Would you like to give advice to psychiatrists?

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I have a mild form of HFA, which allows me to live independently, hold a job, and participate in most social functions. Autism Spectrum Disorders are very diverse. I don't have a problem with bright lights or crowded places, but I struggle to recognize faces or talk to girls.

Back in high school, I was stressed with schoolwork, bullied, and had no social life. I was good with the teachers, but an outcast among students. Like anyone in the same situation, I was depressed. The solution at the time? Anti-depressants. I continued to take them as I didn't know any better. Three years ago, I had a particularly bad incident at work and went to the psychiatrist. His solution? A higher dose.
Like any medication, the brain builds a resistance to it and it takes more of it to have the same effect. It did not do much more than "cover up" my problems. I know that there are better ways to fight stress and depression than drugs. Eating healthy and exercise, getting enough sleep, starting a new hobby, and feeding an obsession are all good alternatives, as well as eliminating the cause of the depression. I was working in retail at the time and transferred to a different area of the store with different people (and eventually got a "real" job several months later). I found that I was not getting my money's worth from the psychiatrist, and stopped going.

I was told that I would need to take antidepressants indefinitely in order to function "normally" because "my chemistry was out of balance" and I that I would never be able to do certain things, such as drive a car. Needless to say, I kicked the "happy pills" two years ago and have had no problems ever since. Not only can I safely drive a car, I can fly a Cessna, and expect to get my private pilot license with the next week or two.

You have my permission to use my comments.

You have my permission to use my comment in your column.

Let us be autistic, and follow our own goals. If someone wants to stay in a basic job and spend the evening building lego instead of socializing, let them! The only way to waste your life is doing something you don't want to do that won't result in anything you want. Our wants and needs are often different from NTs. Autists are a diverse group, don't get fixated on stereotypes or what other autists are like. Listen to us, don't ignore us or tell us we're wrong.

Also: http://web.archive.org/web/200708050652 ... istic.html

Here's one I don't think you've seen yet, though I haven't read every response.

And YES, you DO have permission to use this.

Treat your sessions with Autistics as mutually educational experiences.

Most doctors familiar with Autism know the saying, "If you've seen one person with Autism (any form of it), you've seen ONE person with Autism." It's extremely important NOT to make comparisons based on past experience with other patients. Too often I have heard things like, "I don't see how you (he or she) could be on the spectrum. You (he or she), don't display this or that symptom." That should NEVER happen. Every doctor working with Autistics needs to have that tendency trained OUT of them.

I think it's also very important for doctors to share their own philosophies and beliefs about Autism. Not all doctors have the same idea of what it truly is, or how it should be treated. If your approach is to identify deficits and do what can be done to improve them, SAY SO. Many of us on the spectrum want nothing more than to be accepted for who we are, and have no intention of changing. A doctor with the attitude just described, paired with a patient who doesn't want to change, is not going to get anywhere.

ASK your patients what "Autism" means to them. TELL them what it means to you. If your idea of what it is in conflict with your patient, either try to find common ground and mutual understanding, or have them see another doctor. If your idea of what it is, is in direct conflict with your patients, and that doesn't change, you'll both be wasting your time, but you will also be wasting your patient's money.

I think it's extremely important that ALL doctors working with Autistics gain a SOLID background on the history of the diagnosis. Doctors who do not understand HOW the DEFINITION of the term evolved from its initial meaning when the word was first coined are not, in my opinion, well enough educated to fully understand what Autism TRULY is.

If a doctor does not understand that "Autism" is as enigmatic as it really is, and that many opinions about it, though some may be in complete opposition to each other, are valid, he/she will probably not be open minded enough about it to treat all patients diagnosed with it. It's important not only that doctors be aware of this, but that they recognize the importance of their patients being equally aware of it.

Summed up: Treat every patient as a student AND a teacher.

"Training," on this topic, should not be a one-way street. We need to learn from each other. We need to teach each other.

EDIT: Also, remember that just because most of us do not hold the degrees you do, does NOT mean none of us are equally, if not more intelligent than yourself. LISTEN first, then speak.

You have my permission to use my comments if you wish to.

I personally don't have much experience with psychiatrists, for one very simple reason. There is only one psychiatrist in my area who specializes in autism spectrum disorders and his services are mostly focused on autistic children. There are no options for adults with Asperger's syndrome, let alone recently diagnosed adults.

Adults on the autism spectrum are an underserved group. Many adults still need support or treatment in adulthood, but often face lack of resources aimed at/available to adults on the spectrum. Many adults on the autism spectrum weren't diagnosed until adulthood and therefore never had access to any treatments or support in childhood. When they finally get diagnosed in adulthood they often have a hard time finding any suitable treatment or support options for recently diagnosed adults. It seems to be assumed that as adults they will already have received all the treatment and support they need or that since they went undiagnosed for so long they must not need any, but in fact many actually need it and are struggling without it.

