Classifications

A mini-digression was sparked off this morning by the piece in the Financial Times at reference 2. A piece which serves to remind me of the lack of resources afforded to the mental health sector generally and to the autistic part of it in particular. All part, in this country at least, of our attempting to live beyond our means. What might be called the something for nothing syndrome.

A piece which is decorated with some striking photographs from Emily June Smith, a photographer who was early diagnosed with both ADHD and autism. For the first of these, see reference 7. And for some photographs, reference 4.

A piece which starts off with the attention grabbing assertion that autism has become political and then goes on to discuss other aspects of the case.

A discussion which revolves around the abolition of the 'Asperger syndrome' in the fifth edition of DSM. The syndrome is still allowed, but it is subsumed in the division of autism into three levels of support: very substantial support, substantial support and support. While Baron-Cohen argues in favour of two types, corresponding pretty much to the autism of old and the more recent Asperger syndrome. With part of the reason for dropping Asperger being his Nazi past.

I did not notice anything about the link between DSM, access to medical help and insurance in the US. No DSM diagnosis, no insurance and then, unless you are rich, no medical help. So the way DSM organises and classifies mental disorders is important.

Nor about the interaction between labelling and talking about a disorder and the incidence of that disorder and the course that it takes in an individual. My intuition, for what it is worth, is that this interaction is much stronger in the case of a mental disorder than a physical disorder - where, nevertheless, we still talk about psychosomatic symptoms.

What is clear, is that there has been a massive increase of the diagnosis of autism (in the broad sense) over the last thirty years or so, with most of this being Baron-Cohen's Type 2 variant and with there being poor access to help for many of those adversely affected. What is not clear, to me anyway, is whether there has also been an increase in incidence.

The recent Trump/Kennedy intervention is dismissed as at best unhelpful. What we need is more medical statisticians, not more politicians on the case. And to think that I turned down my own opportunity to join these statisticians more than forty years ago now.

PS 1: I was a little surprised that I was able to download a copy of reference 1, all 1,377 pages of it. Even if there is something a bit odd about the page numbering.

PS 2: there is an impressive number of websites offering information, help and advice about autism. Some respectable, some not so respectable. So where on this spectrum is reference 8?

Reference 1: Diagnostic and statistical manual of mental disorders: Fifth edition:  Text revision – American Psychiatric Association – 2022.  The source of the snap above.

Reference 2: The new politics of autism: As contentious claims over rising diagnoses get a presidential platform, Simon Baron-Cohen explains where talk of an ‘epidemic’ goes wrong –  and why we need more recognition that autism comes in different forms - Simon Baron-Cohen, Financial Times – 2025.

Reference 3: https://en.wikipedia.org/wiki/Simon_Baron-Cohen. An eminence in the world of autism. Roughly ten years younger than I am.

Reference 4: https://www.public-offerings.com/magazine/emily-june-smith. 

Reference 5: https://www.emilyjunesmith.com/.  

Reference 6: https://en.wikipedia.org/wiki/Uta_Frith. Another eminence.

Reference 7: https://www.health.harvard.edu/mind-and-mood/attention-deficit-hyperactivity-disorder-adhd-a-to-z. 

Reference 8: https://www.icdl.com/parents/about-autism.