The NYTimes has published a guest essay by Allen Francis on the expanding rates of Autism. You can read it on my WEAL website.
SUMMARY
Third edition of the D.S.M., 1980, autism was tightly defined and considered extremely rare. Criteria for the diagnosis required a very early onset (before age 3) of severe cognitive, interpersonal, emotional and behavioral problems.
Fourth edition of D.S.M included a new diagnosis, Asperger’s disorder, which is much milder in severity than classic autism and much more common. Based on careful studies, our task force predicted that the addition of Asperger’s disorder would modestly increase the rate of children given an autism-related diagnosis.
Instead, the rate increased more than 16-fold, to one in 150 from an estimated one in 2,500 in the span of a decade and is one in 31 today.
The enormous unintended consequences of adding the new diagnosis.
!) many instances of overdiagnosis — children labeled with a serious condition for challenges better be viewed as a variation of normal.
2) Many school systems provide much more intensive services to children with the diagnosis of autism. Whenever having a diagnosis carries a benefit, it will be overused.
3) Overdiagnosis can happen whenever there’s a blurry line between normal behavior and disorder, or when symptoms overlap with other conditions. Asperger’s was easily confused with other mental disorders or with common social avoidance and eccentricity.
In 2013, the D.S.M.-V, eliminated Asperger’s disorder as a stand-alone diagnosis and folded it into the newly introduced concept of autism spectrum disorder. This change further increased the rate of autism by obscuring the already fuzzy boundary between autism and social awkwardness.
It is difficult to accurately diagnose autism spectrum disorder. There is no biological test; symptoms vary greatly in nature and severity; clinicians don’t always agree; different diagnostic tests may come up with different conclusions; and the diagnosis is not always stable over time.
Social networking has been a powerful force in increasing autism diagnoses. Online communities can promote inaccurate self-diagnosis. As more people with mild symptoms get labeled autistic, it has lost its dire connotations. Some people turn to the diagnosis as a way to feel less shame and guilt around social awkwardness or difficulties in juggling tasks.
The explosion in autism rates has become fodder for Mr. Kennedy’s conspiracy theories. Mr. Kennedy’s statements that people suffering from autism don’t pay taxes, implying they are useless, has created outrage among patients and families. His proposed autism registry is a scary invasion of privacy.
My Comments
The expansion of diagnoses by the American Psychiatric Association has been the bases for much discussion of gender dysphoria in our past posts. Soon I will be posting an article from Commonweal on the grief as a medical disorder, another case of diagnosis expansion.
In all these cases there seem to be a group of physicians along with a group of consumers who are advocating for expansion, accompanied by our drug industry eager to promote new drugs. Many people may benefit from the expansion of these definitions. But the potential for abuse appears to be there.
Diagnoses have become an important part of how we regulate medical, drug, economic and social benefits.
Diagnoses have become an important part of popular culture by which people interpret their own identities as well as those of others.
For sure armchair diagnosing is a popular indoor sport. I have even caught myself doing it; looking back at school days, at kids I knew who were a little odd. Were they "on the spectrum"? Actually I was, and remain, a little odd myself.
ReplyDeleteI guess one good thing about expanding the definition of conditions such as autism is that we are recognizing that there are different degrees. And if a diagnosis means that kids who are struggling in school get some extra help, that would be a good thing. However, I recognize the slippery slope aspect of pathologizing everything.
And about RFK Jr, don't get me started. My diagnosis of him isn't autism spectrum. It's severe brain damage.
Some autistic people still identify as having Asperger's. Musk is one of them. In Nazi Germany, those with autism were put to death, but those with Asperger's were seen as superior to other autistics and even gifted in certain ways.
ReplyDeleteIn recent years, "Aspie Supremacy" has become something of a strange little movement involving autistic people who claim to be superior humans because they are unencumbered with emotional concerns and can approach things scientifically. Musk and other pronatalists run along Aspie Supremacy lines.
High functioning autisticd are sometimes aligned with the effective altruism movement (embraced by convicted fraudster Sam Bankman-Fried), which takes a very statistical of the greatest good for the greatest number.
Many autistic people and others advocating for better care and treatment of autism have rejected Musk et al and their notions of superiority. Those advocates also have to fight Kennedy's notions that all autistic are completely disabled and incapable of normal emotional responses.
