Autism Spectrum and You?
People often wonder why their relationships fail or why they feel left out even when they are with others. It is a profoundly unpleasant feeling which makes people uneasy. Most individuals understand it as anxiety. Although this might be how it feels on the surface, if it is persistent, treatment resistant or is causing problems in multiple social and relational domains of life, it is worth exploring what might be lying beneath the surface. Specifically, the traits of Autism.
The term autism was first coined in 1943 by two pediatricians, Kanner and Asperger. Autism is now called autism spectrum disorder (ASD). This new term collects the previous categories of childhood autism, Asperger syndrome and atypical autism into one. Lorna Wing used the term autism spectrum disorder to indicate a spectrum that could merge with normality. Indeed, that is what we see in clinical practice. It is not synonymous with mental retardation or intellectual disability as once again; we see a wide range of intellectual abilities from profoundly intellectually gifted to intellectually disabled showing signs of ASD. ASD is a neurodevelopmental condition that is present from a young age, though its effects manifest only by late adolescence or early adulthood when separation from family of origin and formation of new relationships outside of family is expected to take place.
Children might come to clinical attention early because of speech delay or poor eye contact. This is often picked up by the child’s educators at kinder or childcare than the child’s own parents. The minor shades of social deficits are often masked by “overlearned social rituals” at home. Hencewe consider the concept of social adaptability than the focus on deficit per se.
Diagnostically Autism is now a diagnostic dyad of:
- impaired social interaction and communication
- restricted or repetitive behaviors and interests.
A Diagnosis is often made by an experienced psychiatrist/pediatrician or clinical psychologist by clinical interview and observations, not by questionnaire and algorithm. As there is clear evidence to suggest that online diagnostic algorithms or questionnaires are not particularly superior to clinical interview. Nonetheless, ASD is a complex diagnosis which requires a combination of self-reported history from the patient along with collateral from their family, teachers or friends as some individuals may under or over-estimate their deficits.
Some say that the deficits are often “felt” by the mental health practitioner during one on one sessions during a course of psychotherapy or an unrelated assessment. This could be because it is easier to pick an emotional, social or communication deficit in the therapeutic relationships as it is a form of human interaction requiring reciprocity and “connection”. However, a social/ relational deficit is not the only criteria. It should be associated with restricted and repetitive patterns of interests or behaviors. Sounds like OCD? Perfectionism and other compulsive spectrum disorders tend to overlap a lot with ASD. In clinical practice, those with early onset developmental form of insistence on sameness, ritualistic behavior and abnormal and intense preoccupation with video games, computer, music and the like may have milder forms of autism. I today’s world when every teenager is using a mobile device and is expected to be spending hours on it, normality is hard to define. Hence the question arises whether the time spend on these devices is giving them any social rewards or not? for instance, an online relationship. This is in contrast with someone using a gaming platform playing the same game over an over with an intention to avoid social contact or showing no desire for social contact. Not surprisingly, gaming addiction is often prevalent in those with ASD.
Symptoms that alert clinician of adult ASD.
People should be mindful that the concept of ASD is new and was unrecognized few decades ago. Hence adults in the current generation may not have received a diagnosis of ASD in their childhood. Hence we look for few other alerting symptoms and signs before we conduct an indepth exploration of ASD.
Some of these are adult ADHD, treatment resistant OCD, generalized anxiety or social anxiety, those with complex diagnosis such as PTSD, eating disorder, bipolar disorder and the like.
Usually during examination, patients often demonstrate an inability to describe their emotional self, they rely on concrete physical symptoms to express psychological distress such as a pounding heart, headache or a fault in their appearance as the cause of their presentation. On exploration one might find that they might have had a recent relationship break down which caused them intense sadness and anxiety, the psychological side of which the individual failed to recognize. Some people with ASD tend to react to emotional crisis happening inside their head as if it is happening in the physical space outside, this may result in behaviors such as self- harm by cutting, hair pulling, compulsive cleaning and organizing. Some people with ASD might have an odd, monotonous speech with lots of unnecessary details.
How does being an adult change the presentation of ASD?
ASD traits are often modified by the childhood environment which can lead to a wide range of outcomes, some may learn the right social skills by imitating others and may become socially adaptive. Some may often be able to mask these deficits until a major life event such as divorce happens. Some may persistently struggle with relationships or even find it hard to approach someone. Some others, become aloof, lose interest in the world or bury themselves in academia or their bedrooms. Others might have developed lifelong anxiety or PTSD after negative childhood. Women with ASD tend not to gain clinical attention until they develop other associated mental illnesses. Some of these women appear tomboyish in their teens, find it easier to connect to boys than girls and often get into crisis when in late teens they fail to fit in with the girl groups. Some develop eating disorder whereas some others may enter abusive relationships and get traumatized.
Treatment for ASD
Essential elements of treatment include improving emotional awareness and skills of self-reflection, learning social skills and scripts, learning to modify behaviors by social imitation and reducing intense focus on repetitive behaviors through CBT.
Associated conditions such as anxiety, depression, OCD and eating disorder can be treated alongside treatment of ASD.
Psychiatrists at Mindoc will be able to assist you in reaching an accurate diagnosing and formulating a management plan. Feel free to give us a call to book a consultation.