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The way autism is currently diagnosed seems quite unreliable, to me.
I feel this would be ok if it were not generally taken to be so definitive and consistent 
A thread 
At the moment, when diagnosing, we tend to enumerate the struggles people have, more than looking at anything intrinsic to them.
It's a bit like... hm... like looking at a penguin and saying, "it struggles to run," "it struggles to speak," "it can't fly."
This, instead of saying "it's a penguin" 
(and listing the qualities that make it so).
The main reason I think this method is unreliable is because a person's struggles can vary so much over time and in different contexts.
There are many traits and qualities which most would agree are autistic ones.
I listed some of them here: https://www.neurofabulous.org.uk/awesome-symptoms-of-autism.html
Those who need support must be able to get it. That is really important.
But could these two things - the traits and the struggles - somehow be differentiated from one another?
Not be quite so inseparable?
Here are some factors that are currently influential when getting an autism diagnosis:
1. Geographic location.
2. Which clinic or specialist you go to.
3. Whether it's private or publicly funded.
4. Whether you are part of a marginalized group or not.
I've read that diagnosticians are influenced by the idea that their patients may, or may not, get support... depending on what diagnosis they get.
This puts them under a lot of pressure.
Perhaps we need to somehow redefine the way autism is identified and diagnosed.
Maybe to something more consistent, and not solely deficit based?
I would love to hear other people's thoughts about this!
@KatyElphinstone I also feel like diagnosis seems based on outside observations rather than asking for insight experiences of the person in question. Like I encountered a psychiatrist who saw me once and she assumed I was giving eye contact.. could have asked and found out I was looking at her forehead because eyes are uncomfortable... 
Yes ... good point. Oh dear 
@KatyElphinstone
This is one of those things that I find so logical that I feel like it shouldn't even need to be said. I mean, I'm not so naive to actually think that; I know all to well how little good information about autism most people have (I didn't have it myself two years ago*), even in the medical/psychology world. It's just that it seems to take me more energy to imagine that state of affairs, whereas what you say comes so easily that it just seems automatic. Like "gravity is down" kind of intuitive.
And this is an experience I find I have often. "What, you mean people *don't* think that way already?"
*I'm not sure that I'm being clear here (I just woke up so I'm not at my best). While I say I didn't know anything about autism, it still seems "obvious" to me to identify things (like autism) by its inherent traits rather than by only apparent deficiencies. But again, when I think about it I can easily see how, given the allistic mindset, people came about this approach instead. That is logical, in context. I hope that made more sense.
@KatyElphinstone
In an ideal world, I would love to see diagnosis simply being the acceptance of self-realisation. In much the same way as identifying yourself as gay is. However, there will always be a need for at least some form of exterior diagnosis, in very young children who may need specialised help and those, including adults, with multiple needs, one of which may be autism and which is adversely affecting the care of the others and therefore needs to be correctly identified.
Moving away from the deficit model of doing this, is definitely required. It perpetuates the image of autism itself being a deficit and whilst it may be more attractive to allistics and make exterior diagnosis somewhat easier, it doesn't always and especially in adults with complex histories. Just think about the good old classic, what is trauma and what is autism?
Tests aimed at our strengths and the properties of the ways in which we differ from allistics, in areas such as morality, honesty, our senses and sensitivities, for example, would certainly be far preferred, emphasising as they would that we are just different from and not better, or worse, than.
@pathfinder @KatyElphinstone
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just writ and deleted a loooong reply . . . it's frustrating, deficiencies matter, I wouldn't mind the model - I was a repairman, "what's wrong," is the most important data there is - just they ought to matter all around.
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It ought to be a straightforward matter to test for the normal neurotype by testing for their normal and accepted list of fallacies and biases - those are deficiencies.
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I wouldn't mind them identifying my faults if I thought there was a general push on to identify faults in general, but that's not it, is it?
@punishmenthurts @KatyElphinstone
The problem is when they see the fault as the normal operating system. Rather than see the system first and then look to see if there's anything that needs work.