If you have ever had a kid who got hit with a spectrum diagnosis after testing (such as it is), your life will be a living hell. Everybody's got theories about whether autism is real (he's a brat who needs more discipline), why the kid is autistic (thimerasol, genetics, infant formula, refined sugar, red dye, trauma), and what you ought to do about it (drugs, special schools, lower expectations, home school).
It's a nightmare.
I think Musk is a legend in his own mind. Seems to me that "effective altruism" is a high-sounding justification for steam-rolling the rights of individuals.
DeletePretty much. I think Jack's observation that everybody's an armchair expert is widespread and pernicious, and not just about autism. I see low-info know-it-alls among politicians, in my cancer group, among opinionated family members, at church, etc etc.
DeleteIf Naomi Klein has it right, Viennese Herr Dr. Asperger, following the Anschluss, became intimately involved in the whole eugenics program with respect to the autistic. Autistics were sent away to their fate but those designated "high functioning" were saved. Asperger made the argument their talents could benefit the State. Whether or not he was doing a Schindler thing, I don't know. We judge people by what they can do. Maybe some people's job is just to be. And our job is to be nice to them, not fix them.. One thing I've seen in Europe, in Germany, too, is families taking their different family members to public venues. A member of my gym brings his autistic son once a week and they both get on treadmills. One lady I knew brought her autistic son to the dances and would dance with him once during the event.
DeleteJack - is any of the 16-fold increase attributable to more medical-community and public awareness of autism, i.e. cases that may have been missed previously are not being missed now?
ReplyDeleteYes, some of the increase is likely due to cases not being missed. However, the increase in numbers is so large that over diagnosis is a more likely possibility. I think I could have been over diagnosed with being on the spectrum as a child if the present criteria had been in effect.
DeleteIn grade school as child, I had difficulty with playing team sports and learning to dance. I didn’t play at recess with the other kids. I hung around the school door and talked with my teachers. I also had problems with arithmetic, memorizing my adds, subtracts, multiplies. They were not concerned with me. They recognized I was very intelligent; I was also very involved with church as an altar boy, coming late to school because of funerals, etc. This was a public school but one of the teachers was the parish organist. I wasn’t having any problems in relating to adults, in fact I was doing so in an exceptional manner. But what would have happened to me if they had known about high functioning Asperger diagnoses? Would my social awkwardness with my peers have been a trigger for that diagnosis.
Because of my social awkwardness with my peers, I was teased and bullied during high school. However, in high school I got along very well with my math and science teachers. A math teacher became a life-long friend. A physics teacher and I got up early to watch the same atomic physics course on public TV. Being an altar boy grew into being in charge of the altars boys at age sixteen, and much parish involvement because I was headed toward the Jesuits. As for my peers, I joked with the adults that all my adolescent rebellion had gone into distancing myself from my peers. However, I did miss out on the development of a lot of social skills, the kind used in meeting people, e.g. dating. I have always done very well in relating long term to people in closer relationships. Once, I entered graduate school, I no longer had to worry about bullying. As a research or teaching assistance I was always in authority positions and never had to related very much to coworkers. That became even more pronounced in the mental health system where I was part of senior management.
Was the social awkwardness in grade and high school related to my brain functioning? When I got my balance problem (which also involved problems with multitasking) I had an extensive workup at the Cleveland Clinic with all types of mental functioning (mainly to rule out Alzheimer, dementias, and Parkinson’s). The conclusion was that it is likely I have some as yet unidentified genetic condition that does not integrate my cortical functions well with my mobility functions. That shows up now with my balance problem which involves integrating sight, inner ear, and feedback from peripheral muscles. The balance problem gets managed better by using a walking stick which gives me more feedback from my muscles in my arms rather than relying on just my legs.
I could have easily been over diagnosed as being on the spectrum as a child and adolescent because of some social deficits which are related to brain-muscular integration problems. Maybe in the future when everyone gets extensive DNA profiling, there will be a diagnosis for people like me. Will there be special physical therapy for kids like me? Will there be special socializing experiences that avoid sports, etc.? I suspect in the future when we know much more about genetics and DNA, everyone will have a unique profile, and much time will be spent navigating those profiles through complex social systems throughout life. In the meantime, parents, teachers and kids have to do their best to figure things out.
