Social skills versus social analytical acting - diagnose?

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ConfuzzledWeAre
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17 May 2012, 7:28 am

Hello there, and sorry about the world of text, this has been bothering me for weeks and I have no one to talk to about it... main points in bold!

My boyfriend had a complete breakdown a year ago, and has been going to a psychologist pretty much weekly since. She's had a really hard time figuring out what may be the underlying cause of all the problems that have been building up, and she's been honest with us about how difficult it's been to try to find something that matches the whole time. As I said, she's a psychologist and in our country, psychologists don't handle things like aspergers, autism and ADHD beyond the basic "how do you feel", those things are diagnosed and handled by psychiatrists only.

Anywhoodle, she brushed past inattentive ADD at one point, admitting that it was a long shot, but I have ADHD, diagnosed about 5 months ago and we both know that my boyfriend doesn't even begin to check the boxes for ADD. After that, she started looking into neurologically based disorders and she landed on Aspergers. As she started reading up what Aspergers is from one of her bible-sized books, it really started to make sense for all three of us, even though we realised that there are some key points that will make it very difficult for my boyfriend to be taken seriously by a psychiatrist if we approach them about testing for Aspergers.

My boyfriend isn't out going, but he appears to be to anyone he talks to. He appears socially skilled, he appears empathic, he puts on a mask and it's so near flawless, you have to spend quite a few hours around him to look past it. That, or ask him what he thinks of your hair/outfit/etc, at which point you get a dead honest answer with no regard for your emotions, "if you don't want to know the answer, why would you ask?" he ponders, if this happens while talking to someone.


The truth is, he has no interest in socializing, making friends or upholding friendships. The truth is, he behaves as is "expected" or "considered polite". He tries to be different from his father and sister, who have even more obvious traits of Aspergers, by asking people how they are, laughing, joking, smiling and showing compassion abeit on a very analytical and by-the-book level.


If you spend time with him every day, you start to notice that he always tell the same stories, often the same way, to different people. His topics of conversation are often on repeat. he likes to repeat his points, and if he feels he's right, he will only give you a very superficial shrug at your opinion.

Another potential problem when we talk to a psychiatrist is his language skills. He speaks 3 languages fluently, abeit mechanical and overly "correct". he forgets words during sentences, but laughs it off before you really notice. He corrects people constantly, and sometimes when faced with a new word or expression, denies it's existance or correctness. However, he's not very good at writing. His written language is very to-the-point, with a fair few spelling or syntax errors, he repeats himself, often writing "usage" or "however" sixteen times in the same paragraph - but would a psychiatrist who isn't really an expert on aspergers care about these minor, well hidden things? Or would he brush it off, saying that many NT people write worse, or forgets words more often?

In our country, not ONE psychiatrist is an expert on adult aspergers/autism. Every single psychiatrist with autism as their specialty works with children, my own ADHD specialist and head of the ADHD research centre admitted this, stating that several of her ADHD patients have strong autism traits but she can't do anything but send them to a general, private practice psyhciatrist.

We've talked to one, and he didn't seem to think Aspergers was very likely at all, simply because my boyfriend can feign social empathy, but the way I see it, the problem is that the man wasn't intelligent enough to delve into the territory of "what if"

What if, a highly intelligent Aspergers child with a troubled childhood, abusive parents and no friends, find studying people and computers to be his special interests? What if the same highly intelligent Aspergers child suffer deep depressions, or other comorbid conditions? What if the child grows up with no ambition, but just one single goal, "I don't want to be like my parents". Who is to say, that child wouldn't develop amazing skills in acting, displaying correct behaviour, learning what phrases to use to make people feel like he cares what they say?

And why wouldn't you ask the family if his behaviour at home differs from this outwardly confident, authoritary, social mask?

I deeply fear that we won't be heard, because my boyfriend has very obvious problems. He has no ambition and despite having an education, he finds himself like a fish out of water in any and all work/carreer situations. He doesn't want to be a drone he says, and whenever he has a job, he is deeply depressed, almost appearing to be imprisoned by his own life, and hates himself to the point where he is suicidal. His temper is explosive and he easily loses control of himself when he gets pissed off, throwing items or hitting himself (but never others). He doesn't care about social interactions, doesn't ever miss having friends, finds it more trouble than it is worth, keeping in touch with people, brush people off the first time they disappoint him and don't give them second chances except in exceptional circumstances... He's intelligent, and he knows it, but he often misjudge situations, is overly logical, have poor abstract skills, is deeply interested in and spends a lot of time on games, gadgers and computers. He's easily bored, never played with anything but lego and other building/sorting toys as a child, questions love, and he really does tick a lot of boxes in the Aspergers questionnairs and charts I've found so far.

