Scott Barry Kaufman on activist psychology; Leon Voss on college and adolescence; Timothy Taylor on what managers do; Oliver Kim on hierarchy in the economics profession
The change in the autism definition was part of a broader philosophy in DSM-V (and in modern psychology/psychiatry). Put bluntly, everyone is somewhat weird. Some are weirder in some way that others. If the weirdness makes if hard to live your life or do what you want to do, then it becomes a "disorder." And once if becomes a disorder and has a name, a medical professional can treat it and charge insurance.
Or to put it a different way, most disorders are the tails of a distribution. They are one end of a spectrum.
So lots of people have rigidities. When I see a pile (say, of books) that do not have the biggest ones at the bottom, I want to "fix" it. When those rigidities become too much, a person has obsessive-compulsive disorder.
Some people hear voices. But most everyone gets "earworms", snatches of songs that play in your head without conscious action. Social workers will often notice that the families of clients diagnosed with schizophrenia contain one or more unusual people.
Goodhart's Law says, "when a measure becomes a target, it ceases to be a good measure." Handle's corollary is, "When a professional's determination triggers access to special desirable benefits, the standards become unreliable and less well-defined." In medicine, this is "diagnosis". In the law, it's whether something gets deemed as a member of a category deserving special status, standing, solicitude, etc.
No diagnosis of rare childhood disorders with lots of money and assistance on the line for very sympathetic beneficiaries can long withstand the temptation for Epistemic Corruption and the gradual erosion of hard conceptual boundaries, tests, and filters into fuzzy and nebulous criteria that potentially describe large portions of the population. Inevitably, in the range of marginal, debatable cases, the diagnosis is less about the child patient's condition and more about the personalities and level of determination (and unfortunately, sometimes shamelessness) of the parents.
I'm trying to untangle what you've written. I see three possibilities:
1) a. Everything is a spectrum.
b. If the spectrum is divided in two, people in one section (the disorder) may get money and privileges, as will the people who "treat" them.
c. Therefore, there is an incentive to include more and more people in the disorder.
2) Yes, it's a spectrum. But in actuality, the spectrum manifests as two distinguishable states, non-disorder and disorder. There is a line separating the two. However, because of incentive problems, the line is put in the wrong place, and includes people who really don't have a disorder.
3) It's not a spectrum. There are two distinct states. And incentive problems mean that too many people are put in the "disorder" state.
I am making a more abstract point about the problem of preserving standards of intellectual rigor in the context of high stakes consequences and the practical necessity to make error-prone binary decisions when objective reality can't be mapped to any non-arbitrary divisions.
I am not making any claims about autism and its diagnosis in particular, though I'll note that even asking whether some observable variations in the human condition lies on a "spectrum or not" in the context of high amounts of complexity, ignorance and, uncertainty about underlying continuity or discreteness is kind of begging the question.
Consider someone observing the symptoms of say, people with malaria, before the acceptance of the germ theory of disease. The attempts to measure the severity of various symptoms would result in the wide-ranging bell-curves typical of biological responses in populations with even small amount of genetic diversity. There would also be lots of both Type I and Type II errors. Probably some people with the infection would be so little affected as to be wrongly excluded from consideration, while other people with malnutrition or completely different maladies would be mistakenly grouped in.
It would seem plausible to say that malaria exists on a spectrum, and while accurate, it would be misleading to say that is is a completely discrete question. In fact, whether one is actively infected is discrete (well, it's complicated, but close enough for this argument), but the severity of symptoms a random infected individual experiences tend to lie on bell curves. Actually, even that is not quite true in population with lots of people having the allele for sickle cell anemia, where a measurement of symptoms across a population would show weird, apparently discrete-ish cutoffs and discontinuities.
It was pretty clear to me that Handle was talking about mostly your series #1, though #2 also fits. I don't think he's at all arguing that the behavior isn't a spectrum as in #3.
Additionally, what constitutes 'disordered' seems flexible and highly contingent on the disposition of the person exhibiting the behavior in question.
I do not for a second deny your point that a big part of this is about the money.
I further concede that for autism it is likely that the money was a relatively bigger factor.
But as we’ve seen most obviously in the case of transgender activism, imo at least as big a part of what’s gone on here is political activism in particular, and in general the progressive belief in the perfection of humanity - and thus their own abilities as progressives - that Thomas Sowell laid out so well in “A Conflict of Visions”.