One added thought, in the absence of science, we all have to be better scientists, being very observant of behavior in relation to surroundings, being willing to think outside the box of social norms to discover new relationships.
DeleteI have found my interdisciplinary training in psychology and sociology, being able to integrate what goes on at the person level with what goes on at the organizational level to be of immense value in my professional and personal life.
Would a future in which everyone gets extensive DNA profiling necessarily be a good thing? I can see too much possibility for control and abuse there. Not to mention a "designer baby" industry, which we kind of have now, for people who are rich enough.
DeleteI know little about autism. I have known only one person who was diagnosed as “possibly” on the ” autism spectrum”. He is the son of a very close friend from college days. Her husband dropped dead of a heart attack about 6 years ago, while she was in a rehab hospital trying to recover from complicated ankle surgery. We went to CT where they lived to try to help. The situation was VERY complicated. Her 29 year old son was living in the house - totally helpless about the simplest things, like picking up the mess of papers on the floor, sweeping, cleaning the kitchen counters with mouse droppings everywhere. The house was a mess and was totally filthy. And I am a messy housekeeper! She had told me on the phone once that he was only working part- time stocking shelves at the grocery store because he was “ on the autism spectrum “. He had dropped out of two colleges. He was 15 when I had last seen him and then he seemed like a socially awkward teenager , like many others. His older brother had died a couple of years earlier from complications of cerebral palsy, and his sister was an emotional mess. At 29 I was shocked that he had never ever done anything to help his parents. His sister was a disaster, not at home. I cracked down on Colin, teaching him how to sweep, vacuum, pick trash off the floor (!), etc. My husband and I stayed with him while we tried to help his mom straighten out some financial issues. Her cell phone had been cut off because she hadn’t paid the bill. Her checking account was dry because she had used the last of it to pay for her husband’s cremation. She was waiting for a life insurance check, which came, but was half of what she had expected because her husband had borrowed against it without her knowing. In earlier years They had been quite well off financially, but were now basically bankrupt because of spending $hundreds of thousands on different rehab programs meant to cure their daughter’s drug addictions. They didn’t, and she was also in legal trouble, just out of jail when we arrived in CT. During the time we were there, I came to the conclusion that Colin’s helpless had nothing to do with autism and a lot to do with his parents having been so overwhelmed by his deceased elder brothers’s non- stop health problems and helplessness for 17 years, and his sister’s drug addiction, that they never expected much from him other than to take care of him because he “couldn’t”, because he was “ on the autism spectrum “. By the time we left town, he was doing things like sweeping, washing dishes etc. He was still socially awkward, and a natural introvert but a nice “ kid”. I kept in touch, especially after his mom died a few months later. He had to leave the house. He got a small inheritance from the house sale. He found a studio apartment. Started working full- time, and went back to school. He was not a bit like the two fictional autistic characters in the shows Jim and I mentioned. So I don’t know what autism really is, at least in a mild form. I only saw a very immature, introverted, socially awkward young man.
DeleteOur eldest son was super active from the time he was born. Hated to sleep, always on the go. When he was two a couple of people suggested that he might ADHD , so I took him to the pediatrician, the father of five. He observed, asked me a lot of questions, and told me that he did not think our son was clinically hyperactive ( the term then). Just very active. He reminded me that “ normal is not a point- it’s a range of behavior“. He said our son was at the active end of the normal scale. I’ve never forgotten that - perhaps it’s true of other things - someone may be normal, but is diagnosed “autistic “ because they are a bit different from the average.
The Boy had exhaustive tests in 3rd grade after concerns from the teacher and a referral to an independent testing center from our family doc. Raber was always told that he was a child genius and refused to accept that his kid had learning problems. Imo, that whole "child genius" label can do as much damage as an autism or retarded label.
DeleteAnyway, the GP told me to have Raber take the kid in for the tests. So I concocted an all-day work meeting I couldn't get out of. The process was an eye-opener for Raber, so the tests were worth the $$.
The psychologist who did them gave us an exhaustive report and had a few good insights, especially about how to navigate the school system.
I also liked that she gave us not only the bad news about the kid's limitations, but the good news about his strengths. It was also good to know that some of the things we were doing already were helpful.
