Highly Intelligent versus Autistic

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I know, my point was that if somebody starts masking early enough it can seem like they're not just not masking, but rejecting such conventions, when really, they're just acting out a less common archetype.

Call me silly, if you(plural) like, but I very much need a clear and precise definition of what is,or isn't 'masking'. One thing I do is agree to x- when y would be personally preferable, so as not to put the other person out.

I completely agree. It's unfortunate that nobody studied it until the late '90s and after less than 15 years, the criteria were changed substantially due to "overdiagnosis." Which causes a bunch of issues in terms of accurately researching the phenomenon, as many of the people most likely to mask well, aren't technically diagnosable now.

When was the criteria changed? Last I heard of was in 2013

From my research it seems intelligence is not part of the diagnosis criteria because it is not diagnostically relevant. That is too day autistics have carried intelligence levels. Also the ability to mask makes diagnosis difficult for all autistics not just those of a higher IQ. Infact masking in females seems to be so innate that females routinely go undiagnosed.

Also using your intense to figure out social situations falls under the diagnostic criteria of social emotional reciprocity. If it were your to the psychiatrist it should be viewed as such.

To me it seems the real problem is a lack of training and understanding by the medical community of autism and the diagnosis criteria.

This Post makes sense to me , And have read similiar things regarding these same situations..
Strongly agree with Last line of the above Post .And have seen the Autism groups saying that is getting some public recognition that is " Nothing about Us without Us" implieing about the medical community needing direct clinical or otherwise feedback on their decisions for treatment by the Autism/ ND communities

I suppose "high intelligence" might help one learn to overcome some social difficulties and learn tricks for social situations, but that's about the extent that I see the relevance.

I wouldn't necessarily call myself "highly intelligent". But I have learned a lot about social interaction compared to 5 years ago. I was able to adapt after getting a customer service job, despite being INCREDIBLY awkward before that point.

My other autistic co-worker on the other hand? You can tell he's autistic immediately by the way he communicates and he's had this job longer than I have.

That doesn't mean he isn't intelligent, not in the least. His autistic traits are just different from mine.

I don't think Asperger's was removed because of concerns about highly-intelligent people being overdiagnosed. Rather, it was because Asperger's was a redundant diagnosis, and the two diagnoses were often misapplied because the differential criteria weren't very relevant.

Everyone eligible for an "old" Asperger's diagnosis would be eligible for a "new" autism diagnosis.

AS was never a redundant diagnosis. It covered people who now don't have any possible diagnosis at all. Same goes for PDD-NOS. The next closest thing is Schizoid Personality Disorder, and that doesn't come with any of the sensory related treatment and therapy that many of us need.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8463351/

I do get your point here. It wasn't officially intended for the removal of the AS diagnosis to remove people from their diagnosis or from treatment. But, they had to explicitly grandfather people in order to make it so. In other words, they knew perfectly well that the higher masking, higher intelligence wing of the diagnosis was going to get screwed, they just didn't put the necessary effort into putting real language into the diagnostic criteria to cover us. To make matters worse, the Schizoid Personality Disorder that has long been autism for people that don't have the documentation to cover early childhood is likely going away in the near future. Leaving us without any diagnosable condition that could be used to argue for both research and treatment, but not necessarily substantively any less impacted by our neurology.

There's an Aspergers book from the early 2000s in which the author outright says the DSM-IV criteria for Aspergers was so narrow as to be almost worthless. So you think DSM-V is even narrower?

Also, why would Schizoid PD go away? Is it going to be merged into Schizotypal or Schizophrenia in DSM-VI?

It will go away because it's an inactive disorder that's neither being researched nor commonly being diagnosed. It, along with Paranoid Personality Disorder, doesn't exist under the alternate model at the back of the DSM 5. From what I understand, the ICD is likely to move in that direction as well. It is also one of the few treatable PDs.

The result is that you've got a diagnosis that was already disappearing from common use with most people being diagnosed as either Schizotypal or Avoidant, and the people who were Schizoid, but not either or those two aren't even a consideration. But, due to the way that that was screwed up, you've got people like me that very clearly have some sort of pervasive developmental disorder going on, but no relevant diagnosis. No diagnosis, no treatment, no legally required accommodations and most importantly little to no research. This isn't a particularly sexy disorder, it doesn't lead to overt suffering, it doesn't lead to anti-social behaviors, it just leads to people that function barely well enough to get by, but far below their particular abilities and generally just existing.

