DSM V Diagnostic Criteria for Autism Spectrum Disorder

Below are the diagnostic criteria for Autism Spectrum Disorder from the DSM V. I wanted to have my own post to which I could refer in future posts. As I work through what each of the criteria means, I’m discovering more examples from my life. Basically, in order to be diagnosed, you have to meet all three criteria in section A and at least two of the criteria in section B. In addition, the symptoms must be present from early childhood and must limit or impair everyday functioning.

As someone who was diagnosed at 51, I had developed a host of masking strategies. It wasn’t as challenging as you might imagine to think back to childhood. Many of the examples for the criteria were things that were fixed in my memory because I had no explanation for them or through the intensity of my interest. My masking strategies for section B have also been more effective than my strategies for section A, so section B took more work to uncover.

One of the challenges as I’ve been working through the criteria to try to understand them and apply them to my life is that much of what you find online are examples from young children. And while some of those help me recall things from early childhood, they offer little explanation for how the criteria might look in an adult. The most helpful resources I have found for that have been posts and videos by other adult autistics.

If you’re reading this and you’re autistic, you already know what the criteria are. If you’re not, you may not be interested in that level of detail. I will be working through some of the specifics as they apply to me in future posts, though, so this post will provide a reference point for those discussions.

DSM-5 Diagnostic Criteria for ASD, 2013

Autism Spectrum Disorder
Must meet criteria A, B, C, and D:

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested by the following, currently or by history (examples are illustrative, not exhaustive):

  1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure to initiate or respond to social interactions.
  2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures, to total lack of facial expressions or nonverbal communication.
  3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to an absence of interest in peers.

Specify current severity:

Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).

B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following, currently or by history (examples are illustrative, not exhaustive):

  1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g. simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
  2. Insistence on sameness, excessive adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat food every day).
  3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g. strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
  4. Hyper-or hyporeactivity to sensory input or unusual interest in sensory aspects of the environment (e.g. apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

Specify current severity:

Severity is based on social communication impairments and restricted, repetitive patterns of behavior (see Table 2).

C. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms together limit and impair everyday functioning.

E. These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum disorder. Individuals who have marked deficits in social communication, but whose symptoms do not otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic) communication disorder.

Specify if:
With or without accompanying intellectual impairment
With or without accompanying language impairment
Associated with a known medical or genetic condition or environmental factor (Coding note: Use additional code to identify the associated medical or genetic condition.)
Associated with another neurodevelopmental, mental, or behavioral disorder (Coding note: Use additional code[s] to identify the associated neurodevelopmental, mental, or behavioral disorder[s].)
With catatonia (refer to the criteria for catatonia associated with another mental disorder, pp. 119-120, for definition) (Coding note: Use additional code 293.89 [F06.1] catatonia associated with autism spectrum disorder to indicate the presence of the comorbid catatonia.)

Table 2: Severity levels for autism spectrum disorder

Severity level Social communication Restricted, repetitive behaviors
Level 3“Requiring very substantial support”
Severe deficits in verbal and nonverbal social communication skills cause severe impairments in functioning, very limited initiation of social interactions, and minimal response to social overtures from others. For example, a person with few words of intelligible speech who rarely initiates interaction and, when he or she does, makes unusual approaches to meet needs only and responds to only very direct social approaches Inflexibility of behavior, extreme difficulty coping with change, or other restricted/repetitive behaviors markedly interfere with functioning in all spheres. Great distress/difficulty changing focus or action.
Level 2“Requiring substantial support” Marked deficits in verbal and nonverbal social communication skills; social impairments apparent even with supports in place; limited initiation of social interactions; and reduced or  abnormal responses to social overtures from others. For example, a person who speaks simple sentences, whose interaction is limited  to narrow special interests, and how has markedly odd nonverbal communication. Inflexibility of behavior, difficulty coping with change, or other restricted/repetitive behaviors appear frequently enough to be obvious to the casual observer and interfere with functioning in  a variety of contexts. Distress and/or difficulty changing focus or action.
Level 1“Requiring support” Without supports in place, deficits in social communication cause noticeable impairments. Difficulty initiating social interactions, and clear examples of atypical or unsuccessful response to social overtures of others. May appear to have decreased interest in social interactions. For example, a person who is able to speak in full sentences and engages in communication but whose to- and-fro conversation with others fails, and whose attempts to make friends are odd and typically unsuccessful. Inflexibility of behavior causes significant interference with functioning in one or more contexts. Difficulty switching between activities. Problems of organization and planning hamper independence.