I am not convinced my friends son is autistic. He was diagnosed in his 20s and I had followed the problems via phone calls for years. Even that final assessment of autism spectrum was only “possibly”. And my friend and her husband were never given help on building his strengths - he had them. For example, I learned after email exchanges that not Only is he bright, he writes exceptionally well. But he was stocking grocery shelves part- time at 29. He had to sink or swim after both of his parents died within months of each other. He learned to swim. From what you have said, you taught your son to swim.
DeleteIt sounds like you had a decent psychologist/tester - who gave you help in navigating the school system (often a nightmare) and told you how to build on his strengths. I have known of several cases that didn’t turn out so well, including assessments that were simply wrong. I have known more than one case where a teacher pushed testing and assessments because she found kids - usually boys - to be more difficult to manage in the classroom than girls. Our eldest son’s kindergarten teacher once said to me (without thinking) that the problem with this class is there are too many boys. Twice as many boys as girls in that class. Only 14 kids and she struggled . They wanted someone to put them on meds - I think Ritalin was the preferred product. I knew two or three families with active, bright boys who were pushed to do this - and refused. One friend moved, so that her son started 2nd grade in a different school in a different state. Clean slate . My friend mentioned this recommendation to his new teacher at some point and she wasn’t surprised. She saw no problems - just a bright, active kid. She said many (usually older, female) teachers of young boys can’t handle the more active kids - almost always boys - and take the easy way out - pushing meds. This friend’s son never took meds. Years later he graduated from Stanford, has had an excellent career and a family. I knew another with a similar academic trajectory for their son, who was not only an outstanding student, but an outstanding athlete, ending up in a top five university - one of our sons. I have sometimes wondered whether or not these boys would have been so successful if their natural energy had been suppressed by meds instead of channeled and guided. Our son had a couple of truly outstanding teachers who did this. I compared notes with several friends who had experienced the same things. I changed my sons’ school after being pushed to medicate the one with “ ants in his pants”. ( direct quote from 3rd grade teacher)
One reason we switched our sons into an all- boys Catholic school was because of this and because I had observed this as a classroom volunteer in the parochial and public schools our sons attended at first . It happened a lot. Around the same time I read a book that I think was called “ The Little Boy Book” or similar, written by the mother of four sons . She went into detail about the reasons for the mismatch of school expectations and the realities of little boys. The Catholic all boys school understood this and designed the program to have old fashioned Catholic school discipline, and curriculum ( phonics anyone?) complete with single desks in rows, with many breaks to allow the kids to move. They had a 20 minute morning recess (done away in the public school), a long lunch break, afternoon recess for the 1-4 grades and afternoon team sports for 5-8th. They had three small buildings - lower school classrooms, upper school classrooms and gym, and an all purpose building for library, Art, and music. The academic subject periods were broken up by art or music etc and the boys were not only allowed to run between buildings, they were encouraged to do so. Running was not prohibited as it had been in public school, and the parochial school we tried for one year.
We let the school do their assessment on The Boy, but we didn't show them the private assessment until our sit down. Results were very close. The school's indicated he didn't qualify for an IEP, which was most likely based on funding vs test results. So we got him into various summer programs with a lot of hands-on learning and music instruction until he graduated. I learned a LOT from watching how he responded to various instruction styles and classroom set-ups, and it made me a much better teacher.
DeleteAnne, your sons' school sounds a lot like what I remember of my grade school days. In the lower grades at least we had a morning and afternoon recess, a milk break mid morning, and an hour lunch break. It was expected that after we finished our sack lunch (some of the kids lived close enough to go home for lunch) we would go out and play on the playground until the bell rang. There were two grades in a classroom, which meant probably 40 kids. We had phonics too. The sisters did not have any trouble teaching boys. Or encouraging girls who tended to be a bit lazy (me) to apply themselves.
DeleteWhat we found out with our boys was that sometimes kids just need more time to be ready for school. They both had summer birthdays (the youngest son's b-day is Aug 31, which is close to the cut-off date). When our oldest started school someone got a grant to assess kids coming in to kindergarten. They flagged our son as not having good hand/eye coordination, which meant they put him in "developmental kindergarten". It was basically pre-school, which didn't do any harm, but we should have just held him back a year, he would have been younger than most of his class anyway. He started real kindergarten at age 6. With the younger son we started him in preschool at age 5 and kindergarten at 6.