Autism is like having one leg, except it cannot be seen from the outside. Most people manage to function with just one leg, but some do not, especially if there is a confounding issue.
The RAADS-R test in particular is highly effective at dividing people into two buckets, so it appears that something binary is going on.
That may be true, but I am reminded of the joke that traditional medical diagnosis involved little more than repeating the patient's reported symptoms back to them, but in Greek and Latin. Something deep and primal in human nature really gravitates towards binary diagnostic labels.
1) True or false? “Personality psychology is a challenge.”
2) Multiple choice: “Personality psychology is”
A) a challenge.
B) a pseudoscience.
C) a quasi-science.
D) All of the above
3) Note the discrete similarities and differences between these smiley face characters. What characteristics do they have in common? Assign them to groups based on these similarities.
4) Note the non-discrete psychological similarities and differences between these real humans.
What characteristic do they have in common? Please assign them to discrete groups.
"It’s not like the work is hard, it’s just that they’re going for the liberal boarding school experience and lose interest in their marketing degree when they’re 20 or 21 and leave for work."
If I think back to the people I knew who dropped out of college, the issue was that they didn't have the self-discipline to complete enough of the coursework or study long enough to earn passing grades. Some of them couldn't even get it together to go to class on a regular basis. I don't think "losing interest" was part of the equation. In fact, I think you could argue some of them were so into the "liberal boarding school" social experience that they neglected the academic part that comes with it.
I had a semester like that sophomore year but I came back as a junior and turned things around, finishing in the standard eight semesters. Some friends' kids had experiences more like you describe and never finished. Other than Gates, Zuckerberg and a couple others like that, I'm not aware of students losing interest.
“I imagine that economists could find a large literature if they walked next door to the business school.”
Indeed it is amazing how much important work has come from economists working in business schools. The economics Nobel committee at least has had the good sense to recognize this as the following list (not sure if it is complete) illustrates:
Douglas W. Diamond, the Merton H. Miller Distinguished Service Professor of Finance at Chicago Booth.School of Business, was awarded the 2022 Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel for his pioneering research on banks and financial crises, alongside Ben Bernanke and Philip H. Dybvig. Bernanke taught at the Stanford Graduate School of Business from 1979 to 1985.
Thomas Sargent, 2011 prize for “"empirical research on cause and effect in the macroeconomy,” taught in the NYU Stern School of Business.
Edward C. Prescott and Finn E. Kydland, both associated with the Graduate School of Industrial Administration at Carnegie Mellon University, were jointly awarded the 2004 prize for their work on the time consistency of economic policy and the driving forces behind business cycles.
And Merton Howard Miller, received the 1990 prize for contributing the Modigliani–Miller theorem which proposed the irrelevance of debt-equity structure, was another who spent most of his academic career at the University of Chicago's Booth School of Business.
"“I imagine that economists could find a large literature if they walked next door to the business school.”
"Douglas W. Diamond, the Merton H. Miller Distinguished Service Professor of Finance at Chicago Booth.School of Business, was awarded the 2022 Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel for his pioneering research on banks and financial crises, alongside Ben Bernanke and Philip H. Dybvig. Bernanke taught at the Stanford Graduate School of Business from 1979 to 1985." [SNIP]
Oh, boy. It was idiots like Bernanke & his even more dysfunctional predecessor whose views on monetary policy & whose "light touch" attitudes towards bank regulation caused the 2008 Global Financial Crisis in the 1st place!
The only person who recognised the above, & whose book on it is completely forgotten:
In thinking about autism and “autism specrtrum disorder” versus “autism spectrum disorders” plural, it might be useful to remember that the DSM is primarily a diagnostic manual for coding insurance claims in the USA for individual cases and not necessarily relevant for research purposes or treatment purposes. And indeed when one surfs the google scholar literature, the use of “autism spectrum disorders” is quite common among researchers outside the United States. I found this article useful for untangling some of the confusion:
Oberman LM, Kaufmann WE. Autism Spectrum Disorder Versus Autism Spectrum Disorders: Terminology, Concepts, and Clinical Practice. Front Psychiatry. 2020 May 25;11:484. doi: 10.3389/fpsyt.2020.00484. PMID: 32636765; PMCID: PMC7317665.
- The DSM-V autism spectrum disorder definition does not speak to the different causes of various autism presentations and “it does not speak to the etiology or impact of co-occurring conditions on the behavioral phenotype or presentation.”