 

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Alexithymia or Emotions Are Really Complicated

As I was reading and digesting information on autism, I stumbled across this blog post on Alexithymia by Cynthia Kim from several years ago. Alexithymia describes the condition in which a person has difficulty identifying and describing emotions. I had a profound reaction to her post. As I tweeted at the time, it never even occurred to me that there might be a name for it.

I hate the simple question, “How do you feel?” I have emotions. Lots of them. Much of the time they stay more or less orderly under the surface. Sometimes they erupt. But if I’m asked to identify and name them? I’m usually stumped. It’s different than the times I lose my words because in these situations I have no problem speaking. I simply have no idea what to say. And I don’t know what to say because I don’t know how I feel. Unfortunately, “I don’t know” isn’t usually considered an acceptable response. So my wife ends up complaining that I’m always “fine” because that’s often one of my stock answers to questions about how I’m feeling.

I also struggle to identify emotions in others. It’s like solving a mystery. For instance, I might notice that my wife seems to be upset, but when I ask she says she’s fine. I’ve learned over the years that I shouldn’t necessarily let it drop there. (And I did have to learn that, since when I answer that way I’m trying to discourage further questioning.) I usually start by trying to figure out if she’s upset at me. So I mentally run through everything I’ve said and done to see if I can identify a way I might have upset her. I also mentally run through what she’s told me about her day to see if something else might have upset her. I’ll try to probe with some (probably awkward) questions. In all honesty, I rarely solve the mystery. Usually, at some point she’ll tell me. When she doesn’t, I’ll often try to figure it out for several days before finally giving up.

Even when I can’t clearly identify them, I’ll also often take on the emotions of others around me. It’s difficult to describe how it feels to realize you’re angry for no reason except another person is angry. Or to have that fact pointed out to you by the other person.

In another post, Cynthia Kim discusses and takes an online Alexithymia test. Unsurprisingly, my results indicated high alexithymic traits. It’s not a diagnostic test, of course and has other caveats. Still, as I find a counselor experienced working with autistic adults, it’s definitely on the list of things I want to discuss.

Test Results: 119 Points

Alexithymia: You show high alexithymic traits. If you are interested in Alexithymia we would be happy to have you as a regular visitor on our pages.

Detailed Results

Your result is broken down into various factors to give you some insight into your result.

Category: Difficulty Identifying Feelings: 22 Points <15 – 18>
In this category you show high alexithymic traits.

Category: Difficulty Describing Feelings: 18 Points <10 – 12>
In this category you show high alexithymic traits.

Category: Vicarious Interpretation of Feelings: 9 Points <8 – 9>
In this category you show some alexithymic traits.

Category: Externally-Oriented Thinking: 22 Points <18 – 21>
In this category you show high alexithymic traits.

Category: Restricted Imaginative Processes: 12 Points <18 – 21>
In this category you show no alexithymic traits.

Category: Problematic Interpersonal Relationships: 24 Points <15 – 18>
In this category you show high alexithymic traits.

Category: Sexual Difficulties and Disinterest: 12 Points <10 – 12>
In this category you show some alexithymic traits.

 

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I Use My Words (Except When I Can’t)

I can’t remember ever not being able to read. After 1st grade our neighbor, a retired teacher with a master’s degree in reading education, noticed me reading to groups of older neighborhood kids and tested my reading level. I was apparently reading on a 12th grade level. I performed a scene from King Lear (all parts) at a talent show when I was in the 4th grade. I took acting classes at the Alley Theatre in Houston from 6th-8th grade and acted in a number of things over that period as well as competing in speaking and drama competitions.

