Asked Dr. about the possibility of having AS, and..

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SarBear
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25 Sep 2009, 3:15 pm

I think I need a little bit of advice.

I made an appointment to see a psychologist I used to see regularly, but haven't in a while, mostly to run by her the possibility of having Aspergers. I'm a little bit disappointed about how it went because she said that she didn't see it in me, because my eye contact is alright. She said that she believed I am really shy, but that there is a difference between shyness and Aspergers. Is it common for a doctor to shoot down the possibility of AS based on decent eye contact?

I wish I would have told her that I can make eye contact, unless I'm really nervous, but that it's hard for me because I spend a lot of energy or thought on trying to "regulate" my eye contact....like trying to make good eye contact, to maintain it, to make it at the right times, ect.

I think next week maybe I will bring it up again...and maybe tell her that I think I need to try to explain things a little better, because I don't think that the way I appear is anything close to how I experience things. I find it really hard to know how others perceive me. Up until recently (when I discovered what AS really was and found the forum)..before then, I've tried my hardest to hide the symptoms that I can now clearly see as Aspergers....maybe I put up a better act than I thought.

What do you guys think?...should I bring it up again? Can anyone offer any suggestions? I really don't know much about the level of awareness and acceptance Drs have of Aspergers...is this going to be a hard thing to get someone to look into it or take seriously?

Thanks for reading this guys. I guess I'm still a newbie with lots of questions : )



Willard
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25 Sep 2009, 3:26 pm

Is this a psychologist, or a therapist?

A psychologist can put you through a battery of diagnostic tests to determine whether or not you have AS. A therapist may make a cursory evaluation, but can't formally make it a medical diagnosis.

But I do think she's kind of brushing you off unfairly. If you've read up on the condition and feel that it fits you to a T, she ought to at least take the possibility a little more seriously.

I, too, can make eye contact normally if I need to, or feel the situation or conversation calls for it, but I certainly think more clearly during a dialogue if I'm not doing it. It makes me quite uncomfortable if I have to do it for extended periods.



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25 Sep 2009, 3:32 pm

Usually once a clinician has a diagnostic impression, that impression sticks. It's hard for them to change waht they see. For a lot of them, it's hard for them to see what they did come up with on their own, which is stupid and frustrating. If you want to pursue a diagnosis, I would suggest seeing someone a-fresh, or if you want/need to stick wtih this person, I would suggest writing down specifically what makes you think "Asperger's" in yourself.

Just my two cents.



DylanMcKay
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25 Sep 2009, 3:56 pm

I went back and skimmed your first post where you were thinking about printing it out and handing it to the psychologist for her to read, were you able to do that? It sounds to me that you do have some sensory concerns like with what you described about going to the movies. To me, that doesn't sound like "shyness" and would seem to be more indicative of something else that is more inherently neurological such as asperger's.

I have been to a psychologist exactly one time in my life, and all that I got out of it was a recommendation that I check out a Dale Carnegie book from the library. Now, no offense to Mr. Carnegie because I'm sure he was a great writer, but I didn't need to see a professional just to be told something like this! So sometime when I get insurance again I will probably seek more help again. Hopefully you will get better advice and answers in subsequent visits. Good luck to you and keep us posted!



SarBear
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25 Sep 2009, 7:30 pm

Thanks everybody for the replies : )

Willard:

She's a psychologist,....so I am hoping that she will look into it some more, she said she would. She is really nice -I just hope she gives it some more thought. She did give me a questionnaire-type-thingy but it was just typical mental health questions. That's how I feel about eye-contact, too. It's difficult to concentrate on the eye contact AND the conversation at the same time.

SuperTrouper:

Yes, I have noticed that before too in some docs. Well, with any kind of doc really. Yes, it is frustrating, and kind of a discouraging thing since we all want Dr.s (any kind) to look out for our best interest and not their ego. That's how it is with some doctors, anyway. It's a shame they do that.

Dylan:

I didn't print out the post because I sort of chickened out and wasn't going to bring it up the first appointment. lol I probably should have taken it with though. That's a bummer all the Dr. did was tell you to buy a book....that's an expensive appointment for a book recommendation! lol



Danielismyname
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25 Sep 2009, 8:11 pm

If you have normal eye contact, you can't have an ASD.

