What is repetitive behavior?

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I had a positive diagnosis of Asperger’s in 2002 based in part on early available testing, childhood ADD, and classical Asperger’s behaviors. Recently, a new psychiatrist said I have social avoidance with advanced sleep phase syndrome and hepatic encephalopathy instead of Asperger’s, but without in depth testing. We did do several of the screens where behaviorally I do test high for PDD-NOS and a low executive score with poor memory – but a high IQ. His diagnosis keyed on my “lack of repetitive behaviors”. Having a diagnosis is not important to me, as I don’t get any services, but my own curiosity is demanding I dig into it more.

As you mature and learn, is there a shift from physical repetitive behaviors or more intellectual ones?

As a child, I was hyper kinetic, collected and categorized things, read encyclopedias and did a lot of wandering and exploring. As an adult, I don’t have time for any of that, well, I"m still kinetic, when my back lets me be. I do still read massive amounts, but I find I forget things as the same rate I acquire them anymore. I have many hobbies, but much of my intellectual energy is taken up by my job, where I’m a professional researcher and analytical modeler. That’s really my lifelong obsession. I love texture. Process data has texture, taste and smell have texture, and nature has texture. They all have patterns of growth and change that can be observed and predicted. All of my hobbies revolve around finding the texture, teasing it out.

Can “finding texture” be repetitive, or is it so esoteric it doesn’t qualify. How do you define a repetitive behavior in an adult?

Why the new psychiatrist and why did he feel the need to rediagnose you? Hepatic Encephalopathy does not explain childhood symptoms and there are plenty of tests for it.

The new psychiatrist was for insurance purposes. My old psychiatrist gave me a scrip for provigil, since I wake up around 3am every day. When I went maintenance, we moved that scrip to my primary docs, who are an internist and a hepatologist. My insurance company required me to see a psychiatrist or neurologist for the provigil scrip. So instead of taking the provigil off-label to help me focus due to Asperger's, now I'm taking it off-label to help with Advanced Sleep Phase Syndrome, which is close enough to narcolepsy that although the button-pusher's at the insurance company denied it, the case-nurse over ruled them and approved the scrip.

The ASPS was backed up with a sleep study and another tet-a-tet with a neurologist. The encephalopathy is also positively diagnosed. I have late-stage small duct Primary Sclerosing Cholangitis (PSC) with insulin resistance and NALF, confirmed with almost elevated (top of normal) ammonia in blood, hand tremor and very mild asterixes. The new psychiatrist thinks the encephalopathy is a complicating factor causing memory loss and aggravating lack of focus otherwise due to tiredness. The childhood symptoms he attributes to ADD and social avoidance, not Aspgerger's. My hyperlexia came up as an "against Asperger's" argument- I was reading full length adult novels by 2nd/3rd grade with near perfect comprehension, 97%tile+ on vocab and reading every year, even when I was failing out of high school.

I understand that adult testing is complex and less accurate, mostly involving a review of childhood evidence. I have no need to pursue it, if I choose to go on full disability, I only need to stop taking one of my medications (a flouraquine) which is causing peripheral neruopathy anyway. Well, the antibiotic is, or the diabetes / liver disease is, or Cushing Syndrome. And although I can sound like a hypochondriac trainwreck at times, everything physically wrong with my body is positively diagnosed and caused by my over-arching auto immune disorder (PSC). The fatty tissue between my ears is a different animal all together, nothing wrong with it, just, different.

For me, it's posting on WP all day.

If all the testing they have done is accurate, then what you call your condition is not as relevant as if the treatments cause improvement. Do you think that Asperger's is still a possibility? If you treat all the other things successfully and there are still questions in your mind then don't let it lie. Treating these issues is a good idea since it would remove complicating factors from the picture.

I would be concerned about the psychiatrist's attitude. Some professionals are enamored with their own skills and insist that you submit to their expertise. Others actually listen and are perfectly willing to adjust their assessments as more information becomes available. If your new doctor is in the second category, then you're going to have positive results.

A lot of what I’ve seen in myself is that I’ve learned to adapt very well.