I have words, more words than most people, and I use my words.

Except, frustratingly, sometimes I lose my words.

It’s something I’ve never really spoken about before, probably because it has always intensely bothered me. My words have always been a core part of my identity. I am expressive and articulate. I never understood how or why I would sometimes find myself effectively mute.

It’s difficult to describe to someone who has never experienced it, but there are times, typically when I am stressed or overloaded, when I will suddenly have no words to speak. Someone will ask me a question, I will start to respond, and … nothing. The harder I try to find words, the more they escape me. I can almost taste the words in my mouth. I know I should be able to respond. I ought to have something to say. But my mind is unable to make that connection. If I’m able to force something out, I can hear my own halting speech, and I don’t recognize it. It’s the voice of a stranger.  I know the words are wrong.

It’s an unpleasant experience made much worse when you have no idea why it keeps happening to you.

After I was diagnosed, I found blogs and videos from other autistic people. When a number of them described a similar experience, I felt relief. No, it doesn’t mean I won’t lose my words anymore. But now, at least, I’ll understand why. It won’t be something I have to struggle to hide. It won’t torment me to the extent it has in the past.

And I’ll know I’m not alone.

That matters more than I can express.

I use my words, at least when I have them.

And that’s okay.

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My Autism Diagnosis

In future posts, I plan to delve into the details of the DSM V Autism Spectrum criteria and relate them to my own life and experience. But I wanted to start with more of an overview of some of the things that are specific to my diagnosis.

First, I apparently do not have any of the disorders that are so often comorbid with autism. My diagnostician emphasized that was highly unusual. In fact, attention issues are so common among autistic individuals that it was once simply assumed. But I tested fine in the tests for attention deficit issues. Similarly, I do not suffer from anxiety disorder, also an extremely common comorbid diagnosis. That doesn’t mean that I don’t have situations and circumstances that make me anxious and which are related to autism. For instance, the prospect of making even a routine phone call tends to require significant preparation and effort on my part. Driving has also never been as easy for me as it seems to be for most people. Fortunately, my wife prefers to drive anyway. However, my coping mechanisms mostly seem to work and my anxiety stays at manageable levels. I seem to be more or less “purely” autistic, whatever that means in practice.

It’s also very common for autistic people to have a significant split in their core intelligence (perceptual reasoning and verbal intelligence). According to my diagnostician, the split can go either way, but it’s often a feature of the autistic brain. Much of the time, that split is expressed as one portion of core intelligence being average or above average while the other portion is low average or below average. In my case, however, perceptual reasoning is high while verbal intelligence is, well, considerably higher. It’s roughly a 30 point gap. However, that apparently means my IQ should not be reported as a single number. Erroneous attempts to do so across varying tests are probably what led to wildly different reported IQ scores throughout the first part of my life.

Still, I find it a little amusing that (technically) I don’t have an IQ. 🙂

The testing did reveal that I have a very difficult time processing and remembering verbal information on a single presentation. My results were almost as low as the test could go. On repeated verbal presentation, my retention quickly moved up to the average or high average range. And my visual memory was close to the ceiling of that test. It’s the sort of problem that could easily be misdiagnosed as an attention issue if my diagnostician didn’t explicitly test for verbal and visual attention problems. But since those were fine, this is simply one of the ways autism is expressed in my brain.

If I’m verbally told something once, I’m pretty unlikely to process and retain it. Of course, I was aware of that fact in at least some contexts. During lectures, for example, I would always take notes even though I often never looked at them again. I thought I was just a visual learner and needed to see the information in writing, but the process of transcribing what you hear apparently transfers it over to a different part of your brain. It can make effective verbal exchange of information more challenging for me.

Those were a few of the somewhat unusual items in my diagnosis. At least, they stood out to me. Autism is such a large and encompassing diagnosis that it’s not easy to wrap your head around it at once. I began there and then started researching and thinking more deeply. I’ll continue trying to peel the layers off the onion in future posts.

