Expert: Trey McGowan - 8/31/2009

Question
Hi,
I was wondering how often high functioning autism is misdiagnosed as things like SAD, OCD, MDD, and bipolar.  
My friend's been through the wringer for years now for symptoms that don't really fit any diagnosis.  They have OCD type rituals, dissociative SAD, MDD, and now really bad outbursts that get worse and more frequent on SSRI's.  They're in the process of getting diagnosed with bipolar disorder, but from the descriptions I've gotten, it seems really manic, but it's triggered, quick, and they can calm down on their own.  
They have a sibling with AS, they’re synesthetic.  Autism seems like it fits, not only with the anxiety/depression/outbursts but also with their general manner, but only if you’re looking.  My qualm is that it doesn’t seem like autism could go undiagnosed for so long.
So, is there any merit to this idea, or am I just seeing patterns in static?  
(Sorry if this is the wrong topic.)


Many thanks.
-S

Answer
Hi there, Sebastian!

In all technicality, a child can *not* be diagnosed with both ADD *and* autism. This is because ADD (or ADHD), is actually one major symptom of autism, and may even be a lesser variety of autism. The actual diagnosis comes from the extreme symptoms, themselves.

You didn't mention ADD/ADHD above. However, this was my way of pointing out that due to autism having a great many symptoms that can be attached to a lot of other issues. OCD is very common, as is ADD (as pointed out above). However, depression is *not* a symptom of ASDs. It can be *caused* by them, due to issues with the child trying to get through life with great difficulty, but they are not directly interlinked. Therefore, if the child is showing signs of depression, I highly suggest that yes, they may very well be depressed. Whether or not autism is added on top of the depression is 'extra'.

You wonder how it can be misdiagnosed for so long. Not knowing the age of your friend, I can only wonder if it's because he's an adult. Back when he was a child, autism had yet to be discovered. Now that he is older, however, autism is mostly diagnosed in children. Adult Autism does exist (obviously), but there are not as many doctors who would diagnose it, and even fewer psychiatrists.

If there is definite signs of the ASD, and I don't know if there is since I don't know your friend's details, I highly suggest that you and he (she?) go looking for a doctor who might be able to help out with the diagnosis. Look around for someone who has diagnosed Adult Autism, or a doctor who knows the signs and handles adults, and bring up the problems with them. They will better be able to give an idea whether indeed, your friend has a dual diagnosis: mental health issue on top of a developmental disorder.

I wish you two the best. If you have some info to add, feel free to send a follow-up. Other questions, comments, and feedback are always welcome as well!

Trey