- “Genetic syndromes, defined mutations, and de novo copy number variations are reported to account for almost 10% to 20% of cases within ASD”
- “DSM-5 stresses through its etiology specifier, an entity with multiple causes and mechanisms”
-”the guidelines appear to be inadequate for addressing social communication impairments associated with genetic disorders that often lead to various degrees of intellectual disability.”
-” three key specifiers are also included in the DSM-5 ASD diagnosis: “With or without accompanying intellectual impairment,” “With or without accompanying language impairment,” and “Associated with another neurodevelopmental, mental, or behavioral disorder.”
My experience with autism was back in the days before legislation mandated insurance coverage for applied behavioral analysis (https://en.wikipedia.org/wiki/Applied_behavior_analysis ) was beginning to be widely promoted as therapy for autism and autism like disorders. Initially insurance companies claimed it was not proven, not medically necessary, and educational in nature rather than medical. It didn’t take long for Congress to respond to the nascent ABA industry and the many parents desperate for what was being billed at the time as the best and most advanced therapy for their autistic children.
The rash of high-profile autism treatment fraud cases might suggest that an “everything but the kitchen sink” definition of autism is conducive to fraud:
I agree about how the DSM works. I didn't know before about ABA, and having looked it up, I agree it's about the right size for a DSM lobby--the $5 billion you cite is about 1/4 to 1/2 the size of the ADHD med industory.
Still, the lack of a slam-dunk treatment does not mean the phenomenon isn't real, and treatments are more likely to be found when there is funded research about them. Asperger would have thought it crazy to say his kids are the same as the others. As well, people who are around children all the time can spot the Sheldons just fine.
When I look at the overall trends in these things, I view them as due to living in a time of plenty. People want, right now, not just to survive but to thrive.
Concur completely. I just doubt funding research for a treatment that works for both people with Asperger's and people with Fragile X makes sense. Research for such distinct and discernible populations really should directed to the specific populations, I'm guessing, even if it is imagined that the symptom "spectrum" somehow ties them together.
DSM stands for Diagnostic and STATISTICAL Manual. It provides the default for research in the USA and many other places. Whether their definitions are "real" and what that means are questions in the field. But their classifications won't be replaced until somebody--or some body--comes up more acceptable ones.
“All governments suffer a recurring problem: Power attracts pathological personalities. It is not that power corrupts but that it is magnetic to the corruptible. Such people have a tendency to become drunk on violence, a condition to which they are quickly addicted.”
The explanation of the situation doesn't need any Turchin. It's just another Malthusian Tournament Market where there are only so many spots for (and resources to be granted to) elites on the A-list, but, competition is cut-throat, but because the rewards for making it are so high (or at least perceived to be), lots and lots of people on the margins with low changes can still be tempted into blowing the huge opportunity costs and investing lots of time, money, and effort into the attempt to get through all the gates.
Academics - and especially the prize of becoming a tenured professor at a top school - is one good example, but also consider folks dreaming of becomes professional athletes or entertainment stars. Learning how to sing, act, or throw a ball as well as one possibly can is also a form of expensive "education", and in tournament markets with high rewards for a few winners, there will too many future losers who spent too much to get overeducated.
Also consider what happens when resources dry up in a famine, as they seem to be doing now in the Economics PhD market. A smaller pie gets cut up by those at the top. At the very top, there might be some belt-tightening, though it's possible the sizes of their slices won't even decrease. Meanwhile, everyone below the mean simply starves to death.
I just listened to a podcast about air traffic controllers. More than half wash out. Should one not try to be one?
Putting that imperfect comparison aside, I object to calling an econ PhD a loser. First, if a grad student doesn't enjoy that process, they probably aren't going to be thrilled with an academic job either. Shouldn't grad school, excepting some such as MBA, JD, EdD, and maybe MD, be looked at as an enjoyment in and of itself?
Second, there are a lot of job possibilities for an econ PhD from a selective school. I don't know about today but at one time Wall Street was paying way more and it was hard to attract top graduates to the academic jobs.
As for students at less selective schools, their job prospects have always been a mixed bag regardless of their major with few exceptions such as doctor, nurse, and maybe engineer.
"Autism became a spectrum. The criteria were thinned down to two domains: first, social-communication difficulties; second, restrictive and repetitive behaviors. … a 30-year-old who recalls feeling “socially overwhelmed” in school and not liking itchy clothing can receive the same diagnosis as a nonverbal child requiring lifelong care."
The difficulty becomes drawing a line between severe and mild. Of course there is still a difficulty of determining mild versus an immature kid.
