distinguishing between AS and schizoaffective

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Hi,

I am new and know I should probably introduce myself in the new forum, but I am anxious for your opinion regarding my son. Last year a school counselor said that she thinks he has AS. We took him to children's and the expert said that she was on the fence about a diagnosis for him. He definately has many of the traits, but she thought he was too mild to diagnosis. He scored a 7 on the ADOS, but she thought it wasn't quite enough considering his comunication level is good. She wanted us to come back in a year. Appt next week.

We obviously see many of the traits and because of trouble focusing and concentrating in school, we took him to a psychistrist to administer stimulents because the GP thought a psychitrist could help better. He started counseling with a great counselor under the psych who said he thinks it is definately AS. But now the psych thinks it is Schizoaffective. The counselor disagrees.

The main reason he thinks it is SD is flat affect. The 3 or 4 times his was with the psych, he got this flat montone affect. Now we don't see that at home, if so rarely, but I do think it happens in schools sometimes. My son and his teachers say he "zones out"sometimes. When I ask my son about that, he said that zoning out happens different ways. Sometimes he is thinking, "inventing things" which he does a lot. He has elaborate inventions and can visualize them and paces and thinks about them. Other times he is just distracted. But the one that concerns me is this:

Sometimes when he is sitting, he feels tired or relaxed and his minds seems to shut down. He becomes flat and monotone and slow to respond. Does this sound like AS. Does anyone have experience with Schizoaffecitve?

It is sort trancelike.

I don't know much about this topic but schizo-affective disorder seems to be a condition where the subject behaves in a very bizarre way, talks to themselves, see hallucinations but still retains some lucidity. A bit like an early stage of schizophrenia. I would say that your son does not sounds like this but I could be wrong.

I'm not exactly sure what schizoactive is, but zoning out is completely natural for AS. I know that when I am thinking about something, I will tune other things out. Normal people do this too, its called day dreaming. The difference is that if you interrupt a normal person's day dream, they will turn thier focus to you. If you try to interrupt an aspie's concentration, he probably wont snap out of it, and just interact with you with only part of his brain. If I am asked something while I am thinking, it goes on the back burner. As in 90% of my brain will still be thinking about some topic, and 10% will be spent on answering the question. This usually means that I will talk a lot slower, take longer to answer, and generally not put any effort into anything more then saying the answer. As in I wont look at the person, use gestures, change expressions, voice tone, etc.

You can generally tell when the aspie is thinking by their fixed stare. Also, they tend to stim alot while thinking. For example, you may see him bounce his leg, bite his lip, wring his hands, etc. while staring at a wall. This is normal AS behavior, I do it all the time. If you really need his full concentration, then you just need to be a bit forceful about it. Try shaking his shoulder or clapping your hands and saying 'HEY, I need you to pay attention to me for a minute'. This will generally snap him out of it (unless what he is thinking about is really interesting).

If he sees things which he knows don't exist (as in he sees a pink elephant dancing in the room, even though he isn't trying to imagine it), then you may have a problem. But if he just zones out to concentrate on something that interests him (like designing things in his head), that is perfectly normal for AS.

Well, I don't see anything you describe that's outside of what I've seen described as a feature of autism/AS. Flat affect isn't universal, but seems to me it's no reason to think it's something besides autism/AS.

Last edited by Mysty on 27 Jul 2008, 11:35 am, edited 1 time in total.

Diet held all the answers for me in this disorder/disability debate. I am celiac according to my confident dietician, evident from a long list of allergy i.e. asthmatic tendencies, Atopic dermatitus and family members with lactose intolerence ec. Though my GP dubbed me bulimic when I told her I vomit ec, and my family would call me anorexic growing up, I fell into an irritable muted vs verbage depression, which could have looked like bi polar, which the phychiatrist was ready to look into stabilising! A week on from that trauma and I was back to normalcy, if a little blunted from yet another let down with 'professionals.' Luckily I am twenty and with a food diary/thought journal/mood chart and research prowess, a correct cause of my physical distress was identified.
This is what perception does for you, as your son is not of an age where he may have the words or inclination to decipher his difficulties or translate them effectively, you need to sit down and research the conflicting views and be scrupulous.
Schizoaffective is bi polar mixed with schizophrenia but the paranoid delusions need to last something like a month consitently between mood episodes. Before medicating your son, remember that with all mentally related issues, including more fresh foods, fish, omega 3, 6, evening primrose oil, flaxseed oil, green leafy vegetables will show some 'mood' improvement. GFCF, additive, sugar, caffeine, citrus free ec worked for me, but consulting a dietician for personalised advise may benefit your sons development dramatically.

