What do I have? I know it's probably not ASD

[Protoman2050]

Hi! My name is Doug. I was tentatively diagnosed with ASD by a child psychologist specializing in ASD when I was three years old. I am currently 18, and I have a lot of doubt about that diagnosis, since several people I know take issue with that dx.

1. When I was born, I suffered 30 minutes of hypoxic brain ischemia, causing periventricular leukomalacia and ataxic CP on my right side (not much of an issue nowadays). Don't you believe that would affect someone's social and physical interaction for at least a few years until the CNS regenerates due to neuroplasticity? How could that previous assessment be valid in light of that
2. I have a WAY more fantastical imagination than the people with ASD I've met, but it probably makes other people look at me like I'm crazy, since I sometimes act out whatever I'm describing.
3. I have a far greater diversity of interests than the average ASD patient (but still odd), from interventional cardiology to admiralty law to heavy metal music to fiction and artwork about werecats/werewolves
4. I often engage in long conversation with myself when alone, or listen to loud music, to break the lack of social interaction
5. At night I have vivid dreams (often continuations of daydreams), often several completely different plotlines interspliced, sometimes so sad as to make me cry (often involving werecats or werewolves, but not violent), others like a day in my future career. But, while they are quite interesting, they interrupt my sleeping. These often go for weeks
5. I have pressured speech, and I am easily distracted during social situations
6. Sometimes I'm in a social situation, and I'm having a sad daydream, and sometimes my eyes water, and I brush off their comments by saying it's allergies
7. Even my closest friends and parents do not have full access to information about me.
8. I have problems understanding subtle nonverbal cues, which leads me to "over-correct", and I end up assuming things about people.
9. I enjoy doing things alone, yet I enjoy social company. But I'm nervous around people I don't know well
10. I feel like what I present to the world is superficial, a mask to please people around me. I don't like to show negative emotions, and try to show a relatively flat affect with respect to negative emotions
11. I prefer phone/email interaction to RL interaction.

What do you guys think I have? I know it's probably not ASD. I hope it's not schizotypy.

Btw, I plan on seeing a neuropsychologist or neuropsychiatrist later this year, after I get my ophthalmological, ENT, and orthodontic issues straightened out.

Thanks!

[SWM]

what do you think your problem is?

[Protoman2050]

I really don't know...the child psychologist I saw said that some of the features of an ASD you don't have, and you have other things someone with an ASD doesn't have. She didn't know what I have, just that she knew I had something.

[Enigma]

I was under the impression that ASD referred to Autism Spectrum Disorders, not a specific disorder in itself. 

7. Even my closest friends and parents do not have full access to information about me.
8. I have problems understanding subtle nonverbal cues, which leads me to "over-correct", and I end up assuming things about people.
9. I enjoy doing things alone, yet I enjoy social company. But I'm nervous around people I don't know well
10. I feel like what I present to the world is superficial, a mask to please people around me. I don't like to show negative emotions, and try to show a relatively flat affect with respect to negative emotions

Do you think you could expand your explanations on these a bit more?

[Protoman2050]

OK (I was saying she said that I had an ASD, but she was doubting that, but it was "the closest thing"):

1. I don't tell my closest friends and parents every single issue I have; I just find it extremely diffcult to open up to anyone. I often push people away when they get too close. I fear that if they know the real me, they won't like me, so I protect them by preventing them from getting dangerously close
2. Sometimes I see people make facial expressions "at" me, and I have difficulty discerning whether they're made at me, or simply in my direction, and I end up assuming things about their intentions that probably aren't true.
3. Like, I enjoy working on my computer, doing solo activities. But I also like to go out with friends, yet I never really "engage" them, like we're just occupying the same space. I also don't like being in strange areas with people I've barely met.
4. I feel that everyone I interact with on a daily basis is merely seeing a facade, something I put on to make myself blend in to the background. Case in point: when someone tells me about a tragedy, I end up saying "Oh, I'm so sorry for you", when I'm really not. In a very flat tone, since I can't generate any type of emotion to my words to make it sound "real". How can I be sorry for someone I've barely met? It's like I'm faking sorrow so I won't sound like a person with a mental illness, but this ends up making me look like one.

Does this help you?

[Karaten]

Everything you've described sounds like High Functioning Autism, maybe Aspergers.

The reason others may seem different than you, even with Autism, could be explained a number of ways.