I know a first grader diagnosed with autism. He gets an aide in school. Without the aide he is rather disruptive. He has all the stereotypical ADHD traits. While he is verbal beyond his age, he has almost no ability to interact socially with other kids. Besides typically not wanting to play with others, when he does he has very limited ability to see how his behavior might make others not want to play with him. I recently learned that by the end of kindergarten he only knew the names of about half of his classmates in a class of less than 20.
"This has been a week to think about political psychology."
American Pastoral is a highly relevant piece of realistic fiction to current events and speculations about others internal states. The daughter is a violent activist that sets off a bomb in the local community and much of the book involves the resulting fall out on her family.
The Beginning by Patrick Smith might be somewhat less realistic fiction, or somewhat more, but also has both negative and positive portrayals of activists in the middle of the 1960s in a small Mississippi town just after the passage of the civil rights act. It is definitely not for certain modern minds because it contains at least as many utterances of the N word as Huckleberry Finn.
In economics terms, the DSM seems a little like the Consumer Price Index. These things are used when an objective definition is needed, and they are in the ballpark of reasonable. However, the exact definitions are made via political football. For the DSM, the codes in there determine whether insurance or Medicaire will cover something, and they affect who can be admitted to public treatment programs. As well, a disorder that is coded will unlock a larger amount of drug research, because a coded disorder has a higher chance of an effective drug being profitable if it is produced.
Let me give three quick examples.
ADHD started as a diagnosis just for kids that disrupted classrooms by acting out all the time. It was then later expanded to include people that had a similar internal life but that were not disruptive to others. The pharmecological treatment is the same for both, so it is easy to imagine who and where the lobbyist might be coming from, though I don't really know. I am glad, though, because it changes people's life when they benefit from ADHD meds. It's like having glasses when everything has been blurry your whole life.
Autism has also had a long evolution, and it does not have medication that widely helps. Hans Asperger studied a certain category of patients in the 30s and 40s that sound a little bit like Sheldon from Big Bang Theory--bright, blunt, reserved. He worked in German, though, which handicapped his work from getting out there. The DSM-3 coded autism but didn't even mention Asperger's Syndrome. Asperger's was added DSM-4, as a sub-category of autism, but then removed in DSM-5 due to the subtypes not having a way to be clinically differentiated. Instead, the DSM-5 does something much better: instead of all these separate subtypes, there is an overall "autism" category and then three levels of support needs. I would imagine the fully non-verbal child must be in the highest category of support needs.
The history of PTSD is also pretty wild and has a major thread that started with treating soldiers and sending them back into the field. Bessel van der Kolk has tried to revise the definition of PTSD to match his non-military patients, especially children, and he reports that he will lead a well-run subcommittee of the best PTSD researchers and then have his work quickly dismissed by the full committee with little explanation given. That sounds an awful like like political football, like a person whose is geeked out in their subject area but, when it comes to politics, does not even know how the points work.
Like with the CPI, it can be good to have some distance from the DSM if you are able to. These tools are far better than nothing, especially because they are objective, but there is usually something better you can use for your particular interest area.
Alas, the statistic for "has a high school education" is probably around 35%.
Okay, that was snarky and unfair. It presupposes that there is something called a "high school education" that is well-defined. But if it means "actually learned and didn't forget the subject matter that is in the state standards and can actually use the skills that are in the state standards", the number would be considerably less than 35%
The change in the autism definition was part of a broader philosophy in DSM-V (and in modern psychology/psychiatry). Put bluntly, everyone is somewhat weird. Some are weirder in some way that others. If the weirdness makes if hard to live your life or do what you want to do, then it becomes a "disorder." And once if becomes a disorder and has a name, a medical professional can treat it and charge insurance.
Or to put it a different way, most disorders are the tails of a distribution. They are one end of a spectrum.
So lots of people have rigidities. When I see a pile (say, of books) that do not have the biggest ones at the bottom, I want to "fix" it. When those rigidities become too much, a person has obsessive-compulsive disorder.
Some people hear voices. But most everyone gets "earworms", snatches of songs that play in your head without conscious action. Social workers will often notice that the families of clients diagnosed with schizophrenia contain one or more unusual people.
Goodhart's Law says, "when a measure becomes a target, it ceases to be a good measure." Handle's corollary is, "When a professional's determination triggers access to special desirable benefits, the standards become unreliable and less well-defined." In medicine, this is "diagnosis". In the law, it's whether something gets deemed as a member of a category deserving special status, standing, solicitude, etc.