Wish you both well

Last edited by Jenk on 27 Jul 2008, 12:04 pm, edited 9 times in total.

Schizoaffective disorder combines schizophrenia and either bipolar disorder or major depressive disorder. Note that there is a very subtle difference, though, between having both schizophrenia and either bipolar disorder or major depressive disorder and having schizoaffective disorder. It mainly has to do with the timing and overlap of the schizophrenic/psychotic symptoms/episodes and the mood symptoms/episodes. Psychiatry likes to make it confusing.

It doesn't sound like your son has discernible features of schizoaffective disorder to me. Flat affect is a common enough associated feature of Asperger's syndrome, and I tend to have a pretty flat or blunted affect much of the time too.

Thanks,

I know what tracker is talking about with the thinking. My son usually paces and designs something. He is very internally focused and it sounds like what others on AS sights talk about. If fact, if I try to talk to him he will even tell me he is too focused on his thoughts right now.

But there are other times when it seems like something different. It is more like he shuts down and says he is tired. I had another AS mom tell me her daughter does that after a lot of stimulation from school and such. And I am wondering if that happens for others, too. I do see if after a overwhelming day. Like he needs to recharge.

He has no loss of reality at all in his thinking, so I just think the schizoaffective is way off. But this concerns me.

The doctors diagnosed me with schizoaffective and high functioning autism. I don't believe the schizoaffective diagnosis because I don't hear voices and 99.9% of people with this disorder hears voices. I have other types of hallucinations like tactile and visual but those aren't common in schizoaffective disorder but rather a physical problem. A flat affect can be seen in other things besides schizoaffective disorder, it happens in autism too. They say I have "bizarre delusions" like the FBI inserting thoughts into my head but it is true and not a delusion. I love the gov! I always have to say that. Spacing out? That happens to me all the time, I would freeze (even while walking) and then stare off into space and not think or and also be not aware of what is going on around me. For some people staring off into space can be a seizure. Not a full blown grand mal seizure, but a much less serious one. Does he have hallucinations or delusions? Any disorganized speech or behavior? I know you mentioned one symptom and flat affect is considered a negative symptom of schizophrenia/ schizoaffective disorder but you have to have the positive symptoms as well. A flat affect alone isn't enough to diagnose schizoaffective disorder.

Well, the times when he seems to shut down are caused by AS also. Basically, when people with AS become overwhelmed, mentally exhausted, or physically tired they tend to go into self-defense mode (fight or flight response). Some people become angry/violent when pushed too far. This will result in screaming, crying, etc. This is commonly referred to as a meltdown. For other people like your son (and me) we tend to just shutdown and block the world out as a way to keep from overloading. Blocking out the world may seem like a very odd and unproductive thing to you, but it keeps him from overloading. So given the choices of yelling/crying, having a nervous breakdown, or just being quiet and withdrawn... Well, I think withdrawing is the best option for him at the time.

I cant say whether or not your son has a big problem, but he sounds a lot like me. Unless he starts running around screaming because the invisible elephants are chasing him, I wouldn't worry about it. He may be odd, and a bit spacy at times, but that doesnt constitute a problem. As it is, I just graduated with a degree in mechanical engineering and a 3.7 gpa despite being 'off in my own little world most of the time'. Overall, if your only problem with him is that he seems aloof, and flat at times, then you have nothing to worry about, thats completely normal. Well, normal for me anyways.

Also, your son paces back and forth while designing things in his head too? Does he have problems with loud sounds? Cause if he does I think he might be copying me.

How do you know that the FBI is inserting thoughts into your head?

Flat affect is a common sign of autism, so is shutdown.

If you have a professional telling you, that they want to diagnose your child, with something that is normally treated by neuroleptic drugs (i.e. any form of psychosis), because they have flat affect and shut down sometimes (which are incredibly common in autistic people), then get away from this person right now and don't look back.