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Autistic Pride Day

Autistic Pride DayApparently June is Autism Acceptance Month and June 18 is Autistic Pride Day. To be honest, I’ve barely started processing my reaction to my diagnosis. I’m not sure how to react to a Pride Day. As an older, white, mostly cishet male I’ve never had one before. Or, as the joke goes, every day is a white male pride day.

I’m certainly not ashamed of my diagnosis. It’s simply a central facet of who I am. My brain apparently really does function differently than the more typical human brain. I’m also pretty well established in life and have a lot of privilege from my other descriptive categories. But I do want to get to better know and understand myself and my fellow autistics. I expect that to be an ongoing process. And I want to offer back what I can, though I hardly know what that might at the moment.

While I can’t claim to have processed my own reaction, I did want to post something today once I realized what it was. It is, after all, my first Pride Day since being diagnosed.

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Autistic

Autism Spectrum Disorder Level 1.

It’s hard to describe what it’s like to hear those words from a diagnostician’s lips. Even when you’ve spent most of your 51 years of life trying to figure out why your brain seems to work differently from everyone else’s, it’s still a shock to hear that it’s because your brain actually is different. And that’s true even when you’re somewhat prepared. I had spent the weeks leading up to and after the testing bouncing from trying to decide how I would react when I was told I was autistic to how I would react when I was told I wasn’t. I couldn’t even figure out which would be the more positive outcome. It’s a pretty serious and significant diagnosis. Even at level 1, the challenges associated with it are not insignificant.

Ultimately, though, I have always known that I experience the world and interact with it differently from most people. The diagnosis finally offers context and an explanation for so many experiences and struggles throughout my life. And with that knowledge, I’m at least hopeful I can better use my energy to work constructively in areas and on relationships that really matter to me instead of floundering in all directions.

The resources available for autistic adults are limited, but I live in a major urban area so at least there are professionals who do work with autistic adults. Unlike many, I have options. I also have a well-paying job with good health insurance, something I gather many in my position lack. And I can well understand why. I’ve been fortunate in a great many ways.

Anyway, for anyone who still checks my blog, I just want to say hi!

::wave::

I have quite a few things bouncing around my head that I need to express, so I’m sure I’ll be writing more frequently. Most of those posts, however, are likely to be autism related. You’ve been warned.

Thoughtful comments always welcome, as usual.

Grace and peace.

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Pulling Yourself Up By Your Bootstraps and Other Tall Tales

Last night I responded offhandedly to a tweet about being a high school dropout. (The person to whom I responded actually had a diploma, I believe, but used the phrase “practically a high school dropout”.) Most tweets are fire and forget, but that one stuck in my head. So earlier today I ended up firing off a series of tweets on my own circumstances as a teen parent.

In the process, I pointed out that all the “pulling yourself up by the bootstraps” stories are basically, as @niais so aptly put it, bullshit. I’m well-respected in my field among the people who know me and I make a pretty good living. I’m a long way from those years as a poverty-stricken teen parent, years that lasted into my thirties, though things steadily improved for the most part. I know how those stories work from the inside.

And those people who think they did it all themselves are simply self-deluded. I had quite a few “lucky” breaks along the way and help from other people. At least some of that I can probably chalk up to my privilege as a straight, white male since it’s unclear if the opportunities would have been afforded me otherwise. But I had the advantage of safety net programs, such as they are, to buffer some of the worst of it. The military provided me opportunities, a limited GI bill for part of my college education, and a VA loan for my first home. There were other structures and systems supporting and helping me, many of them geared to help someone like me.

So yes, I’m smart. I’m good at what I do. And I have worked hard to overcome obstacles. That part of the bootstraps tall tale is typically true and hard work, at least, is usually necessary. The best stories contain elements of truth. But those are not sufficient. Somebody has to provide the bootstraps. And the structures must exist to help keep you from falling on your ass when you pull them. Some of the people, structures, and systems that helped you achieve success will be apparent. Others will typically operate below your level of awareness. They are all necessary.