No diagnosis of rare childhood disorders with lots of money and assistance on the line for very sympathetic beneficiaries can long withstand the temptation for Epistemic Corruption and the gradual erosion of hard conceptual boundaries, tests, and filters into fuzzy and nebulous criteria that potentially describe large portions of the population. Inevitably, in the range of marginal, debatable cases, the diagnosis is less about the child patient's condition and more about the personalities and level of determination (and unfortunately, sometimes shamelessness) of the parents.
I'm trying to untangle what you've written. I see three possibilities:
1) a. Everything is a spectrum.
b. If the spectrum is divided in two, people in one section (the disorder) may get money and privileges, as will the people who "treat" them.
c. Therefore, there is an incentive to include more and more people in the disorder.
2) Yes, it's a spectrum. But in actuality, the spectrum manifests as two distinguishable states, non-disorder and disorder. There is a line separating the two. However, because of incentive problems, the line is put in the wrong place, and includes people who really don't have a disorder.
3) It's not a spectrum. There are two distinct states. And incentive problems mean that too many people are put in the "disorder" state.
I am making a more abstract point about the problem of preserving standards of intellectual rigor in the context of high stakes consequences and the practical necessity to make error-prone binary decisions when objective reality can't be mapped to any non-arbitrary divisions.
I am not making any claims about autism and its diagnosis in particular, though I'll note that even asking whether some observable variations in the human condition lies on a "spectrum or not" in the context of high amounts of complexity, ignorance and, uncertainty about underlying continuity or discreteness is kind of begging the question.
Consider someone observing the symptoms of say, people with malaria, before the acceptance of the germ theory of disease. The attempts to measure the severity of various symptoms would result in the wide-ranging bell-curves typical of biological responses in populations with even small amount of genetic diversity. There would also be lots of both Type I and Type II errors. Probably some people with the infection would be so little affected as to be wrongly excluded from consideration, while other people with malnutrition or completely different maladies would be mistakenly grouped in.
It would seem plausible to say that malaria exists on a spectrum, and while accurate, it would be misleading to say that is is a completely discrete question. In fact, whether one is actively infected is discrete (well, it's complicated, but close enough for this argument), but the severity of symptoms a random infected individual experiences tend to lie on bell curves. Actually, even that is not quite true in population with lots of people having the allele for sickle cell anemia, where a measurement of symptoms across a population would show weird, apparently discrete-ish cutoffs and discontinuities.
Yeah. There are people trying to develop a brain equivalent of the germ theory of disease. I gather they have not been very successful.
It was pretty clear to me that Handle was talking about mostly your series #1, though #2 also fits. I don't think he's at all arguing that the behavior isn't a spectrum as in #3.
Additionally, what constitutes 'disordered' seems flexible and highly contingent on the disposition of the person exhibiting the behavior in question.
I do not for a second deny your point that a big part of this is about the money.
I further concede that for autism it is likely that the money was a relatively bigger factor.
But as we’ve seen most obviously in the case of transgender activism, imo at least as big a part of what’s gone on here is political activism in particular, and in general the progressive belief in the perfection of humanity - and thus their own abilities as progressives - that Thomas Sowell laid out so well in “A Conflict of Visions”.
What I came to the comments to write- Goodhart's Law.
Autism is like having one leg, except it cannot be seen from the outside. Most people manage to function with just one leg, but some do not, especially if there is a confounding issue.
The RAADS-R test in particular is highly effective at dividing people into two buckets, so it appears that something binary is going on.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3134766/
That may be true, but I am reminded of the joke that traditional medical diagnosis involved little more than repeating the patient's reported symptoms back to them, but in Greek and Latin. Something deep and primal in human nature really gravitates towards binary diagnostic labels.
Personality Psychology Final Exam
1) True or false? “Personality psychology is a challenge.”
2) Multiple choice: “Personality psychology is”
A) a challenge.
B) a pseudoscience.
C) a quasi-science.
D) All of the above
3) Note the discrete similarities and differences between these smiley face characters. What characteristics do they have in common? Assign them to groups based on these similarities.
4) Note the non-discrete psychological similarities and differences between these real humans.
What characteristic do they have in common? Please assign them to discrete groups.
"It’s not like the work is hard, it’s just that they’re going for the liberal boarding school experience and lose interest in their marketing degree when they’re 20 or 21 and leave for work."
