Finally Diagnosed... still not satisfied?

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I finally went to a psychologist for a formal diagnosis. I didn’t have any doubt, but I was tired of feeling like an imposter in the autism world, and I like certainty... So she talked to me for an hour or so and did all of the personality questionnaires, IQ tests, and other such things that are typically done… but after she diagnosed me with Asperger’s, she said something that made me question her opinion; she said that she considered a diagnosis of autism, except that my IQ was "just too high" My IQ only tested at about 110, but that is completely beside the point.

Does it sound to anyone else like this woman probably knows nothing about autism? (She is supposedly the only “specialist” in my area that sees adults.) Maybe I am over-reacting, I don’t know.

In addition to Asperger’s she also diagnosed me with:
Expressive/Receptive language disorder
Panic disorder with agoraphobia
Social Anxiety
Schizotypal personality disorder

While I do have problems understanding and using language, it varies depending on the situation. If there are no distractions, I am much better… doesn’t this just sound like sensory processing issues related to ASD? I have a bit more reading to do, so I’m not ruling out the diagnosis just yet.

As for the panic disorder and anxiety, I feel like these are directly related to my issues being on the spectrum… I don’t feel like they should qualify for a separate diagnosis. But, her report also says I think I’m more cool and relaxed than I actually am…
I don’t have any doubts regarding the Asperger’s diagnosis, I’m just wondering if I should trust this lady’s opinion, or if I should continue seeing her for therapy (which she thinks I need… she also thinks I should be on medication since I am “prone to brief psychotic episodes”…)

What do you guys think? Anyone else with a similar strand of labels?

That last part, "prone to brief psychotic episodes," I'd ease back away from this therapist.

The beginning part, she made at least three mistakes about autism:

1) Asperger's is part of the Autism Spectrum!

2) Plenty of people with just plain regular autism have had very high IQs, Nikola Tesla being one of them.

3) And, 110 isn't that high an IQ! I mean, nothing against you. I'm sure you have all kinds of talents and human abilities, much more so than can be measured by a single number. But if we're going to look at a single number, 110 is within a broadly (to just a loaded term!) 'normal' range.

And understanding language better when there are not distractions, that does sound like sensory issues.

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I am self-diagnosed. I've had generally bad luck with mental health professionals, starting with this clown I saw at age 17.

Now, you are aware that a regular doctor like an internist or family practitioner can prescribe medication for a panic disorder, right? My personal issue, I have struggled with bouts of depression, haven't yet tried anti-depressants, but they are kind of my ace in the hole. And what I've read, with antidepressants it's trial and error in a respectful sense, and what's needed on the part of a doctor is light touch and willingness to tinker. Plus, it's often important to phase down in steps from a medication even if it doesn't seem to be working.

Thank you for your reply.

I know 110 is only slightly above average, that's what worried me when she said it was "too high." I took from that that one must have an intellectual disability before she will give a diagnosis of autism... and that's obviously just ridiculous, and makes me seriously question her ability to diagnose anything. But, as usual, I was unable to find the words to argue my point with her.

I think it's time I get a new psychologist and another opinion.

I don't understand the comment about your IQ. As mentioned, it's within the "normal" range. There are many people out there with a diagnosis of Autism / Aspergers with high IQs.

It certainly sounds like you have Aspergers--this is a great example of black/white thinking.

She doesn't agree with your definition of Aspergers/Autism, which means she can't diagnose anything according to your world view!

But, if I search the web, I can easily find pages on Aspergers/Autism that agree with her...

I can't see anywhere that gdgt has displayed B&W thinking myself. But more to the point, there is a lot of bollocks on the internet, a lot of outdated myths and downright inaccuracies about autism particularly. So this does not indicate in any way that OP's therapist is correct. Her therapist sounds like she feels like she's doing her job better if she dishes out more labels - she should have gone into psychiatry then she could have given out a cocktail of drugs to match the labels and felt really validated.

It does sound as if this therapist does not fully understand ASCs. I agree OP that the additional labels are largely unnecessary as the first three are attributable to AS, and the "psychotic episodes" sounds like meltdowns - also part of AS.

I think she meant by saying that she considered your IQ too high for autism, that she is imagining low-functioning autism and there is an IQ cut-off for Asperger's which I think is around the 70 mark from memory. She maybe just forgot to state that she meant low-functioning (or "classic") autism. I don't think with AS you can have a learning disability which is probably what made her put you into the AS category, but she may be ignorant about HFA which would also explain her comment. It reads as if she thinks your traits are very pronounced so she would have put autism but she got confused by your IQ.

As long as you got AS as a diagnosis that should be sufficient, you can ignore the other labels, unless you are unhappy about them, in which case if you've got the funds go for a 2nd opinion.

I suspect that some doctors equate HFA with AS and follow the rule "low IQ → autism; normal or high IQ → asperger"; it goes against the criteria that was in the DSM-IV and it is in the ICD-10, but is not worse than the usual rule "language delay → autism; no language delay → asperger", who is also against the DSM-IV and the ICD; if anything makes more sense differentiate the diagnosis by IQ than by language delay, because I think that the studies show that IQ is a better predictor of outcome for people with ASD than language delay. Of course, sooner this question (autism or asperger) will become irrelevant.

What, IMO, is more dubios is the co-diagnosis of schizotypal personality disorder - StPD is so similar to Autism/Asperger that a double diagnosis should be given very carefully (or perhaps not at all); after all, what is more probable - that the same person have, simultaneously, two rare conditions, or the these person having only one of the conditions, being the apparent symptoms of the other simply a side-effect?

