Lancet Report: Momentum builds toward breaking up the autism spectrum

Dear NCSA community, 

In October, NCSA published its position statement calling for categorical recognition of severe autism in the DSM. We emphasized the irrationality of an ASD diagnostic label that includes both "a young man with no language, a low IQ, few functional abilities, and aggressive, dangerous behaviors" as well as "a college professor with social anxieties and some OCD." 

This galactic overbreadth subverts the essential purpose of psychiatric diagnostic labels: to describe a group of patients afflicted by a consistent set of impairments for the ultimate purpose of guiding meaningful interventions, services, and research.

We are hardly the only voices decrying the DSM-5's nonsensical scheme. And today a prestigious commission from The Lancet endorsed the use of the term “profound autism” to distinguish and support individuals who have high dependency needs and are likely to need 24-hour care throughout their lives. 

Below are commentaries on this direction from NCSA board members Alison Singer, Amy Lutz and Jill Escher.

We are excited to see a larger movement toward a diagnostic scheme that reflects the realities and needs of this population, which includes some of the most devastatingly disabled patients in the entire field of psychiatry — and who must no longer be hidden in a category increasingly associated with "differences" and "strengths."

—NCSA

Labels can harm, but they also can help: See ‘profound autism’
From Stat News

A Lancet Commission report sets out priorities for autism research and practice, including a new designation for “profound autism.”

By Alison Singer

Labels are a divisive subject. When used inappropriately, they have the power to misrepresent and dehumanize people. As the mother of a child with autism, I have seen numerous instances in which hurtful or inaccurate labels have been applied to my daughter. Yet there are times when using accurate labels can dramatically improve the lives of those with autism. The specific label I’m thinking of is “profound autism” — and it’s one being embraced by an increasing number of autism researchers and advocates.

On Monday, The Lancet published a special report by The Lancet Commission on the Future of Care and Clinical Research in Autism, of which I am a member. In the report, several colleagues and I introduce the term profound autism to highlight the needs of people who cannot speak for themselves.

The term profound autism is intended to describe autistic people who are likely to need 24-hour support throughout their lives. The goal of introducing this designation is to provide more specificity to the extremely broad autism spectrum to equip parents, service providers, and the public with the language necessary to ensure that individuals with autism receive the accommodations and interventions they need. Concise, meaningful terms like profound autism will simplify the process of determining appropriate care, leading to quicker and more forceful interventions....

This muddle has had catastrophic consequences for those who, like my son Jonah, fall under the category of profound autism. Not only has their exclusion from research been well-documented, but their policy needs and preferences have been eclipsed by those of high-functioning autistic self-advocates who have spearheaded the ongoing fight to close the intensive, disability-specific settings that are often most appropriate for those who struggle with aggression, self-injury, and elopement. As the Commission noted, the most affected population is "at risk of being marginalized by a focus on more able individuals."... Read more

Lancet Commission Calls for New Category: "Profound Autism"

Pressure mounts to split the broad autism diagnosis created by the DSM-5.

By Amy Lutz, in Psychology Today

Yesterday, the Lancet Commission on the future of care and clinical research on autism — a group of 32 researchers, clinicians, family members, and self-advocates from around the world — released a comprehensive 64-page report detailing changes that should be made over the next five years to improve the quality of life of autistic people and their families.

Besides a common-sense call for individualized, incrementalized, evidence-based interventions, one of the Commission’s key recommendations is to carve out the most impaired section of the spectrum and give it its own label of “profound autism,” which would include autistic individuals who also have significant intellectual disability (IQ below 50), minimal or no language, and who require round-the-clock supervision and assistance with activities of daily living. The Commission expresses “hope that [the introduction of “profound autism”] will spur both the clinical and research global communities to prioritise the needs of this vulnerable and underserved group of autistic individuals.”... Read more

Podcast interview calls out absurdity of over-broad autism spectrum

Thanks to Mary Barbera for hosting NCSA President Jill Escher on her latest podcast episode. In addition to the failings of autism diagnostics they discuss new directions for autism research, exponentially increasing autism rates, NCSA, and national autism policy (or lack thereof). Listen in

Have an opinion about breaking up the autism spectrum? Join the conversation on NCSA's very active Facebook page.

See NCSA's position statement on the need for categorical recognition of severe autism in the DSM.

The Sia Shaming Spectacle Is a Tragedy for the Arts and the Autism Community

By Jill Escher

Humans have a long tradition of public shaming spectacles. Think of the public hanging of criminals, the burning of heretics at the stake, the guillotine-ing of aristocrats, the stoning of women accused of adultery.

But in our modern era the spectacles are more likely to take place online by outraged (or, more likely, mildly ruffled and anonymous) mobs who gleefully dogpile on hapless victims after the latest e-fatwa is announced by their leaders.