The lack of empathy and ability to connect is a symptom of the disorder and could even apply to others with the condition.

We could also consider the behavior of them similar to how you feel with friends.

Finally, Autism is a wide spectrum that can come paired with other disorders as well, that meaning, not everyone with Autism is the same, and just because you have Autism doesn't mean you couldn't have another condition as well.

[Protoman2050]

Everything you've described sounds like High Functioning Autism, maybe Aspergers.

The reason others may seem different than you, even with Autism, could be explained a number of ways.

The lack of empathy and ability to connect is a symptom of the disorder and could even apply to others with the condition.

We could also consider the behavior of them similar to how you feel with friends.

Finally, Autism is a wide spectrum that can come paired with other disorders as well, that meaning, not everyone with Autism is the same, and just because you have Autism doesn't mean you couldn't have another condition as well.

But, I don't have any obsessive interests, stimming, and I can carry on a normal conversation.

Is there any real difference between schizoid personality disorder and HFA/Asperger's?

[SWM]

I really don't know...the child psychologist I saw said that some of the features of an ASD you don't have, and you have other things someone with an ASD doesn't have. She didn't know what I have, just that she knew I had something.

so you are no better off for this psychologists interference. i would like to try and get you out of the medical mindset at least for the brief interactions that you have with me here on this board.

in your own terms what are the problems that you are faced with in living your life. what are the psychological behavioural and emotional problems that are causing you distress in your daily functioning?

forgetting about diagnostic criteria and medical symptomatology.

thinking just about you and how you function and your probems.

[SWM]

OK (I was saying she said that I had an ASD, but she was doubting that, but it was "the closest thing"):

1. I don't tell my closest friends and parents every single issue I have; I just find it extremely diffcult to open up to anyone. I often push people away when they get too close. I fear that if they know the real me, they won't like me, so I protect them by preventing them from getting dangerously close
2. Sometimes I see people make facial expressions "at" me, and I have difficulty discerning whether they're made at me, or simply in my direction, and I end up assuming things about their intentions that probably aren't true.
3. Like, I enjoy working on my computer, doing solo activities. But I also like to go out with friends, yet I never really "engage" them, like we're just occupying the same space. I also don't like being in strange areas with people I've barely met.
4. I feel that everyone I interact with on a daily basis is merely seeing a facade, something I put on to make myself blend in to the background. Case in point: when someone tells me about a tragedy, I end up saying "Oh, I'm so sorry for you", when I'm really not. In a very flat tone, since I can't generate any type of emotion to my words to make it sound "real". How can I be sorry for someone I've barely met? It's like I'm faking sorrow so I won't sound like a person with a mental illness, but this ends up making me look like one.

Does this help you?

these things are quite normal. a lot of people have similar feelings.

[Protoman2050]

I really don't know...the child psychologist I saw said that some of the features of an ASD you don't have, and you have other things someone with an ASD doesn't have. She didn't know what I have, just that she knew I had something.

so you are no better off for this psychologists interference. i would like to try and get you out of the medical mindset at least for the brief interactions that you have with me here on this board.

in your own terms what are the problems that you are faced with in living your life. what are the psychological behavioural and emotional problems that are causing you distress in your daily functioning?

forgetting about diagnostic criteria and medical symptomatology.

thinking just about you and how you function and your probems.

Yeah, four years of my life wasted at "Camp Escapades", where I had more fun with the counselors than the campers, one of which who tried to suffocate me.

I guess the psychologist was confused, b/c I was recovering from the damage to my white matter I suffered a birth. I don't blame her.

I'm not really having any problems now, I've just realized that forming any type of meaningful life-long relationship would be very difficult for me. I would feel like I would be faking the whole thing, thus acting like a sociopath. I feel like a very superficial person.

I've called up that psychologist to ask for a re-assessment. Or should I see a neuropsychiatrist.

Incidently, I've noticed my problems get better when I take my diphenhydramine to stave off my allergies. Could that be because of it's mild SSRI effect?

[SWM]

what exactly feels better for you when you take the diphenhydramine?

[Protoman2050]

what exactly feels better for you when you take the diphenhydramine?

My mood seems slighlty elevated from flat, and my thoughts stop racing, so I can concnetrate on train of thought w/o switiching back-and-forth.

