I feel wronged by a psych tester who didn't see my AS

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This is why I wanted to see a doctor specialized in AS (working in the public), the waiting list was almost 2 years long, I got on the list in 2006... But now, with his experience, he DXed me with AS.

Maybe if I had see a general psy (in the private in 2006) he would have not diagnosed me with AS as I am on the "border".

Thank you for that additional information. It gives me a reason to go through Asperger's writings finally. (That Gillberg's criteria are closer to those of Asperger's original of AS makes sense as Gillberg does it include a speech delay!) Interesting, I also got asked by therapist and psychologist for motor clumsiness right away, but could not deliver any more than being untrained and inattentive, which seemed odd to them. I'm curious about Asperger's comments on motor clumsiness and actually, I'm curious about motor clumsiness/development of WP's user now too.

I'm back again after round 2 with Dr. Gale today.

We didn't do any talking/interviewing this time but, instead, some cognitive testing involving matching up things that go together and finding patterns, etc. He also asked me if there were any other areas I felt that I struggle with that he didn't test for. I mentioned my difficulty holding multiple pieces of information in mind at the same time and manipulating them without paper to write on, such as simple arithmetic involving multiple numbers at once (even though I can do complex physics and calculus problems on paper no problem). He asked if I have that problem when writing papers, and I said "Yes, it's a pain, but the extra effort makes the writing turn out good after all." Nobody's asked me that before, and I was glad to be able to articulate it for the first time.

He said we'd be meeting again for a feedback session. He will have consulted with my parents and hopefully received the previous testing results by then.

I asked him 2 questions at the end:

1) Does he use the Gillberg criteria? (No, just DSM.)
and
2) Does he write down his clinical impressions and diagnoses based on what's helpful psychologically or what would look good to third parties, or does he just write everything as he sees it in its totality? Some clinicians will leave out an Axis II diagnosis and only put an Axis I, for example. (He said he was keeping in mind my possible need for work-related accommodations and, upon learning I wasn't using insurance for his services, he said it wouldn't matter what was written on my records. I already knew this but wanted to see what he'd say. I can do what I will with my records, and nobody has to see it if I don't want them to.)

So here's my prediction: He'll probably say I currently qualify as having Pervasive Developmental Disorder-Not Otherwise Specified, since I'm pretty good at socializing and responding in conversations (social reciprocity) but have some autism/Asperger symptoms nonetheless. And the fact that I'm able to be a therapist attests to that. But I probably qualified as having Asperger Syndrome as a child and then worked my way out of it. To get an idea for how this happened, see this excerpt from the personal narrative I wrote yesterday on a school application (which I handed to him as I left):

"I entered Williams College expecting to major in physics, but left with a B.A. in psychology instead, since I felt both perplexed by and distanced from the world of people. I set my mind on figuring out the inner workings of the human mind in order to fill my personal deficits and satisfy my natural leaning toward analytical thinking. I have a natural pull towards total self-actualization, and my urge to become a social being inspired this move. I decided that, if I could excel at speakers’ Spanish class and outperform the native Spanish speakers, I could learn to become effectively social too." (And then more on practicing and how Vitamin D helped me concentrate and achieve more awareness to improve social skills, etc., etc.)

I wouldn't mind getting the PDD NOS diagnosis because I'd still be on the autism spectrum, as I've suspected all along, and I'm close enough to Asperger for the category to be a conceptually useful tool for finding solutions for myself. I'm probably "Asperger light" or "mini-Aspie," as I like to put it. As long as I get my work accommodations, I'm cool.

I don't think he'd give you the PDD-NOS label for your reasoning, as one needs "severe and pervasive impairment in the development of reciprocal social interaction", either with verbal or nonverbal communication deficits, or repetitive behaviors.

Social impairment is stable [for the most part] across the whole spectrum; one's personality will reflect how it shows. An introverted and quiet individual will probably seem isolated and aloof, but someone who's outgoing and loud will appear "intense", inappropriate, and with no idea of boundaries.

If you now have trouble with nonverbal communication, plus repetitive behaviors that affect you negatively in an important area of functioning, you're probably out of luck for a label in the PDD catergory.

Are you sure about that? Found the below here: http://www.med.yale.edu/chldstdy/autism/pddnos.html

"The term Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS; also referred to as 'atypical personality development,' 'atypical PDD,' or 'atypical autism') is included in DSM-IV to encompass cases where there is marked impairment of social interaction, communication, and/or stereotyped behavior patterns or interest, but when full features for autism or another explicitly defined PDD are not met.