If I think back to the people I knew who dropped out of college, the issue was that they didn't have the self-discipline to complete enough of the coursework or study long enough to earn passing grades. Some of them couldn't even get it together to go to class on a regular basis. I don't think "losing interest" was part of the equation. In fact, I think you could argue some of them were so into the "liberal boarding school" social experience that they neglected the academic part that comes with it.
I had a semester like that sophomore year but I came back as a junior and turned things around, finishing in the standard eight semesters. Some friends' kids had experiences more like you describe and never finished. Other than Gates, Zuckerberg and a couple others like that, I'm not aware of students losing interest.
“I imagine that economists could find a large literature if they walked next door to the business school.”
Indeed it is amazing how much important work has come from economists working in business schools. The economics Nobel committee at least has had the good sense to recognize this as the following list (not sure if it is complete) illustrates:
Douglas W. Diamond, the Merton H. Miller Distinguished Service Professor of Finance at Chicago Booth.School of Business, was awarded the 2022 Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel for his pioneering research on banks and financial crises, alongside Ben Bernanke and Philip H. Dybvig. Bernanke taught at the Stanford Graduate School of Business from 1979 to 1985.
Thomas Sargent, 2011 prize for “"empirical research on cause and effect in the macroeconomy,” taught in the NYU Stern School of Business.
Edward C. Prescott and Finn E. Kydland, both associated with the Graduate School of Industrial Administration at Carnegie Mellon University, were jointly awarded the 2004 prize for their work on the time consistency of economic policy and the driving forces behind business cycles.
And Merton Howard Miller, received the 1990 prize for contributing the Modigliani–Miller theorem which proposed the irrelevance of debt-equity structure, was another who spent most of his academic career at the University of Chicago's Booth School of Business.
"“I imagine that economists could find a large literature if they walked next door to the business school.”
"Douglas W. Diamond, the Merton H. Miller Distinguished Service Professor of Finance at Chicago Booth.School of Business, was awarded the 2022 Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel for his pioneering research on banks and financial crises, alongside Ben Bernanke and Philip H. Dybvig. Bernanke taught at the Stanford Graduate School of Business from 1979 to 1985." [SNIP]
Oh, boy. It was idiots like Bernanke & his even more dysfunctional predecessor whose views on monetary policy & whose "light touch" attitudes towards bank regulation caused the 2008 Global Financial Crisis in the 1st place!
The only person who recognised the above, & whose book on it is completely forgotten:
https://www.getabstract.com/en/summary/econned/14906
Embarassing.
In thinking about autism and “autism specrtrum disorder” versus “autism spectrum disorders” plural, it might be useful to remember that the DSM is primarily a diagnostic manual for coding insurance claims in the USA for individual cases and not necessarily relevant for research purposes or treatment purposes. And indeed when one surfs the google scholar literature, the use of “autism spectrum disorders” is quite common among researchers outside the United States. I found this article useful for untangling some of the confusion:
Oberman LM, Kaufmann WE. Autism Spectrum Disorder Versus Autism Spectrum Disorders: Terminology, Concepts, and Clinical Practice. Front Psychiatry. 2020 May 25;11:484. doi: 10.3389/fpsyt.2020.00484. PMID: 32636765; PMCID: PMC7317665.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7317665/
It makes some points that seem relevant:
- The DSM-V autism spectrum disorder definition does not speak to the different causes of various autism presentations and “it does not speak to the etiology or impact of co-occurring conditions on the behavioral phenotype or presentation.”
- “Genetic syndromes, defined mutations, and de novo copy number variations are reported to account for almost 10% to 20% of cases within ASD”
- “DSM-5 stresses through its etiology specifier, an entity with multiple causes and mechanisms”
-”the guidelines appear to be inadequate for addressing social communication impairments associated with genetic disorders that often lead to various degrees of intellectual disability.”
-” three key specifiers are also included in the DSM-5 ASD diagnosis: “With or without accompanying intellectual impairment,” “With or without accompanying language impairment,” and “Associated with another neurodevelopmental, mental, or behavioral disorder.”
Thus, contra the article, the argument for a singular definition of autism spectrum disorder appears weak at best to this reader. And misdiagnosis remains an issue (https://www.healthline.com/health/autism/autism-misdiagnosis#frequency-of-misdiagnosis )
My experience with autism was back in the days before legislation mandated insurance coverage for applied behavioral analysis (https://en.wikipedia.org/wiki/Applied_behavior_analysis ) was beginning to be widely promoted as therapy for autism and autism like disorders. Initially insurance companies claimed it was not proven, not medically necessary, and educational in nature rather than medical. It didn’t take long for Congress to respond to the nascent ABA industry and the many parents desperate for what was being billed at the time as the best and most advanced therapy for their autistic children.