Flat affect is normal in autistic people, monotone voice (and other sorts of flat affect) is part of the diagnostic criteria in some places, and shutdown is a normal autistic response to overload or exhaustion.

Moreover, an increase in flat affect, monotone, and shutdown (which may even extend to not being able to talk at all), can be a sign, in autistic people, of a problem that involves motor skills, and that will get way way way worse on neuroleptic drugs (and that may even increase the chance of death from neuroleptic drugs). That condition is rare, but I have it, so I wanted to note that.

I have that condition. I have been misdiagnosed as various kinds of psychotic, leading to the prescription of neuroleptic drugs. Not only did the movement disorder I had get worse, but the drugs almost killed me several times. Even a tiny tiny dose of a mild one for nausea I took a few years ago, I had life-threatening reactions to. These are drugs that cause parkinson-like symptoms. Having a movement disorder already that's in the parkinson-like family (which the one associated with autism in a minority of autistic people is said to be) and adding those drugs is incredibly destructive.

And if you have a doctor who doesn't even know that flat affect, monotone speech, and shutting down, are all incredibly common parts of autism, then you need to get away from that person because they have no business doing a differential diagnosis and they could put your child in severe danger. This cannot be overstated.

I absolutely agree with anbuend - very good advice. For years my son was diagnosed with mental illness by psychiatrists, even his speech deficits were "anxiety based" according to them. They only treat with medicine, so they need to give it a medical diagnosis in order to treat it with medicine - autism is not so they don't diagnose it as often. What you need to do is see a neuro-psychologist or a developmental neurologist to find the right treatment and diagnosis. For my son, once we found the right team, we found out he had sensory disfunction, central auditory processing disorder, expressive speech and pragmatic speech deficits. All this put together caused his flat affect and shutdowns. Myy other son on the other hand, has similar deficits but has good expressive speech, when he is overwhelmed however, he has meltdowns.

Because I have thoughts that are not my own. They accuse me of terrible things that are impossible. They say I am responsible for millions of deaths worldwide by existing and that I am a bad person. They blame me for everything that goes wrong in the world. But these thoughts are not audible as in voices. Just thoughts coming from the outside. It is from a chip in my brain if I have one of those. Sometimes they control me as well I actually feel my legs and arms moving on its own occasionally. Its no fun being controlled. It usually happens around crowds because of the added stress. The people talk about me because I am so weird.

You are displaying symptoms of paranoia but you could have a severe form of OCD. Have you seen a psychiatrist? If the thoughts ever become unbearable, go to the nearest ER and explain. I have some unusual and irrational thoughts at times but I attribute them to OCD, anxiety and bad wiring.

I have both shutdowns and meltdowns, depending on the situation.

And yes, the original poster should see someone who knows about autism in all forms it could take (i.e. someone who knows that people who can talk can still be diagnosable with autism, AS, or PDD-NOS). Because flat affect, monotone voice, and shutdown sound incredibly autistic, and true psychosis is exceedingly rare in a child. Just the odds point towards autism in one form or another.

The person's expertise in autism is more important than their job title, too. They could be a neurologist, a psychologist, a neuropsychologist, a psychiatrist, or a neuropsychiatrist, sometimes even a regular doctor. I was assessed by a neurologist, a neuropsychologist, and a psychiatrist, and then my diagnosis was decided on by the neuropsychologist and psychiatrist working together, and formalized by the psychiatrist. Then it was re-confirmed by an independent psychiatrist over a decade later.

Also, I would suggest buying Tony Attwood's book A Complete Guide to Asperger Syndrome. Be aware that he says Asperger throughout the book, but many of the people he gets his information from are diagnosed with autism as well, he just uses Asperger as a general term. So don't think that some of that stuff doesn't apply just because of the terminology.

When you do get the book, read through it and highlight or bookmark every single section that describes how autistic people can be mistaken for having a psychosis. There are so many different ways that can happen. I've discussed them on some other threads, I don't feel like retyping them at the moment. But at least half the ways he mentioned happened to me.

(And I want to note that the way I was treated, and my family was treated, would not have been remotely appropriate even if I truly had hallucinations or delusions.)

Another thing that was discovered by a friend of mine when she went through my records, that I would not have noticed: Many of what were being taken as psychotic episodes were clearly seizures. I did not know this because my memory of my seizures is fuzzy at best and non-existent at worst (I have a kind that can make me unconscious sometimes, but can also impair my consciousness without making me forget everything.) She told me that the events described in the records over and over were, absolutely, exactly, precisely, what my seizures to this day are like. I had no clue.

