If a person has AS, and doesn't think they have AS, do they?

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Frequently people post on here saying they think they have AS because they feel the diagnostic criteria and other things they read on AS describes them well. Some of them likely actually have AS and some of them probably don't, but what about people who actually have AS and don't believe they do?

I'm speaking of people who meet the diagnostic criteria rather blatantly, and perhaps even have a formal diagnosis using the most recent autism assessments, and honestly don't believe they have AS?

I know one such individual. Upon further questioning, I discovered the reason he rejected his diagnosis was because he didn't feel he had social issues. He perceived his social life and social interactions as completely normal and typical of others his age, as well as his ability to read others and managed his life fine within the context in which he lived.

So my question is, should one not feeling that they have AS nullify a diagnosis of AS?

From DSM-IV:
(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

So, if it doesn't, one doesn't meet the criteria, even if one meets all the other.

I think even in this case one can be an Aspie, since the neurology can not change. And, there still may be surprises in life, like an autistic burnout, a divorce etc.

I'm speaking of someone simply not feeling they do not meet that specific section in the criteria, even if others perceive their social interactions or lack there of to be odd.

For example, say that this is a man named Tim, and when at family gatherings and parties and the likes, Tim sits in the corner by himself and doesn't speak to anyone. Tim has people he considers to be friends, but he rarely sees them and when they do meet, it's always at the friend's behest. In fact let's say Tim spends a significant amount of time alone, and while he doesn't necessarily like being alone, it never occurs to him to invite a friend to do something with him, or even call them.

Let us also say, that Tim's social short comings are so obvious to others that they wonder if he does indeed have AS or some other type of issue, yet Tim is not aware that they perceive him differently and thinks he socializes just fine.

Apparently it is normal to be in denial about it. I was for 10 years or so. But its an interesting question. And I would like the DSM to add the notion that subjective perception of oneself is an important factor. Because if a person does not see themselves as having problems, and those around them don't either, then why label them with it.

I could be wrong but the assumption is that the person in questions sees that there is a problem or others see a problem.

In the example given, the key question would be "Does Tim see himself as having any problems?". If the answer is "no" than there is no point to a diagnosis.
The DSM was written with treatment in mind so that would mean:
The patient finds something wrong with themselves and It causes functional impairment of some kind.
If neither of those are true then there would be no point to a diagnosis.

Yes.

Any person may be capable of mimicking a person with a different neurotype and may even mimic so well that the behaviors feel natural, but their belief is immaterial. Their neurotype is not affected by it.

Hence the above criterion. Subjective perception of oneself is indeed taken into account during an assessment. If not, it should.

The question is, whether it's enough that the person thinks he hasn't got any problems, or we should look further into his environment at the opinion of people around him, or maybe independently from all this at the functioning level of the person in question.

If the person has aspergers and they dont believe it, it doesnt make them any less aspie it just means they havent accepted it simply.

Theres ways to justify aspie behavior has 'normal', like he's just very introverted.

Yes because it just means they are in denial. It's great if someone sees themselves as normal and don't think they are impaired but it can also be a bad thing too if they are in denial.

This post reminds me of myself when I was a teen. Up until I was 21 I didn't think I had Asperger. I didn't have any friends, but I was assuming I was CHOOSING not to because I wanted to focus on my career. So I thought that if I were to "choose" to have friends I would easily have them. I was wrong: at 21 I decided I wanted friends and then no matter how hard I tried I couldn't make them and I became increasinly frustrated and upset about it. So thats when I realized I actually DO have Asperger.

So I guess part of the answer to your question is that you can't truly know how good your social skills are until you try. I mean social skills is not about you, it is about other people who set a criteria of what behavior is considered "sociable" and what isn't. When I was assuming that I know how to make friends and was "choosing" not to, what I really MEANT was that

(i) I know how to do A, B, and C.

(ii) If I do A, B, and C then I would in fact make friends

(iii) I don't want friends and thats why I chose not to do A, B, C

(iv) (ii) and (iii) implies I don't have friends because I chose not to

(v) (i) and (ii) implies that I have good social skills and, therefore, don't have Asperger

Now I was right in items "about me", namely (i) and (iii). But I was wrong in the item that involved other people, namely (ii). Thus, I was also wrong in items (iv) and (v) since both of them logically depend on (ii). The reason I assumed (ii) is precisely BECAUSE I didn't know how society operates, which, in turn, is due to Asperger. Thus, having Asperger might be the very thing that would make me unaware of just how severe my issue might be.

On the other hand, I agree that whether something is "disturbance" or not should be up to the person. So if a friendship is not important to them altogether, then they are not disturbed either. Even if they are wrong in assessing their own social skills, their wrong assessment is a non-issue. For instance, I don't honestly know if I could learn to play violin if I were to try, or not. But I don't care about playing violin. So even if I were to tell you "I can easily learn to play violin" and I happen to be wrong, so what?