Another thing that I think is important to note is that many people on the spectrum find it a lot easier to communicate in writing than verbally, so instead of a conventional, verbal, face to face conversation it may be more useful and effective to let them bring a pre-written text with them for the psychiatrist to read, or to let them communicate in writing during the session if they prefer that over talking. I for one would be able to express myself very little through talking face to face to a stranger (a psychiatrist) compared to having a written conversation with them. I think it can make a big difference to pick the communication method based on the patient's needs/preference. With today's technology that should be easier to facilitate than ever.

Don't give me that look of pity when talking to or listening to me. I'm Autistic, I don't have a terminal illness.

Thanks to everyone who responded. I have sufficient and very useful material for the column now. The column is only 900 words, so it will be quite brief and won't be able to go into depth. It should, however, be a useful. I will include the link to this thread so that readers can get depth if they want.
The themes from the thread that I will convey are listed below. I'm sure they could be summarized is other ways, and that my summary reflects not only the content of the thread, but also my own point of view regarding what will be useful for psychiatrists to read.
Again, my thanks for your posts.

You might be interested in the video of an hour long educational program we held recently at Oregon Health & Science University entitled Partnering with Autistic Adults to Improve Healthcare. The co-presenters were a physician and an autism advocate.
That presentation was part of an on-going educational program for psychiatrists, residents, students, and other professionals "Psychiatry Grand Rounds"
Wrong Planet won't let me post urls yet. You can find the presentation via a search for OHSU Psychiatry Grand Rounds Archive

Themes
1)Recognition of person-hood and individuality. Psychiatrists need to appreciate and convey respect and trust for the individual and recognition of the person's intelligence and capabilities, as well as the person's particular expression of autistic traits.
2)Age. Middle aged and older patients may not have been diagnoses in childhood. Consider autism spectrum in initial evaluations of older individuals.
3)Gender. Autism presents somewhat differently in women than in men, and the social challenges differ somewhat. Pay attention to these gender differences.
4)Treatment Focus. The focus of psychiatric care is not to treat autism, per se, but rather, the to treat co-occurring problems such as anxiety, depression, psychosis, etc. and/or to help the person function more effectively in relationships and at work. Unless a psychiatrist has specific skill in psychotherapy with autistic people, it may be useful to work together with a psychologist, social worker, or other therapist. Medication used without consideration of an individual's life history and current situation may be counterproductive.
5)Collaboration. The person's own desires should guide the goals of treatment. One person may wish to learn to function within a competitive work environment which is populated by neurotypicals while another person may wish to work at a simple job and pursue a solitary special interest. Each of these goals should be respected by the psychiatrist.
6)Sensory overload. Autistic people are very sensitive to sensory stimuli and easily overloaded. The treatment setting should take this into consideration by minimizing extraneous noise and other distractions.
7)Communication. Autistic people have difficulty with office visits due to difficulty with with communication in the context of interpersonal interaction, alexithymia, and difficulty with abstraction. To facilitate communication it is helpful to use specific inquiry rather than open ended questions and phrase your recommendations clearly and precisely. Do not assume that your recommendation have been understood verbally. Written, asynchronous communication may be more effective than conversation. Encourage patients to bring their concerns to you in writing. Email may be useful. Write out your instructions.
Access. Psychiatrists with interest and expertise in working with adults autism are in short supply and there are financial barriers to care.

"Written, asynchronous communication may be more effective than conversation. Encourage patients to bring their concerns to you in writing. Email may be useful. Write out your instructions."

As an Aspie (DX'd PDD_NOS at age fifty), with ADD, I can't stress how incredibly important this is. Our local hospital offers an online messaging system to communicate with our doctors. Recently, I asked if a certain doctor could be reached via the system because her name doesn't show up in the contact list, though she is our children's pediatrician.

I was told to call was my best bet.

I'm replying to them with the same basic explanation you outlined above. Verbal communication for spectrum individuals is already difficult. Add ADD into the picture, and it becomes a virtual disaster.

With all due respect, 900 words is scarcely enough to address just one of the points brought up. Perhaps a series of columns?

wavefreak58 wrote [quote] With all due respect, 900 words is scarcely enough to address just one of the points brought up. Perhaps a series of columns? [quote]

I agree entirely! The reality is that 900 words is all the space I am allotted in each issue, and over the course of time I need to cover a variety of problems, each of which deserves it's on ongoing column (schizoprenina, depression, bipolar disorde, OCD, ADHD, other anxiety disorders, gender issures, minority issures, legal issues, medications during pregancy and lactation, other medication issues, end of life care, etc, etc.)

About all I can do in any column is to promote interest and point the doctors in the direction of more information.
The column is just one channel of communication I have with the psychiatric community. You might be interested in watching the video of a teaching conference from earlier this month regarding the expressed needs of autism spectrum adults. Wrong Planet isn't letting me post urls yet, but you can find the video by googling "OHSU Psychiatry Grand Rounds Archives" and scrolling to the appropriate title.

The need for psychiatric education regarding autism in adults is very much on my mind, and I will keep it coming.