There's a little bit on that in the discussion to talk about some sex asymmetries in certain outcomes (as sex asymmetries in BPD, fibro, and other conditions that would greatly increase suicide risk are totally a thing, and it's not like being autistic makes you immune to having those conditions)

So I hope everyone enjoys the paper. For those of you without access to the paper, you can find a version of the PDF on my ResearchGate! Enjoy! www.researchgate.net/publication/...

And even though the autistic sample is clearly not representative of the whole autistic population (they are much more depressed and suicidal than average, being selected from three studies that oversampled people for those topics), the descriptive clinical phenotype of that group *is* the paper.

Similar age trends were observed for some but not all of the C-SSRS items representing suicidal ideation severity, as well as the ordinal "level of ideation," as seen below. No meaningful sex differences were observed across the sample in any of these outcomes.

Below are the plots of (lifetime) suicidality and NSSI likelihood as a function of age in the sample. Both were quite common and had some complex/interesting age relationships that reflected both real clinical effects (like peaks in early adulthood) and recruitment biases (drop-offs later on)...

P. S. I'm proud of how good I could make him look with a little Facebook stalking and a B+W filter. Shows what you get for accepting my friend requests 😉

I think it's going to depend on just which services those are going to be. Home an community-based services through medicaid in the US, at least, definitely require a medical diagnosis, and I don't expect those to ever be granted on the basis of anything other than that.

Though this paper made some pretty strong mechanistic claims, it was peak replication crisis for experimental psychology, and I'm not sure that the findings re: the association of pitch discrimination and clinical features actually hold up in later studies (or support that mechanism).

I guess a question is whether ND activists will ever develop a clinically practicable alternative to medical autism diagnosis, because self-ID is clearly not sufficient for services/accommodations in many settings (hence the need to interface with the medical system).

But once again, in a pluralistic field, it behooves us to respect the values of the other side and not force our approach on them, particularly if we acknowledge that both approaches are needed for some autistic people at least sometimes.

I would argue that those using medical-model approaches should control the ways in which ASD is defined medically, and people who wish to have different (non-medical) definitions of autism "caseness" that reject the autism diagnosis (as many already do by including self-identification) can do so.

of interest and make people eligible for medical services under that medical model. This is largely the function of a medical diagnosis in the first place.

ND activists also view diagnosis as a much more collaborative process than it has been historically, where a clinician just assigns labels.

Though this is a reasonable perspective to have, I do wonder to what extent it actually makes sense to try and shift official DSM criteria to include non-pathological traits.

After all, the DSM and associated ASD diagnosis are clearly situated in a medical model *meant* to pathologize the traits

intellectual disability and medical problems that are "co-occurring" with the characteristic physical features and hypotonia that signal the condition early in life. Again, @awaisaftab.bsky.social discusses how psychiatric labels go beyond simply being reflections if the same criteria on his blog.

Imagine, for a second, if we diagnosed rare genetic NDD syndromes clinically and only used the features that didn't overlap with other conditions to make the diagnosis. Those diagnoses would have high specificity, but we would come to absurd conclusions like Down syndrome is highly associated with >

Nevertheless, "autism" as a syndrome can go beyond DSM/ICD because the features exist in the world/phenotyping literature. This is why sensory features didn't magically appear in 2013--they were present all along and just elevated to be part of the diagnostic criteria at that point.

is one example of a "non-DSM" feature of autism that's pretty uncontroversial, and gets used as a soft sign sometimes when making diagnoses. It's also not present in many autistic people, especially those with more significant forms of ID and rare genetic syndromes, so far from universal.