Autism as another manifestation of Cerebral Palsy, caused by birthing trauma. Look out Obstetricians!!!

Obstetricians love legal battles. They especially love Cerebral Palsy.

I provided verifiable information about autism “severity.” I did this (again) to indicate, in case anyone’s interested, that there is research and there are data.

You’re free to promote subjective impressions and assumptions (you know a “severe” autistic when you see one), which are prone to all the usual biases. But I thought I’d point out that popularly repeated assumptions and cliches about autism “severity” might need examining. I thought this was the kind of blog where allusions to critical thinking and the peer-reviewed literature would at least not be totally unwelcome.

As I’ve commented here before, “Anyone who, like Dr Novella, uses his authority to divide autism by ‘severity’ (or any other way) should have some scientific basis for doing this.”

“Severity” of autism, in autism research, is the attempt to quantify the extent to which autistic traits and abilities are obvious, in an individual.

I am wondering who exactly you would regard as “severely autistic.” Autistics who encounter a lot of difficulty do not necessarily present with strong autistic phenotypes (one way of describing individuals whose autistic traits and abilities are very obvious). Autistics who are not obvious, who present with “weak” phenotypes (e.g., they do not meet full autism criteria) sometimes have the most difficulty, for various reasons. This is a clinical observation (not mine; I’m not a clinician or anything close, but I do work within shouting distance of clinicians) with some support in the literature.

The most obvious (farthest from being “normal”) autistics include autistic savants, among whom are some of the most successful autistic individuals.

Also, the extent to which any autistic (or otherwise disabled) person is disabled is not necessarily dependent on our own characteristics (including “severity”). This is reflected here and there in the autism literature (both descriptively and empirically). How we are regarded and treated as a group and as individuals has a major impact on how well we can function and on how good our outcomes are. This should not surprise anyone.

Thanks for clarifying your position, and I am sorry that I mischaracterized it. In my haste I made certain incorrect assumptions and have apparently confused your position with that of others. (Actually looking at the resources I was thinking of I see that is exactly what I did.)

Getting to your specific points – I actually don’t see their relevance to my original blog entry. I only mention severity in my opening paragraph, by way of introduction, and it is not a premise of the rest of the entry.

My use of “mild” and “severe” were global and subjective – they were not intended to be empirically defined because it was not relevant to my entry. As such it is trivial so say that “more severe manifestations can be significantly impairing.”

The fact that severity at one age as measured by a specific metric does not predict later outcome is irrelevant. The fact that “severity” is not one-dimensional and will vary based upon what you choose to measure is certainly interesting, but does not invalidate the notion that some people are disabled by their autism and others are not (however you choose to refer to that fact).

So I guess I am not sure what your point is or how it is relevant. Are you just objecting to my use of the word “severity” without operationally defining it? If that is the case then I have to disagree with your criticism. Terminology is defined by usage, and these terms (“mild” and “severe”) are often used in a global sense without implying anything empirical. It is common practice (at least in my experience) to qualify the terms when wishing to imply an empirical definition. For example, by saying “severity as defined by…” and then giving the specific scale or measure. Often just the measure is given, so if I want to refer to the NIH stroke scale as a measure of stroke severity I will simply say “patients with a higher NIH stroke scale” for example.

But if I am writing to the lay public I may simply and adequately write: “patients with more severe strokes may be significantly disabled.” And it will be generally understood that I am using the term “severe” colloquially and not implying any specific metric.

Do you have an alternate terminology you would favor, or do you not think it is ever legitimate to refer to autism “severity”?

I would be happy to address any further comments you have.

Your description of my position isn’t accurate. I suggest reading my work (rather than what other people write about it), if you are going to write about it. I’m not much of an “advocate” except by necessity; and my work has to pass peer review.

Nor is your description of “neurodiversity” (a word that appears once in my formal writing, and this is still sitting in press) accurate. “Neurodiversity” is not about autism (it is part of the general idea that disabled people should have human rights), and even informally, I’ve written almost nothing about it.

I don’t use the word “neurotypical.” You will not find it in my formal or informal writing, except when I have to explain that I do not use the word “neurotypical.”

For what it’s worth, my position can be compressed into two sentences that I’ve repeated a lot.

1. Autistics are human beings with human rights; and autistics deserve the recognized standards of science, ethics and advocacy that automatically protect and benefit nonautistics.

2. Services for autistics, whatever those services may be, should be asked for accurately (including with respect to the existing science), ethically, and respectully.

Nor have I written anywhere that “there is no such thing as ‘severity’ since it is all just natural variation.” I really doubt that would pass peer review, or even be accepted at IMFAR.

What I did write is sitting up there in the 2nd comment, and appears to have been ignored in favour of a series of stereotypes and caricatures about what people like me are presumed to believe. But the information in my ignored comment arises from existing instruments (anyone familiar with autism will recognize the CARS, e.g.) and the peer-reviewed literature (with the sole exception of the data we presented at IMFAR 2007)–on the off-chance you might be interested in empirical measurements and evidence re autism “severity.” Unfortunately, that doesn’t seem to be the case.

Also for what it’s worth, the current data-based consensus (as opposed to popularly repeated cliche) is that “severity” of autism is a relatively poor predictor of later outcomes (see Howlin, 2005, for a major review). I provide some instances of this in my post above. There are others.

This is a complex question, one that heavily involves the various definitions of entities in medicine and the meaning of “normal” and “healthy”. Without getting in too deep (which I probably will do at some point in the future when I have time for an in depth entry) I prefer the more conventional view that autism can be meaningfully thought of as ranging from mild to severe, and at some point along that spectrum it is reasonable to consider autism a disorder.

“latest example of the legendary skeptic Dr Steven Novella resorting to inaccurate, non-subjective characterizations of autistics”

“And look, no one was the least concerned that all this
non-empirical, very subjective information about autism was
being thrown around by a legendary skeptic.”

Now that this grave concern has been brought to my attention, I am very concerned about non-empirical, very subjective information about autism was being thrown around by a legendary skeptic – if Michelle Dawson could please clearly explain what she is writing about! But quite frankly, based on the limited information provided by Michelle Dawson about the supposed deficiencies in the post by Dr. Steven Novella, I really am left in the dark, as I have been by a number of other “factual” statements she has recently made. On the other hand, her four year-old article “The Misbehaviour of Behaviourists” provides adequate information – but that article prints out to 30 pages. I think Michelle Dawson may cause more harm than good to her concerns when she makes such harsh criticisms without providing adequate explanation for common people like me to be able to understand. I really want to make things better for human beings with autism and I would be glad to cooperate with any one with the same highly ethical goal. I already told her I am willing to discuss these matters if she sends me a private email to golden@shani.net