However, abnormal eye contact can appear as normal to the untrained eye; intently looking at a single point on a person's face to avoid eye contact can oftentimes be seen as such, as well as constantly shifting your eyes away, even though you're facing the person correctly.



zer0netgain
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25 Sep 2009, 8:28 pm

My 2 cents....

Based on what I've heard on WP, any ADULT looking to be evaluated and diagnosed with AS needs to find someone who does AS diagnosis in adults and is willing to issue the diagnosis if they can find supporting evidence in your evaluation.

Adults with AS frequently learn to adapt and repress AS symptoms to pass as "normal" and get by in society. So, a lot of AS sufferers won't appear very symptomatic during an evaluation. It is also possible to have AS symptoms that are most severe in the ways that don't show in a one-on-one evaluation but would be obvious in a group social setting.

Get someone with limited knowledge, experience or even bias against AS as a diagnosis and you likely won't like the outcome of the sessions.



Danielismyname
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25 Sep 2009, 8:41 pm

Well, you can go and see Professor Attwood himself, and he'll tell you the same thing I just did. You need inappropriate eye contact to have it, and there's physiological reasons for why the eye contact is inappropriate (two papers spring to mind; one is a heightened fear response, which is really a chicken or the egg question, and signals from the optic nerves are degraded).



pandd
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25 Sep 2009, 11:04 pm

People who do not know how to look for the difference are surprisingly easily fooled, especially if they are more than a metre or so away (as psychiatrists often are when carrying out assessment).

I would expect a specialist to have the expertise to not allow themselves to be fooled, but the whole point of “faking it” is that the result is reasonably plausible and non specialists (in assessing for ASDs) are as easily fooled as the rest of the general public in my experience.



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25 Sep 2009, 11:51 pm

Anybody can have an opinion and in some cases that will be a very insightful and well-informed opinion. But I believe that Aspergers is a psychiatric condition that can only be "diagnosed" by a psychiatrist. Abnormal eye contact is a very common symptom but not required for diagnosis. DSM IV criteria for Aspergers

My daughter was recently diagnosed with Aspergers. I'm not sure that her eye contact is unusual and the doctor didn't mention it, but she fits all the other criteria quite well (except perhaps "persistent preoccupation with parts of objects" which I never really understood anyway).

You know yourself better than any doctor. If you believe that you meet the DSM4 criteria then you are very likely to have AS. One of the great things about WP is that sometimes it's hard to understand what the DSM4 criteria are referring to. What is a "restrictive pattern of interest"? What is a "repetitive motor mannerism"? From reading WP you can get a sense of Aspie experience and see whether or not it matches your own.

Good luck.



sinsboldly
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26 Sep 2009, 12:54 am

Danielismyname wrote:
If you have normal eye contact, you can't have an ASD.

However, abnormal eye contact can appear as normal to the untrained eye; intently looking at a single point on a person's face to avoid eye contact can oftentimes be seen as such, as well as constantly shifting your eyes away, even though you're facing the person correctly.


this. People see what they want to see and if they don't notice you are faking it, then what kind of a therapist are they anyway?


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bhetti
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26 Sep 2009, 1:53 am

I got the same response from a psychologist, the one who is handling my family evaluation. he's a respected forensic psychologist and when I went in for my interview I told him up front that I have a provisional dx of asperger's and he told me he was initially confused by my good eye contact skills because my physical aspect kind of screams out "AS". he asked me how I got so good at it and I told him: over 30 years of practice after hearing someone complain about our cultural expectation for it. I didn't realize until I heard the complaint that eye contact is important to people.

my therapist, who was the first person I went to about AS, had already been seeing me for 2 years and didn't believe it was possible that I had it because of how well I make eye contact, but she went through the criteria with me anyway since I have a couple of family members with PDD's. she concluded I'm on the spectrum and sent me to my shrink to confirm. he confirmed but wanted me to get a specialist for full assessment because he doesn't have the qualifications. it may turn out that I'll be dx'd NLD or "other" but I kind of doubt it.



