Francis wrote:
When I read the DSM, I don't see any thing which is specifically geared for children.
It does speak of various childhood milestones such as speech non-impairment, cognitive abilities and environment curiousities. But those wouldn't limit diagnosis to children. You either met them as a child or you didn't. Your past doesn't change when you become an adult. So it wouldn't limit diagnosis to children.
The issue I was trying to raise was that an adult has had more time and often times, but not always, more ability to be or become aware of themselves than a child, and take the initiative to correct certain behaviors. So an inexperienced clinician, or a bad one, or someone with a critical thinking deficit (you know, the ones who think things like sick=bed ridden, not bed ridden=not sick), may erroneously declaire a wrong diagnosis.
For example, our fictionary patient Johny gets fired from his job over an AS related miscommunication. Johny does not have an "official" diagnosis, but knows he has AS, and would like to file a wrongful dismissal suit so he goes to get a diagnosis.
Now a while back, Johny realized he didn't make eye contact with people, talked about his life long passion, bus routs, to everyone, and realized sweat pants and a Barney T-Shirt wasn't very becoming of a 40 year old man, so he began to make eye contact, stopped talking so much about bus routs, and started dressing a little more appropriate for his age.
He goes to get a diagnosis wearing a brand new suit, and on being called into the office, looks the clinician in the eye, smiles, extends his hand and with the charisma of Bill Clinton, he says "Hello, I'm John Smith. How are you today?"
During the whole process, he's very composed. He doesn't rock or fiddle with his fingers like he used to. He maintains eye contact, and doesn't talk contanstantly about bus routs. He pauses frequently and takes a moment to ask himself if the clinician is communicating anything to him non-verbally, and at the end of the process the clinician declares "Well despite your history you certainly don't appear like someone with AS in my book. Maybe you were just one of those quirky kids and went through a few phases"
Of course we all know Johny is going to go right home, take off that itchy suit, and map new bus routs as he wonders how many more people are going to fire him for doing exactly what they told him to do.
I guess I just don't relate. I am in my 40s and I still meet the diagnostic criteria as well as I did 35 years ago. Despite years of trying I can not make or maintain eye contact. My fingers still fidget- I can't stop them for any extended period of time. Still make facial grimaces. My finger nails are chewed down, some are completely gone after 40 years of chewing. When I try to read non-verbal cues, I usually misread them so I stopped trying. Its less trouble that way. And my sentences with the clinician would probably only consist of three word sentences. (unless I had known them for awhile.) And the fact I would probably show up pedalling a boneshaker probably wouldn't help.
So really, it's the third diagnostic criteria that you are having trouble with. The one thats states the traits have to cause an impairment. As an adult, you have learned cover-up tools to hide your traits. I've heard many people state that. That is consistent with what my doctor told me. She says her usual reason for not giving a diagnosis to adults isn't that they don't have the traits, it's that they haven't proved to her that it causes an impairment. She says the people will usually walk in and ramble on about their traits, but never mention any impairments. But in fact, sometimes, they'll say the opposite. Its a blessing not an impairment. No impairment = no diagnosis. I think if your seriously seeking a diagnosis as an adult, you'd want to go to a counselor to discuss your life issues (not can I get a diagnosis) and then slowly lead the counselor down that road. Thats what my doctor would be looking for, the impairment.
30 Apr 2010, 6:25 am