It is worth noting that the diagnostic tools for assessing various autism conditions in the DSM IV days were not particularly well-developed for certain populations. Adults and women are very well known issues, although people of color also weren't particularly well evaluated. Also, AS and PPD-NOS were removed at the same time, collectively they did represent a fair number of people who still exist and still need treatment, but only around a third of those combined that don't qualify for the new criteria do get the SPCD. And only then if there are issues related to communication and it's unclear that SPCD isn't autism anyways. Similarly, Schizoid Personality disorder is the current closest equivalent to SPCD for those that have sensory integration problems that is included in the DSM, but it also is likely to be in a similar state that it's likely to be autism.

Without further research, it's unclear as to how exactly ScPD in cases that can't more readily be combined with Schizotypal or Avoidant Personality Disorders is anything other than an extremely high masked autistic individual who doesn't have the sensation to notice the drive for connection to other people and doesn't engage in externally visible traits early enough on. Which is a perfectly reasonable stance to take given the whole history of the diagnosis and the nose dive that the disorder took about the time that both APD and AS were introduced.

Which is exactly the kind of thing that usually flies under the radar anyway.

Having people with a developmental disorder getting diagnosed with a personality disorder is not a good solution.

The DSM seems to lag behind reality with practical ASD diagnosis.

Basically, it's not relevant because of the way that they wrote the criteria. But, with less than 15 years between the first study looking into masking and the revision that caused most of this problem, there wasn't sufficient research to know what the precise impact might be. It is something that really should be considered along with masking as the ability to pattern match and choose a pattern quickly is a feature of most IQ test. Somebody that's a bit old for diagnosis, but of normal intelligence is less likely to be masking than one that is the same age with a much higher level of intelligence. All other things being equal.

Regardless, this is just something that I'm personally curious about because there is a major blindspot in terms of people with internal symptoms not being autistic or those that didn't have the normal amount of unstructured social interactions being really hard to accurately assess. You can then run into somebody that doesn't qualify as autistic from a criteria standpoint, but doesn't really have a different diagnosis either. The addition of SPCD does help a bit with that, but it still leaves a lot to be desired.

I personally think that it's about time that we just accept that trying to diagnose adults should involve some sort of brain scan to see what's going on there. Just call it "adult diagnosed autism" and study it independently of the form identified in childhood. Which should be completely defensible, as not knowing about the brain difference leads to a different set of issues. I don't think I've seen anybody arguing that finding out as an adult is the same as finding out about it as a child.

I'm likely to give Amen Clinics a try. The use of SPECT scans is somewhat controversial, but they've been doing this for decades at this point and with the concussions, heat stroke, water intoxication and whatever is going on neurologically, I don't have much optimism about continuing to get misdiagnoses based on just what I can express, or know to mention.

I would like diagnostic criteria or more importantly the APPROACH clarified for the high-masking or non-stereotypical individuals. It's more about level of effort for us and what we've come to normalize. I think we need a little bit of help to distinguish those. For example, I didn't report that I stimmed or was anxious b/c twirling my hair, doodling and pacing and panic attacks are normal for me - I didn't know that was unusual since all my life I was/am told I make "mountains out of mole hills".

My diagnosis at 48 was easy enough with an evaluator experienced with Autistic women and my 25 pages of supporting documentation. However, other Autistic friends haven't received their diagnoses as they didn't present in that way. I haven't been able to get my Autistic daughter diagnosed yet. Mostly b/c I was not reporting well for her, again frequency and severity of "unusual" - I am inadvertently masking her or the evaluators think "it's her choice" or she's too good at it.

I am highly intelligent but what came out in my formal testing was the spikiness - genius here and average there. I was able to see clearly that my responses were delayed by how highly connected the topic was for me, e.g. I knew the expected answer but couldn't access it until the trigger response passed, otherwise I would have shared a missive on the state of support in society rather than answering the question with the intended one-word response "authority".

Good luck with all that.