Diagnostic help?

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As I've mentioned before in a previous post, I have had difficulty formulating a compelling argument to support my self-diagnosis, also hampered by the professionals being somewhat clueless.

Something I have noticed, however, is that the diagnostic criteria only vaguely fit me, to the point that it could be argued that they don't.

I came to WP open-minded, only to find there's much more in favour of my self-dx than against, with lots of traits/symptoms mentioned that are not part of the diagnostic criteria, but I find I relate to very strongly.

Something I mentioned before is that I couldn't answer very easily directly, but a checklist would circumvent that difficulty.

Let's work together to build one for reference. A full list of everything AS-related, whether common or rare, so that people (or professionals) could be clearer in themselves.

I actually really like that idea. I'll start, and everyone can just copy it and paste it in their post and add on to it?

lack of eye contact, or too much eye contact
toe-walking
must have routines
gets easily attached to objects
can't and/or doesn't understand small talk
takes things too literally
must follow the rules
repetitive behaviors; rocking, pacing, handflapping, etc.
special interests
awkward gait
inappropriate or wrong facial expressions, and lack of understanding facial expressions
sensitive to lights and/or touch and/or smell and/or sounds
frequent meltdowns
poor motor skills (tying shoes, handwriting, buttons, etc)

im awaiting checks and stuff, one thing ive cought myself doing for years, unaware of "aspergers"

is to test people,
especially cashiers/waitors/clercs, cus theyre "safe"

i test eyecontact, noise-level when talking, initiating and breaking off small talk.

When I read the Wikipedia entry for AS, I knew without a doubt that it was talking about me. If that source leaves you inconclusive about yourself, then maybe it's not you.

If you think you have AS, then you're probably not normal - but not necessarily AS. There's a number of similar and/or related conditions more common than AS, which can occur with or without AS, maybe this list should include ways of telling them apart from AS.

psychological (acquired): social anxiety, schizoid PD, depression, anankastic PD, narcissistic PD, borderline PD, avoidant PD, dependant PD, etc
biological (genetic): ADHD, bipolar, tourettes, OCD, schizophrenia, sociopathy, CAPD, dyspraxia, ...

From what I've seen, self-diagnosed AS can often be explained by social anxiety, adhd, bipolar disorder and sometimes schizophrenia. People who suspect their boyfriend/girlfriend of having AS usually didn't consider the more common possibilities of social anxiety, bipolar, schizoid, narcissistic, or sociopathy.

Meanwhile, any of these conditions can co-occur in aspies, and several are frequent among people with AS. Some discover their AS after a bad reaction to ADHD meds, or when bipolar meds fail to cover everything.

Personally, I welcome anyone friendly to aspies, regardless of their neurology or psychology.


Let me try to help sort it out a bit...
- social anxiety: also affects public speaking, taking the bus, going to the mall, ... while AS doesn't really (but aspies often also have social anxiety due to years of failure)
- schizoid PD: avoids socializing by choice - aspie-like in adulthood, but normal when very young (but again many aspies end up with this too)
- schizophrenia: delusional - aspie-like in adulthood, but normal when very young (can look like schizoid PD at first)
- narcissistic PD: can't ever admit/accept than anything is their fault (nice aspies can apologise once they realize they screwed up)
- sociopathy: lacks remorse, not just empathy (nice aspies will avoid /knowingly/ hunting people)
- ADHD: distracted, forgetful, have to get up and run, ... "pocket macarena" ... (many aspies and relatives have this too)
- CAPD: trouble processing sounds, which can lead so avoiding noisy places/situations (many aspies and relatives have this too)
- dyspraxia: bad motor skills, which can lead to avoiding situations like sports, etc (many aspies and relatives have this too)


Incidentally, i was diagnosed with schizoid PD before getting my PDD-NOS diagnosis, and I think dyspraxia and CAPD also fit.


Long posts like this one are most commonly caused by compulsive rambling disorder. Despite many claims of miraculous recovery, there is no scientifically proven cure.

Last edited by ghostpawn on 11 Mar 2009, 1:42 am, edited 1 time in total.

oh, and if you think you might have all the conditions listed above (and more), ask your doctor if you might have hypochondria

I tend to hang on the outside edge of social situations, but can speak publicly quite fine, especially as I can be very polite and well spoken. I recently spoke in front of at least 40 people in Parliament, yet I don't particularly enjoy speaking to my mum :p

You mis-spelled 'taking', but I find taking the bus is fine, provided I don't run into acquaintances, as I like to travel with only my mp3 for direct company.

