Autism/Awkward Diagnosis

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Hi Sharon!!  I have a complicated question for you.  My Goddaugther (to keep her identity confidential, I am going to call her Liz; I should note too that she is 33 years old) is living under my roof, and definitely has something going on that is not right upstairs.  I am a nurse at a psych ward, so it is all too easy for me to pick up on it.  On her own, she chose to seek out a therapist, and I am proud of her for that, however, she agreed to some testing, which I think hurt her rather than helped her.  I should note that the reason I took her in is b/c she took money from her widowed mother w/out asking, and it ruined that relationship.  Liz needed medication, for a physical problem, and her insurance wouldn't cover it, but the pharmacy promised her she would get reimbursed.  With that said, she took $1800 from her mother's safe deposit box, and insurance did not reimburse her.  That right there obviously has messed with her psyche.  Anyway, back to the point~ my hope for her is that the therapist can help her rise above her mistakes, and find a job, to pay her mother back, and mend things.  Liz was encouraged to do a variety of testing, and it was no surprise to me that she was diagnosed with depression, OCD, and a personality disorder.  However, she also somehow earned a score that gave her a "provisional" diagnosis of an autism spectrum disorder.  To me, it makes no sense... she adjusted right away when she moved in with me, and is fully ready to make lots of changes in her life.  She doesn't insist on any kind of routine, or engage in awkward rituals.  Honestly, she spoke complete sentences when she was only 8 months old, and learned her colors, as well as every state in the US, on the map before age 3.  Socially though, it has been more of a challenge.  From my professional eye, I have to believe it all comes from the fact that she was physically and sexually abused, something fierce, particularly at ages 8 and 11.  She still talks about it like it is going on today, even though one of her biggest tormentors (it was all words with this girl) has reformed proven she cares about Liz, and has reached out to her, and Liz is always receptive, and seems a lot happier when they hang out.  It was mostly the socially awkward trends that caused Liz to earn the score, however, she asked a cousin to answer some questions about her, and here is the difference in the scores:  Liz scored 55, and her cousin's answers scored 83.  I had Liz take the autism spectrum quotient test online, and she scored a 6.  I told her just be honest, and if she is truly committed to knocking off the behaviors, that should be good enough to declare her out of the woods, if she is truly able to do so.  I ask the question did she involve the right person.  B/c I am not the best source in terms of her past, I am not sure if asking me to evaluate would be the best way to go.  I don't agree with the diagnosis, even though it is provisional, and it has Liz upset.  I want to help her, as she has reasons to be depressed (she keeps saying she wants to commit suicide, but won't b/c she believes she will go to hell), but her therapist needs to address the true issues.  Like I said, Liz and I agree with most of it, but not the autism spectrum part.  My niece by marriage has high functioning aspergers, and is a happy girl, and really rather oblivious to reality.  Liz, on the other hand, can't stand herself, and I rarely see her smile.  She keeps saying everybody hates her, and seems to realize when people don't like her.  What do you think I should do?  Is it possible her cousin didn't understand the instructions?  She obsessed on the fact that Liz should eat better, to be able to have a healthier mind, and it is true, but her head and well-being go hand in hand, and she complains frequently of feeling awful physically.  I feel so lost, and never like when I can't fix something on my own.  MDs I work with tell me professionals know best, but I have been a witness to mistakes these same people have made.

Answer
Hi Kristen,
I was with you for the first part of your description, when you were wondering how this could be an autism spectrum disorder, especially since she adjusted well to new living arrangements and does not insist on routines. Like you, I wondered if the symptoms of the other diagnoses were prominent and perhaps mimicking ASD.

Then, I read more and several of things you mentioned are characteristic of kids with high functioning autism - speaking well @ 8 months,, recognizing map areas before age 3 and ongoing social difficulties. So, I would not rule out the possibility of autism.

It is not uncommon for people with autism to have mental health issues, in particular depression. And, from what you say, it sounds like Liz is struggling with depression.

But, does the exact label matter? She has some diagnoses already; sometimes a diagnosis is needed for insurance purposes or access to supports. Are there additional supports available if she also has an ASD diagnosis?

If not, I'm not sure that the label matters. What is important is for Liz to learn the strategies that will help her become as independent, productive and content as possible.

I'm please to hear that you have a relative who is on the autism spectrum and doing well. That's great. All too often, that is not the case. Depending on the studies you read, only about 10% of young adults with Asperger's or high functioning autism are able to live independently and hold down a job or attend post-secondary schools. That is so worrisome when they people have intellectual abilities in the average to above ranges.