Since then, rapidly growing ABA services industry apparently reached $4 billion in 2023 (https://www.gminsights.com/industry-analysis/us-applied-behavior-analysis-market ) at the same time questions regarding the quality of the therapy have arisen (https://pmc.ncbi.nlm.nih.gov/articles/PMC8359641/#Sec24 ) as well as a dearth of cost-effectiveness research: “Future research into the cost-effectiveness of ABA-based interventions compared to existing and emerging interventions should be conducted, as only a few articles within the current review discussed the cost effectiveness of the ABA interventions in use.” (https://pmc.ncbi.nlm.nih.gov/articles/PMC9458805/#Sec24 )
The rash of high-profile autism treatment fraud cases might suggest that an “everything but the kitchen sink” definition of autism is conducive to fraud:
https://oig.hhs.gov/fraud/enforcement/ag-campbell-announces-more-than-25-million-in-fraud-settlements-with-two-autism-services-providers/
https://oig.hhs.gov/reports/all/2025/wisconsin-made-at-least-185-million-in-improper-fee-for-service-medicaid-payments-for-applied-behavior-analysis-provided-to-children-diagnoses-with-autism/
https://minnesotareformer.com/2024/12/12/feds-serve-search-warrants-in-autism-fraud-investigation/
https://oig.hhs.gov/fraud/enforcement/early-autism-project-inc-south-carolinas-largest-provider-of-behavioral-therapy-for-children-with-autism-pays-the-united-states-88-million-to-settle-allegations-of-fraud/
So at any rate, one might be excused for taking experts’ supposedly magisterial pronouncements on autism with a grain of salt.
I agree about how the DSM works. I didn't know before about ABA, and having looked it up, I agree it's about the right size for a DSM lobby--the $5 billion you cite is about 1/4 to 1/2 the size of the ADHD med industory.
Still, the lack of a slam-dunk treatment does not mean the phenomenon isn't real, and treatments are more likely to be found when there is funded research about them. Asperger would have thought it crazy to say his kids are the same as the others. As well, people who are around children all the time can spot the Sheldons just fine.
When I look at the overall trends in these things, I view them as due to living in a time of plenty. People want, right now, not just to survive but to thrive.
Concur completely. I just doubt funding research for a treatment that works for both people with Asperger's and people with Fragile X makes sense. Research for such distinct and discernible populations really should directed to the specific populations, I'm guessing, even if it is imagined that the symptom "spectrum" somehow ties them together.
DSM stands for Diagnostic and STATISTICAL Manual. It provides the default for research in the USA and many other places. Whether their definitions are "real" and what that means are questions in the field. But their classifications won't be replaced until somebody--or some body--comes up more acceptable ones.
“All governments suffer a recurring problem: Power attracts pathological personalities. It is not that power corrupts but that it is magnetic to the corruptible. Such people have a tendency to become drunk on violence, a condition to which they are quickly addicted.”
— Frank Herbert
If Turchin is right, and I think he is, we reached Economics PhD's overproduction some time ago.
The explanation of the situation doesn't need any Turchin. It's just another Malthusian Tournament Market where there are only so many spots for (and resources to be granted to) elites on the A-list, but, competition is cut-throat, but because the rewards for making it are so high (or at least perceived to be), lots and lots of people on the margins with low changes can still be tempted into blowing the huge opportunity costs and investing lots of time, money, and effort into the attempt to get through all the gates.
Academics - and especially the prize of becoming a tenured professor at a top school - is one good example, but also consider folks dreaming of becomes professional athletes or entertainment stars. Learning how to sing, act, or throw a ball as well as one possibly can is also a form of expensive "education", and in tournament markets with high rewards for a few winners, there will too many future losers who spent too much to get overeducated.
Also consider what happens when resources dry up in a famine, as they seem to be doing now in the Economics PhD market. A smaller pie gets cut up by those at the top. At the very top, there might be some belt-tightening, though it's possible the sizes of their slices won't even decrease. Meanwhile, everyone below the mean simply starves to death.
"Need" is a subjective condition. Lots of words trying to one up what doesn't need it.
I just listened to a podcast about air traffic controllers. More than half wash out. Should one not try to be one?