With our eldest, a fall birthday in a state with a Dec 31 cut- off, we agonized about starting him in school. He was very bright, but also very, very tall, and immature. And had horrible fine motor skills for learning to write. In Sept of the year he could start kindergarten he was already as tall as the second graders. I had read a lot about holding boys back, but because he was so tall, and gawky and awkward, we were afraid that this would be even worse if we waited a year. So he went to kindergarten before his 5th birthday. He never had academic problems - he was “gifted”. He did have social problems - he was immature. He reached 6’6 by freshman year of high school ( size 15 shoe) and was a very good basketball player. Being a varsity athlete helped, but he was pretty miserable for many of his school years. Our youngest is also a fall birthday - November. He was also tall, but not quite as tall as he older brother (he is now 6’4”). Because of our experience with his eldest brother we held him back a year. It was a good move. The middle son has a May birthday. He was taller than average but not a giant compared to other kids . He is now 6’. He went to kindergarten the Sept after he turned five. He was fine. One reason I worried about our very tall first- born staying back was my own experience as a child. I was very tall - The tallest in my class of 50 boys and girls starting in first grade. I was 5’3” by 5 th grade when I changed schools. I was constantly mocked and bullied in my new school and was miserable. I ended up at 5’7” by age 12 and didn't get any taller after that, which is great. I have actually always loved my adult height, but was miserable at 5’3” by age 10.
DeleteI'm not sure it makes much diff when kids start kindergarten, tho it seems to be something parents take considerable time pondering. But I never heard early kindergarteners associated with high rates of divorce, drug use, murder, or a yen for country-western music.
DeleteIt’s hard to know, the folk who study these things say that it often makes a difference with boys, who develop some skills needed for school later than girls - such as fine motor skills. And sitting still ( no ants in the pants). When I volunteered in my oldest son’s parochial school kindergarten (the one with “ too many” boys) I was a bit surprised at the differences in letter formation (printing, not cursive) between the boys and the girls. The boys’ letters were usually pretty sloppy, veered off the lines on the paper, and spacing was often strange. The girls mostly wrote pretty neatly, stayed on the lines, and some even decorated their letters by putting little hearts in place of dots on their “i”s, and rounded exclamation points. Fancy stuff. My handwriting was always awful - still is to this day. But my friends who were also taught the Palmer Method by the nuns had lovely handwriting. I still remember the only “D” I ever received- for Penmanship- in 3rd grade or so, or whenever we started cursive. My printing was bad, but my cursive was really ugly. Still is.
DeleteSome believe that the reason far fewer boys are diagnosed with learning disabilities in some of the Scandinavian countries than in the US, UK and many other countries is because they delay teaching formal reading, writing, and arithmetic until age 7. They emphasize outdoor learning, lots of exercise, hands- on learning. music, art etc. They know that the brain readiness for formal academics for many children, especially boys, is often not present until age 7 in perfectly normal children. Once they start, the progress is rapid, and they catch up quickly to their age peers in other countries.
I think they try to push academic learning too early now. When I was in kindergarten it was "playing well with others, sharing, and not running with scissors".
DeleteI think kindergarten is a waste of time, since many kids are in a preschool/daycare combo situation from infancy onward. I also think high school drags on way too long. I took summer credits before my senior year so I could be out of school by noon and go to work until 5. My friend Tony crammed in enough summer credits to graduate a year early. My brother took the GRE, which isn't very hard, at 16, then dropped out of high school.
DeleteI probably could have pushed through high school in less time, if that option had been available. But you can't fast forward maturity. And I wasn't. Mature, that is. And I had to get through the senior year boyfriend thing.
DeleteI started kindergarten at 4, started working senior year at 16. Nothing matures you like work!
DeleteI also started kindergarten at age 4. The holding back a year wasn't a thing in that time and place, at least not that I ever heard of. I was ready academically and socially but I was immature, even into young adulthood. In high school, I discovered I was comfortable hanging out with kids in the class behind mine - I wonder now if it was because I was closer in age to many of them than the kids in my own class.
DeleteDid working high school jobs help with maturity? Boyfriends/girlfriends? I would never go out with guys in my high school, though I went out with a friend's older brother who had graduated and was a Conscientious Objector. He was a drywaller and always had bits of plaster in his hair. Very sweet guy.