I'm not sure if it actually IS aspergers, but if it isn't, I want him to be taken seriously because something is definitely off, and it isn't something that changes over time. I know myself, how good it was to finally get a diagnose, an answer to why I'm experiencing things differently, having so many troubles with fitting into "normal" society, and I'm convinced part of our relationship is based on this understanding we have between us, in an "us against the world" kind of sense.



Blownmind
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17 May 2012, 12:53 pm

Welcome to the planet!

I read all the bold points, and couldn't find a question anywhere. ..so I went ahead and read it all.

The things you mention about him acting normal for others, that is common among Aspergers with above normal IQ. My wife has experienced this with me, and it can be hard to get sympathy and understanding from others when the problems talked about never shows themselves to anyone else than her. Which leads to her feeling even more lonely than she does when I dive into my special interests.

Some Aspergers want to socialize, make friends, uphold friendships, they just aren't able to do so. But then again some Aspergers don't bother socializing.

Does he indulge in his special interests after he has been in a social situation? If he does, thats another checkbox for Asperger's to tick.

Have you considered Schizotypal Personality Disorder, that might be a valid diagnosis aswell?


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AQ: 42/50 || SQ: 32/80 || IQ(RPM): 138 || IRI-empathytest(PT/EC/FS/PD): 10(-7)/16(-3)/19(+3)/19(+10) || Alexithymia: 148/185 || Aspie-quiz: AS 133/200, NT 56/200


FasHawks8
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17 May 2012, 1:31 pm

I'm just curious, what country do you live in? It can be extremely difficult for an adult to get an accurate diagnosis based on all the coping skills you wrote about. The smart ones learn tricks to get by.



ConfuzzledWeAre
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17 May 2012, 1:42 pm

We live in Denmark, and my psychiatrist told me straight out that it's rare for adults to get diagnosed with Aspergers here.

There have been psychologists, psychiatrists and worried teachers in his past, but his parents have done a "good" job ignoring them, they're wonderful people, but they weren't always. His father disrespects psychologists and psychiatrists completely, probably because he knows something's off about himself. He doesn't have my boyfriend's coping mechanisms, and shows all signs in the newest diagnose chriteria of having Aspergers.

The question, which I probably forgot to formulate is basically if there's something we can do to make it more clear to a psychiatrist that he's acting, that it's analyzed, studied behaviour and not natural for him, and that he really CAN be clumsy, socially, the way I KNOW he can be...

I looked into schitzotypal personality disorder, but he doesn't really check many boxes there, not only because he doesn't have any "odd" beliefs really, but mostly because he does care about people, just very few people, myself included. We knew each other for 4 years before we became a couple though, and our first weeks together he talked very philosophically about what love is. His sister repeats the same things he said then these days, she's very worried she'll never be with anyone.

*sigh* another super long post but...Let me try to break down the symptoms as I and his psychologist see them compared to the Aspergers criteria:
[i]
A. Persistent deficits in social communication and social interaction across contexts, not accounted for by general developmental delays, and manifest by all 3 of the following:

1. Deficits in social-emotional reciprocity; ranging from abnormal social approach and failure of normal back and forth conversation through reduced sharing of interests, emotions, and affect and response to total lack of initiation of social interaction,
[/i]

Yes, well masked, but definitely there.

2. Deficits in nonverbal communicative behaviors used for social interaction; ranging from poorly integrated- verbal and nonverbal communication, through abnormalities in eye contact and body-language, or deficits in understanding and use of nonverbal communication, to total lack of facial expression or gestures.

I wouldn't know about eye contact, I have ADHD and suck at it myself. Body language is stiff, over analyses people's reactions, corrects people's language, writes very "dry", talks very "correct", forgets words often or can't explain something the way he wants to.


3. Deficits in developing and maintaining relationships, appropriate to developmental level (beyond those with caregivers); ranging from difficulties adjusting behavior to suit different social contexts through difficulties in sharing imaginative play and in making friends to an apparent absence of interest in people


Relationships with caregivers are real, but he's overly honest and hurt people inadvertently, finds conversation boring, doesn't want to go places or do things with people, prefers to just do his own thing even when socializing, has one single friend and she keeps in touch.


B. Restricted, repetitive patterns of behavior, interests, or activities as manifested by at least two of the following:
1. Stereotyped or repetitive speech, motor movements, or use of objects; (such as simple motor stereotypies, echolalia, repetitive use of objects, or idiosyncratic phrases).


Repeats topics that interest him, things MUST be done his way (ritualistic habits), if I cut bread the wrong way, he'll "teach" me how to do it "properly". keen coordination, including fine motorics such as finger movements. (but terrible hand writing).