It only takes about 30 seconds of your time, provides a rush of sanctimonious satisfaction, and, best of all, it’s free! Can you say, “Cheap Thrills”?

Yes, the singer/filmmaker Sia is the latest casualty to succumb after committing a truly TERRIBLE SIN … an unforgiveable transgression of the Book of Neurodiversity … she cast an actor in the role of a girl with severe autism in her new film “Music” … and that actor was only pretending to be that character! OMG, shut the door! Daniel Day Lewis you are cancelled! Eddie Redmayne you too are cancelled! Dustin Hoffman, consider yourself cancelled! Every actor who has ever played someone beset by a condition they didn’t actually have, enjoy the gruel in Cancel Jail! (Goodbye Leonardo DiCaprio, and oh no, also Russell Crowe, I am sobbing….)

The attack on Sia by a vocal, unhinged minority is so preposterous that one would normally shrug it off with a “Oh, there go those-people-who-have-so-much-time-on-their-hands-they-attack-a-stupid-puzzle-piece,” but in reality this is much worse. This time, evil has triumphed.

Evil because the crusade to crucify Sia sends a diabolical message to every person in the performing arts: depict severe autism in your movie/film/play at your own peril. If you don’t do it exactly the way we want, you are toast. Transgress the Book of Neurodiversity in even the slightest manner and you will be pilloried, putting at risk months and years of creative effort and financial investment. Your reputation will be stained. Your artistic freedom squashed.

In other words, what artist would dare to tread on the subject matter of severe autism when a tidal wave of mindless insta-denunciation awaits them, at the merest stroke of a self-righteous Tweet?

For that’s what’s at stake here — banishment of depictions of severe autism. As the autistic writer Lucy Kross Wallace observed:

“It is one thing to suggest that casting actors with disabilities might produce more compelling performances, but it is quite another to foist these requirements upon every artist. In calling for Music’s cancellation, neurodiversity advocates cross the boundary from exercising their own liberty to infringing on that of others, including Sia’s autistic collaborators.”

What a tragedy for the autism community. Children with severe forms of autism have become a vast proportion of the population, about 1 to 1.5% of all children! Clearly they deserve more and more representation — in the news, on film, on TV, on stage, in print, everywhere. But the hair-trigger threat of Neuro-scorn will surely help keep severe autism firmly in its dark corner, orphaned, abandoned from the broader autism discourse, despite the monumental societal urgency.

As the mom of a nonverbal autistic teenage girl who seems, based on the trailer (I haven’t seen the film, it’s not yet out in the US, and I should add that for all I know I won’t like the film at all), very much like the lead character Music. How fabulous that a filmmaker chose to make a movie with a character like my darling Sophie, it’s happy dance time! People like Sophie are so dreadfully hidden from public view. So my feeling was, hurray for Sia for shining an oh-so-rare light!

But — according to the mob but also Autism Speaks, which tweeted in support of the mob — no happy dancing for me, because someone like my dear Sophie was not cast in the lead role.

Okaaaaaayyyy… say what? Let me tell you what would have happened if Sia had cast Sophie as Music. She would have wandered off the set, flung off her costume and headphones, flipped out at the lights and noise, fell asleep at the late hours, and failed at following a single directorial direction. In other words, disaster.

This point was conceded by the mob, which instead took the position that Sia should have cast a girl with high-functioning autism who had the cognitive-functional capacity to perform in the role. Sure, okay, I saw the lovely film “Keep the Change,” which, for example, cast actors with high-functioning autism in the lead roles, and to my mind it was triumphant.

But, really, we can acknowledge that actors with autism or other disabilities can do great work and should be among those considered for roles of all kinds without the disproportionate hysterics of demanding that every single autism character be played only by those who pass some sort of bizarre spectrum purity test? Or should a zealous mini-mob wield veto power because through some loony logic that I have been unable to fathom, they own the whole turf of “autism”?

Yesterday I am told Sia took down her Twitter account after enduring months of attacks. I am told she apologized to the mob (for what, I’m not sure).

We are all losers here. The autism community. Artists. Writers. Actors. The public. Creative expression. Free speech. Disability awareness. And of course Sia herself.

It cost exactly nothing for vindictive and self-absorbed Sia shamers to cast a dark shadow on her heartfelt endeavor over a mere triviality. This is not how reasonable people behave. Reasonable people may write a negative film review (have at it!) but they don’t launch a cancel crusade over something as innocuous as casting choices (right, Daniel, Eddie, Dustin, Leonardo, and Russell? or shall we demand your penance too?).

The frightening bottom line here, to borrow the words of a neurodiversity leader, is that Bullying Works.

Jill Escher is President of the National Council on Severe Autism.

Disclaimer: Blogposts on the NCSA blog represent the opinions of the individual authors and not necessarily the views or positions of the NCSA or its board of directors.