I tend to be the opposite of narcissistic, sometimes claiming more responsibility for things than is necessary. For example, I have blamed myself for 8 years that an old acquaintance was attacked in the street when I didn't meet her at a bus stop. Fair enough, I should/could have been there, but reality says I could not have predicted the events that happened. It's little comfort.

ADHD seems off, as I tend to only crave limited attention. I do crave attention, and can get quite frantic at being ignored, but hate being the focus of attention. As for hyperactivity, this only really makes appearances when I'm in a bouncy mood (manic??).

I'm not too bad with loud/quiet sounds, only certain scratchy ones, quite a few more than ones that bother others (peers). I can walk quite happily into a building with blaring fire alarms, but absolutely cannot bear hearing plaster being sanded off a wall, as I found a few weeks ago. Nobody else present was at all perturbed by it, but for me, it had 'fingernail meet blackboard' effect. Agony.

As for dyspraxia, my handwriting is legible only to humans, and that's barely, for some people. For most, it's ok. For handwriting recognition software, I may well be writing in Arabic. I also run funny, "legs everywhere, like a duck", according to my flatmate.

However, my eye contact is fine. I'm a little unclear about specialised, focused interests. How 'into' something constitutes the threshold? I've been an avid map reader since I was about 6, and can use them easily, but still can't give directions very well. I wouldn't call my daily dive into Google Maps 'an obsession', though. Dates, times and astronomy captivate me, but again, not (IMO) too much. I think the one thing I really need to calm it on is the fact I spend around 16 hours a day here on WP. Obsession? I don't actually know. It's fun and informative. That time is healthily spent.

Rituals: There's my coat, for example. Everything has a designated pocket when I'm out. If I put something in the wrong pocket, I can end up in a bit of a panic about it being 'lost'.

I notice how your checklist 'did the trick' to an extent. I have actually got somewhere with describing myself. That part's missing on the original post.

Thanks

((((hugs))))

~LL~

I feel EXACTLY the same way.

This resource should definitely include any self-administered evaluations that are out there that people can agree are accurate, like that "Aspie Quiz" etc.

Wow! Your responses all seem so familiar!

Yes, social anxiety includes fear of crowds whereas AS by itself doesn't.

Fixed the typo, thanks for spotting it.



Definitely not narcissistic then.



I sense a misunderstanding. Attention-deficit doesn't mean you crave attention, but rather that you're distracted and disorganized, which may be caused by limited short-term "working" memory. So for example you'd constantly misplace keys and other common items, forget items on mental lists, show up with mis-matches socks, etc. The "pocket macarena" mental image was very familiar to every person I met who had ADHD. As for hyperactivity, it seems to be the reverse of motion sickness - hyperactive people feel sick when staying still for more than a few minutes at a time, yet feel comfortable when moving at break-neck speeds (or being bombarded with sensory information).

Meanwhile mania involves delusion, or at least extreme optimism in the case of hypomania.

Q: Why did the Bipolar guy jump off the bridge?
A: We're not sure, either he wanted to kill himself (depressed) or he thought he could fly (manic).

I'm not sure how someone who's bipolar can really self-diagnose with mania, but depression tends to be depressingly realistic, pun intended.



Hmm, I don't know so much what to say about this.

I think sensory sensitivities cause problems based on volume, and maybe some frequencies more than others, while CAPD has more to do with the pattern than the volume, like difficulty sorting out voices from background noise, getting used to annoying sounds, and remembering spoken information.

Like if the radio or TV is on and someone tries to talk to me, their voice sounds a bit like... they're talking through a glass of water, maybe. It's still recognizable as human, and I can still catch a few words here and there, but for the most part I couldn't tell you what language they're speaking. The usual

Suggested coping mechanisms for CAPD include taking notes, and reading body language. As if I could.



I takes me a few minutes to sign my name on forms and things. I can write legibly, but it takes longer than normal and my hand starts to cramp very quickly.

I also had/have difficulty with scissors, brushing my teeth, and so on. If I didn't have my electric toothbrush I think I'd just let my teeth rot away.

I've been told I walk like a drunk, too fast, too slow, etc. I used to fall a lot and drop things until I learned judo (I recommend it for anyone).



Meaning you can intensely stare people in the eyes like a psycho, or that you make appropriate and timely eye signals?

If your profile picture is representative, I'm thinking it's more like the former. Search for images of "thousand yard stare".

People are so picky. Too little eye contact and you're evasive, too much and you're a homicidal maniac.

Combine an intense stare with a big happy smile and you can scare the life out of people. Even some who know me find that so creepy they can't stand it.



If you talk about a subject until people verbally tell you to change topic, neglect other important activities to do research/analysis/work on it, and no detail is to minor to study, I think it's an obsession. It can be anything - train schedules, doorknobs, football, martial arts, game theory, music, religion.

