithymia through being conditioned to suppress emotions that their parents deemed unacceptable. Eventually they suppress these emotions to the point that they stop recognising them.

I do know how others feel though which is strange.

You might be able to infer that reliably most of the time but you can never know for sure how someone else feels or thinks because you aren't in their head and people can lie. Some of them are paid to lie very convincingly: we call them "actors".

I have, through research, learned to recognise patterns of behaviour because they make patterns and I have learned that patterns co-occur with other patterns, for example, the set of behaviour patterns associated with narcissism. I consider this knowledge to be a survival skill.

Whatever the truth about accuracy of diagnoses, the rise will see a swing of the pendulum in social attitudes.

More people will be accepting if not that interested, some people will carry on being rude, and everyone will call out bad behaviour rather than SEN or cancer when it is. It won’t be an excuse.

I wasnt suggesting it was a trait only associated with ASD, which is sort of my point in this thread, we all have a myriad of skills, traits, behaviours, personalities and often are hugely influenced by our formative early experiences.

I got similar advice at a different point regarding social skills (something quite similar to the scene in Pride & Prejudice where Elizabeth and Darcy are discussing her piano skills).

People have tried to explain social skills to me repeatedly and I still get it wrong. I would argue that if you understood the social skills explanation the first time, you probably aren't autistic, because the diagnostic criteria says "persistent" and by definition "persistent" doesn't disappear after one person ticks you off once.

I continue to believe that that diagnosis is in most (almost all?) cases is inappropriate.

Tell me that your lack of social skills has never got you fired without telling me...

My diagnosis has unlocked reasonable adjustments at work, including detailed, in-depth coaching to try to do basic (to other people) things like learn how to recognise that I am angry. My diagnosis is very appropriate.

All those behaviours still exist, but she managed better than I think she might have if she was diagnosed.

I am, post-diagnosis, managing better than I have done in my life. Knowing that I need adjustments (which may look like something as simple as wearing sunglasses on the bus) and being able to give myself permission to not fit in so that I can use adjustments has made a huge difference. A lifetime of "well, everyone else copes", with its subtext of "so if you can't it's because you're not trying hard enough" destroys someone's sense of self-worth.

A diagnostic label immediately gives you a means of searching for what other people with the same diagnosis do to cope, so that you can try their ideas and adopt the ones that work for you.

A diagnostic label gives me a justification for ordering my groceries online and it gives me an answer to anyone, including my own inner voice, who tries telling me "well, everyone else manages to do the shopping themselves". Without that diagnosis, I'd still have that inner chorus of the voices of all the people who've ever called me "lazy" telling me to toughen up and go shopping, and I'd still be having meltdowns in aisle 37 every time Tesco moved the catfood.

@selffellatingouroborosofhate I don't think I'm autistic - I said I think I could walk into an autism diagnosis though which is a different thing (given the context of the thread)!

I have managed very well in my career through very, very actively only choosing to work in an industry which suits how my brain is wired. My industry has a high concentration of autistic men (across the entirety of the "spectrum").

I agree with your other post about how a diagnostic label has helped you find practical suggestions. I've followed a lot of tips I've read and very aggressively manage my life to be as easy as possible via such tips.

I guess I just see this as a philosophical difference: I don't think that I have a disability or something that needs a medical "diagnosis". I think I have a personality that likes operating in certain kinds of environments and life is easier if I align to that 80% of the time, which gives me energy to learn skills consciously for the other 20%.

I'm not saying I think "autism isn't a disability". I think there are genuinely disabled autistic people: I have met several in my industry and hobby groups. I am not one of them and I think most people similar to me aren't either.

I have managed very well in my career through very, very actively only choosing to work in an industry which suits how my brain is wired.

A lot of people don't have the luxury of making that choice without a diagnosis. Being able to tell the Job Centre that your autism precludes retail work, bar work, or other noisy environments is an example of where a diagnosis, and accompanying report detailing the impact of that diagnosis upon you, is a huge help. I can tell you from personal experience that the JC aren't going to let you decline that type of work without medical evidence.

It's really unjust of you, in a very "I'm alright, Jack" way, to decide that other people don't need a diagnosis (in your own words, "diagnosis is in most (almost all?) cases is inappropriate") based on your personal and extremely privileged experience of being able to choose your career path freely.

Yes I do know. Friends with diagnosed mental health problems who see or have seen an NHS psychiatrist.
Truthfully I find it offensive that you seem to think only neurodiverse people have severe mental health difficulties.

And of course the NHS decides who is unwell enough to see an NHS psychiatrist. There is a real shortage of psychiatrists with many vacant posts, so only the most unwell people see an NHS psychiatrist.

I agree the Job Centre will not allow that. But the role of parents is to steer children into suitable employment. One of my friends has an adult child with moderate levels of ASD. He works in agriculture and lives in toed housing. The work suits him totally and his parents guided him towards suitable work that suited his interests and needs.

I was explaining why diagnosis of low grade cancer is not always a good thing. Treatment comes with side effects. If you have chemo for a low grade cancer, that will get rid of the cancer. But you may be left with side effects of the chemo when the cancer may have disappeared by itself anyway or never developed beyond a low grade.
And even if you just decide to monitor and you never have treatment, the fact you know you have cancer may have negative side effects. These can include anxiety and depression, as well as affecting you financially with travel insurance and life or medical insurance.

It can also be a good thing. Chemotherapy isn’t going to be the go to treatment for low grade cancer but if it develops into high grade cancer? Catching it early could save a life.

Some low grade cancers are treated with chemo.
Some peoples lives are saved by diagnosis of a low grade cancer, but some people are harmed.