"she said that she considered a diagnosis of autism, except that my IQ was "just too high" Confused My IQ only tested at about 110, but that is completely beside the point. "

"she also thinks I should be on medication since I am “prone to brief psychotic episodes""

Only for those 2 things, I would avoid that psychologist and i dont fully understand the rest of the situation, I got diagnosed with Asperger Syndrome(High functioning autism) with an IQ of 143 Wechler(169 Cattell), if yours is too high, mine is off the charts, also, is dumb to diagnose a person with autism by using his IQ, the IQ test are not made for autistic persons.

And you can not said if a person is prone to "brief psychotic episodes" that easily, that is just stupid, they just appear out of nowhere, the only way you could tell if he is prone to psychotic episodes, if you are properly diagnosed with schizophrenia,psychotic episodes or psychotic depression

Other way to know if a person could be prone to psychotic attacks but the odds are very low, is if you have autism or schizotypal personality, but this is not very probable and the fact that she wants to put you into meds without even having a psychotic attack is despicable, you dont give meds to a person just because you "think" he is going to have a psychotic attack, just stop going with that crazy lady.

Many posters here at WP are looking for a diagnosis, or want to talk about their dx experiences. One thing is pretty clear to me though is that psychology and psychiatry are art and not science. These diagnoses are opinions... "educated" opinions if you want, but as far as logic is concerned they are "appeals to authority."

People go to these helping professionals with this open existential wound..."What's wrong with me?" "What have I got?" "Who am I?" And the "authority" tells them. If you go to a psychiatrist looking for the answers to these questions they will then offer you drugs, and you come back to see how they are working. If you see a psychologist they want you to come back to "work" on your situation. Maybe get into group... maybe they will suggest a psychiatrist if your diagnosis is anxiety or depression, or if you are schizophrenic.

Just my 2¢ of course, but once you open this can of worms it can go on forever.

I suggest just trying out whatever sorts of treatment your p-doc recommended in your report. I assume that would probably involve meds and perhaps cognitive behavioural therapy. The actual things they diagnose you with are less important than being given the options to perhaps improve your ability to cope with some of your problems through treatment.

In her defense, the DSM 5 (where Asperger's and Autism are now combined into Autism Spectrum Disorder) is released but not active, so she is right to consider these two separate diagnoses.

As tall-p mentions, diagnoses are just opinions based on one person's interpretation of symptomatic presentation. They are meant to guide treatment more than to define an individual. I am diagnosed with Asperger's and Obsessive Compulsive Disorder, but I don't really identify at all with the OCD diagnosis.

Could I ask some questions?

Did you ever (as a kid) have a temporary loss of language, or were you delayed in developing language? If not, that'd point more towards Asperger's than classic autism.

Also, what's with the claim you're prone to psychotic episodes? Any basis for that claim? If so, then it may be valid. If not, where is this idea coming from?

I believe that I had selective mutism as a kid. I very rarely spoke at school until around 4th grade, I just couldn't do it, but was perfectly capable of speaking at home. I also had a slight language delay, but not necessarily clinically significant (I was using single words by age two, but not phrases). My language skills at that age are based on my mother's admittedly-bad memory, however. I do have video from age five, and it seemed to me that my language wasn't as advanced as it should be, and fairly difficult to decipher.

As for the psychotic episodes, I was misdiagnosed as schizoaffective and bipolar at age fourteen (by a psychiatrist, who then prescribed me meds that gave me lasting tardive dyskinesia...), and I think the current psychologist was trying to somehow incorporate my history... my other theory would be that she got that idea from some of the personality questions. I have always had very intense visual and tactile experiences, and I think these have often been misinterpreted as psychosis, even though they are totally grounded in reality. I have only really discovered this after learning about autism, so the notion that I am sometimes a psychotic person had been thoroughly ingrained in me for a good ten years.

I have never been a big fan of psychology, the DSM and such, especially since learning many years ago that homosexuality was once a diagnosis. This whole thing started as simply a way to hush up any naysayers in my life, yet I kind of got sucked into psychiatry's whole "something is wrong with me" mentality. I think I'm gonna call it quits for now, and rest assured that my knowledge of autism (especially as it pertains to me) is probably more up-to-date than any of the "professionals" in my area.

Thank you all for the replies. I really just needed to see what some other knowledgeable people thought.

I bet that's what she meant when she said "brief psychotic episodes". Some mild psychosis does involve exaggeration of existing sensations. Apparently it's why marijuana is considered a hallucinogen even though people just report things being generally more intense, rather than having outright hallucinations. I had some of that when I had a high fever--I saw the walls kind of bending and waving out of the corner of my eye. That is technically called delirium rather than psychosis, but the effects are much the same. I didn't see anything that anybody else couldn't see, yet my perceptions were different. (I had strep throat; antibiotics brought the fever down by the next day, thankfully.) If a doctor knew nothing about autism and you described sensory overload and a possible subsequent meltdown, they might well think you are describing some kind of psychosis.

However, if these sensory experiences--perhaps overload or general sensitivity--are better explained by autism, then it doesn't make sense to call it psychosis of any sort, brief or mild or otherwise. You don't add diagnosis on top of diagnosis if only one will explain and describe things fully by itself. Sometimes these things will stick on your record just because they've been there before and you have to explain the problem to a psychiatrist or psychologist to get them to "rule out" those diagnoses (which means, "this is on the person's record, but we have reason to believe it isn't actually correct, so we need to investigate whether this diagnosis applies or not"). Have a talk with a psychiatrist or whatever next you see one and explain that you think that the psychosis thing was a doctor trying to describe your sensory overload without knowing about autism.

gdgt,

Could I ask who you saw? I am trying to find a provider here in kentucky so I can be evaluated and hopefully get a diagnosis. Knowing who to avoid is often as helpful as knowing who to go to. If you find someone better, I would appreciate knowing who they are.