On the other hand, I think aspies are just obsessive in general, and like normal people some have wider interests than others.



My coat is a different color, but I'm the same way. I never leave home without it, even in the middle of summer.



With the extra details you just provided it sounds like AS or schizoid, and some experts aren't sure there's a difference. Probably also some dyspraxia, still not sure about CAPD or other such things.

Hi LuckyBunny

pop down to your library and go to the health section and there should be several books on aspergers. I would recomend Tony Attwoods Complete guide to aspergers (most librarys carry this) or any books by Luke or Jacki Jackson. Most books will give you a good picture of AS as long as their not too old. Stear clear of Simon Baron Cohen as he writes with an emphasis of 'other' about AS which makes it hard to relate to the descriptions as they are painted as so unhuman lol.

Thanks for starting this topic LuckyBunny. It resonates with me too, though I suspect that veterans of the WP community must see variations of this arise very regularly and maybe they take turns to reply to the latest confused and curious people to arrive.

I'm very much in your situation I think, though you've been looking into the possibility that AS is the source of your difficulties for a bit longer than I have. We're not exactly the same in the traits that we have identified in ourselves, but we're similar I think in where we have reached so far. Unlike you, eye contact is a problem for me - though I confess I didn't really understand how poor I am at making and maintaining eye contact until after I first stumbled upon information about the spectrum. I really suck at that and it's a wonder that more people haven't said something about it to me over the years. I've been trying to do something about it since I appreciated just how bad I am, but it's really difficult - people provide a running commentary with their eyes to elaborate on their actual words, but unfortunately for me it seems to be in Mongolian!

When I look at them critically, I do meet the diagnostic criteria for AS in (for instance) the DSM, though some of the traits are expressed comparatively mildly which sometimes makes me doubt that I am aspie. I have a fondness for routines for instance (like you I can tell if I've forgotten anything just by patting my pockets in turn), and it takes me ages to get out of the house in the morning because of it, but compared to the examples I've read of others that side of things is pretty manageable for me. So maybe as well as a list of potentially diagnostic issues what we need is an expression of how debilitating those are for people?

Those aspie traits that cause me the most problems from day to day are the social interaction issues, so bearing in mind that helpful list of alternate diagnoses in ghostpawn's post I'd be inclined to assume that perhaps what I really have is some form of social anxiety disorder. But I don't actually meet the criteria for that very well. I can't cope with public speaking as well as you seem to LuckyBunny, but I speak to meetings every day without too much trouble, cope OK with public transport, can go shopping easily enough if it's not too noisy and crowded (but hate music stores and the sort of clothing stores my children always want to take me to - the ones with flashing lights and thumping music).

We're quite involved with church, and thinking that through I've realised that the things I can do include some which would be out of the question if social anxiety were my main problem. I can stand on the front steps welcoming people for instance, because there's no real small talk or interaction to that, you say pretty much the same thing to everyone. But I can't meet the same people en masse at coffee time afterwards because it's all noisy and confused, with multiple conversations in earshot, people interrupting you, and no time to think of a proper reply to what people say.

I hide in the kitchen, though washing the cups isn't necessarily the best option actually because I'm quite clumsy. I have no problems accepting the dyspraxia diagnosis from ghostpawn's list. I was always terrible at all sport at school, though quite good at karate for some reason when I discovered that at college. I am still really clumsy and unco-ordinated, can't drive for instance, and I have distinctively awful handwriting that everyone at work can always spot at once whether they can read it or not.

So there you are. Possibly AS depending on how you interpret "clinically significant" in the context of routines and stimming, possibly co-morbid with dyspraxia ,and certainly co-morbid with compulsive rambling disorder.

Ghostpawn, Your views on CAPD and the thousand yard stare are interesting. I've often wondered if that look had a name. Thank you

It doesn't work like that. If you consider getting a diagnosis, you must fit the criteria. Doesn't matter what other traits associated with the condition you think you have.

You must fit the criteria or you cannot receive the diagnosis because you don't have the disorder as it is defined by the criteria.

There's BAP too, you know. Broader Autism Phenotype.

Not an official diagnosis, because individuals with BAP usually do not have any significant impairments that those with a PDD have. They can also have those many traits that are often associated with AS, for example, but are not part of the criteria. (sensory issues, slight communication abnormalities and so on)

AD(H)D doesn't have to do with seeking attention.

It can be a side effect of the symptoms (when the kid with AD(H)D is ignored a lot due to their syndrome or is so hyperactive and impulsive that they often attract attention without knowing or if they have additional independent disorders such as ODD) but it's not a symptom of AD(H)D.