[PsyChris]

So many diagnoses in one topic

I apologize if I am being counterproductive but let's keep you in the medical mindset for a minute. Can you list your differential for ASD? What do you think is the most likely diagnosis, don't forget to include "well adult."

It's also important to note that we medical professionals have a habit of assuming the worse. The diagnosis contained in the DSM are not for most people. The majority of people do not have a personality disorder, they are just undesirable people to be around! As for learning disorders, ADHD is the big culprit of false diagnosis but ASD can fall quickly behind that. There is a fine line between eccentricity and learning disorder.

I think its interesting that you are attempting to evaluate your self objectively and using medicine to do so. In medicine, psychiatry and most walks of life we cannot objectively analyze ourselves. You need the opinion of a trained neuropsychologist to diagnose ASD. We can say your symptoms "seem" like something in ASD but they really are the symptoms as you present them. I do commend you for your thorough review.

I am curious, what will you do if your diagnosis of ASD is confirmed? How much will a diagnosis change your life? Should it change it at all?

One of the things I try to impress upon patients is that you are not a diagnosis. You are far more complex than any book will be able to accurately portray in a list of criterion. A diagnosis is a requirement for treatment, for insurance and for administration. The real work is getting you to accept yourself, flaws and all and move toward a more complete and peaceful sense of self.

[Protoman2050]

So many diagnoses in one topic

I apologize if I am being counterproductive but let's keep you in the medical mindset for a minute. Can you list your differential for ASD? What do you think is the most likely diagnosis, don't forget to include "well adult."

It's also important to note that we medical professionals have a habit of assuming the worse. The diagnosis contained in the DSM are not for most people. The majority of people do not have a personality disorder, they are just undesirable people to be around! As for learning disorders, ADHD is the big culprit of false diagnosis but ASD can fall quickly behind that. There is a fine line between eccentricity and learning disorder.

I think its interesting that you are attempting to evaluate your self objectively and using medicine to do so. In medicine, psychiatry and most walks of life we cannot objectively analyze ourselves. You need the opinion of a trained neuropsychologist to diagnose ASD. We can say your symptoms "seem" like something in ASD but they really are the symptoms as you present them. I do commend you for your thorough review.

I am curious, what will you do if your diagnosis of ASD is confirmed? How much will a diagnosis change your life? Should it change it at all?

One of the things I try to impress upon patients is that you are not a diagnosis. You are far more complex than any book will be able to accurately portray in a list of criterion. A diagnosis is a requirement for treatment, for insurance and for administration. The real work is getting you to accept yourself, flaws and all and move toward a more complete and peaceful sense of self.

It's just the fact that my psychologist wasn't sure and was hesistant about the dx, and the fact that I'm planning to have her re-assess me after almost a decade, since the info in the file I use to get disability support (which merely amounts to a note-taker, nothing more) is rather out-of-date...on paper I'm a hemiplegic person with no social skills; I don't like having someone give me stuff based on a dx that may be totally inaccurate for my current state.

When that psychologist comes back from vacation in January, I'll be making an appointment with either her, or whatever colleague she recommends, to get reassesed.

I just want to have the most accurate, up-to-date info in my file, not something that's almost two decades old and doesn't reflect what I am today.

Merry Christmas!

[PsyChris]

Ah, that makes more sense. In all honesty testing at such a young age is very difficult and far from accurate. A diagnosis of "possibly" ASD would be appropriate. Later in life you would get more extensive testing and a more accurate diagnosis.

[Protoman2050]

Ah, that makes more sense. In all honesty testing at such a young age is very difficult and far from accurate. A diagnosis of "possibly" ASD would be appropriate. Later in life you would get more extensive testing and a more accurate diagnosis.

Isn't PDD-NOS " 'possibly' autism"? Should I see a neuropsychologist, or neuropsychiatrist?

 I think I may have hit on something with the diphenhydramine...I can concentrate better, and my mood is elevated a bit, not that I'm depressed or anything. Anyone care to offer theories?

[PsyChris]

PDD is a category. It would be like giving a diagnosis of Chest Pain. You mentioned an interest in Interventional Cardiology, so hopefully that helps bring into perspective how non-specific a diagnosis of PDD and even ASD is.

There is no such thing as neuropsychiatrist. If someone did want to go through all that education it would be medical school for psychiatry and graduate school for neuropsychology. You need to see a neuropsychologist for testing.

I think its most likely you are experiencing a sedative effect from the diphenhydramine and that is providing an anti-anxiety effect rather than serotogenic.