Working with a therapist is good. She also might be a good candidate for medication; she is blessed to have someone with your skills and experience around to help her monitor how any medication is affecting her.

It sounds like Liz has had a lot to contend with in her life. Cognitive behavior therapy is often successful. Hopefully, Liz will be encouraged to not dwell incessantly on what has happened in the past. Therapy can help her put some of that in perspective while helping her to not be defined by those experiences. She needs strategies that will help her make a plan to take charge of her life in small steps, then to move on in the areas that you mentioned.

I also agree with the cousin, who believes that if she ate better, Liz's mental health would be better. As true as that is, it's often easier to understand that truth than it is to carry through on the intention, especially when depressed. Perhaps though, she'd eat the food presented to her if she did not have to go to the effort of shopping and preparing the food herself.

Liz is very lucky to have someone like you in her life.

Best wishes to both of you,

Autism

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Dr. Sharon A. Mitchell

Expertise

Sharon can help with parenting and educational concerns. She has worked in teaching, special education, counseling and consulting for over thirty years and gives workshops to educators and parents on working with kids with autism spectrum disorders. Sharon speaks from both the education and parent points of view, having an adult son with Asperger's.

Experience

Sharon has spent decades as a special education consultant with a school district and autism consult for the province's Department of Education, giving workshops and individual consults. Currently she works as regional autism consultant for a health district in between teaching university classes. She is an Amazon bestselling author or a series of novels, each depicting a child who has an autism spectrum disorder. Sharon's Master's thesis looked at the long-term outlook for persons with high functioning autism and Asperger's. Her Doctorate focused on strategies to help those with autism spectrum disorders.

Organizations
Website at http://www.drsharonmitchell.org and sits on Autism Today's Panel of Experts (www.autismtoday.com)

Publications
Author of "Autism Goes to School" - a novel about autism that that became an Amazon bestseller. Get this Amazon bestseller free at http://www.drsharonmitchell.org. In the next book, Autism Runs Away, Ethan is only in grade one and already has been kicked out of one school due to his tantrums and pattern of running away when in a panic. Now in a new school his mom remains glued to her phone, waiting for the call to tell her that they don’t know what to do with a child who has autism. Sara is about to learn if this new school is up to the challenge. (https://www.amazon.ca/Autism-Runs-Away-Book-School-ebook/dp/B01FCYQ7DC). Autism Belongs is the 3rd book. Manny's life has shrank to the confines of their house. His parents are desperate not to rock his world because the aggression has gotten to much worse. Where will this lead? Is there a chance that Manny could actually belong out in the world? You bet! Get a free sample at https://www.amazon.com/Autism-Belongs-School-Daze-Book-ebook/dp/B0184ZQMI6. Book four, Autism Talks and Talks, is about a 12 year old girl who has Asperger's. She's bright, inquisitive, highly verbal, but lacks social skills. Try a free sample at https://www.amazon.ca/Autism-Talks-Book-School-Daze-ebook/dp/B01IIUZH3S Book five, Autism Grows Up features Suzie, a bright, twenty-one year old whose life collapsed after she finished high school. Now, she lives in her mother's basement, spending nights on her computer, afraid to broach the world outside their door. Autism Grows Up is found at https://www.amazon.com/Autism-Grows-School-Daze-Book-ebook/dp/B01JB8QW3U. Prefer a boxed set? Get the first 3 books bundled together at https://www.amazon.com/Autism-Box-Set-School-Books-ebook/dp/B01KBEHJ08. Co-author of Amazon.com bestseller, The Official Autism 101 Manual (http://autism101manual.com/).

Education/Credentials
B.A. in Psychology, B.Ed. in Special Education, M.A. in Educational Leadership PhD. in Psychology Management, specializing in autism.

Awards and Honors
B.R.A.G. Medallion for the novel Autism Goes to School - Book 1 in the School Daze Series. (http://www.bragmedallion.com/medallion-honorees/2013/school-daze-autism-goes-to-school). Like Autism Goes to School, the third book in the series, Autism Belongs, also ranked #1 on Amazon (http://www.amazon.com/Autism-Belongs-School-Daze-Book-ebook/dp/B0184ZQMI6). Manny is not like other children. He doesn’t talk. He doesn’t leave the house. His parents desperately try to arrange their world so that Manny does not get upset. Because, when he does, well, the aggression was getting worse. At ten, Manny was becoming difficult to handle.

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