DeleteI started school at the normal age then - 5. Reading lessons, starting with the alphabet, started in first grade. I started baby sitting around 12 and got my work permit at 13. I hated babysitting! I loved working “real” jobs, but they were great jobs because I lived in a resort town and the resort jobs I had were fun. I wasn’t working at a real job like cashier at CVS. I was a cashier (among other jobs) at a resort attraction gift shop, at the beach in the summer, at a winter attraction called Santa’s Village, at a miniature golf course, etc., working with other high school and college kids.
DeleteSo I was 13 when my first social security payments were withheld. My social security record does reflect this. Until I was 15 I only worked in the summer. At 15 I also started working on weekends and the holidays (Christmas, Thanksgiving, Easter). The boys in my high school never asked me out, so I didn’t go to dances like homecoming. I only did social things during the school year with my girlfriends. They had dates for movies and dances, but I didn’t. I didn’t have a boyfriend like Katherine did. The summer resort workers and summer camp counselors were mostly college kids from out of town and I did date in the summer. I had boyfriends then, but they disappeared right after Labor Day weekend. Back to college somewhere. When I finished 5th grade the PTB decided that I should skip the 6th grade, and go right to 7th. So I was the youngest in my high school graduating class. I had friends in my high school graduating class, and in the one behind us, that I had been part of in elementary school. They were my peers in age. I graduated from college at 20, about 2 months before my 21st birthday. Looking back, I feel like I spent a lot of my growing up years “behind” socially, trying to catch up. I was mature as far as work ethic and responsibility, but was immature socially from 7th grade on.
I had my first real job, working in a grocery store the summer after HS graduation. That was how I met my husband. People find it hard to believe we didn't know each other before, growing up in the same town. But he was four years older, and I went to Catholic school the first 8 years. The funny part is, I knew his parents, since forever. They were part owners of that grocery store. Fast forward, we married when I was 21, and I still wasn't very mature. I was a mom at 23. That grew me up in a hurry!
DeleteAnne, working in the resort sounds like a fun teenage job.
DeleteMy 17 year old granddaughter works part time at a trampoline parlor. Pretty sure that job didn't exist when we were young!
The jobs were fun because for me there was a social aspect, working with the summer kids. I was accepted y them even though bullied at my school. The state of California had a work permit age of 15, but resort areas dependent on seasonal teenage labor had a waiver, permitting us to get work permits at 13. My mom had no money. I earned a $1/hour and saved most of it for college expenses. I had two scholarships for college that, together, covered tuition, room and board. All of my personal expenses - clothes, hamburgers with friends, movies etc came out of my high school savings. I was financially on my own for those things from age 17 because the big stuff was covered by the scholarships. I tend to worry a lot about having enough money. I haven’t forgotten lending my mother money out of my savings to buy groceries or pay the mortgage - until she lost the house to pay my dad’s debts. Then my mom lived on- site in a room at the Conference Center where she had gotten a job after the divorce. So I was very lucky in many ways to have grown up where I did. It was beautiful, and a very unique place to grow up. The classes from the years I was there have stayed connected for all these years because the classes were small then ( ours was about 80), and we had unusual shared experiences and memories. How many people had jobs working as “elves” when they were in high school?
Deletehttps://rovology.com/united-states/california/exploring-the-tranquil-beauty-of-lake-arrowhead/
I got my first job as a 16 year old. I worked in a restaurant, first as a dishwasher and busboy, then got promoted to soda jerk. The dishwasher gig paid minimum wage - I think it was $2.35 an hour my first year. I got something like a 10 center per hour raise when they made me a soda jerk. Soda jerks got to work in the front of the house, where it was air conditioned. The short-order cooks made even more money than the soda jerks, but I would have had to move back into the kitchen and cook over a hot grill, so I wasn't too motivated.
DeleteThe restaurant's concept was basically a rip-off of Shakey's: ice cream sundaes and hot sandwiches with fries. The guys wore red-and-white striped shirts and silly ersatz-straw hats; the waitresses (there were no male waiters) wore bright-red short skirts and aprons. The employee manual they gave us was pretty upfront that they wanted "bright, attractive, high-energy" girls as waitresses. Their waitress employment pool was the cheerleader and pom squads from the local high schools. As a teen-age boy at the time, it all made perfect sense to me and I saw the short-skirted girls as a compelling benefit to working there. But in another way, it kind of sucked because, working with other teens (including some I went to school with), it was just like high school. I had enough angst and drama from actual school.