Yes, but often the criteria don't explain the symptoms. You can research the symptoms, but then you're left with knowing what isn't normal, instead of knowing what is. The manuals are no good for a self-diagnosis unless you really work at understanding normal and abnormal for the listed traits.

I am so tired of seeing what isn't normal. I once read an article about eye contact, and how much is normal, and then I asked other people if that is the case, and they were like, "What? No, that's too much." So I read another, and that one is also too much. Granted, I never make eye contact, so I don't need to know how much is normal for a comparison.

What about routines? What is normal for that? How many routines are required? How complex or simple can they be? Do the routines lack a logical reason? Do the routines have to be recognized by the individual? Are they planned for structure?

What about change? How does that work? Does that mean aspies don't clip their nails, or clip them quite frequently? They don't get their hair cut or get it cut quite frequently? Maybe it is more of change of environment? So they don't wash dishes or do them all the time? Okay, so those are stupid examples, but it works my point. What kind of change? Or is it not limited to any specific kind of change and it just happens to be dependent on the individual?

You see, people read the criteria and symptoms and it seems they know exactly what they mean. I have done hours and hours of reading and have read many stereotypes, a lot of BS, and pretty much the same undefined crap everywhere. Heck, I have read autobiographies on individuals formally diagnosed with AS and even what they describe appears lacking according to the criteria.

So, I'd appreciate a little bit of definition as opposed to a checklist. How about some expanding instead of compressing?

I previously noted that the diagnostic criteria fit me vaguely, if at all. Now that I've dug them out (couldn't remember them all off-hand), I can elaborate, point by point:

DSM-IV DIAGNOSTIC CRITERIA FOR ASPERGER'S DISORDER
A.Qualitative impairment in social interaction, as manifested by at least two of the following:
(1) marked impairment in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction

* Unsure. I actually read a book ('Body Language' by Allan Pease) on the subject as a child. It used to be one of my favourite books, behind the Family Medical and Health Encyclopedia. I've noticed that the majority of the 'signals' described in the book do not actually occur in real life (or do I just not see them?). Feet indicate intent, palms up - honesty, nose touch - lying.... every time I've spotted these things, it's been incorrect.

(2) failure to develop peer relationships appropriate to developmental level

* Again, unsure. Usually, my friends are somewhat younger or older than me (with the exception of my flatmate, who is only 6 months younger). Also, the ratio of online friends to real life friends is close to 30:1. Off-topic, I'm sure, but I really don't 'get' what's being described in the criteria here.

(3) a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g., by a lack of showing, bringing, or pointing out objects of interest to other people)

* Yes. I usually need prompting in this area.

(4) lack of social or emotional reciprocity

* Had to ask someone, but the answer came back in the affirmative

B.Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
(1) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus

* As previously mentioned, unsure.

(2) apparently inflexible adherence to specific, nonfunctional routines or rituals

* Not certain. Again, I don't quite 'get' what's being described here.

(3) stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)

* If this includes playing with fingers and hands, and neck rubbing, then yes.

(4) persistent preoccupation with parts of objects

* I can say no to this one.

C.The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning.

* I'm jumping on 'occupational', I've had few jobs, far between, and the longest time I've been employed is 3 months (probationary period). I spent 5 months as a courier, but that's technically a self-employed position.

D.There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years).

* I was reading children's books aloud by 3. Check.

E.There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than in social interaction), and curiosity about the environment in childhood.

* To the best of my knowledge, no delay. Check.

F.Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.

* Needs exploration.

So basically, there's a lot of uncertainty on my part as to whether I fit most most of these. Though I am near certain in my opinion, I disregard my opinion in favour of objectivity, and recognise that I am not exactly a professional.

That said, I recently saw professionals who seemed to show even less understanding than me. I saw an educational psychologist in 2006, who first flagged up AS as a possibility, but her instructions only asked for a test of cognitive ability, and I'm sure diagnosis would have required a separate appointment. She flagged up potential AS after doing Weschler Adult Intelligence Scale-IV, House-Tree-Person Test, Kinetic Family Drawing, and Thematic Apperception Test. There is a comment in her notes about good eye contact, which is where I sourced my previous mention.

The recent psychologists (a pair) sat with me for a half hour and declared me NT after no tests whatsoever. Their diagnosis seemed hugely flawed to me, as it seemed they chose some of the wrong questions to ask, and missed a lot of right ones.

Okay, I'll stop now, before I write a 50 page reference guide to my life. :-p

((((hugs))))

~LL~

I think the expanded texts on the ICD-10 and the DSM-IV-TR on both AS and classical do provide many of the information needed for interpretation of the criteria and for a diagnosis. The criteria of the ICD and DSM are not meant to be used by professionals without the expanded texts for reasons of misinterpretation.