[Protoman2050]

PDD is a category. It would be like giving a diagnosis of Chest Pain. You mentioned an interest in Interventional Cardiology, so hopefully that helps bring into perspective how non-specific a diagnosis of PDD and even ASD is.

There is no such thing as neuropsychiatrist. If someone did want to go through all that education it would be medical school for psychiatry and graduate school for neuropsychology. You need to see a neuropsychologist for testing.

I think its most likely you are experiencing a sedative effect from the diphenhydramine and that is providing an anti-anxiety effect rather than serotogenic.

Actually, I have seen neuropsychiatry (AKA behavioral neurology) fellowships: http://dms.dartmouth.edu/psych/training/neuropsychiatry_fellowship/

And, the psychologist said the dx was "Pervasive Developmental Disorder - Not Otherwise Specified": http://www.med.yale.edu/chldstdy/autism/pddnos.html

I agree with you about the diphenhydramine.

I'm sure there are psychiatrists who went through an MD/PhD program, and did their PhD in psychology.

Also, I had an MRI done years ago that mentioned dysgenesis of the corpus callosum. No one really paid attention to it, since it didn't seem to be affecting me much. I do know that my 30 minutes of hypoxia after birth killed off portions of my white matter.

[PsyChris]

That is interesting to know about Neuropsychiatry! I am still bias toward neuropsychology though. Psychiatrists will go to medical school and receive general medical graduate school training with rotations in many specialties. They will then have a residency based upon their specialty of psychiatry in which they will learn the most about mental health care. They could then go to apply for a fellowship in neuropsychiatry and that would be considered post-doctorate training.

A typical neuropsychologist will receive undergraduate training in psychology, graduate training in neuropsychology, an internship in neuropsychology, and then a post-doc in neuropsychology. Their research and academic careers are more psychologically oriented than a neuropsychiatrists would be. You could argue that the neuropsychiatrist would have more experience in residency and that will makeup for the lack of academic foundation. I have known many medical doctors who have told me they absolutely did not feel prepared for their specialty when they finished residency. I just feel like neuropsychologists are better prepared to treat problems related to psychology and neuropsychiatrists are more prepared to treat disorders involving biomedical solutions (medication).

[Protoman2050]

That is interesting to know about Neuropsychiatry! I am still bias toward neuropsychology though. Psychiatrists will go to medical school and receive general medical graduate school training with rotations in many specialties. They will then have a residency based upon their specialty of psychiatry in which they will learn the most about mental health care. They could then go to apply for a fellowship in neuropsychiatry and that would be considered post-doctorate training.

A typical neuropsychologist will receive undergraduate training in psychology, graduate training in neuropsychology, an internship in neuropsychology, and then a post-doc in neuropsychology. Their research and academic careers are more psychologically oriented than a neuropsychiatrists would be. You could argue that the neuropsychiatrist would have more experience in residency and that will makeup for the lack of academic foundation. I have known many medical doctors who have told me they absolutely did not feel prepared for their specialty when they finished residency. I just feel like neuropsychologists are better prepared to treat problems related to psychology and neuropsychiatrists are more prepared to treat disorders involving biomedical solutions (medication).

Which is why psychologists evaluate and provide therapy, while psychiatrists medicate.

I'd have a neuropsychologist evaluate every stroke victim, just in case the MRI/CT misses something.

[PsyChris]

Yes. In the end I think you will require the services of both but the testing should be relegated to neuropsychology.

[Protoman2050]

Yes. In the end I think you will require the services of both but the testing should be relegated to neuropsychology.

Why do you think I may need a psychiatrist? For an anxiolytic or major tranquilizer?

The original psychologist I saw is going to advise me on whether she should re-evaluate me, or whether I should see an adult neuropsychologist; she's a child psychologist/speech pathologist.

[PsyChris]

The use of medication in treating disorders that involve impulsiveness, attention and staying on task is very common. That is why I mentioned the psychiatrist.

[Protoman2050]

The use of medication in treating disorders that involve impulsiveness, attention and staying on task is very common. That is why I mentioned the psychiatrist.

Oh, right. I doubt I need Ritalin...if caffeine makes me even more hyper than what I already am, I can't imagine what methylphenidate would do. I'd probably need something like a diazepam, haloperidol, or chlorpromazine. In low doses, of course