As for my own kids, who grew up in this suburban area: the idea that their first jobs would consist of running a commercial dishwashing system or busing tables was so far outside their expectations that they couldn't even conceive of applying for such a job. Around here, teens typically aren't given restaurant jobs; those jobs go to immigrants (of unknown legal status, I suppose). Three of my kids worked for local park districts, one at the front desk, one as a summer-camp counselor, one as a lifeguard. The other's first job was at the parish as a front-office secretary.
The summer after I graduated from high school, I went to work at my dad's employer, a big factory. The first summer, I worked in the office in the IT department, doing punch cards and similar low-level work. I don't remember exactly what I was paid, but it might have been as much as $4.50 per hour - a big boost from the restaurant. Then, sometime after I went away to college for my freshman year, the factory's main union went on strike. All the office workers were sent into the factory to keep production going. Eventually, the company hired replacement workers and the union was decertified. A process that took several years. So the next two summers, I worked in the factory. I made $8 per hour, which was unheard-of for a student (but still considerably below what the union workers were making prior to the strike). The pay was so high that a number of my high school friends came to work there, too, but the factory was so hot, dirty and dangerous, and they made us work so hard, that most of them didn't last more than a week or two.
You don't have to read too many Victorian novels to realize that doctors linked mental problems with illness and bodily weakness. Build up the body with beef tea, fresh air, and exercise, and you dispel hysterics and depression.
ReplyDeleteAfter Freud the emphasis was on upbringing and environment.
Now it's all about genetics, though genetics is not destiny any more than illness or bad parenting.
Conflating a diagnostic label with an explanation for "why we are the way we are," as Jack notes in his comments, has been around for a long time. My dad was a believer in astrology, and he chalked up a lot of my personality to being a Virgo. Some people swear by Myers-Briggs profiles. Or the Enneagram. We're all looking for a key to understanding ourselves and others.
Nature, nurture, genetics all shape a personality and give us preferences and proclivities, I'm sure. (And when you have a parent who points out your Virgo traits, even astrology might become a self-fulfilling influence.)
But individuals will do some mighty surprising things--both terrible and wonderful--in their lives because they *choose* to. You see it in the saints constantly. The soul, with God's help, can transcend what the world, our parents, and our DNA throw at us.
Isn't that what the Church teaches? Isn't that where human dignity and hope lie?
"The soul, with God's help, can transcend what the world, our parents, and our DNA throw at us."
DeleteI do believe that! It is hope in troubled times.
To drag a sidetrack closer to Jack's original post: The conversation above talks about "social immaturity." I wasn't sure exactly what freight that carries, so I looked it up. It's doing things not appropriate to age like excessive attention-seeking, lack of empathy, failing to control emotions, impulse control, etc.
ReplyDeleteIstm that we love these shrink-y shorthand terms for people's behavior. Labels like "autistic," "narcissistic," "co-dependent," "hyperactive," "dry drunk," etc. reflect how we perceive others and, of course, how we dismiss them.
Interesting.my understanding is different. I felt socially immature meaning I felt shy, awkward, not as sophisticated as my classmates, prone to saying or doing uncool things etc. No attention seeking - I tried to be not noticed. I have always been empathetic - almost too much so. No problem with impulse control, but I do have trouble controlling emotions. It doesn’t take much to bring on tears, a trait that has gotten worse since my husband fell off that ladder.
DeleteI sometimes wonder about all the labels that are assigned to kids these days when they are young children, especially for ambiguous conditions. Is the child really ADHD or simply a very active child with a teacher doesn’t know how to channel high energy kids. Autistic or simple not typical? Does being labeled set them up for a lifetime of self- doubt? I do t know enough to say.
Yes re labels. I see nothing emotionally immature about the younger self you describe, just somebody who isn't high on being around a lot of people.
DeleteI went to a big party at some guy's house at 15 and had more fun playing with the family dog than trying to talk to stoners over the blaring Jimi Hendrix music. As soon as I realized that, I called my dad to come and get me and politely turned down other invites.
