Autism/Follow up

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Hi Sharon,

Please refer to the question I asked yesterday.  Here is some additional information, to explain why I find the diagnosis hard to believe.  I don't want Liz to be labeled as something she is not; she already has no self-confidence, which doesn't help the job search.  Liz is almost finished with graduate school, and is going to be taking on her own business (she wants to be a freelancer... with all of her health problems, she is worried if she works for a business, when her problems flare up, it will backfire). These are her other issues:

1.  Liz does truly come across as socially awkward at times.  From my perspective, I think she needs more experience in social settings.  Her health has prevented her from getting involved, and with her ruined relationship with her mother, it just makes it that much harder.  Liz was a very spoiled child, who would go ballistic if things didn't go her way.  The cousin she asked to do the evaluation has probably heard stories from her nieces about Liz having tantrums, at an older age than what would be expected.  Liz is ashamed of the behavior now, and would love to go back, and do a lot of things differently.  Also, I think it would even be reasonable to say that those Liz does talk with probably find her boring, as she does not have much going on in her life.  I am encouraging Liz to just reach out to people, and ask them about their lives, and hopefully somewhere along the way, she might find something she could get involved in, so she could socialize at least a little bit.  With her resentment about her health, Liz is quite negative, which unfortunately nobody likes to be around.  I want her to vent all of this to the therapist, and hopefully start to put some closure on her past, and hopefully be able to mend some of her health.  As a nurse, I can tell you her health will always be far from perfect, as she has many conditions that are not curable.
2.  For the longest time, Liz was putting all her eggs in one basket.  There is a lady in my neighborhood, who I want Liz to be able to be bffs with, as she does lift Liz's spirits, but also has a lot in her life outside of Liz.  Liz feels the need to tiptoe around her, as she just for once in her life wants a best friend of her own.  She is always asking the cousin who did the evaluation if her messages she wants to send are acceptable, so her lack of self-confidence is as clear as day.  I think what Liz likes is being "babied" by this woman, and shared with my daughter that she has had dreams about being rocked by this lady, and nurtured.  This probably stems from the fact that Liz has always wanted to be nurtured, and proven that she is loved.  As of right now, it probably comes back to the ruined relationship with her mother, who was so frustrated with her for even the last 2 years when Liz lived with her, that she never offered Liz a hug for all that time.  I try to do so before leaving for work, but at this point, it's not enough.   After reading her testing report, Liz has decided that she wants to try to expand her social circles.  She is scared, but also acknowledged that she was surprised at how many people did like her at her high school, and wishes she would have tried harder to make and keep friends.  Some of them have even told Liz how they always thought she was one of the kindest people they knew.  Unfortunately, during the primary years of school for Liz, kids didn't like her, and they picked up on the fact that she was vulnerable.  When she started kindergarten, she was coming out of an abusive experience, as well.  Her parents thought a Montessori school would be a good fit for her, as she had a summer birthday, and they didn't think being the youngest all of the time would be good.  Well, from my perspective, that was a very poorly-made decision.  Liz told us a few weeks ago at dinner that the teacher there abused her both verbally, as well as threatening to physically.  Liz was a witness to children as young as 3 being physically abused there.  Thankfully, the school is no longer open, but I know I would be traumatized if I were in Liz's shoes.  It didn't help that Liz felt unattractive when starting kindergarten either.  Her paternal grandmother and aunt messed with her hair against her will, and I'll be the first to say that knowing the eye of the beholder means nothing to children, it makes perfect sense to me that Liz would be a perfect candidate in their eyes to bully.  The bullying went on for her by students, and even her 5th grade teacher (she took the cake over any kids), and that really mutilated Liz's psyche.  As a result, by the time she got into high school, she didn't want anymore than to not have to eat lunch by herself.  She did find some friends, and hung out a few times, but did not ask for a lot, as she had a fear of losing friends more than anything.  The bottom line, Liz has an intense fear of rejection.  I have honestly never met anybody with more "likes" on a career placement test, so I think she could find something to talk about.  She always takes an interest when I talk about health conditions, as asks me lots of questions, so she could converse with people.  This is what she needs to discuss in therapy.

With that extra information, here is what I am thinking is the best solution:  Liz should give building a social life her all, and continue to try with my neighbor... maybe even share her fears in that respect.  My daughter and I will point out socially awkward behavior, which Liz is committed to stopping.  Once Liz has socialized for a while, ask to repeat whatever test enabled a score that would label her with ASD, and I will try to do an evaluation, to bring the score down to a level with more chemistry.  Does that sound like a reasonable plan, to at least find an answer one way or the other?  Liz clearly doesn't agree, and I'm worried therapy won't be a good thing if there are lots of disagreements.  I think that one knows oneself the best, so she needs to decide what needs addressing.  The diagnosis is only provisional, I know, but I can't watch this woman be so upset, when it probably isn't even the case, and she is so self-conscious that she hasn't even shared with her therapist some perspectives.  I think it's hard for Liz to work with people younger than her, which is the case here.  When she told my daughter about her dreams of being rocked in a rocking chair, by the lady in the neighborhood, she kept saying "I'm not a lesbian," as she was worried my daughter would think that, therefore, she felt uncomfortable admitting she would love it if this would come to pass.  I can tell you my niece does not like to be nurtured at all.  We don't try, but Liz always feels better when somebody will do so.  Since Liz was once a psychology major, she learned the ropes about patient confidentiality quickly, therefore, she didn't ask the intern who did one of the tests questions, in a way that would be interacting; she didn't think it was acceptable, so that caused a problem too.  Sorry for all this information.  I just hate to watch a woman who could achieve a lot, if she would just have some faith in herself, and put the past behind her.

Here is a copy of the question I asked yesterday:
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
What an interesting young woman, with a complicated history.

I'm still not sure that the exact label matters, at least not right now. Your idea of addressing the possibility of autism later on sounds good, if Liz wants to come back to it at all. If she does indeed have autism, I don't see how that diagnosis contradicts any of the hopes and plans you have for Liz, nor would it interfere with her attaining any of her goals.

No matter which label(s) she has now or in future, what is key is finding the skills to move forward.

You've identified the social area as crucial and it seems to mean a lot to Liz. The plans you mention sound excellent. There are a # of books (available on places like Amazon) that might. Some teach social thinking. Michelle Garcia Winner has a few on this topic that are easy to use and to the point. Author Jerry Newport has a book you might like called, "Your Life is Not a Label". Temple Grandin has a nice book called, "The Unwritten Rules of Social Relationships" and another called, "The Way I See It".

Often, when things in the social realm seem difficult or the person has not had much experience with friendships, then it is easier to begin social interactions around a shared interest. You mention that Liz has many interests; joining a club, lessons, volunteering, etc. around one of those interests offers built-in conversation openers for those who feel they're not comfortable with small talk or initiating conversations.

I'm a fan of volunteering. Often people like Liz tend to be introspective, focusing on their own thoughts, feelings and needs - perhaps overly so. Volunteering means that for short periods of time, the individual must think of someone else. Your own problems may seem smaller and you gain the sense that life is not as rosy for the rest of the world as you may have assumed. It also builds self-esteem to help someone else.

In the end, no matter what the exact diagnoses may or may not be, Liz is still Liz. She's in your home and she's a student who will be entering a new phase of her life soon. A label(s) won't change that. So, acquiring skills, practicing them and working towards small goals matter to Liz, despite any diagnoses.

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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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