The stories are inspiring. And that’s not bad. It’s important to work hard. People need to know that it is possible to overcome hurdles, however high. But when we come to believe the lie that anyone is “self-made” the stories can become destructive instead.

Anyway, my tweets on the subject were apparently of interest to others, so I storified them below.

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Empty Nest

I’m no stranger to watching my children enter their adult lives. My oldest daughter is 33 and currently working as a traveling nurse in California. My older son and foster-son are both 30. My son is married with his own daughter now starting sixth grade and my foster-son is an attorney and major foodie. My younger son is 23 and graduated magna cum laude from Baylor this spring with majors in both physics and mathematics. He’s now starting graduate school in particle physics at the University of Texas after receiving their highest fellowship.

Still, none of that has prepared me for my youngest daughter starting the next phase of her life and leaving us with no more children at home full time. I became an expecting parent when I was 15 years old and still a child myself. I learned to be an adult as I learned to be a parent. I’m now 50 years old and I’ve never known anything else. That ‘parent’ label lies close to the core of my identity. And through the good and the bad, I’ve never wanted anything else. I love my children as most parents do, but I also really like them all. They are very different from each other and I’ve made more than my share of mistakes along the way, especially with the older ones, but I still genuinely love, like, and respect each one of them. I’ve never been one of those parents who couldn’t wait for their kids to leave.

But now the youngest of them has left. And I’m thrilled for her. It’s been her dream for years now to study neuroscience and she’s excited to be at Baylor. So I’m excited for her, worried about her, and cheering her on all at the same time.

But I also miss her already. Which is silly, in a way, since she’s been attending Camp Mystic every summer since she was 10 and worked there this summer as a counselor. She’s barely been at college three days at this point. Still, this time it’s different. When she’s been at camp or on any other outing, she was just gone for a little while and then would be home again soon. From this point on, she’ll only be home with us for brief interludes in her journey. And that’s great for her!

But my heart hurts even as I’m happy and excited for her. I want her to succeed. I want her to achieve her dreams. But I can’t just knock on her door and tell her something. She won’t come running up to show me something funny or interesting. I won’t see her bouncing out of the corner of my eye. She’ll only sometimes be there with us at the dinner table. We won’t have many of those ad hoc kitchen conversations in the future. Our daily lives will mostly be lived in separate places from this point forward.

And I don’t know who I am anymore. I’m not ready. I don’t think there’s any point in my life when I would have been ready for this day. But inevitably it came.

I storified some of my tweets below.

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I’m a College Graduate!

I finally completed the Bachelor of Science in Computer Science degree that I started way back in the 1980s. I enrolled at the Park University Austin Campus, then at Bergstrom AFB, when I was serving in the Texas Army National Guard. In fact, I found out about Park (then called Park College) through the military. Over the years, Bergstrom AFB was closed and the new Austin-Bergstrom International Airport opened on the site. The local Park campus has relocated multiple times. The main campus, of course, is where it has always been in Missouri. One day I would like to see it in person.

Before dropping out of high school, I had taken the ACT (32 out of 34 composite if I recall correctly). I had also already obtained my GED, so I had everything I needed to enroll. I never planned to spend as long as I did completing my degree, but life intervened, as it usually does. That’s especially true when you’re an unconventional student. Along the way I took many CLEP tests, and some courses at the local community college in addition to my night courses at the local Park Campus. I even took Calculus by correspondence course from UT. Internet classes made things a lot easier in the later years, of course, but I still ended up taking classes in fits and starts, often with lengthy gaps between those periods. But I never gave up on finishing it, which shows that eventually if you keep taking them, you will have enough classes to graduate.

Below are my storified tweets on my reaction and my thanks to Park for their military and veteran friendly policies that allowed me to finally accomplish this goal!