I deal with cancer way better than a lot of people because I didn't have to give up socializing. I occasionally get gussied up to have lunch or coffee with one of the five or six friends I've had for decades, and I'm happy to spend the rest of the time in solitary pursuits.
A couple of other addenda to the original topic:
ReplyDelete1. I had lunch yesterday with a person who, while not a clinical pyschologist, works in a clinical setting with autistic children. I believe he said his job is "behavioral technician". As I understand it, the psychologist puts together a treatment plan for the patient, and this friend executes it, working one-on-one with the patient.
I mentioned to him a couple of things from the post: the 16-fold increase in autism diagnoses; the notion that there may be some over-diagnosis going on; and that earlier editions of the diagnostic manual didn't include the concept of a spectrum. He didn't have much comment on the diagnosing - I don't think he does any diagnosing in his role. He did think there is a lot of validity to the idea of the spectrum. His explanation to me was that each patient is unique. My thought was: theoretically, each patient could be unique without their being lined up on points along a spectrum. But we didn't get a chance to pursue the conversation - this took place at a lunch table with six other people, and the conversation veered off in another direction.
2. Two or three years ago, one of my children went through an intensive set of psychological tests. But I had never read through the full report of the test results. Last night, I read all the details. There was a lot of jargon and various acronyms I wasn't familiar with, but I think I got the gist of it. In the tester's opinion, he is 'borderline' autistic. I had previously been told he has ADHD, but reading through the report, it seems that isn't the case, even though he may present with some ADHD-like characteristics.
I don't know the full implications of what this all means. I am guessing it helps explain some of his struggles throughout school. He's quite bright but was never a rock star academically at school.
Jim's lunchtime convo points out that there is a whole industry that has grown up around kids on the spectrum, largely paid for by public education. Once public education reaches the tipping point, as it seems likely to do fairly soon, parents of kids who are on the spectrum will have to scramble to find special ed and probably pay substantially more than they would have spent on public education taxes. If supports for spec ed are crumbling even as the rate of diagnoses are rising, seems like yet another good reason for young people to be hinky about bringing kids into the world.
DeleteI didn't think either of our kids were on the spectrum, but they are certainly different from each other. The oldest was a scholastic achiever. He got straight As in high school. The younger son was just as bright, he actually scored better on the ACT. But he absolutely did not give a darn about subjects he wasn't interested in. Had to be prodded to do his homework and get stuff done in time. I heaved a sigh of relief when he graduated HS. College was out of town, and he had to sink or swim. He swam, graduated with a degree in fine art with graphic design emphasis. But he had to take a class in ceramics for a requirement. He hated it and squeaked by with a D.
ReplyDeleteThe older boy hated some stuff too, but he sucked it up and did well in all of it.
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DeleteThanks everyone for a wonderful experience-filled discussion of this topic. Two last comments:
ReplyDeleteGreenleaf, hearing from his sociology professor that the large bureaucratic institutions like medicine, education, and the churches were failing to serve us well, dedicated his life to helping them serve us better by joining one of the largest institutions of his time, AT&T.
Catholic social teaching reminds us that human parenthood came into being long before medicine, education, churches, and even the nation state, and that all these others are meant to serve families.
A few more comments before we get back to politics with Katherine and Jim's posts.
DeleteMy father left school after eighth grade to work in the mines. That made it somewhat easier to deal with his father who was a real tyrant.
My mother began caring for her family after eighth grade (cooking and housework) because of her ailing mother. She did finish high school.
Both of them became adults when they became teens. Essentially, they let me become an adult whenever I became a teen shaping my own life academically and vocationally because they knew little about the academic and church world that I was beginning to enter.
All three of us ended up being persons very different from the people around us. My father was very different from the average steelworker. My mother very different from the average housewife. I became very different from the students in my high school. Throughout life we supported one another in our uniqueness. We never cared much what other people thought of us.
I see Bryan Kohberger, who is on the autism spectrum, will plead guilty to the four student murders in Idaho. His defense worked the autism diagnosis into the case, but it was determined that he was not intellectually impaired. Readers commmenting on the report fall into armchair psychologizing, mostly to support their outrage that he will escape the death penalty.
ReplyDelete