TheCurs
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26 Sep 2009, 5:54 am

Hi SarBear,

I had a very similar experience to the one you are describing when I was diagnosed with AS last year. A CPN I had been seeing for about two years totally dismissed the possibility that I had AS when I suggested I thought I might have it a couple of years back. He was equally dismissive when I recieved the Diagnosis last summer. I showed him the printed report I recieved from the team that DX'd me and he felt it did nothing but focus upon my 'quirks' ( obsessive interests etc ), saying "well everyone has these" and not getting the intricate differences between how an autistic person and an NT experience the world. Like I was trying to explain to him as an example how, if I'm on a bus and its very busy (especially if theres lots of students on) that the noise for me goes beyond being intrusive and while I understand that many NT people hate being in similar situations they can cope by just switching off wheras I can't do this and thus having to listen to dozens of conversations that I am not a part of is just sensory overload and I have to try very hard to try and relax and get through it. Basically he thinks I am just a very shy person who is naturally quiet and reserved, and to a degree he's right. But as I've started to progress I've realised that I am not shy, I want to take part and socialise (most of the time), I just don't know how to and this causes depression which makes me withdraw and therefore others think I'm just really shy because they are not aware that I have AS. My CPNs reluctance to take my AS seriously may stem from the fact that he only really sees me on a one to one basis and, because I have grown to be calm and relaxed with him, I come across as pleasant and articulate. He rarely sees the other side of me that withdraws completely in a group situation or struggles to take part in office banter and, when he does, in his mind this probably just supports his belief of me as being very shy

Now, I have a LOT of respect for this particular CPN. He helped me, through exposure therapy, to overcome a lot of my Social anxieties and to start doing things that I enjoyed again. When I had started to make significant progress he asked me to take part in a Pilot scheme in a new mental health service within the area of the UK in which I live and over the last 3 years this has developed to such an extent that I am now working 10 hours a week, helping others overcome their anxieties and depression and am slowly and steadilily building a little career for myself within the mental health field. Four years ago I honestly believed 100% I would never work again because of my difficulties. Therefore I can't help but be totally grateful to my CPN for basically handing me a great opportunity in life on a plate. I still see him regularly as he works in the same office as me and I get on well with him and consider him someone I can go to if I'm feeling down, about most things.

Anyway SarBear, the best advice I can give you is if you feel you're getting nowhere with this psychologist, if possible make an appointment with another one and keep trying as many as possible until you find one who takes your feelings seriously. Try your Gp aswell, if you haven't already, and just say you think you might have AS and you want to be tested, can they advise you where to go. And don't be put off by a negative reaction, unfortunately a lot more education needs to take place within the mental health sector to inform some practitioners that people with AS arn't carbon copies of one another and you can't dismiss the possibility that someone has the condition just because they maintain good eye contact or articulate themselves fluidly and with confidence in the setting of a one to one interview. But on the flipside there are drs etc who will listen to what you have to say and help you seek the diagnosis you want. If you get negative feedback from one person just don't go back to them with this particular problem, try someone else. I'm sorry if this sounds glaringly obvious but this approach worked for me in getting my diagnosis and it is the only advice I can think to give.

Hope it helps and take care.



AnnaLemma
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26 Sep 2009, 7:55 am

My paltry experience with psychology professionals suggests that their experience/expertise drives their conclusions. I mentioned it to both and one immediately dismissed the idea, the other was pretty convinced that I had it. That was good enough for me, since at my age pursuing a "real" diagnosis is pointless, but many of the suggestions for AS folks work extremely well in my life. Although the field of professionals experienced in dealing with adult AS and its presentation may be small, it could be worth trying to find such a person for your peace of mind.


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26 Sep 2009, 3:06 pm

I have AS and used to appear to make reasonable eye contact and really, I seemed a little shy sometimes or made social mistakes but most people wouldn't have been able to see the AS.

Eye contact is a form of communication and it is not just about looking at a person's eyes. That is why it is important for an autism specialist to diagnose people.

When I first told my own GP about my concerns, she doubted it because often people with AS do very well on a one to one basis and can hide the difficulties adequately. Compare this to my specialist who clearly knew I had something autistic going on within the first twenty minutes.



24shaz
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26 Sep 2009, 3:19 pm

I was told by a doctor who specialises in behavioural problems that it was unlikely my son was autistic because he made appropriate eye contact with her during a half hour appointment, but she referred him on to the multidisciplinary team and six months later - after a week long assessment - he got the dx. His eye contact is good when he is interested in a person or wants something from them, he makes great eye contact with family members and other people he knows well.