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GOP Lies: Social Security

While it’s true that these days the GOP relationship with truth and reality has become strained to the point of non-existence, their lies about Social Security stand out as both particularly egregious and especially cruel. Moreover, much of the time, the worst of these lies are simply allowed to stand, relatively unchallenged. Yes, attempts to debunk them exist, but much of the public discourse either treats the claims as fact or allows them to stand as reasonable arguments.

In this post, I hope to debunk some of the worst of the assertions. Few people read my blog, so I don’t expect to have any particular impact on public discourse. But at least I’ll have a post which I can reference in future discussions.

First, there are no major structural deficiencies in Social Security that form an impending crisis. If you examine most of the discussions, you’ll find an often unchallenged assumption that Social Security has major problems. That happens in several interesting ways.

One common tactic involves the use of the broad term “entitlements” to lump Social Security, Medicare, and remaining social welfare programs like Medicaid, SNAP, free/reduced school lunches, WIC, and TANF together into a single large pool. When politicians speak generally about “entitlement reform” they are engaged in a form of newspeak deliberately intended to make their constituents believe they are talking about cuts to welfare programs for the “undeserving” rather than Social Security and Medicare.

Of course, that particular deception only carries them so far, as George W. Bush discovered when he tried to attack Social Security directly. Most Americans, including most GOP constituents, understandably responded with outrage. Interestingly, the GOP learned that lesson and proceeded to abuse it in 2010 with their coordinated and well-funded attacks against the ACA. (Anyone who confuses the Tea Party with a “grass-roots” movement is, frankly, either dishonest or an idiot. It was a well-funded and coordinated nativist movement playing off fears and prejudices that ended up spinning out of control and attacking its host.) That’s why we saw people earnestly waving protest signs that said patently absurd things like, “Keep the government out of my Medicare!”

And that’s the grain of truth embedded in the term “entitlement”. The overwhelming majority of Americans now view Social Security and Medicare as something they’ve somehow “earned” and thus do not consider them “government programs”, but rather something to which they are “entitled”. And in a sense I agree with that broad attitude, but not because any single individual has somehow “earned” their benefits. Rather, Social Security represents a form of “pay as you go” social insurance. Collectively, we all contribute throughout our working prime to support those who are past that prime, surviving spouses and minor children of those who die during those prime years, and those who through disability are fully or partially unable to work. And we then reasonably expect our society to provide us those same benefits when we or our loved ones require them.

Lumping all those things together and then claiming that “entitlement” growth is out of control represents a deliberate effort to make people think a given pundit or politician is talking about whichever group the hearer considers the “undeserving” in order to set up a pivot toward dismantling Social Security. So far, at least, those efforts have been unsuccessful. That does not mean they won’t be successful in the future. The reality, of course, is that the only program growing at unsustainable rates has been Medicare. The ACA appears to have had some impact on that growth rate, but it was never designed to fix our entire health care system, so its impact will likely be limited. The problems in Medicare actually reflect the broader problems in our overall health care system. Out of all the components that make up that system, Medicare is actually the most efficient. It’s certainly not the cause of the problem and while it can impact it to some degree, Medicare can’t by itself fix the system within which it operates. But that’s a topic for another day.

More recently, proponents for dismantling Social Security have been asserting that there are major structural deficiencies in Social Security and we need to make major cuts in benefits before the whole thing collapses. They might blame changing demographics while pointing to assumptions made back in the early decades of Social Security to support their wild claims. There is, of course, one major problem with all their hand-waving and bellicose grandiosity.

We already reformed Social Security to correct its structural defects in the 1980s. Sadly, many Americans seem completely unaware not only of historical events, but even those events that have happened in their own lifetime. By the 80s, the children being born were in the generation that would come to be known as the Millenials. There was no demographic surprise about the small size of Generation X relative to the Baby Boomers. The entire reform effort was a pretty big deal involving lots of analysis and input from all sectors in a truly bipartisan effort. (This was back well before the GOP went completely off the rails.) And it was successful.