Anyway, knowing that, a certain sequence of events in my records that also happened several times, went like this:

I would start having a seizure. This made me disoriented and afraid, and often acting as if I were somewhere else. (The best I can describe that, is that... normally I had the layout of nearly everywhere I've ever been memorized. During a seizure, I will experience a whole lot of the layouts overlapping to the extent of total disorientation. My friend also tells me I often describe being in an enormous geometric room or something, and experience severe time-distortions, and just before a seizure I feel a dryness that water won't affect, all of this was in various forms in the records as well.) And I would also have some sensory distortions that would go on.

They would respond one of two ways to the seizure.

Sometimes, they would give me Risperdal, a neuroleptic. This would invariably make the seizures worse. (They wouldn't call it seizures, they'd either reference my behavior or call it psychotic or dissociative.) This is absolutely consistent with what neuroleptics do, they lower the seizure threshold and make seizures more likely.

Other times, they would give me Ativan. Presumably for perceived anxiety about the disorientation. But the other thing about Ativan, is that it has anti-seizure effects too. And my reaction to Ativan was almost invariably to become exceedingly clear-headed and lucid and to go straight back to whatever was normal for me.

They never noticed this pattern, although they did eventually decide I had a seizure disorder and put me on Depakote and Neurontin, which when combined had intolerable side-effects, but on them I was considered also more lucid and less erratic and stuff than I'd ever been on the other meds, and even when I ended up in mental institutions I was rated as functioning better than the other times I was in there. They never entirely noticed that pattern either.

But I wanted to mention that pattern, because some forms of epilepsy also can confuse doctors into thinking you're psychotic, and many many people with my form of it have been misdiagnosed over the years. And Tony Attwood didn't, I think, mention that, although throughout his book he has described things explicitly as being mistakable for psychosis, or just described things that can be mistaken for it. You'd have to read through the whole thing to find them but it's worth it, because it was so stunningly like reading what happened to me it was bizarre.

Also there was a woman who wrote an article about her son that ended up on Salon.com years ago, that included an autistic son with a similar movement disorder to mine, and who was on neuroleptic drugs that worsened it (and also anti-depressants that caused things that looked like psychosis, which was similar to something that happened to me on Wellbutrin). Before she wrote that article, she had posted somewhere asking for people with a similar experience, and my best friend replied to her and (with my permission) gave her details about my life, so it's quite possible that my experiences had some kind of tangential influence on the article as well. It's worth looking up, someone posted it here once and I had trouble even reading it from the memories it brought back.

Also if you go to this page (that's the internet archive page for it since I can't find the current page) there are many experiences on that site of autistic people who've been given neuroleptics, many of whom have also been diagnosed as psychotic at some point. (They once even did a study somewhere, where they went to psych wards looking for autistic adults, and most of the ones they found were there under a diagnosis of schizophrenia. Schizoaffective is basically like schizophrenia+depression or schizophrenia+bipolar as far as the criteria go.)

(Please note I don't necessarily believe in each of these psych categories exactly as stated, but I don't have the energy right now to disclaim everything or explain what I mean by that.)

So yeah... being diagnosed with these things can lead to nightmarish treatment (whether the diagnosis is accurate or not), and in some cases it actually is worse for autistic people to receive certain treatments (as in some things we're more prone to anyway might make us more prone to severe adverse reactions). And any doctor who doesn't know flat affect and monotone are absolutely classic traits in autism, ought not to be let near an autistic child.

Oh and I should mention, speaking of that... one of my doctors had a lot of fun declaring half of my family to have "schizophrenic traits," when really what it was, was my dad is autistic, my mother has some traits and it runs in her family but she's not autistic, it runs in the family on both sides, and all the eccentric people with flat affect and weird social skills and the like, were suddenly being described by this doctor as "psychotic" even though only one of them (out of many) had anything approaching a delusion, and none of them hallucinated except during times when it was caused by a medical condition. So not only did they start calling me that, but they started calling my entire family that, especially the ones with autistic traits, and thus established a "family history" (even though the people in question, with that one exception, were all clearly autistic or something related).