@pathfinder @KatyElphinstone
thanks, K.
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which seems to me, if they addressed their list of fallacies, and bred it out, that would be them being "conscious," self aware.
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To simply learn the fallacies and use them as sales tools is less than conscious, it isn't taking charge of yourself. That's what I'm always after, something in there.
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EDIT TO ADD: I don't expect them to breed out any majority traits, that wasn't right, of course. It's about spanking.
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It just seems clear to me that if I was trying to create some of the common fallacies, the first thing I would try is spanking everyone before school. Only an intuition to most minds, I suppose, feels like simple logic to me. 
@KatyElphinstone
I have actually thought about writing a toot on this subject myself. (Currently I don't have the spoons). But basically you mention many of the same points I have. I also want to mention some of the myth/hypothesis there considered true among many professionals, like lack og "theory of mind".
Also to answer you question, I currently think the "intense world theory" make sense as a description of autism (curious to what other think).
genericartdad (on youtube) made a video about it a few weeks ago.
The intense world theory is referenced in my research proposal that I was working on over the weekend
@uva @KatyElphinstone
I find both the intense world theory and monotropism to be highly effective explanations for autism. Not surprising really as they were both basically put forward by autistic researchers.
@KatyElphinstone the thing is, in some countries and situations, it may be a disadvantage to actually get the correct diagnosis. It shouldn’t be so, but it is. In some places, official autism diagnosis can be taken to account (negatively) when deciding things like custody, citizenship, certain jobs, etc. And the support this diagnosis can give you may be not worth anything in some cases.
My psychiatrist openly told me that I can, of course, spend money to pursue the official autism diagnosis from the few private licensed doctors, but as there’s no some specific ‘treatment’ or ‘cure’, and there may be some limitations, aside of the pricey evaluation not covered by an insurance, for me, there’s no much sense doing that, as she can work with me on any issues I have because of my autism without me getting an official diagnosis, and getting one will not add anything
Unfortunately this is very true... I remember some time back I asked people about if there were negatives to diagnosis. Some of the answers shocked me. Hang on, I'll see if I can find it...
Here: https://x.com/KatyElphinstone/status/1752933156716425699?t=2EU8U7xASccSn4R5MhcDog&s=19
I'm so sorry it was on the evil used-to-be-a-bird site 
@KatyElphinstone oh, I don’t have an acc there, and it doesn’t let one without an account to see the comments, unfortunately(
Really?? Gosh ...I am so sorry about that.
Basically it's just as you say. Disadvantages of an autism diagnosis being things like;
- barriers to getting a driver's license in some countries
- difficulty getting custody of your kids & being more likely to lose custody
- you have to declare it when applying e.g. for visas and citizenship
holly 
️
@KatyElphinstone @olena This is a shame because there are areas where having a diagnosis leads to more appropriate care. One example, I was reading an article on how to re-integrate employees with burnout back into work, and how that differed for neurotypicals (start with social contact as that is the least taxing for them) and autists (start with small clearly defined work tasks as socializing is more taxing for them). But if there's a lack of diagnosis, these things don't get implemented.
@holly @KatyElphinstone if you need to have an official diagnosis for that - yes. I feel that no one should require to provide a workplace with a doctor’s note in order for reasonable accommodations to be made. Like, if you’re having allergy attacks after your office is cleaned - you should not require to provide medical confirmation that you’re allergic to a specific thing they use, you should be able to just ask HR if it’s possible to change the things that are used. Same for mental things. There are lots of things that would make work easier not just for people with the medical note, you know. If places really cared about people, it would be about people, not about paper
@KatyElphinstone@mas.to
We would add age.
There was no adult diagnosis by the health board here until recently. It is still woefully underfunded and oversubscribed. On top of that, having just supported a woman in her twenties in part of the process, what she went through compared to us at ~50 is very different. She had an ADOS session where materials (toys etc) were clearly aimed at a child. She is younger and tiny in stature, but wickedly smart and and formidable. It seemed deeply patronising to us. Kept asking about future work too, when she has chronic health conditions that means she may never be able to do any work.