Putting that imperfect comparison aside, I object to calling an econ PhD a loser. First, if a grad student doesn't enjoy that process, they probably aren't going to be thrilled with an academic job either. Shouldn't grad school, excepting some such as MBA, JD, EdD, and maybe MD, be looked at as an enjoyment in and of itself?
Second, there are a lot of job possibilities for an econ PhD from a selective school. I don't know about today but at one time Wall Street was paying way more and it was hard to attract top graduates to the academic jobs.
As for students at less selective schools, their job prospects have always been a mixed bag regardless of their major with few exceptions such as doctor, nurse, and maybe engineer.
"Autism became a spectrum. The criteria were thinned down to two domains: first, social-communication difficulties; second, restrictive and repetitive behaviors. … a 30-year-old who recalls feeling “socially overwhelmed” in school and not liking itchy clothing can receive the same diagnosis as a nonverbal child requiring lifelong care."
The difficulty becomes drawing a line between severe and mild. Of course there is still a difficulty of determining mild versus an immature kid.
I know a first grader diagnosed with autism. He gets an aide in school. Without the aide he is rather disruptive. He has all the stereotypical ADHD traits. While he is verbal beyond his age, he has almost no ability to interact socially with other kids. Besides typically not wanting to play with others, when he does he has very limited ability to see how his behavior might make others not want to play with him. I recently learned that by the end of kindergarten he only knew the names of about half of his classmates in a class of less than 20.
"This has been a week to think about political psychology."
American Pastoral is a highly relevant piece of realistic fiction to current events and speculations about others internal states. The daughter is a violent activist that sets off a bomb in the local community and much of the book involves the resulting fall out on her family.
The Beginning by Patrick Smith might be somewhat less realistic fiction, or somewhat more, but also has both negative and positive portrayals of activists in the middle of the 1960s in a small Mississippi town just after the passage of the civil rights act. It is definitely not for certain modern minds because it contains at least as many utterances of the N word as Huckleberry Finn.
In economics terms, the DSM seems a little like the Consumer Price Index. These things are used when an objective definition is needed, and they are in the ballpark of reasonable. However, the exact definitions are made via political football. For the DSM, the codes in there determine whether insurance or Medicaire will cover something, and they affect who can be admitted to public treatment programs. As well, a disorder that is coded will unlock a larger amount of drug research, because a coded disorder has a higher chance of an effective drug being profitable if it is produced.
Let me give three quick examples.
ADHD started as a diagnosis just for kids that disrupted classrooms by acting out all the time. It was then later expanded to include people that had a similar internal life but that were not disruptive to others. The pharmecological treatment is the same for both, so it is easy to imagine who and where the lobbyist might be coming from, though I don't really know. I am glad, though, because it changes people's life when they benefit from ADHD meds. It's like having glasses when everything has been blurry your whole life.
Autism has also had a long evolution, and it does not have medication that widely helps. Hans Asperger studied a certain category of patients in the 30s and 40s that sound a little bit like Sheldon from Big Bang Theory--bright, blunt, reserved. He worked in German, though, which handicapped his work from getting out there. The DSM-3 coded autism but didn't even mention Asperger's Syndrome. Asperger's was added DSM-4, as a sub-category of autism, but then removed in DSM-5 due to the subtypes not having a way to be clinically differentiated. Instead, the DSM-5 does something much better: instead of all these separate subtypes, there is an overall "autism" category and then three levels of support needs. I would imagine the fully non-verbal child must be in the highest category of support needs.
The history of PTSD is also pretty wild and has a major thread that started with treating soldiers and sending them back into the field. Bessel van der Kolk has tried to revise the definition of PTSD to match his non-military patients, especially children, and he reports that he will lead a well-run subcommittee of the best PTSD researchers and then have his work quickly dismissed by the full committee with little explanation given. That sounds an awful like like political football, like a person whose is geeked out in their subject area but, when it comes to politics, does not even know how the points work.
Like with the CPI, it can be good to have some distance from the DSM if you are able to. These tools are far better than nothing, especially because they are objective, but there is usually something better you can use for your particular interest area.
According to google, the 35% graduation rate statistic is old and inaccurate. The rate is now up to 61% in the US.
Alas, the statistic for "has a high school education" is probably around 35%.
Okay, that was snarky and unfair. It presupposes that there is something called a "high school education" that is well-defined. But if it means "actually learned and didn't forget the subject matter that is in the state standards and can actually use the skills that are in the state standards", the number would be considerably less than 35%