2. Excessive adherence to routines, ritualized patterns of verbal or nonverbal behavior, or excessive resistance to change; (such as motoric rituals, insistence on same route or food, repetitive questioning or extreme distress at small changes).


Like I said, yes, hell yes. He can eat the same thing for a week, he likes routines to be spot on and sometimes even gets anxiety attacks when something comes up.


3. Highly restricted, fixated interests that are abnormal in intensity or focus; (such as strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).


Yup, definitely.

4. Hyper-or hypo-reactivity to sensory input or unusual interest in sensory aspects of environment; (such as apparent indifference to pain/heat/cold, adverse response to specific sounds or textures, excessive smelling or touching of objects, fascination with lights or spinning objects).

Has amazing hearing, some noises drive him mad, clutter in his environment drives him mad, deep fascination with colour changing lights and special lamps, and one of the first things I noticed about him was how all of his clothing is extremely soft with tactile textures. Keen sense of smell, and very "primal" when it comes to touch


C. Symptoms must be present in early childhood (but may not become fully manifest until social demands exceed limited capacities)

Yes.

D. Symptoms together limit and impair everyday functioning.


Yes because he doesn't fit in with the norm, work life is impossible for him, and it takes a patient person to endure his stubborn, honest and negative look on life sometimes :roll:



Last edited by ConfuzzledWeAre on 17 May 2012, 2:09 pm, edited 1 time in total.

Tuttle
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17 May 2012, 1:46 pm

The first thing that comes to mind with that description is the question of whether he's always been like this. That's not a question you can answer, but one which would be quite relevant to looking further into Asperger's.

People who were mistreated as children are more prone to developing traits that are often associated with the autistic spectrum.



FasHawks8
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17 May 2012, 1:58 pm

Well rare isn't impossible! Would his mother be willing to help in any way? I would guess psychiatrists would much rather hear from the mother than the father anyway in most cases.
I wish you both luck.



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17 May 2012, 2:07 pm

Social interaction is much like that for me - spitting out repeat stories, responses, etc. I also have little desire for friends, and find many/most friendships to be a real pain to maintain. I often feel incredibly bored doing things with friends, and feel like I'm wasting time. All the friendships I do maintain have to do with my special interest - music. Whenever we hang out the topic is pretty much always on a special interest if we're talking, or we are actively playing music. But this is the only social interaction I can really stand.

I wouldn't be surprised if he has some form of Autism. I was diagnosed HFA/Aspergers as a child.

I don't think social interaction is a special interest of his though. If it were, I think it would give him much enjoyment, and it doesn't sound like he enjoys it from your description.



CuriousKitten
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17 May 2012, 2:11 pm

Aspies that are sufficiently high functioning and motivated can and often do learn how to fake being social very effectively.

Even if he does get a diagnosis, what will he gain?

a fall-back position could be to seek treatment for the symptoms, like the depression and social anxiety.



Ivasha
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17 May 2012, 2:16 pm

ConfuzzledWeAre wrote:
What if, a highly intelligent Aspergers child with a troubled childhood, abusive parents and no friends, find studying people and computers to be his special interests?
[...]
Who is to say, that child wouldn't develop amazing skills in acting, displaying correct behaviour, learning what phrases to use to make people feel like he cares what they say?


Sounds like me, and as you mention: so far I do seem to run in to that very narrow minded view shared by various professionals. I do have another 'diagnostic' appointment coming up next week though so I'm hoping I'll be heard then...

That's the thing isn't it? Being heard. When there's too much 'other' stuff in your life people can attribute your oddities to, they're really not that interested in looking at what else might be going on. And to me, that 'obvious' is not really the area in which I have issues, yet pointing that out leads too 'ooooh you must be in denial!'. Grrr.. :( Sorry for venting some frustration.

Anyhow, I'll let you know if I run into anything useful :)



Rascal77s
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17 May 2012, 5:17 pm

I can't tell you whether he has AS but I can say that it's possible to fake being social and it's how a lot of us get by. For me personally I can be very charming (yes I know some of you are thinking "him???") but it's completely superficial and I don't really feel any connection to the person I'm talking to. It's like a script and after a while I just run out of script and people start to realize there is something 'off' about me. It is also very tiring. From other accounts on WP my impression is that many mental health professionals don't realize that we have this ability to mimic but we can't maintain it for longer than a few hours to a few days, thus they reject AS assuming we don't have a social deficit. IMO it is important that you think about this social issue and explain it clearly so he is not mistakenly rejected for being 'social'. I don't know what other advice to give you. I wish you guys the best luck.