Nevertheless, here is the area where they "are" disturbed: they might "not care" about social skills at the moment but they might begin to care later on. In my case I began to care at the age of 21. So even though I was not "disturbed" until that age, the disturbance were "waiting to get me". So in this sense it would have been better if I got some help, even if I didn't see why I needed it. That way, I wouldn't have been hurt when I actually reached 21 and actually wanted friends.

Another thing is that social skills might impinge upon something else that the person with Asperger DOES want. For example, I always wanted career as a physicist. This has been my life time goal since I was 9. Then, at the age of 28, I realized that my lack of social skills affect my career. The way I realized it is that when I wnet to interview for a postdoc I failed it simply because I didn't know how to socialize with the professors that were inverviewing me. Then, at the age of 29, I successfully got a postdoc at another place (which by the way is far worse than the one I could have gotten at 28 ), and there I have allienated my advisor due to bad social skills. As a result, I had a very hard time getting new positions since my advisor was unwilling to write me any recommendation letters. I got another position, but not nearly as good as I could have had.

Now, as far as physics career goes, I ALWAYS thought that it was important, starting from age 9 onward. I simply was unaware that bad social skills can impinge upon it. Yes, back in my teens, I was told several times that they could. But I was only told this in a context of deliberate bad behavior; so I was assuming that the moment I start "choosing" to act appropriately whatever I am told would not be applicable any more. And in fact I was right: back in high school or even college, neither teachers nor professors would react to anything unless it is extreme. But when I go beyond college and I try to pass an interview or when I am a postdoc and my boss is not really a teacher but more like a collegue, the social expectations increase. And that is what I was unaware of.

Again, I was unaware because of Asperger: after all if I didn't have Asperger I would have had friends who are postdocs and what not and I would have seen a big picture. But because of Asperger I only seen my own little box. So I was thinking that everything is fine since I was comfortable inside my own little box. But it never occured to me that at one point I will have to get out of that little box. I assumed that since I do so well within that little box I will do just as well in the outside world; and that was simply not true.

So in light of this, the person you are speaking of might be similarly comfortable in THEIR little box, whatever their box might be, and THATS why they say they don't have Asperger. What they might not realize is that the person who diagnosed them of Asperger might be well aware that they do fine within their box. What they are concerned about is that they will have to get out of that box at some point. And in this sense the person who diagnosed them knows better than they do. Their social skills outside the box have to do with the rules of the game at the outside. So how can the aspie say they "are very good" at a game Z, if they do'nt even know what the game Z is about to begin with?

Last edited by Roman on 20 Oct 2011, 5:46 am, edited 6 times in total.

Note that the ICD-10 (who is supposed to be the official criteria in almost any country in the world) does not have this point.

More, ICD-10 has an explicit rule of "interference with the performance of social roles should not be used as defining characteristics of disorders or diseases" (although they make an exception for childhood disorders).

Thank you for pointing that out. I think despite the lack of the criterion in question in ICD-10 a general rule in practice is that some kind of detriment must exist before a DX can be given, simply because of limited resources of the health system. You're only eligible for support if you need it, including getting a DX, which isn't a cheap procedure in itself anyway.

Basically you can relate to AS/ASD in three ways:

1. Know about it and accept it
2. Don't know anything about it and thus not accepting it
3. Know about it and refuse to acknowledge its consequences
(accepting and not knowing isn't an option )

Tim in Chronos' example falls in the 3rd category. Roman explains it well in his post why. (in-out the box)

I think it's hard to tell which would be better for most adults well in their age (over 40), being in the 1st or 2nd? Though question, imho.

Adults around 40 have already an evolved personality, they have ideas, principles, notions by which they live and have formed and perfected their coping mechanisms. Throwing a big rock in the pond (disclosing their ASD to them) might not have the desired effect on them. Rigid thinking, low self-esteem may play a major role in it. But, as always, it depends on the individual.

Last edited by OJani on 20 Oct 2011, 7:31 am, edited 1 time in total.

I think the consensus is that if a person doesn't percieve themselves to have problems, then doctors will leave well alone. However, if those around them (friends, family) think they have problems then this is a difficult area and very touchy. I think back and wonder how many people around me have thought I had problems but dared not say so.

Also from a professional angle, they label people as pshycotic when they don't think anything is wrong (schizophrenia, bipolar sufferers).

I met a parent who wanted advice on how to persuade his son, who was attending university at the time, to take a diagnostic test for Asperger's. The father and the family doctor thought he had the condition. However, since the son dismissed the notion and refused to take the test, medically or technically, he does not have the condition and other people's opinions are just opinions – though the family doctor's opinion would carry some medical weight if included in his medical record.

I guess there are a lot of people getting away with a little bit of it unnoticed. The old phrase applies here too, it's a continuum.