It should be emphasized that this 'subthreshold' category is thus defined implicitly, that is, no specific guidelines for diagnosis are provided. While deficits in peer relations and unusual sensitivities are typically noted, social skills are less impaired than in classical autism. The lack of definition(s) for this relatively heterogeneous group of children presents problems for research on this condition. The limited available evidence suggest that children with PDD-NOS probably come to professional attention rather later than is the case with autistic children, and that intellectual deficits are less common."

What's the difference between marked and severe? I'd guess marked just means obvious.

Yes, personality and temperament are definitely part of the manifestation. It's the same with with AD/HD in terms of inattentive type versus hyperactive type.

This is kind of what bothers me. If you feel you have AS but dont fit the Gillberg/DSM you can feel a bit undefined and confused. I dont know if I am an atypical version of AS, or a weird AS/NT mix.

There seems to not be a diagnosis available for those between Gillberg and NT. I feel like I sort of fall into the cracks because I need help but I'm not sure I would qualify for it.

Taken from the DSM-IV-TR:

Zen mistress, I agree and wish there were more categories of autism spectrum disorders out there. Maybe in the future...DSM-X? It takes so damn long to have conceptual updates.

Ah, I see, Daniel.

Yep, I do qualify on the side of stereotyped interests, but I have some (not severe) social impairments. Like the fact that I can't meet new people in person for the life of me. (Online is another story.) And I'm totally lost at a party and can't keep a conversation going if it's not on one of MY subjects. And I can't flirt (but who really cares about that one). But anyway, I get very obsessed with a subject and it pulls me away from my social life if I'm just researching it all the time.

I dont think that severe social impairment requirement is fair. my social impairments are moderate, not severe.

Plus, I have met people who got the PDD-NOS diagnosis and they seemed to have atypical aspergers, though atypical autism would also qualify I think.

With the Gillberg, and the DSM, it makes me wonder: Why does Aspergers have to be typical anyway? I think they are a bit too anal about it, or they should come up with some in-between conditions to explain the many people who dont fit the DSM.

It sounds pretty severe to me. Whether you want to or not, but if you cannot approach someone out there in a social setting for a relationship, or even in a mechanical setting (at school for example) for the same, then I'd define that as an impairment. I don't know your life, but if you have friends, a partner, and/or etcetera due to them building the "original" bridge that made you comfortable; you met them online, or there was another allowance made for you to do these things, and you don't know how to converse in a social setting other than speaking about your subjects of choice--that's a lack of social reciprocity in my experience.

Sometimes, the external environment can "protect" the individual with the ASD so they don't "appear" affected, but they would be if those events didn't make the situation, i.e., I have autism, but I had "friends" in high school, it's just that I never approached them, and when I spoke to them it was always in relation to an interest, but I still had "friends" (I didn't really care if I did or not, I'm apathetic to social relations for the most part, but that's a part of my personality as far as I can deduce).

O, and the "usual" stereotype of people that have an ASD don't "appear" to interact with others is in children rather than adults, and not all children with Asperger's/autism are aloof (I was, but that's only one type of person).

I think it is hard to define "severe social impairments." it is such a slippery thing.

Generally, if you cannot form relationships with people out there without them taking the lead, or you're someone who approaches others in a highly verbose, and oftentimes "insensitive" manner, and you keep on being rejected socially, this will be seen as "severe" to most professionals. The idiom, the door swings both ways applies here; if social and/or emotional reciprocation is absent, it's not swinging both ways, and it's then impaired.

The DSM-IV-TR isn't that hard to meet for someone with Asperger's as you only need two of the following: lacking in "appropriate" friendships for your age, lacking the desire to share your interests with people; a lack of exhibited and appreciation for multiple nonverbal ques, and/or a lack of social or emotional reciprocation.

I dont understand what "a lack of social and emotional reciprocation" is. But I think I meet these 2:

- lacking in "appropriate" friendships for your age
- a lack of exhibited and appreciation for multiple nonverbal cues

It certainly means a lack of empathy, some aspies have beter empathy with animals than with humans for instance.

Social: Someone approaches you for a conversation; they start it how they innately know, and you may respond with one of these depending on who you are:
Ignoring them
shrugging them off with basic receptive words
being unable to understand what they mean with their words, and you respond "inappropriately", or with words that aren't social or related to what was said to you
etcetera
Emotional: Someone says something that perhaps denotes pain or suffering that is asking for comfort (even if it's not stated explicitly), you respond with:
Indifference
"inappropriate" or "insensitive" words

This is in my experience, of course.

I certainly have the lack of empathy. I have the reciprocity, but generally it turns out to be the wrong kind of reciprocity, or so Im told.