For example, I did the 'Reading the mind in the eyes' test. For the first dozen, I was panicked. I had no idea what any of the eyes meant. Then I figured the pattern out. The 4-choice solutions typically have two passive and two active emotions. When people look at you, they have active engagement and would have active emotion. When they don’t look at you, they are disengaged. Once I remembered that, I calmed down and the rest of the test went smoothly, I scored normal. But even looking at pictures of eyes looking at me makes the small of my back weak. To me, I need to figure out the patterns, if I don’t know it, I’m very uncomfortable and actively thinking about how to find the solution to unlock it. Once I figure it out, it’s smooth sailing. This fits well with cognitive tests where I score exceptionally high on mental rotation, ie spatial thinking or pattern fitting. It’s what I’m best at. But is that in any way related to Asperger’s? I’ll read more and try to figure that out. The fast, fluid learning may lead to why it’s hard to ID Asperger’s in adults.

Habits are one of those funny things with me. I form them and I follow them. But I’m not married to a habit. I’ll practice and do the same thing, think about the same idea, very frequently for years. Then one day I’ll just stop and won’t touch it again for years. I used to count my fingers as a calming routine, one-two-three-four, four-three-two-one. Over and over. I still bring it up when I’m nervous, but I rarely do it any more. I used to track every penny I spent, for years, daily categorizing every single transaction from a pack of gum to a leather jacket, breaking out sales tax into it's own catagory. I had plenty of money and no kids, I just did it for fun. One day I forgot what I spent that morning, and I never tracked another penny in my notepad again. Habits are like hobbies. I follow them as long as I like them, and once I find them in the slightest bit disinteresting, I quit, although I'll likely come back later. So I tell my wife, “I don’t form habits”. She tells me, “Yes, you’ve got more than anybody I know, you just don’t follow them at the same time.”

Physiological responses are different. Screaming human voices always have and always do drive me into a rage. I gotta get out if people are screaming or if there are high decibel throbbing noises. Eye contact burns. That’s how I describe it. I can make myself look at eyes when I remember to, but it makes the small of my back squirmy. I don’t get social custom. I can’t say that I’ve ever introduced two people, likewise I don’t think to say goodbye, I just leave. I did learn in college not to borrow without asking, although I never get why as long as I don’t damage it. And why do people obsess so much on what other people are doing? Either somebody has something useful to you, or knows something interesting. If they aren’t either, I can think of no reason to call or text them, especially when I could be doing something enjoyable like reading or building something instead. But I do study these things. I enjoy listening to people (maybe eavesdropping is a better term), figuring out why they think or do things, which seem mostly self-destructive. That’s the other thing. Why would a person ever in their life do something obviously and patently self-damaging? Never do something without figuring out the expected result first, that’s one of my key mantras. Maybe that’s a habit? I am calm, cold and deliberate in every choice I make.

When I was between 7 and 11 and played with my dinosaurs and action figures, if the play was interrupted, I began all over from the beginning again.

I do not recall needing to start over from the beginning when being interrupted at play as a child.

But I do remember endlessly ordering things. I loved LEGO's. Not only could you build something, but you could put the LEGO's into sets and patterns. Like 4 red 2x2 LEGO's followed by 8 4x2 yellow. Repeating and matching patterns, then see if anybody noticed! Nobody would. But that would never stop me from trying.

Doesn't mean I'm an Aspie. There's something atypical in my thinking, but it might not be autism. I tend to lean towards thinking it is because I can't identify something that fits better. That's why I'm curious, it's an enigma that does impact my life.

Another reason I may not be Aspie is my sense of humor. I love to laugh, I love jokes. I get jokes other people tell, most of the time. I tell jokes constantly. Few people get my jokes, but I personally find them very humorous. I'll even start laughing for no reason because I randomly thought of or remembered a good joke. Jokes are another texture, or more specifically, a surprising and pleasing interruption of an expected texture. Where that texture are preconceived notions of cause and effect. But I don't get the same jokes, physical comedy for example. Why is it funny when a little kid smacks his dad in a sensitive place with a baseball bat? The poor might might have been injured, that's not funny. I'd rather hear a good limerick, which would be pattern and texture again. Now Gary Larson, there's a man who I wish never retired.

I built lego fortresses usually. Did not match patterns and tried to make them look as realistic (and big!) as possible,