On the other side, we as older had issues where they wanted to talk to us about childhood and we have no memory before the age¹ of 11 and our parents are estranged and hostile to us²
They seem very fixed in diagnosis at a fixed stage and with specific manifested behaviours from very fixed prompts.
¹(When we formed as a plural system)
²(Cannot even use our chosen name, let alone recognise our gender or neurodivergence.)
Unfortunately, AIUI (& in my observation), most clinicians (in any specialty) tend to be very recipe-driven. They have a checklist they're supposed to hold the client up against to determine diagnosis & choose interventions from.
I've found it to be exceedingly (vanishingly?) rare to encounter a clinician that actually thinks systemically & analytically, & can actually Figure Shit Out.
Irritating af, but most training teaches the recipe. They don't teach thinking.
@KatyElphinstone@mas.to @cavyherd@wandering.shop
Absolutely, and the irony that they describe autistics as inflexible in their thought patterns and behaviours, whilst demonstrating exactly that, is not lost on us 
...yeah. & of course, point this out is likely to produces...less than desired results.
Bc while autistics tend to land lower on the power spectrum, this is by no means the case with clinicians. Certainly not in the sanctuary of their own minds.
Which is a crowning irony.
"Learning How To Learn" is actually a study that fascinates me. I understand the need to get students through the mill at speed to keep the pipeline filled.
But I'm also sure it's 100% a power thing, also.
@cavyherd @coth @KatyElphinstone this, to be honest, has been my experience of all professionals, regardless of which profession. When I was younger I naively assumed that you were paying for intelligence or problem solving ability - it's only dawned on me relatively recently that what you're actually paying for is their training / education / knowledge. 1/
@cavyherd @coth @KatyElphinstone Which isn't to say that's not still useful - I don't have the ability or the desire to understand the tax system the way my accountant does - but it's really not the way the "professions" present themselves to the outside world.
I'm not sure that your typical electrician or plumber doesn't do more creative problem solving that the average doctor / lawyer / accountant. 2/2
@srtcd424 @coth @KatyElphinstone
The good ones, do, certainly. (I mind the time the junior plumber made an absolute hash of a comparatively simple task, & company founding plumber came out the next day, had it sorted in about an hour (& cleaned up the mess).)
Sturgeon's law, man.
(For those unfamiliar: "90% of everything is crap.")
Yes, I had that happen to me with a dentist. He made such a mess - wisdom tooth, I was twenty. I won't go into detail.
Not many years later I needed two more removed. Pre- booked a taxi, huge kitchen roll in my bag, painkillers...and got ready for a week of bleeding, bruising, and general agony.
But (very experienced) dentist did it so beautifully. These teeth were even buried (so worse)...but it was incredibly adeptly done. No precautions were necessary!
@KatyElphinstone @srtcd424 @coth
The difference between the ones who Know What They're Doing vs The Ones Who Don't can be truly astonishing. It's kind of terrifying that it's really hard to tell in advance.
In this year or our Internet, you'd think there would be good filters (and there used to be some), but now we're pretty much back on our own again, relying on personal word of mouth 
@KatyElphinstone
This is a great list, well explained. I will be saving it and using it when I need to help explain autism to people.
Thank you so much! It makes me really happy that it was useful
I think it needs a couple of small edits, now I look at it again. E.g. not all autistics have a pronounced sense of smell (though many of us do).
@KatyElphinstone
I'm pretty sure that I have a good sense of smell, it's just that I don't usually notice it because of my chronic nasal/sinus congestion. But every once in a while I notice smells others don't. So yeah, like other autistic traits it can be hard to identify due to interference from so many other things.
@KatyElphinstone I now had time to read these. Love the list, so many points resonate with me. Thanks a lot for sharing! 
Thank you for telling me, warm glow over here.
@KatyElphinstone It swims! It is monogamous, with both parents caring equally for the eggs! It has a layer of subcutaneous fat insulating it from the Antarctic cold! Also, it's cute :-)
@KatyElphinstone those little waving wings!!