In fact, there is only one structural problem that has arisen since that reform. And that problem is directly related to the extreme explosion of inequality, in itself also a direct result of government policy, in our country. One of the decisions made at the time was to cap overall earned income subject to the Social Security tax at 90% of all earned income. While the cap was indexed to inflation, nobody anticipated that income at the top would grow from 11% then to roughly 25% of all annual earned income today. That concentration of income has reduced the overall percentage of income subject to the social security tax from 90% to 83% and falling. While that’s not sustainable over the course of decades, the fix is simple. The cap must be adjusted so at least 90% of all income is subject to the tax again.

Personally, I believe the cap should be eliminated altogether. After all, we don’t cap the Medicare portion of the tax. But a compromise that would compensate for the years we’ve collected less than 90% while ensuring that at least 90% of all annual earned income is subject to the tax moving forward would fix the only structural problem that has developed in Social Security since the last major reform. It’s worth noting that this problem could also be addressed by reducing the concentration of earned income at the top. So addressing our current extreme inequality would also “fix” Social Security.

While the current insane version of the GOP is obviously incapable of accomplishing even something that straightforward, it’s also not a crisis. Yes, we’ll need to fix it at some point over the next forty to fifty years and the longer we wait, the more expensive the fix will be. But it’s a problem we will still be able to fix at almost any point along the way. That’s what makes the frantic hand-waving so absurd. Think about it. The basic claim is that if we don’t do anything to fix Social Security, in four decades we might have to cut benefits. And their solution to that “crisis” is to cut benefits now.

As an aside, I can’t help but compare that reaction to the GOP take on an actual looming crisis with climate change. While the consequences of climate change will take decades to unfold, unlike Social Security it really does require action today. We spent decades reaching this point and even if we acted aggressively right now, it’s likely too late to repair much of the damage we’ve done. The longer we wait, the worse the consequences will be. Yet the GOP is in almost complete denial about that actual looming crisis in favor of ones with no basis in reality.

And that takes us to one of the most commonly promoted ideas for cutting benefits — raising the retirement age. I believe Jeb Bush most recently floated that proposal, but it’s widespread throughout the GOP and even among some so-called “serious” Democrats. But this proposal is actually deeply cruel. It’s simply not physically possible for many people to work much longer than they already do. Our bodies get old. They get weaker. And we become more prone to illness and injury. Nothing about that fundamental reality has changed.

While that’s most clearly true in physically demanding blue collar jobs, the impact is actually much broader. My oldest daughter is an intensive care nurse, one of the professional service occupations (though perhaps one not as widely respected as it should be). The job requires significant and ongoing education and skill. However it is also a physically demanding job. And even in the jobs, such as mine, that rely almost entirely on intellectual capability, we have no guarantees. Alzheimer’s is only considered “early onset” when it strikes before age 65. And that’s only one of myriad ways our ability to perform can be impaired by age.

Underlying these proposals to increase the retirement age is the idea that people are living significantly longer now than they did fifty years ago. That’s simply untrue and represents, at best, a naive understanding of life expectancy. At worst, it represents a prime example of what Mark Twain meant about lying with statistics. Dr. Aaron Carroll does an excellent job unpacking these statistics in his Healthcare Triage episode on life expectancy. He also includes other links on the topic. If you’re interested in the topic, check out his full post. But the video is included below.

We have greatly improved the average life expectancy at birth, but primarily by reducing infant and child mortality. The average life expectancy at age 65 has improved overall, but not by all that much. Moreover, the improvements are not evenly distributed across all groups and it’s actually fallen in some groups. Therefore, claims that we need to increase the retirement age because people now live longer are simply untrue. The only real question is whether or not the people repeating those claims are ignorant, misinformed, or lying — not to imply that those categories are mutually exclusive.

In closing, I’ll note that we actually have one of the lowest levels of effective social insurance in the industrialized world. Rather than trying to cut or limit Social Security, we should actually be working to expand and improve it. It has proven to be remarkably effective and efficient and is certainly one of the reasons the latest financial crisis did not spiral into another Great Depression. (Benefits like SNAP and unemployment insurance also mitigated the impacts of the financial crash.) It’s time to end the lies.

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